Bad Men Do What Good Men Dream: A Forensic Psychiatrist Illuminates the Darker Side of Human Behavior Read Online Free PDF

was asked by a young psychiatrist to supervise her therapeutic work with a difficult patient. During the course of the supervision, she reported to me an incident with the patient that was deeply troubling her. Therapy sessions with this patient, a single, middle-aged woman with chronic depression, had begun 8 months earlier and were characterized by the patient’s anger and complaints about her life. The patient seemed to find the minor problems in life to be very wounding. My colleague traced these reactions to the patient’s sense of self-importance and entitlement. After the conclusion of an especially difficult therapy session, full of bitter, tearful complaints and recriminations, the patient went into the bathroom of the waiting room area. A few moments later, my colleague opened the door from her office to the waiting room to greet the next patient, but that one had not yet arrived. The previous patient, still in the bathroom, had left her purse on a waiting room chair. My colleague was jolted by an impulse to take something from the patient’s purse. Astounded and ashamed of this impulse, she closed the door and shut herself back in her office to contemplate her urge to steal from the patient.
    Later that day, she and I had a regularly scheduled supervisory session. She told me of the incident and felt comfortable enough to examine the unbidden impulse to steal. She had been turning over in her mind what it might possibly mean. It was not money or anything in particular she wanted from the purse, the psychiatrist told me, it was that she just wanted something back from the patient. This deeply selfcentered patient was an inveterate taker, giving nothing in return to any of her relationships. After a time people would drop her, leaving her with a numbing sense of rejection, isolation, and chronic depression. Now, after 8 months of treating the patient, the psychiatrist was experiencing feelings of emotional depletion and reacting against being treated as an object. This patient, of course, aroused similar feelings in nearly everyone with whom she came into sustained contact. The psychiatrist knew that these were also feelings the patient had experienced at the hands of a distant, depressed, rejecting mother and an indifferent father.
    But why had she wanted to steal or to possess something from this patient now? After examining her own feelings, the psychiatrist recognized the extent of desolation and emptiness in the wake of the recent breakup of her unhappy marriage. Also, the failure of the marriage had triggered unresolved feelings of loss and loneliness from her childhood, following the sudden death of her mother. Now my colleague realized that she had been subconsciously looking to her patient for nurture and sustenance at a time of her own personal crisis. In this paradigm, the patient stood both for the psychiatrist’s lost mother and her more recently lost spouse, and her yearnings for both of them.
    With the insight she had gained about her own mental and emotional situation through examining the singular impulse to steal, the psychiatrist then returned her therapeutic attention to the patient. For the first time, the psychiatrist felt empathy for the patient and pointed out to her the pattern of feelings the patient aroused in others, which enabled the patient to see how she was reversing and reenacting the distant, cold relationship she had experienced with her mother. This insight proved to be of great assistance to the patient.
    My colleague’s breakthrough with the patient was made possible because she was willing to face directly the black pain of her own losses and to insist on understanding why it had erupted as a wish to steal in this particular situation. The ability to face, hold, and examine antisocial thoughts and feelings is not just a requirement for psychiatrists and their patients. It is necessary for everyone. I am not naïve enough, however, to believe that the vast majority of