Editorial

Dementia, personality disorder and suicide respectively constitute three of the most pressing public health matters of growing concern as we enter the third decade of the 21^st Century. There are, of course, many different theoretical frameworks within which to research and formulate preventative and treatment interventions for each of these conditions, but as the papers in this issue demonstrate, psychoanalytic and psychodynamic approaches are of increasing relevance in addressing these issues in public health settings.

The first two papers examine their subject not from the direct perspective of the patient or sufferer, but from those tasked with their care. The first paper, ‘Living with dementia: Using mentalization-based understandings to support family carers’, by Phil McEvoy, Lydia Morris, Natalie Yates-Bolton and Georgina Charlesworth, describes a mentalization-based communication skills training course, ‘Empowered Conversations’, for the family carers who provide support to people with dementia in their own homes. This intervention examines the emotional dimensions of communication between the carer and the person being cared for, focusing on the impact of mentalizing and non-mentalizing states of mind on their relationship. Illustrated by moving case vignettes, the authors show how in enabling carers to become more aware of their own mental states in relation to their relative with dementia, positive shifts in defences, emotional attunement and empathic understanding may occur in both partners in the relationship.

The second paper, ‘Containment? An investigation into psychoanalytic containment in the NHS in relation to someone with a diagnosis of personality disorder’, by Elizabeth Weightman and Janet Smithson, investigates the attitudes of the staff looking after patients with a diagnosis of personality disorder in a National Health Service (NHS) personality disorder specialist unit. Drawing on the psychoanalytic literature exploring staff and institutional responses to hospital patients originating in the seminal studies of Tom Main (1957) and Isobel Menzies (1960), this qualitative research study aimed to identify what containment was provided by staff for someone with personality disorder, by using psychoanalytically-informed discourse analysis of the discussions and responses of staff members in different roles in the organisation following exposure to a written assessment of a patient with personality disorder. What emerged was that staff used primitive defence mechanisms such as splitting, projective identification and idealisation to defend against containment, and that anxieties regarding power and control in their relationships with patients and other professionals within the organisation interfered with their capacity to develop containment. Key to the research methodology was reflexivity – use of the researcher’s subjectivity, via their countertransference to the interviewees, as an integral part of the analysis. The paper highlights the continual need for staff to regularly engage in supervision and reflective practice to become more aware of these pathological dynamics, to feel contained sufficiently to provide containment for their patients.

The final paper, ‘Quality of object relations and suicidal ideation among community mental health outpatients’, by David Kealy and Olivier Laverdiere, is a psychoanalytically-oriented study examining the association between suicidal thoughts and the quality of object relations impairment in a sample of patients presenting for community mental health services in Vancouver, Canada. The authors found that patients who were more likely to feel alienated and lack trust in relationships, have insecure attachments and experience social anxiety were significantly more likely to experience current suicidal thoughts after controlling for past suicide attempts and severity of psychiatric symptoms. These results suggest that assessment and treatment focussing on the patient’s internal object relationships, an area which is often not considered, may be helpful for patients prone to suicidality.