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Marcus Evans’ book is aimed at engaging a general audience of mental health professionals in thinking psychoanalytically about their day to day work with severe mental illness. In a way, his title sets out his agenda. He uses the word “madness” deliberately and provocatively, since he wishes practitioners to listen to and engage with their patients’ psychotic thinking, rather than deny or collude with it. In his introduction, he comments, with some regret, that he sometimes finds himself wondering “where we thought the ‘illness’ had gone when we changed the term from ‘mental illness’ to ‘mental health’.”
Evans is a nurse and psychoanalyst by background who for a number of years has worked in a broad range of mental health and psychotherapy settings within the National Health Service (NHS) in the UK. He trained in psychoanalytic psychotherapy at the Tavistock Clinic and he later held a number of clinical lead and managerial roles there. Of particular note, he was involved in founding the Fitzjohns Service, which offers psychoanalytically informed treatment to patients with complex mental health needs (including psychosis) who may not ordinarily have been considered by generic NHS psychotherapy services. Much of his detailed clinical material seems to be from this area of his work. He also has extensive experience of providing supervision to frontline staff from various settings—including secure (forensic) units—and he derives further interesting material from this area of his work.
In her brief foreword, Edna O'Shaughnessy—who had worked with Evans at the Fitzjohns Service—notes that, according to Money-Kyrle, “most people fear contact with the insane,” which in her view (and Evans’), is why people tend to want to “keep insanity out of view.” O'Shaughnessy herself cites Klein and Bion as key influences but mainly highlights the value, in her view, of Evans’ application of psychoanalytic understanding to everyday practice, especially through the supervision of frontline