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The approaches shared during the day were admirably holistic and inclusive in philosophy and aims, looking to the “self” beyond diagnosed disability, whatever its severity and prognosis. Challenging concepts have led to a flowering of research into the emotional and intellectual possibilities for patients previously written off as untreatable. We are all of us constantly vulnerable and only “temporarily unimpaired ”! Personal experiences were by no means to be excluded as being thought ‘unprofessional' to share. (I was delighted to learn during the day that the parents of one of the lecturers were founders of Ravenswood Village Community, where my own severely disabled daughter has been resident for many years.) Professor Nigel Beail, Clinical Psychologist, from Sheffield, illustrated his discussion of The Impact of Physical and Learning Disabilities on Attachment, Individuation and Mechanisms of Defence with a telling account of his own grievously disabled childhood, which his appearance belied. He was able eventually to overcome frightful physical abnormalities, and parried ridicule of his clumsy efforts to walk by exaggerating his difficulties with a swaying ‘penguin walk', which generated humour! Dr Valerie Sinason, Psychoanalyst, St George's Hospital , underlined the importance of a multi-professional, holistic approach in IPD. Everyone is ‘ a walking victim/perpetrator' ; gaps between therapies are merging. She gave a graphic account of pioneering work on the body as ‘ part of mortality and fragility ' and the role of a baby's early love (or its lack) at the deepest imprinted level in the creation of an identity able to cope later with the shame of ‘ ordinary things going wrong '. She emphasised the key issues of early imprints about sexuality and defaecation, and the dire results of the common lack of a thoughtful approach to toileting; the importance of making toilets and bathrooms comfortable ‘ to prevent humiliation' ; social issues add to handicapping experiences. Joan Kingsley, Psychotherapist, The National Hospital for Neurology & Neurosurgery, talked about neuro-psychotherapy and reported the delicate approach needed to introduce dynamic short-term psychotherapy into the Neuro-Rehabilitation Unit of The National Hospital, where she works with severely neurologically damaged patients and supports staff carers. Brett Kahr (Radio 2's resident psychotherapist – 15 million audience weekly!) underlined that remarkable success, a ‘path-breaking achievement' to gain a footing for psychotherapy in the ‘scary' National Hospital. Dr Nancy Sheppard, Consultant Clinical Psychotherapist, led a workshop with Ms J Usiskin on long term support provided by the fairly new Learning and Complex Disabilities Service at the Tavistock Clinic, their methods and gratifying results.
Rounding up from an NHS perspective, Dr Banks said ‘payment by results' had little place either in helping disabled patients not to deteriorate, or in helping them to manage inevitable worsening. Those are important considerations for the disabled, which don't match the usual government driven check lists which determine funding. The day had many lessons for clinical and social psychiatrists to ponder.
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