Tom Main, The Ailment and Other Psychoanalytic Essays,  Free Association Books, 1989,  256pp, £29.50

Tom Main, a psychoanalyst, who was Medical Director of the Cassel Hospital for 30 years, was always concerned with the application of psychoanalytic insights to other fields. This book is a selection of sixteen of the fifty or so papers written by him between 1943 and 1987. They are preceded by a short historical background written by his daughter Jennifer Johns, also a psychoanalyst, who edited the book. In an introductory chapter a colleague, Eric Rayner, introduces Main to the many readers who will not actually have known him and gives a very lively picture of the way Main thought and of the ways in which he translated his thoughts into action. This kind of introduction to papers covering such a large span of years helpfully relates them to the context in which the ideas developed.

The book is divided into two parts. The first consists of papers arising from the application to the work of the Cassel of what Main calls the ‘culture of enquiry’. There are three papers dealing specifically and brilliantly with the concept of the therapeutic community (the term itself was introduced by Main) — ‘The hospital as a therapeutic institution’ written in 1946, ‘Some dynamics of large groups’ written in 1975 and ‘The concept of the therapeutic community: variations and vicissitudes’ written in 1981. Between them they give an extremely clear account of the therapeutic community concept and the approach to institutional life that derives from it. From general description to psychoanalytic depth they delineate with telling illustrations what a therapeutic community in its true sense is all about. Unfortunately the term ‘therapeutic community’ has, over the years, been used in so many ways as to have become almost meaningless and this has therefore sometimes given the impression that it was all a passing fashion. However, the concept, based on deep understanding of unconscious