pieghevole

Carine Minne
Consultant Psychiatrist in Forensic Psychotherapy at Broadmoor Hospital, West London Mental Health
Trust and the Portman Clinic, Tavistock & Portman NHS Foundation Trust, UK
RAGE, NOT MOURNING: A CHILD'S LOSS BECOMES
A YOUNG MAN'S VIOLENCE
In this paper, I will present two patients diagnosed as suffering from severe
Personality Disorders with psychotic episodes. I will illustrate 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 earlier childhood losses contributed to these adolescent boys’
homicidal violence. I also hope to show that it is more helpful to consider
such patients as suffering from a single entity diagnosis where, at times, their
mental states are more manifestly personality disordered and, at other times,
more manifestly psychotic. At each end of that diagnostic spectrum, a different
set of anxieties is being defended against. 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’.
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