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Ronald Doctor, London, Karnac Books, 2008, 124 pp., £19.99, ISBN 978-0-415-42992-14
It could be argued that the underlying reasons for killing another are as numerous as the patients who do it. To what extent is it helpful to attempt to understand patients according to what they have done as opposed to the reasons for which they have done it? This is one of the questions which this book addresses through contributions from clinicians who have worked within different parts of the forensic mental health system, specifically with patients who have killed. What emerges through the course of the book are the common themes, conflicts and ways of understanding this form of extreme enactment that are encountered within this patient population. Through a range of chapters written by clinicians with considerable expertise in the area, the book offers different perspectives on how it is possible to understand and work psychotherapeutically with perpetrators of homicide.
Gwen Adshead, Sarita Bose and Julia Cartwright give a detailed account of the complexities of running a group for patients within a high security hospital who have killed. There are numerous examples of the ways in which the patients' pathology is expressed not only within the group itself, but also within the dynamics of the wider institution. They emphasize how institutions can act out as a means of avoiding the conscious experiencing of primitive anxieties that staff and patients would otherwise be required to face. The chapter also offers an insight into the emotional demands that staff face in attempting to facilitate group psychotherapy with this particular patient group.
Peter Aylward and Gerald Wooster suggest that within any killing, there is always an internal triangular constellation in which one of the three members is killed off. They relate this to the Ian Huntley case as well as to a patient from their own clinical work. They conclude that murder results from a failure to manage loss in the context