The Royal College and the dying joy of learning.
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Biomedical subjects
Publications and source records attributed to G N Conacher.
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Recent work on the phenomena associated with the concept of psychopathy has made more confident the clinician's identification of the syndrome, and enables a better examination of certain behaviors related to the diagnosis. One of these is an extreme form of regressive reaction often associated with adaptation to a new restrictive environment. In dynamic terms this can be seen as a primitive attempt to seize control of the maternal universe, perhaps re-enacting a successful strategy of the infant past. The case of a convicted offender with an extensive psychiatric history is described, and consideration is given to the management of such a case in the institutional environment.
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An attempt is made to delineate some parameters surrounding the use of force within a psychiatric service to a correctional system. Descriptive study in using case material and incident statistics are followed by discussion. Reference is made to some recent articles on ethics in the medical and psychiatric literature. This article is offered in recognition that examining these troublesome issues can be very difficult for the clinicians involved, and not in the expectation that any ready solutions are to be found.
The case is presented of a young and violent chronic schizophrenic patient whose symptoms respond to antipsychotic medication but who was recorded, at a time when he was deemed competent, as expressing a wish that he should not be given antipsychotic treatment. Under the present usage of the Ontario Mental Health Act, substitute consent givers are bound by such a "prior competent wish" and this patient must now be considered one of a growing group of "legally untreatable" psychotic patients.
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Genital self-multilation is rare, and reports suggest that it is usually associated with psychotic illness. We report a case in which penile self-multilation was an attempt to commit suicide and justified as a rational action. The literature on genital self-mutilation is reviewed. It is argued that the strong association between genital self-mutilation and psychosis may be the result of selective reporting.
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