Chapter 3. Four Discussions

Questioner: Do you still do group work, or are you still interested in group work?

Bion: I am still interested in it, but I get very little chance to do it because I get so much pressure on me for individual analysis which I find extremely rewarding and interesting. Is anybody here taking groups?

Q: Yes; but I doubt the use of applying group relations methods to patient work. I don't think it works very well from what I can see of running a small group of hospitalized people.

B: You don't find it helpful with the actual family group?

Q: I don't feel ready to use it with families yet. I do get a sense of sub-groups forming and of groups getting into basic assumptions – I think family life is an established basic assumption, the pairing group in a sense. At present I find it difficult to deal with the complexity of the inner actions in my own life.

B: One thing which strikes me in dealing with the individual is how little consideration seems to be given to this question of what is basic, what is fundamental. Is there any way in physical medicine of defining what the fundamentals are? What does the doctor concern himself with? What could you call fundamental in the sense of wishing not to diffuse your observation or your time?

Q: I have often wished that in psychiatry there was something as fundamental as the vital signs – blood pressure, pulse. One can consider vital signs in psychosomatic medicine, and in psychiatry too I suppose, but it is much harder in working with groups or individuals in therapy to have something as a baseline of ‘normality’ as readily as the blood pressure, pulse, respiratory rate and temperature. I am

not sure if that is what you are talking about when you say ‘fundamentals’.

B: I think it is.

Q: Even more fundamental than that I suppose is that when in physical medicine a person presents himself to a physician and says, “It hurts here”, if you look there you may find something in that vicinity and the patient is able to cooperate, to participate in