The work of W. R. Bion changed the shape of psychoanalytic theory in fundamental ways, one of the most important of which was Bion's insight into the nature of normal projective identification. No other psychoanalytic theorist has Bion's ability to represent the horrors of psychic abandonment and the converse, the absolute necessity of the presence of another mind for psychic survival. Through a discussion of Bion's War Memoirs 1917-1919 (Bion, 1997), Attacks on linking and A theory of thinking (1993), this paper explores the link between war, masculinity, the maternal and Bion's sensitivity to the significance of everyday interpersonal contact. It is argued that Bion's apocalyptic experiences as a teenage tank commander gave him shattering insight into the extent to which mind is inter-mind, self is inter-self. Bion's life writing has the quality of survivor insight: 'And only I am escaped alone to tell thee' (Job 1: 14-19), as he returns repeatedly to the events of the day when he 'died ', 8 August 1918. His insight into the elemental passions nature of love, hate and mindlessness are borne of his experiences on the battlefield, and exquisitely crystallized in his repeated explorations of an encounter with a dying soldier.
A hospital antenatal clinic conducting routine psychosocial screening changed the Edinburgh Depression Scale (EDS) referral criterion for determining which women needed to be referred to a multidisciplinary meeting health professional ("Safe Start meeting"). The criterion was changed from a score of 10 or more to 13 or more, when no other psychosocial risks were present. Women scoring 10-12 on the EDS, with no other psychosocial risks, were now informed they should contact the Social Work Department if they had issues they wanted to discuss with a health professional. The study evaluated the impact of this change in EDS clinical practice. Records were audited over a 20-month period. In addition, 20 women scoring in this EDS marginal range (10-12), with no other psychosocial risks, participated in a telephone interview to ascertain if they should have been referred to the Safe Start meeting. Of 174 eligible women who scored in the marginal EDS range, none had contacted the Social Work Department. In addition, none of the 20 women interviewed indicated that they would have wanted to talk further with a health professional. This change in clinical practice reduced monthly referrals to the Safe Start meeting by about 20%. There was a linear relationship between the increasing EDS category scores and the likelihood of psychosocial risks being endorsed. Increasing the automatic referral EDS cutoff score from 10 or more to 13 or more does not appear to result in women "in need" being missed. The reduction in referrals allowed more time in the Safe Start meeting to be devoted to women with greater needs.
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