Modern Mental Health by unknow

Author:unknow
Language: eng
Format: epub
Publisher: Critical Publishing
Published: 2013-08-15T00:00:00+00:00

Admittedly, this is not as grave a form of acting out as is frequently encountered, but it enables us to observe in slow motion, as it were, the important features of the reflection. There are several features which contribute to this being a successful piece of reflection:

•The individual carers were able to feel they could work something out and to increase the scope of their awareness, and thus to feel less helpless.

•With this sense of awareness, they were enabled to resist playing a part in the way that the carers in Davies’ example did succumb.

•To reflect on the occurrences is not to reject, as so often happens. Instead, a recognition developed in the key workers so they could be with, or remain with, the disturbance, without being overwhelmed by it.

•Perhaps most significant of all, the two members of staff were able to speak together in a constructive and fruitful way, in fact in a manner that did not replicate the implicit divorce that existed between Joe’s parents.

•In consequence, Joe was, shall we say, better held in the hospital’s parental embrace, and able to resume a therapy process.

In connection with the last of these factors, the fruitful interaction of the staff together in a way that contrasted with Joe’s experience of carers, I have in mind a short quote from Elliott Jaques:

Individuals may put their internal conflicts into persons in the external world, unconsciously follow the course of the conflict by means of projective identification, and re-internalise the course and outcome of the externally perceived conflict by means of introjective identification. (Jaques, 1955, p 497)

In Joe’s case he was able to insert his problematic ‘parents’ into the persons around him in the external world, and there to witness them at variance with each other. However, in this instance, the parental roles adopted by the carers created a situation in which Joe could witness the course of this parental conflict and as a result offered him a model for greater integration in himself.

The outcome of the use of this hypothesis/theory was indeed the possibility of a continuing therapeutic relationship and a treatment success, at least in terms of the patient’s return to a normal life. This is one success only but it indicates that the hypothesis does not just have explanatory power but promises at least some outcome success.

Conclusions

The speculative hypothesis developed has been investigated in various ways. It postulates unconscious collaboration in developing cultural attitudes which distort the work, the practice and the effectiveness of treatment in psychiatry, especially with difficult patients. First, the hypothesis appears to be explanatory of occurrences which can only be weakly addressed by other hypotheses drawn from social psychology and from the criticisms about the limitations of training. And second, at least one case shows that the explanatory power follows through as a treatment success in this category of notoriously difficult and frequently rejected kinds of people.

We started by applying a critical leverage to the current over-emphasis on objectivity and the social construction by care organisations of an isolated individualism, in contrast to the context of the client plus their carers.

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