122

2
3
4
5
6
7222 MURDER
8
9
10
1
2
3
4
5222
6
7
8
9
20111
1
2
3
4
5
6
7
8
9
30
1
2
3
4
5
6
7
8
922

i
Other titles in the
Forensic Psychotherapy Monograph Series

Violence: A Public Health Menace and a Public Health Approach

Edited by Sandra L. Bloom
Life within Hidden Walls: Psychotherapy in Prisons
Edited by Jessica Williams Saunders
Forensic Psychotherapy and Psychopathology:
Winnicottian Perspectives
Edited by Brett Kahr
Dangerous Patients: A Psychodynamic Approach to Risk Assessment
and Management
Edited by Ronald Doctor
Anxiety at 35,000 Feet: An Introduction to Clinical Aerospace Psychology
Robert Bor
The Mind of the Paedophile: Psychoanalytic Perspectives
Edited by Charles W. Socarides
Violent Adolescents: Understanding the Destructive Impulse
Lynn Greenwood
Violence in Children: Understanding and Helping Those Who Harm
Rosemary Campher

ii
122
2
3
4
5
6
7222 MURDER
8
9
10
A Psychotherapeutic
1
2
Investigation
3
4
5222
6 Edited by
7
8 Ronald Doctor
9
20111
1 Foreword by
2 Tony Maden
3
4
5
6
7
8
9
30
1 Forensic Psychotherapy Monograph Series
2 Series Editor Honorary Consultant
3 Brett Kahr Estela Welldon
4
5
6
7
8
922 KARNAC
iii
First published in 2008 by
Karnac Books Ltd.
118 Finchley Road
London NW3 5HT

Arrangement, Introduction © 2008 by Ronald Doctor;

chapter 1 copyright © 2008 by Gwen Adshead, Sarita Bose
and Julia Cartwright; chapter 2 copyright © 2008 by
Peter Aylward and Gerald Wooster; chapter 3 copyright ©
2008 by Anna Motz; chapter 4 copyright © 2008 by Maggie
McAlister; chapter 5 copyright © 2008 by Ronald Doctor;
chapter 6 copyright © 2008 by Philip Lucas

The rights of the editors and contributors to be identified

as the authors of this work have been asserted in
accordance with §§ 77 and 78 of the Copyright Design
and Patents Act 1988.

All rights reserved. No part of this publication may be

reproduced, stored in a retrieval system, or transmitted,
in any form or by any means, electronic, mechanical,
photocopying, recording, or otherwise, without the prior
written permission of the publisher.

British Library Cataloguing in Publication Data

A C.I.P. for this book is available from the British Library

ISBN13: 978–1–85575–572–7

Edited, designed, and produced by

Florence Production Ltd, Stoodleigh, Devon
www.florenceproduction.co.uk

www.karnacbooks.com

iv
122 CONTENTS
2
3
4
5
6
7222
8
9
10
1
2
3
4
5222
6
7
8
9
20111 ACKNOWLEDGEMENTS vii
1
SERIES FOREWORD ix
2
3 Brett Kahr
4 EDITOR AND CONTRIBUTORS xiii
5
61 FOREWORD xvii
7 Tony Maden
8
9
Introduction 1
30
Ronald Doctor
1
2
CHAPTER ONE
3
4 Life after death: a group for people who have killed 9
5 Gwen Adshead, Sarita Bose and Julia Cartwright
6
7 CHAPTER TWO
8 Murder: persecuted by jealousy 35
922 Peter Aylward and Gerald Wooster

v
vi CONTENTS

CHAPTER THREE

Women who kill: when fantasy becomes reality 51

Anna Motz

CHAPTER FOUR

Killing off the shadow: the role of projective identification

in murderous acts 65
Maggie McAlister

CHAPTER FIVE

The history of murder 79

Ronald Doctor

CHAPTER SIX

The dog that didn’t bark: a mild man’s murderousness 93

Philip Lucas

REFERENCES 117

INDEX 123

vi
122 ACKNOWLEDGEMENTS
2
3
4
5
6
7222
8
9
10
1
2
3
4
5222
6
7
8
9

I
20111 would like to thank Karen-Anne Quatermass for her contribution
1 to Chapter Five, The history of murder.
2
3
4
5
6
7
8
9
30
1
2
3
4
5
6
7
8
922

vii
viii
122 SERIES FOREWORD
2
3
4
5 Brett Kahr
6
7222 Centre for Child Mental Health, London
8 and
9 The Winnicott Clinic of Psychotherapy, London
10
1
2
3
4
5222
6
7
8
9

T
20111 hroughout most of human history, our ancestors have done
1 rather poorly when dealing with acts of violence. To cite but
2 one of many shocking examples, let us perhaps recall a case
3 from 1801, of an English boy aged only 13, who was executed by
4 hanging on the gallows at Tyburn. What was his crime? It seems that
5 he had been condemned to die for having stolen a spoon (Westwick,
6 1940).
7 In most cases, our predecessors have either ignored murderous-
8 ness and aggression, as in the case of Graeco-Roman infanticide,
9 which occurred so regularly in the ancient world that it acquired an
30 almost normative status (deMause, 1974; Kahr, 1994); or they have
1 punished murderousness and destruction with retaliatory sadism, a
2 form of unconscious identification with the aggressor. Any history of
3 criminology will readily reveal the cruel punishments inflicted upon
4 prisoners throughout the ages, ranging from beatings and stockades,
5 to more severe forms of torture, culminating in eviscerations, behead-
6 ings, or lynchings.
7 Only during the last one hundred years have we begun to develop
8 the capacity to respond more intelligently and more humanely to acts
922 of dangerousness and destruction. Since the advent of psychoanalysis

ix
x SERIES FOREWORD

and psychoanalytic psychotherapy, we now have access to a much

deeper understanding both of the aetiology of aggressive acts and of
their treatment; and nowadays we need no longer ignore criminals
or abuse them—instead, we can provide compassion and contain-
ment, as well as conduct research that can help to prevent future acts
of violence.
The modern discipline of forensic psychotherapy, which can be
defined, quite simply, as the use of psychoanalytically orientated
“talking therapy” to treat violent, offender patients, stems directly from
the work of Sigmund Freud. Almost one hundred years ago, at a
meeting of the Vienna Psycho-Analytical Society, held on 6 February
1907, Sigmund Freud anticipated the clarion call of contemporary
forensic psychotherapists when he bemoaned the often horrible
treatment of mentally ill offenders, in a discussion on the psychology
of vagrancy. According to Otto Rank, Freud’s secretary at the time,
the founder of psychoanalysis expressed his sorrow at the “non-
sensical treatment of these people in prisons” (quoted in Nunberg &
Federn, 1962, p. 108).
Many of the early psychoanalysts preoccupied themselves with
forensic topics. Hanns Sachs, himself a trained lawyer, and Marie
Bonaparte, the French princess who wrote about the cruelty of war,
each spoke fiercely against capital punishment. Sachs, one of the
first members of Freud’s secret committee, regarded the death penalty
for offenders as an example of group sadism (Moellenhoff, 1966).
Bonaparte, who had studied various murderers throughout her career,
had actually lobbied politicians in America to free the convicted killer
Caryl Chessman, during his sentence on Death Row at the California
State Prison in San Quentin, albeit unsuccessfully (Bertin, 1982).
Melanie Klein concluded her first book, the landmark text Die
Psychoanalyse des Kindes [The Psycho-Analysis of Children], with
resounding passion about the problem of violence in our culture.
Mrs Klein noted that acts of criminality invariably stem from
disturbances in childhood, and that if young people could receive
access to psychoanalytic treatment at any early age, then much
cruelty could be prevented in later years. Klein expressed the hope
that: “If every child who shows disturbances that are at all severe
were to be analysed in good time, a great number of these people
who later end up in prisons or lunatic asylums, or who go completely
to pieces, would be saved from such a fate and be able to develop
a normal life” (1932, p. 374).
x
 SERIES FOREWORD xi

122 Shortly after the publication of Klein’s transformative book, Atwell

2 Westwick, a Judge of the Superior Court of Santa Barbara, California,
3 published a little-known though highly inspiring article, “Criminology
4 and Psychoanalysis” (1940), in the Psychoanalytic Quarterly.
5 Westwick may well be the first judge to commit himself in print to
6 the value of psychoanalysis in the study of criminality, arguing that
7222 punishment of the forensic patient remains, in fact, a sheer waste of
8 time. With foresight, Judge Westwick queried, “Can we not, in our
9 well nigh hopeless and overwhelming struggle with the problems of
10 delinquency and crime, profit by medical experience with the
1 problems of health and disease? Will we not, eventually, terminate
2 the senseless policy of sitting idly by until misbehavior occurs, often
3 with irreparable damage, then dumping the delinquent into the
4 juvenile court or reformatory and dumping the criminal into prison?”
5222 (p. 281). Westwick noted that we should, instead, train judges,
6 probation officers, social workers, as well as teachers and parents,
7 in the precepts of psychoanalysis, in order to arrive at a more
8 sensitive, non-punitive understanding of the nature of criminality. He
9 opined: “When we shall have succeeded in committing society to
20111 such a program, when we see it launched definitely upon the
1 venture, as in time it surely will be—then shall we have erected an
2 appropriate memorial to Sigmund Freud” (p. 281).
3 In more recent years, the field of forensic psychotherapy has
4 become increasingly well constellated. Building upon the pioneering
5 contributions of such psychoanalysts and psychotherapists as Edward
6 Glover, Grace Pailthorpe, Melitta Schmideberg, and more recently
7 Murray Cox, Mervin Glasser, Ismond Rosen, Estela Welldon, and
8 others too numerous to mention, forensic psychotherapy has now
9 become an increasingly formalized discipline that can be dated to
30 the inauguration of the International Association for Forensic Psycho-
1 therapy and to the first annual conference, held at St. Bartholomew’s
2 Hospital in London in 1991. The profession now boasts a more robust
3 foundation, with training courses developing in the United Kingdom
4 and beyond. Since the inauguration of the Diploma in Forensic Psy-
5 chotherapy (and subsequently the Diploma in Forensic Psychothera-
6 peutic Studies), under the auspices of the British Postgraduate Medical
7 Federation of the University of London in association with the
8 Portman Clinic, students can now seek further instruction in the
922
psychodynamic treatment of patients who act out in a dangerous and
illegal manner.
xi
xii SERIES FOREWORD

The volumes in this series of books will aim to provide both

practical advice and theoretical stimulation for introductory students
and for senior practitioners alike. In the Karnac Books Forensic Psy-
chotherapy Monograph Series, we will endeavour to produce a regular
stream of high-quality titles, written by leading members of the
profession, who will share their expertise in a concise and practice-
orientated fashion. We trust that such a collection of books will help
to consolidate the knowledge and experience that we have already
acquired and will also provide new directions for the upcoming
decades of the new century. In this way, we shall hope to plant the
seeds for a more rigorous, sturdy, and wide-reaching profession of
forensic psychotherapy.
As the new millennium begins to unfold, we now have an
opportunity for psychotherapeutically orientated forensic mental
health professionals to work in close conjunction with child psychol-
ogists and with infant mental health specialists so that the problems
of violence can be tackled both preventatively and retrospectively.
With the growth of the field of forensic psychotherapy, we at last
have reason to be hopeful that serious criminality can be forestalled
and perhaps, one day, even eradicated.
122 EDITOR AND CONTRIBUTORS
2
3
4
5
6
7222
8
9
10
1
2
3
4
5222
6
7
8
9
20111 Gwen Adshead is a forensic psychiatrist and psychotherapist. She
1 has worked at Broadmoor Hospital as a psychotherapist since 1997,
2 and has been involved in setting up a number of therapeutic groups
3 as part of the Centralised Group Work Service in the hospital. She
4 is a member of the Institute of Group Analysis and is a Fellow of the
5 Royal College of Psychiatrists. Gwen has research interests in attach-
6 ment theory as applied to forensic work, and ethics in psychiatry;
7 she has co-edited three books and is working on two more.
8
9 Peter Aylward, before training in psychoanalytic psychotherapy, had
30 extensive experience in a forensic setting, and took the opportunity
1 to marry the two together to specialise in forensic psychotherapy at
2 Broadmoor Hospital, where he has worked for the past twelve years.
3 He also provides supervision to a wide variety of clinical teams
4 within the South London and Maudsley Trust (eating disorder, self-
5 harm, adolescent forensic, and personality disorder therapeutic
6 community), and in addition to supervising on the Advanced
7 Diploma Course in Psychodynamic Counselling at the Westminster
8 Pastoral Foundation (WPF) in Kensington, London, he also runs a
922 small private practice.

xiii
xiv EDITOR AND CONTRIBUTORS

Sarita Bose has worked in high security services for eleven years,
and is currently a nurse therapist in the Centralised Group Work
service in Broadmoor Hospital. She has a Masters’ degree in
Psychodynamics of Human Development from Birkbeck College and
a Diploma in Forensic Studies from the Portman Clinic.

Dr Julia Cartwright is Consultant Forensic Psychiatrist at

Oxfordshire and Buckinghamshire Mental Healthcare Partner-
ship NHS Trust, and works in the DSPD Progression Service at HM
Prison Grendon. She has experience of forensic psychotherapy in
high security hospital and prison settings, and has an interest in the
adaptation of psychological therapies for use with high risk
populations.

Ronald Doctor is a Consultant Psychiatrist in Psychotherapy and

Forensic Psychotherapy at the West London Mental Health NHS
Trust. He trained at the Tavistock and Portman NHS Trust, and is a
member of the British Psychoanalytical Society. He was formerly a
Visiting Psychiatrist at HM Prison Wormwood Scrubs. He is Chair
of the Association for Psychoanalytical Psychotherapy, Academic
Secretary of the Psychotherapy Faculty, Royal College of Psychia-
trists, and Hon. Secretary of the NHS Liaison Committee of the British
Psychoanalytical Society. He has edited a book: Dangerous Patients:
A Psychodynamic Approach to Risk Assessment and Management (Karnac,
2003).

Philip Lucas is Consultant Forensic Psychiatrist in Psychotherapy

in the North London Forensic Service. After higher training in
general medicine and nephrology and carrying out research leading
to an MD, he retrained as a psychiatrist, completing higher training
in forensic psychiatry and psychotherapy. He subsequently qualified
as a member of the Institute of Psychoanalysis, London, and has a
small private practice. He is currently treasurer of the Association
for Psychoanalytic Psychotherapy in the NHS and a member of the
NHS Liaison Committee of the British Psychoanalytical Society.
He has published and presented papers on a range of medical,
psychiatric and psychoanalytic subjects. His recent focus has been
on the application of psychodynamic thinking to patients with
psychotic illness and severe disturbance of personality.

xiv
 EDITOR AND CONTRIBUTORS xv

122 Maggie McAlister is a Jungian analyst and a member of the Society

2 of Analytical Psychology, London. She has worked in a forensic
3 setting for the past ten years as a drama therapist and more recently
4 as a psychotherapist. She also works in private practice.
5
6 Tony Maden is Professor of Forensic Psychiatry at Imperial College
7222 London and clinical director of the service for dangerous and severe
8 personality disorder at Broadmoor Hospital. His main research
9 interests are in the treatment needs of prisoners and forensic patients.
10 He is the author of Treating Violence, published by Oxford University
1 Press in 2007.
2
3 Anna Motz is a consultant clinical and forensic psychologist working
4 within the Thames Valley Forensic Mental Health Service, and Past
5222 President of the International Association for Forensic Psycho-
6 therapy. She is the author of The Psychology of Female Violence: Crimes
7 against the Body (Routledge, 2001), and has extensive experience of
8 working with both victims and perpetrators of violence.
9
20111 Gerald Wooster, before retiring from the NHS, was a consultant
1 psychotherapist at St. George’s Hospital, London, with special
2 responsibility for its work in groups. He is a psychoanalyst who has
3 also received psychiatric training at the Maudsley and Bethlem
4 Hospitals. He had a special interest in the university student
5 counselling field, and later in pioneering visits to drama events
6 followed by joint discussions. He has recently contributed to forensic
7 psychotherapy, and is particularly interested in the erstwhile
8 psychoanalytically neglected field of sibling order and the dynamics
9 associated with loss in his study of the Bible and Shakespeare,
30 also reflected in his parallel interest in using Matte Blanco’s ideas of
1 biologic.
2
3
4
5
6
7
8
922

xv
xvi
122 FOREWORD
2
3
4 Tony Maden
5
6
7222
8
9
10
1
2
3
4
5222
6
7
8
9

I
20111 abhor violence. The real thing—as opposed to the glossy
1 Hollywood version—has a unique power to disturb, so the
2 witnessing of even a single punch thrown in anger lingers in the
3 mind for years. So I can still recall vivid images of occasional violence
4 witnessed at school, when many other memories of that time have
5 been lost in the neurological soup. And I was at a good school, where
6 violence was a rare event and mild by any standard. Murder is at
7 the opposite end of the spectrum, so it is understandable that we are
8 tempted to shy away from the almost overwhelming horror it evokes.
9 The temptation takes many forms. In forensic mental health we
30 may assume that because a homicide arises from illness it must be
1 totally irrational and therefore impossible to understand. There is
2 no point wasting time and energy on impossible tasks, so we get
3 on with the business of treating the illness with chemicals. In busy
4 clinics, the pressures to treat and to fill in all the forms leave little
5 time for consideration of the patient’s internal world in anything but
6 broad-brush terms. The pressures are real, but we sell ourselves and
7 our patients short if we fool ourselves into thinking there is no more
8 to observe than whether delusions or hallucinations are present or
922 absent.

xvii
xviii FOREWORD

Most worrying of all, at the political level the profession is

retreating into a defensive stance which claims it is stigmatising to
draw attention to those cases in which the outcome of treatment
is violent death. It is crass to argue that we should trumpet our
successes and sweep failure under the carpet; no profession can
survive in the modern world with such a complacent and, literally,
mindless attitude.
So I am delighted to welcome this book, which shines a bright
light on a murky world. The contributors attempt to understand the
origins of murder, but they also deal with the detail of treatment and
show us how professionals are affected by powerful psychological
forces. The impartial detachment of the observer/supervisor is an
artificial construct, and once we realise that, we will be in a better
position to do the job properly. The approach is psychodynamic, but
there is plenty here to stimulate non-believers. In fact, the book is a
challenge to the world of cognitive behavioural therapy; there is more
to murder than relapse prevention. It made me think, and what more
can you ask?

xviii
122
2
3
4
5
6
7222 MURDER
8
9
10
1
2
3
4
5222
6
7
8
9
201
1
2
3
4
5
6
7
8
9
30
1
2
3
4
5
6
7
8
922

xix
xx
122 INTRODUCTION
2
3
4 Ronald Doctor
5
6
7222
8
9
10
1
2
3
4
5222
6
7
8
9

T
20111 his book is a sequel to the edited book Dangerous Patients: A
1 Psychodynamic Approach to Risk Assessment and Management. It
2 brings together clinicians who specialise in various aspects of
3 forensic psychiatry and psychotherapy in order to consider the
4 difficult and problematic issues of dangerousness and murder.
5 This particular volume places the emphasis on working in
6 psychodynamic psychotherapy with patients who have killed, in
7 order to gain a greater understanding of their internal world and
8 object relationships. I am proposing that entering into the intensity
9 of the clinical experience itself, meeting and facing the feelings
30 as they emerge within the microcosm of the transference and
1 countertransference, provides an “experience-based” opportunity for
2 therapist and patient to discover and explore the violence, both
3 conscious and unconscious, within a safe environment. The phrase
4 “evidence-based” has spread from medicine to psychiatry and now
5 to psychotherapy, but as a phrase, and in forensic psychotherapy in
6 particular, it resonates with the lawyer and the tribunal in us more
7 than the doctor or the therapist. The claim “evidence-based” seems
8 to brook no argument and dismisses all those activities, clinical
922 opinions and theoretical ideas which are not easily demonstrated or

1
2 RONALD DOCTOR

for which there is not yet sufficient evidence. This makes them seem
unreasonable, if not reprehensible. It is a phrase which supplies
a sense of authority in situations where uncertainty is a daily
companion, anxiety is high and needs are pressing (Britton, 2003).
The other aid to “experience-based” and personal knowledge in such
difficult situations is that a number of these chapters have arisen in
the context of workshops and supervisions, and it is the authority
of experience that is relied on.
When viewed from a psychoanalytical standpoint, even the most
apparently insane violence has a meaning in the mind of the person
who commits it. There is a need to be aware of this meaning and to
learn from it in an attempt to prevent further violence. One of the
objectives of this publication is to provide professionals working in
this field with a means of approaching the subject of extreme
dangerousness and murder with enriched understanding, in the hope
that the risks of violence in their patients may be reduced. However,
this is a demanding option which involves risk on various levels,
both physical and emotional. Being in the presence of a violent
patient induces enormous anxiety, and our thinking may become
impaired. There is a danger that our own emotional violence, when
faced with a violent patient, may threaten to undermine our self-
esteem and our sense of professional identity (Doctor, 2003).
The Oedipus complex has been recognised as the central conflict
in the human psyche—the essential group of conflicting impulses,
phantasies, anxieties and defences. If we consider the Oedipus myth
from the angle of the role played by the gods, we can follow this
process. The god Apollo has ordained that Oedipus would kill his
father Laius and marry his mother Jocasta. Laius’ only hope was that
Oedipus would not survive; Oedipus was delivered to a shepherd
with orders to abandon him on a mountain, but human compas-
sion—the antidote to cruelty—intervened and entrusted the child to
a Corinthian shepherd. After killing his father and marrying his
mother, Oedipus had to root out his father’s murderer, and pursued
this course with persistent vigour. The tragic revelation led to his
plucking out his eyes and his abandonment to cruel exile.
Thus the violence relates to a core phantasy that involves both
the primary relationship with the mother and phantasies about the
primal scene, i.e. the original act which created the individual. The
violence has the function of allowing the perpetrator to believe that

2
 INTRODUCTION 3

122 he can create a space in which he can survive in the face of an object
2 which is experienced as terrifying. Violence is thus a communication
3 about these patients’ belief systems about themselves, about their
4 relationships with others, and about their origins. The violent act or
5 phantasy tells a story which represents the patient’s personal myth
6 of creation, and contains both pre-oedipal and distorted oedipal
7222 theories. The function of the analytic process is to follow the chains
8 of associations as manifested and enacted in the transference and
9 countertransference, and to reconstruct the narrative of their origins.
10 What is needed is a structure or setting which can take the
1 patient to the crossroads of their beginning and to explore how, when
2 he is exiled from the family, the family is in turn exiled from the
3 past, the present and, until their tragic relationship is resolved, the
4 future. The analytic work is about discovering not the trauma of a
5222 singular catastrophe that can be overcome and healed, but a trauma
6 that involves the destruction of life itself. This creates a void, an
7 overwhelming emptiness in which the continuity of life and history
8 is so brutally disrupted that the structure of life is forever torqued
9 and transformed. The patient lives in a world where there is only
20111 darkness and nothingness, and fills this crack with sado-masochism
1 and psychosis in order to encapsulate his or her murderous rage.
2 With the help of psychotherapy there is the painful awareness of
3 the loss and the hope that the patient might begin to mourn his or
4 her loss.
5 The chapters in this book are concerned with the primitive forms
6 of the Oedipus complex, the combined parental figure, the role of
7 projective identification and primitive psychotic forms of the Oedipus
8 complex, and represent an enriched understanding of violence and
9 murder.
30 The first chapter by Gwen Adshead et al is set in a special
1 hospital and is concerned with group therapy for patients who have
2 murdered. Adshead argues that all homicides occur within the con-
3 text of a group (i.e. more than two people), be it the family, the gang,
4 the community, or society. As such, an understanding of the group
5 dynamics surrounding acts of homicide may help to answer the
6 question of why some people kill.
7 She describes how the process of group psychotherapy provides
8 an intense arena in which the forensic patient can be observed, as
922 well as one in which psychodynamic change may occur. We might

3
4 RONALD DOCTOR

therefore expect group psychotherapy to be an important treatment

modality in work with those who have killed, and question why such
treatment is not routinely offered. A possible reason for the lack of
published literature on group work with people who have killed
(especially those who have killed someone close to them) is that the
story to be written is essentially an incoherent one of contrasting
identities. On the one hand, these people are homicide perpetrators,
and this may be their own adopted defining identity. On the other
hand, they are also victims of trauma, who have been suddenly
and terribly bereaved. In a group context, they are people who are
simultaneously fearsome perpetrators and traumatized victims. One
of the tasks of group therapy is to integrate these two often polarized
aspects of the group and its members, and to pose the question: how
do you survive a disaster when you are the disaster?
Peter Aylward and Gerald Wooster explore the dynamics
surrounding the crime of murder. They believe that murder
represents the “solution” to feeling persecuted (feeling impotent
while under attack through being harassed, tormented and pursued)
by a threesome experience, i.e. in a three-person jealousy, in the
delusional belief that the resulting twosome will eliminate any
further feelings of persecution. The persecution is an intrinsic part
of an internal configuration, so that any external act of murder only
represents a momentary, perverse and ultimately ineffective solution.
It is their view that three-person jealousy is a critical feature in all
murder in that it represents externally the internal experience of the
perpetrator being killed off in a relationship he or she had with
another by the arrival of the third. By extension they postulate that
the persistent persecution resulting from having to accommodate
the third into a two-person relationship, particularly when the
subject has not yet digested the dynamics involved in the two-
person relationship, creates the environment for murderousness to
be triggered when external circumstances mirror or approximate
to such an internal configuration.
Anna Motz’s chapter proposes that unconscious rage and
murderousness can be stirred up in pregnancy, with its concrete as
well as symbolic invocation of the woman’s own attachment to
another. Unconscious forces may shape the desperate desire for
pregnancy (particularly acute in young women without an inter-
nalized sense of mother, or good internal object) as she strives to feel

4
 INTRODUCTION 5

122 filled up with something good and nourishing. This fantasy of

2 pregnancy as offering wholeness may consume her as she seeks
3 urgently to have a baby, to have someone who loves her, as she feels
4 so unloved, unlovable and unwanted. The narcissistic pleasure of
5 pregnancy, of the woman’s fantastic power, can become totally
6 removed from any genuine concern for or awareness of the separate
7222 and dependent creature within. While the fantasy of pregnancy offers
8 the dream of being filled up with a loving object that can provide
9 the maternal care of which she was deprived, its reality can create a
10 sense of persecution and ultimate disappointment. In pregnancy the
1 body of the woman is invaded, intruded upon, fought within
2 and fundamentally altered in order to enable another life to take
3 shape. The sense of wholeness and completeness that has been
4 wished for may actually become a sense of almost psychotic and
5222 paranoid engulfment. Women with difficulties in their own earlier
6 relationships with mothers in terms of separation and individuation
7 are likely to find this situation rather disturbingly different from their
8 conscious fantasy of pregnancy. The experience of giving birth to an
9 actual child, with its hungers and demands, may feel even more
20111 disappointing and persecutory. Rather than realizing a wish for love
1 and completeness, childbirth re-awakens earlier horrors of
2 deprivation, neglect and starvation. The bodies of children are not
3 seen as independent subjects in their own right, but as extensions of
4 the mother: if she has harmed herself, she may well extend this
5 damage to the child who represents her.
6 Maggie McAlister’s chapter deals with a patient in a regional
7 secure hospital who has paranoid schizophrenia and who killed two
8 victims. She highlights in her work with forensic patients a wish
9 on their part to erect powerful, projective defences against a part of
30 the self they cannot bear to know about, and the consequences of
1 this murderous projection to the ego. In normal usage, projective
2 identification takes place when an unwanted part of the personality
3 is projected into the object, and the object is then experienced in part-
4 object form as if it were the projected content. In a sense, what she
5 feels she is attempting to do with her patient is to enable him to
6 integrate an appropriate level of anxiety about his ongoing
7 dangerousness that has previously been unthinkable for him; yet
8 this is in powerful conflict with his own motivation for coming to
922 psychotherapy. The last thing he wants to do is get in touch with

5
6 RONALD DOCTOR

what he believes, in phantasy, he got rid of in his offences. This work

presents many challenges. In her countertransference she often felt
tired, bored, distracted and disengaged, mainly as a result of his
extreme concreteness. By creating a rigid structure which stops
creative thought both in his mind and between them in the sessions,
he creates a kind of murder zone which destroys anything that might
allow him to move on and progress.
Ronald Doctor’s chapter proposes that in most cases murder
occurs concretely only after it has been committed many times
previously in daydreams, nightmares, and sometimes in unconscious
fantasy that has never become conscious. Before the deed, conscious
efforts—sometimes unconscious ones too, both sado-masochistic
and psychotic—are designed and devoted to keeping the impulse to
murder encapsulated in order to prevent action. Then a sudden
reversal takes place internally which breaks the murderousness
loose from its cordoned-off status, and the energies of the individual
become devoted to enacting the murderous deed. The death
constellation always includes a psychically traumatic and indigestible
experience to do with loss and death.
In this chapter Doctor uses clinical material from two patients.
They sought refuge respectively in a psychotic and a sado-masochistic
retreat, and this made it difficult for them to mourn the loss of the
mother, to process their history of loss, and to negotiate the
depressive position. In their paranoid-schizoid states of mind the
death constellation became virulent, manifesting in their tendency to
maintain the attacks upon themselves by suicidal behaviour in which
they enacted the abused victim. Only with a life-threatening trigger,
displayed as the fear of death, do they enact their murderousness.
Philip Lucas’ chapter deals with a man who killed three people,
and describes how, by a particular use of projective identification,
the self identifies with idealized people, who are psychically held
“outside” so as to keep them away from the buried badness inside.
This is much less familiar than the experience, particularly in
borderline patients, of a split between good and bad, between the
idealized and the denigrated, in both the inner and the external
world. And it is less familiar than the projection outwards of badness
seen in paranoid patients.
What was distinctly unfamiliar about this patient was the
projection of idealized goodness, with badness internalized and

6
 INTRODUCTION 7

122 hidden. At the heart of the concept of projective identification is the

2 idea that the unconscious phantasy of one person can, via verbal and
3 non-verbal behaviour, give rise to emotional states in the recipient
4 of the projection which correspond to the original phantasy of the
5 first person. Thus the patient somehow contrived to induce in his
6 treating team the “belief” in his phantasy that he was not a killer,
7222 that he was in fact a nice, reasonable man. And somehow the
8 members of the treating team found themselves reacting to him
9 according to his phantasy, as if he were in fact innocuous.
10 As the narcissistic exoskeleton structure rigidly separating
1 internalized encapsulated bad and externalized goodness became less
2 effective or broke down, the patient became aware of aspects of
3 himself that he could not tolerate, such as neediness and rage, and
4 so suffered the painful loss of his idealized version of himself. And
5222 because of the longstanding rigid splitting, he has developed little
6 capacity to integrate these aspects of himself, so he experiences them
7 psychotically as coming from outside the self, as persecutory attacks.
8 The sequence of the killing begins with weakening of the
9 narcissistic exoskeleton, followed by its complete collapse, provoked
20111 by some particular trigger. The collapse of the defensive structure
1 involves a shift from identification with an idealized external version
2 of the self to identification with a previously buried, intolerably bad
3 version of the self. This latter is experienced as an unbearable
4 intrusion which threatens survival. In that moment the threat is
5 evacuated and projected into the victim, who is then experienced as
6 life-threatening. The final murderous attack represents an attempt
7 to destroy the threat, an attempt to annihilate the bad object, which
8 is at that point experienced concretely within the victim.
9
30
1
2
3
4
5
6
7
8
922

7
8
122 CHAPTER ONE
2
3
4
5
6
7222 Life after death: a group for people
8
9
who have killed
10
1 Gwen Adshead, Sarita Bose and
2 Julia Cartwright
3
4
5222
6
7
8
9
20111 “No one interrupts when the murderers talk.”
1 Paul Celan, Wolfsbuhne (1959)
2
3
Introduction
4

A
5 significant proportion of patients in forensic psychiatric
6 hospitals are admitted because they have killed someone.
7 Homicide is a rare event in the UK, with only 600 on average
8 recorded each year in England and Wales. This figure has remained
9 relatively constant over the last 30 years, since the abolition of capital
30 punishment, implying that of the 60 million people who live together
1 in the UK, fewer than 1000 will die each year as a result of murder
2 by another.
3 Such rare events are inevitably complex and multi-determined.
4 If we accept the psychoanalytic position that all of us (consciously
5 and unconsciously) have murderous impulses that we can sometimes
6 struggle to contain, then the question becomes: why is homicide so
7 rare? Most of us will never kill anyone even though we have these
8 murderous thoughts, so what made these people cross the line from
922 fantasy to reality? There is an urgent need to find an answer to this

9
10 GWEN ADSHEAD, SARITA BOSE AND JULIA CARTWRIGHT

question: for the therapist, the public, the perpetrator, and the
victim’s family.
There is equally an urgent existential problem for the perpetrator:
how do I live now that I have done this? How do I think about myself
in relation to others? What identity can I let myself have? In this
chapter we discuss how members of a psychodynamic group for
people who have killed approach these questions. This group has
been running for a year in a high security psychiatric hospital, as
part of a centralized group work programme offering a range of
different psychological group interventions for patients in the
hospital.

Beyond words: a review of the literature on groups

and homicide
All homicides occur within the context of a group (i.e. more than
two people), be it the family, the gang, the community, or society.
As such, an understanding of the group dynamics surrounding acts
of homicide may help to answer the question of why some people
kill. However, review of the offender treatment literature reveals a
marked lack of published material on group work with homicide
perpetrators. Instead, most of the published literature on group
therapy and homicide is concerned with group therapy for those who
have been bereaved by homicide.
Cox (1976) describes how the process of group psychotherapy
provides an intense arena in which the forensic patient can be
observed, as well as one in which psychodynamic change may occur.
We might therefore expect group psychotherapy to be an important
treatment modality in work with those who have killed, and question
why such work is not routinely offered. One reason could be that
society, as a large group, views victims as more deserving of help
than perpetrators, and finds it easier to empathise with the victims
than to be put in touch with its own murderousness. There may also
be a belief that forensic populations in general are not amenable to
group therapy. People who have killed a parent tend to isolate and
alienate themselves within institutions, and this may be seen as a
contraindication to group work (Hillbrand & Young, 2004). Stein and
Brown (1991) argue that the personality characteristics of forensic
patients inhibit group-mediated change, regardless of the patients’

10
 LIFE AFTER DEATH: A GROUP FOR PEOPLE WHO HAVE KILLED 11

122 diagnosis. From their observations of group psychotherapy in

2 medium and minimum security settings, they conclude that psychic
3 change was hindered by the inability of patients to form a cohesive
4 group or to develop positive group dynamics such as altruism, trust,
5 or a sense of universality. Finally, there may be an anxiety about what
6 feelings might arise out of a pooling of homicidal experiences
7222 (Schlabopersky, 1996).
8 Another possible reason for the lack of published literature on
9 group work with people who have killed (especially those who have
10 killed someone close to them) is that the story to be written is
1 essentially an incoherent one of contrasting identities. On the one
2 hand, these people are homicide perpetrators, and this may be their
3 own adopted defining identity (Hillbrand & Young, 2004). On the
4 other hand, they are also victims of trauma, who have been suddenly
5222 and terribly bereaved. In a group context, they are people who are
6 simultaneously fearsome perpetrators and traumatized victims. One
7 of the tasks of group therapy is to integrate these two often polarized
8 aspects of the group and its members, and to pose the question: how
9 do you survive a disaster when you are the disaster?
20111
1
Group work for survivors of homicide
2
3 Klein and Schermer (2000) define trauma as “an earth-shattering
4 intrusion and disruption that is difficult to assimilate into ordinary
5 consciousness and discourse”. The DSM diagnostic criteria for post-
6 traumatic stress disorder (PTSD) include a defining criterion for
7 traumatic events, namely that they include the experience of witnes-
8 sing injury or death of another, and the experience of intense fear
9 and helplessness (APA, 1994). Empirical study has shown that some
30 traumatic events are psychologically so stressful that they overwhelm
1 the individual’s capacity to manage his or her own distress, and result
2 in psychiatric illnesses of various sorts, which require and respond
3 to psychiatric treatment, including group therapy.
4 The capacity to overcome trauma is dependent upon a number
5 of factors, including the experience of previous victimization,
6 particularly in childhood (Adshead & van Velsen, 1996). A high pro-
7 portion of patients within high secure settings have been the victims
8 of childhood trauma (Coid, 1992) and are therefore potentially more
922 vulnerable to the effects of further trauma. However, there is some

11
12 GWEN ADSHEAD, SARITA BOSE AND JULIA CARTWRIGHT

debate as to whether doing violence to another person is traumatic

in the sense described above. The DSM criteria would require
evidence of intense fear and helplessness, which is not commonly
described by perpetrators at the time of the offence. On the other
hand, there is some limited evidence that killing another person is
traumatic, especially if the killing takes place in a grotesque or
socially unacceptable way, such as military atrocities (Haley, 1974),
or if the victim is psychologically important to the perpetrator
(Papanastassiou et al, 2004). Perpetrators of homicide can develop
PTSD, pathological grief and clinical depression in relation to their
offences, and will require treatment for these conditions.
Most information on the psychological needs of those traumatized
and bereaved by homicide comes from the study of secondary
victims of homicide, i.e. parents, partners, siblings and children of
those who have been killed. Rynearson (2001) describes the reactions
of family members to a violent death, and suggests that a particular
problem for survivors is that their story is an incoherent one which
cannot contain the simultaneous drama of killing and caring. He
describes three phases of the distress response in those traumatized
by a violent death. The first response is avoidance, where the death
is acknowledged but grief and distress are denied. This is then
followed by a conflict between trauma distress, which is associated
with intrusive re-enactment fantasies and fear, and separation
distress, which is associated with longing and searching. Rynearson
describes the value of group therapy for those bereaved by homicide,
emphasizing the therapeutic effects of universality, altruism,
vicarious learning and cohesiveness for people who are both grieving
and frightened.
Brunning (1982) comments on the similarity of psychological
responses between those who have killed and those who have been
bereaved by a killing. In describing a group he ran for male prisoners
who had killed someone close to them, he reported that the men went
through an initial stage of disbelief, reliving the trial “in the manner
of the bereaved who go through repeated circumstantial accounts”.
He also described a denial phase, where the victim is thought of
as being still alive, and a depressive phase characterized by social
withdrawal and an unwillingness to identify with other prisoners.
He found, however, that cohesiveness was stronger in this group
than in other groups he had conducted, although it was slower to

12
 LIFE AFTER DEATH: A GROUP FOR PEOPLE WHO HAVE KILLED 13

122 develop. Similarly, Hillbrand and Young (2004) have described how,
2 in a psychodynamic group intervention for psychiatric patients who
3 had killed their parents, members of the group benefited from the
4 therapeutic effects of universality and the instillation of hope, and
5 did experience meaningful group-mediated change, especially a
6 reduction in feelings of alienation.
7222 Garland (2003) has written about the impairment of fantasy and
8 symbol formation in traumatized individuals. Fantasy and symbol
9 formation are crucial steps in the regulation and modulation of
10 negative feelings, because they are part of the unconscious cognitive
1 processes whereby emotions (which are largely unconscious) are
2 transformed into conscious feelings (Damasio, 2000). This transfor-
3 mation takes place at the boundary between the internal reality of
4 the individual and the external reality of the group(s) to which he
5222 or she belongs. Thus symbolic capacity is an essential feature of the
6 total capacity both to monitor reality and to manage negative
7 emotions by transforming them from the unspeakable into something
8 that can be communicated in the external world. If, as Garland
9 suggests, trauma impairs symbolic capacity, then this should result
20111 in trauma survivors experiencing memory problems and communi-
1 cation problems; this is in fact the case. Trauma survivors do
2 experience real problems in putting their experiences into words,
3 and do struggle with unregulated memories and emotions, especially
4 fear and anger. These are the symptoms which are therefore likely
5 to be present in any traumatized group of people and may make the
6 group process more complicated to manage. In such patients, failure
7 of symbolization and an inability to express their feelings in words
8 leads to the acting out of violent impulses and the enacting “on an
9 external stage what takes place internally in the mind of everyone”
30 (Foulkes, 1990).
1 Klein and Schermer (2000) have written about the countertrans-
2 ference responses of therapists working with groups of traumatized
3 people. He described such countertransference as being on a
4 continuum between primarily irrational personal conflict in the
5 analyst and a sense of disruption and turmoil that would be
6 normative and expected, particularly as the therapist becomes a
7 “witness” of recollected and re-enacted catastrophic events, and
8 experiences “vicarious traumatization” and vicarious grief. Ideally,
922 the therapist should be able to “work with” rather than “detach from”

13
14 GWEN ADSHEAD, SARITA BOSE AND JULIA CARTWRIGHT

his or her countertransference feelings and to sustain a sense of being

alive through the experience, thus surviving and transcending the
inner trauma whilst manifesting the ability to contain his or her own
and the group’s emotionality. This requires a “sensitive navigation
between internal containment through self-reflection and genuine
emotional experience judiciously self-disclosed”. Unsurprisingly,
Schermer has highlighted the importance of a co-therapist and/or
experienced supervisor when working with traumatized groups.

Homicide and group analysis: “killing in the group, of the

group, by the group . . . including the conductor”
This famous quote by Foulkes about group process has been crucial
for us in understanding the dynamics of a group for men who have
killed. As described above, we can understand the group members
as people who have been traumatized and bereaved, and appreciate
how this affects the group process. We also have to keep in mind
that the group members are also perpetrators of cruelty and
destructiveness, and this experience is also likely to be manifested
in the group process in recognisable ways.

Killing in the group

Rage, anger and hostility are common factors in all therapy groups,
but the conscious expression of such aggressive feelings is often
defended against (Ormont, 1984). Group members may cover their
hostility towards each other (or the conductor) with silence,
intellectualisation, or by indirect manifestations of rage such as
withdrawal or distress. In patients whose extreme rage has once been
enacted in the form of taking a life, there may be a justifiable fear
that to experience rage will result in killing whoever provoked it.
Rage towards other group members, and particularly towards the
therapist, may be enacted within the group by ignoring the therapist
or by non-attendance. New members generate rage in the form of
sibling rivalry with the new “baby” who joins a family. Therapist
absences provoke the rage of rejection, abandonment, deprivation
and jealousy. The therapist’s role is to help these patients find words
for their rage, and guide the group into helping its members elaborate
their feelings, uncouple them from actions, and thereby give access

14
 LIFE AFTER DEATH: A GROUP FOR PEOPLE WHO HAVE KILLED 15

122 to real emotions which, once contained and expressed in the reflective
2 language of feelings, can be understood and resolved (Ormont,
3 1984).
4
5
Killing of the group
6
7222 Nitsun (1996) formulated the concept of the “anti-group” to describe
8 the destructive aspect of groups which threatens the integrity of
9 the group and its therapeutic development. The anti-group may be
10 located within a particular group member who may, for example,
1 drop out of the group, having been unconsciously selected by the
2 group to enact the group’s rage. Alternatively, the anti-group may
3 be located in the wider institution, and may be expressed as attempts
4 to sabotage the running of the group.
5222 Nitsun saw the anti-group as being constructed of the fantasies
6 and projections of its members. The early group, because it is not
7 yet an integrated unit, is seen as a weak or dangerous container,
8 which provokes anxiety and attack. This attack further weakens and
9 fragments the group, which invites attack, and so a vicious circle
20111 begins. The ultimate expression of the anti-group is to destroy the
1 group, but this rarely happens as there is often sufficient good
2 projected onto the group to counteract the destructive forces.
3
4
Killing by the group
5
6 Outside war, killing by groups occurs most often in the context of
7 the gang. Williams (1998) describes the dynamics of gang structure
8 as authoritarian, strictly stratified into a pecking order, and based
9 on power principles. Gangs are often made up of individuals who
30 feel mistreated by others and have little sense of responsibility or
1 connection to wider society. The gang thus constitutes an “in-group”
2 which views society as the “out-group”, which is both adversarial
3 and persecutory. The humanity of members of the “out-group” is
4 denied, allowing brutality to take place. Gangs regulate negative
5 feelings almost entirely by projecting them into an “other” (“out-
6 groups”, rival gangs or victims), and then destroying them. Any
7 expressed feelings of compassion, conscience or a tendency to
8 compromise with others are regarded as a threat to the security of
922 the gang, and are dealt with harshly and often violently. In a study

15
16 GWEN ADSHEAD, SARITA BOSE AND JULIA CARTWRIGHT

of gang homicides, Decker and Curry (2002) found that homicides

occurred more often within gang factions than between them. By
killing “weaker” group members in this way, the group maintains
cohesion at the expense of coherence (Adshead, 2002).

Including the conductor

Working with groups for people who have killed necessitates regular
supervision and attention to the strong countertransference that can
be evoked. The members of the group have at least on one occasion
acted out the universal fantasy of fatal destruction, and if serious
destructive behaviour has occurred once, there is no theoretical
reason why it should not occur again (Cox, 1976). The therapist may
not only fear further destructive acting out by the group, he or she
may also be put in touch with his or her own murderous feelings.
These may then manifest as a wish to kill off the group. Murderous-
ness in the therapist may also manifest itself as a reaction formation,
with extreme attachment to group members, denial of their capacity
for cruelty, and attacks on anyone who appears to threaten the group
(Lanza, 1999).
The therapist has to work with this discomfort, and be prepared
to relinquish the defences that usually make working with offenders
in prisons or secure hospitals survivable for the majority of staff
(McClure, 2004). Such groups are therefore potentially exhausting
for the therapist, and exacerbate the vicarious traumatization
described above. Understanding both positive and negative feelings
towards the patients has been an essential part of the supervision
space.

Restorative justice: uniting the victim and the perpetrator

In reviewing the literature on groups for both victims of trauma and
those who have killed, a number of common themes emerge. Firstly,
the impairment of symbolization and the inability to use language
to express feelings is common to both groups. In people who have
killed, it may be that early victimization and traumatic experiences
have impaired symbol formation, leading to the acting out of
impulses, at least one of which has led to the committing of homicide,
further traumatization and further breakdown of symbolic function.

16
 LIFE AFTER DEATH: A GROUP FOR PEOPLE WHO HAVE KILLED 17

122 Thus a common focus of group work for both the perpetrator and
2 the traumatized victim would be to prevent any further damage to
3 the symbolic capacity, and perhaps to try and facilitate the
4 regeneration of symbolic functioning by the provision of reflective
5 space in which to name and reflect on emotion. Secondly, in both
6 groups there is evidence of the importance of “ordinary” group
7222 therapeutic factors such as universality, instillation of hope and cohe-
8 siveness. Thirdly, for both groups the importance of attention to
9 countertransference and the need for supervision cannot be over-
10 emphasized.
1 By highlighting these common themes, the polarized split
2 between perpetrator and traumatized victim becomes less marked,
3 and the possibility of working with and bringing together both
4 aspects of these individuals is created. As with the restorative justice
5222 movement which aims to bring together the victim and perpetrator
6 to create an understanding of the crime in the context of the lives
7 of the individuals, so the bringing together of the “victim” and
8 “perpetrator” parts of those who have killed, in the context of each
9 as a whole individual, may help to create a sense of coherence from
20111 an otherwise incoherent story. We now want to describe another
1 aspect of incoherence, which relates to the relationship between the
2 group and the institution.
3
4
The larger group: forensic institutions and
5
organizational acting out
6
7 Institutional and wider social factors can have a significant impact
8 upon trauma groups, and it is impossible to consider group psycho-
9 therapy as an isolated therapeutic exercise (Cox, 1976). Benson (2005)
30 has described how trauma within the social context of the group can
1 impact upon group processes, with parallel processes being played
2 out in the group, highlighting the need for the therapist to take into
3 account the social realities of the wider setting. Traumatic experiences
4 are often a reality of life within the high security hospital in which
5 the group takes place. In reality, all groups for perpetrators of serious
6 violence are likely to take place within some kind of secure
7 institution, so therapists need to understand how the dynamics of
8 their therapeutic work interact with the dynamics of personal
922 relationships within the institution.

17
18 GWEN ADSHEAD, SARITA BOSE AND JULIA CARTWRIGHT

Context
All the patients in the group are detained in a high security hospital
for offenders with a diagnosis of mental illness, personality disorder,
or both. For many patients, their current psychological distur-
bance can be understood as the long-term sequelae of trauma and
childhood adversity, to a degree rarely experienced outside in the
community. They have commonly experienced a combination of
neglect, emotional, physical or sexual abuse, loss or abandonment,
and inconsistency of care. Hearing from the patients themselves
or reading about their histories is very distressing; it is sometimes
difficult to comprehend how one human being/infant/child
enduring so much pain and suffering could actually survive.
As a consequence of their traumatic experiences, the patients’
emotional and personality development has been severely impaired.
Patients’ internal worlds are fragmented and/or un-integrated, and
they utilize very primitive defence mechanisms to manage their
feelings. These patients appear to be emotionally and psychologically
stuck, functioning at pre-verbal or very young levels of psychic
human development. The role of the staff of forensic institutions is
to both physically and psychologically contain the patients’ capacity
for destructiveness, without becoming destructive themselves.
What is perhaps most alarming about this patient group is their
capacity to act out so that cruel or murderous fantasies do not
stay simply in their internal world. Managing this risk is the primary
task that unites approximately 1200 employees. However, the
nursing staff and other therapists also have to attend to the patients’
therapeutic needs and care for them in the traditional role of health
professionals. Nurses especially may then find themselves caught
between the conflicting demands of containing the patients and
caring for them (Aiyegbusi, 2003).
Most therapy takes place off the wards. The homicide group
described here is a new venture for the centralised group work
programme (CGP), which provides a wide range of group therapies
in the hospital. All patients can be referred to the unit for treatment.
The Consultant Psychiatrist (RMO) of each ward makes referrals for
any of their patients, in collaboration with their clinical team. The
unit has been open for two years, and is managed jointly by a Clinical
Nurse Manager (CNM) and a Lead Psychologist. The facilitators or

18
 LIFE AFTER DEATH: A GROUP FOR PEOPLE WHO HAVE KILLED 19

122 group therapists come from a wide range of professional disciplines.

2 They volunteer to allocate a regular period of their working week to
3 commit to running a group on the unit with other staff.
4 The beginning of a new group is an anxious time for both
5 therapists and new group members, like the birth of a first baby.
6 Anxieties in the therapeutic space within institutions may well be
7222 played out in the relationship between the therapists and the
8 institution. We will describe a series of events in relation to our
9 group, and discuss them in the context of the group’s relationship
10 to the institution. We have not used the real names of anyone
1 involved except for the authors.
2
3
Resistance: the absentee patient
4
5222 All assessments for each patient had been completed prior to the
6 group beginning. One patient, Bill (who had killed his mother), had
7 been referred and accepted for the group. However, in the days prior
8 to the first session, Bill’s clinical team became anxious about his
9 attendance, first saying that he could come and then retracting this.
20111 Consequently, at the first session we were pleasantly surprised to
1 find that Bill had attended, believing that this was the final decision
2 of the team.
3
4
Trouble and strife: Bill’s second session
5
6 What follows is a narrative account of an interchange between one
7 of the therapists (SB) and other ward staff. This account is presented
8 by SB in the first person, for clarity.
9
30 Prior to the group beginning its second session, Jenny, one of
1 the CGP staff, received a phone call from Claire, an F grade
2 nurse who has worked on Bill’s ward for many years. Claire
3 demanded to know why Bill had attended the homicide
4 group the week before, as she did not want him to attend and
5 she had told staff so the previous week. Jenny felt verbally
6 attacked by Claire. Jenny non-verbally gestured for me to
7 remain near her while she told Claire that Bill’s RMO had
8 agreed his attendance last week, just prior to the first session.
922 Jenny then swiftly transferred the telephone to me, rolling her

19
20 GWEN ADSHEAD, SARITA BOSE AND JULIA CARTWRIGHT

eyes and sighing with relief. I took the phone, now feeling
slightly anxious.
Claire: “What I want to know is what happened in last week’s
group . . . You do know what happened here, don’t you?”
I felt her to be slightly intrusive and demanding.
SB: “Yes, Jenny just informed me.”
Claire: “Yes, well, he self-harmed last week in the afternoon.
He said that it was because of the homicide group that
morning. What I want to know is what you talked about
. . . [she did not give me time to answer] . . . I mean I
presume you talked about ground rules, did introductions
and talked about what the group was about.”
SB: “Yes, that’s correct.”
Claire: “Well, I don’t think he should go to this group. It’s too
much for him. I did say so, and really he shouldn’t have
gone last week. He already attends two groups on our
ward and is struggling with them. Your group on top is
too much for him.”
I felt this was said in an apparently caring and non-angry way,
which also felt patronizing.
SB: “I was wondering what Bill thought of all this?”
Claire: “Oh, he wants to attend your group, but I think it’s
too much for him.”
I then attempted to voice my opinions on why he should
continue to attend the group. However, she continued to
counter my thoughts with “I still think it’s too much for him”
or “It’s a wider issue”.
We finished this conversation with her suggestion that she
would talk to Bill again before the group started this morning.
At this point my co-facilitators appeared and I relayed my
telephone conversation to them. They thought of more reasons
for him to attend. I initially asked my co-therapist GA, who
is a consultant psychotherapist, to ring Claire back, but after
some discussion we agreed that I would ring her back as I
had spoken to her earlier and the discussion should remain
within the same professional group. GA decided to ring Bill’s
RMO (a fellow doctor), knowing he was in support of his
20
 LIFE AFTER DEATH: A GROUP FOR PEOPLE WHO HAVE KILLED 21

122 patient’s attendance. However, he was not on duty until

2 10 a.m., when the group was due to start. We also tried the
3 ward’s more senior nurse, but he was also not available until
4 10 a.m. This left the decision to Claire as junior manager on
5 duty. I rang Claire back 6–7 minutes after our previous
6 conversation. I felt increasingly anxious about speaking to her.
7222 SB: “Claire, I’m not meaning to add pressure to your decision,
8 but there were a couple of points I wished to discuss before
9 you decide about sending him or stopping him from
10 attending this morning . . .”
1 Claire: “It’s too late; I’ve already told him that he can’t go to
2 your group this morning, until we have discussed it at the
3 clinical team meeting on our ward this morning.”
4
SB: “What did he say?”
5222
6 Claire: “Well, I told him he couldn’t go today and he said that
7 he wanted to, but I explained that I thought it was best for
8 him to stay today until we’ve discussed it.”
9 I finished the conversation by asking her to get back to me
20111 after the meeting. She assured me she would. I was left feeling
1 even more angry, frustrated and irritated. I felt she had not
2 listened to any of my points in either conversation or prior to
3 the first phone call with Jenny, and that she had already made
4 up her mind not to send Bill to therapy. Added to my anger,
5 I felt our planning time for the group had been wasted. In the
6 post-group debriefing, all three co-facilitators expressed their
7 fury at this situation.
8
9 What’s going on? Organisational dynamics
30
1 To understand what happened between our group and Bill’s clinical
2 team, we drew on the application of psychoanalytic thinking to
3 large groups and institutions. All individuals, in any organisation,
unconsciously invest in generating policies, procedures and “ritual”
4
practices that serve to defend against and contain their uncon-
5
scious (and conscious) work-specific and individual anxieties
6
(Hinshelwood, 2001). These structures, procedures and practices
7
enable the system as a whole to encourage and support each
8
individual in avoiding such anxieties and conflicts as are unbearable
922
to experience consciously.
21
22 GWEN ADSHEAD, SARITA BOSE AND JULIA CARTWRIGHT

Menzies Lyth (1989) describes how staff in medical institutions

struggle to contain feelings of despair and hatred of the patients, and
the “socially structured defence system” they use in that struggle.
There are real questions about the extent to which forensic institu-
tions experience particular anxieties that make the task of caring even
more difficult (Hinshelwood, 2000). We believe that working with
people who have perpetrated homicide and cruelty generates a very
powerful work-specific anxiety which affects everyone (staff and
patients) to different degrees. This anxiety combines with the staff’s
individual anxieties, and emerges as conflicts of envy, jealousy,
helplessness, rivalry, omnipotence, murderous rage, guilt, and so on,
in the staff groups. In turn, this generates a potentially physically
and psychologically toxic environment in which to work and reside.
One way that patients unconsciously re-enact abusive situations,
be it on themselves or others, is by attempting to force the nurse into
the position of their victim or perpetrator. All staff are therefore
exposed to patients’ anxieties, which they are expected to contain
because the patients’ immature defences cannot do so. However, the
institution as a whole functions as a container for social (large group)
anxieties, and so the staff have to hold and defend against the fear
that tragedy will occur and they will be blamed. The fact that this
fantasy has been enacted in various homicide inquiries only serves
to increase the fear. This then raises the question of the staff’s own
defences against intolerable negative affects and fears, the state and
nature of their own defences, and how they mirror those of the
patient and the institution (Sarkar, 2005).

Bill, Claire and the group

There are several interpretations of the dynamics around Bill’s non-
attendance. In his own particular story, there is reason to believe that
his mother split off from her consciousness her son’s dangerousness
and aggression towards her. There is evidence that she was not
psychologically available to him, either in his infancy (because of her
own traumatic life experiences and psychopathology) or later in his
adolescence, when he began to act out violently. She may not have
been consciously aware, through the defence of denial, that he was
psychotic, and indeed dangerous, for most of his teens. Rather, she
was (like Claire) in touch with his vulnerability. However, the RMO
(like Bill’s father) seemed to be aware of Bill’s dangerousness, but

22
 LIFE AFTER DEATH: A GROUP FOR PEOPLE WHO HAVE KILLED 23

122 could not act to contain it. Bill’s father and mother could not connect
2 over his need for treatment and containment, just as the RMO, Claire
3 and the therapists could not connect.
4 An individual re-enactment for Bill was mirrored and amplified
5 in the relationship between the group and the clinical team. Bill’s
6 anxiety about (and enjoyment of) his own cruelty was projected
7222 into the team and split between members of that work group. We
8 then, in the therapy group, mirrored the split in the clinical team.
9 What was apparently a specific work anxiety to nurses (and other
10 professionals) was also an expression of the patient’s anxiety. Bill
1 seems to have projected split off parts of himself into the immediate
2 ward nursing staff. This generated a split in the staff, who now divide
3 into those who can’t bear to think about Bill’s murderous rage
4 (mother) and those who can (father). It appears that this process
5222 culminated in the team refusing to send Bill to the group when a
6 week earlier they had agreed to send him. This indicates a real
7 incoherence in the family of the team.
8 These unconscious projections of work-specific anxieties are
9 then acted out between the ward team and the therapy team. This
20111 work anxiety mirrored our own anxieties about being ignored and
1 belittled, and our fears that our newly-born group was under threat.
2 We found ourselves feeling angry and contemptuous, experiencing
3 an omnipotent attitude that we can provide effective treatment,
4 but “they” (less competent others) are preventing it. After reflection
5 and supervision, we could hear Claire’s concerns about Bill’s
6 vulnerability, and then work together with the clinical team to
7 ensure that both his vulnerability and his risk to others are as well
8 contained as possible by the group.
9 We also became aware that at a wider organizational level there
30 were plans from senior management to close Claire’s ward down.
1 The ward team was literally facing being “killed off” in its current
2 form. Historically, this ward had enjoyed high praise and recognition
3 for their full in-house group work programme, which was run as
4 part of the patient’s daily routine. One could understand Claire’s
5 difficulty in letting Bill attend a group off the ward in terms of her
6 unconscious anxieties of helplessness, envy and rage that another
7 group was taking away her “work life”. These anxieties were then
8 manifested in an attack on the unit’s group work by preventing her
922 patient from attending.

23
24 GWEN ADSHEAD, SARITA BOSE AND JULIA CARTWRIGHT

In this situation, much confusion was generated by the leaders

of teams. Leaders avoid or abdicate responsibility as a way of dealing
with anxiety about the burden of responsibility and guilt if anything
goes wrong (Hirschorn, 1997). Projected anxieties from the people
managed by the leader intensify the leader’s anxieties. In this case,
Claire made the active decision to prevent Bill’s attendance, but she
utilized a social structural defence of abdication of responsibility
(Menzies Lyth, 1988), in that she deferred the decision to the clinical
team meeting. She used this protocol to defend against her own
unconscious anxieties inherent in making the decision.

Killing off the group

Through researching this paper we have become more consciously
aware of the enormity of the primary task of creating a therapeutic
group, in this institution, for people who have killed. There seems
to be both a conscious and a deeply unconscious defence and
resistance to this group. The work-specific anxiety of aggression and
murderous rage will inevitably need to be psychologically defended
against (significantly due to its intensity) by such social systems as
creating confusion, abdicating or avoiding decisions, and use of
rituals and protocols such as clinical team meetings. Individuals
involved in the work (including myself) will also have their own
unconscious and conscious anxieties, phantasies and conflicts about
meeting their own aggressiveness and potential for murderous rage
in the patients.
There were many attempts to “kill off” the group between its
conception and the day of the first session. Consequently, it is not
surprising that in the second session, unconscious re-enactments
of “killing off” have already emerged. Murderous rage, and the
anxieties and conflicts this creates, have been demonstrated at every
level of the organization, starting with Bill’s deeply unconscious
aggressive phantasies and anxieties; in Claire “killing off” his
treatment; in the clinical team’s lack of decision-making due to
unconscious aggressive phantasies about the patient and whether this
can be safely contained; and at an organizational management level
by generating anxiety in the staff that their ward is going to be “killed
off” by closing it down. We could not have managed these anxieties
without regular clinical supervision to act as a container for our

24
 LIFE AFTER DEATH: A GROUP FOR PEOPLE WHO HAVE KILLED 25

122 feelings and as a “witnessing third party” (Aylward & Wooster, this
2 volume).
3 All these different perspectives can be generated in the under-
4 standing of just one telephone conversation. This suggests that it is
5 vital to pay attention to the language used in the therapy of offender
6 patients. In the next section, we describe how incoherence of thought
7222 is expressed in the language of the group.
8
9 Crossing the line: the language of the group
10
1 One of the intriguing technical questions for group therapists
2 working with “special” groups is to what extent the material of the
3 group could be found in any psychodynamic group (anxieties about
4 deprivation, competition, basic assumptions, resistance), and how
5222 much seems specific to the psychological task. In this homicide
group, there is a real danger that the therapists will be so preoccupied
6
with the murderous material that they will miss the ordinary stuff
7
of group discourse that needs to be reflected on. If they fail to
8
interpret ordinary group process, then there may not be sufficient
9
group matrix to hold the group together, and something or someone
20111
will be missed or lost to the group. This in turn may be experienced
1
as a type of “killing off”.
2
After each group, we keep process notes that serve as the basis
3
for this discussion. We have concentrated on the metaphors and
4
process, not the individuals; however, in general terms it may be
5
helpful to know that the group consisted at the start of seven men:
6
Brian, Bill, Sam, David, Patrick, Robin and Charles. Brian, Robin and
7
Patrick all killed a partner; the other members all killed parents or
8
step-parents. The men range in age from 26 to 65.
9
Two group members, Patrick and Robin, are still actively
30 psychotic, whereas Sam and Bill are not. Patrick is virtually silent;
1 attempts to explore this with him and in supervision have so far
2 proved inconclusive. Robin has been unwell since the group began.
3 Bill is a frequent absentee compared to the others, although he seems
4 to have made a good engagement with the group in other ways. He
5 is still the focus of a certain amount of institutional acting out. Two
6 people have left the group: Charles, who said that the group was no
7 help to him, and left after six months, and David, who had a planned
8 departure from the group at nine months, when he was transferred
922 to another hospital.

25
26 GWEN ADSHEAD, SARITA BOSE AND JULIA CARTWRIGHT

In the beginning . . .
There was a great deal of tension and fear at the start of the group,
as expressed by the acting out in terms of attendance. Brian never
came back to the group after the first session, and there was another
man (Isaac), who was meant to join when he recovered from a back
problem, but never did. Bill would often just not come, sending a
message that he “could not be bothered to get out of bed”. We
interpreted this as partly a reflection of the enormous anxiety about
what might happen in the group, and what the group members
thought we might expect of them.
The material in the early stages indicated a great deal of paranoid
anxiety. In any new group, anxiety is both expected and under-
standable, but in this group, the anxiety was connected with death
and destruction. The first time one of the three facilitators was away,
Robin said: “I wonder how we’d all feel if, because of what we’d
done, something happened to the therapist.”
One session was dominated by discussion of the “Big Brother”
TV programme. The links with the group were all too clear: a group
of people trapped together in a situation, being observed all the time
by unseen critical forces who set them impossible tasks. There were
references to “sadistic producers winding people up”, and to the
therapists putting thoughts into the heads of the members. We made
the link with ourselves, but also linked the material with the
experience of group members that being “made” to think horrible
things (for instance by illness or by drugs) had led to fatal violence.
We also responded to the view often expressed at the start that
no-one could understand their experience, that we were too young
or inexperienced, that it was too traumatic, that we would patronize
them or use what they said against them. We sometimes struggled
to separate out what was neurotic anxiety, and ordinary resistance
to the analytic process, from the reality that we had not been through
what they went through, and it might be the case that there were
some things in their minds that could not be understood.

The words to say “it”: metaphors and films

Perhaps because of the anxieties present in the group about the
dangers of articulating their thoughts, the group has made repeated

26
 LIFE AFTER DEATH: A GROUP FOR PEOPLE WHO HAVE KILLED 27

122 use of film and TV experiences as a basis for discussion. We have

2 tried to use these as metaphors that help to develop the emotional
3 vocabulary of the group, especially around fears of destructiveness
4 and alienation.
5 One film discussed early on was “Scanners”; a story, in which
6 ordinary people are affected by alien thoughts that get into their
7222 heads and make them explode. The next film discussed repeatedly
8 by Robin was “Zardoz”. This was also about heads; in this case a
9 huge disembodied head that flew round the Universe on a quest of
10 some kind. Each time Robin has brought this film to the group,
1 something new emerges from the material, and in this sense the film
2 acts like a dream that might be brought into an ordinary analytic
3 session by any patient. We have wondered, however, whether films
4 and TV are especially helpful communication devices for people who
5222 have either lost or never acquired the capacity to put feelings and
6 experience into symbols or words. The metaphors represent an
7 object of constancy in their lives over which they are in total control;
8 they also provide something that can be shared and “played with”,
9 in Winnicottian terms.
20111 The film “Zardoz” is poignant, as Robin describes it, because the
1 name itself is only a fragment of a much bigger word, which is only
2 revealed at the end, and after a violent death. This links with the
3 anxiety that the men have had in the group about the purpose of the
4 group, and what they will find out, if anything. There was consid-
5 erable anxiety expressed that the group would be too upsetting:
6
7 “Therapy is like a car crash . . . it knocks you off a path.”
8 “It’s like asking us to take off all our clothes.”
9 “You come here and they move the goalposts.”
30 “It’s a long walk over here . . . like a marathon.”
1 “The therapists take you down roads you don’t want to go.”
2
3 Again, there seems to be a tension between a neurotic anxiety that
4 we are going to be intrusive, unhelpful carers who will not listen
5 and understand but impinge and hurt, and the reality that talking
6 about their experience of killing may well be upsetting, and we
7 cannot pretend that it is not. Also, although we may assure them
8 that they will feel better for talking about it, it is easy for us to say
922 this when we do not have to experience any distress they may feel,

27
28 GWEN ADSHEAD, SARITA BOSE AND JULIA CARTWRIGHT

and we do not have to go back to a ward in a high security hospital

after a difficult session.
An important theme for the group has been the issue of mental
illness and responsibility for the homicide. Below are some quotes
on this topic:

“It was a drug-induced mental illness.”

“I did it, but I was ill at the time.”
“I wasn’t really responsible.”
“She was trying to kill me and it was self-defence.”
“I’ve put it behind me.”
“I acted out of fear.”

There is an interesting ethical dilemma that arises here, in relation

to the medical model of explanation for the homicide and the
analytic model. The medical model says that there is no meaning in
the offence; it was just caused by the psychosis, and if the patient
accepts that they were ill, and takes their medication, they will be
fine. However, the analytic explanation would argue that there is
unconscious meaning to be elaborated from the homicide, and that
the psychosis did not cause the homicide, just made it more likely
to happen. We have no brief to set up an argument with the clinical
teams, but we are sometimes aware that the medical model dismisses
the possibility that these men were really struggling with profoundly
hostile and dangerous feelings towards their partners or parents, and
these feelings needed then (and still need now) to be taken seriously.
Cox (1976) described the importance of the journey in therapy of
offender patients towards full responsibility, and how draining this
journey can be for everyone, both therapist and patients.
The question of mental illness keeps recurring in the group, not
least because the members themselves worry away at what it means.
Take this discussion about whether telepathy is real (in the context
of one member having discussed his belief that others could read his
mind):

“It is, but it might be my illness.”

“It is your illness.”
“It feels real . . . is it?”
“It isn’t, but the CIA used it in the Gulf War.”

28
 LIFE AFTER DEATH: A GROUP FOR PEOPLE WHO HAVE KILLED 29

122 Or this, about tangential thinking:

2
3 “My doctor calls it ‘tangential thinking’.”
4 “What’s that?”
5 “It’s when you talk normally, it goes round in a circle, but
6 if you draw a line from the middle to the edge, and a line
7222 perpendicular to it, that’s a tangent where the lines meet.”
8 “What’s wrong with that?”
9
We returned to this several sessions later; the therapist asked:
10
1
“Is it about making connections between things that perhaps
2
don’t have a connection?”
3
“Yes, I thought this man was having a go at me . . . so I
4 attacked him . . . he was a nice bloke who’d been kind to me
5222 . . . and he said ‘what did you do that for?’”
6
7
8 In the middle way . . .
9 After six months, the group seemed to settle somewhat, although
20111 there has still been considerable resistance and acting out. Charles,
1 who held the hopelessness and contempt for the whole group,
2 dropped out after six months. The group was quite dismissive, as
3 one might expect about the loss of a scapegoat; and we ourselves
4 were frustrated by Charles’ inability to see any future for himself or
5 the group. It seemed to us that this departure was both a type of
6 suicide and a type of homicide, not least because Charles expressed
7 the view that the group would collapse without him.
8 Robin became very ill, both physically and mentally, and was
9 away from the group for about six weeks. On his return he seemed
30 very anxious about both what he had missed and what he might say
1 in the group: “I need a therapeutic needle and thread to sew my
2 mouth up”. Patrick remained virtually silent throughout, and Bill’s
3 attendance continued to be punctuated with absences that he was
4 reluctant to discuss as avoidance. Only David and Sam were regular
5 attendees.
6 There was an interesting discussion by the members about the
7 name of the group, which merits quoting in full. The context was
8 what could be talked about in the group. It may be relevant that eight
922 people were present in the group at the time.

29
30 GWEN ADSHEAD, SARITA BOSE AND JULIA CARTWRIGHT

“If Sam talks about football, it’s not relevant.”

“But we’d get to know about him . . . as a person.”
“But this isn’t the getting-to-know-each-other group, it’s the
homicide group.”
“Why homicide?”
“Yes, why? Why not murder?”
“I don’t think I like murder.”
“You make it sound more serious.”
“Murder sounds so graphic.”
“Why is everyone so fascinated by murder? Waking the dead,
Midsomer Murder . . .”
“Every night on TV, you can watch something about murder.”
[Pause]
“If you get seven or eight crows together, you call it a
murder.”
“In Broadmoor, there’s a myth that the crows are the souls of
dead staff.”

At which point it was time to stop. The issue of the identity of being
a murderer is a recurrent theme: can they be something else apart
from their offence (or “my index”, as it is often referred to)? Several
members have described the feeling of unreality that they had at the
time of the killing and subsequently; and also sometimes finding it
hard to believe that the person is dead. At least one person in the
group has indicated that he experiences his victim as still alive.
Anniversaries of the homicide, visits to the grave and Christmas have
been potent reminders for people of what they have done, and how
impossible it will be to forget it.
Metaphors of courts, trials and juries have been useful for
exploring not only their experience but also unconscious anxieties
about the group process and the facilitators. Bill came with a dream
about a jury, and the difficulty of explaining what had happened
both in the dream and in reality. Two of the therapists were absent
due to court work during the group, and we disclosed this in order
to bring the reality of the larger group process of justice to life in the
group. We think this has facilitated discussion of the anxieties that
relate to the group, as evinced perhaps by this:

30
 LIFE AFTER DEATH: A GROUP FOR PEOPLE WHO HAVE KILLED 31

122 “In other places, I would get the death penalty for what I’ve
2 done . . . I had a mad thought that I should give a life for a
3 life.”
4 “Are you judging us?”
5
6 At time of writing, we are planning to bring new members into the
7222 group. This is a deeply unpopular idea with the existing group
8 members, two of whom have announced that they want to leave.
9 We think there must be a fundamental anxiety that the arrival of new
10 members means the annihilation of some sort of current existence,
1 and a hopeless future. We also wonder to what extent it makes sense
2 to think of the parricidal patients as having committed their homicide
3 as an attack not just on their parents but on their siblings and their
4 family structures.
5222 Some of the distress at new members may be because the
6 members have begun to function as a group. Recently, Robin said
7 that whenever he heard the word “group”, he thought of a band of
8 singers. Somewhat manically, we asked each man what role he
9 thought he played in the band. Robin said he was the bass guitar,
20111 Bill said he was the man who drove the van for the band, and Patrick
1 said he was the piano player. We commented on a lack of vocalists,
2 at which Robin said to one of the therapists: “You aren’t doing so
3 badly!”
4 This moment of play is a reminder of how far we have come in
5 terms of trust. We have no doubt that ordinary group dynamics
6 operate and need to be attended to by the therapists and in super-
7 vision. But we do think there are some increased anxieties about
8 existence, absence and non-existence that are more pronounced in
9 this group than in non-forensic psychotherapy settings.
30
1
Supervision
2
3 This group would not have been possible to run without supervision.
4 We have already alluded to the need for the therapists to have a
5 reflective space in which their countertransferential feelings towards
6 the group, and each other, could be contained. More specifically, the
7 supervision space creates a third position alongside the patients and
8 therapists to aid reflection on that which remains unconscious to them.
922

31
32 GWEN ADSHEAD, SARITA BOSE AND JULIA CARTWRIGHT

This movement from the inner world of the dyad to the outer
triadic world can seem like a “bridge too far” for both therapists and
patients. We are familiar with the usual range of resistances and
defences to psychological pain that any patient can bring to a thera-
peutic encounter. These defences and resistances are echoed in the
parallel process of supervision, which is therefore well placed to see
what cannot be seen by the therapists, who are caught up in the
process. This is particularly so in groups where there are multiple
different types of resistance occurring simultaneously. One key issue
for the supervision of this group is the extent to which both the
patients and the therapists defend against psychological pain and
distress by “killing off” the reflective space.
In the introduction to our paper, we commented that there is
an urgent need to find out why some people cross the line from
homicidal fantasy to murderous reality. Aylward and Wooster (this
volume) suggest that

It is [. . .] three-person jealousy [which] is a critical feature

in all murder, in that it represents externally the internal
experience of being killed off in the relationship that the
perpetrator had with another by the arrival of the third . . .
the environment for murderousness [is] triggered when
external circumstances mirror or approximate to such an
internal configuration.

The supervision of this homicide group has had to consider the

notion of a group within a group, given that there are three co-
therapists facilitating a group of six patients. While this provides the
patients with a concrete experience of a three-way relationship, the
co-therapists have also had the potential to be affected by the inherent
murderousness towards “the third” (perpetrator, victim, witness),
which is present in all the group members. One of the therapists has
been absent more often than the others, generating anxieties about
killing and being killed off. There have also been anxieties about the
experience of jealousy and envy between the therapists, arising from
the real differences between them in terms of profession and
experience. It therefore continues to be essential to provide a safe
space, so that the therapists can reflect on their own murderousness,
and that can feel contained. The supervisor acts as “witness” in the

32
 LIFE AFTER DEATH: A GROUP FOR PEOPLE WHO HAVE KILLED 33

122 discourse between the murderer and the victim, and is thus in a
2 position not only to express his own voice, but to record and report
3 on the voices of the other two. In this context, it is interesting to note
4 the mirroring with the traumatic stress literature, where “witness
5 testimony” becomes an important part of the process of recovery
6 from trauma.
7222
8
Conclusion
9
10 The group is now a year old, and has begun to be more sure-footed
1 psychologically. We are planning to bring in new members, which
2 has caused anxiety in the group and further institutional acting
3 out from one clinical team, very similar to what we experienced
4 with Bill. We have learnt an enormous amount from our work in
5222 this group, and while it can be draining and distressing, it is also
6 enormously stimulating. For example, we did not imagine that in a
7 group of such disturbed men we would have a fascinating discussion
8 about the meaning of the word “existentialism”, or about the nature
9 of trials and evidence. We have also been tested technically: what is
20111 the proper response of a therapist when a group member drops
1 to his knees and picks up a tiny shard of glass to offer to them?
2 We hope that the group can continue to survive and grow, and
3 demonstrate that there is some kind of life after death.
4
5
6
7
8
9
30
1
2
3
4
5
6
7
8
922

33
34
122 CHAPTER TWO
2
3
4
5
6
7222 Murder: persecuted by jealousy
8
9
10
Peter Aylward and Gerald Wooster
1
2
3
4
5222
6
7
8
9
20111 “Full fathom five thy father lies;
1 Of his bones are coral made:
2 Those are pearls that were his eyes:
3 Nothing of him that doth fade
4 But doth suffer a sea-change
5 Into something rich and strange.
6 Sea-nymphs hourly ring his knell:
7 Burthen Ding-Dong
8 Hark! Now I hear them,—ding-dong, bell.”
9 Shakespeare, The Tempest
30
1

O
2 ur aim in this chapter, which is a development from a
3 paper entitled “Perverse Triangulation”, presented at the
4 International Association of Forensic Psychotherapy (IAFP)
5 Conference at Arnhem in April 2003, is to explore the dynamics
6 surrounding the crime of murder. We believe that murder represents
7 the “solution” to feeling persecuted (feeling impotent while under
8 attack through being harassed, tormented and pursued) by a
922 threesome experience, i.e. in a three-person jealousy, in the delusional

35
36 PETER AYLWARD AND GERALD WOOSTER

belief that the resulting twosome will eliminate any further feelings
of persecution. The persecution is an intrinsic part of an internal
configuration, so that any external act of murder only represents a
momentary, perverse and ultimately ineffective solution. It is our
view that three-person jealousy is a critical feature in all murder, in
that it represents externally the internal experience of being killed
off in a relationship that the perpetrator had with another by the
arrival of the third. By extension we postulate that the persistent
persecution resulting from having to accommodate the third into a
two-person relationship, particularly when the subject has not yet
digested the dynamics involved in the two-person relationship,
creates the environment for murderousness to be triggered when
external circumstances mirror or approximate to such an internal
configuration.
In symmetry with this, whilst we are presenting a clinical picture
of a man who murdered his girlfriend, and whose start in life meant
that he immediately had to accommodate a third into the relationship
between himself and his mother (like a twin), at the start of this
chapter we also want to introduce into the mind of the reader (into
the relationship between yourself and the patient we are presenting)
another person: the recently convicted murderer Ian Huntley. We
intend to discuss his case briefly at the end of this presentation, as
we feel it has distinct parallels with our primary subject.
We have asked you to hold in mind the fact that we will be
discussing the Huntley case, and given its press and media coverage
and that it is a more recent example than the patient we will be
discussing, it may be that the Huntley issue holds more interest for
you and therefore your affective attachment to it is greater; this
creates circumstances in which our patient, Mr G, struggles to
compete. We are aware that this puts the reader in the position of
holding two in mind where there can be a tendency to eliminate
one for the other. Moreover, in writing this chapter, I also have to
hold a twinning in mind, in that it will also be the subject of a
presentation at the IAFP Conference in Edinburgh in April 2004 on
“Understanding Persecution”. I therefore need to relate to the
twinship of “book” and “conference” by identifying their similarities
and differences and having a relationship with both that is linked
and yet separate. Should I merge the two, then I would be murdering
the benefits of a threesome for the sake of a twosome, and whilst

36
 MURDER: PERSECUTED BY JEALOUSY 37

122 this would be easier for me (less thinking and work), I would merely
2 be repeating the same crime I want to understand and think about.
3 Indeed, this is so often our experience: when the press and media
4 report a murder, they commit the very crime they are so drawn to
5 reporting in that the threesomeness represented by reflective thinking
6 concerning the complexity of the situation is so ubiquitously
7222 eliminated in favour of the dyadic twosomeness of the good/bad
8 scenario to which much crime reporting succumbs.
9 To begin with our patient Mr G, we feel there were two significant
10 areas of trauma in his early infancy. The first was the loss of his father
1 five months prior to his birth. This was a trauma for his mother, who
2 was unable to come to terms with this loss and mourn appropriately.
3 Research work, particularly by Lewis and Bourne (1984, 1992), has
4 shown how difficult it is for normal mourning processes to take place
5222 approaching or around the time of birth. The denial and confusion
6 involved in accepting minus one at the time of creating plus one has
7 been further highlighted by the same researchers’ important work
8 on stillbirths, which demonstrates the hidden resistances which
9 appear to occur both to mourning and to its subsequent remembering
20111 and recording in history. Their research work illustrates how difficult
1 it is to sort out the emotional complexities of situations where births
2 and deaths are found in close proximity. When Mr G was born, not
3 only was he given part of his father’s name, but we believe that in
4 fantasy he became identified with his biological father by his mother
5 through projective identification. Effectively he had forced on him
6 the third dead other as a compound image in the relationship
7 between his mother and himself. He therefore had to embrace
8 another into himself, whereby a part of his own self was killed off:
9 he was related to by his mother as if he were the dead husband/
30 father who was now still alive, causing a part of his own newly alive
1 self to be killed off. We are suggesting that Mr G’s mother became
2 traumatized by the loss of her husband, who represented one point
3 of the triangle (the points of the triangle being mother, father, son),
4 and being unable to deal with this loss and thereby unable to hold
5 her part in the triangle, she projected the loss of the father into her
6 foetus/son. This gave rise to Mr G having to embrace that which
7 represented his father, and he has consequently lived his life being
8 persecuted by any tendency towards a threesomeness, which always
922 tends to carry the seeds of threats leading to eruptions of murderous

37
38 PETER AYLWARD AND GERALD WOOSTER

jealousy. That is to say we believe this would have generated an

underlying rage in having a part of himself wiped out and replaced
with the dead father. This provides an inner world template whereby
a part of his own self has been killed off (he is not seen wholly for
who he is, but more as a composite figure with his dead father), and
it is this killing that he repeats in any triangular scenario which
emerges externally. This is particularly emphasised in his index
offence, to which we will turn shortly, after a discussion of the
particular transference experience.
A common theme countertransferentially in the work with Mr G
is his struggle to embrace anything new, that is anything other than
what exists between himself and myself and his perceived control
of the dyad. Thus I might say something, and the moment I begin
to speak, his mind shuts down and he is unable to accommodate the
thinking. I experience this as a persistent destruction of my reflective
function (thinking), and my survival of this is one of the main
therapeutic tasks. Moreover, we feel that the dilemma Mr G was
faced with during the start of the relationship with his mother was
similarly faced by me in our first session. Mr G informed me in the
first minute of our first session that the timing of our session
coincided with his weekly off-ward visit to the library, which was
important to him. Given that Mr G was aware that this was the only
time I could meet him, and that he insisted his regular visits to the
library were a vital part of his week (he is an avid reader and sought
solace in childhood through visits to the library), I was faced with
the potential destruction (killing off) of our relationship together in
the face of the competing demand of the library. I also knew that
this was the ward slot for visits to the library, and felt angry that
there was a competing attachment which was potentially destructive
at the beginning of this new attachment in therapy. My response was
to say: “Perhaps we need to find a way that you can receive both.”
I firmly took the stance that the time with me would not be
compromised and that I would work with the triangulating third
in our relationship within the ward structure (the clinical team) in
finding a way to ensure that his relationship with the library was
also not compromised. He visibly warmed to this, although he
subsequently smiled, suggesting that I was mad, when I commented
that enabling him to have both books and therapy was as if he were
being given the opportunity to have both parents in support of him.

38
 MURDER: PERSECUTED BY JEALOUSY 39

122 In this opening session it was as if I were being put in the same
2 affective field as he had been postnatally, in having something
3 historically interfere with the initial attachment, forcing him to
4 accommodate its presence. I believe my response to him, which was
5 in support of the real relationship between the two of us not being
6 affected by the relationship he had with the “deadness” of the
7222 written word, at the same time not denying the importance of it,
8 provided him with something good.
9 An alternative solution would have been that the therapy or his
10 library trips would have been lost (a potential of three being reduced
1 to two), and as soon as he introduced the dilemma, this momentarily
2 became a real option, as if a form of murderousness featured. It is
3 this unexpected intrusion into the dyad that Mr G was originally
4 faced with postnatally, and this was a critical feature in his index
5222 offence. Just prior to his index offence he learnt that his girlfriend
6 was meeting with a male work colleague socially, apparently because
7 she was helping him with a problem. They returned to the
8 accommodation where Mr G and his girlfriend were living, and spent
9 a while in the late evening talking together, during which time Mr
20111 G recalls feeling enraged and livid with jealousy. After this man left,
1 they retired to their separate beds (they were living in his girlfriend’s
2 father’s house), and in the early morning Mr G strangled his
3 girlfriend, after which he had the impulse to have intercourse with
4 her, but was physically unable to do so. We believe his murder was
5 a “solution” whereby he brought to an end the feelings of jealousy
6 which were persecuting him. In exploring the identifications and
7 symmetries at the time of the offence, it is important to consider that
8 at the time he believed his girlfriend was a few days pregnant with
9 his child, so that effectively he believed he was killing a mother who
30 was pregnant with child. Here we believe that at the moment of
1 strangulation he was killing his girlfriend (representing his mother)
2 with a child (representing himself). This would place him as
3 identifying perversely with his father. In essence he was killing off
4 his own self whilst at the same time surviving (akin to his mother’s
5 experience, where a death was survived when her husband was
6 recreated in her son, Mr G). That a pregnant mother was killed off
7 reverses the original scenario where the pregnant mother survived
8 the death of the father. The trigger for this murder was the jealousy
922 he felt creating the potential for the loss of his girlfriend to somebody

39
40 PETER AYLWARD AND GERALD WOOSTER

he felt he couldn’t compete with. An additional factor suggesting

that a reversal was taking place is that he and his girlfriend were
staying in her father’s house at the time, and her father was asleep
in another bedroom. Mr G had felt that her father had often related
to his daughter as if she were his wife (a similar denial of his wife’s
death). In Mr G’s mind his girlfriend therefore represented a twin
figure, one who was dead (his girlfriend’s mother) and the other who
was alive (the child), resonating with his own twinning. Moreover,
her family circumstances were identical to his own in that she had
also lost a parent, and her other parent, being unable to deal with
the loss, twinned her with the lost parent.
Following his girlfriend’s death, her father was left with the
experience of having to deal with the feelings of loss associated with
his wife/child; as opposed to the wife/child having to deal with the
feelings over the death of the father. This points to an important
reversal and projective identification of Mr G’s own early experience.
Mr G’s impulse for sexual intercourse with the dead victim
(corresponding to my countertransference) was unsuccessful due to
his inability to develop an erection. Given that Mr G’s life has been
spent persecuted by being twinned with a dead other, and there
has been an internal dynamic whereby he has felt impotent, given
the deadness, to engage in any intercourse, the scene of the crime
represents an external re-enactment of that internal picture. The
brilliant Chilean psychoanalyst Matte Blanco (1975) helps us to
understand the complexities of the identifications at work here,
when we apply his most helpful understanding of unconscious
process in which gross symmetrization can take place. Generally
speaking, Matte Blanco said that conscious logical thinking usually
works within a framework of distinguishing things, and the uncon-
scious that Freud investigated tends to unite and fuse everything.
The one is regarded as rational at a somewhat precise and impersonal
level, whereas the other is in every respect its reverse. Matte Blanco’s
genius was in bringing the two together creatively. He argued that
the unconscious must obey some rules. As we go about our business,
the human mind continuously classifies: acts of recognition are made
constantly, so that we don’t persistently relearn something already
experienced. This classifying involves the registration of sameness
or identity. Relating to the world also entails distinguishing the
relationships between things, without which it would be impossible

40
 MURDER: PERSECUTED BY JEALOUSY 41

122 to negotiate the environment. Matte Blanco called the registration

2 of sameness symmetry and of difference asymmetry. The apparently
3 inappropriate mixing or insertion of symmetrical thought into
4 asymmetrical relations is called symmetrization. For example, a
5 bird and an aeroplane both fly. You and I would know to catch an
6 aeroplane in order to fly to Greece; however, if we fell under the
7222 influence of gross symmetrization, as in psychosis, it would be
8 perfectly reasonable to check the availability of the next crow. At first
9 this often feels mad, and Matte Blanco himself, studying schizo-
10 phrenic thought, was aware of this. However, he took pains to show
1 that such madness uses symmetrized logic when asymmetrical logic
2 is characteristically appropriate to the conscious sane mind. Let me
3 cite a more immediate example here. Allow me for a moment to be
4 arrogant and suggest that in writing this chapter we are giving
5222 something good to you. In ordinary logic we could conclude that
6 you are being given something good by us, but if this becomes
7 suffused by unconscious process and we slip into what Matte Blanco
8 would call symmetrization, we might say that we are giving
9 something good to you so you are giving something good to us.
20111 Ordinarily this is not a very logical conclusion, but affectively this
1 is in fact the experience. Here subjects and objects would become
2 less differentiated, so that there is more of a diffuse feeling akin
3 to “goodness is happening”. So in this example subjects and objects
4 tend to be fused, merged or reversible. Thus, thinking about psy-
5 chotic processes, the psychotic sees symmetry where the non-
6 psychotic person does not, and this in turn may open the door to
7 inflating the accompanying emotion to an infinite degree. The
8 stronger the emotion, the more such symmetric deductions are likely
9 to occur. Given the strength of Mr G’s feelings of jealousy (in addition
30 to a lifelong internal persecution), gross symmetrization took place
1 whereby subjects and objects became fused, merged and reversible.
2 We would suggest that Mr G was faced with having to embrace
3 a third into the relationship between himself and his partner, and
4 this resonated with his early experience in such a way that he lost
5 awareness of time, so that his current experience became his early
6 experience, was symmetrized, and the rage erupted. In relation to
7 the absence or elimination of time, Matte Blanco said that we might
8 say event B follows event A. In conscious logic we would be able to
922 recognise that A precedes B. However, if symmetrization intervenes,

41
42 PETER AYLWARD AND GERALD WOOSTER

then B follows A, so A follows B; awareness of time sequence is lost,

so time as we know it disappears.
This persecution by the third (in that it doesn’t go away and
remains a constant and hostile presence) was exacerbated a few years
after Mr G’s birth, when his mother remarried, and was magnified
further when she gave birth to his half-brother. His rage regarding
these displacements was demonstrated through his diurnal and
nocturnal encopresis, which started shortly after his half-brother’s
birth and lasted many years. This soiling can be understood as
angry attacks in a way not dissimilar to murder. So there is acting
out where there is an absence of reflective thought. Through the
process of psychotherapy he is beginning to be able to understand
some of this, which means that it puts a strain on his capacity to
contain any thinking around his feelings associated with rivalry. This
was particularly highlighted when one day he turned up for a
session with bruises on his face. I learnt that the day before, at six
in the evening, whilst watching television in his room, he had
collapsed unexpectedly, falling to the floor and injuring himself (he
had lapsed into unconsciousness). When I explored the circumstances
at the time, I learnt that he had been watching an episode of “The
Simpsons”, and upon further enquiry learnt that this particular
episode resonated deeply in that its storyline was effectively auto-
biographical. Whilst the clinical team were naturally keen to explore
any other possible physical reasons for this unexpected collapse,
Mr G felt that the psychodynamic understanding that we momen-
tarily reached (before destroying it) in that session was as close
to the truth as we could get. The sibling rivalry demonstrated in
this episode by an older brother on a younger sister (which was
murderous) resulted in reconciliation between the siblings and an
acknowledgement of their true feelings. This linked deeply with
Mr G’s struggle to reconcile himself with a rivalry which could not
become fully conscious in him, causing his collapse into uncon-
sciousness. We could say that there was a similar killing off of
consciousness that occurred in the index offence.
Mr G has lived his life representing the embodiment of a duality
in which one part of the duality is dead, so the other part is unable
to compete with it, which means that he is forever persecuted by its
presence and seemingly unable to resolve the rivalry. This dead part
of the duality (represented by his father) was always the victor in

42
 MURDER: PERSECUTED BY JEALOUSY 43

122 that he was experienced universally as an idealised figure when alive,

2 and therefore somebody with whom Mr G could never compete
3 (have intercourse). This dual figure was perfectly represented when
4 Mr G attended a session more recently without teeth. Mr G has
5 a full set of false teeth, and apparently during the week between
6 sessions his plate had cracked. This was being repaired, which
7222 meant that he attended his session toothless. We were able to think
8 about the duality of the spectrum of toothlessness (it exists on the
9 one hand postnatally, in a baby without teeth, and on the other hand
10 in old age, when the teeth are lost). This led on to thinking about his
1 experience of feeling toothless in the face of a rival (his father?).
2 What we would like to emphasise is the feeling of deadness which
3 can pervade the work, given the destruction that can be experienced
4 in relation to any reflective thinking. My attempts at interpersonal
5222 or interpsychic intercourse are often rendered impossible in that I
6 am put in the frustrating and enraging position of feeling impotent
7 to engage with the deadness that he portrays. Thus his intrapsychic
8 impotence in the face of this persecutory internal object, which
9 cannot be related to because it is dead, is a persistent dynamic
20111 interpersonally. Whilst there is no direct and overt attack upon me,
1 there is an attack upon what I offer. There has been a slight shift in
2 his reaction from initially killing off the intrusive other that comes
3 into the room (represented by my thinking) to his capacity to start
4 thinking about this destructive anger and how it becomes manifest.
5 An example of this arose when I had written, in a report forming
6 part of an annual review of our work, that it was clear he had not
7 reached any position of remorse in relation to his victim (this was
8 largely based on the persistent murderousness in the room). In a
9 session some time later, he was talking about having seen a television
30 programme where they were discussing the issue of remorse, and
1 said how difficult it was for anybody to tell that somebody had
2 reached that position. At the same time he was also talking about a
3 particular patient who was leaving the ward (being discharged),
4 making it clear that the two were very much linked in his mind. We
5 were able to consider that he was angry with me for postulating that
6 he hadn’t reached a feeling of remorse, which in turn was preventing
7 him from leaving and being discharged himself. I commented that
8 this was also an anger with himself about the absence of remorse,
922 which meant fundamentally his inability to come to terms with the

43
44 PETER AYLWARD AND GERALD WOOSTER

jealousy in himself: he splits/kills off the murderer in himself and

projects it out (he experiences me killing off his chances), and this
causes the collapse of the potential for reflective thought in dyadic
thinking. This was the scene when he was born, when his mother
was not able to triangulate within herself healthily between the
father, herself and her son, so that one part of the triangle collapsed
(was projected into her son, Mr G). In the same way, Mr G projected
his own murderousness into me by making me responsible for his
not being discharged, as opposed to integrating the murderer in
himself. An understanding of these potentialities can highlight the
observed rotations within triangles, which may correspond not only
to the three real objects concerned, but may also allow complex
movements of single intra-psychic contents or mixtures in two-to-
one variations of the different players in the overall triangle.
Melanie Klein, in her work on loneliness (1963), mentions the
longing to understand oneself and the need to be understood by the
internalised good object. She adds that one of the manifestations of
this longing is the universal fantasy of the twin soul, as shown by
Bion (1950). This fantasy can be linked with the phenomenon of the
double, studied by Freud in “The Uncanny” (1919). Freud points out
that the double was primordially a safety measure against the
destruction of the self (1908). The creation of this double is intended
to stave off annihilation, and is said to represent those split off parts
which the individual longs to recover with the hope of attaining
plenitude. Grinberg (1992) confirms that this fantasy was implicit
in the states of infatuation or extreme dependence felt by some
individuals towards certain persons who possessed, by projective
identification, the characteristics felt as corresponding to the lost
qualities. They sometimes behaved like real addicts of these objects,
whose company they sought desperately and compulsively with the
unconscious aim of recovering those aspects (the stalking dynamic
features here). He states: “it is another expression, pathological in
this sense, of mourning for the self”. We believe it is in this way that
Mr G has developed a relationship in his therapy, and the previous
example I quoted is a case in point, where he is seeking to recover
lost aspects of himself. In thinking about his capacity to integrate
jealous murderousness, we are referring to his experience of my
own capacity to triangulate using a reflective function, as opposed
to identifying with the projective identification and ending up with

44
 MURDER: PERSECUTED BY JEALOUSY 45

122 a re-enactment of the same destruction in dyadic thinking. Moreover,

2 perhaps in this same way, Mr G was “created” as a twin by his
3 mother in an attempt to reconcile herself to her loss.
4 A factor central to understanding the roots of his psychopathol-
5 ogy is his mother’s inability to deal with the trauma of the loss
6 of her husband. This, as we would expect, is being repeated in his
7222 identifications, represented by the attachments he has had, not least
8 with his victim. It also featured in his previous institution, where he
9 had been in therapy with a female therapist; this came to an end
10 when the therapist left the institution as a result of getting married
1 and becoming pregnant. This occurred after a period of four years
2 in therapy, and given that this four-year duration “twins” with the
3 four years that separated him from his next sibling, re-igniting
4 with his mother/therapist the feelings of jealousy and displacement,
5222 we might think that his previous therapist was caught up in the
6 projective world of her patient, who was unable to triangulate with
7 sufficient reflectivity, which caused a re-enactment to take place.
8 Mr G developed a strong libidinal attachment to this therapist,
9 whom he continues to keep alive following the death of the therapy
20111 by pursuing a complaint against her. To date I remain unconvinced
1 that he has reached the stage where he is able to let go of her,
2 experience the loss and move on.
3 It is perhaps relevant to now turn to the parallels with the recent
4 case of Ian Huntley. You will recall that he was convicted of the
5 murder of two ten-year-old girls. The parallel to which we want to
6 draw attention will, I hope, become clear as I give you a very brief
7 biography of Huntley.
8 He was born into a parental couple where it appears that the
9 father had difficulty with his own jealousies, which interfered with
30 his capacity to triangulate with his first-born. Mother and son (Ian)
1 were very close. Soon after Ian’s birth, his younger brother Wayne
2 was born, and given the proximity of their births, they were
3 apparently dressed identically and related to as if they were twins.
4 This twinning and identical dressing reminds us of the identical attire
5 that Ian’s two victims wore with their Manchester United football
6 tops (moreover, he was a Manchester United supporter). It became
7 apparent as they began to grow up that Wayne was the more
8 successful of the two both intellectually and socially. It seems that
922 Ian grew up feeling that he couldn’t compete, and in addition he

45
46 PETER AYLWARD AND GERALD WOOSTER

was at the receiving end of an abusive relationship with his father.

When Ian was 14 he exposed to his mother his father’s sexual
encounter with their babysitter. His father responded with increased
cruelty to Ian, which was all linked to this situation where Ian was
closest to his mother. There were numerous examples where Ian felt
unable to compete with his brother as they grew, whilst they were
still being related to as twins. This rivalry was exacerbated when on
one particular occasion his mother chose Wayne over himself in
relation to a job opportunity. The most significant example of his
brother triumphing within the rivalry was when Ian’s bride of three
weeks left him, aborted their child, and moved in with and subse-
quently married his brother Wayne. His rage was such that there
was no communication between the two for over a year; apparently
they were subsequently reconciled approximately two years prior
to the offence.
The circumstances surrounding the offence were that Ian Huntley
was angry that his girlfriend, Maxine Carr, was away from his control
in another part of the country and socialising with others, provoking
his jealousy. Minutes prior to the murder of the two girls, he’d had
an angry telephone conversation with Maxine Carr, and we can infer
from what has been reported that he was livid with jealousy. He was
aware of the relationship that she had with these two girls, which
was very close. Thus unconsciously they represented a mother and
her twins, symmetrically matching his own mother with himself and
his brother. We suggest that his rage with his girlfriend/mother was
such that he attacked and killed off the perceived rival to her
affections represented by the two girls as if he had killed off the
double-headed figure that was the twins in himself with his brother,
whilst at the same time surviving the attack in an identical way to
Mr G. Thus his lifelong feeling of being persecuted by jealousy of
his brother through being caught up in the twinship was perversely
resolved through a displacement of the killing off of the twinning
and surviving. In monitoring other “familicide” killings, we are
further convinced of the importance of this dynamic. Not unlike
the reference at the beginning from “The Tempest”, surviving in a
different form after being killed is the best way to describe my own
countertransference experience, as it also represents what Mr G does
with my contribution as well as describing his own early experi-
ence. Moreover, this quotation from “The Tempest” was alluded to

46
 MURDER: PERSECUTED BY JEALOUSY 47

122 in a session by Mr G, when he commented that his mother had

2 informed him that his biological father, who had died at sea, was a
3 reader of Shakespeare, and she had thought about placing in the local
4 church a plaque with this quote inscribed, to mark his death.
5 When I engage with what Mr G might have said and then
6 contribute something, he momentarily hears it, then erases it from
7222 conscious memory (so can forget it in an instant or after the session),
8 but knows also that “it” hasn’t completely disappeared. It’s as if he
9 were re-enacting in the transference the transformation of an alive
10 third into a dead one, which is simultaneously kept alive but out of
1 consciousness. It is a way of holding a deadness in storage, which
2 puts me in the position which he has persistently experienced
3 himself: not feeling able to engage with this third other, yet feeling
4 persecuted by its presence.
5222 Both Mr Huntley and Mr G had the early experience of being
6 displaced by a rival and then being related to as if they were part of
7 a twinship. Both experienced impotence in competing openly with
8 their rival, which meant that they were forever caught as the loser,
9 that is to say they lost out to their rival’s relationship with their
20111 mother. Prior to the index offence, both Mr Huntley and Mr G experi-
1 enced a jealous rage when their partners were out with others. Where
2 the circumstances differ is that Mr G’s attack was upon his girlfriend/
3 mother, ostensibly for the jealousy she had provoked in him by forcing
4 him to embrace a rivalrous third, whereas in the case of Mr Huntley,
5 whilst he was similarly provoked by jealousy over Maxine Carr, his
6 attack was displaced in her absence onto his rival, these two girls,
7 thereby momentarily resolving his conflict. In both cases there
8 was, we believe, the fantasy of killing the double-headed figure of a
9 duality, of twinship, in that Mr G was killing the wife and daughter
30 of his girlfriend’s father whilst she was (in his mind) pregnant, and
1 Mr Huntley was killing the duality represented by these two girls.
2 In both examples there is an attack on the child/children
3 representing the product of the union of the parents and thereby the
4 third in the relationship, and it is this attack upon the third which
5 Mr G experienced postnatally, whilst at the same time surviving,
6 which was in essence a feeling of being persistently persecuted by
7 a third and not feeling free to compete with it. This was the case
8 with Mr Huntley too, and this is what is at work intra-psychically
922 in Mr G and experienced interpersonally, when anything that is

47
48 PETER AYLWARD AND GERALD WOOSTER

conceived from the union between us is automatically attacked by

him, and whilst he takes it in and joins with it in a dead form, no
open and lively engagement, interaction or intercourse is possible.
Thus he kills the child, which is also a feature externally, with his
previous therapist, in that his jealousy of a rival he cannot compete
with (the person who took her away from him) has resulted in his
solution of denying the loss of her by holding on to her, albeit
perversely. Similarly, we might think that Mr G has managed to hold
on to his girlfriend by killing her (so no loss experienced), as indeed
Mr Huntley acted in the belief that this was the way he could hold
on to his girlfriend/mother.
Returning to Mr G, an incident occurred in his married life prior
to his conviction, which serves to illustrate this feeling of persecution
at having to accommodate threesomeness. (Mr G subsequently
separated and moved in with his girlfriend, who was to become his
victim.) It was when neighbours called round unexpectedly and to
all intents and purposes invited themselves into his home. Mr G felt
powerless to prevent this from happening, and his feelings were
subsequently acted out onto the child in the home (their infant
daughter), when as a result of her crying he took her upstairs and
began to strangle her. His rage at the displacement by the neighbours
was transferred onto his daughter, representing the third in the rela-
tionship between himself and his wife, and this had to be strangled
off. This all symmetrized with his experience of being forced to
accommodate the intrusiveness of a third when he felt power-
less to avoid feeling persecuted by its presence. This was no less a
feature for Mr Huntley in his lifelong experience of having to
embrace his brother and feeling powerless against the persecution
of jealousy, which resulted in murder. What we haven’t had time to
consider here was the possible part that Maxine Carr (Ian Huntley’s
girlfriend) and Mr G’s brother might have played in the provocation
of jealousy, perhaps in an attempt to deal with their own, so that Ian
Huntley may have caught a double dose of the jealousy in the family
in the same way that Mr G may have done, perhaps for his own
stepfather and brother.

Actually we can never give anything up; we can only exchange

one thing for another. What appears to be renunciation is really
the formation of a substitute or surrogate. [Freud, 1908]

48
 MURDER: PERSECUTED BY JEALOUSY 49

122 What is unavoidable in life is the experience of loss, and what we

2 are suggesting is the critical importance of the capacity to triangulate
3 using threesomes in the process of reconciling oneself to the loss
4 encountered. It is the monitoring of this area of functioning which
5 for us is the key to Mr G’s eventual prognosis. Engel (1975) raises
6 the question whether certain key losses in life can actually ever be
7222 completely resolved, and Freud opined that a loved object is never
8 really relinquished. What neither Mr G nor Ian Huntley had the
9 opportunity or the resources to effect at such an early age in their
10 psychic development was the benefit of being able to triangulate. This
1 Mr G is in the process of working through. Whether Ian Huntley has
2 that opportunity remains to be seen.
3
4
5222
6
7
8
9
20111
1
2
3
4
5
6
7
8
9
30
1
2
3
4
5
6
7
8
922

49
50
122 CHAPTER THREE
2
3
4
5
6
7222 Women who kill: when fantasy
8
9
becomes reality
10
1 Anna Motz
2
3
4
5222
6
7
8
9

W
20111 e are all guilty of the wish to murder, all subject to
1 thoughts of killing, and all capable of extreme violence
2 in fantasy. But to translate such feelings into action
3 requires some other, qualitative shift from ordinary fantasy to
4 extraordinary behaviour. What happens when murderous wishes,
5 either unconscious or indeed conscious, are actualised? Why can’t
6 thoughts be kept in the mind rather than acted out? In this chapter
7 I will address the specific dynamics of mothers who kill, at moments
8 of disastrous identification both with their infants and with their own
9 depriving/killing mothers.
30 The question I pose in this paper is how best to understand, from
1 an analytic perspective, women who move from murderous thoughts
2 to murderous behaviour. I will illustrate the discussion with the
3 clinical case of a woman who killed her four-year-old daughter.
4 In this case reason is clouded by the fact of psychosis. Nonetheless,
5 the murderous rage which underpins the act is neither rational
6 nor irrational; it is more primitive, an expression of unconscious
7 phantasy.
8 For those women who have experienced cruelty in their own
922 childhood, becoming a mother, while apparently providing an

51
52 ANNA MOTZ

opportunity for reparation, may unconsciously offer darker possibil-

ities for enacting revenge. The multiple identifications which operate
in such cases are enacted in the tragic situations where mothers inflict
cruelty on their own children. These events unfortunately often
represent the exact opposite of the stated desire “never to repeat what
was done to me”.
Estela Welldon (1988) was the first contemporary analyst to draw
attention to the sense in which women can use the opportunities
afforded by motherhood for perverse and cruel purposes, challenging
the sentimental and idealised notion of mothers that shaped social
stereotypes. Her views were radical, frightening and unacceptable
when first published 17 years ago, but increasingly they have been
borne out by new information about women who hurt, kill and sex-
ually abuse their children. Although still shocking, there seems to
be an increasing capacity to challenge this most deeply held taboo—
that mothers can use their privileged position to wreak revenge.
It is still difficult to accept that mothers can kill, as the recent outcry
against the notion of Munchausen’s Syndrome by Proxy reveals.
When they do, as in the case of Rosemary West and Myra Hindley,
or even when they are associated with child killers, as Maxine Carr
was, they are demonised and targeted in a kind of contemporary
witch-hunt—they can no longer be considered women in the sense
of obeying “maternal instinct”. As Warner notes (1998): “The new
demons of crimes against children still act as biological women, but
they have disqualified themselves from the rank of mother, and the
category of women altogether. A woman like Myra Hindley is seen
to embody a violent sexuality that is more appropriate to the male
than the female.”

Murderous phantasies in pregnancy

Unconscious rage and murderousness can be stirred up in pregnancy,
with its concrete as well as symbolic invocation of the woman’s own
attachment to another. Welldon located the source of female
perversion in the woman’s own reproductive capacities, in contrast
to the male, who uses his phallus for perverse purposes. In pregnancy
the woman is able to turn her hatred of her mother, as symbolised
in her own procreative body, towards herself and her own unborn
baby. Unconscious forces may shape the desperate desire for

52
 WOMEN WHO KILL: WHEN FANTASY BECOMES REALITY 53

122 pregnancy (particularly acute in young women without an inter-

2 nalised sense of mother, or good internal object) as she strives to feel
3 filled up with something good and nourishing. This fantasy of
4 pregnancy as offering wholeness may consume her as she seeks
5 urgently to have a baby, to have someone who loves her, as she feels
6 so unloved, unlovable and unwanted. As Welldon so powerfully
7222 argues, the narcissistic pleasure of pregnancy, of the woman’s
8 fantastic power, can become totally removed from any genuine
9 concern for or awareness of the separate and dependent creature
10 within. While the fantasy of pregnancy offers the dream of being
1 filled up with a loving object that can provide the maternal care of
2 which she was deprived, its reality can create a sense of persecution
3 and ultimate disappointment.
4 In pregnancy the body of the woman is invaded, intruded
5222 upon, fought within and fundamentally altered in order to enable
6 another life to take shape. The sense of wholeness and completeness
7 that has been wished for may actually become a sense of almost
8 psychotic and paranoid engulfment. Women with difficulties in
9 their own earlier relationships with mothers in terms of separation
20111 and individuation are likely to find this situation rather disturbingly
1 different from their conscious fantasy of pregnancy. The distortions
2 in their own bodily boundaries and shape and the accompanying
3 sense of helplessness may be unbearable for women who have
4 complex feelings about their own bodies and the integrity of their
5 personal boundaries, or those for whom hatred against their mother’s
6 body is now turned against themselves and their children. Their own
7 adult body can become the symbolic representation of their mother’s,
8 and can then become subject to attack through self-harm or eating
9 disorders; interestingly, anorexia can be viewed as an attempt to
30 prevent the young girl’s body from becoming mature, as she keeps
1 herself child-like through self-starvation: this may differentiate her
2 from her mother and be an attack on her own reproductive capacities.
3 Pregnancy may afford opportunities for extreme disappointment,
4 and childbirth a forum for the expression of violent impulses.
5 The experience of giving birth to an actual child, with its hungers
6 and demands, may feel even more disappointing and persecutory.
7 Rather than realising a wish for love and completeness, childbirth
8 re-awakens earlier horrors of deprivation, neglect and starvation.
922 Pines notes (1993, p.103): “Mature object love, in which the needs of

53
54 ANNA MOTZ

self and object are mutually understood and fulfilled, cannot be

achieved, and the birth of a real baby might be a calamity.” The bodies
of children, Welldon argues, are not seen as independent subjects
in their own right, but as extensions of the mother: if she has
harmed herself, she may well extend this damage to the child who
represents her.
One striking feature of these disturbances in women who turn
their violence against their own bodies and those of their children
is the location of identity in their physical bodies and the sense in
which thoughts inevitably lead to action. There is profound difficulty
in what might be considered a form of abstract or symbolic thinking,
and a dramatic need to express feeling through physical action and
release. Women who self-harm typically describe how they convert
psychic pain to physical pain in an attempt to confine emotional
pain to their bodies, hurting themselves to release the tension that
has tormented them. Self-harm serves as a physical expression of
emotional pain and a powerful release from unbearable and unthink-
able distress. It is of course a violent act, symbolically attacking
the body of the mother whose representation lies in the woman’s
own body.
Fonagy and Target (1999) explore the nature of the compulsion
to enact violence with specific reference to the “failure to mentalize”
that characterises perpetrators of violence. Rather than concretely
following a “cycle of violence” model, in which former victims of
physical violence enact this on others in an attempt to rid themselves
of their own experiences of passivity and helplessness through
identification with the aggressor, violent adults often follow a more
complicated and subtle route to violence. Their early experiences of
care-giving have not provided a central mirroring function in which
their own mental states, feelings and intentions have been reflected
back to them; a central developmental step towards symbolisation,
bearing awful thoughts, has been bypassed. They are not able to
hold painful mental states in their minds, nor find satisfaction
through others’ responses, and so have a tremendous need to act on
these feelings and thoughts and expel them through bodily acts
of violence. In women, the violence is typically directed onto their
own bodies, representative of the body of the mother; in men, such
violence is directed outwards, onto others. Welldon (1988) stresses
that symbolically, the bodies of babies are also extensions of the self

54
 WOMEN WHO KILL: WHEN FANTASY BECOMES REALITY 55

122 for women with these early experiences of deprivation, neglect and
2 cruelty, and therefore also become objects to be used as receptacles
3 for violent impulses. De Mause’s notion of children as poison
4 containers is highly relevant here, in his conceptualisation of infants
5 as universal receptacles of unwanted impulses, as the carriers of toxic
6 human feeling. I will illustrate these complex dynamics with the
7222 following (disguised) clinical material, which contains distressing and
8 disturbing details about a mother who killed her child.
9
10
1 Clinical illustration
2
3 The offence
4 Dolores, a single mother of Eastern European origin in her late
5222 twenties, had been living alone with her two young daughters, one
6 aged four (Angel) and one aged seven, when she had attempted to
7
kill both of them and herself. She had become convinced that the
8
girls were in danger of abduction by a paedophile gang who would
9
use them in “snuff movies”, i.e. pornographic films in which an actual
20111
murder is filmed. She had planned the homicides and own suicide
1
in some detail, but the decision to carry them out seemed to have
2
been made on the day of the offence. She had taken the children to
3
school as usual and then prepared the materials for their deaths,
4
hanging three nooses in her home as well as mashing barbiturates
5
6 into the children’s pudding; she had hoped that this would sedate
7 them so that she could gently suffocate them before hanging them
8 and then herself. She was convinced that the house was being
9 observed by the ringleaders of the paedophile gang and that the
30 people she encountered on the way home were spies for this gang,
1 using their mobile phones to alert one another about her movements.
2 She had attacked Angel’s head with an ice pick prior to drowning
3 her. During this frenzied and violent attack, one that she said she
4 had never intended to be painful for the child, her older daughter
5 escaped, although she had also suffered head injuries. The older
6 child ran for help, but by the time the police arrived and managed
7 to gain entry to the house, they found the younger girl dead in the
8 bath and Dolores in a frenzied state, searching for her older daughter,
922 claiming she needed to “save” her as she had “saved” Angel.

55
56 ANNA MOTZ

Mental state
Dolores was transferred very shortly after being imprisoned and
subsequently detained under sections 37 and 41 of the Mental Health
Act, having pleaded guilty to manslaughter by virtue of diminished
responsibility. She was considered to be suffering from a psychotic
disorder at the time of the offence and was to receive treatment at a
medium secure unit. I saw her for weekly psychotherapy from the
time of her admission into hospital until after her discharge into
the community: a total of four years.
Despite the horror of her own history in childhood and recently
as the killer of an apparently beloved child, Dolores managed to
present a superficial veneer of calmness, rationality and charm. As
a kind of “false self” personality she was always polite and friendly
to me, beautifully dressed with make up, fashionable clothes and
freshly washed and styled hair. Her sense of herself as located in her
physical body was highly evident, and she seemed to attempt control
over inner chaos through rigid control over her appearance, and a
mask-like made up face. She appeared in many ways like a doll, with
a steady, impermeable gaze and artificial, but delicate and precise
gestures.
When I asked about her feelings of guilt at our first meeting,
she replied that she felt terribly guilty, not because she had killed
the younger child but because she had not succeeded in “saving”
(i.e. killing) the surviving child. She revealed an underlying and
pervasive belief in the delusion which had guided her—that she
needed to kill to save.
Often she would begin sessions by relating details about her
wardrobe or her plans to return to her previous employment as a
beautician. While this revealed something about how she had
covered up her illness and hidden the facts of abuse in her own
life from her adoptive parents, disguising the fact of her paranoid
delusions from those around her, including her daughters’ father, it
also conveyed the quality of distant communication and avoidance
in our sessions. Everything bad or frightening, violent or destructive
was covered up and made safe. Dolores was fascinated by fake-ness,
and delighted in her false nails, which struck me as symbolic of
weapons that couldn’t actually harm, as well as providing her with
a sense of glamour and grooming.

56
 WOMEN WHO KILL: WHEN FANTASY BECOMES REALITY 57

122 Background
2
Dolores’s mother already had three older daughters before she had
3
been conceived as a result of a relationship with a foreign sailor.
4
She decided to give Dolores up for adoption at 10 days old. Dolores
5
was four when she learned that she had been adopted (the same
6
age as her murdered child). She had felt totally devastated and
7222
betrayed by this revelation, and saw its disclosure as an act of
8
cruelty by her mother. Her adoptive father had lavished attention
9
on her, but she felt that her mother resented this and had told her
10
she was not really “theirs” as punishment. She had been sexually
1
abused in childhood, and felt that her mother had always disliked
2
her, treating her with a degree of distance and harsh discipline just
3
falling short of physical abuse.
4
She had a history of anorexia/bulimia, shoplifting and self-harm,
5222
displaying what may be considered a typical constellation of female
6
expressions of disturbance, and of violence, largely directed towards
7
the self. In adolescence she became promiscuous and formed many
8
short-term sexual relationships with men. An attractive and vivacious
9
girl, she had tended to prefer the company of men to women, but
20111
remained very close to one older woman. At age 17 she had become
1
desperate to meet her natural mother, and had traced her, only to
2
discover that she had moved to Central Europe with her third
3
husband. She had travelled to meet her, and described feeling a
4 strong bond with her and with her sisters, denying feelings of envy
5 or rejection.
6
7
8 Progress in therapy
9 At initial presentation Dolores was clearly psychotic, believing the
30 hospital was a factory for experimentation and that various patients
1 had special connections with the CIA and other secret groups.
2 She attributed special significance to simple statements, ascribing
3 meaning to commonplace phrases which indicated that she was in
4 a unique and privileged relationship to the speaker. Her florid
5 delusions abated within the first six weeks, and nursing staff became
6 concerned that with her increasing insight into the horror of her
7 actions, a strong suicidal tendency would emerge. It was at this point
8 that she was referred to me for “supportive psychotherapy” and
922 psychodynamic evaluation.

57
58 ANNA MOTZ

During her time in hospital she had formed two significant

relationships with violent male patients and, despite the close
supervision of these relationships by the medical and nursing staff,
become pregnant. This was a wished for event, which she had often
related to me in sessions, describing a wish to replace loss, a desire
to forget what she had done and, as she put it, “lead a normal life”.
She had initially resisted this impulse in the light of reality and the
knowledge that she would be unlikely to be allowed to bring up
another child because of the risk that she would kill again. After much
discussion with the multidisciplinary team, and the realisation that
pregnancy would require her to come off psychotropic medication,
which would prolong the time she would be likely to spend in
hospital, and that she would in any case have to give the baby up for
adoption after birth, Dolores decided to undertake a termination.
This termination, at 12 weeks, recapitulated her murder of her
daughter and sent her into a deep state of depression, requiring her
to relinquish her fantasies of bringing another “perfect” replace-
ment baby girl into the world. Her hope of reparation was actually
destroyed as she found herself again in the position of killing;
additionally, her physical solution to unbearable loss was obliterated.
As her memories and dreams progressed, Dolores sometimes
recalled vivid details about the actual killing. These again centred
on physical sensations—feelings in her body and physical environ-
ment at the time, akin to the attention to detail found in post-
traumatic stress disorder, but with another quality too, as though
her understanding were located in her physical body. The memory
seemed inscribed in central physical sensations which threatened to
destabilise her, and she sometimes seemed to dissociate in the session
itself. She described feeling unable to bathe, as it triggered the
visceral memory of the wound in the little girl’s head, which she said
she could feel when water touched her own head. She could only
take showers, as these were less vividly associated with that day and
with her last memory of her child. It seemed to be possible for
her to focus on the horror of the unintended physical violence, the
pain, disfigurement and mess, while thinking about the loss seemed
impossible. Again this illustrated the tremendous need to locate
emotion in the body, and the difficulty in conceptualising the minds
of the children she harmed, or indeed what went on in her own mind
at the time.

58
 WOMEN WHO KILL: WHEN FANTASY BECOMES REALITY 59

122 The unbearable irony of her killing Angel to save her from
2 imagined suffering and eventual murder was also too much for
3 Dolores even to contemplate. It was equally impossible for her to
4 consider the sense in which she, in identification with a cruel mother
5 and envious of a loved child, might wish to inflict suffering on another.
6 At some level she was in touch with a sense of real guilt, and never
7222 fully accepted that responsibility lay in her loss of the distinction
8 between fantasy and reality and the power of her delusional beliefs.
9 It is possible that this guilt seemed somehow misplaced, as she had
10 so clearly been psychotic at the time. I wondered if her guilt feelings
1 stemmed from awareness of actual neglect or some inklings of
2 her unconscious hostility, as she seemed to have discounted the fact
3 of her apparently psychotic breakdown, seeing herself as wholly
4 responsible for Angel’s death. In this case the therapeutic task
5222 involved helping her to relinquish a sense of guilt, whereas in so many
6 cases in forensic work the aim is precisely the opposite, to encourage
7 guilt and remorse.
8 Through getting to know Dolores and hearing about her tremen-
9 dous rage at the adoptive mother who betrayed her and her natural
20111 mother who gave her up, I formed a hypothesis about the meaning
1 of her offence. I would suggest that in an important sense this
2 murder had been directed at someone else, at the mothers who had
3 abandoned her. This homicidal motivation can also be seen in her
4 own attempted suicide: she herself was a mother who had failed.
5 Although danger apparently lay in the nameless, faceless “gang
6 of men” who lived to torture her and her children and to immortalise
7 their pain and humiliation in film, this gang could be understood as
8 the family unit of the strangers who had raised her and exposed her
9 to abuse. Her deceptive adoptive mother and abandoning natural
30 mother could be seen as the unconscious targets of her murderous
1 rage, who were out of reach. Symbolically the murder also stood for
2 suicide, as Angel also represented Dolores herself, the four-year-old
3 child who had learned that her apparent mother was a fraud, that
4 she had been given away, killed off. From very early on, Dolores
5 had felt she could trust no-one.
6 Welldon has shown how women who kill or harm their children
7 behave towards them as narcissistic extensions of themselves,
8 treating them as they themselves were by treated by their own
922 mothers. Linking this notion with the deep tie between homicidal

59
60 ANNA MOTZ

and suicidal urges, it becomes possible to understand something of

the dynamics of murder in the case of this profoundly damaged
young woman. She could not see her daughters as separate from her,
imagining them to be extensions of herself, vulnerable to the same
neglect, abuse, deception and ultimate abandonment that she had
suffered. She had externalised her own violent urges towards her
daughters (or envy of them for being brought up by her, their
natural mother), seeing all danger as located outside herself. Despite
her denial of abuse or neglect of them prior to the offence, statements
by other family members revealed that she had been neglectful and
at times cruel. On occasion she had used physical violence towards
them, and she had displayed her older daughter’s soiled underwear,
which had been hidden, and laughed about it with friends in front
of her. She had organised a fourth birthday party for Angel, but
hadn’t allowed her friends to come, going through the macabre
motions of hosting a silent, friendless children’s birthday party. This
seemed a symbolic recreation of the emptiness and falsehood of her
own early life. Dolores was adamant that she loved the girls though
she hated herself. Her suicidal impulses were converted into
homicidal urges towards them. She had planned to kill herself after
killing them, as the three nooses she had hung demonstrated; at the
time she was apprehended she had also stockpiled a large supply of
antidepressant medication that she had planned to take just before
hanging herself.
This violence directed onto the woman’s own body, or its
narcissistic extension, her children, is a symbolic attack on the
mother’s body. For Dolores, her mother’s body had been a betraying
and abandoning object, and her adoptive mother inadequate,
deceitful and ultimately cruel; she had allowed Dolores to be sexually
exploited by men, treating her with contempt and envy.
The symbolic meaning of Dolores’s violence in relation to her
fears of the sexual exploitation and murder of her children for the
gratification of adults was a recapitulation of her own earlier “soul
murder”. She enacted on her children’s bodies the violence to which
she felt she had already been subjected in her own childhood, and
the suffering she imagined would return to torture them. Her
narcissism, evident in her failure to view the children as separate
from her even before her psychotic breakdown, was also apparent
in her behaviour and demeanour after the offence. Her narcissistic

60
 WOMEN WHO KILL: WHEN FANTASY BECOMES REALITY 61

122 personality structure, though clearly destructive in the extent to

2 which it contributed to her fatal assault on her daughter, proved in
3 another sense to be protective in her recovery; without this defence
4 against overwhelming depression and guilt it would not be possible
5 to imagine her survival. Dolores continued to plan for her future and
6 to focus on immediate sources of gratification like new clothes,
7222 losing weight, finding a boyfriend and experimenting with different
8 hairstyles. She also hoped to prove herself well enough to have
9 contact with her surviving daughter when the girl felt able to visit
10 her, or her estranged ex-partner allowed such contact. Yet again she
1 focused on the shape and outward appearance of her physical body,
2 believing that she needed to be slim and pretty to prove her health
3 to her surviving daughter. The ugliness and deformity in her mind
4 seemed invisible to her.
5222 A central feature of the ending of therapy was that I had become
6 pregnant, to which Dolores reacted with surprise, concern and
7 apparent generosity. It seemed to me that the fact that I was going
8 on maternity leave evoked unbearably strong fears in her and
9 removed the opportunity for richer understanding of her desires to
20111 give birth, and to kill. Dolores was discharged from hospital after
1 approximately three and a half years. She retained ties with both
2 adoptive and natural mothers, and began a part time job, continuing
3 to attend regular outpatient appointments with the consultant
4 psychiatrist. She had attended our last few sessions as an outpatient,
5 living under a new name in the community. She chose not to enter
6 into psychotherapy with a different person, saying she felt she had
7 “come to terms” with what she had done. I was left feeling that she
8 had never fully explored the extent of her unconscious hatred for
9 herself, her mother and her daughters. She expressed the fear that
30 this level of analysis would destabilise her to the extent that she
1 would not feel able to leave the containment of the secure unit. I
2 believe she was also trying to protect me from a murderous rage
3 towards me that could have emerged so powerfully in the trans-
4 ference, with consequences she might have felt unable to predict
5 or control.
6 Dolores’s identification with her own tortured, abandoned and
7 deceived child was evident as she described the deep similarities
8 between herself as a child and her younger daughter. The guilt she
922 felt about her murderousness seemed to have become projected into

61
62 ANNA MOTZ

me when I was pregnant, and at times I felt that I could not subject
her to such a cruel situation. The similarities between us, as women
of similar ages, became as undeniable as the differences once my
pregnancy was obvious and I informed her that I would be going
on maternity leave. She reacted with extreme concern and solicitude.

Transference and countertransference issues

The transference issues that arise in working with women who have
killed are complex and powerful, as the therapist may alternate
between hiding behind the false protectiveness of the patient’s
idealisations of her and exposure to her murderous rage. The
primitive defences of splitting have been dramatically and irrevo-
cably enacted when women have killed, and the atmosphere in the
consulting room reflects this. At times there is an almost unbearable
deadening of all feeling and thought between therapist and patient,
as though the danger of acknowledging feelings must be kept at bay
through a kind of suffocation, and at other times there is an exciting
sense of danger, which seems to be manifested in great curiosity
about the awful unthinkable event. This fascination may come across
to the patient as a kind of intrusive voyeurism in which they are
implored to revisit traumatic scenes and relate them in intimate
detail. Case presentations by clinicians can indicate the level of
prurient interest or excitement found in working with people who
enact these universal fantasies.
The feelings of depression, dread and fear which underlie the
violence may resurface in therapy, threatening to engulf both
therapist and patient in an overwhelming sense of helplessness.
Perhaps the most insidious attack on thinking is the invitation to
collude with the denial of what has happened. The passive voice
takes over in sessions, as the patient describes their offence with
distance and conveys their sense that something outside of
themselves has “happened”, as it were, to them. Indeed, it may be
difficult for a therapist to keep in mind the fact of explosive violence
when faced with a calm, depressed woman, who may present herself
as victimised. Perhaps it is only at times of great vulnerability in the
therapist that such memories or thoughts become vivid and appear
in the transference as immediate threats to psychic or physical safety.
These issues are particularly relevant when the therapist is female

62
 WOMEN WHO KILL: WHEN FANTASY BECOMES REALITY 63

122 and of childbearing age, and are even more intense when the
2 therapist is herself actually and visibly pregnant.
3 A personal example of this which I can share, in relation to the
4 clinical material just presented, comes from my own pregnancy,
5 when I became convinced in a session with Dolores that my unborn
6 baby had actually died inside me. I felt as though paralysed with
7222 fear and could hardly think, let alone respond to the patient. I
8 became somewhat suspicious, wondering whether the patient had
9 willed this apparent death. I became so focused on this fear that it
10 developed a quasi-delusional quality, and it was almost impossible
1 to retain an awareness of the patient as she sat with me in this state.
2 There are, of course, various hypotheses about why my fear should
3 have reached such intensity during this session, probably related to
4 an unconscious communication of her tremendous envy and
5222 hostility. I wondered if through projective identification I had become
6 the murderous mother, or even the dead object that I imagined I was
7 holding. I considered it most likely that Dolores had projected into
8 me her own envy and murderousness, and her desire to attack the
9 living creature whose growth I could sustain, in stark contrast to her.
20111 Perhaps through surviving this unconscious attack I was able to help
1 her to understand that sometimes her destructive fantasies could
2 be managed and defused.
3 Pregnancy in the therapist is a direct challenge to the neutrality
4 and anonymity usually aimed for in relation to the transferential
5 situation, as there is concrete and undeniable evidence not only of
6 sexual intimacy but of physical interconnection with another living
7 creature, the unborn baby. The mind as well as the body of the
8 therapist may become an unreliable, untrustworthy and otherwise
9 occupied object. There may be sense of triumph in the therapist as
30 she faces her bereft or barren patient with the fullness of her own
1 successful intercourse, or a sense of shame as she becomes known
2 in some basic, human and very vulnerable sense. How can a thera-
3 peutic alliance be preserved without direct acknowledgement of
4 the tremendous changes that the presence of this third party brings
5 to the therapy situation? It is essential that the therapist can allow
6 such thoughts to be developed, articulated and addressed, but the
7 fears of filling the room with anger or envy may still make direct
8 communication difficult. Working with women who have killed their
922 babies creates situations of great complexity and sensitivity, as well

63
64 ANNA MOTZ

as the possibility of an enhanced intimacy and depth in the therapy,

as issues which may have been left unexplored, like the therapist’s
sexuality, are thrust into the consulting room.
Starting in pregnancy, we can use Welldon’s shocking insights
to see how women’s bodies, particularly their reproductive capaci-
ties, can become vehicles for the expression of unconscious conflict
and sites for the re-enactment of earlier trauma. Such conflicts are
potently and often destructively expressed in pregnancy and child-
birth. Women who have felt deprived and neglected in their own
childhood may seek to fill this inner emptiness through pregnancy
as a fantasised act of reparation, but in fact it becomes a forum
for the reactivation of earlier deprivation. Motherhood can then
offer opportunities for revenge and recreation of earlier cruelty. The
complexity of the relations between the murderous woman and her
children, her relation to her own mother, and her relationship with
her therapist require careful and close analysis in each case, with the
hope of enhancing awareness of how and when such tragedies
occur. Such insight can inform preventive actions to reduce the risk
of such tragic re-enactments taking place.

64
122 CHAPTER FOUR
2
3
4
5
6
7222 Killing off the shadow: the role
8
9
of projective identification in
10 murderous acts
1
2
3
Maggie McAlister
4
5222
6
7
8
9
20111 “You have to get close to stab. You can’t be stand-offish when
1 you stab.”
2 Helen Zahavi, Dirty Weekend
3
4
5 “When they entered they found, hanging on the wall, a
6 splendid portrait of their master as they had last seen him,
7 in all the wonder of his exquisite youth and beauty. Lying
8 on the floor was a dead man, in evening dress, with a knife
9 in his heart. He was withered, wrinkled and loathsome of
30 visage. It was not till they had examined the rings that they
1 recognised who it was.”
2 Oscar Wilde, The Picture of Dorian Gray
3
4

I
5 have chosen the above two quotes from fictional writing to
6 introduce the theme that is to be the subject of this chapter: the
7 use of projective identification in acts of murder. In Oscar Wilde’s
8 novel, the protagonist, Dorian Gray, is engaged in a supernatural,
922 symbiotic relationship with a painted portrait of himself, which

65
66 MAGGIE MCALISTER

records all of his crimes and misdemeanours, including murder,

while he remains in a state of perpetual youth and beauty, free from
any physical signs of his split off secret life. In Jungian terms, this
story could be seen to illustrate an attempt to deal with the “shadow”:
those parts of one’s personality which are unacceptable to the ego
and projected externally. As Dorian degenerates deeper into dark
and corrupt behaviour, his portrait, secretly hidden away in the attic,
becomes more and more hideous, until Dorian, finally filled with
horror and repulsion, decides to “destroy” it by stabbing a knife
through its heart. It is only on “killing” the image that the true
identities of the subject and portrait are reversed, and in the act of
killing his shadow, Dorian kills himself.
This story highlights something which is central to my work with
forensic patients: a wish to erect powerful, projective defences against
a part of the self they cannot bear to know about, and the
consequences of this murderous projection for the ego. In normal
usage, projective identification takes place when an unwanted part
of the personality is projected into the object, and the object is then
experienced in part-object form as if it were the projected content.
Klein first named this concept in 1946, and it has made a central
and important contribution to subsequent developments within
psychoanalysis. In later explorations of the subject, Bion did much
to differentiate abnormal and normal uses of projective identification,
mainly through distinguishing two separate uses: firstly as a means
of violent evacuation of unwanted parts of the self into the object,
and secondly as a means of communicating unbearable states of mind
(Bion, 1959; 1962a, b). For the purposes of this chapter, I wish to focus
mostly on the former, which Bion saw as a psychotic use of projective
identification and which he linked to schizophrenic disturbances
due to the level of violence employed, the quality of omnipotent
control, the impoverishment of the ego, and the destruction of
internal reality. In his essay about his concept of “the shadow” (1948,
paras. 13–19), Jung also emphasised some of these qualities himself,
especially the loss to the ego of excessive projections, and the
resultant difficulties in the ego’s capacity for reality testing, “in which
one dreams a world whose reality remains forever unattainable”.
However, in drawing these theories together, I would like to ask:
what is the result to the ego when the object, or (perhaps more
accurately) the external object is killed? Does the act of murder make

66
 KILLING OFF THE SHADOW 67

122 working with projections excessively difficult, both because of the

2 concrete nature of the act and the psychotic extent to which evacu-
3 ation, in the form of annihilation, has taken place? This is the area
4 of work I wish to explore in this chapter.
5 I am going to write about a patient whom I shall call Mr D. In
6 order to protect confidentiality, I have based Mr D on a number of
7222 cases where the features I wish to emphasise were common to all.
8 I have disguised any history and personal information, therefore
9 Mr D cannot be identified. Mr D has a diagnosis of paranoid
10 schizophrenia, and during a state of acute psychosis killed two
1 victims. In my psychotherapy work with him, which takes place once
2 a week in a regional secure unit, he appears to cope with the reality
3 of his offences by stating that he was ill at the time and that he is
4 well now and therefore no risk to the public. Any of my attempts to
5222 explore the underlying features of his psychosis or his offences are
6 extremely threatening to him and need to be killed off instantly with
7 the mantra “ill at the time; safe now”. In fact the level of concreteness
8 in these statements demonstrates his ongoing psychotic, paranoid
9 state, where any interpretations are experienced as murderous
20111 attacks which he has to defend against. In a sense, what I feel I am
1 attempting to do with Mr D is to enable him to integrate an
2 appropriate level of anxiety about his ongoing dangerousness that
3 has previously been unthinkable for him; yet this is in powerful
4 conflict with his own motivation for coming to psychotherapy. The
5 last thing he wants to do is get in touch with what he believes, in
6 phantasy, he got rid of in his offences. This work presents many
7 challenges. In my countertransference with Mr D, I often feel tired,
8 bored, distracted and disengaged, mainly as a result of his extreme
9 concreteness. By creating a rigid structure which stops creative
30 thought both in his mind and between us in the sessions, he creates
1 a kind of murder zone which destroys anything that might allow
2 him to move on and progress. This creates many technical difficulties.
3 Mr D’s ongoing psychotic state (seen in his concreteness and
4 paranoia) prevents an apprehension of the reality of his murdered
5 objects. It is very difficult for him to comprehend what he has done,
6 and by wishing to place his psychosis firmly in the past, he obliterates
7 the fact that the problem is still in the present. But then there are
8 also moments when the work appears to come to life and both he
922 and I feel suddenly moved by the tragic consequences of his illness.

67
68 MAGGIE MCALISTER

However, the main feature of the sessions is the way in which he

attempts to defend against knowing about anything inside himself
that could be thought of as having been projected wholesale into his
victims and “successfully” killed off.
Before I begin to describe specific challenges of this work in more
detail, it is important to contextualise the work by describing the
setting in which I work. The regional secure unit has the task of
both containing and treating mentally disordered offenders, many
of whom have a diagnosis of paranoid schizophrenia, who have
committed a range of offences from homicide to all forms of physical
violence against the person, robbery, arson, and sexual offences.
Most of the patients are held under sections 37 and 41 of the Mental
Health Act, which require them to be detained in hospital until the
Home Office authorises their discharge. This is done on the
recommendation of the consultant psychiatrist in consultation with
the multidisciplinary team, which consists of many professions,
including psychotherapy. The ongoing task of the MDT is one of risk
assessment and treatment, with the aim of monitoring a patient’s
level of insight and risk of further offending.
One of the distinctive features of working with forensic patients
is the factual, historical event of the index offence, the offence that
precipitated their current admission to a secure hospital. In forensic
psychotherapy work, one engages with the story of the index offence
as being dynamically central to the internal object relations of the
patient. This also remains the case when the index offence was a
result of psychosis. In order to explore this further, I have disguised
the following history, without, I hope, losing any of the important
themes of the inner world.
Mr D grew up in a religious family in Northern Ireland, under
the constant threat of sectarian tensions and violence. His father was
a military man, and there was an expectation that Mr D should have
great loyalty to the Protestant cause. When he was a young man, he
got a loyalist tattoo on his arm, demonstrating his allegiance to
his British nationality. However, he was tyrannised by his father
throughout his childhood, and grew up trying to protect his mother
and younger sister from the father’s frequent violent episodes. He
finally left home and came to live in England, where he embarked
upon further study and began to have significant relationships with
women. It was soon after this that Mr D started to become unwell

68
 KILLING OFF THE SHADOW 69

122 and began to develop grandiose religious delusions about saving the
2 world from evil and being the Son of God. Alongside this, he also
3 wanted to have his tattoo removed. It was at this time that he
4 encountered two strangers and mistook them, via a hallucination,
5 for “emissaries from the devil”; he returned later with a knife and
6 stabbed them to death. He has been detained in secure hospitals
7222 ever since.
8 The reason for Mr D’s referral to the psychotherapy department
9 was that his consultant and the treatment team felt that he was able
10 to repeat, parrot fashion, terms and phrases he had learnt during his
1 contact with various psychologists in the past, and subsequently
2 there was some concern about his level of insight. It was thought a
3 psychotherapy assessment would help to clarify this matter. It was
4 also noted that Mr D was very eager to please and was willing to
5222 comply with anything that would ultimately facilitate his discharge,
6 and in this sense he was described as “the model patient”.
7 During our assessment, it quickly became apparent that Mr D
8 was keen to present himself as someone who was very calm and well.
9 He appeared to view the assessment as an opportunity to convince
20111 me that he had “insight into his offence”, and to this end he brought
1 along a portfolio of certificates from psychology courses he had
2 attended in the past, as proof that he had already engaged with
3 psychological work and gained “insight”. When I asked him what
4 he meant by this, he stated that he understood he had an illness
5 at the time of the offences and that what he was experiencing were
6 hallucinations and delusions. He also stated that he knew he needed
7 to be on medication for the rest of his life as it kept him tranquil-
8 lised and calm. He repeatedly stated that he had “coping strategies”
9 now, in the form of medication and what he had learned from his
30 psychological help. He did not feel that he needed to undergo
1 psychotherapy, but told me that he was happy to do anything that
2 would help the team see that he was safe. He dutifully recounted
3 the circumstances leading up to his offences, describing a series of
4 “stress triggers”, and his own attempts to ask for psychiatric help,
5 but this had fallen on “deaf ears” (which he first pronounced as
6 “death ears”). I made a link with his fear of things falling on deaf
7 ears with me now, especially as I was struck by his wish to impress
8 on me the work he feels he has done and also the level of insight he
922 has gained since the time of his admission. He agreed with this,

69
70 MAGGIE MCALISTER

indicating that the doctors and I had all the power, and it was up to
us whether he was discharged or not. When I indicated that this
might make him feel he has to prove something to us, he agreed,
but also spoke about taking responsibility for his crimes. He became
very tearful at this point, and stated that he felt remorse and would
never forget what he had done. This was the only moment when the
session came to life. The overall tone otherwise was highly controlled,
dead and lifeless. Afterwards I was left wondering if even this
emotional moment of contact had been real. The other important
theme that emerged during this first meeting was his father’s violence
to Mr D, his mother and his sister when he was growing up.
After our session, I was struck by the importance of his portfolio
as something external from himself that contained all his “insight”.
In fact, the certificates had been for his attendance at very brief
psychological courses, even including a short health and safety
course. My impression was that Mr D’s coping strategy was to keep
his insight superficial, because to really understand would be to bring
back inside himself something he has needed to project into his
victims. Furthermore, in the lead-up to his offences, it was when there
was an attempt to remove something “skin deep” that Mr D became
acutely dangerous. There was a question at the time, in my supervi-
sion, about how safe it would be to attempt psychotherapy with
Mr D, and how I too might quickly come to represent something
extremely dangerous and “diabolical” that may become too
threatening for him. It was decided that I should continue, but that
we would work in a room on the ward.
The following session proceeded in exactly the same manner as
the first. I commented on this by making an interpretation about his
portfolio and the tattoo, suggesting that in the same way that he
wanted to have his tattoo removed when he became ill, the idea of
coming to psychotherapy and having the portfolio of “insight”
removed might also leave him feeling anxious about being vulnerable
and dangerous. Mr D strongly disagreed with this. However, during
the session, he elaborated further on his father’s violence, very much
conveying how he had felt unable to protect his mother or his sister
from the father’s violent attacks. It was after this time that he began
to develop delusions about being chosen by God to kill the devil and
protect all the children in the world. I linked these later delusional
beliefs with his helplessness and inability to protect his mother, sister

70
 KILLING OFF THE SHADOW 71

122 or himself from his father’s attacks. However, I was also mindful of
2 the transference communication, and wondered how much he was
3 experiencing me as trying to violently force things into him, i.e.
4 interpretations and insight. In fact, I was aware of a wish to somehow
5 penetrate through his defences, a feeling which has been a consistent
6 countertransference feature throughout the therapy. I understand this
7222 as a communication from him of the central mechanism of projective
8 identification employed in his offences. For example, an interpre-
9 tation I attempted at this time was to suggest that he might have had
10 murderous feelings towards his father at the time of his beatings.
1 This was unbearable to Mr D, and he heard me say that he had
2 murderous intentions towards his family. He repeated this later
3 in a ward round, stating that he did not want to do psychotherapy
4 with me any more. However, we recovered, with Mr D very much
5222 wanting to reassure me of his religious values and beliefs and how
6 these foster feelings of forgiveness and tolerance towards his father
7 and towards anyone who might be seen to provoke feelings of anger
8 within him.
9 A feature of the treatment is how we often reach these moments
20111 of deadlock or stalemate, where my attempts to wonder about links
1 and connections are met with very flat, concrete responses, which
2 have the effect of killing meaning. This puts me in mind of Bion’s
3 concept of –K, an idea which came as a later development of his
4 thoughts on the failure of maternal reverie to act as a container for
5 the infant’s projections of extreme anxiety and “nameless dread”
6 (1962a). Bion later conceived of –K as a factor in the infant which is
7 opposed to any form of maternal understanding and containment,
8 and which in psychotic thinking can be seen as a murderous attack
9 on meaning (1962b). In this sense there is an aspect of “death ears”
30 in the sessions, both in Mr D, but also perhaps in me, where I think
1 he experiences me as someone who kills off what he is trying to
2 communicate, perhaps leaving him with the belief that the only
3 way to get through is in an extremely violent, evacuative form of
4 projective identification, very much acted out in his index offence.
5 The only way we can get out of these deadlocks is for me to
6 metaphorically sit back and allow Mr D to relax and speak less
7 guardedly about his thoughts. In this way, material emerges which
8 has more space within it and the possibility of a third place from
922 which we can view his offences. During these times, Mr D often

71
72 MAGGIE MCALISTER

ruminates on news from his home town in Northern Ireland,

particularly his preoccupation with the level of violence there and
news of punishment beatings, etc. carried out by paramilitaries,
despite the peace process. In his concrete way of thinking, he
perpetuates a very definite split between the opposing sides of the
conflict, and is often at great pains to present his own side as being
peaceful and tolerant, whilst all the aggression is located in the other
side, so that they can be comfortably viewed as the ones who are
solely murderous and at fault with how they have interpreted their
religious beliefs. This could be seen to be a clear shadow projection,
where the concept of the shadow is what Jung defines as “the thing
a person has no wish to be” (1966, para. 470). The shadow is the
repository of what is unacceptable to consciousness (and is therefore
always unconscious), and it is always found in projected form. All
the bad, unwanted and feared aspects of the personality are split off
and located in “the other”, leaving the ego free, and yet powerfully
impoverished, much along the lines of a paranoid-schizoid split
(Klein 1946), which splits good and bad in both the object and the
ego. Part of any work in a treatment is the withdrawal of projections
and the integration of the shadow, but for Mr D this would mean
coming to terms with his own murderousness and dangerousness,
a task he perceives as very much at variance with his concrete goal
of persuading the Home Office that he is safe for discharge. From a
psychotic viewpoint there is also the difficulty of taking back what
one has wished to be rid of. Klein states: “By introjecting and re-
introjecting the forcefully entered object, the subject’s feelings of
inner persecution are strongly reinforced; all the more since the
re-introjected object is felt to contain the dangerous aspects of the
self” (1946, p. 23).
However, there has been some very gradual movement in this
direction, which I shall illustrate by describing a series of sessions
over several months. The work often starts with the “war zone” of
Northern Ireland, which then moves a bit closer to home as the
“war zone” within his family, to finally allowing us to begin
acknowledging the “war zone” within himself. However, this process
of attempting to work on gradually withdrawing shadow projections
is difficult, painstaking work, often interspersed with several sessions
where there is a regression to a retreat where Mr D wishes to
convince me that he is safe.

72
 KILLING OFF THE SHADOW 73

122 At the beginning of this sequence, Mr D began the session by

2 talking about his future hopes for a conditional discharge from his
3 tribunal, and his plans to study tourism and become a tourist guide
4 once his country is more settled and there is less of a civil war feel
5 about it. I responded to this by commenting on what we were
6 “touring” here in the sessions, and the idea of a civil war inside him.
7222 Mr D responded that there was no civil war inside him, that he was
8 a moderate. He went on that his family were all moderates, that there
9 was nothing fundamentalist in him: “I don’t believe what they
10 believe [IRA terrorists]. They’re fundamentalist fanatics. They believe
1 that killing’s all right—they go against the Bible, where it says ‘Thou
2 shalt not kill.’ They’re a disgrace to Christianity. I’m a moderate.” I
3 told him that I thought he had a wish to see himself as differently
4 from them as possible, to distance himself as much as possible,
5222 because to see himself as the same was too unbearable. Mr D agreed
6
with this. I went on to say that I thought nonetheless there was
7
a war inside him because he did kill, like them, and that in some
8
ways he was like them. Mr D’s response to this was: “It was my
9
hallucinations and delusions, it was my illness at the time”, which
20111
made me feel rather hopeless. However, Mr D continued by describ-
1
ing in a more engaging way the exact detail of the circumstances
2
of his offences, his subsequent arrest and detention, his illness
3
while he was held in hospital and his initial diagnosis of paranoid
4
5 schizophrenia, which he believed came from various precipitating
6 events before his psychosis. These themes very much continued in
7 the sessions that followed, with Mr D frequently returning to the
8 split of the sectarian divide within Northern Ireland and the wish
9 to place all the badness in the other side, which I consistently
30 interpreted as an aspect of himself that he was very much afraid of
1 acknowledging.
2 A development came when we were getting ready for a break;
3 this was coinciding with the timing of a case conference when
4 various professionals would be coming together with reports of their
5 work, in Mr D’s presence. Near the beginning of the session, Mr D
6 informed me that had made copies of his reports for his portfolio,
7 and insisted on leaving the room so that he could fetch it and show
8 it to me. I encouraged him to stay and wondered about the timing,
922 in terms of the forthcoming break. We had the following interaction:

73
74 MAGGIE MCALISTER

MM: “I wonder if you feel you want to give something very

concrete to me—put something very concretely into my
mind, so I’ll think about you in a certain way.”
Mr D: “No—no hidden agenda. They’re just factors, just evi-
dence for my tribunal. I’ll give them to the psychologist.”
MM: “But there’s this idea of evidence—that you need to
provide evidence of your progress, like I become the
tribunal doctor.”
Mr D: “I’m just telling you the truth. That’s all I can do, and
keep myself well by doing all my activities. They’ve all
written reports which are in my portfolio.”
MM: “I think structure and routine is very important to you,
and the portfolio is like another structure, something that
holds you together and proves you are safe. I think there’s
an anxiety of what I’ll think outside the portfolio.”
He agreed, and began to tell me his hopes that the nurses
would allow him to visit a religious group where he would
be able to hear a preacher who preaches forgiveness and
tolerance. He then went on to describe a television programme
where a Muslim imam had been preaching dangerous ideas,
namely that it was all right to kill people sometimes. He
described how before the offences he had become influenced
by some religious leaflets, which he thought had a part to play
in the development of his delusions. He said this made him
afraid for the other patients who were also watching the TV,
as some of them were ill and hallucinating.
MM: “You mean you think they were vulnerable.”
Mr D: “Yes. He was preaching very dangerous views. It
wasn’t good for them to hear that.”
MM: “I think you’re saying something about how dangerous
it became for you—that you were vulnerable and became
dangerous.”
Mr D: “Yes, that’s right.”
MM: “So there might be something about your own danger-
ousness that gets put onto the other patients watching the
TV programme, so they somehow carry it for you.”

74
 KILLING OFF THE SHADOW 75

122 Mr D: “Yes, that’s right. I know just to avoid those pro-

2 grammes completely now.”
3 MM: “You feel you have to completely avoid them because
4 it still feels too dangerous for you.”
5
Mr D: “Yes, it’s best to avoid them.”
6
7222 MM: “You seem to be recognising a vulnerability in yourself,
8 you’re recognising some anxiety.”
9 Mr D: “No [realises what he’s done; backtracks]. They don’t
10 mean anything to me. They’re just insignificant.”
1
2 However, following this session, Mr D decided that he was going to
3 cancel his tribunal as he felt “realistic” that he “wasn’t ready” and
4 wouldn’t be discharged. He explained this in quite concrete terms in
5222 that he didn’t have enough leave privileges to have a convincing case.
6 My attempts to wonder if he was recognising that he wasn’t ready
7 in other ways were dismissed. As the session progressed, he talked
8 in some depth about his father’s violence when he was growing up,
9 in a way which again indicated that he was splitting off all his own
20111 anger and violence into his father and was unable to tolerate any of
1 my own links between his father’s anger and violence and his own.
2 This material culminated recently in a session where Mr D was again
talking about his father’s violence, but in a way in which he was
3
indicating some parallels between himself and his father, which I
4
commented upon. Mr D found this extremely challenging, and again
5
sought to distance himself as much as possible.
6
7
Mr D: “I’m very different from him. I’m a totally different
8
person.”
9
30 MM: “I think you want to distance yourself from him because
1 you’re afraid of being like him.”
2 Mr D: “But I’d never be like him. I’d never beat my kids if I
3 had any. I’m a tolerant, peaceful person. I never get angry.
4 I used to get angry, have fights, but I’ve learned tolerance,
5 forgiveness, how to deal with my anger, become the model
6 person. I’ve become the model person.”
7 MM: “There’s a big schism between this angry person you
8 once were and the model person now. I wonder what’s
922 happened to all your anger.”

75
76 MAGGIE MCALISTER

Mr D: “I used to be angry, anxious and aggressive. But not

any more. I’ve pushed that person away. I’ve pushed that
person away. That person doesn’t exist any more.”
MM: “It’s almost as if that person is dead.”
Mr D: “Yes. I pushed that person away. That person is dead.
I hate that person.”
MM: “I think you might feel that killing off that person is a
kind of solution, in the same way that killing the devil and
your victims felt like a kind of solution.”

Mr D responded to this again by telling me that that person was dead,

that he was ill at the time and suffering from hallucinations and
delusions. I acknowledged this, but also highlighted the idea that
killing that person, that part of himself, felt like a kind of solution.
Mr D then agreed with this, which could be seen as the beginnings
of an important step in coming together in a shared understanding
of the parts of himself that feel deeply problematic to him.
In fact, like Dorian Gray, Mr D could certainly be said to have
attempted to get rid of a very dangerous, disturbing part of himself
in the act of his offences, and with it the knowledge of his own
murderousness. What emerges in the course of this kind of work is
how much patients like Mr D empty themselves of anything, any
feelings, in the act of violently splitting off parts of themselves into
others—in Mr D’s case his father, his victims, the devil, the other
side of the conflict in his country. At the beginning of this chapter I
referred to times when the work comes to life and there is an
awareness of the tragic consequences of the illness. At these times,
patients can express a level of remorse for their offences, which
suggests that they are not completely depleted. However, it is
difficult to know whether these are moments of genuine insight or
dissociative states which remain fragmented and split off. Therefore
a large task of the work remains in seeing whether it is possible to
arrive at some kind of understanding of the index offence where
some of the patient’s projections can be withdrawn, as this is very
much linked to levels of insight and also future risk management.
Without this, one is left to wonder how safely patients can manage
their own anxieties, and whether they will continue to resort to
projecting all the anxiety into treatment teams while they remain

76
 KILLING OFF THE SHADOW 77

122 “convinced” that they are safe, or alternatively to creating a collusive

2 blindness where the temptation is to deny or minimise the level of
3 risk involved. Both of these poles are tensions I recognise within
4 myself as aspects of my countertransference, and I oscillate between
5 a wish to penetrate his defences on the one hand, and on the other
6 hand a feeling of cruelty in persisting with my interpretative lines
7222 of thought. In both of these poles I have to recognise what is being
8 projected into me and whether it is possible to understand some of
9 the deep anxieties being defended against. The challenge for
10 treatment teams is how to contain the level of anxiety we are made
1 to feel, by not acting on it through a wish for patients to be detained
2 indefinitely, but at the same time not wishing to get rid of it by
3 denying the very real risk patients like Mr D pose to themselves and
4 the public. Paradoxically, one could say that it is not until Mr D
5222 begins to experience anxiety about himself that his treatment team
6 will feel safe enough to make plans for his discharge. In this sense,
7 the patient would have arrived at a position where there is greater
8 capacity for non-psychotic functioning, where some capacity for
9 integration is possible, where some shadow projections can be
20111 withdrawn, and where Jung’s admonition may apply, that “one does
1 not become enlightened by focusing on images of light but by
2 making the darkness conscious” (1954, para. 335).
3
4 The author would like to thank those colleagues who read the first
5 draft of this paper, in particular Michael Mercer, whose comments
6 were extremely helpful.
7
8
9
30
1
2
3
4
5
6
7
8
922

77
78
122 CHAPTER FIVE
2
3
4
5
6
7222 The history of murder
8
9
10
Ronald Doctor
1
2
3
4
5222
6
7
8
9

T
20111 he story of the crime of murder is nearly always a cover-up,
1 an attack on history and its meaning. Hyatt-Williams (1998)
2 gives us the concept of the “death constellation”—the many-
3 faceted situation from which murder is generated. This is like an
4 iceberg—only a small portion is visible.
5 In most cases murder occurs concretely only after it has been
6 committed many times previously in daydreams, nightmares, and
7 sometimes in unconscious fantasy that has never become conscious.
8 Before the deed, conscious efforts—sometimes unconscious ones too,
9 both sado-masochistic and psychotic—are designed and devoted to
30 keeping the impulse to murder encapsulated in order to prevent
1 action. Then a sudden reversal takes place internally which breaks
2 the murderousness loose from its cordoned-off status, and the
3 energies of the individual become devoted to enacting the murderous
4 deed. The death constellation always includes a psychically traumatic
5 and indigestible experience to do with loss and death.
6 In this chapter I shall use clinical material from two patients.
7 They are both adopted, and they thus carry the experience of severe
8 loss. They sought refuge respectively in a psychotic and a sado-
922 masochistic retreat, and this made it difficult for them to mourn the

79
80 RONALD DOCTOR

loss of mother, to process their history of loss, and to negotiate the

depressive position. In their paranoid-schizoid states of mind the
death constellation became virulent, manifesting in their tendency to
maintain the attacks upon themselves by suicidal behaviour in which
they enacted the abused victim. Only with a life-threatening trigger,
displayed as the fear of death, do they enact their murderousness.

Psychotic retreat
In his paper “Attacks on Linking” (1959), Bion states that: “projective
identification makes it possible for the patient to investigate his own
feelings in a personality powerful enough to contain them” (p.106).
The use of this mechanism is denied to the infant, either by the refusal
of the mother to serve as a repository for her baby’s feelings, or by
the hatred and envy of the infant who cannot allow the mother
to exercise this function. This leads to the destruction of the link
between infant and breast and consequently to the destruction or
psychotic denial of the patient’s past, narrative and history. Further-
more, since the infant has rejected the main means of dealing with
his overwhelming emotions, the exigencies of emotional life can
become intolerable. Feelings of hatred are therefore directed against
all emotions and against the external reality that stimulates them. It
is a short step from hatred of the emotions to hatred of life itself, and
ultimately to murder. When persecutory and depressive feelings
become unbearable, therefore, the psychotic patient may project the
problem concretely into a stranger and then seek relief through
attacking and murdering him (Lucas, 1993).

Sado-masochistic retreat
Glasser (1979) suggests that the unconscious aim of sadism is the
preservation of the mother and the ensuring of a continuing viable
relationship with her. The primary intention to destroy is converted
into a wish to hurt and control. Sexualised aggression or sadism
therefore acts as a binding, organising force in this internal state of
affairs, enabling defensive measures to be effective and a certain
stability to come about. It is only when this process breaks down
that sadism may revert to aggression. Sadism can thus shade into
sexual crimes, which in turn shade into crimes of violence and

80
 THE HISTORY OF MURDER 81

122 murder, the realisation of the victim as an external object decreasing

2 in the process.
3
4
History
5
6 In her book Psychoanalytic Understanding of Violence and Suicide
7222 (1999), Perelberg puts forward her hypothesis that violence relates
8 to a core phantasy which involves both the primary relationship with
9 the mother and phantasies about the primal scene, i.e. the original
10 act which created the individual. She states that violence has the
1 function of allowing the perpetrator to believe that he can create a
2 space in which he can survive in the face of an object which is
3 experienced as terrifying. Violence is thus a communication about
4 these patients’ belief systems about themselves, about their relation-
5222 ships with others, and about their origins. The violent act or phantasy
6 tells a story which represents their personal myth of creation and
7 contains both pre-oedipal and distorted oedipal theories. The
8 function of the analytic process is to follow the chains of associations
9 as manifested and enacted in the transference and countertrans-
20111 ference, and to reconstruct the narrative of their origins.
1 What is needed, as I see it, is a structure or setting that can take
2 patients to the crossroads of their origins, where they can explore
3 how, when they are exiled from their family, the family is in turn
4 exiled from the past, the present and, until their tragic relationship
5 is resolved, the future. The analytic work is about discovering not
6 the trauma of a singular catastrophe that can be overcome and
7 healed, but a trauma that involves the destruction of life itself. This
8 creates a void, an overwhelming emptiness in which the continuity
9 of life and history is so brutally disrupted that the structure of life
30 is forever torqued and transformed. The patient lives in a world
1 where there is only darkness and nothingness, and fills this hole with
2 sado-masochism and psychosis.
3 According to Benjamin in Theses on the Philosophy of History (1940),
4 personal narratives can become fragmented and psychotic, and
5 appear like a “pile of debris” which is at times all that may stand out
6 as intelligible in a life story containing abuse, trauma and psychosis.
7 The psychotic experience can become reified and may occupy a
8 disproportionately pre-eminent position in a person’s autobiography
922 and its translation by acute psychiatry. The patient’s version of history

81
82 RONALD DOCTOR

can become devalued, and the meaning of the story, in his or her own
words rather than in psychiatric translation, is too often disregarded.
For the patient, the relative vividness of the psychotic experience
can stand out against a background of impoverishment; it can form
a powerful, collective historical continuum that subsumes the
individual history. At this point the ability of the individual to
maintain a view of himself which is distinct from the image offered
to him by the psychotic spectacle begins to fade. The risk for people
with psychosis is that the full complexity of their memories of
themselves is fractioned and distilled, leaving only the most potent
of images to represent them. Perhaps the act of murder is such an
image, the sudden flash of recognition which passes from the patient
to us in a moment of extreme conflict. However, this is also the
moment of its passing, unsustainable in the aggression which has
produced it (Prenelle, 2006).
History is revealed not by the momentous events but by the ones
that lie hidden in their shadows. This is what brings the past alive
in the present, shifting the lens from the subject of history to the
history of the subject. Telling stories can be an important source of
meaning for patients. Their exploration offers opportunities for
individuals with experiences of psychosis to reclaim a sense of their
own identity and biography, and to escape, at least to some extent,
the one-dimensional narratives of pathology. Thus psychotherapy
offers such a setting where stories can be told and heard, and
histories understood. The continuous construction of the meaning
of what goes on between patient and analyst reconstructs, in the
transference, something of the history of the patient’s relationship
to his objects, the anxieties involved, and the way the defences were
built up. The work of reconstruction in analysis is a continuous
interweaving of the threads of history as experienced in the analysis
with the threads of remembered history, and this combination
enriches his understanding of himself, thus providing him with a
new autobiography (Riesenberg-Malcolm, 1999).

Clinical vignette 1: psychosis

Mr A, a 46-year-old divorced man, was introduced to me by a nurse
in the medium secure hospital, who said that the alarm button was
behind the door. My anxiety had become concrete as a relaxed

82
 THE HISTORY OF MURDER 83

122 Mr A walked into the room. He complained that his memory was
2 poor, thus ensuring that his history would consist of an erratic,
3 unreliable and protracted psychiatric narrative. At the age of 12 or
4 13 he was seen by a psychiatrist after taking an overdose. At 14 he
5 took a second overdose after threatening to kill a child in a local park
6 with a knife, and there was a third suicide attempt at the age of 20,
7222 when he jumped from a bridge. Then followed a story of numerous
8 admissions to psychiatric hospitals and follow-up appointments
9 from the age of 30 until the index offence at the age of 44, when he
10 killed a man in a park by repeated stabbing.
1 On further encouragement, Mr A said that he felt people liked
2 to pick arguments with him, and his early memories were of the
3 constant arguing and fighting between his parents. During the
4 arguments he would say to his parents “you are not my father or
5222 mother”. He was adopted at the age of three months, but his parents
6 had one biological son who was five years older than Mr A. He also
7 had an adoptive sister. He remembered at the age of 12 going to
8 family therapy with his sister, his depressed mother and his police
9 officer father. His mother died of breast cancer when he was 20.
20111 Mr A told me that he had committed murder. He could not
1 remember much about it, but he felt that everywhere he went,
2 whether Brighton or Bedford, everyone knew him: “they knew all
3 about me or my history”. He remembered that he had obtained a
4 knife in Bedford, and had then walked around the city three or four
5 times, but he had amnesia for the actual crime. Mr A had apparently
6 stabbed a man whom he did not know numerous times in a park.
7 He said he knew that he was going to be attacked “because everyone
8 in London knew me”, and he was worried that he was going to be
9 killed. He also stated that that he wanted to kill someone as he
30 wanted help, i.e. admission to a hospital or home. When he thought
1 about what happened in the park, he felt that he was going to die,
2 and yet it was what he wanted. He said that he felt he was losing
3 his mind, and he was annoyed with a nurse who told him he would
4 “get better within a couple of years”. Mr A thought he would not
5 get better, and felt hopeless about his future. For him, the dread of
6 getting better concerned entering the depressive position and
7 becoming aware of his losses. He ensured by his act of murder that
8 no one would know him or his history, and he could return to
922 hospital with one more notch on his psychiatric record, safe in the

83
84 RONALD DOCTOR

knowledge that his story would be stripped of meaning and his alarm
and hopelessness would be left projected into me intact.
He was diagnosed initially as suffering from chronic paranoid
schizophrenia and, more recently, from a severe personality disorder
with polysubstance misuse and borderline learning disability. Mr A
had made strenuous efforts to keep the murder encapsulated from
action, by splitting off and denying his awareness of who he was,
who he had been, his origins and his profound sense of loss. He was
thus ensuring the destruction of the link to his history and life story
by means of a paranoid psychotic process.
When he projects into the stranger his belief that people knew
him, his history and his reality, and then kills him, a sudden flash of
recognition occurs, which passes from the patient to us at a moment
of extreme conflict. To quote Benjamin: “The true picture of the past
flits by. The past can be seized only as an image that flashes up at
the moment when it can be recognized and is never seen again.” A
hitherto unseen image of reality may become visible in the present,
emerging from the debris of history as a clash of a moment of the
past and a moment of the present. The disruptive synthesis involves
a process of surreal juxtaposition akin to photomontage, in which
apparently banal images can be combined to reveal a constructed
image of tremendous force and vividness, one which is historically
truthful only for one specific moment. In other words, the act of
murder brings a new reality, a new creation.

Clinical vignette 2: sado-masochism

Ms D was able to tell me more of her history, but it was suffused
with sado-masochism as a defence against loss and depressive
anxiety. She started the interview by saying that she did not think
she would ever get over the fact that she had killed her husband. She
said she didn’t know what to do with her life—or what was left of
it. She felt terribly guilty about the killing, but didn’t miss her
husband any more. She said: “I will always be haunted by the ten
seconds of my life when I killed him”. Sometimes she wished she had
turned the gun on herself. Ms D informed me that she was given a
four-year sentence of which she served two years. She said that in a
lot of ways prison was the easy bit. There were people who had done
similar things to her; they were all the same and she didn’t feel any

84
 THE HISTORY OF MURDER 85

122 different from them. She said: “I didn’t feel judged by the people in
2 there. I didn’t have time to think of it, I was just trying to survive
3 every day.” She didn’t know why she had wanted to survive then or
4 why she wanted to survive now. She said the murder was a dramatic
5 high point in her life, akin to a “flash of recognition”; she had always
6 felt alone, different, never belonged to anyone or anywhere.
7222 Ms D had always felt bad and guilty. She was adopted at 18
8 months from an orphanage, and she said she could not understand
9 or forgive the abandonment by her mother. She said that her adop-
10 tive parents did not really want her either, and they were very distant
1 and undemonstrative of affection. She had worked out a long time
2 ago that being adopted was a really bad thing. The person who was
3 supposed to give her unconditional love did not want her, and to
4 make matters worse, her adoptive mother was “not a very mumsy
5222 sort of person”. It would seem that Ms D’s early experiences—of
6 feeling abandoned by her natural parents, of not being wanted by
7 her adoptive parents, and of her adoptive mother’s physical and
8 psychological unavailability—had led to the development of perva-
9 sive feelings of self-hatred and a profound sense of inner emptiness.
20111 She described a reasonably happy childhood, though she was bullied
1 at school for being the only child in her class who did not live on
2 the local council estate, and her adopted status was mocked and
3 denigrated. At the age of 14, she was sent to an approved school as
4 she was felt to be “in need of care and protection”. She seemed to
5 feel quite bitter about this and said she had been sent away because
6 her mother was not prepared to keep her at home. During her three
7 years there she frequently ran away. She described her father as kind,
8 but a worrier, and her adoptive mother as an unemotional woman
9 who punished disagreement by withdrawal and who liked to be the
30 centre of attention.
1 Ms D went on to say that abandonment had something to do with
2 the murder. The victim was her fourth husband, and she joked that
3 she had not killed the other three husbands but divorced them. The
4 relationship with her first husband, a jealous man, had been very
5 complicated in that they were both struggling to be grown up. They
6 used to fight a lot, “like kids”, but he was more of an adult than
7 she was, so he did more damage to her; she became an abused victim
8 and so she divorced him. She tried to kill herself by taking an
922 overdose, and was admitted to a psychiatric ward for 28 days. She

85
86 RONALD DOCTOR

had known her second husband for five years, but the marriage lasted
only three months. She then married for the third time, and this
lasted four weeks. A year later she met her fourth husband, and they
were together for seven years until she killed him. She says her
parents, “disappointed and horrified”, stood by her, although they
would never talk about any of it. She says she has progressively
withdrawn from people since, and cannot cry. She has difficulty now
in making friends because it means having to tell them about the
killing of her husband, and she never knows whether she can tell
them or not. As soon as she says she is a widow, they want to know
why, and she usually lies; then if they found out that she lies they
wouldn’t trust her.
She continued by saying that her fourth husband was very
popular with both men and women as he was intelligent and
charming. He was having affairs during their marriage, and she felt
like a battered wife. She said that it was both her husband’s and her
fourth marriage, and they had become dependent on each other.
They both started drinking and arguing a lot, and he was hoping
that Ms D would kill herself. He went on a hunting trip one day,
and before he left he hit her in the face and broke her nose. When
he returned he crept back, expecting something to happen. Ms D said
she was going crazy; one night she felt a gun pointing at her head
and heard him saying quietly, over and over again: “Don’t leave me”.
She had managed to turn the tables: he was now the unwanted
little child. In order to try and calm the situation down, she said
to him: “I won’t leave you”. A couple of weeks after that she asked
him if she could go back to the UK to see her mum and dad, but her
husband just ripped up her passport. He had become very
unpredictable, and finally she shot him with his gun, in self-defence,
because she thought he was going to kill her. She remembered him
telling her that she was as pitiful as his dog, which he had just shot
because the dog was killing ducks.
She told me that she overheard a conversation in the corridor:
she thought she heard the statement “the patient was crying and was
asking ‘why weren’t you there?’”, and both the staff were laughing.
She was concerned that her personal history would be a source of
amusement to others. She went on to say that she has not cried for
nine years and no one knows that she has depression. People have
only so much sympathy. She tries to keep her depression inside

86
 THE HISTORY OF MURDER 87

122 herself. I made the comment to Ms D that she had no one to turn to
2 with her depression, nowhere to take her sad feelings, so her only
3 resort was to laugh and joke. She surprised me by saying that her
4 friends suddenly came out of the woodwork after the incident. Ms
5 D says that she has friends in the country where the murder took
6 place, who care for her. “They don’t know how I was before the
7222 killing, they treat me as a victim, and therefore this makes me feel
8 very manipulative.” I think she felt that she was able to manipulate
9 her history; she had killed and got rid of her past, and with it her
10 identity as the sad unwanted little girl.
1 The following is a clinical session I supervised with this patient,
2 who was seen for once weekly individual psychotherapy in a
3 Psychotherapy Out-Patient Department for twelve weeks. This was
4 her twelfth and last session, as she then dropped out of therapy. I
5222 reproduce the session to show her sado-masochistic defence to her
6 enormous feelings of loss and abandonment, and also something
7 more hopeful.
8
9 Ms D: “The guilt-loving part of me will never let it go, it was
20111 the high point of a screwed up life. I’m so self-destructive,
1 and I’m not good at taking responsibility for things. I’m
2 supposed to be going to the day hospital, now if they forget
3 and don’t phone, Dr A knows that there’s no way I’ll
4 phone them.” (Laughs.)
5 (Therapist: I felt very hopeless as Ms D was talking, as if
6 nothing would or could change this.)
7
Therapist: “What’s that about?”
8
9 Ms D: “That’s saying I told you so, I told you I don’t care. I
30 must be grown up sometimes.”
1 Therapist: “I think I’m hearing something about your feelings
2 towards people who are supposed to be looking after
3 you—the day hospital, who abandons you and then might
4 forget to phone; me, who leaves you all week; Dr A, who
5 has been away; your parents in the past. There are a lot of
6 people who are supposed to be there and aren’t. Maybe
7 the part of you that remembers being let down in the past
8 is still angry—the child in you that wants to be loved and
922 cared for all the time gets angry about it.”

87
88 RONALD DOCTOR

Ms D (crosses legs and arms and sits up straight, pouting, and

laughs): “. . . and I’ll take the phone off the hook.”
(Therapist: Again Ms D made a joke of my intervention. I had
to remind myself how difficult she found her own feelings
and I tried again.)
Therapist: “It sounds as if it’s hard for you to feel that you
need people?”
Ms D: “Yes, I have high expectations of everyone, including
myself.”
Silence.
Ms D: “My friend wants to find his Mum, he’s adopted too,
and I tried to talk him out of it because he wasn’t in a good
place, just split up with his wife. I’ve never wanted to
because I’ve always hated her for abandoning me, I can
deal with it intellectually—at 15 years old, thought it was
the best thing—but not emotionally. I decided at quite a
young age, five or six years, that being adopted meant your
mum didn’t want you, and it stuck. The person who gave
birth to you didn’t want you so why would anyone else?”
(Therapist: this was said seriously and questioningly. I felt that
my recognition of her feelings had touched a chord and she
had decided to trust me.)
Therapist: “So is it a sense of ‘why would anyone else want
me either?’—you won’t phone in case they reject you?”
Ms D: “Well, it has a certain logic to it. Somehow I re-enact
it in every relationship I have.”
Pause.
Ms D: “You remember when I told you about my birthday
party? I thought you seemed rather upset, so I decided that
I shouldn’t tell you anything too upsetting.”
(This referred to an incident when she was nine years old and
she invited the class to her birthday party, but no-one came.)
Therapist: “I was upset for you, that little girl let down, partly
because I felt for her, you, and partly because I felt that
you could not feel it yourself, that you could not bear to
feel those feelings and had given them to me. Maybe also
part of you wanted to protect me from them?”
88
 THE HISTORY OF MURDER 89

122 Ms D: “It did make me feel you weren’t going to respond well
2 to me being knocked unconscious, and coming round to
3 find myself tied to the shower installation, having my legs
4 burned with cigarettes.”
5 Silence.
6
(Therapist: I felt she meant to provoke me. It was a sort of
7222 further test to see how I would react. I was shocked and
8 uncertain what to say in case I failed her.
9
Supervisor: I commented that she also immediately goes into
10
a sado-masochistic mindset when the therapist tells her she
1
is sad and tries to push it back to the patient.)
2
3 Therapist: “I just feel shocked—I wonder if that was how you
4 felt, and disbelief that one human being can do that to
5222 another . . . can you tell me what it was like for you?”
6 Silence.
7 Ms D (head in hands): “Apparently not.”
8
(Therapist: I could see by her despairing attitude that she was
9
experiencing strong emotion, holding herself.)
20111
1 Therapist: “It must be really difficult for you to bring it all back.
2 If you are not ready to go there, that’s OK.”
3 Ms D: “It’s just so scary to be so powerless, to have no
4 control; you can’t do anything, say anything with duct tape
5 over your mouth. You’re sort of cut off from what’s
6 happening, frightened of killing yourself by choking on
7 your tears and snot and what not, trying not to asphyxiate
8 yourself, you get frightened that it’s going to stop, what’s
9 going to happen next, you wonder what he’ll do with the
30 body . . .”
1 Therapist: “Afraid of dying . . .”
2 Ms D: “No, more worried they wouldn’t find me, that Mum
3 and Dad wouldn’t know where you were . . . He left me
4 there for three days.”
5 Therapist: “Trapped in pain, terrified.”
6
(Therapist: this was wrong, jarring, supposing that I knew her
7
feelings, and she rightly became angry at my lack of
8
sensitivity. I gave in to my need to say something rather than
922
allowing her to come to it in her own time.)
89
90 RONALD DOCTOR

Ms D: “Fuck it! Should have shot him sooner!”

Silence.
(Therapist: I was aware the session was near the end and was
simply uncertain what to say. She seemed lost in reverie, not
looking at me but down at the floor. Suddenly she sat up again
and shut off her tangible emotion.)
Ms D: “I can’t think about this any more. (Apologetically)
I went for a walk with J to Windsor, to the Punchbowl,
and it was full of rhododendrons, azaleas, magnolia . . .
amazing. There was a totem in the middle, all carved, the
bottom covered with grass, and we were trying to work
out which animal was which—is that a bear or an elephant?
No, you don’t get elephants in Canada.” (Laughs.)

Conclusion
Though Ms D had projected her feeling of abandonment and shock
concretely into the therapist and then killed her off by not returning
to the therapy, there was a glimmer of anticipation, the beginning
of a link with her past. The totem pole tells a story about the family
and the rights and privileges it enjoys. Totem poles, elaborately
carved with images of animals and people, can be thought of as three-
dimensional family histories, histories that began in the time before
people lived on the earth, when animals spoke to each other, histories
that tell of journeys from distant places, marriages and births,
supernatural transformations and heroic deeds. Totem poles embody
the tribal clans, the family and inter-tribal identity, and serve as a
visible reminder of the past and present.
Unlike Mr A, who had placed one more notch on his totem pole
of psychiatric histories by his psychotic act of murder, ensuring that
he had found a hospital home forever, Ms D, after her act of murder,
returned to live at home with her parents, albeit “an elephant in
Canada”. She felt able to begin to construct a totem pole in her mind,
to get to know her history, even if in concrete terms, and there are
the beginnings of an awareness of her painful past.
In both patients there is an attack on their origins and their
histories, creating a void, an emptiness which they fill with their
psychotic debris of the psychiatric history and sado-masochistic

90
 THE HISTORY OF MURDER 91

122 abuse in order to encapsulate their murderous rage. With the help
2 of psychotherapy comes the painful awareness of the loss and the
3 hope that the patients might begin to mourn their loss.
4
5
6
7222
8
9
10
1
2
3
4
5222
6
7
8
9
20111
1
2
3
4
5
6
7
8
9
30
1
2
3
4
5
6
7
8
922

91
92
122 CHAPTER SIX
2
3
4
5
6
7222 The dog that didn’t bark: a mild
8
9
man’s murderousness
10
1 Philip Lucas
2
3
4
5222
6
7
8
9
20111 Introduction
1
“
I
t still strikes me myself as strange that the case histories I write
2
should read like short stories and that, as one might say, they
3
lack the serious stamp of science.” So wrote Freud (1895,
4
5 p. 160) in his discussion of the case of Fräulein Elisabeth von R in
6 “Studies in Hysteria,” and the case I am writing about suffers from
7 a similar stamp of fiction. Freud then consoles himself for being
8 scientifically unconvincing by pointing to the fact that his case
9 histories drew out “an intimate connection between the story of the
30 patient’s sufferings and the symptoms of his illness”, something
1 unknown in the work of his psychiatric contemporaries. I hope to
2 demonstrate a similar close link between “the story of the patient’s
3 sufferings” and the serious offences he committed.
4 I shall be focusing on the personality structure which sustained
5 an individual uneventfully into middle age but which then came
6 apart with dire and unexpected homicidal consequences. As I shall
7 discuss, his personality structure has much in common with the
8 “narcissistic exoskeleton” described by Cartwright (2002) in a series
922 of perpetrators of “rage-type” murders.

93
94 PHILIP LUCAS

But it is not only the inner world that demands thought. Aspects
of the external response to the patient’s violence have been puzzling.
There has been a persistent tendency for the risk he posed to recede
into the background, with eventual fatal consequences. I hope to
illuminate the process by which the structure of the patient’s mind
distorted the perceptions of the professionals involved.
In a climate where a professional’s livelihood may be put in
jeopardy by a single mistaken judgement (Carvel, 2006), I need to
emphasise that the “message” of this chapter depends upon hind-
sight. In comparison with those who played a direct role in the
drama, the author is in the privileged position of the dispassionate
historian of a distant war. From such a vantage point, the play of
otherwise invisible forces, notably powerful projections from the
patient’s inner world, could be brought to the forefront of the stage.

The case of Mr N
Mr N appears mild-mannered and polite, eager to please, with
difficulty being assertive. There’s something slightly comic about
him: always well turned out, but outmoded, and he often tells
childish jokes. He looks the quintessence of harmlessness—but Mr
N killed his wife (let’s call her Maureen), who had been his girlfriend
in their early teens. There had been no violence in the previous
21 years of their marriage. He killed her in a frenzied attack. He
bludgeoned her head repeatedly with a hammer, and also left her
with severe injuries to her throat. He was then 42 years old. In
addition, and seemingly as an afterthought, he killed his female
general practitioner, who had come to see him at home, in the same
brutal manner and leaving similar injuries.
He was seen by a neighbour outside his house, holding a hammer,
shouting, “Help me, help me, I’ve killed Maureen!” He had blood
splashed on his clothes and glasses, and was frantically trying to
swallow a large quantity of pills. Between his arrest and being taken
to hospital, Mr N made the comments: “I told the doctor these tablets
were making me worse”, and: “My God what have I done? We just
rowed. She went on and on.” When seen before his trial, Mr N
described his wife as “marvellous” and his marriage as “very happy”.
He claimed complete amnesia for the violent act itself, and continues
to do so. His GP victim is not mentioned.

94
 THE DOG THAT DIDN’T BARK 95

122 Background
2
What of his family? He maintains that his parents wanted him to be
3
a girl, and called him by a girl’s name as a child. We have no clear
4
picture of his mother, but Mr N describes her as always loving and
5
6 caring. She had Alzheimer’s disease for some time before her recent
7222 death in her 90s. His father suffered from early onset Parkinson’s
8 disease, and Mr N describes him as weak. He died when Mr N was
9 21. Mr N has a brother seven years his senior.
10 Mr N was born with a hare-lip and cleft palate, and underwent
1 several surgical interventions in the first year of his life and further
2 facial surgery later. Reports describe a nervous, clinging child. At
3 secondary school he was bullied, which included being forced to
4 perform fellatio in the toilets. He told neither parent what was
5222 happening, but truanted from school. Eventually he moved to
6 another school, where things improved. In his teens he was found
7 to be depressed at the time of a hospital admission for a mastoid
8 operation. At 26, there was a further episode of depression after a
9 bout of flu, during which “aggressive feelings towards others” were
20111 noted. In his early and again in his late thirties, there were two further
1 episodes of depression, both treated as an out-patient. There was
2 some suggestion that the episodes were increasing in severity.
3 We have no clear picture of his wife, but it is known that she
4 suffered from frequent epileptic fits and that Mr N felt required to
5 look after her. He describes backing down from confrontations with
6 her for fear of triggering a fit. There were no children because of Mr
7 N’s low sperm count. He had various jobs, including several as a
8 hospital porter, in which he reported enjoying the chance to look after
9 others.
30
1
Homicide and after
2
3 An episode of depression began three weeks before the killing,
4 again following a bout of flu. This time Mr N experienced psychotic
5 symptoms. He believed he was being watched and talked about. He
6 described derogatory second person auditory hallucinations and
7 depersonalization. He became agitated, cried frequently, and felt he
8 could not cope with his wife. A few days before the offences, he was
922 prescribed an antidepressant by his GP, to whom he failed to reveal

95
96 PHILIP LUCAS

his symptoms of psychosis. His wife requested a home visit from

the GP for Mr N, which ended in tragedy.
Mr N was found guilty on two charges of manslaughter on the
grounds of diminished responsibility. It was judged that his
psychotic depression had substantially impaired his responsibility
for his actions in killing his wife and GP. He was made subject to a
Hospital Order with restrictions, and ordered to be sent to hospital
under sections 37 and 41 of the Mental Health Act 1983. Unexpectedly
in retrospect, Mr N was sent to an open ward in an ordinary
psychiatric hospital. It is worth stressing how unusual this would
be. Mr N not only avoided incarceration in prison for two brutal
killings, he was also not sent to a secure psychiatric hospital but to
an unlocked psychiatric ward.
There the records describe Mr N as a “model patient”. He took
medication as prescribed and his depression lifted rapidly, but he
remained amnesic for the killings. Nevertheless, before five years had
elapsed after the killings, he was being considered for conditional
discharge from his Hospital Order. And this occurred in the context
of a new relationship in hospital with a fellow patient, whom we
can call Patricia.

Review
The Home Office has a duty to review and comment on proposals
to Mental Health Review Tribunals for patients to be discharged from
“restricted” Hospital Orders (section 41 of the Mental Health Act).
There was clearly concern that the proposed discharge of Mr N was
inappropriate, and the matter was referred to the Advisory Board
for further consideration. The Board’s report states that “special
hospital treatment might have been expected in this case, but instead,
N was sent to a local hospital . . . told that he was not responsible
for the killings, and told that all he had to do to secure release back
into the community was to sit tight for two years.” The Board
concluded that the case had been mismanaged and that it was
premature and unsafe for Mr N to be conditionally discharged in
view of his “un-redressed personality problems, the stress of his
current relationship and his lack of insight into his condition”.

96
 THE DOG THAT DIDN’T BARK 97

122 Dr B’s views

2
Because of this disagreement, Mr N’s consultant psychiatrist asked
3
Dr B, a colleague with considerable experience and expertise (but
4
previously uninvolved), to review the case. Dr B commented that
5
6 the “limitations to progress hinge upon his amnesia”, which is
7222 “extremely resistant, as it is his primary defence mechanism and may
8 protect him against further breakdown in the form of psychotic
9 depression. At the same time it prevents progress in terms of remorse,
10 coming to terms with what he has actually done.” He noted Mr N’s
1 “over-controlled personality”, “extreme passivity”, and compliance
2 even in the face of frustrating circumstances. He also noted an
3 “inability to assert himself in any way within the context of his
4 relationship with his wife”.
5222 Regarding the killings, Dr B commented that “disinhibition
6 resulting from severe, agitated and psychotic depression was the
7 primary factor”. This, Dr B thought, combined with long-repressed
8 feelings of irritation and hostility towards Mr N’s wife that had
9 “never been vented in a normal manner”. Dr B believed that such
20111 feelings emerged explosively following the final precipitant of being
1 told by his GP to persevere with medication in which he had no faith,
2 and which Mr N believed at the time was making him worse. Dr B
3 commented: “Although such a form of stress would seem trivial, in
4 Mr N’s disturbed and agitated mental state, and with a progressively
5 distorting view of reality, it may well have combined with these
6 other factors to produce the final homicidal outburst.” Dr B wrote
7 that the risk of further violence would hinge on three factors coming
8 together: recurrence of psychotic depression; the presence of ongoing
9 frustrating factors that he is again repressing and concealing from
30 himself and others; and finally, sudden stress acting as a trigger.
1
2
Act II
3
4 Dr B’s views turned out to have been horribly and precisely prescient,
5 because more than a decade after he conveyed them to Mr N’s
6 consultant, many years after the homicidal episode of which his
7 wife and GP were victims, Mr N killed his girlfriend, whom we’ve
8 called Patricia, the vulnerable fellow patient he had met so many
922

97
98 PHILIP LUCAS

years before. When the second homicidal episode took place, Mr N

was sixty. He was again depressed, there were difficulties within the
relationship with Patricia, and again there was precipitating stress.
The post mortem findings indicated that there was blunt force injury
to the head and stab wounds to the neck, injuries very similar to those
of eighteen years before.
An awful irony is that it was Dr B himself who was looking after
Mr N in the community, years after he had been granted an absolute
discharge from his restriction order. A further irony is that Dr B had
found himself unable, despite considerable effort, to transfer Mr N’s
care to the local services. Mr N had resisted, declaring his faith in
Dr B, who had, he said, “rescued” him from hospital.
It seems that two months before the killing, Mr N developed an
itchy anal rash and stopped taking lithium, his prophylactic treat-
ment for depression, when a pharmacist suggested it could be the
cause of the rash. Depressive symptoms emerged three weeks before
the killing, but Mr N failed to inform Dr B of this when he saw him.
Nor did he tell him he had stopped taking his lithium and restarted
it just two days before his clinic appointment with Dr B, six days
before the killing.
When seen by Dr B, Mr N complained of having to look after
Patricia, and mentioned his fear that his disability allowance would
be stopped. He has since stated that at the time he believed Dr B
would see how ill he was and would get him a bed in hospital. At
the time, however, he denied any symptoms other than anxiety and
insomnia. Dr B increased Mr N’s amitriptyline dose and arranged a
further appointment for a few weeks later.

Mr N: preliminary understanding
Mr N was admitted to hospital once more, this time to a medium
secure unit, having again been convicted of manslaughter on the
grounds of diminished responsibility. Again, psychotic depression
was held to have substantially diminished his responsibility for his
actions. Again, he was made subject to a Hospital Order under
sections 37 and 41 of the Mental Health Act 1983 and detained under
the category of “mental illness”. The question for the treating team
was whether, with the benefit of hindsight, it could build on Dr B’s
1991 assessment. The latter had proved both accurate and highly

98
 THE DOG THAT DIDN’T BARK 99

122 relevant, but had nonetheless failed to prevent an almost exact

2 repetition of a homicidal scenario.
3 A full explanation of what had taken place when Mr N was in
4 his early 40s and again at the age of 60 required further under-
5 standing of Mr N’s psychic development as he moved from infancy
6 into adulthood, particularly during his extensive periods of relative
7222 stability. The next task was to make more sense of what was
8 happening in his inner world at the times of the killings and then as
9 he returned rapidly to his previously stable state. Much would,
10 however, remain a matter of speculation because of Mr N’s lack of
1 access to so much of his inner world.
2 To start at the very beginning: it is almost certain that there
3 would have been serious difficulties in the relationship between the
4 infant Mr N and his mother. He was born with a hare-lip and a cleft
5222 palate and required more than one surgical intervention in the first
6 months of his life. We can only surmise just how his mother would
7 have reacted to the birth of such an infant, especially as she had been
8 hoping for a girl. Depression on her part seems highly likely. His cleft
9 palate and hare-lip, apart from the revulsion (and then the guilt) they
20111 might well have provoked in his mother, would probably also have
1 interfered with his feeding. The stage is clearly not set for the infant
2 Mr N to internalise a picture of himself as adored and worthy of his
3 mother’s adoration. Much more likely is the development of a deep
4 sense of shame. And admission to hospital was in effect abandon-
5 ment at a time before it was expected, as it is at present, for mothers
6 to stay with their children. So he was abandoned to the hands of
7 strangers who would have left him in desperate pain and misery.
8 So in the speculative narrative we are building up, there appears
9 a carer who failed Mr N just when he needed her most; and carers
30 who fail him appear again when he is coerced into performing oral
1 sex on the school bullies: he believes his father far too weak even to
2 be told of his son’s misery, much less to be asked to intervene.
3 So what happens? In the course of his development, Mr N
4 becomes a carer for the damaged. His childhood sweetheart has
5 epilepsy and he makes her his wife. He is able to look after the
6 damaged part of himself in her, to become the good carer he felt he
7 so conspicuously lacked. And the pattern continues after the killing
8 of his wife: he quickly finds another needy person to look after, the
922 vulnerable fellow patient, Patricia.

99
100 PHILIP LUCAS

Personality
Mr N developed into an unusually mild, good-hearted man who
could not bear confrontation. So the question arises as to what was
happening to the hostile, angry feelings which would appear with
a vengeance when he was in his fifth decade. By his twenties, Mr N
had become someone who needed to be seen as a good man and
who required the good opinion of others. He would not challenge
or confront. Few hints of aggression were allowed to emerge—apart
from when he was depressed.
An assessment of his personality during his second hospital
admission, when he was in his mid-twenties, suggested that he “has
always been a worrier, but [is] a cheerful man who usually makes
people laugh . . . He has been married for six years and is very
happy, although they have not yet been able to have the children
they want . . . During the course of his depression, he has often felt
extremely aggressive towards other people, but realises this feeling
is irrational.”
A “split” in his personality was evident to those looking after
him after the first homicidal episode. By now in his 40s, it was
reported with regard to Mr N that “a lot of energy has to go into
this ‘pleasing for others’ way of being in the world, while resentment,
anger, annoyances are not shown . . . [He has] a tightly controlled
personality that could tolerate little deviation from preconceived and
somewhat sterile interactions.”
Early in his admission to medium security after the second
homicidal episode, professionals involved in his care became aware
of strong pressure on them to forget, disregard or otherwise be
unaware of the nature of Mr N’s offences. And while there was a
quality of desperate urgency in Mr N’s demands for a close relation-
ship with a female carer, he remained oblivious of any reason why
this might be thought to require careful consideration. His disavowal
of such matters was tellingly illustrated by his ward round joke about
Henry VIII and his wives, without a hint of awareness of any link
with his own actions.

Narcissistic exoskeleton
In his book Psychoanalysis, Violence and Rage-Type Murder, Duncan
Cartwright discusses in considerable detail the cases of seven men
without a history of previous violence who killed in sudden outbursts
100
 THE DOG THAT DIDN’T BARK 101

122 of violence. While none of his cases had been diagnosed with a psy-
2 chiatric illness, his descriptions of them suggested that Cartwright’s
3 ideas might help in understanding Mr N.
4 Cartwright introduces the concept of the narcissistic exoskeleton to
5 describe the personality structure of his seven killers: “exoskeleton”
6 referring to both the rigidity and the defensive function of the
7222 “outer” personality, and “narcissistic” to the quality of object
8 relations. Mr N’s personality structure is strikingly similar, and is
9 “characterized by a rigid split between a constellation of idealized
10 object relations and internalized bad objects, where the former
1 assumes the position of an outer ‘holding’ personality” (2002, p. 113).
2 The “key defensive aim” of this personality structure for Mr N and
3 for Cartwright’s subjects is “to maintain an apparently all-good
4 compliant personality in order to deny and split off intolerable
5222 elements of the self that have become associated with badness,
6 weakness or aggression” (ibid., p. 117).
7 Cartwright describes how, by a particular use of projective
8 identification, the self identifies with idealized people who are
9 psychically held “outside” so as to keep them away from the buried
20111 badness inside. This is much less familiar than the experience,
1 particularly in borderline patients, of a split between good and bad,
2 between the idealised and the denigrated, in both the inner and the
external world. And it is less familiar than the projection outwards
3
of badness seen in paranoid patients.
4
What was distinctly unfamiliar about Mr N was the projection
5
of idealized goodness, with badness internalized and hidden. At the
6
heart of the concept of projective identification is the idea that the
7
unconscious phantasy of one person can, via verbal and non-verbal
8
behaviour, give rise to emotional states in the recipient of the
9
projection which correspond to the original phantasy of the first
30
person. Thus Mr N somehow contrived to induce in his treating team
1
the “belief” in his phantasy that he was not a killer, that he was
2
in fact a nice, reasonable man. And somehow the members of the
3
treating team found themselves reacting to him according to his
4 phantasy, as if he were in fact innocuous.
5
6 Depression
7
On the two occasions when Mr N killed, he was suffering from
8
psychotic depression, and the relationship between his mental illness
922
and his personality organisation requires elucidation. Cartwright’s
101
102 PHILIP LUCAS

cases were not diagnosed as psychiatrically ill, but some did suffer
affective symptoms in the build-up to murder, as the defensive
narcissistic exoskeleton gradually lost its protective function. In a
similar fashion, Mr N’s recurrent depressive states seemed to arise
as the rigidly maintained defensive structure started to break down.
Episodes of depression occurred in association with bodily illness
(flu) or imperfection (rash), which appear to have represented an
unwelcome change in a narcissistically idealised body state equated
with an idealised version of the self.
Freud characterised depression as the reaction to the loss of a real
or imaginary object: “a loved person, or [. . .] some abstraction which
has taken the place of one, such as one’s country, liberty, an ideal,
and so on” (1917, p. 243). Freud posited the depressive state as a
reaction because the essence of the depressive phenomenon resides
not in the loss itself, but in the way the mind deals with that loss: in
the unconscious fantasies and conscious thoughts which organise the
way that loss is experienced. For depression to appear, the loss of
the object must be accompanied by a persistence of the desire for
that object and by a representation of its unattainability. In other
words, the object must be psychically constructed as lost (Bleichmar,
1996, p. 935).
As the narcissistic exoskeleton structure rigidly separating
internalised encapsulated bad and externalised goodness became less
effective, Mr N became aware of aspects of himself that he could not
tolerate, such as neediness and rage, and so suffered the painful loss
of his idealized version of himself. As Bleichmar makes clear, such
a loss may represent a pathway to the state of extreme helplessness
and hopelessness familiar to us as “depression” (ibid., p. 944). And
because of the longstanding rigid splitting, Mr N has developed little
capacity to integrate these aspects of himself, so he experiences them
psychotically as coming from outside the self, as persecutory attacks.

The killings: intra-psychic events

So we come to the killings. Cartwright (2002) presents a convincing
sequence of intra-psychic events which culminate in the frenzied
killings of his rage-murderers. The sequence is schematised: what
may well occur almost simultaneously is represented as taking place
over a period of time.

102
 THE DOG THAT DIDN’T BARK 103

122 The sequence begins with weakening of the narcissistic exoskele-

2 ton, followed by its complete collapse, provoked by some particular
3 trigger. The collapse of the defensive structure involves a shift from
4 identification with an idealized external version of the self to
5 identification with a previously buried, intolerably bad version of
6 the self. This latter is experienced as an unbearable intrusion which
7222 threatens survival. In that moment the threat is evacuated and
8 projected into the victim, who is then experienced as life-threatening.
9 The final murderous attack represents an attempt to destroy the
10 threat, an attempt to annihilate the bad object, which is at that point
1 experienced concretely within the victim.
2 We have seen how much Mr N’s personality structure has in
3 common with that of Cartwright’s subjects. We hypothesise that the
4 events in Mr N’s inner world leading up to his brutal killings follow
5222 a similar pattern. Could we determine more about the nature of
6 Mr N’s bad object, that which threatens his psychological survival
7 from within? And what about the specific features of the final
8 provocation that triggered the collapse of Mr N’s defensive structure?
9
20111
A digression into fiction
1
2 Only a few years before Freud’s comments cited at the beginning of
3 this chapter, reluctantly recognising similarities between his case
4 histories and short stories, a Sherlock Holmes story appeared in
5 which the key to the mystery lay in something missing, in an absence
6 the significance of which was only recognised by Holmes. In the
7 story, a senior Scotland Yard detective asks Holmes to explain his
8 reasoning:
9
30 “Is there any point to which you would wish to draw my
1 attention?”
2 “To the curious incident of the dog in the night-time.”
3 “The dog did nothing in the night-time.”
4 “That was the curious incident,” remarked Sherlock Holmes.
5 [Conan Doyle, Silver Blaze, 1892]
6
7 In Mr N’s case too, an absence turns out to be of the greatest
8 significance. Hostile impulses, aggression, recall of the killings,
922 remorse, guilt, and mourning: all are mostly absent. On the surface

103
104 PHILIP LUCAS

all is harmless, bland, with only an occasional negative ripple to

disturb a calm surface. But the truly striking absent “bark” is the GP
victim of the first episode. Mr N never mentions her spontaneously,
though he talks of both other victims from time to time in a variety
of contexts. And this profound silence about his GP affected the
wider understanding of the case. Various reports to the Court failed
to mention the fact that it was the GP, not Mr N’s wife, whom he
attacked first. Several clinicians seemed to have assumed that his wife
was the victim of the first blow.

The bad object and the final provocation

The profound silence maintained by Mr N regarding his GP victim
speaks eloquently of the nature of his bad object, of the internalised
encapsulated aspect of himself associated with all he found
unbearable about himself. The silence calls attention once more to
the central role of versions of “the carer” in Mr N’s inner world, and
also helps us identify the stimulus that triggered the complete
breakdown of his defensive system. Dr B’s assessment of Mr N
suggested that the final precipitant was “being told by his GP to
persevere with medication in which he had no faith”—almost exactly
what he found himself telling Mr N so many years later, only days
before second homicidal episode.
Thus the defensive structure appeared finally to collapse on
both occasions when Mr N asks for help, seeks the intervention
of an idealized carer—and feels that he is abandoned to his fate, not
rescued but humiliatingly rejected.
The silence with regard to his GP victim suggests that she had
come to reside, much more fully than the other victims, in the
scarcely symbolised, normally inaccessible bad object world. We can
only be tentative, but Mr N’s bad object seems linked to inchoate
memory traces of aversive experiences in very early life, perhaps
particularly his experience of undergoing facial surgery in his first
few months of life. Such an object seems a representation of a cruel,
neglectful carer, responsible for persistent disappointment and
rejection, unrelieved humiliation and the threat of abandonment to
an eternity of painful sadistic torment.
It seems that when Mr N experiences rejection in place of hoped-
for rescue, a transformation is provoked in his perception of his

104
 THE DOG THAT DIDN’T BARK 105

122 external carer such that the carer switches in Mr N’s mind from ideal
2 to hateful, a reversal of perspective brought about, of course, by a
3 complete about-turn in his projections. An important implication is
4 that in Mr N’s mind during the second homicidal episode the target
5 of the frenzied attack might have been Dr B as much as his actual
6 victim. And of course subsequently Dr B did suffer at Mr N’s hands,
7222 not least in having to face a Homicide Inquiry.
8
9
The lack of psychic change
10
1 For Mr N, time is not the great healer. The detailed replay of the
2 violent internal scenario suggests that nothing fundamentally
3 changed in the years between the first and second homicidal
4 episodes. The lack of change is manifested chillingly in the manner
5222 in which Mr N continued to talk about his wife and his girlfriend as
6 if they were still alive despite such errors frequently being brought
7 to his attention. It appeared that such a barrier separated his inner
8 world from the outer world that little of his destructive activity in
9 the external world was genuinely taken in. The consequence seemed
20111 to be that his inner world remained largely unmodified by the
1 violence he had perpetrated. He therefore did not truly know what
2 he had done, and so was, at an important level, unconvinced of his
3 losses. The result is that he cannot go through any real process of
4 mourning; he cannot experience authentic remorse or guilt. Thus,
5 after a relatively short period of horrendous turmoil, his rigid
6 defensive system rapidly re-establishes itself and he regains his
7 equilibrium essentially unchanged.
8
9
The inquiry and the “third position”
30
1 There was, of course, a Homicide Inquiry. Perhaps unusually, its
2 reflections helped in furthering understanding of Mr N and the
3 effects he had on those around him. The Inquiry had three main
4 points: firstly, that Mr N’s apparent compliance with his medication
5 and co-operation with his supervisor was wrongly taken as a sign
6 that he had insight into his situation. The Inquiry’s second main point
7 was that somehow the focus on the couple of which Mr N was a part
8 was lost. The Inquiry members found this particularly difficult to
922 understand given that the risk posed by Mr N was so clearly located

105
106 PHILIP LUCAS

within an intimate relationship. The third point was the Inquiry’s

observation that Mr N’s psychiatric supervisor was working in
relative isolation with little support from other professionals.
Psychoanalytic theory suggests that a single intra-psychic process
may underlie and interlink the three apparently disparate aspects
held up in the Inquiry’s spotlight. The key to each of the failings
identified by the Inquiry may be Mr N’s insuperable difficulty in
allowing different parts of his mind to come together. This appears
to have a profound effect not only on his own thinking but also on
the thinking of others, including his supervisor.
Mr N’s inability to tolerate a couple in his mind seemed somehow
to reduce the salience of “the couple” in the mind of his supervisor.
Somehow, for Dr B, the focus shifted from consideration of the state
of the couple, Mr N and his girlfriend, to concern with Mr N alone.
Linked to this is the fact that, as we have seen, Mr N somehow
contrived to avoid the appropriate supervision arrangement, a social
worker and a psychiatrist couple working together. The avoidance
of “coupling” in the mind also affected Mr N’s insight. Britton
suggests that

If the link between the parents perceived in love and hate can
be tolerated in the child’s mind, it provides the child with a
prototype for an object relationship of a third kind in which
he or she is a witness and not a participant. A third position
then comes into existence from which object relationships can
be observed. Given this, we can also envisage being observed.
This provides us with a capacity for seeing ourselves in
interaction with others and entertaining another point of view
while retaining our own—for observing ourselves while being
ourselves. [1998, pp. 41–42]

Thus for some people—including, it seems, Mr N—a consequence

of not tolerating “coupling” in the mind is the failure to develop
the “third position” from which Mr N would have been able to
observe himself while being himself. This helps us understand his
inability to report to Dr B with any reliability what was going on in
his mind—his lack, in other words, of insight. Hence also his inability
to describe what was happening in the couple of which he was
a part.

106
 THE DOG THAT DIDN’T BARK 107

122 The Homicide Inquiry’s three main points can thus be understood
2 in terms of powerful projective processes originating in Mr N’s inner
3 world. The overestimation of his insight when he was in fact
4 incapable of taking an objective view of himself, the shift of focus
5 from the couple of which he was a part, and the lack of a supervising
6 couple: all three seem to have occurred as a consequence of a
7222 mechanism related to Mr N’s inability to allow the different parts of
8 his mind to come together.
9
10
Act III
1
2 Returning once more to the lack of fundamental change in Mr N’s
3 inner world, there has been considerable emphasis in the present
4 article on the fact that the two homicidal episodes, years apart, both
5222 followed appeals by Mr N to health professionals for help, appeals
6 which were met with (in Mr N’s view) inadequate responses. In this
7 context, it seems significant that in a discussion with Mr N of how
8 a future relapse of illness would be dealt with if he had moved on
9 to a hostel as he hoped, Mr N became uncharacteristically indignant
20111 and heated when it was suggested that there might well be a delay
1 in obtaining a bed in hospital. It was clear that in Mr N’s view, the
2 hostel staff and other professionals, not he, would be responsible for
3 any consequences that ensued.
4 Recently, the junior doctor involved in Mr N’s care found himself
5 struggling to express something of his frustration with Mr N. The
6 doctor mentioned the fact that Mr N had done terrible things but
7 took no responsibility whatsoever. He found himself indignant at
8 Mr N’s assertion that others, not Mr N, had pushed for the absolute
9 discharge a decade after the first episode. He found himself reacting
30 similarly to Mr N’s complaint that Dr B had failed to see how ill he
1 was, and also to Mr N’s sense of entitlement to move on to a hostel
2 only three years after the last killing.
3 Reflecting later on the sense of outrage the junior doctor was
4 conveying, it became clearer that he had been filled with frustration
5 by the shamelessness, the brazen effrontery of Mr N’s responses. This
6 seemed to lead to further illumination of the defensive structure. The
7 powerful and profound sense of shame was being completely dis-
8 avowed by his surface persona, a process which left him “shameless”;
922 whereas at his core there was a sense of a terrible narcissistic

107
108 PHILIP LUCAS

vulnerability, a deep and hopeless well of limitless shame, revealed

by its absence.

Discussion
Mr N, an elderly man, killed his longstanding girlfriend nearly two
decades after killing his GP and his wife in a single episode. Amnesic
for the first killings, his fate was to personify Santayana’s celebrated
saying: Those who cannot remember the past are condemned to
repeat it. And his story illustrates very precisely the truth of Freud’s
observation on the power of unconscious urges:

The patient does not remember anything of what he has

forgotten and repressed, but acts it out. He reproduces it not
as a memory, but as an action; he repeats it, without, of course,
knowing that he is repeating it. [1914, p. 150]

The replaying of the homicidal scenario eighteen years after it first

manifested itself revealed aspects of Mr N’s internal world which
would otherwise have remained hidden.

The trigger to violence

A striking aspect of Mr N’s case is the specificity of the trigger to
violence: the disappointingly unhelpful response of the idealised
carer in place of Mr N’s anticipated rescue. The fact that a second
homicidal episode occurred allowed the latter understanding
to emerge more clearly. In a comparable way, the nature of Mr N’s
bad object, the persecuting, rejecting, sadistic “carer”, could be more
clearly recognised. Prior to the second homicidal episode, the violent
outburst was seen as the result of long-repressed feelings of irritation
and hostility towards his wife that had “never been vented in a
normal manner”, a “pressure-cooker” model in which such feelings
emerged explosively following an apparently trivial trigger. The
repetition, the re-enactment of what has not been remembered,
allowed meaning its place in the picture, allowed the “psycho-
dynamic” its place alongside the “hydraulic” or “thermodynamic”.
Specifically, particular object relationships are given appropriate
prominence in the story. In this regard, Stephen Mitchell, comparing

108
 THE DOG THAT DIDN’T BARK 109

122 the hydraulic drive theory of aggression with a more object relational
2 approach, asks us to
3
4 think about aggression, like sexuality, not as a push from
5 within, but as a response to others, biologically mediated and
6 pre-wired, within a relational context . . . Then the question
7222 of whether there is an aggressive drive or not is replaced by
8 questions concerning the conditions that tend to elicit
9 aggressive responses and the nature and variation of those
10 responses. Viewing aggression in this way preserves, in a
1 different manner than drive theory, an emphasis on the
2 importance of what the individual brings to the interpersonal
3 field . . . Thus aggression can be considered an extremely
4 powerful, universally wired (although individually varied),
5222 biological response to the subjective experience of endanger-
6 ment and being treated cruelly, without an assumption of
7 actual and/or intentional mistreatment (although many
8 children are actually and/or intentionally mistreated). [1998,
9 pp. 25–27]
20111
1
Ideal types of violence
2
3 Mervin Glasser (1998) distinguishes two “ideal types” of violence,
4 “self-preservative” and “sado-masochistic”, at extremes on a spec-
5 trum. Self-preservative violence can be thought of as related to the
6 primitive “fight or flight” instinctual response to the presence of
7 danger. The individual feels in mortal danger and, in a rage, reacts
8 furiously to eliminate the danger, mobilizing the biologically pre-
9 wired potential present in each of us. There is no concern for the
30 source of the danger, the victim, while the violence erupts, merely
1 that the danger should be eliminated. Sado-masochistic violence is
2 much more controlled, and the aim (which may not be conscious)
3 is to make the victim suffer, not to obliterate the source of danger.
4 Because of the salience of exerting power and causing suffering, it
5 has been called sado-masochistic violence. The perpetrator obtains
6 gratification from inflicting violence, and so the fate of the victim,
7 the suffering of the victim, matters.
8 Mr N’s acts of violence seem to exemplify “self-preservative”
922 violence, as desperate responses to perceived threats to his

109
110 PHILIP LUCAS

“psychological self”. The repeated blows to the heads of his victims

with a blunt object appear to represent desperate attempts at concrete
obliteration of vicious persecuting thoughts which he felt threatened
his very existence. It seems plausible that the vulnerability of his
psychological self stemmed from lack of early maternal containment
leading to a terror of annihilation through falling apart—hence the
desperate need to be bound by his narcissistic exoskeleton.
While highly speculative, it is possible that in the course of
Mr N’s homicidal violence, a different process, sado-masochistic
violence, may have taken over from self-preservative violence. The
battering with the hammer was followed by repeated knife attacks
on the victims’ neck and, in at least one case, the chest. Perhaps
something less uncontrolled, more sadistic followed the initial
hammer blows, somehow enacting Mr N’s split off identification with
the bullies who persecuted him, the cruel rejecting carers in his mind,
allowing satisfaction in the exertion of power and the infliction of
suffering on the weak and helpless victims. Whilst the sadistic
impulse to violence is, of course, pure speculation with regard to his
offences, the later discovery of “True Crime” and “Nazi” magazines
in Mr N’s home testifies to the presence of an “interest” in such
matters.

Projective processes
Throughout the course of Mr N’s involvement with psychiatric
services there is evidence of powerful projective processes affecting
the responses of professionals. Repeatedly, those who viewed the
case from a distance estimated the risk posed by Mr N higher than
those personally involved with him. Mr N seemed to convince those
around him that he was innocuous, indeed that he was a helpful
and kindly soul. He thereby avoided the secure hospital and was
considered for discharge from the ordinary psychiatric hospital
remarkably quickly. By projective identification, Mr N succeeded in
inducing professionals to accept his idealised phantasy of himself as
a good, concerned carer. At the same time, he managed to get those
professionals to act as if that version of him represented the whole
story, while somehow Mr N’s murderous past slipped from the
forefront of consciousness.

110
 THE DOG THAT DIDN’T BARK 111

122 Another manifestation of this projective process noted by the

2 professionals in the medium secure unit was an intense and
3 persistent pressure from Mr N for a relationship with a female
4 professional to whom he could confide his thoughts and feelings.
5 Fonagy’s comments, taken from a discussion concluding a collection
6 entitled Psychoanalytic Understanding of Violence and Suicide are
7222 chillingly apposite:
8
9 The depleted self comes desperately to depend upon an
10 object to mirror its internal states. This gives rise to a two-
1 fold and desperate need to ensure the continued physical
2 presence of the object: first to ensure the continued possibility
3 of externalisation; and second to provide the essential
4 auxiliary ego function for self-preservation. Of course, side by
5222 side with this need for the other is the unconscious fantasy
6
that by killing, annihilating, terrorising or murdering the
7
other, the self would remain forever free of the alien object.
8
[1999, p. 164]
9
20111
1 Impaired symbolic function and the depressive position
2
In Mr N’s case, the unconscious fantasy of annihilating the other was,
3
of course, acted out in the external world. Fonagy’s formulation also
4
draws attention to another of the intertwined concepts that may
5
6 further understanding of Mr N’s complex psychopathology: the
7 desire for the continued physical presence of the object as indicative
8 of the lack of the capacity for symbolisation. This developmental step,
9 not reached by Mr N, enables the individual to recognise that there
30 is a distinction between his or her own state of mind and external
1 reality, to have a sense of the difference between how others are
2 perceived and what is actually going on for them.
3 Thus the lack of symbolic functioning in Mr N means he cannot
4 truly separate from his objects, as separateness and the capacity for
5 symbolisation develop hand in hand, the one depending on the other.
6 And both the latter achievements depend on working through the
7 depressive position and the Oedipus situation, as—again—working
8 through the one depends on working through the other (Britton,
922 1998, pp. 29–30).

111
112 PHILIP LUCAS

An essential element in the depressive position is the growth

of the sense of distinction between self and object, and
between the real and the ideal object. Hanna Segal has
suggested that failure to make such distinctions results in
failure of symbolisation and the production of “symbolic
equations”—that is, symbolic objects experienced as identical
with the original object. [ibid., p. 34]

Mr N’s inability, even temporarily, to approach the depressive

position is vividly pointed up by Segal’s description:

The implications and ramifications of the gradual changes that

occur in the psychic organization with the onset of the
depressive position are enormous. They include the discovery
of ambivalence, sense of loss, guilt, a differentiation between
internal and external realities, a capacity for symbolisation
and many others. The depressive position carries with it not
only change in the nature of the object relationships, but
an important change in the whole of mental functioning.
[1989, p. 4]

As we have seen, Mr N’s psychic development was diverted from

this path. Mr N’s projection into his objects, his narcissistic
relationship with them, represents the mechanism by which true
separation is avoided, and is a manifestation of his lack of symbolic
function. His persistent tendency to mix up his wife and his girlfriend
when talking of either of them suggests that they are interchange-
able, that neither is a “real” person, that both are two-dimensional
“symbolic equations” containing projected aspects of Mr N. As
mentioned above, Mr N has frequently spoken of both his dead wife
and his dead girlfriend in the present tense as if they were still alive.
In his inner world, because of the lack of true separation, he has
not accepted their deaths as final and irrevocable. Indeed, Mr N’s
story was filled with repeated manifestations of his urgent desire to
actualise his phantasy of an exclusive, everlasting, intimate
relationship. Predictably, Mr N’s inability to negotiate the depressive
position was inextricably intertwined with his unresolved oedipal
situation.

112
 THE DOG THAT DIDN’T BARK 113

122 Lack of oedipal resolution and pressure to enact

2
The Homicide Inquiry panel’s evident puzzlement at what they
3
called the “stark omission” of a focus on the couple of which Mr N
4
was a part suggests some awareness of the operation of unfamiliar
5
and unexpected forces. No putative explanation was offered in their
6
7222 report, but there was a sense that the Inquiry panel felt it inappro-
8 priate to hold Dr B entirely responsible. As suggested above, the
9 configuration of Mr N’s inner world appeared powerfully to affect
10 his supervisor’s mind, specifically incapacitating the latter’s ability
1 to hold a couple in mind. I think this may be understood as
2 comparable to a process familiar in psychoanalysis, that “impairment
3 of ego functioning that can be visited on the analyst by means of
4 certain projective identifications” (Shafer, 1997, p. 261). In other
5222 words, projective identification originating in Mr N’s mind appears
6 to have interfered with Dr B’s ability to think. And the compromised
7 “ego functioning” seems specifically to relate to oedipal issues.
8 Speculatively, Dr B may have unconsciously avoided thoughts
9 located outside the dyadic relationship with Mr N because of
20111 (unconscious) awareness that such thoughts would be experienced
1 by Mr N as abandonment and rejection (turning from him to a
2 “third party”), which would in turn have been experienced as a cruel
3 attack by a sadistic Dr B. Dr B may have thus been drawn into an
4 enactment with Mr N such that the latter’s “narcissistic omnipotent
5 balance” (Feldman, 1997, p. 335)—his narcissistic exoskeleton—was
6 maintained. The pressures to which Dr B was subjected by Mr N
7 may have been similar to those Britton experienced in relation to a
8 patient in analysis who “could not conceive of relationships between
9 others, and it was intolerable for her to feel that I was communing
30 with myself about her”. As a consequence of the patient’s difficulties
1 in her “first encounters with the oedipal situation”, Britton noted,
2 any thinking on his part that the patient felt to be deviating from
3 direct engagement was experienced by the patient as an extreme
4 threat. Such thinking by the analyst was experienced as betrayal with
5 an oedipal rival (1989, pp. 87–88). Mr N seemed to share with
6 Britton’s patient “the reality of [a] belief that catastrophe was
7 associated with the emergence of the oedipal situation, and [. . .]
8 consequently she resorted to violent splitting to prevent it occurring.
922 The result was an internal division within her mind organized

113
114 PHILIP LUCAS

around separate parental objects whose conjunction [the patient]

believed must be prevented” (ibid., p. 93). In consequence, in Mr N’s
encounters with Dr B, their relationship, and their relationship alone,
could be held in Mr N’s mind in one of a series of “monadic serial
worlds”: “In normal development the perception by the child of the
parents’ coming together independently of him unites his psychic
world. It creates one world in which different object relationships
can occur, rather than monadic serial worlds each with its own object
relationship.” (Britton 1998, p. 41)

Failure of maternal containment

Mr N entered a developmental cul-de-sac. His defensive personality
structure, the narcissistic exoskeleton, seems to originate from a
serious failure of the mother-infant couple to establish a good enough
relationship. So Mr N experienced “a failure of maternal containment
leading to problems with meaning and impediments to negotiating
the depressive position and the Oedipus situation, which in turn
limits the capacity for symbolisation” (Britton 1998, p. 44).
As discussed above, the arrival of Mr N, a baby son with a cleft
palate which required surgical repair in his first months, to a mother
who had been hoping for a daughter was not the ideal setting for
the mother optimally to take in and metabolise her infant’s projec-
tions and for the infant to begin to learn to tolerate frustration. The
nature of the bad object residing within Mr N has been described
above. To repeat, such an object seems a representation of a cruel,
neglectful carer, responsible for persistent disappointment and
rejection, unrelieved humiliation, and the threat of abandonment to
an eternity of painful sadistic torment.
The emergence of such a putatively annihilation-menacing object
in Mr N can be understood in terms of Bion’s A Theory of Thinking,
where Bion explains that “if the capacity for toleration of frustration
is inadequate . . . what should have been a thought . . . becomes a
bad object, indistinguishable from a thing-in-itself, fit only for
evacuation” (1962a). We cannot know the relative contributions of
Mr N’s mother’s inability to provide sufficient containment for the
infant Mr N’s projections on the one hand, and the strength of
the infant Mr N’s hostile, angry projections on the other to the
inability of Mr N to tolerate frustration. Whatever the situation, what

114
 THE DOG THAT DIDN’T BARK 115

122 developed was an inner world in which what should have been
2 symbolised as thoughts is experienced as concrete and hostile. And
3 twice in Mr N’s history the concrete monstrous thing-in-itself was
4 subject to evacuation and frenzied retaliatory attack.
5
6
“Absent” father
7222
8 And what of Mr N’s father? All of Mr N’s accounts of his father
9 suggest weakness and ineffectiveness, and there is some historical
10 evidence for the picture. Consistent with the thinking of Fonagy and
1 Target, Mr N’s father did not appear able, and certainly was not
2 internalized as able “to present the child with a reflection of his
3 place in relationships” (1999, p. 67). Unfortunately, after the failure
4 of maternal containment and separation, Mr N was not given the
5222 second chance provided by some fathers to gain access to “triangular
6 space” and the perspective provided by oedipal resolution.
7
8
Conclusion
9
20111 In conclusion, I have presented the case of a mild-mannered man
1 whose murderousness emerged only in his fifth decade, when he
2 killed his wife and GP during an episode of psychotic depression.
3 Despite psychiatric involvement, he killed again at the beginning of
4 his seventh decade. By detailed consideration of the similarities
5 between the two homicidal episodes and of the patient’s personality
6 structure, I have attempted a psychodynamic formulation of the
7 patient’s developmental trajectory and also of the way powerful
8 projective forces originating in the patient’s inner world affected
9 those in the external world involved in his care. The case is one in
30 which a purely medical model focusing on “mental illness” and the
1 avoidance of relapse of depression proved inadequate. Similarly,
2 actuarial and clinical risk assessment instruments were of strikingly
3 little help.
4 My discussion of the case of Mr N has largely followed a
5 contemporary Kleinian approach. Many of the key conceptual
6 constructs derived from that perspective are particularly helpful in
7 making sense of the case, but I am of course aware that other
8 traditions have claims on some of these concepts and also contribute
922 significantly to the understanding of the case of Mr N: see Fonagy

115
116 PHILIP LUCAS

(1999), Fonagy and Target (1999), Glasser (1998), Mitchell (1998),

Perelberg (1999) and Fonagy (2003).
I began the present chapter with a quote from Freud writing in
1895 about the somewhat uncomfortable similarity between his case
histories and fiction. Mr N’s story has about it much of the quality
of Greek tragedy: a man driven by powerful unknown forces to
commit terrible deeds and to repeat them despite warnings. It seems
somehow fitting that so much of Mr N’s story should be bound up
with an unresolved oedipal situation, as only two years after Freud
had been puzzling over the connection between psychopathology
and stories, he reported the discovery of the Oedipus complex. In
1897, Freud wrote:

I have found, in my own case too, [the phenomenon of] being

in love with my mother and jealous of my father, and I now
consider it a universal event of early childhood . . . If this
is so, we can understand the gripping power of Oedipus
Rex . . . the Greek legend seizes upon a compulsion which
everyone recognises because he senses its existence within
himself. Everyone in the audience was once a budding
Oedipus in fantasy. [1897/1985, p. 272]

So humankind’s stories, myths and legends were to be found at the

core of each individual, in each individual’s case history. Continuing
the discussion of the case of Fräulein Elisabeth von R, Freud wrote:

Case histories of this kind are intended to be judged like

psychiatric ones: they have, however, one advantage over the
latter, namely an intimate connection between the story of
the patient’s sufferings and the symptoms of his illness. [1895,
p. 160]

In this chapter I have tried to show an intimate connection between

the story of Mr N’s sufferings and, instead of the symptoms of
hysterical illness that preoccupied Freud, an enactment of a very
different kind: a specific homicidal scenario that surfaced on two
separate occasions, years apart, and that sadly but ominously remains
available for a repeat performance should we fail in our efforts to
remember that Mr N’s bite is, exceptionally, far worse than his bark.

116
122 REFERENCES
2
3
4
5
6
7222
8
9
10
1
2
3
4
5222
6
7
8
9 Adshead, G. & van Velsen, C. (1996). Psychotherapeutic Work with
20111 Victims of Trauma. In: C. Cordess & M. Cox (Eds.), Forensic
1 Psychotherapy. Vol. 2: Mainly Practice (pp. 355–370). London: Jessica
2 Kingsley.
3 Adshead, G. (2002). A Kind of Necessity. In S. Bloom (Ed.), Violence: a
4 Public Health Phenomenon. London, Karnac.
5 Aiyegbusi, A. (2003). Forensic Mental Health Nursing: Care with Security
6 in Mind. In: F. Pfäfflin & G. Adshead (Eds.), A Matter of Security: the
7 Application of Attachment Theory to Forensic Psychiatry and Psycho-
8 therapy (pp. 167–192). London: Jessica Kingsley.
9 American Psychological Asociation (1994). Diagnostic and Statistical
30 Manual, version 4. Washington: American Psychiatric Press.
1 Bateman A., Brown D. & Pedder, J. (2000). Introduction to Psychotherapy:
2 An Outline of Psychodynamic Principles and Practice. Third Edition.
3 London: Routledge.
4 Benjamin, W. (1940). Theses on the Philosophy of History. In: Illumina-
5 tions. London: Pimlico, 1999.
6 Benson J.F., Moore, R., Kapur, R. & Rice, C.A. (2005). Management of
7 Intense Countertransference in Group Psychotherapy Conducted
8 in Situations of Civic Conflict. International Journal of Group
922 Psychotherapy, 55: 63–86.

117
118 REFERENCES

Bertin, C. (1982). La Dernière Bonaparte. Paris: Librairie Académique

Perrin.
Bion, W.R. (1950). The Imaginary Twin. In: Second Thoughts (pp. 3–22).
London: Karnac, 1984.
Bion, W.R. (1959). Attacks on Linking. In: Second Thoughts. London:
Karnac, 1984.
Bion W. R. (1961). Experiences in Groups and Other Papers. London:
Routledge, 2000.
Bion, W.R (1962a). A Theory of Thinking. In: Second Thoughts. London:
Karnac, 1984.
Bion W. R. (1962b). Learning From Experience. London: Karnac, 1984.
Bleichmar, H.B. (1996). Some Sub-Types of Depression and their
Implications for Psychoanalytic Treatment. International Journal of
Psychoanalysis, 77: 935–961.
Board R. de (1978). The Psychoanalysis of Organisations: A Psychoanalytic
Approach to Behaviour in Groups and Organisations. London: Routledge.
Bourne, S. & Lewis, E. (1984). Pregnancy after Stillbirth and Neonatal
Death. The Lancet, 11: 31–33.
Bourne, S. (1992). Psychological Aspects of Stillbirth and Neonatal Death: An
Annotated Bibliography. London: Tavistock.
Britton, R. (1989). The Missing Link: Parental Sexuality and the Oedipus
Complex. In: R. Britton et al, The Oedipus Complex Today: Clinical
Implications. London: Karnac.
Britton, R. (1998). Belief and Imagination: Explorations in Psychoanalysis.
London: Routledge.
Britton, R. (2003). Sex, Death, and the Superego: Experiences in Psycho-
analysis. London: Karnac.
Brunning, J. (1982). The Group Psychotherapy of Murderers. Prison
Medical Journal, 23: 6–10.
Cartwright, D. (2002). Psychoanalysis, Violence and Rage-Type Murder:
Murdering Minds. London: Brunner-Routledge.
Carvel, J. (2006). Care Blunders Led to Murders, Admits NHS. The
Guardian 30 September.
Coid, J. (1992). DSM III Diagnoses in Criminal Psychopaths. Criminal
Behavior and Mental Health, 2: 78–95.
Conan Doyle, A. (1892). Silver Blaze. In: The Memoirs of Sherlock Holmes.
London: Penguin, 2001.
Cox, M. (1976). Group Psychotherapy in a Secure Setting. Proceedings of
the Royal Society of Medicine, 69: 215–220.
Damasio, A. (2000). The Feeling of What Happens. London: Heinemann.

118
 REFERENCES 119

122 Decker, S.H. & Curry, G.D. (2002). Gangs, Gang Homicides and Gang
2 Loyalty: Organized Crimes of Disorganized Criminals. Journal of
3 Criminal Justice, 30: 343–352.
4 deMause, L. (1974). The evolution of childhood. In: Lloyd deMause (Ed.),
5 The History of Childhood (pp. 1–73). New York: Psychohistory Press.
6 Doctor, R. (Ed.) (2003). Dangerous Patients: A Psychodynamic Approach to
7222 Risk Assessment and Management. London: Karnac.
8 Engel, G. (1975). The Death of a Twin: Mourning and Annivrsary
9 Reactions. Fragments of 10 Years of Self-Analysis. International Journal
10 of Psychoanalysis, 56: 23.
1 Feldman, M. (1997). The Dynamics of Reassurance. In: Roy Shafer (Ed.),
2 The Contemporary Kleinians of London. Madison, CT: International
3 Universities Press.
4 Fonagy, P. (1999). Final Remarks. In: R.J. Perelberg (Ed.), Psychoanalytic
Understanding of Violence and Suicide. London: Routledge.
5222
Fonagy, P. & Target, M. (1999). Towards Understanding Violence: the
6
Use of the Body and the Role of the Father. In: R.J. Perelberg (Ed.),
7
Psychoanalytic Understanding of Violence and Suicide. London:
8
Routledge.
9
Fonagy, P. (2003). Towards a Developmental Understanding of Violence.
20111
British Journal of Psychiatry, 183: 190–192.
1
Foulkes, S.H. (1990). Selected Papers: Psychoanalysis and Group Analysis.
2
London: Karnac.
3
Freud, S. (1895). Fräulein Elisabeth von R. In: Studies on Hysteria, SE2.
4 Freud, S. (1897–1904). The Complete Letters of Sigmund Freud to Wilhelm
5 Fliess, ed. Jeffrey Masson. Cambridge, MA: Harvard University Press,
6 1985.
7 Freud, S. (1908). Character and Anal Eroticism. SE 9.
8 Freud, S. (1914). Remembering, Repeating and Working Through. SE 12.
9 Freud, S. (1917). Mourning and Melancholia. SE 14.
30 Freud, S. (1919). The Uncanny. SE 17.
1 Garland, C. (2003). Understanding Trauma: a Psychoanalytic Approach.
2 London, Karnac.
3 Glasser, M. (1979). The Role of Aggression in the Perversions. In: I. Rosen
4 (Ed.), Sexual Deviation. Oxford Medical Publications.
5 Glasser, M. (1998). On Violence: a Preliminary Communication.
6 International Journal of Psychoanalysis 79: 887–902.
7 Grinberg, L. (1992). Guilt and Depression. London: Karnac.
8 Haley, S. (1974). When the Patient Reports Atrocities. Archives of General
922 Psychiatry, 30: 191–196.

119
120 REFERENCES

Hillbrand, M. & Young, J. (2004). Group Therapy for Parricides: The

Genesis Group. Forensische Psychiatrie und Psychotherapie Werkstatt-
schriften: 89–98.
Hinshelwood, R. D. (1991). A Dictionary of Kleinian Thought. London: Free
Associations.
Hinshelwood, R. D. & Skogstad, W. (2000). Observing Organisations:
Anxiety, Defence and Culture in Health Care. Hove: Brunner-Routledge.
Hinshelwood, R. D. (2001). Thinking About Institutions: Milieux and
Madness. London: Jessica Kingsley.
Hirschhorn, L. (1993). The Workplace Within: Psychodynamics of Organi-
sational Life. London: MIT Press.
Hirschhorn, L. (1997). Reworking Authority: Leading and Following in the
Post-Modern Organisation. London: MIT Press.
Hyatt-Williams, A. (1998). Cruelty, Violence, and Murder: Understanding
the Criminal Mind. London: Karnac.
Jung, C.G. (1948). The Shadow. In: Aion (Collected Works 9, part 2).
Routledge, 1991.
Jung, C.G. (1954). The Philosophical Tree. In: Alchemical Studies (Collected
Works 13). Princeton University Press, 1992.
Jung, C.G. (1966). The Psychology of the Transference. In: The Practice
of Psychotherapy (Collected Works 16). Princeton University Press.
Kahr, B. (1994). The historical foundations of ritual abuse: an excavation
of ancient infanticide. In: Valerie Sinason (Ed.), Treating Survivors of
Satanist Abuse (pp. 45–56). London: Routledge.
Klein, M. (1932). The Psycho-Analysis of Children, trans. Alix Strachey.
London: Hogarth Press and The Institute of Psycho-Analysis. [First
published as Die Psychoanalyse des Kindes. Vienna: Internationaler
Psychoanalytischer Verlag.]
Klein, M. (1946). Notes on Some Schizoid Mechanisms. In: The Writings
of Melanie Klein Vol. 3 (pp. 1–24). London: Hogarth, 1975.
Klein, M. (1963). On the Sense of Loneliness. In: The Writings of Melanie
Klein Vol. 3. London: Hogarth, 1975.
Klein, R.H. & Schermer, V. (2000). Group Psychotherapy for Psychological
Trauma. New York: Guilford press.
Lanza, M. (1999). Psychotherapeutic Treatment of Violence. In K. Tardiff
(Ed.), Medical Management of the Violent Patient (pp 311–334). New
York: Marcel Dekker.
Lucas. R. (1993). Risk Assessment in General Psychiatry. In: R. Doctor
(Ed.), Dangerous Patients: A Psychodynamic Approach to Risk Assessment
and Management. London: Karnac.

120
 REFERENCES 121

122 McClure, M. (2004). Working with the Unbearable. In D. Jones (Ed.),

2 Working with Dangerous People: the Psychotherapy of Violence (pp. 81–98).
3 Oxford: Radcliffe.
4 Matte Blanco, I. (1975). The Unconscious as Infinite Sets. London:
5 Duckworth.
6 Menzies Lyth, I. (1988). Containing Anxiety in Institutions: Selected Essays,
7222 Volume 1. London: Free Associations.
8 Menzies Lyth I. (1989): The Dynamics of the Social: Selected Essays, Volume
9 2. London: Free Associations.
10 Mitchell, S.A. (1998). Aggression and the Endangered Self. Psychoanalytic
1 Inquiry 18: 21–30.
2 Moellenhoff, F. (1966). Hanns Sachs, 1881–1947: the creative uncon-
3 scious. In: F. Alexander, S. Eisenstein, & M. Grotjahn (Eds.), Psycho-
4 analytic Pioneers (pp. 180–199). New York: Basic Books.
Motz, A. (2001). The Psychology of Female Violence: Crimes Against the Body.
5222
Hove: Brunner-Routledge.
6
Nitsun, M. (1996). The Anti-Group. London: Routledge.
7
Nunberg, H., & Federn, E. (Eds.) (1962). Minutes of the Vienna Psycho-
8
analytic Society. Volume I: 1906–1908, trans. Margarethe Nunberg.
9
New York: International Universities Press.
20111
Ormont, L. (1984). The Leader’s Role in Dealing with Aggression in
1
Groups. International Journal of Group Psychotherapy, 34: 553–572.
2
Papanastassiou, M., Waldron, G., Boyle, J. & Chesterman, L.P. (2004).
3
Post-Traumatic Stress Disorder in Mentally Ill Perpetrators of
4 Homicide. Journal of Forensic Psychiatry, 15: 66–75.
5 Perelberg, R. J. (Ed.) (1999). Psychoanalytic Understanding of Violence and
6 Suicide. London: Routledge.
7 Pines, D. (1993). A Woman’s Unconscious Use of her Body. London: Virago.
8 Prenelle, I. (2006). Memory, Modernity and Urban Psychosis. In M.
9 Heinze et al (Eds.), Utopie Heimat. Berlin: Parados Verlag.
30 Riesenberg-Malcolm, R. (1999). Construction as Reliving History. In: On
1 Bearing Unbearable States of Mind. London: Routledge.
2 Rynearson, E. (2001). Retelling Violent Death. Philadelphia, PA: Brunner-
3 Routledge.
4 Sarkar, S. (2005). The ‘Other 23 Hours’: Special Problems of Psycho-
5 therapy in a ‘Special’ Hospital. Psychoanalytic Psychotherapy, 19: 4–16.
6 Schlapobersky, J. (1996). A Group Analytic Perspective: From the Speech
7 of Hands to the Language of Words. In C. Cordess & M. Cox (Eds.),
8 Forensic Psychotherapy. Vol 1: Mainly Theory (pp. 227–244). London:
922 Jessica Kinglsey.

121
122 REFERENCES

Segal, H. (1989). Introduction. In: R. Britton et al, The Oedipus Complex

Today: Clinical Implications. London: Karnac.
Shafer, R. (1997). The Contemporary Kleinians of London. Madison, CT:
International Universities Press.
Stein, E. & Brown, J.D. (1991). Group Therapies in a Forensic Setting.
Canadian Journal of Psychiatry, 36: 718–722.
Warner, M. (1998). Peroxide Mug-Shot. London Review of Books, 1
(January).
Welldon, E.V. (1988). Mother, Madonna, Whore: The Idealisation and
Denigration of Motherhood. London, Free Associations.
Westwick, A. (1940). Criminology and Psychoanalysis. Psychoanalytic
Quarterly, 9: 269–282.
Wilde, Oscar. (1891). The Picture of Dorian Gray. London, Penguin, 2003.
Williams, A. H. (1998). Cruelty, Violence and Murder. Understanding the
Criminal Mind. London: Karnac.
Zahavi, Helen (1991). Dirty Weekend. London: Flamingo.

122
122 INDEX
2
3
4
5
6
7222
8
9
10
1
2
3
4
5222
6
7
8
9 abuse in childhood 18, 51–60, 68, 81 child as extension of the mother 54
acting out 13, 18, 29, 33, 42, 51, 108 core phantasy 2, 81
20111 by the group 16, 26, 29 coupling 106
1 by the institution 17–25, 33 Cox, M. 10, 28
2 adoption 56–7, 58, 79, 83, 85 countertransference 13–14, 16, 17, 31,
3 aggression 22, 24, 72, 80, 82, 100, 101, 38, 40, 46, 62–4, 71, 77, 81
103, 109
4
amnesia 83, 94, 96, 97, 108 death constellation 79
5 anxieties 26 Decker, S.H. and Curry, G.D. 16
6 leaders’ 24 delusions 69
7 projected 24 depression 12, 95, 97, 98, 100, 101–2
unconscious 30 depressive position 111–12, 114
8
work-specific 22–4 dreams 27, 30, 58, 79
9 Aylward, P. and Wooster, G. 32
30 ego 66, 72, 111, 113
1 bad object 101, 103, 104, 108, 114 Engel, G. 49
2 Benjamin, W. 81, 84
Benson, J.F. 17 false self 56
3 bereavement 11, 12 fantasy 9, 13, 51, 59, 79
4 Bion, W.R. 44, 66, 71, 80, 114 fathers 2, 23, 37–40, 42, 44–7, 57, 68,
5 Britton, R. 106, 113–14 70, 71, 75–6, 85, 95, 99, 115–16
6 Brunning, J. 12 feeling of deadness 43
bullying 95 films 26–9 see also television
7
Fonagy, P. and Target, M. 54, 111,
8 carers 52, 95, 99, 108 115
922 Cartwright, D. 93, 100–3 Freud, S. 44, 93, 102, 108, 116

123
124 INDEX

gangs 15–16 perpetrator’s inner world 18, 32, 38,

Garland, C. 13 94, 99, 103–7, 112–15
Glasser, M. 80, 109 persecution, feelings of 35, 42
Grinberg, L. 44 personality structure 93, 100
group dynamics 10–11, 14–25 Pines, D. 53–4
groups 9–33 post-traumatic stress disorder 12
pregnancy 52–3, 63, 64
hallucinations 69, 74, 95 projective identification 37, 44, 63,
Hillbrand, M. and Young, J. 13 65–77, 80, 110–11, 113
Huntley, Ian 45–9 psychosis 28, 41, 53, 56–60, 66–8,
Hyatt-Williams, A. 79 71–3, 79–84, 90, 95–8, 101–2, 115

internal object 53, 68, 111 remorse 43, 70, 97, 105
institutions 17–25 responsibility of perpetrator 28, 107
as a home forever 90 restorative justice 16–17
revenge 52, 64
jealousy 35–49 Rynearson, E. 12
Jung, C.G. 66, 72
sadism 80
-K 71 Segal, H. 112
Klein, M. 44, 66, 72 the self 38, 44, 55, 66, 73, 76
Klein, R.H. and Schermer, V. 11 self harm 20, 53, 54, 57
the shadow 66, 72
Lewis, E. and Bourne, S. 37 sibling rivalry 14, 42, 46
linguistic capability 27, 106 see also splitting off 22, 23, 44, 62, 66, 72–6,
symbolic capacity 84, 100–2, 110, 113
Stein, E. and Brown, J.D. 10
Matte Blanco, I. 40–1 stress triggers 69, 103
de Mause, L. 55 precipitating stress 98
medication 28, 58, 60, 69, 95–6, 97, 98, supervision 31–3
104, 105 symbolic capacity 13, 16, 111–12
Menzies Lyth, I. 22 symmetrization 40–2
metaphors 26–9, 30
Mitchell, S. 108–9 tangential thinking 29
mothers 2, 4–6, 19, 22–3, 36–40, 42, television 42, 74 see also films
44–8, 51–64, 68, 70, 80–1, 83, 85, therapist’s feelings 2, 16
95, 99, 114, 116 three person jealousy 35–49
murder as a solution 35, 76 transference 38, 47, 61, 62–4, 71,
murderous rage 22–4, 51, 59, 61–2, 91 81, 82
murderous thoughts 9, 51 trauma 3, 17, 18, 64, 81
in childhood 11, 37, 57, 68, 79, 99
narcissistic exoskeleton 93, 100–3, 113, trigger for murder 9, 32, 36, 39,
114 108–9
Nitsun, M. 15 twinning 36, 40, 45–7
types of violence 109–10
Oedipus Complex 3, 111, 113, 116
organisational dynamics 21–2 Warner, M. 52
Welldon, E. 52–5, 59, 64
paranoid schizophrenia 67, 68, 73, 84 Williams, A.H. 10, 15
Perelberg, R.J. 81 women murderers 51–64
124