ABSTRACT
The nature and function of aggression, described so elegantly by Don Campbell in his chapter, and the theme of the conference, “Aggression: from fantasy to action”, are subjects that have intrigued me for many years and caused so much suffering to the patients I have seen, and to those around them, particularly their victims. In particular, I have wondered what is it that makes a mind that entertains an aggressive fantasy, a common occurrence, transform into a violent muscular action, a much less common occurrence. When violent patients have psychoanalytic psychotherapy as part of their treatment plan, and the prospect of understanding develops, what does one need to indicate has changed in the patient and, indeed, how can one demonstrate any changes that may have arisen which would mean the patient is now less at risk of being violent again? Generally, clinical risk assessments on patients who have been violent tend to focus on the patients’ behaviour, combined with a psychiatric mental state examination. This often neglects what, if any, changes may have arisen in the patients’ internal worlds, and it is here that a psychoanalytic approach can contribute to clinical risk management, one that emphasizes the fluidity of risk as opposed to presenting a snap-shot.
