Dogma in retreat

BMJ 1999; 319 doi: (Published 27 November 1999) Cite this as: BMJ 1999;319:1444
  1. Simon Wessely, professor of psychological medicine
  1. Maudsley Hospital, London

    Talking Cure, BBC2, Tuesdays at 9.50pm, 2 November to 7 December

    The fly on the wall documentary has now developed its own clichés, but when done well it can still grip. Talking Cure, filmed at London's Tavistock Clinic, made compelling viewing.

    The Tavistock has been the spiritual home of psychoanalytic practice in this country from its foundation after the first world war—its original patrons being the rather unlikely combination of Field Marshall Haig and Admiral Beatty of Jutland fame. Although it no longer has the influence it once did, it remains the largest NHS psychotherapy clinic.

    In six episodes we saw six different aspects of the work of the clinic, based around six patients. Granted the patients were not straightforward: all had responded to advertisements placed by the programme makers and had then got themselves referred to the Tavistock. All thus went to the clinic having already agreed to take part in a television programme, and there were echoes of narcissism in the first “patient,” if we can call him that, elegantly dissected by the impressive psychotherapist. However, other stories clearly involved serious psychological distress. The second programme was gripping, centred on a woman terrified by the thought of dying from her cystic fibrosis yet whose lifesaving heart and lung transplant seemed to create more emotional problems than it solved. A later episode will cover a moving example of a couple derailed by overwhelming, unbearable grief. Any thoughts that the Tavistock deals only in well heeled north Londoners anxious to find the meaning of life were swiftly dispelled. This was mental disorder and distress by anyone's criteria.

    The programme opened with a close up of the statue of Sigmund Freud outside the clinic, but, at least in these programmes, there was little sign of his continuing influence inside. Perhaps with the cameras running the therapists kept any tendencies to talk about death instincts, ids, and superegos under control. But it seems the influence of the inventor of psychoanalysis is not what it was. When the articulate Sebastian Kraemer, a child psychiatrist, was confronted with the quintessential Freudian jargon of the Oedipus complex, he looked nonplussed—“I've dried up” was his uncharacteristic response.

    So even in the heartland of psychoanalysis the old dogmas are in retreat Instead what we saw was psychotherapy at its best. There was little jargon, no obfuscation, and apparently little reliance on unprovable theory. In its place we saw a series of intelligent, sincere professionals using their clinical experience and wisdom to make some sense of the human condition.

    We need the Tavistock Clinic more than ever. At a time when formal psychiatric services are more and more dealing with those who hear voices—not only schizophrenic voices but those of the Daily Mail so clearly audible to Jack Straw—the skills and expertise to help those who are suffering but not psychotic are in increasingly short supply. Not just at the Tavistock but across the NHS, those who try to help complex patients with complex disorders that do not fit with the Care Programme Approach are under threat.


    Natasha and her son Damien try the talking cure

    (Credit: BBC TWO)

    One reason is because, as the programme so ably demonstrated, there are no quick fixes or instant cures. Talking therapies, not just those practised at the Tavistock but elsewhere in the NHS, do not come easy, and there is no substitute for experience. Therapist skill is critical but hard to come by. Nowadays, when everyone seems to be either a counsellor or receiving counselling, this programme was a salutary reminder that it is not easy to do it properly, and even the best can come unstuck, as Anton Obholzer proved rather dramatically when his “institutional therapy” for a Welsh school promptly led to the headmaster going on long term sick leave. But all the stories illustrated the power and humanity of good psychotherapy based on the combination of time, wisdom, and experience. How sad and ironic then that each programme ended with that modern ritual, an invitation for those upset by the programme to telephone a number for advice. Very modern, and the antithesis of everything the Tavistock represents.

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