Discussion of Seymour Boorstein's Article, A Psychoanalytic Overview of the Offender: Implications for Therapy

Reading Dr. Boorstein's paper elicited my appreciation for his keen understanding of the offender. Atascadero State Hospital since its start in 1954 has cared for approximately 18,000 mentally disordered patients who have committed acts dangerous to others. Hundreds of mentally ill, too assaultive to be cared for in the 13 other State hospitals in California, have been transferred here, and the 200-plus superior courts throughout all California send us mentally disordered sex offenders and criminal offenders for, first, the protection of society, and second, rehabilitation.

A therapeutic community approach has been established here: its main goal is social rehabilitation to the point where the patient is no longer dangerous and where any complete personality change beyond that can be accomplished outside a maximum security setting. The concept of “consequences” is important in our program, and it is effective as part of the educative process in the socialization of the patient.

We believe that the second phase Dr. Boorstein mentioned could be completed at the community level, utilizing public and private facilities. The structured treatment program recognizes the core defense—the feeling of entitlement—and deals with it from admission to discharge. Controlling behavior in the here-and-now is stressed.

All patients are assigned to mixed groups, and hospital privileges are earned by proper behavior. Problems of authority, responsibility and accountability are discussed by men who were previously loners but who now are becoming part of a group living situation. Useful inhibitions are established and strengthened, attitudes of remorse and concern for victims are encouraged. Education in correct decision making is fostered. The struggle to become a man and how to deal with feelings of fear, anger and love are consistently discussed with the final result being that improved patients leave the hospital knowing how to get along with other people, do some type of productive wor