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This meeting was designed to remember and celebrate the life and clinical preoccupation of Richard Lucas, who was very involved in the psychotic elements in his patients, be it the straightforward presentation of a psychotic illness or, more significantly, the role of psychotic processes, either manifestly or unconsciously. He was particularly interested in the role of psychotic defences and how these psychical mechanisms can interfere with the treatments provided. Such defences can be overt such as when the patient says, ‘there's nothing wrong with me’ and refuses treatment, despite the obvious reasons for their admissions to a psychiatric hospital. Patients can also present with a variety of rationalizations that lead them to find treatment invasive or for whom any psychoanalytic enquiry of no interest.
The two patients discussed in Dr Minne's paper, despite the outcome in the young woman, show quite clearly their availability to our understanding of them and their therapeutic accessibility. This work would have been of considerable interest to Dr Lucas's mind and therapeutic attitude.
An important question is why there exists a gap between our understanding of our patients and theirs? This gap is greatest at the time of ‘acting out’ leading to their admission to a high security hospital. How strong is the psychotic process that made the patient unaware that he or she could take the life of another as opposed to just feel like killing them? What is happening in the mind of an individual that permits such enactment? Is it enough to look at the history of our patients to provide an explanation?
I don't minimize the significance of these individuals' traumatic histories, which hardly encourage normality or even neurotic patterns of behaviour. What happens to the developing person who ends up in a high security hospital, where they re-enact within the treatment system an attitude in living so reminiscent of the index offence? In other words, are there aggressive attitude