Suffering Insanity: Psychoanalytic Essays on Psychosis

Suffering Insanity: Psychoanalytic Essays on Psychosis

Suffering Insanity: Psychoanalytic Essays on Psychosis

Suffering Insanity: Psychoanalytic Essays on Psychosis


When madness is intolerable for sufferers, how do professional carers remain sane? Psychiatric institutions have always been places of fear and awe. Madness impacts on family, friends and relatives, but also those who provide a caring environment, whether in large institutions of the past, or community care in the present. This book explores the effects of the psychotic patient's suffering on carers and the culture of psychiatric services. Suffering Insanity is arranged as three essays. The first concerns staff stress in psychiatric services, exploring how the impact of madness demands a personal resilience as well as careful professional support, which may not be forthcoming. The second essay attempts a systematic review of the nature of psychosis and the intolerable psychotic experience, which the patient attempts to evade, and which the carer must confront in the course of daily work. The third essay returns to the impact of psychosis on the psychiatric services, which frequently configure in ways which can have serious and harmful effects on the provision of care. In particular, service may succumb to an unfortunate schismatic process resulting in sterile conflict, and to an assertively scientific culture, which leads to an unwitting depersonalisation of patients. Suffering Insanity makes a powerful argument for considering care in the psychiatric services as a whole system that includes staff as well as patients; all need attention and understanding in order to deliver care in as humane a way as possible. All those working in the psychiatric services, both in large and small agencies and institutions, will appreciate that closer examination of the actual psychology and interrelations of staff, as well as patients, is essential and urgent.


Not everything that can be counted counts, and not everything that counts can be counted.

(Albert Einstein)

Practitioners in mental health services and in the Western world are subject to increasing expectations from health authorities, from professional guidelines, from the current zeitgeist for 'evidence'-based approaches and from the increasingly powerfully expressed expectations of users and carers.

In this outstanding series of essays, Bob Hinshelwood takes us 'inside' and 'alongside' those who work with severe mental disturbance. In his Introduction he emphasises that he is writing this book in order to illustrate as fully as possible the psychological impact and responses of professionals to their mentally ill patients who cannot cope at a particular point with aspects of life. He wants this book to balance the many treatises on medical responses to such people, which tend to downplay the subjective, which leads to the psychology of the mental health professions and psychiatrists becoming neglected.

He illustrates, with admirable clarity, that it is in fact the nature of these ubiquitous psychological responses in individuals and groups of professionals that will play a central role in determining whether the expectations just referred to have some chance of being fulfilled, and in determining the quality of the service provided. He does this in a way that does not diminish the importance of biological and medical approaches, but his aim is clearly to get a better balance, to provide better bridges between models and between patients and practitioners and services and to describe everyday crucial

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