The Fitzjohn’s Unit

Abstract

This article provides a description of the development and work of The Fitzjohn’s Unit a specialist service, housed within the Adult Department of the Tavistock and Portman NHS Foundation Trust, providing psychoanalytic psychotherapy for patients suffering from the more complex/serious disorders many of them having been unwell for many decades. The paper describes the patients treated, the model of care and also aims to show how this work can illuminate more general consideration such as the nature of the psychoanalytic attitude and the relation of psychiatry to psychoanalysis

Keywords:

• psychoanalysis
• psychiatry
• severe disorder
• specialist service

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. This seminar is now led by Francis Grier.

2. Perhaps a word of caution is needed as regards the very term ‘biological’, as its use here is really a misuse. A biologist is always interested in the interactions between an organism and its natural environment. If she wants to understand what is ailing a tree, she will examine the soil, the climate, the surrounding trees, etc. So, if a ‘biological’ or ‘medical’ decision, made in a psychiatric context, is derived solely or entirely from material endogenous factors, then this, in fact, constitutes a parody, or even a perversion, of biology and medicine.

3. I am aware that I am touching on an important epistemological issue that cannot be dealt with here in any detail. For some, meanings and causes are entirely distinct phenomena, whilst for others it is the intertwining of meaning and cause that characterises the human subject. It is this latter view which is consistent with psychoanalysis as discussed here.

4. In the psychiatric literature, there is a growing sense that that the distinction between mental disorder and personality disorder (which underlies the differentiation of axes in DSM-IV) is questionable (for example, Westen et al, 2006).

5. This commitment, to the restoration of continuity to that which appeared to be discontinuous, again manifests the developmental perspective, as discussed above.

6. The popular term for this state is of course a ‘breakdown’ and in many ways this is quite accurate, as the cause of the disturbance is a breakdown in the capacity to maintain the defensive structure. The consequent state is usually of mixed anxiety and depression and this was the usual diagnosis up to the 1980s, when, instead, many of these cases came to be diagnosed as suffering from depressive disorder. The phenomenology, however, remains the same although the label is different.

7. For an excellent discussion of the subtle but profound effects of this need for psychic equilibrium see, Joseph (1989).

8. Hanna Segal (1993) provides an excellent account of this kind of triumph over the wish to live, making use of clinical and literary material.