Denise Cullington Routledge, 2018, PB, 188pp, £19.74, 978-1782203674
How many psychoanalysts does it take to change a lightbulb? Only one, but the lightbulb has to be willing to change. Do any of us want to change? Can we change? Psychoanalysts believe so; certainly the author, Denise Cullington, does. The premise of this book is that psychoanalysis works. Not only that it works, but also that it is phenomenally effective. I suspect that you would only read this book if you were already an enthusiast.
Snapping at the children or partner at home, the tension in our shoulders on the drive to work, losing our patience with the receptionist or nurse: these are all the ‘rough beast’ of the title. The anxiety, panic, and rage we all carry beneath the carapace of professionalism. The rough beast lurks in us all and can trip us up unexpectedly. We all need an outlet for our rough beast: it used to be the consultant who barks at his juniors on a ward round or the GP who took to drinking a bottle of (good) red each evening. Now we tend to exorcise our rough beast in a more subtle way: yoga, pilates, long walks at the weekend. Or at least that’s the idea.
The author is unashamedly a Freudian. Expect long rambling paragraphs about how a baby resents its father and wishes to rescue its mother; how a father wishes to reclaim his wife from his children; and, of course, plenty about penis envy. If this isn’t for you, feel free to speed read these chapters.
If you manage to sieve out these exasperating lengthy nods to Freud you can find a treasure trove of gems in this book. Cullington writes how ‘defences are established for a good reason: the hope is to stay pain-free and protected’. We see this every day in patients who present to us with psychosomatic symptoms, but I also see it in colleagues. When we get home and are asked ‘How was your day?’, we reply ‘Not bad, fine’ when really we mean ‘I feel totally overwhelmed, I don’t know how I can go on, but I don’t know how to admit it.’
Yet Cullington also points out:
‘it is only if you no longer have a job that you can realise what you did not appreciate at the time: how the income earned as a result of your efforts, the companionship, a sense of achievement and of structuring time are all important parts of self-esteem.’
Consider that as you plan to take early retirement.
While I consider Eric Berne’s A Layman’s Guide to Psychiatry and Psychoanalysis to be essential reading for any GP with a modicum of psychoanalytical thought,1 be warned: The Rough Beast is for the specialist reader.
- © British Journal of General Practice 2020
