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allegati
estela Welldon, in a recent paper on perversion as a manic defence, considers it as
an attempt of the individual to protect himself from a profound depression. others, like
limentani, regard perversion as a defence against psychosis.
The Treatment of Children and Adolescents at the Portman
even though the portman only accepts patients who are violent, delinquent or who
manifest sexual disturbances, an absolute or simple rigid distinction is not made between
the victim and the perpetrator when thinking of the individual and his personal history,
which presents a particular challenge. For example, in the case of sexual abuse: the majority
of young abusers have themselves been victims of some kind of trauma or abuse. 50% of
them, according to one study, have been sexually abused. the other 50% have perhaps
been victims of other types of trauma, such as witnessing or being part of domestic violence,
which a very commonly found element in the family history of abusers.
on the other hand, who will become an abuser cannot be predicted: only 5% of
children known to have been abused become abusers themselves. there are not as yet
enough studies to give a more precise idea as to what might predispose young people to
adopt sexually abusive behaviour.
in the case of violent and delinquent adolescents, it is well-known that most of them
have suffered physical and emotional maltreatment in their early life.
it is difficult to evaluate the treatability of young abusers, and impossible to ensure
success in therapy, as we cannot predict which of them will grow into adults who persist
with perverse practices.
Thoughts about the Future
in the 75 years of the existence of the portman Clinic, a great deal of very detailed
knowledge has been accumulated regarding the pathology and treatment of children and
adolescents who are delinquent, violent, or who act out sexually. the work at the portman
has had a positive influence on the attitudes of the authorities; there have been changes
towards more therapeutic rather than punitive models.
Nevertheless, we face serious problems in the management and treatment of
these young people. Cognitive therapies have become very popular at present in the
uK. they are attractive to public health bodies because of the relatively low cost, low
duration and apparently quick recovery of the individuals treated – despite the known
fact that the improvements may only be temporary, and the reality that this type of
therapy does not touch the most basic underlying psychic structures that determine the
offending behaviour. For the young people in question, the risk of not obtaining anything
more than the most superficial improvement is that the psychic structures that form a
“perverse adaptation” will become established in a more definite form and result in a
more permanent perversion in adulthood. the authorities, just like the victims of abuse,
are misled by the positive external results, while the internal fraudulent scenario continues
to exist. the adolescent simulates, imitates, and convinces everyone that his attitudes and
behaviour have changed, while the fantasies and the impulses that govern his internal
world triumph in deceit.
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