Illness: physical and mental

Mental Health Nursing,  Jan 2006  by Jones, Alun

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Books Illness: physical and mental Psychotherapy and the treatment of cancer patients: Bearing cancer in mind. Lawrence Goldie with Jane Desmarais (2005) Routledge. ISBN: 1 58391 8574. pp 579. £18.99

Fear and uncertainty concerned with serious ill-health, dying and bereavement can hinder the ability to think clearly and so the experience of illness cannot be endured in ways that allow some measure of comfort and meaning to an ill person. People who are seriously ill, dying or bereaved can also cause health professionals to feel uncomfortable because there are no standard remedies to ease emotional pain and suffering.

To protect themselves, health professionals might subsequently avoid or marginalise patients who cause them to feel discomfort in ways that are not easily recognised. Discouraging conversations that dwell on the progression of illness or the experience of dying, are, therefore, possible. This is typically unintentional, yet if a person is unable to express his or her feelings frankly then opportunities to explore possibilities for change may be lost. Suffering remains wordless and so cannot be shared or thought over constructively.

This rich and compassionate book is fundamentally about the experience of being or becoming seriously ill and dying together with the nature of communications between persons receiving care and those providing it. The principal author, Lawrence Goldie, demonstrates, from beginning to end, how principles derived from psychoanalysis can be harnessed to the benefit of cancer sufferers and their families.

This book, therefore, challenges conventional psychological approaches to caring for people with cancer, who are dying and grieving. The case is made for better emotional care for people suffering serious illness and facing death.

Each of eight chapters explores psychoanalytic approaches to addressing emotional issues concerned with cancer in different general hospital settings. Disguised case illustrations show the many ways by which talking therapy can restore dignity and self-worth to an ill-person as well as allow for a greater sense of authorship for his or her life. The idea that illness and death are concerns which can faced up to rather than denied, features prominently throughout. The book will subsequently be of value to all nurses, addressing as it does various existential dilemmas. Those working in specialties concerned with serious physical illness and, with mental health nursing in mind, liaison/consultation mental health nurses will find this work a particularly useful reference source.

Lawrence Goldie is a consultant psychiatrist and psychoanalytic psychotherapist. He has had a distinguished career and trained at the Institute of Psychoanalysis in London where he undertook supervision with Hannah Segal and Wilfred Bion, acknowledged sources of inspiration. Bion's ideas concerning emotional containment are as such illustrated in context. At this point in my review, I have also to declare a bias. Having completed the innovative D14 course, concerned with a psychoanalytic approach to caring for the dying and bereaved at the Tavistock Centre, London, I was taught and supervised by the author. So I am as well a devotee to working with those who are seriously ill in psychoanalytically informed ways.

That aside, this book is a much needed testimony to the potential benefits to be gained from psychoanalytic work with the seriously ill. With the help of Jane Desmarias who teaches English and Comparative Literature at Goldsmiths College London, Lawrence Goldie has written an eloquent text that fosters in the reader the idea of thinking about cancer as a way of helping the seriously ill cope with suffering.

Alun Jones

Alun Jones is a senior lecturer at the University of Manchester School of Nursing and Midwifery

Copyright Community Psychiatric Nurses Association Jan 2006
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