The quality of mentalisation in people with chronic kidney disease

End-stage renal failure is the irreversible loss of kidney function caused by various conditions: diabetes, high blood pressure, polycystic kidney disease... some of which are hereditary. Our clinical practice and countertransference with these patients have provoked disconcerting feelings - a mixture of empathy, distress and sometimes even bewilderment - leading us inevitably to raise clinical questions. These questions concern the mental functioning of patients with kidney failure. The dialysis patient has been left vulnerable by a real loss - that of their kidneys - which echoes a loss of a different kind. The rupture that has occurred gives rise to primal and life-threatening anxieties, as they are expressed. Yet a psychological dynamic seems to be emerging despite the weariness: 'Leave me alone', 'I want to end it all', 'There's no point in living like this', 'I feel useless', 'I don't want to come for dialysis any more'. Rather than seeking to educate the person on dialysis or develop their skills, perhaps we can seek to learn from them and their subjective experience in a palliative care setting. This is the aim of this book.