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From Michael Sinason
I am grateful for the opportunity to respond to the very interesting letter from Richard Lucas. One of Richard's points is that ‘at times one has to stand up to murderous states …’ I think the difficulty is that the sanity of pursuing a psychoanalytic investigation with a patient is not a fixed feature but a highly context-related dynamic of the situation. When faced with out-of-control psychotic forces the only safety that can be obtained is by finding sufficient force to overwhelm and control those processes. It is on this principal that psychiatric crash-teams use substantial force of numbers to subdue the threats of a seriously disturbed psychotic and allow safety to be restored. In a similar way, social violence requires the police to arrive in force to deal with the emergency, and if a country is at risk of invasion by a hostile army then an army of defending soldiers is needed to deal with the situation, not an army of interpretations!
What is necessary for safety in these emergency situations is not, however, the same issue as what is the understanding of these phenomena. The real difficulty of establishing what is mad is exposed once the emergency has passed. Joscelyn Richards and I have recently had to deal with a situation at the Willesden Centre which may serve to illustrate some of the points at issue. A man turned up at the Centre demanding that he be seen and treated there and then. He was not a ‘patient’ of ours, although we had recommended to his GP that he be seen by the Forensic