Addictive States of Mind
Marion Bower · Robert Hale · Heather Wood
jun 2019 · Routledge
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This chapter, written by a psychiatrist working with people with severe and complex addictions, sets the scene. We are provided with a graphic account of the multiple problems—physical, psychological, social, financial—of someone with severe drug addiction, where sex working and the risks of pregnancy, infection, and assault compound an already challenging presentation. The personal history of trauma and abuse means that the patient requires highly skilled and sensitive management, and adaptations in service provision—such as no morning appointments—that respect the individual’s lifestyle. The conflict for professionals is encapsulated in a brief description of the responses of Vanessa Crawford’s patient group when asked what messages they would like to be conveyed to future doctors: don’t prejudge us, treat us as individuals, give us proper pain control—and “don’t trust us”. Implicit in this is the recognition that they are in the grip of something that leads them to deceive, probably themselves, but also others—a wish to pervert a relationship to someone who is trying to help. Crawford conveys the importance of being knowledgeable, but not omniscient; of helping the individual to overcome the barrier of shame, which may lead to information being withheld; and the crucial contribution of a collaborative and coherent staff team in containing such challenging patients and in helping them to turn a corner towards recovery.
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Marion Bower is a consultant social worker in the Learning and Complex Disability service at the Tavistock Clinic. She is also a psychotherapist in private practice. She edited 'Thinking Under Fire: Psychoanalytic Theory for Social Work Practice'. She is currently working on a biography of Joan Riviere. Rob Hale trained as a psychiatrist and psychoanalyst and since 1980 has worked at the Portman Clinic and the Tavistock Clinic. His initial clinical interest was in self destructive acts moving to perverse acts, particularly those individuals who seek help for paedophilia. This clinical experience has provided the basis for the consultative work, both clinical and organisational, in other institutions starting with the work in drug dependency described in this volume. For the past eighteen years he has spent an increasing amount of time working with Medium and High Secure Hospitals as an external consultant for the clinical staff and managers of those institutions. Heather Wood is a consultant adult psychotherapist and clinical psychologist at the Portman Clinic, Tavistock and Portman NHS Foundation Trust, and is a psychoanalytic psychotherapist with the British Association of Psychotherapists. She has a special interest in the problematic use of internet pornography and virtual sex, and the related subject of paedophilia, and has published chapters and papers on these and other topics.
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