The secluded minds of violent patients

1. The two cases presented in this paper have been described before in order to highlight different theoretical and treatment issues. The papers where they appear are: Psychoanalytic perspectives on assessing dangerousness. In R. Doctor (Ed.), Treating dangerous patients, Karnac Books, London, 2003; Psychoanalytical aspects to the risk containment of dangerous patients treated in high security. In D. Morgan, & S. Ruszczynski (Eds), Lectures on violence, perversion and delinquency, Karnac Books, London, 2007; Violence to body and mind: Infanticide as suicide. In S. Briggs, A. Lemma, & W. Crouch (Eds), Relating to self-harm andsuicide, Routledge, London, 2008; The dreaded and dreading patient. In J. Gordon, & G. Kirtchuk (Eds), Psychic assaults and frightened clinicians, Karnac, London, 2008; and Infanticide, matricide or suicide. British Journal ofPsychotherapy, 25(2), May, 2009.

Abstract

In this paper, I will present two violent patients suffering from severe Personality Disorders, illustrating the changes that can arise during the course of several years' psychoanalytic treatment in high security hospital. Progress was monitored using the Operationalised Psychodynamic Diagnostics (OPD) system. The clinical presentations will indicate how secluded these patients' minds are to themselves and to those involved in their care. The psychoanalytic treatment, as one part of the overall treatment, is described to show how the secluded parts of the patients'' minds can be approached, including references to the regular regressions that arise, provoked by ‘getting better’.

Notes

1. The two cases presented in this paper have been described before in order to highlight different theoretical and treatment issues. The papers where they appear are: Psychoanalytic perspectives on assessing dangerousness. In R. Doctor (Ed.), Treating dangerous patients, Karnac Books, London, 2003; Psychoanalytical aspects to the risk containment of dangerous patients treated in high security. In D. Morgan, & S. Ruszczynski (Eds), Lectures on violence, perversion and delinquency, Karnac Books, London, 2007; Violence to body and mind: Infanticide as suicide. In S. Briggs, A. Lemma, & W. Crouch (Eds), Relating to self-harm and suicide, Routledge, London, 2008; The dreaded and dreading patient. In J. Gordon, & G. Kirtchuk (Eds), Psychic assaults and frightened clinicians, Karnac, London, 2008; and Infanticide, matricide or suicide. British Journal of Psychotherapy, 25(2), May, 2009.