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I was glad to be asked to review this book. The request was somewhat serendipitous, given the subject matter, as I had recently ended a long period of work with a violent and potentially suicidal patient. I was also currently helping a supervisee come to terms with the suicide of a patient whom she had assessed as very high risk and had referred on to specialist services. Both these patients presented in general practice (primary care) via their GPs. The treatment of dangerous patients is not solely confined to the settings of forensic psychiatry, hospitals, or secondary and tertiary mental health services. Patients with personality disorders which may indicate varying degrees of ‘danger’ can present in the ordinary course of general practice and in non-statutory and voluntary sector services. Thus I have to admit to some slight disappointment alongside much admiration for this volume because of its emphasis on the treatment of such patients in specialist settings and the implication that psychodynamic therapy is only possible in such contexts. It would have been interesting to have included in the volume an additional chapter from the vantage point of primary care, perhaps written from the multi-disciplinary perspective of this setting. It has been my experience that some very disturbed patients can be contained and treated in primary care teams which are well resourced and have the right degree of therapeutic expertise in the team.
Having said this, however, standing on the shoulders of giants is no bad thing, particularly in this very frightening arena. The experience and expertise which such as Ronald Doctor (formerly psychiatrist at Wormwood Scrubs Prison), John Lowe (psychiatrist in a psychiatric intensive care unit) and Carine Minne (consultant psychiatrist in forensic psychotherapy at Broadmoor) are able to bring to the subject matter of this volume, because of the nature and context of their work, is hugely valuable. What they have to say from their consider