'A heavy and blessed experience': a psychoanalytic study of community Macmillan nurses and their roles in serious illness and palliative care.

This paper explores the psychoanalytic ideas of containment as described by Wilfred Bion and applies them to the work of community Macmillan nurses and to the ways in which they might understand and structure therapeutic conversations with people that are seriously ill. Case vignettes show the application of psychoanalytic thinking in context. The discussion offers the idea that the impact of physical illness is such that the emotional issues of patients, their families and fellow palliative care workers can saturate nurses. To protect themselves, nurses and other health workers might assimilate the emotional traumas of others into physical symptoms, and so they are ignored or overlooked in favour of drug therapies, pre-occupations with breaking through silences and other concrete or demonstrable methods of treatment. An environment is needed in which a person with serious illness and his or her family member is helped to make sense of their experiences and so integrate them into a meaningful life continuum. Similar provisions are needed for nurses. Appropriate methods of clinical supervision might help these important provisions.