You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
I'm pleased to introduce this summer issue of the journal containing a wealth of stimulating papers which continue to grapple with the challenges of working, and indeed surviving, within the National Health Service (NHS). Although the first paper overtly focuses on survival as one of its main themes, all of the papers are in some way about not only how psychoanalytic psychotherapy practice may survive in the modern NHS, but how a psychoanalytic perspective may enable us to survive in an ever-changing world.
Change can be experienced as alien, hostile and threatening, and risks mobilizing the use of destructive primitive defence mechanisms that operate within and between individuals and institutions. Where there is little dialogue between those who impose change and those upon whom it impacts, a fight-flight response ensues, which may tip into a sado-masochistic dynamic and perpetuate a deadlock which stifles any room for real growth and mere survival seems the only option. But change, albeit disturbing, may also have the potential of promoting growth and creativity in a genuine sense, if losses, disappointments and resentments can be acknowledged on both ‘sides’ and worked through.
Barry Jones' and Thomas Bradshaw's paper, ‘Surviving as a personality disorder service’ eloquently describes the evolution of a new service in a London Borough and the struggles to negotiate a course through the threats and gains of financial cuts and organizational re-structuring imposed within the larger mental health trust. Whilst such changes may sound all too familiar to many of us working within today's NHS, Jones and Bradshaw highlight the unfamiliar nature of change with reference to Freud's notion of the ‘Unheimlich’, introduced in his paper The Uncanny (Freud, 1919). The authors argue that to aid the development of a robust service capable of supporting the developing identities of the patients, it was necessary to first foster the ability of staff to inhabit an unfamiliar ‘unheim