The Angry Patient in the Large Group: Classification and Management at a London University Unit
The purpose of the present discussion is to share with you thoughts on the classification and management of some of the more disordered personalities that have been treated by me at a teaching hospital unit in London. In this context personality disorder is used to distinguish the group of patients who because of developmental factors have life-long disorders of function which cannot be accurately diagnosed. Characteristically these patients show a variety of affective reactions which includes anger. The material is based on a large group which three months ago, consisted of 12 in-patients and 8 day patients. Cases are referred by colleagues who are unable to carry out appropriate management in conventional psychiatric settings. Most have a history of early and repeated separations and up to two-thirds have been suicidal or are referred because of this. In order to understand the managment of such cases we have developed an increasing interest in adolescent pathology. A third of our cases fall into this category. Most frequently the basis for admission is depression which is associated with anger as well as a life-long history of poor interpersonal relationships, problems of impulse control, and some deficiency in the capacity to experience guilt.
KeywordsPersonality Disorder Impulse Control Borderline Patient Object Relationship Angry Feeling
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- Bonime, W., (1979). Paranoid psychodynamics. Contemporary Psychoan., 15, 514–27.Google Scholar
- Bromberg, P.M., (1979). The use of detachment in narcissistic and borderline conditions. J. Amer. Acad. Psychoanalysis, 7, 593–600.Google Scholar
- Flugel, J.C., (1973). Man, Morals and Society. A psychoanalytical study. Duckworth: London.Google Scholar
- Karpman, B., (1941). On the need of separating psychopathy into two distinct clinical types: the symptomatic and the idiopathic. J. Criminal Psychopathology, 3, 112–37.Google Scholar
- Kernberg, O.F., (1975). Borderline Conditions and Pathological Narcissism. Jason Aronson: New York.Google Scholar
- Klein, M., (1946). Notes on some schizoid mechanisms. Int. J. Psycho-Anal., 27, 99–110.Google Scholar
- Kohut, H., (1977). The Restoration of the Self. International Universities Press: New York.Google Scholar
- Lorand, S., (1967). Adolescent depression. Int. J. Psycho-Anal., 48, 53–60.Google Scholar
- Mahler, M.S. and Furer, M., (1963). Certain aspects of the separation individuation phase. Psychoanal. Quart., 32, 1–14.Google Scholar
- Menninger, K.A., (1941). Recognizing and renaming “psychopathic personalities,” Bull. Menninger Clin., 5, 150–56.Google Scholar
- Schachter, S., (1950). “Deviation, Rejection and Communication” in Theory and Experiment in Social Communication (Leon Festinger et al) Institute for Social Research, Ann Arbor.Google Scholar
- Witteis, F., (1937). The criminal psychopath in the psychoanalytic system, Psychoanalytic Review, 24, 276–291.Google Scholar