Letter to the Editor

Dear Dr Milton

I read and was moved by David Bell's paper, ‘Primitive Mind of State’ (Volume 10 p. 93). The paper resonates beyond the demise of the National Health Service and now threats to psychotherapy in Health Trusts.

Firstly, I refer to Education, which is even more politically vulnerable than Health, because there has always been an easily exploited split between a service for the poor and one for the rich, something which Health now shares again with Education. Secondly, there are Social Services, which have been decimated in the last fifteen years. Thirdly, the consequences of the Primitive Mind of State resonates through the whole of the Justice system, from the Lord Chief Justice to probation officers, police officers and prison officers.

One thing in particular struck me as it was emphasised by David Bell. This is the issue of ‘survival’ of services: Departments, beliefs, and psychic survival. This made me think about work relating to soldiers who have survived a high probability of death, sight of horrific injuries and loss of comrades. In a theatre of war, there is often a sudden degradation of the individual to ‘survival-only’ mechanisms. By contrast, David Bell gives an account of the chronicity of degradation, culminating with a personal anecdote in which he describes an experience of

… enslavement similar to the dependent relationships inherent in charity.

The survivalism described in the paper is like a perverse relationship to a parent who sadistically plays with meeting or not-meeting the infant's need. David Bell describes a primitive mentality which imposes a relationship to the object without any genuine attempts at understanding. The notion of enslavement reflects our feelings of helplessness, the more so if we are able to remember a reasonable parent of the past who made better provision. The consequence of the primitive mentality described in the paper is a process - which disempowers the individual by transforming justifiable need into unreas