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.
Over the last twenty years or so, psychological aspects of psychosis have attracted renewed interest. The early intervention paradigm, developments in cognitive behavioural and family therapies, hearing voices networks, dialogical approaches, and research into attachment and to trauma have all played a part, but psychoanalytic contributions have been largely absent. It as if these recent developments and psychoanalytic thinking inhabit different worlds, and within mental health services it can feel as if a century of psychoanalytic attempts to understand psychosis had never happened. The situation is epitomised in Understanding Psychosis and Schizophrenia (Cooke, 2014), a major recent publication about psychological approaches to psychosis, where psychodynamic approaches are barely mentioned. In this context, Evans’ book seems to me to offer two very important contributions. Firstly it sets out what a psychoanalytic understanding might add, and secondly it makes a case for making use of such understanding.
In defining psychosis, Evans quotes Freud and O’Shaughnessy, viewing psychosis not as defined by psychiatric classifications, but in psychoanalytic terms, that is as a withdrawal from reality and thus a condition which may underlie apparently ‘neurotic’ problems, and which may at times affect us all. He includes chapters not only on conditions labelled psychosis within psychiatry, but also on borderline and antisocial personality, eating disorder, self harm and hysteria, arguing that recognising the psychotic processes that underlie such problems offers a better chance of understanding them. Despite this diagnostic breadth, the book seems to me very clearly focused on difficulties that are severe and challenging and which attract attention and resources even within the most hard-pressed mental health services. This aspect perhaps links to Evans’ own clinical experience, which is based not just on working therapeutically in specialist settings, but also on lengthy e