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Psychoanalysis and Mental Handicap

Edited by Johan De Groef & Evelyn Heinmann

Oxleas NHS Trust, 183 Lodge Hill, Abbey Wood, London SE2 0AY

EDITED BY SIDNEY CROWN and ALAN LEE

London: Free Association Books. 1999. 214 pp. £16.95 (pb) ISBN 1-85343-431-0

This book arises from European conferences held in Belgium in 1996 and France in 1997 to exchange ideas on the relations between psychoanalysis and learning disability. The editors and translators for this book have provided a supporting structure for diverse chapters from European psychoanalysts, psychologists, educationalists and an anthropologist to reflect on their psychoanalytical work with people with learning disabilities and the similar work of others.

As such, the book benefits from having chapters written by authors from a wide range of European cultural, professional, theoretical and service system backgrounds. Several authors pay tribute to the pioneering clinical, theoretical and political work of the French psychoanalyst Maud Mannoni who died in March 1998. Chapter authors also draw on the work of Bettelheim, Bion, Freud, Gaedt, Goethe, Klein, Lacan, Öe, Sinason, Tustin and Winnicott.

Given the authors' diverse backgrounds, languages and psychoanalytical perspectives, chapters vary in their organisation, accessibility and overall quality. Though the book covers individual psychoanalytical therapy and family issues extensively, and to some extent systemic and institutional psychodynamic issues, I was disappointed by the relatively limited consideration of group psychoanalytical work with people with learning disabilities (apart from in the final chapter by the only UK contributor, Valerie Sinason).

Key themes include needing to acknowledge and tolerate the anxieties associated with difference, disability-associated thinking and communication difficulties; appreciating transference and countertransference issues; and defence mechanisms for all people encountering disability, handicap and debility. Several chapters use rich clinical material to illustrate the key psychoanalytical issues in the lives of people with disabilities namely identity, dependency, sexuality, trauma and bereavement.

Several authors also provide theoretical and clinical evidence that people with learning disabilities have the capacity for insight and can make good use of psychoanalytical therapies, despite their primary organic disabilities and particularly given their frequent secondary psychosocial handicaps and psychic-numbing and stupefying traumatic experiences.

Some chapters explore family issues including mother-child dynamics, the effects of trauma and guilt on the siblings who are not disabled, the relationship between a sole-caring father and his disabled son, and intra-familial abuse. Other chapters draw on the fields of anthropology, politics, literature, mythology and art, particularly when considering monstrosity, sexuality, exclusion/integration, institutionalisation and normalisation issues.

Overall, given this book's wide-ranging European professional, service and theoretical prospectives, it should prove a useful contribution to the growing international literature on psychotherapy for people with learning disabilities. In the UK, analytical psychotherapy provision for people with learning disabilities is extremely patchy and mainly provided in specialised centres such as the Tavistock Clinic, London.

I recommend this book primarily to professionals undertaking and supervising analytically-informed psychotherapy work for people with learning disabilities. They should find that this interesting and easily readable book will broaden the theoretical perspectives underpinning their clinical psychotherapy work and lead to better psychodynamic understanding of people with learning disabilities, their families and carers. The book would also be a useful addition to psychiatry and psychology of learning disabilities and psychotherapy departmental libraries.

This Article Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Gravestock, S. Search for Related Content PubMed Articles by Gravestock, S.