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Peter Bruggen is a well-respected psychiatrist and psychoanalyst who had been the consultant psychiatrist at Hill End Adolescent Unit for twenty-five years and at the Tavistock Clinic for twenty, until his retirement in 1994. By that time, he had also been a medical director of an NHS Trust. It is with this commitment to the NHS in mind that we should read this book. I read it with particular interest because a large part of my work, both in private practice and at the Tavistock Clinic is focused on helping those working in the NHS to work more effectively and to understand the pressures on them which aim to stop their thinking and interfere with best practice. In the last five years or so, I have had to include, in my support work with staff, the impact upon them of their managers and the Trusts for which they work. This is a significant change, because, with very few exceptions, if issues were brought into discussion which pertained to the institution or the management, I used to be pretty sure that this was a projection in line with Bion's basic-assumption fight/flight, and that the real difficulties originated in the work with the patients or staff dynamics within the staff team. Dr Bruggen's book, a collection of the experiences of various staff from the NHS, gives vivid and moving evidence that the institutions of the NHS have become the source of an attack of great destructive power on the good practice of the work-force.
The book begins with a brief but clear and helpful summary of the history of the changes in the NHS. I thought it was a fair and balanced account of the changes and reforms as well as an indication of the attitudes of those behind the changes. This is followed by twenty-four chapters, each describing a story (sometime more than one, but related) which comes from a careful process of interviewing and checking. At the end of the book there is a conclusion, but this is not an analysis or an attempt to explain; instead, Bruggen seems to want to l