Containing, thinking and public health

Date01 September 2007
Publication Date01 September 2007
AuthorMark Cohen
SubjectHealth & social care
40 journal of public mental health
vol 6 • issue 3
Containing, thinking and public health
© Pavilion Journals (Brighton) Ltd
This paper argues that the capacity of individuals and of society as a whole to ‘contain’experience,
and to use this as a basis for thought, is central to good health.The paper first defines and describes
‘containing’ and thinking,with reference to a psychoanalytic model, and compares these definitions
with similar concepts.The circumstances that promote or impede the development of the capacity
for thought are then outlined, and a spectrum of this capacity is described and correlated with a
spectrum of vulnerability–resilience to ill health. A review of the associated literature indicates
significant links to health-related behaviours, health outcomes and inequalities;interventions at a
population level could aim to shift people at the vulnerable end of the spectrum towards resilience.
However such measures are unlikely to be effective on their own: what is needed is a containing and
thinking society,characterised by a wish to know about reality, and to link together information about
the state of its citizens and the wider world.The paper concludes with a discussion of the political
and policy-making implications.
Containing, thinking and
public health
public health
health inequalities
Mark Cohen
NHS Greater Glasgow
and Clyde
Correspondence to:
Dr Mark Cohen
NHS Greater Glasgow
and Clyde
Carswell House
5/6 Oakley Terrace
Glasgow G31 2HX
There is growing interest in
psychosocial factors with respect to
public health. Psychiatric illnesses
are recognised as increasingly
common and disabling conditions in
their own right and, in addition, the links between
psychological factors and somatic illness are ever
more apparent (Marmot, 2004). A number of
observers remark on the phenomenon of
increasing wealth without an associated increase
in happiness or satisfaction with life (James, 1998;
Layard, 2005). In some respects, many note the
irony of this being a particularly challenging
period due to the greater affluence of our society.
The difficulties faced by our society are as much, if
not more, in the realm of emotions and thinking,
rather than what would traditionally be described
as material poverty. While it is important to
investigate the particular links between discrete
conditions, or experiences, and health outcomes
(Wulsin & Singal, 2003), it is also valid to attempt
to understand common psychological or
emotional factors that are linked to vulnerability
or resilience to ill health in general (Stewart-
Brown, 1998; 2003; 2005). Using a psychoanalytic
framework, this paper aims to contribute towards
this understanding.
The capacity to think
In this paper I argue that the capacity to contain
experience and to use this as a basis for thought
occupies a central position in public health. In
referring to containing and thinking capability, I am
basing my definition in a psychoanalytic framework,
and particularly on the work of Wilfred Bion (Bion
1962a; 1967). In broad terms, I define it as a capacity
to know about, tolerate and respond to reality in a
flexible but coherent manner. In considering reality,
I include not only the external environment but also
internal states, such as sensory experiences and
emotions. I view this capacity as central to mental
well-being and linked to psychological and physical
resilience, and have in mind the notion of a spectrum
ranging from vulnerability to ill health (associated
with an impaired capacity to think) to mental well-
being and associated resilience (figure 1, over page).
In this framework, seeing the external world
realistically is dependent on understanding internal
emotional factors: for example, if one knows about
and can tolerate one’s own envy, one is then more
likely to be able to see the value in the creative work
of others, without recourse to unconsciously
devaluing its worth. I am approaching thinking and
its development from one particular angle and so,
while recognising other known factors that impact

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