Safety first: The Focus on the Body in Psychological Care

This paper was written on the occasion of the third edition of the “Prize for humane mental health care”, organized by the psychiatric hospital in Sleidinge. It is an account of my first year as a social worker in mental health care, in which I focus on the struggle one can experience while working within the rules set up to ensure “quality care”. This set of rules has a profound effect on the bodily and psychological wellbeing of the patients. Its one-sided focus on safety and organization makes it difficult for social workers to work with their patients on a psychological level. Furthermore, constant adherence to these rules seems to provoke aggression when they primarily target the body. I will present several clinical examples that describe how “quality care” does not achieve its own goals, and can lead to ridiculous situations. The conceptualization of mental health care should not be fixed, but something we have to invent every day anew.

The Sadness in his Eyes: Encounters with a Juvenile Delinquent with Psychopathic Traits

Both popular and scientific definitions of psychopathy are far from neutral and could be seen to promote stereotyping. For example, the psychopath is often described as a social predator or cold-blooded beast. Such metaphors might influence how individuals with psychopathic traits experience emotions and social relations, and how they think about their criminal acts. We argue that the mental and contextual embedding of psychopathic behaviours is frequently neglected. Building on a detailed qualitative investigation of the affective, interpersonal and antisocial life of a male adolescent with clear psychopathic traits this paper aims to describe how he positions himself in relation to others. Based on our case materials we suggest that his antisocial behaviour and his emotional and interpersonal functioning bear witness to specific defensive processes, as well as to a psychotic structure.

A child is killed

The author begins his argument by confronting child murder in the real: in clinical work, in the media, in historical accounts of rituals. Studying ritual child murder within the Inca culture, together with stories of child murder throughout history, allows the author to draw some initial parallels between ritualistic child murder and its treatment in the clinic. A Winnicottian reading of the genesis of the subject, with narcissism as a central focus, provides a framework for understanding this kind of aggression in the clinic. Taking into consideration the effects of being able to psychically represent, we learn that fantasmatic, real and ritual murder of a child is embedded in the structure brought about by the entrance into language.

Cain and Abel: The Prodigal Sons of Psychoanalysis?

It is widely known that Freud gives Oedipus a central place in both his psychoanalytic theory and praxis. Freud introduces the Oedipus myth as the crucial key for understanding the tragedy of human life. One of the most problematic issues innate to the human condition is aggression. This paper argues: (1) that Freud’s insights into human aggression can at the very least be viewed as one-sided and problematic; and (2) that the heuristic potential of the Oedipus myth, correspondingly, is limited. It considers how the Hungarian psychiatrist and analyst, Lipót Szondi, tries to bridge this gap using the myth of Cain and Abel. The aim of this paper is to explore how Szondi’s interpretation of this myth offers a much more subtle approach to human aggression. Szondi’s alternative and distinctive look at aggressive phenomena offers an exciting and fruitful addition to Freud’s interpretation as exclusively referring to sadism and/or the death drive. This contribution wants to highlight Szondi’s amendment to Freud’s Oedipus and aims to show that psychoanalysis can benefit from taking into account the mythical figures of Cain and Abel as its ‘prodigal sons’.

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Coping with Aggression within an Institution

Physical aggression incidents directly confront care workers with the limits of their capacity “to be good” to the patient. The severity of these incidents is not determined by the measurable and objective facts but depends upon the subjective experience of the victim. Coping with aggression within the context of an institution means giving team members enough room to verbalize this subjective experience in order to make working with the patient possible again. With three clinical cases it is shown how team members that took the opportunity to verbalize their subjective experience discovered, to their surprise, that they had contributed to the incident.