Good People, Bad Politics

Last week I went to a conference about the most radical shift in the NHS you’ve never heard of. A conference about Sustainability and Transformation Plans (STPs), held by a well-known health policy and research foundation populated by the new generation of blue-suited corporate account managers and a few good people of a clinical persuasion. The beards have gone, but a glance around the room is sober confirmation about the consequences of ‘strong and stable’ leadership on diversity and class participation in public service debates.

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Further Reflections on Transference, Countertransference and Containment in Extreme Settings

Writing about clinical work with psychotic patients, Bion noted with his inimitably dry, understated irony: “It follows that it is a matter of difficulty for the analyst to conduct himself in such a manner that his association with the analysand is beneficial to the analysand”. In preceding passages he had discussed such patients’ hallucinated and deluded constructions, products of massive evacuations of both persecuting and idealising internal scenarios into external reality to an extent which obliterated awareness that there even might be differentiated and autonomous internal (unconscious phantasy) and external (material reality and other minds) worlds at all. Real other people, analysts and mental health professionals included, become so infused with patients’ projective identifications that everything they say or do is “interpreted” or “perceived” in a manner almost impossible to grasp when compared with their intentions.

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How Projective Identification is an integral aspect of the Sociopathic Narcissist


With all of the discussions going on about Donald Trump’s ‘narcissism’, I thought I might offer a broader clinical perspective regarding sociopathic narcissism. Clearly there is great ongoing discussion about Donald Trump’s ‘narcissism’, however, I believe what has been errant in the discussion is that Trump is by definition not just ‘narcissistic.’  Trump’s narcissistic manifestations also appear to be well entrenched in sociopathy.

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Why Mentalization is a gift for anyone working with Trauma and Neglect


The interest in mentalization as a concept has been steadily on the rise over the last decades. Mentalization and mentalization-based theory aimed at collecting different schools of thought and years of research, and by doing that has succeeded in describing complex phenomena in relation to interaction between people – both when it is successful and when high emotional arousal prevents the ability to mentalize. 

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The Psychoanalytic Understanding of Psychotic Communication


In her foreword of my book, Edna O’Shaughnessy says ‘that the psychoanalytic method does not keep insanity out of view, but tries to offer madness a habitat for human understanding’.  In this book I have tried to demonstrate how psychoanalytic thinking can make ‘Room for Madness in Mental Health’. One of the issues the book tries to address is the challenge of madness – both that which is identifiable as being madness and also madness that is disguised.

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David Smail: Clinical Psychologist, Sociologist, Philosopher, and Political Critic

David Smail, clinical psychologist, who has died aged 76

As Karnac Books republish four key works by the pioneering clinical psychologist, his son Alastair reflects on his achievement.

When my father died just over a year ago, the family was unsure what to do with his books. He had said he would like them published on the internet for free; either that or left alone. We did not have the capacity to post them on the internet, although David had put many articles and an internet publication on his website: The reaction to his death, as for example inThe Guardian obituary persuaded us that we needed to do something.

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The Eve of Destruction: Germanwings flight 4U 9525 and Pilot Suicide


A popular but dated image of pilots probably derives from war movies showing scenes in which they wrestle with the controls of a damaged aircraft to avoid catastrophe. Modern aviation is far removed from what are now outdated Hollywood depictions of pilots.  Wrestling at the controls to save the aircraft is hardly in a day’s work.  Planes now fly via computers following the calm and well-rehearsed inputs from pilots.  The recent Germanwings pilot suicide crash, however, highlights that there are a rare few pilots who do not wrestle with the flight controls to save their aircraft, but they may wrestle with very powerful and destructive forces within their minds.

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Therapeutic atmospheres can be created anywhere

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One flew into the cuckoo’s nest—but how do we help them get out?  We are all familiar with the usual images of the film and many of us have worked in mental health units and found wanting the knowledge base we have been presented with to help patients recover from mental ill health and get out of ‘the nest’ (hospital).

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Psychoanalysis is a psychic pilgrimage that reveals the depths of our loves and our depravities


I thought long and hard about what to write for Karnacology regarding my book, Clinical Dicta and Contra Dicta and kept struggling how to introduce a book that, even though I wrote still do not fully know how to describe it.  So I thought I would write a clinical vignette that may offer the reader a glimpse into the clinical vignettes in the book.

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