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It is rare to have the opportunity to review a book which deserves unqualified praise. Valerie Sinason's book, which summarises her work over the past ten years in psychodynamic treatment of individuals with learning difficulties, is that relatively unusual volume which advances practice and theory at the same time as transfixing the reader, compelling him/her to read on to hear about the next interpretation, the next session, the next case. It represents a milestone in psychoanalytically-oriented understanding of this extremely complex group of patients, as well as representing a major development and extension of the clinical domain of psychotherapeutic practice.
Valerie Sinason makes a major theoretical contribution in identifying important aspects of our subjective reactions to individuals labelled ‘stupid’, ‘mentally handicapped’, or ‘experiencing learning difficulties’. She understands and is sympathetic to our struggle with the stupid parts of ourselves, and illustrates how social structures come to our aid to buttress our fragile selves and prevent us from fully accepting the reality of the truth of impaired cognition. She is quite brilliant in tracing the processes of euphemism and linguistic acrobatics put in the service of avoidance and denial of knowledge about this group. She tracks it to our inability to deal with difference without guilt or envy, whilst highlighting the closeness of euphemism and abuse.
Valerie Sinason is not the first person to have worked with this group of patients, as her highly informative review acknowledges. Her short history of work in this area offers a very balanced coverage of previous work. It is, however, the case studies, the second part of this exciting book, which make this volume such a special one. For me it opened a window on a world which I had but the vaguest and, if I am honest, the most distorted, ideas about before reading the book. Reading these cases is a liberating experience; the treatments convey the human t