Editorial

Nuttall, S., 2003. Editorial. Reformulation, Spring, p.3.


Editorial - Spring 2003

The first edition of Reformulation in 2003 has been primarily dedicated to articles on CAT Practice in the NHS. We are pleased to have subject areas as diverse as Occupational Health, Community Mental Health Teams and GP Practice: and to have a general overview of the history of CAT in the NHS, and of the hard graft of developing and promoting CAT in this problematic and complex institution.

We were grateful and surprised to find such a good response to the subject from ACAT members. Not quite so much arm twisting with this topic! It appears to be an area where there are a lot of different experiences, and where CAT is adapted in a variety of ways. Members seemed to want to write about their rich experiences working in the complicated structures of the NHS. Some have been able to contribute this time. We feel it would be helpful to do another edition on this topic. But realistically it may be that we have to have a section on this area, General Papers/NHS, as it is difficult to get people to follow through on ideas and to feel they can put commit something to paper without massive amounts of lead in time.

We have thought it would be preferable to have themed editions. But the practicalities of gathering material may mean themes will weave in and out of editions. We have wondered about snags or dilemmas operating in writing about current practice. Pressures can be very real but can also be a way of defending against sharing experiences in an open and unprotected way. Is it a case of a perfect or hopeless dilemma which stops more of the membership coming forward to write either opinion or something about their own work? The NHS and today’s work culture draws people into a procedure of being too busy to think or feel, and have time for real reflection. Or is it a case of ‘if I must I won’t’? Luckily some of us will show ourselves and so we have a magazine. But we would love more new people to come forward and write about their work. We would be glad to see any essays or dissertations as we hear tell there is much work of good standard lurking in people’s filing cabinets.

On the other hand what may have felt freeing about the NHS topic was the fact that people could write about their own experience without the burden of references that are part of purely academic writing. Anna Jellema et al show the wisdom of hard won experience. All experience in the NHS being hard won! Sarah Lucas’ piece on how to get a CPD group going is helpful in that it shows what does and does not work.

We have been working on this while all the time the threat of war is in the news. Between using the blue pencil and sending e-mails to possible contributors we have been asking ourselves: what is all this messianic stuff about? Perhaps the preoccupation with possible external attacks towards and from abroad, where we can feel it is unsafe to travel or to be in London, means we can forget about the internal attacks on our safety inside our hospitals and GP practices – the attempt to break up the NHS by having the two tier system of the Foundation Hospitals, and the new GP contract. Labour have found it impossible to come up with the goods in the two corner stones of health and education and the Prime Minister turns to war as a way of distracting from these difficulties.

While the external Attacker/Attacking is seen to be the other, Saddam Hussein, we can ignore the self to self attack which is happening in our own domain. It reminded us of the beautiful construction by Melanie Klein in her description of Projection. She was the first to describe a reciprocation between self to other, which involves putting the bad outside. This was developed by Fairbairn, then Ogden, and finally in the elegant simplification and modification of Ryle’s Reciprocal Roles. A move to see Attacking/Attacked as an outside force, outside ourselves, helps us manage the more destructive feelings of the Attacking/Attacked of self to self, which could feel too dangerous. It needs to be projected onto another; in this case another culture. At this time Klein's mythological language about projection of murderous feelings as poisonous substances would parallel what is going on between nations, both in what it is feared the dictator Hussein will do to the West and what Blair and Bush then will do to Hussein and the Arab world. In times in severe borderline behaviour the language of Klein can still be a useful tool.

Serena Nuttall

Mog Scott Stewart

Full Reference

Nuttall, S., 2003. Editorial. Reformulation, Spring, p.3.

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