Affiliated member of the WPA – World Psychiatric Association

Abstract Orrell, Katya; Mundici, Elena; Spadaro, Francesco

Symposium
War and No Peace: Running away from Murder

‘Those whom God wishes to destroy he drives mad’ (Tolstoy, War and Peace)

This paper explores destructive aggression and its subsequent obliteration of a man’s peace.  I discuss this idea using the case study of a man who needs conflict, particularly around race and gender; a man who needs to be at war with the world.  He has to keep running in order to not commit murder, first in reality and then later in his mind.  Exploring the mechanisms involved when, after suffering early trauma, as a young teenager he runs away from home in order to stop himself from killing his stepfather.  Unable to settle, he moves from continent to continent finding himself in violent conflict again and again.  Using Freud’s concepts of repetition compulsion, denial and disavowal to think about this patient, I examine what is driving his internal war and destroying his peace of mind.

Katya Orrell is a Psychodynamic Psychotherapist trained at the Tavistock Clinic. She is a Director and Founding Partner of Panoptikon, an organisation working with both offenders and prison staff and winner of the 2017 British Psychoanalytic Council PP Now Award for Innovative Excellence.  She is Secretary of the Forensic Psychotherapy Society, a Board member of the International Association for Forensic Psychotherapy and is currently the Ethics and Professional Standards representative for the Tavistock Society of Psychotherapists.  She works individually with clients in private practice and at the Grenfell Trauma service in the NHS and her work also involves training, consultancy and research. She is a course tutor on the Russian Forensic Psychotherapy training and is winner of the 2018 Rozsika Parker prize for her paper describing the ‘Swansong Complex’.  She is currently editing a book on prison experience.  Address for correspondence: E-mail katya.orrell@panoptikon.uk.com

 

‘The Pit and the Pendulum’: Challenges in forensic psychotherapy

In the short story ‘The Pit and the Pendulum’, Edgar Allan Poe describes the impossible predicament of a prisoner locked in a cell where he can either fall through an imperscrutable abyss or be slowly lacerated by a swinging blade. Edgar Allan Poe powerfully depicts the psychological aspects of torture, where the prisoner is at first made to experience hope of salvation, which exacerbates the despair of realising that death and pain are ineluctable. The ephemeral happy ending at the hands of an improbable deus ex machina, with its irrelevance to the claustrophobic narrative that precedes it, only highlights the tragic condition of the prisoner, faced with a fictitious choice between prolonged pain and obliteration.

Forensic psychotherapy pursues the psychodynamic understanding of the offender patient, through the exploration of their internal world, including the conscious and unconscious meaning of the patient’s destructive acts and phantasies both towards themselves and others.

In this paper I use the metaphor of the ‘The Pit and the Pendulum’ to describe the dynamics emerged in my therapeutic work with a patient in a forensic psychiatric facility. This man had suffered and committed what he described as ‘unspeakable acts’, and felt stuck in the perpetual oscillation between the wish to die and the pull towards a self-destructiveness that would keep him alive in constant suffering. Either way, only pain was possible – peace was not conceivable.  I will try to describe how his internal dilemma challenged our psychotherapeutic work and how it impacted on the institutional dynamics of the wider team.

Elena Mundici is a Psychotherapist member of the Tavistock Society of Psychotherapists, the Forensic Psychotherapy Society and the British Psychoanalytic Council. She is the Treasurer of the International Association for Forensic Psychotherapist. She works as a Psychodynamic Psychotherapist in the North East London NHS Foundation Trust and is Co-Founder and Co-Director of Panoptikon, an organisation that works with prisoners and prison staff.

 

Dead calm on a Monday morning session: Counter Transference and Sadism detection in forensic psychoanalytic psychotherapy

During forensic psychotherapies, it may happen that the psychotherapist found himself in a dead calm session. The patient has nothing to say: she/he appears quiet, relaxed even bored. She/he may eventually refers that everything is fine and for this reason has nothing to say. It seems that the wind of transference has ceased to blow. It happened to find myself in a similar atmosphere when, on a Monday morning session, a patient, who had seriously injured her baby daughter  several  years ago and, at the end of a detention period, had  rejoined the family, was telling me that she had nothing to say. She had passed a typical quiet Sunday, helping her daughter to do her homework. After a while, as to answer to an unclear intuition, I asked what she had done in particular that Sunday. She had forced her daughter to do her homework. All day long. From the morning till the evening: a torture for both as she defined it. She added that she had to do it because her daughter was not cooperating. It came to my mind what the torturer say of the tortured person in order to justify her/his conduct: you see she/he doesn’t want to cooperate ! Thanatos was silently operating, while the wind of eros had ceased to blow. The detection of the sadism brought out feeling of humiliation in the patient but not any sense of guilty. Furthermore, a trangenerational mother-daughter sadistic behaviour appeared to be present and had infiltrated her relational pattern becoming the model of a most intense relationship. How the superego of the patient may affect the therapist’s  counter transference and may determine a dead calm in a psychoanalytic and psychotherapeutic session will be discussed.

Dr Francesco Spadaro

  • Psychiatrist
  • Board Member of the International Association for Forensic Psychotherapy (IAFP) and President of the Italian Forensic Psychotherapy (SIPFo) viale Vittorio Veneto 87, 95127 Catania, Italy.
    E-mail fspadaro22@gmail.com
  • Medico Psichiatra
  • Presidente della Società Italiana di Psicoterapia Forense
  • Board Member International Society for Forensic Psychotherapy
  • Didatta della Società Italiana di Psicoterapia Psicoanalitica
  • HM Louisiana State University Medical Center in Shreveport, LA, USA

 

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