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Psychoanalysis often suffers within mainstream psychiatry and mental health because its papers are written mainly for internal consumption, and can strike the un-schooled as abstruse or off-putting in their focus on unconscious sexual and aggressive motivations. In the UK where continental philosophy, like psychoanalysis, has not – at least historically – gained such a foothold a further charge is made around the relative lack of empirical support within a simple scientific frame.
Marcus Evans, in his most recent book, does much to present psychoanalytic ideas in a language which any mental health worker can read, understand and apply. He begins by defining the concepts he will use, which are drawn primarily from Freud, Klein, Bion, Rosenfeld and Steiner. He limits and clearly defines his concepts, which is helpful, as throughout the text different clinical scenarios are then formulated and explained in these terms.
The book is organised around chapters on theory in practice, supervision and consultation, and therapeutic and anti-therapeutic factors. A range of common clinical scenarios are each given a chapter: including depression and suicidal risk, emotionally unstable personality disorder, psychosis, treatment resistance, and psychosomatics. There is a final chapter on the NHS as a social system and the effects of its target culture.
Marcus Evans’ background as a frontline and then senior nurse means that he is always coming back to the realities faced on the ground in often very challenged mental health settings. The patients strike one as real and their problems complex. Anyone who has worked in NHS general psychiatry will have struggled to understand and help patients similar to the ones described in this book.
What makes this approach accessible is that the psychoanalytic understanding is so ordinary in its use of language and its description of what drives us as human beings. Concepts such as identification, splitting, transference, countertransference and cont