Living in two worlds: Psychodynamic theory and social work practice*

At the heart of current psychoanalytic thinking — investigating, as it does, the nature and development of character and personality — lies the issue of mental pain. Drawing on the work of Melanie Klein in particular, psychoanalysts have been exploring the ways in which — whether in the individual, the family, the community or society at large — growth may be fostered or held in abeyance to the extent that pain is variously modulated, modified or evaded.

Such preoccupations have, of course, always been the stuff of literature, expressed with great beauty and intensity by George Eliot in Middlemarch:

That element of tragedy which lies in the very fact of frequency, has not yet wrought itself into the coarse emotion of mankind; and perhaps our frames could hardly bear much of it. If we had a keen vision and feeling of all ordinary human life, it would be like hearing the grass grow and the squirrel's heart beat, and we should die of that roar which lies on the other side of silence. (1872, ch. xx, p. 226)

Here George Eliot is describing the anguish of a young wife, Dorothea, returning home from her honeymoon, having suffered deep