Disturbances of ‘groupishness’? Structural violence, refusal and the therapeutic community response to severe personality diso

Journal Article or Monograph

Title: Disturbances of ‘groupishness’? Structural violence, refusal and the therapeutic community response to severe personality disorder
Year: 2009
Authors: Adlam, J., & Scanlon, C.

We explore the problematic dynamics in the relationship between societal systems of care and the chronically excluded, with particular reference to severe personality disorder and the "difficult-to-reach" patient. The individual who "refuses" is often met with a violent response: yet his violence must be understood as related to an experience of being violently excluded. We reformulate personality disorder as a disturbance of "groupishness" and suggest, as a paradigm for the problem of refusal, the story of Diogenes the Cynic, who "holed himself up" in a barrel; and of his legendary encounter with Alexander the Great, who tried unsuccessfully to persuade him to "come in from the cold". We suggest it may be as important to focus on Alexander's violence as on that of Diogenes, and we examine modes of violence deployed by society against the excluded outsider, with particular reference to the hostile attribution of intentionality to the personality disordered individual's acts of violence and self-harm. We conclude by considering both the merits of the democratic therapeutic community model as a response to severe personality disorder and the dangers, inherent in this model among others, in an unconscious identification with Diogenes in his barrel.

Keywords: Cynicism, exclusion, homelessness, intentionality, nihilism
Language: English

Journal: International Forum of Psychoanalysis
Volume: 18
Issue: 1
Start page: 23
End page: 29
Publisher ID:

Submitted by:
Christopher Scanlon
Consultant Psychotherapist and Organisational Consultant
NHS Mental Health Services

Corresponding author: Christopher Scanlon

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