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Khalid Ali: London Human Rights Watch Film Festival 9-18 March 2016

7 Mar, 16 | by Ayesha Ahmad

London Human Rights Watch Film Festival

https://ff.hrw.org/london, 9-18 March 2016

Various venues across London

Over a period of 10 days, London will host the ‘Human Rights Watch Film Festival’ showing 20 feature and documentary films. The opening night will screen ‘Hooligan sparrow’, a documentary in Southern China following a group of activists campaigning to unravel the truth behind the rape of a group of young school girls. ‘Mustang’ the closing night film from Turkey tells a story of five sisters fighting their family and community to have control over their education and choice of future husbands. Women as fighters for political reform in the Arab world feature in the documentary ‘The trials of Spring shorts’.

 

BMJ

 

‘Hooligan sparrow’ opening the London Human Rights Watch Film Festival, 10 March 2016

The history of gay rights in different parts of the world are seen in: ‘Larry Kramer in love and anger’ which chronicles his fights as a novelist and activist to push the AIDS agenda into public health policy in the USA, and ‘Inside the Chinese closet’ which portrays real stories of fake marriages between gay men and lesbian women trying to conform to their community’s social and religious rules that do not tolerate homosexuality.

The plight of international refugees is seen in ‘Mediterranea’, ‘Desperate journey’, ‘If the dead could speak’, ‘At home in the world’ and ‘The crossing’; telling heart-breaking real and fictionalised accounts of violations of humanity towards asylum seekers from Burkina Faso, Syria, Somalia, Eretria and Iraq.

If you are interested in films focusing on Palestinian/ Israeli issues, you might want to watch; ‘P. S. Jerusalem’ about a family trying to start their life in Jerusalem, or ‘The idol’ a fictionalised account of the story of Mohammad Assaf, Palestinian winner of ‘Arab Idol’ TV music competition.

British conflicts between the residents of Tottenham, London and the Metropolitan Police that followed the killing of Mark Duggan in 2011 are analysed in ‘The hard stop’.

The rise of fundamentalism is uncovered in ‘Among the believers’ a documentary filmed in a school in the Red Mosque in Pakistan.

Most of the films screening will be followed by Q and A discussion with the film-makers.

 

 

 

Related reviews

http://blogs.bmj.com/medical-humanities/2015/05/26/khalid-ali-fil-review-mediterranea/

 

Address for correspondence

Dr Khalid Ali, Screening Room editor

Khalid.ali@bsuh.nhs.uk

 

 

 

 

Khalid Ali: Film review – A political leader declares war on stroke

2 Mar, 16 | by Ayesha Ahmad

A political leader declares war on stroke  

Churchill’s secret- ITV drama- shown on Sunday 28th February 2016

                               Directed by Charles Sturridge 5* 

                                Released on DVD later in 2016

                               

Stroke back in 50’s England was not the well-characterized disease we know so much about today with effective interventions such as thrombolysis that can save lives. In a fascinating account of what the director Charles Sturridge describes as ‘secret history’, the ITV drama tells the story of Winston Churchill’s stroke in the summer of 1953. Churchill’s wife, Lady Clementine, and the Conservative Party conspired to hide the news of his stroke by keeping him out of the public eye for three months to recover. That well-kept secret became public knowledge when his private doctor Lord Moran published his autobiography ‘The struggle for survival’ years later (1). The book was faced by a storm of criticism as a breach of confidentiality and an exploitation of doctor- patient relationship by Lord Moran.

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Screening of ‘Radiator’

26 Feb, 16 | by cquigley

 

Described by the Guardian as ‘an absorbing portrait of ageing and unhappiness’, Radiator has been the recipient of a number of nominations and awards at national and international film festivals.

There will be a special screening of the film on March 4th, followed by Q&A with Tom Browne (writer and director) and Daniel Cerqueira (co-writer and actor).

Read a review of Radiator by Dr Khalid Ali on this blog.

 

All welcome.

Friday March 4th, 7.30pm

Venue : POSK, The Polish Culture Centre, 238 King Street, Hammersmith, London W6 ORF

Sapphire Room, 2nd Floor

Nearest Tube Station :Ravenscourt Park

 

 

 

 

 

 

The Reading Room: Jenny Downham’s ‘Unbecoming’

17 Feb, 16 | by cquigley

 

Unbecoming by Jenny Downham.

Published by David Fickling Books, 2015.

 

Reviewed by Katie Hodgkinson, Medical Student

 

Unbecoming jacketfront

They say don’t judge a book by its cover, but the cover of Unbecoming is beautiful, and the story inside even more so. I’m generally a bit wary of Jenny Downham as an author because I did not enjoy Before I Die, and when I read the blurb for her most recent work, I wasn’t intrigued. It sounded very stereotypical, and to be honest, just like every other young adult book out there.

How wrong I was.

Unbecoming is a long, thoughtful book that covers three family stories, giving us three beautifully explained situations. The power behind such wonderful writing will make you think and question whether you’ve really determined the extraordinary richness behind the lives of people you might generally consider entirely average.

The book follows the story of three characters: Katie, who’s struggling with her sexuality, her mum Caroline, who’s struggling with just about everything, and Katie’s grandmother Mary, who has Alzheimer’s and who has just lost her long term partner. Unlike most young adult books, Unbecoming contains an LGBT character without the need for the book to be entirely devoted to the issues of LGBT acceptance and romance. I thought Mary’s story in particular was very well crafted and it formed the bulk of why I liked Unbecoming so much. The book explains the thoughts and feelings of someone with progressive memory loss very effectively, and for this reason I’d say that this book (or at least Mary’s parts) is a must read for anyone working with the elderly.

At the start of the book, Katie and Caroline barely know anything about Mary. We begin at the same point that many doctors might do – seeing the grandmother as someone in need of care, but for whom we have no particular attachment. Mary is sent home with Caroline and Katie to a world unfamiliar to her.  As the story develops we learn more and more about Mary – how she struggled to raise Caroline, how her relationship with her sister and father shaped her, and how all of this affects how she interacts with Katie. There are a lot of difficult topics involved, yet this remains an optimistic book.

At the beginning I thought that this was going to be a very long and tedious read about some very commonplace issues. Katie starts off by talking about her life and it all sounds very much like a whiny blog post from a teenager about how hard her life was – but then a rich tapestry evolves. When you meet someone you just don’t consider the ways that his/her life might interlink with those around them. This book demonstrates just how wrong such thinking can be. I’ve never read anything that works so well in support of holistic care – although there are several problems that could be solved so easily, in context some solutions make no sense at all. You question the hospital’s decision to send Mary home to a daughter she’s never known, and who has no idea how to cope with her mother. You wonder why on earth social services are so unhelpful to a family already struggling. The expectations placed on these three women by society are woven in and together seamlessly, showing you just how flawed these expectations can be, especially when created by those who have no understanding of what the lives and challenges of those outwardly viewed as ‘normal’ might be.

Unlike most young adult books, the focus here is firmly placed on family relationships. Yes, there is romance in Katie’s developing liaisons, but love doesn’t in the end conquer all. It also isn’t a typical ‘issue’ book that focuses exclusively on sexuality or dementia or learning difficulties or depression – it just presents the problems as part of everyday life, which makes them much more realistic. There was a real sense of the characters having a whole life, rather than the book merely showing the progression of one aspect. There is supposedly a twist at the end, but I thought that this was quite predictable and left a flat conclusion to an otherwise amazing book.

Unbecoming covers several hard-hitting issues and on discussion you’d assume they were too numerous to cover sensitively in one work. The book successfully shows us that an ‘ordinary’ person will go through many of these struggles in the course of their life, sometimes all at once, and that normally it just wouldn’t be considered that anyone would be processing this much turmoil in their life at any one time. Divorce, learning difficulties, Alzheimer’s, the changing views of society on single parent families, sexuality and grief – all of these are covered beautifully, giving us a real understanding of these three women and what makes them act in the way that they do.

The storytelling around Katie’s sexuality is beautiful. Far from realising her orientation and everything being sorted as is so often depicted in the fictional world, we see that same sex relationships are just as, if not more complex than otherwise seen. There is none of the usual ‘you’re gay I’m gay therefore we’re automatically in love with each other’ trope that seems so prevalent in young adult fiction at the moment. The pressures on Katie are realistic and ones that we can all relate to, and it’s so interesting to read the views of Caroline and Mary on these issues.

The descriptions of the relationships between mother and daughter, siblings and grandparents are diverse and evocative. There is something in Unbecoming for everyone because of the sheer detail and complexity, delivered so well as to be relatable in every sense. There is a slow unfurling of what makes these people tick and it’s something we perhaps miss in the hustle and bustle of everyday medicine. The relationships in the book develop slowly, with individual thoughts and processes being described so beautifully as to be haunting. You’ll go through your days after reading this book questioning everything. Unbecoming succeeds in delivering justice to the gradual development of its characters, both in spite of, and because of, the difficulties afforded to them.

Take Me With You: the Museum of Friendship, Remembrance and Loss

8 Feb, 16 | by cquigley

 

Take Me With You: the Museum of Friendship, Remembrance and Loss

6.00-8.30 pm, Thursday 18 February 2016 at the Chowen Lecture Theatre, Brighton and Sussex Medical School, Falmer Campus BN1 9PX

Museum open from 6.00 pm

Clare Best and Tim Andrews in conversation (+q&a) 6.30-7.30 pm

Drinks reception from 7.30 pm

Museum open until 8.30 pm

 

From Clare Best’s blog:

‘Here is what I wrote in my journal after Tim and I first met in a café in Brighton in January 2013:

Met Tim Andrews in Brighton 16 Jan. Thought on train on way home about some kind of flexible/low-maintenance start to a collaboration. Thought more overnight.

‘Take me with you’ – this is the phrase that kept coming to me in the night. It has connotations of journey, of packing, of accompaniment, of company, of gathering in, of sharing.

I see it perhaps for now as making ‘swaps’ by email of what each of us would take with us to the next world, if we could, if there is one… Things/ideas we hold dear. Then each of us interprets or responds to each other’s chosen thing. And so on.

The items sent might be very fragmentary and abstract. They could be anything: a line from a song, a particular person’s smile, a food, a mood, a book, a film, a favourite walk, a memory, etc etc – it could be literally anything.

So we’d build up a collage, a narrative. And each time we corresponded we’d know each other better, so we would construct a kind of overlapping journal, or a conversation, through what we’d choose and send each other.

And here we are, three years later, with a robust friendship and about 50,000 words written, quite literally, between us – and all kinds of things we’d like to show you.

It’s been a stimulating journey, full of laughter and tears and adventure and tea and cake, and we look forward to sharing it at BSMS on 18 February.

The event is free, but if you’re coming along please register in advance here.

Tim has produced a trailer and has blogged about the project.’

 

The Reading Room: Clive James’s ‘Sentenced to Life’

4 Feb, 16 | by cquigley

 

Sentenced to Life

by Clive James. Published by Picador, 2015.

Reviewed by Dr Sam Guglani.

 

On a ward round, I notice a colleague speaking with one of the palliative care nurses – about a patient, or perhaps about processes, maybe even about a personal matter. His posture, and what I can hear of his tone, feels familiar. That particular weight and tempo given to conversations with palliative care, like those invoked for hospital chaplains – both the ostensible familiars of death and carriers perhaps of a particular wisdom. What wisdom? What lessons are there for the living – or do we romanticise it all? – from those so near the dying and those close to death?

The extraordinary Clive James – critic, essayist and poet – is unwell and almost certainly close, however modern medicine allows us to define that, to death. In 2011, he developed emphysema, renal impairment and leukaemia. A couple of years ago, medics and media alike anticipated his death as imminent, but new drugs have him in remission, very much alive and impressively prolific. He finds this ‘all a bit embarrassing’ and, regardless of the sensibility of that emotion, there is a sense of the world’s said media shuffling its combined feet and checking its watches. Waiting for him to die, so they can get on with the business of illuminating his life.

James, however, is ‘restored by [his] decline/ And the harsh awakenings it brings.’ And amongst a remarkable number of recent publications – translations of Dante, collections of essays – last year he returned to one of his first mediums of artistic expression: poetry. Described by James himself as ‘funeral poems’, Sentenced to Life feels like a collection of elegies. It forces us to think again about elegy as poetic utterance: what it is for and what action it might hold for the still living. Is it an analgesic against the pain of loss? Or might it turn us to face that loss, face death squarely, and in doing so actually illuminate life? Understood as such, might every poem – as Seamus Heaney is said to have commented – in fact be an elegy?

Throughout the collection, James points to the stark fact of human life’s presence and all our experiences, here, transiently, on this earth. In Event Horizon, he proclaims:

you get to see the cosmos blaze

And feel its grandeur, even against your will,

As it reminds you, just by being there,

That it is here we live or else nowhere.

 

And all the poems feel like they follow from this assertion, worrying away at the question of what we then do with our lives, how best to live, questions of meaning. For Clive James, so much meaning clearly gathers in the very fact of the world’s beauty as refracted within the human gaze. In Too Much Light, his cataracts ‘invest the the bright spring day/ With extra glory, with a glow that stings.’ In the title poem, he looks with astonishment at goldfish swimming in a garden pool: ‘never touching, never going wrong:/ Trajectories as perfect as plain song.’ Both poems sing of the imperfections of human agency, our messy trajectories and sight, as being both a source of pain and of wonder. But the fact of dying, of breathing the air ‘as if there were not much more of it there’, heightens for him a sense of sustained astonishment in the brevity and glory of every conscious moment, and its released multitude of revelations. He goes on, in Sentenced to Life, to reflect:

Once I would not have noticed; nor have known

The name for Japanese anemones,

So pale, so frail. But now I catch the tone

Of leaves. No birds can touch down in the trees

Without my seeing them. I count the bees.

 

This view of life’s preciousness echoes Dennis Potter who, in the last months of his life, spoke of seeing the beauty of the blossom outside his window in Ross: ‘it is the whitest, frothiest, blossoms blossom that ever could be, and I can see it…The fact is, if you see the present tense, boy do you see it! And boy can you celebrate it.’ Within these poems though, the revelation of our earth- and time-bound lives and of these brightly lit moments, carry further still. They bring us to what T. S. Eliot described as: ‘the only wisdom we can hope to acquire…/ the wisdom of humility.’

This is most manifest in his acknowledgement of the inevitability of death. In Driftwood Houses he declares this unsentimentally:

To hear me talk

You’d think I found my fate sad. Hardly that:

All that has happened is that I’ve hit the wall.

Disintegration is appropriate’

 

Such honest and forthright acceptance that our flesh must weather and fray feels infrequent in the consumer clamour within medicine and society for longevity, perhaps even for immortality. In Plot Points, further to the expressed awe in Event Horizon, James parallels the universe’s diminishing with our own, and notices how capable we are of choosing to forget both:

While you were reading this

Millions of stars moved closer

Towards their own extinction

So many years ago –

But let’s believe our eyes:

They say it’s all here now.

 

None of this hard-won sense of truth feels bleak or despairing, but instead is suffused with enchantment and perspective. He suggests that the truth clears away ‘so many souvenirs’. And in a life such as his, there are many such souvenirs. If there is regret in these poems, and there’s much of it, it isn’t around the fact that he is dying, but rather around how he has lived, how he might have lived otherwise: ‘If I seem close to tears/ It’s for my sins, not sickness.’ And from this regret he comes away with the remarkable conclusion that his current state is in fact more authentic than the illusory existence that preceded it. In the brilliant poem, Landfall he asks – ‘those years in the clear, how real were they’, and goes on:

I called it health but never stopped to think

It might have been a kind of weightlessness,

That footloose feeling always on the brink

Of breakdown: the false freedom of excess.

 

So now, rather than a life of ‘sirens’ and adoration, he asks for, and is gratified by, the present and the real: ‘Remember when I asked for thousand kisses?/ Let’s make it ten. Why not kiss me just once?’ And he arrives at, and brings us to, a place of ‘Thanks for the heartbeat which still lets me live:/ A consolation even now, so late’. Thanks for our life-giving pulse is a different position altogether to one of reductive expectation and rights. Faced with our finitude we might readily arrive at either: at thanks or at greed. However, it is a position of gratitude that opens us to what we owe, over and above what it is we are entitled to.

T.S. Eliot asked not to hear of ‘the wisdom of old men but rather of their folly, / Their fear of fear and frenzy, their fear of possession, / Of belonging to another, or to others.’ In the presence of his death, Clive James pushes against Eliot’s assertion and details in formally accessible and powerful poems, a recognition of his essential belonging to others, his fragility and so demonstrates acres of wisdom. In Leçons de Ténèbres, he wonders at the value of this:

But are they lessons, all these things I learn

Through being so far gone in my decline?

The wages of experience I ran

Would service well a younger life than mine.

I should have been more kind. It is my fate

To find this out, but find it out too late.

 

I can’t agree that wisdom like this can ever be won too late for any of us and, if we choose to listen, it will serve younger lives. So we ought to listen – as patients, as doctors, as one-day patients, and as human beings.

 

Khalid Ali and Jane Peek: Cinema of splendour: Reporting from Dubai international Film Festival (DIFF) 2015

29 Jan, 16 | by Ayesha Ahmad

Cinema of splendour: Reporting from Dubai international Film Festival (DIFF) 2015

Dr Khalid Ali, Screening Room Editor

When I visited Dubai International Film Festival (DIFF https://www.dubaifilmfest.com/) for the first time in December 2015, I was not expecting to find so many films exploring health and well-being from all over the world. The variety of films on offer explored contemporary issues such as euthanasia and the right to die (Last cab to Darwin, directed by Jeremy Sims, Australia 2015), terminal illness (Dry, hot summers, directed by Sherif El Bendary, Egypt,2015, http://blogs.bmj.com/medical-humanities/2016/01/04/khalid-ali-taxi-ride-to-eternity-review-of-dry-hot-summers/), doctor-patient relationships (Waiting, directed by Anu Menon, India 2015), sports medicine and its ethically challenging medico-legal implications (Concussion, directed by Peter Landesman, USA 2015), and the aftermath of an epidemic of sleeping sickness (Cemetery of splendour, directed by Apichatpong Weerasethakul, Thailand 2015).

Old age and its colourful diversity of frailty alongside resilience, health and disease, creativity and cognitive decline were also present in ‘The lady in the van, directed by Nicholas Hytner, UK 2015’ and ‘Youth, directed by Paolo Sorrentino, Italy 2015’. I was once again reminded that arts and films in particular have a lot more to offer. By portraying artistically the lived experience of human suffering, healthcare professionals can begin to understand the determinants of physical and mental well-being and subsequently deliver dignified compassionate care. Films are no longer entertainment vehicles only; they do have a ‘healing power’. An elegant example of such ground-breaking ability of ‘healing through understanding’ came from the film ’23 Kilometres’ that will be reviewed here.

more…

Nadeem Akhtar: Film Review – “Wake in Fright”

29 Jan, 16 | by Ayesha Ahmad

‘Wake in fright’ directed by Canadian director Ted Kotcheff’s film is considered a masterpiece for its innovative, daring storyline, psychological focus and exceptional visual imagery [1]. The film premiered in Cannes in 1971 to great critical acclaim, but in its homeland of Australia (where the film was set), it was poorly received.

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The Reading Room: Ronald Britton’s ‘Between Mind and Brain’

27 Jan, 16 | by cquigley

 

Between Mind and Brain: Models of the Mind and Models in the Mind

by Ronald Britton. Published by Karnac, 2015.

 

Reviewed by Dr Neil Vickers.

 

Ronald Britton is one of the most significant psychoanalytic theorists writing today. Now retired from clinical practice, though still active in training, he is perhaps best known for his contributions to Kleinian theory. His first book, Belief and Imagination: Explorations in Psychoanalysis (1998), asked questions such as ‘What is and where is the Imagination in any modern model of the Mind?’ and ‘How can we conceive of it in psychoanalytic terms?’ His second, Sex, Death and the Superego: Experiences in Psychoanalysis (2003), set out his thinking on three concepts that were important to psychoanalysis historically. Britton has always used literature as a kind of interlocutor for analytic theory. Belief and Imagination contains lengthy discussions of, and arguments with, Wordsworth and Coleridge, Blake, Milton and Rilke, as well as Freud, Klein and Bion; and Sex, Death and the Superego contains a compelling reading of the Book of Job and a fascinating extended speculation about the role that Wagner’s operas played in Jung’s correspondence with Sabina Spielrein. Britton is a medical humanist avant la lettre.

 

The theme of his new book, Between Mind and Brain: Models of the Mind and Models in the Mind, is that we think in models. Britton’s concern is more with the mind than the brain though the early chapters do make reference to contemporary neuroscience. In the first chapter Britton asks a question that once tormented Freud: would psychoanalysis and brain science ever arrive at a substantially overlapping account of mental experience? Britton’s answer is ‘probably not,’ though he thinks the reasons for this have changed since Freud’s time. The success of quantum biological models in neurology has resulted in a situation in which a mechanistic account of how the brain works has been replaced by one that is probabilistic (so outcomes can never fully be determined in advance), and full of complex, counterintuitive interaction (Patrick Haggard of Queen Square has demonstrated that, in a range of situations, the brain executes our intentions before these are consciously formulated in the mind). Freud originally hoped to ground concepts like repression in the workings of different types of neurones. Today, Britton suggests, convergence would have to be sought in other places, using different concepts borrowed from each discipline. At one point, he playfully suggests that the evaporating black holes of quantum mechanics might somehow dovetail with the psychic ‘black holes’ that psychoanalysts have described in very disturbed children. But the comparison remains at the level of play, because the two models aim to capture very different things. And models, along with their potential and limitations, are where Britton’s real interest lies.

 

For better or worse, psychoanalysis, like other psychotherapies, has to derive its models from directly-reported mental experience. Fantasies, conscious and unconscious, are models in Britton’s sense. But so too are theoretical constructs such as the Oedipus complex, the ‘depressive position’, or ‘basic assumptions’. Many people imagine that psychoanalysts apply these models dogmatically to their patients. On this view, patients are talked into seeing their difficulties as having an Oedipal origin, say. Britton takes this case apart at some length. The psychoanalyst, in his view, should aim as far as possible to set aside all models, especially those to which he is most attached. They will only distort what he sees. To understand another person, you have to tolerate not understanding him or her for a long time. Britton is on record as saying that he assumes he does not understand his patients for the first two years of four- or five-times-a-week analysis. Of course, psychoanalytic models are brought in, sceptically, but only gradually.

 

Occasionally, patients’ difficulties will be very well captured by a model. In Chapter 6, Britton gives the example of a man called Peter who entered psychoanalytic psychotherapy with a stammer. Peter led a very ordered life. He did not work. He had a celibate marriage. He avoided talking to his mother on the telephone, writing typed letters to her instead. And he appeared to have few friends. The model that seemed to fit Peter’s case was of a narcissistic organisation, as described by Herbert Rosenfeld. Patients in the grip of narcissistic organisations may want to make contact with others in the outside world but are prevented from doing so by an internal figure or group of figures who threatens terrible punishment. So it seemed with Peter who felt he had to isolate himself from his wife and mother and from the world of work for reasons that were unclear. Eventually he revealed that from the age of fourteen, ‘there had been a voice in his head that had ordered him not to speak and not to get close to anyone’ (53). Stammering was a way of obeying that voice. Peter also revealed he never stammered and could talk fluently when he was at home alone or when he was with children. Britton and Peter’s analyst took care not to introduce Rosenfeld’s model directly in Peter’s treatment until such time as he gave them cause to, which to their amazed delight he did. The model might otherwise have been a source of distortion and misunderstanding.

 

Analytic models can be useful only if they illuminate the analyst’s subjective experience of the patient’s subjective experience. But before such a point can be reached, analyst and patient have to learn to hear one another in as unprejudiced a manner as each can manage. It is to Britton’s credit that he does not minimise how difficult this can be for both parties. This stage of ‘building out into the dark’ as Freud called it, has its own micro-models too. Chief among these are the beliefs that the patient holds about himself and his analyst. ‘Believing,’ writes Britton, ‘is a form of object-relating. I think belief as an act is, in the realm of knowledge, what attachment is in the realm of love. The language of belief is clearly cast in the language of a relationship’ (82). For this reason, beliefs offer a point of entry into the patient’s internal world and the figures who inhabit it. They supply models of that world, seen from a certain point of view. At a more basic level still are the unmentalised psychophysical experiences that manifest themselves in the transference as ‘imageless expectations’ (19). These await transformation into the models constituted by fantasies, symbols and dream elements. These lower-level models form the bedrock of most patients’ and analysts’ analytic experience. The larger theoretical models such as the Oedipus complex or the ‘depressive position’ shimmer in and out of view but they must take their shape from this more detailed and theoretically open work. They have no substantial existence independently of it.

 

The systole and diastole of this process are transference and countertransference. Britton subscribes to the now widely-held but once heretical view that the analyst’s countertransference, far from being an obstacle to analytic progress, is a spur to it. The analyst has to be willing to receive the patient’s unconscious fantasies and to allow them to act on his unconscious mind. The hope is that the analyst will have enough self-understanding to distinguish what belongs to the patient from what he brings himself. Acting as the crucible for other people’s unconscious experience in this way is intellectually and emotionally demanding. As Britton observes, ‘Analytic neutrality does not mean freedom from emotion, it means unbiased observation of its play within ourselves’ (23). In his last book, Sex, Death and the Superego (2003), Britton went so far as to propose a new psychoanalytic nosography based on the kinds of countertransference experience that different sorts of patients evoke and some of that work is rehearsed again in chapter 7 of Between Mind and Brain.

 

Unsurprisingly, given his previous books, Britton thinks that literature and theology are rich sources of models of mental life. This volume contains interesting new material on myth as a model of mental life and on writing by Blake, Milton and Mary Shelley. Britton sees Milton as a man divided against himself. The theologian author of De Doctrina Christiana needed to secure himself against a suspicion that God might be a sadist (a line of inquiry which Stanley Fish argues runs through Paradise Lost). But the poet of Paradise Lost makes Satan the hero of his poem and depicts him as ‘a whole person experiencing conflict, remorse and dread’ (115). Satan (distinct from Milton) is a destructive narcissist in Herbert Rosenfeld’s terms and by engaging with him imaginatively, Milton defends himself against the depressive melancholia Britton thinks lay at the core of his theology. Britton has a vivid sense of what an achievement it is to live out ones conflicts in this way. In similar vein, Britton reads Blake’s Marriage of Heaven and Hell as an exploration of what is entailed in substituting one’s own ideal self for the superego. Most impressive of all is the chapter on Mary Shelley’s Frankenstein (‘What made Frankenstein’s creature into a monster?’). which Britton reads as a parable about the absolute horror of perinatal rejection for both mother and child’ (106).

 

I have given the barest indication of the many riches contained in this very fine book. I was left with only one puzzle. Britton says a great deal about Darwin the man in this book but very little about Darwinism’s implications for psychoanalysis. He complains at one point that the radicalism of Darwin’s theory of evolution has scarcely penetrated educated opinion. I think he’s wrong about that but what about Darwinian models of psychoanalysis: Bowlby’s, pre-eminently, but also the more modern version of attachment theory promulgated in this country by Peter Fonagy, Anthony Bateman and Mary Target and in the United States by figures such as Allan Schore? Neuropsychoanalysis is completely Darwinian in outlook. It would be good to have Britton’s opinion of these models, not least because they engage so many of his interests. The same thought was with me when it came to neuroscience, a field Britton holds in high regard. Neuroscience uses a thoroughly Darwinian framework when considering the structures of the brain: the basal ganglia making up the reptilian complex were the first to evolve; later came the limbic system, the seat of most of our emotional reactions; finally, the neocortex evolved, from which we humans derive so many of our cognitive advantages. These structures, which can be found in non-human animals too in different proportions, now supply the basis for a great deal of neuroscientific theory. Has psychoanalysis nothing to say about them?

These quibbles are based on a wish that the book had been longer. Coming away from it, my overall feeling was of gratitude for such an incisively-argued and powerful book.

Ageing, Embodiment and the Self: A One-Day AHRC Symposium

13 Jan, 16 | by cquigley

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