At the same time, an old interest, in what we did with the passive patients in our care which had troubled me right back to my days training as a psychiatrist, began to emerge as an interest in ethics. With these various encouraging developments in my life in the 1990s, I felt able to return to these interests to reflect on them cautiously, and to surface again with something I felt worth saying. Eventually I wrote the book , Therapy or Coercion, on coercion as a danger in therapeutic practice.
1990 Therapy or coercion: a clinical note on personal change in a therapeutic community
International Journal of Therapeutic Communities 11 53-59
This paper develops the issue commenced in the 1985 paper on group cohesiveness, and raises the issue of how much does the therapeutic community succeeds by coercing its members into new behaviours, and indeed into seeing themselves in ways acceptable to the community.
1995 The social relocation of personal identity.
Philosophy, Psychology, Psychiatry 2 185-204.
This paper develops the themes of two papers in 1988 and 1989 on social possession, and on communication flow; and it connects with the concern described in the 1990 paper just listed. This paper attempts a slightly more philosophical reflection on the nature of identity and how it may be corrupted, distorted, and fragmented within the dynamics of the social group a subject is in at any particular moment. It develops the notion that personal identity is a much more fluid experience that is usually granted in contemporary Western society.
1997 Primitive mental processes: psycho:analysis and the ethics of integration.
Philosophy, Psychology, Psychiatry 4 121-143
This follows the previous paper on identity and links the vicissitudes of identity to the the primitive mechanisms, and unconscious phantasies of introjection, projection, splitting, and identification.
1997 Therapy or Coercion: Psycho-Analysis and Ethics
RD Hinshelwood (London: Karnac)
From my entry into the psychiatric profession in the mid-1960s and the influence then of ‘anti-psychiatry’, I had felt a nagging discomfort about the ethics of professional paternalism. In psychiatry this entails compulsory admission and treatment (including ECT) of very vulnerable people who often lack a self-determining motivation towards themselves, their lives, or anything else very much. In the last papers listed, I was moving towards the extended treatment of the principles of ethics which might emerge from a psychoanalytic understanding of the unconscious aspects of the person, of the self, and of relationships. My approach was based on the distortions of the sense of self and identity arising from primitive phantasies, notably projective identification. The latter specifically arises from a splitting of the self/ego, and a loss of one of the parts created by the splitting, that part being seen in others, not oneself. It is a curious and deeply unconscious process which is never taken into account in the philosophical literature on ethics and moral philosophy. In my view it is nevertheless important and gives rise to one important principle of ethical relations between people: that principle is to ensure that the sense of self of the ‘other’ is rendered as intact as possible. Ethical responsibility must be a care of persons that they remain themselves as much as possible, and this applies both to professional care, as well as to general ethics. Despite the removal of responsibility for themselves that the compulsory admission of people to a mental hospital entails, the long term aim must be to restore that self-responsibility at the earliest moment and in the gentlest way.
2003 A psychoanalytic perspective on confidentiality – the divided mind in treatment.
Allannah Furlong (ed) Confidential Relationships- Psychoanalytic Ethical, and Legal Contexts. New York: Rodopi Press
One aspect of the work in the last book (on ethics) was the need to understand the usual ethical principles, such as informed consent in terms of the fragmentation and potential integration of the self in the context of others, including and especially the professional. In this paper I had the chance to discuss the issues of confidentiality in care. What for instance does the understanding of the unconscious contribute to the issues of confidentiality and especially when confidentiality must be broken for the sake of the subject or others.
2000 Clinical and institutional relations to personal identity.
In Chris Heginbotham (ed) Philosophy and Psychopathology -An Exploration of Personal Identity in Mental Disorder. Aldershot Ashgate Publishing.:
This invited Chapter focussed considerations ethical care on the conditions of identity in clinical work and care institutions. It thus followed on, and generally summarised the work of the texts above on identity and ethics.