The fears and tyranny cycle: the movement between mental pain and tyranny in the forensic patient

Abstract

This article describes a forensic reading of the "fears and tyranny cycle", a concept described by Barcai and Rosenthal (1974) to characterise the behaviour of some children and the dynamic origins of this in the relationship with their parents. This concept can be helpful in developing a formulation of the dynamics between the forensic patient and their professional carers, when a patient behaves in tyrannical and fear-inducing ways. Three clinical illustrations of the development of a formulation are described. The examples pay attention to the unique and unconscious fears of a patient, in a particular set of circumstances, and how this can assist in going beyond a characterisation of fear-driven tyrannical behaviour as being explained simply as institutionalisation, anger, or anxiety. Links to the wider psychoanalytic literature are drawn and the potential value of this approach to thinking with individual clinicians or clinical teams in reflective practice is considered.