ABSTRACT
Duncan is suffering from a paranoid psychosis, which could be regarded as being precipitated or aggravated by drugs and alcohol. The use of alcohol and drugs has had an anxiety-lowering effect that allowed him to feel safe in the company of other alcohol abusers but, at the other times in other settings, disinhibited his capacity to control his violence. The staff’s strategy of setting limits to his demanding behaviour may help to provide him with a firm role-model that will help him control his aggressive feelings. A further, and potentially more psychotic, development may follow if, by the use of projective identification, the encounter with an aggressive relative comes to serve as a container for the child’s own primitive aggressive feelings. These dual and unstable identifications may help to account for the startling contrast in Duncan’s behaviour. The dreams that Duncan reported are interesting, and they may throw light on his unconscious pathogenic phantasies.
