Treating People with Psychosis in Institutions: A Psychoanalytic Perspective

This book brings together the histories of a number of psychoanalytically-informed hospitals, and provides a synthesis of the theoretical underpinnings in the institutional practice of each. Of particular interest is how psychoanalysts and psychoanalytically-trained staff working in institutions apply their theoretical understanding, and in what ways the psychoanalytic technique has been modified or adapted to the treatment of individual patients with psychosis and to the workings of an institution in general. Here the institution is the subject of the case study. Institutions that are theoretically orientated to psychoanalysis were chosen and examined, taking into account their various approaches to the treatment. A number of institutional models that are informed by psychoanalysis offer a guide to the treatment and present a version of institutional practice that is different from the prevailing models in psychiatry. This has implications for health services in the current climate of mental health reform.Psychoanalysis has its greatest efficacy in long-term treatments and has shown its suitability for patients diagnosed with psychosis when the method is adapted to the uniqueness of each person and is conducted by an experienced clinician. The treatment of psychosis cannot usually be conceived without considering some form of institutional care, although this does depend on the level of the individual's psychopathology. This is because the majority of people with a psychotic illness, especially those with schizophrenia, will be exposed to inpatient, community or outpatient treatment, in one form or other, during the course of their lives.

About the Author :
Belinda S. Mackie worked in public psychiatric institutions before and during deinstitutionalisation in Australia. She is a registered psychoanalyst with the Australian Centre for Psychoanalysis and is a member of the Forums of the Lacanian Field. She practices as a psychoanalyst in Melbourne.

Review :
'Psychoanalysis has from the beginning had a role to play in understanding human endeavour, way beyond the therapeutic work of the consulting room. Working with institutions is one of the biggest fields for its application. However, the combination of understanding both therapeutic and institutional work is a lot less common. Here is a book that makes a scholarly survey of the whole of this field in which institutions are the arena for therapy, for understanding the work practice of caring, and for developing healthy social systems. This book is a fine example of a coherent historical and geographical account of these dispersed mission-like centres of expertise.'- Professor R. D. Hinshelwood, Centre for Psychoanalytic Studies, University of Essex, UK'This book is theoretically wide-ranging and examines how the conceptual frameworks of a variety of different psychoanalytic perspectives have informed the development of institutions for the treatment of the seriously mentally ill, including those diagnosed with psychoses or who have undergone psychotic episodes.'- Susan Long, PhD, author of The Perverse Organisation and its Deadly Sins, and editor of Socioanalytic Methods'Belinda S. Mackie has written a rich and comprehensive historical and theoretical account of psychoanalysis in mental health institutions. She clearly and critically reviews a wide range of psychoanalytic approaches across different continents and eras. This important resource fills a large gap from which emerges a general assessment of the value and validity of utilising a psychoanalytic method in the institutional treatment of psychosis. The author skilfully conveys the sense of what made the particular institutions special - historically, theoretically and clinically.'- Douglas Kirsner, PhD, Emeritus Professor, Philosophy and Psychoanalytic Studies, Deakin University; author of Unfree Associations; Honorary Member of the American Psychoanalytic Association'Exploring the advances in the treatment of schizophrenia and psychosis over the last hundred years or so, this fascinating book tells the story of the way in which psychoanalysis flourished in institutions in the twentieth century. If Freud had wished for psychoanalysis to inherit the promised land of psychiatry, then it was into the field of treating psychosis that psychoanalysis would need to venture. Belinda S. Mackie's account, with a particular dash of Lacan, narrates the emergence of psychoanalysis as a mainstay idea in the treatment of psychosis and shows how Freud's dream was at last realised. Demonstrating how the development of the best known psychiatric institutions were threaded together by common psychoanalytic family ties, Mackie's book makes for essential reading.'- Dr Gary Winship, Associate Professor, School of Education, University of Nottingham; Senior Fellow, Institute of Mental Health