ABSTRACT
The psychopath defies conventional therapeutic treatment, since this relies on an implicit commitment between physician and the patient based on trust and good faith, but this person cannot enter into such a commitment because of a lack of ability to trust. Impulsiveness and lack of judgment prevent his attending clinics, taking medicines (the effects of which are dubious), or entering into a classic psychotherapeutic relationship. Supervising the person during treatment is also a problem since his impulsive acting out behaviour will be accentuated during any process of change in treatment. This person is intractable to treatment by psychoanalysis, supportive psychotherapy, and physical methods; in conventional hospital treatment regimes he disrupts the treatment of other patients and staff management and has to be expelled. These settings appear to offer him the opportunity to act out his distorted methods of relating, and actually intensify his pattern of behaviour. The therapeutic community directly designed for the treatment of personality behaviour disorders attempts to allow him to grow; experiment with emotional and social relationships and so develop an awareness of himself and his behaviour in relation to others. In Britain a therapeutic community system for the treatment of behaviour disorders was set up by Maxwell Jones at the Henderson Hospital in the 1950s, and developed in England at HMP Grendon Underwood and HMP Wormwood Scrubs Annex, and in Scotland at the (recently closed) Barlinnie Special Unit.
