I. Introduction

I am often asked how being a psycho-analyst affects my work as a family doctor and this book is an attempt to provide an answer.

My experience has been that psycho-analysis – a set of theories about the mind, and a method of observing its workings – has primarily affected the perception and response to anxiety as a mental pain. Many family doctors are aware that our scientific and technical grasp of somatic medicine is not matched by an understanding of illness of the mind and mind-and-body. There is little consolation from the chastened physician for the many patients who are told, “It is true that we have made enormous progress in the last thirty years, except in your case.”

But today, more than ever before, patients press in with these very problems and demonstrate that painful states of mind and psychosomatic illnesses cannot be understood in terms of ‘disembodied minds and demented bodies’ (Hutten).

Confidence in diagnosis is important, and if we hand the patient over to technical equipment for tests this provides the necessary secure base for discussion with them about their emotions and imagination. The inner world of dreams and phantasy, generally so inaccessible, mysterious and alarming, is not only the source of artistic and scientific inspiration, but also the locus of emotional life from which meaning is attributed to external reality.

Psycho-analysis has documented the struggles of different parts of the child's personality with the parental relationship. Internally and externally, feelings of love, admiration and gratitude for mental and physical succour contend with the grudges, spites and jealousies stirred by frustration. The dreams and daydreams of children dramatise a conflict between a desire to take possession of the mother (for which the price must be paid in subsequent guilt and depression) and the opposing hope that the mother, defended by her husband, will be able to retain her vitality, forgive the offender, and continue the work of raising the