Making Room for Madness in Mental Health: The Psychoanalytic Understanding of Psychotic Communication

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In this book, Marcus Evans argues that in addition to providing a helpful treatment for patients who suffer from serious psychological difficulties, psychoanalytic thinking can also help mental health staff develop a better understanding of their patients and complement other ways of thinking about mental disturbance. Mental health professionals need to be receptive to their patients’ projections and communications, but these powerful projections can become overwhelming, especially for clinicians who are in direct contact with their patients for long periods of time. A psychoanalytic model which puts the understanding of the relationship between the clinician and patient at the centre of its preoccupations can also give mental health professionals a language for describing their experiences of, and interactions with, their patients. This model is developmental and provides a dynamic picture of the ways in which different parts of the patient’s self wrestle for control of the patient’s mind over time. Evans argues that this framework for understanding can help in the day-to-day management of these changes and fluctuations.

Evans believes that the diagnosis and active interventions employed by psychiatry need to be accompanied by a receptive approach to treatment and care. Mental health professionals need to be interested in the meaning of their patient’s symptoms and verbal and physical communications. These may convey important information about the patient’s internal world and underlying conflicts. This receptive approach requires mental health professionals to make a switch from the active state of mind demanded by active interventions, to the receptive state of mind required by the need to take in the patient’s emotional state and underlying personality structure.

Making Room for Madness in Mental Health draws on the author’s extensive experience of working psychoanalytically with people with severe and enduring mental illness, as well as providing psychoanalytic supervision and consultation in a range of mental health settings to show how psychoanalytic ways of thinking may complement other approaches to mental disturbance by highlighting the communication and meaning of such disturbance. This is illuminated by lively clinical vignettes, supported by accessible accounts of key psychoanalytic theory.

Working with people with mental illness can be rewarding and enlightening. It can also be disturbing, frightening, boring, frustrating, anxiety provoking and stupefying. Evans argues that we need to provide room and space for mental health professionals to reflect upon and think about their experiences on a day-to-day basis, and to train clinicians to senior levels in order that they can offer clinical supervision to front-line staff, which can help them develop ideas about the meaning of their patients’ symptoms and behaviours. Psychoanalysis offers a model for thinking about and providing meaning for, the anxieties that drive us ‘out of our minds’, and this can reduce the risk of thoughtless action. To some extent this involves putting the madness back into mental health.