Out of time: adolescents and those who wait for them

ABSTRACT

This paper draws on the scholarship of an inter-disciplinary project about time and waiting in healthcare to explore questions of urgency and risk in clinical work with depressed and suicidal young people, and how the feeling of being compelled to act can be meaningfully explored from a psychoanalytic perspective. The paper examines adolescence as both a time of inherent crisis and one in which self-harm and suicidal ideation represent particular challenges. It then considers Child and Adolescent Mental Health Service practice in relation to acute mental health crisis, and in the context of the chronic crisis affecting the UK National Health Service. Considering both formal psychoanalytic psychotherapy and the contribution of psychoanalytic thinking to multidisciplinary discussions and emergency work in CAMHS, the author then considers the anticipatory anxieties that affect such work, and the particular role of psychoanalytic thinking for young people burdened by suicidal ideation and the professionals caring for them.

KEYWORDS:

• Crisis
• risk
• adolescent mental health
• deliberate self-harm
• suicide
• psychoanalytic psychotherapy

Acknowledgments

I am grateful to Kate Stratton and Ben Yeo for their comments on this paper. I am indebted to colleagues on the Waiting Times project for their support, wisdom and inspiration, in particular Lisa Baraitser, Laura Salisbury, Kelechi Anucha, Stephanie Davis, Michael Flexer, Martin Moore and Jordan Osserman. The paper was developed and written as part of the project Waiting Times, supported by The Wellcome Trust [205400/A/16/Z], (see waitingtimes.exeter.ac.uk). I am also indebted to Margot Waddell for many years of guidance, supervision and inspiration. Quotations from The Waste Land by T. S. Eliot are reproduced by kind permission of Faber & Faber Ltd.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1. http://waitingtimes.exeter.ac.uk/

2. https://wellcomeopenresearch.org/collections/waitingtimes

3. For thoughts on the way in which adolescent time may be seen as giving the lie to the halting of time in the Covid-19 lockdown, see Catty (2020).

4. All the vignettes used in this paper are composites: that is, they have been created from diverse clinical experiences drawn from years of practice. None of them represents a single real person.

5. https://zerosuicide.edc.org/

Additional information

Funding

This work was supported by the Wellcome Trust [205400/A/16/Z].

Notes on contributors

Jocelyn Catty

Jocelyn Catty is Senior Research Fellow on the Waiting Times project and Research Lead for the Child and Adolescent Psychoanalytic Psychotherapy Doctoral Training at the Tavistock and Portman NHS Foundation Trust. She is Principal Child and Adolescent Psychotherapist, Bromley CAMHS, and a member of the Association of Child Psychotherapists and the Foundation for Psychotherapy and Counselling. She was previously Senior Research Fellow in Mental Health at St George’s, University of London. She co-edits the Tavistock Clinic Series, published by Routledge.