Chapter 4. Four Discussions

Bion: Seeing patients many times as we usually do, it is difficult to achieve that degree of naïveté in which we can see them each time as if we have never seen them before. It is easy to think, “Oh, here's the same old stuff again – yesterday, the day before that, for weeks, months, years”. It cannot in fact be so because tomorrow the patient we saw yesterday, or last week, month, or year, will not be the same person. We should get as near as possible to feeling that it is the first time we have ever seen that patient. It is difficult because we always feel that we ought to know his history and so on and so forth – a backwash of our own medical training. It is useful for two or three sessions, but after that this information which one has from hearsay is unimportant. From that time on we should be launched out into a different realm altogether – not the realm of the patient's history.

Questioner: You are really saying that you don't have to take notes. Each time a person comes in he is a new person and it is only what is being presented at this moment that is important.

B: Yes. As I said before, Plato pointed out that language is extremely misleading – it appears to be precise and exact, but in fact it is no more exact than painting or drawing. A painting doesn't tell you anything – it has to be interpreted. Charcot, by whom Freud was impressed, said you have to go on looking at a patient until a pattern begins to obtrude. In physical medicine a doctor's sense of touch, smell and so on, should be so acute that he doesn't read books but reads people. With regard to these mental symptoms, what can we say? Neurotic? Psychotic? It doesn't tell us anything. The difference between people appears to be so striking that it seems to demand a description; so we resort to this crude division. We have to make the

assumption that there is such a thing as a mind. I don't know what evidence there is for it – it may be completely erroneous. In Homeric times the mind was thought to