Psychotic processes in forensic institutions

Abstract

In this paper the authors illustrate how they have developed the contributions made by Richard Lucas towards the psychoanalytic understanding of psychosis and in particular his use of the concepts of psychotic and non-psychotic parts of the personality. They discuss how they have developed these ideas in their own work within forensic institutions where the psychotic part of the personality can be so in the ascendancy that little communication is possible with the non-psychotic part of the patient. These situations are often beyond words, and containment might have to involve limit-setting in the form of physical boundaries and the use of seclusion. It is our intention to show how meaning can be created for staff even when this is beyond the patients' grasp; and how, through the use of reflective practice, we can help staff to recover their equilibrium and move towards a more integrated picture of the patient. This allows staff to become more available to their patients as containing objects.