Trust scientific meeting: Catch 22 – the inflammatory nature of insight
Presenter Marcus Evans
Chair David Bell
“In this presentation I will describe the psychoanalytic treatment of a man, Mr A, who had a history of serious drug abuse and violent psychotic episodes. He also suffered from numerous persecutory auditory and visual hallucinations. At the start of psychotherapy Mr A had little capacity to tolerate anxiety or depression. Over time, however, he became able to increase his capacity for self-observation, noticing the way he withdrew into psychotic states of mind in order to avoid painful feelings of rage humiliation and shame.
“In the book Catch 22, Joseph Heller described the paradox of pilots who wish to claim insanity in order to avoid fatal flying missions. The authorities maintained that in claiming insanity to avoid suicidal missions the individual demonstrates a sane awareness of the insanity of the missions! In a somewhat similar manner, Mr A’s developing capacity for reflective functioning faced him with a ‘Catch 22’ for the insight he needed threatened to overwhelm him with depressing realities about the extent of his illness and dependence upon others.”
Marcus Evans was the first nurse appointed to the Tavistock and Portman in 1996 after completing the adult psychotherapy training and subsequently became a Member of the British Psychoanalytic Society. He held the position of Head of Nursing from 1998-2017 and Associate Clinical Director of the Adult & Adolescent Departments 2011-15. He has given outreach courses to frontline staff in Mental Health Trusts for the last twenty years and was a long standing member of the Fitzjohns unit until he retired from the NHS at Easter this year. His book, Making Room for Madness in Mental Health: the psychoanalytic understanding of psychotic communications was published in 2016.