Although psychiatry often has to work with aggressive patients, the huge amount of coercion and exclusion based on aggression, teaches us that psychiatry does not know how to handle violence. In 1948 Lacan wrote an essay on aggressiveness, trying to approach the phenomenon within a structural framework, albeit without the conceptual tools to work this through. His later work, notably the differentiations between the imaginary, the symbolic and the real, helps us to read aggression in a structural fashion, taking anxiety at the core of the problem. The author wants to expand this by making a differentiation between implicated violence and non-implicated violence. The former is about the aggression as we usually understand it: between subjects, with the feeling one is implicated in it and grounded in anxiety. The latter is carried out as a collective, grounded within discourse that veils anxiety. This violence is essentially dehumanizing for both victims and perpetrators. One is violent because it ‘needs to be done’, justifying its action through discourse. The author explains how in clinical practice, we should read the violence of mental health workers (like coercion or exclusion) and its accompanying anxiety, rather than simply denouncing it. If not, we risk that implicated violence will alter to non- implicated violence, making it even harder to tackle. The author concludes with an example of her own clinical practice and analysis.
This article describes a number of concrete initiatives taken in the De Meander in Melle (near Ghent, Belgium), a psychiatric ward for patients with a mental disability or an acquired brain injury, with the aim of introducing and safeguarding a psychoanalytic ethic. In the latter, the particularity of the patient plays a central role. De Meander tried to achieve this by abolishing many of the ward rules, allowing more space for the singular solution of the patient. Furthermore, the author describes how aggression is addressed differently, in order to learn how to read this rather than punish it. From an ethical perspective, the values and standards of mainstream society are no longer strictly adhered to, but the starting point is the suffering and the questioning of the patient as a unique subject. The author describes how patients of De Meander are given more responsibility for their lives and future. Hierarchical positions are lifted by creating the possibility of circulation between different team members and by using the therapeutic potential of patients. Finally, the author describes how, via volunteer work, an opening to the outside world is created for so-called chronic patients. These various concrete initiatives are illustrated using clinical vignettes.
In the 18th century Bentham proposed the idea of the panopticon as a reliable method for exercising power. By capturing the gaze, the guard owns the power of seeing in order to force the prisoner to submit. In this way, the undesirable behaviour of the prisoner can be suppressed. In the 1970’s there were several interesting commentaries: Foucault (philosophical) and Miller (psychoanalytic). This article examines the effects of a panoptical architecture, starting from concrete experiences. A clinical fragment will allow us to argue that the panopticon cannot guarantee the one-sidedness of the gaze (namely, on the part of the guard). As a consequence the panopticon has not only suppressing effects, but is also a possible ground for transgression.