Fear of Death or of Murder? Challenges confronted in the modified psychoanalytic setting established by Forensic Psychotherapy
“ Is it hard for the reader to believe that suicides are sometimes committed to forestall the committing of murder? There is no doubt of it. Nor is there any doubt that murder is sometimes committed to avert suicide.” Karl A. Menninger
The fear, not only of death, but also of murder, could be closely related in the forensic patient when transferential interpretations may evoke gross unconscious archaic memories of loss and despair. This could produce compelling and potent feelings of revenge and acting out behavior and could be easily activated in the transferential relationship of patient and staff.
In this paper we shall describe clinical material to demonstrate the enormous challenges facing the patient and staff in dealing with the fear of annihilation. This is especially so when therapists are confronted with patients who inform the therapist that they have a gun. We will describe two patients, a man and a woman, to illustrate the triangular situation of society and power dynamics inherent in forensic psychotherapy. We will compare and contrast their differences, with their disordered personalities bordering on psychosis and perversions, with particular emphasis on their sadism and destructiveness and how this may be difficult to counter-transferentially stomach. When the fear of death occurs in the therapists’ counter-transference feelings, beyond the secure settings of Forensic Psychotherapy, massive acting out may occur in the therapist to counteract one’s own threat of death.
It is the enactment on the part of the offender, and possibly the therapist, which we think defines forensic psychotherapy, and it is the fact that even the most apparently insane violence has a meaning in the mind of the person who commits it. There is a need to be aware of this meaning, and to learn from the enactment, in an attempt to prevent further violence.
It was Welldon’s (2011) p140 novel idea that the “psychotherapy involved in forensic psychotherapy is different from other forms precisely because society is, willy-nilly, involved.” Forensic psychotherapy has gone beyond the special relationship between patient and psychotherapist. It is a triangular situation: patient, psychotherapist, society. Welldon (2015, p212) uses the idea of different triangular situations in working with the forensic patient. Thus, another triangle, besides the society, is the “existence of the triangular process of power dynamics in social roles such as the bully, the victim and the bystander, (sometimes intervening as rescuer), where the bystander becomes the audience of the bully-victim drama.” The bystander role is often an important but unrecognized part of the problem and psychotherapists can become part of this dynamic.
Ronald Doctor is a Consultant Psychiatrist in Medical Psychotherapy and Forensic Psychotherapy, West London Mental Health NHS Trust, a Fellow of the British Psychoanalytical Society, member of the IPA committee on Psychoanalysis and Law, board member of the International Association for Forensic Psychotherapy, and Hon. Clinical Lecturer, Imperial College, London. He has edited two books: Dangerous Patients: A Psychodynamic Approach to Risk Assessment and Management (2003) and Murder; a Psychotherapeutic Investigation (2008) and published History, murder and the fear of death, International Journal of Applied Psychoanalytical Studies (2015) 12.2 152-160.
Estela V Welldon is a psychoanalytical psychotherapist who worked for three decades at the Tavistock Portman Clinics NHS Trust. She is the founder and president of the International Association of Forensic Psychotherapy, which was established in 1990 and continues to hold Annual International Meetings. www.forensicpsychotherapy.org. The Italian sister organization SIPFo was established in 2018. www.sipfo.it Presently she works in private practice and lectures worldwide. Author of Mother, Madonna Whore: The Idealization and Denigration of Motherhood (1988) translated into 13 languages, Sadomasochism (2002), Playing with Dynamite: A Personal Approach to the Understanding of Perversions, Violence and Criminality (2011) translated into 3 languages, main editor of A Practical Guide to Forensic Psychotherapy (1997). Sex Now, Talk Later Karnac (2016) and Sadomasochism in Arts and Politics. In 1997 she was awarded by Oxford Brookes University a D.Sc. Honorary Doctorate of Science and in 2014, she was made an Honorary member of the American Psychoanalytic Association for her work in helping to understand women who harm children. Visiting International Professor at Universidad Católica Lima Peru since June 2018. Director of 1st Russian (Moscow) course on Forensic Psychotherapy, which started in 2019.