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In this issue the majority of the papers focus on treatment, within the public sector, of patients with serious disturbance of one sort or another.
Burgner's paper describes some of the work of the AIDS workshop at the Tavistock Clinic, and gives some vivid clinical illustrations of work with HIV sufferers. The next series of three papers, Lindbom-Jakobson & Lindgren, Hart and Milton, are all concerned with the aftermath of ‘man's inhumanity to man’, seen variously from the angle of victim and perpetrator. Lindbom-Jakobson & Lindgren, experienced in work with refugees in Stockholm, use a film, Costa Gavras's Music Box, to explore how the psyche of a torturer may evolve and become fixed. Hart is concerned on the other hand with the victims of persecution, and describes movingly some work from the Refugee Support Centre. In my own paper I describe how perverse structures may develop to defend some women who have been severely abused by their parents in childhood, and I consider some of the consequences of this, including the situation where an identification with the aggressor continues the inter-generational cycle of abuse.
Lucas discusses the serious problem of depressive psychotic breakdown in the puerperium, with its consequences for mother and infant. He gives illustrative examples from an acute psychiatric ward, where psychoanalytic understanding complemented more standard psychiatric management.
Freeman makes a theoretical contribution to the understanding of certain hallucinatory experiences, and uses illustrative clinical examples from his hospital practice.
Finally, Hinshelwood helps us to consider our unconscious position as psychotherapists within institutions, and illustrates this with two institutional ‘cases’ — one of a mental hospital and one of a prison — where social defence systems impeded the therapeutic task.