Conference review by Ann Scott
100 delegates attended a conference at the Institute of Psychiatry, London, on 10 November 2012 to pay tribute to the late Murray Jackson. ‘Unimaginable Storms: Continuing to think psychodynamically about psychosis in the NHS’ drew its title from the name of one of Jackson’s books, co-authored with Paul Williams; the conference brought together a wide range of mental health professionals, trainees and carers from the UK and the Republic of Ireland, Canada, Denmark and Sweden. Speakers reflected this international perspective, showing how Jackson’s work had influenced practice in a variety of settings.
Brian Martindale, Chair of ISPS and co-organizer with Gary Winship, chaired the morning session (‘Dr Murray Jackson: the man and his ideas’) and provided an overview of Jackson’s life. Born in Sydney, and trained initially as an analytical psychologist and psychiatrist in England, Jackson worked as a consultant psychiatrist at Kings College Hospital for 10 years, and was then invited to work at the Maudsley by Sir Denis Hill. He undertook further training at the Institute of Psychoanalysis, and, at the Maudsley, developed a close relationship with the psychoanalyst Henri Rey. Somewhat disarmingly, Martindale suggested that ‘Murray wouldn’t claim to have made original discoveries in psychosis’; what Jackson did develop was a scrupulously reflective approach to work on the ward, following psychoanalytic principles of mental functioning. This practice was perhaps of particular relevance to the work of nurses, and a number spoke at the conference: Ben Thomas, a former Ward 6 nurse and now UK Department of Health Chief Advisor on Mental Health Nursing and Learning Disability; Rita Bourke, a lecturer and former Ward 6 Sister; Beatrice Stevens, Ward 6 founder; and Gary Winship, Associate Professor at the University of Nottingham, and a Ward 6 student and staff nurse.
It is probably true to say that ‘Ward 6’ has acquired almost mythic significance in the psychoanalytic community. To someone like myself, who has not worked at the Maudsley, it was profoundly moving to hear Rita Bourke say that Murray Jackson himself did not want Ward 6 ‘to be seen as a special unit’. What was conveyed by a number of speakers, in this spirit, was Jackson’s commitment to what one might call an ‘embedded’ psychoanalysis: a psychoanalysis that existed within a multidisciplinary setting in which there were ‘multiple levels of explanation’, in which treatment plans were devised by whole staff teams and in consultation with patients, and in which attention to clinical detail was paramount. Much emphasis was put on structure, administration, and ‘purposeful supervision’. ‘Assessment of the potential for growth’, in Beatrice Stevens’ words, was central, and ‘depended on close observation and interview with the patient’. Ann-Sofie Hansson Pourtaheri, from Sweden, who was supervised by Murray Jackson at a later time, described how Jackson would ‘draw a lifeline of important events in the patient’s life: their whole life story in one glance’, for use in supervision. David Bell, Past-President of the British Psychoanalytical Society, speaking on ‘Psychoanalytic Ideas on Psychosis’, commented on Jackson’s ‘thoroughness and dedication to the task’, and remembered Jackson ‘looking at every page’ of a patient’s notes when on the ward.
The morning speakers addressed the huge changes to the in-patient setting since 1987, when Jackson retired from Ward 6. Ben Thomas recalled an era of Registered Mental Nurse training in which sociological and psychological perspectives were integrated at degree level. In-patient stays are much shorter now, averaging 20 days in comparison with the 6-12 months in the 1970s and 1980s. A very high proportion of in-patients are now on section; David Bell mentioned 90% now, in comparison with 2 or 3 out of 20, when he was on Ward 6. The change at the level of ward culture was captured in Bell’s memory of staff ‘leaving the ward on a Thursday afternoon, for the staff group’. One member of staff would remain on the ward. This ‘impressed on the patients that this is something the staff needed to do,’ Bell observed, ‘and the patients contain themselves’. This would be all but unimaginable now.
Gary Winship chaired the afternoon session, ‘Current and future perspective on psychodynamics and psychosis care’, which had two main speakers: Len Bowers, Professor of Psychiatric Nursing at the Institute of Psychiatry, and Marcus Evans, Nurse Psychoanalytic Psychotherapist and Chair of the Adult Department at the Tavistock Clinic. Both brought out particular difficulties of the work today. Speaking as a qualitative researcher, Bowers addressed ‘The role of psychological understanding in in-patient nursing’. He surveyed current data on staff responses to the ward environment, including ‘anxiety and dread’ that have been identified in recent research, and the negative impact of ‘the inexorable engine of acute care’ on the staff’s scope for reflective work; a poignant marker of change, when set against Bell’s comment about the ‘weekly group’. Interview data shows ‘profound ambivalence’ about the exercise of ‘power, restraint and seclusion’; at the same time, nurses’ motivation included ‘compassion towards the intolerable’. Marcus Evans, in ‘Tuning into the psychotic wavelength: psychoanalytic supervision for mental health professionals’, expanded on two themes that had run through the conference: the first being the flattening of affect in the psychotic patient, and the importance of turning this ‘psychotic/dead monologue back into something alive’; the second being the need for time in handover, reflective practice and supervision, in order to ‘help staff separate from the effects of patients’ projections’. Both saw the need to understand (through research) and to process (through reflective work) the impact of the task.
The closing Panel, comprising the psychoanalyst Paul Williams, Dr Alan Lee, and Paula Morrison, gathered in the discussion and began to consider what new structures and policies might be needed to sustain Jackson’s approach within current health care systems. The depth and urgency of the discussion led to a suggestion for an annual conference on psychodynamics under the auspices of ISPS. Acknowledging the presence and support of Murray Jackson’s widow and daughter, Brian Martindale lastly invited all present to a champagne toast in Murray’s memory.
Ann Scott
Editor-in-Chief, British Journal of Psychotherapy
