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Mr M (referred to in chapter 3 of this book) asks his therapist what 'exactly’ he means, in response to his therapist's suggestion that he uses a particular mental mechanism to feel safe. This question 'What exactly do you mean?’ was one that I found myself returning to again and again as I read this book - who 'exactly’ are these 'patients with complex needs’ for whom the psychoanalytic approach of the Fitzjohn's Unit is being described?
I thought that I had found part of the answer in David Bell's clear and concise introduction where he describes the difference between nomothetic (where objects that are similar are grouped together in a single category, as in disease classification) and ideographic (where the aim is to capture the unique qualities of an individual case) levels of description. At this point I thought that my desire for an exact description of the patient group served by this unit, based on psychoanalytic or psychiatric classifications, was going to be frustrated, but in the long run this was going to be a helpful experience. I was going to have to work a little harder to answer my own question.
Paradoxically I then felt somewhat frustrated by Birgit Kleeberg's chapter 'Finding a way in: The work of the Fitzjohn's Unit’, which includes a more detailed look at who the patients are. Most commonly, in terms of psychiatric diagnoses, Fitzjohn's Unit patients are classified as having recurrent depression, specific personality disorder, and bipolar affective disorder, with the most common presentation being comorbidity between personality disorder and serious affective disorder. So clearly, in psychiatric terms at least, these are very ill patients. But what about their (complex) needs? For a book about the treatment of patients with complex needs there is in fact very little in this book about needs, and indeed it is a word that makes an appearance only once in Kleeberg's chapter - with reference to the need in many patients for longer-term work, resources