Lectures on Violence, Perversion and Delinquency

David Morgan, Stanley Ruszczynski, David Morgan, Stanley Ruszczynski

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780367325312
• eBook ISBN: 9780429915642
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

In this volume contemporary staff describe their thinking and clinical work. Theoretical underpinnings for the understanding of perversion and violence, questions of risk and ethics and the institutional difficulties which emerge in the care of these patients are presented alongside chapters on clinical work, with adults and adolescents, including chapters on paedophilia, the compulsive use of internet pornography and transsexuality. This volume is of relevance to all those working with people with a range of personality disorders and those working with individuals who present with these types of problems in the mental health services and in private practice. The Portman Clinic has been applying a psychoanalytic framework to the understanding and treatment of violent, perverse, criminal and delinquent patients since its foundations in the early 1930's. All Portman Clinic patients have crossed the boundary from fantasy and impulse to action - action which defies legal and moral boundaries but which also breaches the body boundary of the victims.

Chapter One
The Portman Clinic

An historical sketch

Carlos Fishman and Stanley Ruszczynski

The Portman Clinic began in 1931 as the Psychopathic Clinic and was the clinical arm of the Institute for the Scientific Treatment of Delinquency, later to be called The Institute for the Study and Treatment of Delinquency (ISTD) (Glover, 1960; Dicks, 1970). The Institute was founded by a small group of people impelled by the research of Dr Grace Pailthorpe, a psychiatrist and psychoanalyst, who had worked as a doctor in the trenches during the First World War. After the war she worked in Birmingham and Holloway Prisons. She became interested in the personality of women prisoners and wrote Studies in the Psychology of Delinquency (Pailthorpe, 1932). Her approach and her research attracted likeminded psychoanalysts including Edward Glover and Kate Friedlander, and their shared interests and, more importantly, Edward Glover’s impetus and dedication, founded the Institute and with it the idea of developing a Clinic. Glover was already developing the understanding of sexual perversions, criminality, and addictions, and had also been Director of the London Clinic of Psychoanalysis.

Later, when writing about the beginnings of the Institute, Glover stressed that “The first concern of the ISTD (was) to make a thorough examination and the second to arrive at a provisional diagnosis. The diagnosis should be sound enough to permit of a satisfactory recommendation of disposal; the examination should be comprehensive enough not only to exclude diagnostic error but to permit of subsequent ... research” (Glover, 1960). So, from its very inception, the Portman Clinic had as its purpose assessment, treatment and research. In addition, Glover wrote that because delinquency and crime are social phenomena they appropriately attract the attention of a variety of disciplines including social workers and social psychologists. However, in his view, “... the most fundamental approach to crime, pathological or otherwise, is that of psychoanalysis” (Glover, 1960). This view remains central to the work of the Portman Clinic, which, whilst fully recognizing the necessary team work between the various disciplines involved in the care, treatment and containment of delinquent, perverse and violent patients, takes upon itself the task of refining and developing the in-depth understanding of the unconscious forces operating in the psychic make-up of its patients and of the patients of those professionals who approach the Clinic for consultation or teaching.

Perhaps it is not surprising that the Portman Clinic was born at a time in the history of the twentieth century that was particularly stormy. The period between the two great wars saw the birth of Communism, the rise of National Socialism and important developments in the move from fascism to democracy. Most of those who were associated with the early days of the Portman Clinic shared a particularly idealistic view influenced no doubt by the enthusiasm which Freud’s theories of the mind encouraged in the early days. One can glean from documents that refer to the early days of the Clinic the belief that perhaps “treatment” might replace “punishment”. Over seventy years later, and with the accumulation of substantial clinical experience, that idealism has certainly been modified and has evolved into something more realistic and therefore more hopeful. Portman clinicians treat individuals with complicated and severe psychopathologies using psychoanalytic psychotherapy, believing that, as Glover wrote, “... so long as the existence and power of unconscious motives is disregarded, we cannot learn any more about crime than an apparent commonsense dictates.... However speculative and uncontrolled some psychoanalytic views on crime may be they do at least promise to uncover the fundamental flight from reality that leads to pathological and possibly all forms of criminal conduct” (Glover, 1960, p. xiii). This understanding of the disavowal of reality as being at the heart of much perverse, violent and delinquent behaviour sustains much contemporary clinical practice in the Portman Clinic today.

Early vice-presidents of the Institute for the Study and Treatment of Delinquency included Alfred Adler, Havelock Ellis, Sigmund Freud, Ernest Jones, Carl G. Jung, Emmanuel Miller, Otto Rank and H. G. Wells among others. One can see that the founding members of the Institute obtained the support of important intellectual figures of the time. As with many such ventures, funding was a major difficulty and apparently seeking charitable donations for the study and treatment of criminality was not easy, and there were serious struggles in this respect in the early days. It is very likely that support of such figures did help to secure some funding.

Dr Edward Glover was the main promoter of the Institute developing a clinical arm. The idea was that through a clinic the treatment aims of the institution would be complete. Initially, clinicians volunteered to see patients referred to them through the Clinic in their own consulting rooms and at much reduced fees so as to fulfil the charitable purposes of the Association. The Clinic saw its first formal patient on the 18th September 1933, “a woman, 47 years of age, noted as having a violent temper, charged with assault on her woman employer” (Saville & Rumney, 1992). At that time the staff of the Clinic included Dr Bion, Dr Eder, Dr Aubrey Lewis (one of the pioneers of psychiatry in the UK), Miss Barbara Low, Mr Adrian & Mrs Karen Stephen, Dr John Rickman, Mrs Melitta Schmideberg and others, many of them pioneers of psychoanalysis in Britain.

Later on, in the mid-thirties, the arrangement at the Clinic changed. With the help of Emmanuel Miller (the founding father of the first Child Guidance Clinic and an early supporter of the ISTD) the Clinic secured a room at the Western Hospital. The doctors, lay therapists, psychologists and social workers worked without payment. The clinic room was available mornings only. Five shillings had to be paid to the Western Hospital each time it was used. The physical examination was carried out by the hospital and psychometric examination by a psychologist on the Clinic staff. Where psychotherapy was necessary, it continued to take place in the therapist’s own rooms.

The Institute for the Study and Treatment of Delinquency and the Clinic found their first own home at number 8 Portman Street, London W1 in May 1937, and the Clinic centralized its services there starting in February of the following year. The present Portman Clinic carries its name after the street where it was first located, and replaced the earlier, rather contentious, name of “Psychopathic Clinic”.

During the Second World War the staff of the Clinic was reduced considerably due to many joining the military. Despite the war clinical work continued, in a limited way: only assessments and short-term treatments were undertaken. Most of this was undertaken by a small group of psychiatric social workers that staffed the clinic during this time.

After the war the Clinic moved again, this time to Bourdon Street in Mayfair, and it seems that at the time the Clinic was located between a residence for nuns on one side and a brothel on the other! It was just before and after the war that many well-known psychiatrists and psychoanalysts, such as Dr John Bowlby, Dr Wilfred Bion, Dr William Gillespie and others, joined the staff of the Portman where they spent a part of their early psychiatric career.

With the coming into being of the National Health Service Act of 1948 the Clinic was formally separated from the ISTD and became part of the NHS. It was at this time that the Portman Clinic formally took its name, although it was still housed with its parent organization. After the Clinic joined the NHS a number of very creative developments occurred. Many of the staff who have contributed significantly to the literature of the psychoanalytic understanding of sexual perversions and delinquency gradually joined the Portman. Major works of Dr Glover and later Dr Glasser, Dr Limentani, Dr Weldon and others emanated from their work at the Portman. Classical papers of Edward Glover, contained in his book The Roots of Crime (1960), and also The Early Development of Mind (1956) were influenced directly by his work at the Portman. In the same vein, Mervin Glasser’s seminal papers: “From the Analysis of a Transvestite” (Glasser 1979b), “Some Aspects of the Role of Aggression in the Perversions” (Glasser, 1979a) as well as “On Violence: A Preliminary Communication” (Glasser, 1998), were all based on his clinical work at the Portman Clinic. Adam Limentani’s contributions included: “Clinical Types of Homosexuality” (Limentani, 1989c), and “A Re-evaluation of Acting Out in Relation to Working Through” (Limentani, 1966). Estela Welldon’s work on female perversion Mother, Madonna, Whore (Welldon, 1988) was also based on her clinical work at the Portman Clinic.

In 1961 the Portman Clinic organized a conference as a contribution to the celebration of the World Mental Health Year. This successful two-day conference resulted in the publication of the first edition of the well-known volume on the pathology and treatment of sexual deviation, Sexual Deviation, edited by Ismond Rosen (Rosen, 1964). This volume has seen two subsequent editions. The second edition (1979), probably the most widely quoted, includes a greater number of major contributions by the then staff of the Portman Clinic.

In 1970 the Portman Clinic moved to its present location in Fitzjohn’s Avenue, London, a house adjacent to the Tavistock Centre. Together with the Tavistock Clinic it was at the time under the management of the Hampstead Health Authority. The Portman was a vibrant institution staffed, as always, along multi-disciplinary lines, having Clinical Psychologists and Psychiatric Social Workers, as well as Consultant Psychotherapists and a Consultant Physician. Most had trained as either psychotherapists or psychoanalysts. During the eighties a serious review of the role of psychotherapy was undertaken by the NHS and the special and dedicated work of those at the Portman Clinic and the Tavistock Clinic was organized under a special sub-committee of the Hampstead Health Authority. It was partly due to the standard of clinical work of both the Tavistock and Portman Clinics that the Seymour Report found that psychotherapy did have a continuing role to play in the NHS despite opposition (Seymour Report, 1985). Because of their standing as providing psychoanalytic psychotherapy services and training in the NHS, the Tavistock and Portman Clinics joined forces, and, as part of changes in the structure of the Health Services, the two jointly became an NHS Trust in 1994, and a Foundation Trust in 2006, whilst maintaining their separate identities.

During the late eighties, but principally during the beginning of the nineties a major change took place at the Portman Clinic. So far the staff had comprised doctors, psychologists and social workers, not all trained as psychoanalysts or psychoanalytic psychotherapists. In the late eighties the Portman Clinic was one of the first mental health institutions in the UK that created posts for non-medical adult psychotherapists and later on, in the early nineties and in recognition of the clinical work that non-medical staff did, all nonmedical staff took the title of Adult Psychotherapists. Since then the clinical staff consists of Consultant Psychotherapists, Adult Psychotherapists and Child and Adolescent Psychotherapists and all are now trained as psychoanalytic psychotherapists or psychoanalysts.

The founding of the International Association for Forensic Psychotherapy was another of the major developments that the Portman Clinic was involved in during the nineties. This international organization was formed in recognition of the need for a dedicated forum for those psychotherapists that work with individuals suffering from criminality, sexual perversions and violence. Its origins lay in the European symposia where colleagues mainly from Holland, Belgium, Austria and Germany would meet with Portman staff to exchange views on the treatment of patients who had been involved with the criminal justice system because of their psychopathology. These symposia took place bi-annually, mainly under the leadership of Mervin Glasser, then Chairman of the Portman. Developing on these clinical exchanges Estela Welldon, a Consultant Psychiatrist, Psychotherapist and Group Analyst, who by then was already recognized internationally as an authority in the understanding of perversions in females, became the driving force behind the creation of the International Association of Forensic Psychotherapy. Since its founding, the IAFP has had ten international conferences in different parts of the world. Portman Clinic staff continue to play an important role in this association, contributing regularly to their international conferences.

It is perhaps because of the efforts of Estela Welldon and other members of staff of the Portman Clinic that the somewhat controversial title of Forensic Psychotherapist has come to exist.

Among many short conferences and courses initiated at the Portman Clinic for a variety of professionals in the mental health field, as well as the justice system, Mervin Glasser initiated a course on the Psychodynamic Understanding of Perversion and Delinquency. Estela Welldon then expanded this course into a two year, one day a week day release course for professionals working in the forensic field leading to a Diploma in Forensic Psychotherapeutic Studies. In addition, the Portman Clinic has been very involved, since very early in its history as a NHS institution, in the training of junior doctors who wanted to train as consultant psychotherapists. At present the Portman is involved in an imaginative arrangement with the educational authorities of the Royal College of Psychiatrists whereby junior doctors can do the double training as Forensic Psychiatrists and Psychotherapists, the forensic psychotherapy aspect of it being done at the Portman.

Finally, since being founded, the Portman Clinic has seen over twenty thousand patients and the substantial scientific contribution of the Clinic has been based on this clinical experience. A number of books and numerous papers and book chapters have emerged from the Clinic. We have referred to some above and many others will be referred to in the following chapters and in the bibliography. There is a further body of work to be edited as well as newly written, and published. This volume is the first of a series which will build on the work of our predecessors and further contribute to the psychoanalytic understanding of violence, perversion or delinquency.

Chapter Two
The problem of certain psychic realities

Aggression and violence as perverse solutions

Stanley Ruszczynski

Introduction

Both Freud arid Klein understood psychological development as grounded in the interweaving of love and hate, life and death instincts, involving both the body arid the mind. In health, in the context of a benign parental environment, the normal development of the infant's instincts results in the strengthening of the life instincts and hence the lessening in the power of destructive impulses. The aggressive element of hate is contained, and comes under the influence of the capacity for concern for the other and therefore of love. Aggression may then be recruited in the service of passion and creativity and thus contribute towards the possibility of healthy relationships. As a result, true intimacy, which requires both the recognition of and respect for a separate other, becomes possible (Ruszczynski and Fisher, 1995). Sex, and in particular intercourse, is experienced as reparative and potentially creative, arousing little or no guilt.

However, this benign integration of physical sex and love is one of the most difficult achievements of human beings’ psychic development. The full expression of intimacy, love and sexuality, requires the involvement of another and this dependence on another, an affront to narcissism and omnipotence, carries with it the inevitability of feelings of ambivalence towards that other. The achievement of this capacity for ambivalence, in reality a life-long struggle, is one crucial indicator of the potential for relatively healthy and mature relationships.

In the absence of this achievement of the capacity for ambivalence, love and concern do not temper and moderate aggressive instincts and aggression retains ascendancy. Fonagy has stressed the developmental need for normal aggression to be contained and writes that “violence is unlearned not learned”. He says:

models of aggression have tended to focus on how human aggression is acquired. Yet aggression appears to be there as a problem from early childhood, arguably from toddlerhood and perhaps from birth. Violence ultimately signals the failure of normal developmental processes to deal with something that occurs naturally.

[Fonagy, 2003, p. 190, italics added]

In such circumstances relationships, sexual and non-sexual, are recruited in the service of malignant aggression, and sexuality in particular may be hijacked and become expressed as sadomasochistic, perverse and destructive. Robert Stoller refers to perversion as “the erotic form of hatred”. He writes:

Think of the perversions with which you are familiar: necrophilia, fetishism, rape, sex murder, sadism, masochism, voyeurism, paedophilia—and many more. In each is found—in gross form or hidden, but essential in the fantasy—hostility, revenge, triumph and a dehumanized object. Before even scratching the surface, we can see that someone harming someone else is a main feature in most of these conditions.

[Stoller, 1976, p. 9]

Perversion

This understanding of the interlacing of sex and aggression, of love and hate, whether for loving or for malignant purposes involves both the body and the mind. It originates from Freud’s delineation of mankind’s “Oedipal destiny” (Hartocollis, 2001). Freud describes a 3- to 5-year-old boy’s sexual attraction to his mother and his rivalry with and hatred of his father. He soon came to realise, however, that the young child pursues the love of the opposite sex parent with ambivalence because such a pursuit is feared to be at the expense of an affectionate attachment to the same sex parent. This dilemma is at the heart of the true nature of the triangular Oedipal situation, and hence feelings of ambivalence inevitably accompany any feelings of attachment, love or sexual expression.

Our Oedip...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• LIST OF CONTRIBUTORS
• INTRODUCTION
• CHAPTER ONE The Portman Clinic: An historical sketch
• CHAPTER TWO The problem of certain psychic realities: Aggression and violence as perverse solutions
• CHAPTER THREE The internal couple and the Oedipus complex in cases of perversion
• CHAPTER FOUR Psychoanalytic contributions to risk assessment and management
• CHAPTER FIVE Psychoanalytical aspects to the risk of containment of dangerous patients treated in high security
• CHAPTER SIX Perverse female: Their unique psychopathology
• CHAPTER SEVEN From biting teeth to biting wit: The normative development of aggression
• CHAPTER EIGHT Brief communications from the edge: Psychotherapy with challenging adolescents
• CHAPTER NINE Compulsive use of virtual sex and internet pornography: Addiction or perversion?
• CHAPTER TEN Trans-sexuality: A case of the "Emperor's new clothes"
• CHAPTER ELEVEN Perverse partients' use of the body—their own and that of others
• CHAPTER TWELVE Ethical problems treating paedophile patients
• CHAPTER THIRTEEN The forensic network and the internal world of the offender: Thoughts from consultancy work in the forensic sector
• REFERENCES
• INDEX