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Working in a reflective manner with patients in modern psychiatric services is becoming increasingly difficult. Many pressures conspire against the exploration of feelings that are engendered by the appearance of major psychotic disorders, cruelly often making their entry in early adulthood and with potential catastrophic consequences for those who suffer from their symptoms and those involved in a caring capacity, either family or statutory services. Hinshelwood's new book of essays is a welcome addition from a psychoanalytic practitioner, reminding us of the need to keep at the forefront of our interventions the persons behind the symptoms and, equally as important, the emotional burden and impact on those selected by kinship or career choice to be involved in their care.
Going back to the late 1960s, Scott and Ashworth (1967) and Scott et al. (1993) explored how the appearance or suspiciousness of madness induces characteristic responses in families, a term the authors describe poignantly as ‘closure’, when the everyday business of human interrelatedness becomes brutally interrupted by a diag nosis, which renders those assigned by such as possessed by an alien process which depersonalises interactions. This process can equally clearly extend to professional services, sometimes under the benign guise of an overemphasis on evidence-based medical approaches, performance-linked psychiatric practices or user-and carer-empowerment measures. An important finding from the research led by the recently deceased Scott, now sadly neglected, was that people thus diagnosed were not necessarily passive agents in the process. In fact, subtly disguised attacks on the identities of the significant members of their families were the main instigators of untenable situations, which more often than not, led to crises and prolonged hospital admissions.
Hinshelwood says in his Introduction that psychosis (and in this he focuses principally on schizophrenia) affects all those involved and