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Dangerous and severe personality disorder

  • Conor Duggan (a1)
Summary

The Dangerous and Severe Personality Disorder (DSPD) initiative was introduced a decade ago against overwhelming opposition from psychiatrists and others concerned with the implications of extending the public protection agenda through the use of a questionable medical ‘diagnosis'. As this initiative is now being scaled down, it offers an opportunity to consider the positive and negative aspects of the initiative together with its longer-term legacy.

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References
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2 Maden, T. (2007) Dangerous and severe personality disorder: antecedents and origins. Br J Psychiatry 2007; 190 (suppl 49): s811.
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23 Tyrer, P, Cooper, S, Rutter, D, Seivewright, H, Duggan, C, Maden, T, et al. The assessment of dangerous and severe personality disorder: lessons from a randomised controlled trial linked to qualitative analysis. J Forens Psychiatry Psychol 2009; 20: 132–46.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Dangerous and severe personality disorder

  • Conor Duggan (a1)
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eLetters

Goodbye to All That?

Raymond F Travers, Consultant Forensic Psychiatrist
08 June 2011

Duggan challenges his colleagues1. Did we form a Faustian pact with the government in embracing the DSPD programme? It was definitely a Tragicall Hiftory.

The ethnographic record of human life documents a mix of insight and irrationality. Given our capacity for competence, systematic, persistent, and expensive incompetence is puzzlingly maladaptive. Evolutionary psychology emphasises change as the explanation of human irrationality. Richard Dawkins’ views emphasize conflict more than change as the source of our collective idiocy2.

The DSPD programme should be seen in the context of its times. Nurtured by the selfish amoralism of Thatcher and Reagan in the ‘80s, political life was smugly stagnant when the programme was introduced in the late ’90s; the first of two lost decades, during which fantasies of prosperity and limitless personal advancement displaced all talk of political liberation, social justice or collective action3.

Though change was afoot, as Thatcher’s children, clinicians had no experience of genuine political movements. There were many single shared interest issues at play; new buildings and resources, new jobs, new careers and new challenges. But efforts to convert such interests into collective goals; the care and treatment of the personality disordered individual, the role of mental health services in either safeguarding public safety or contributing to the common good, were undermined by the fragmented individualism of our concerns. We responded to the broad gamut of competing objectives as individual consumers lacking the imagination tocombine these into a coherent whole.

Christopher Ricks reminds us that as a critic Duggan ‘must resist allthe time the temptation to write as if the discussable things were the most important ones.’4 The absence of trust is clearly inimical to a well-run society. In the late ‘90s the practice of psychiatry was under threat as exemplified by the media response to the Michael Stone tragedy. A corrosion of trust was evident in the state’s hardening attitude to its forensic practitioners in the run in to the introduction of the DSPD programme. Tension, conflict and even fear fuelled relationships.

Was it an error for certain clinicians to support the DSPD programme?The idea of error has always contained a sense of motion: of wandering, seeking, going astray5. Duggan wonders about what has been learnt. Perhaps, above all, that nothing is necessary or inevitable. History is not foreordained. We shall have to ask the perennial questions about personality disorder, forensic psychiatric practice and risk management again, but be open to different answers.

We need to rediscover how to talk clinically about risk management: how to imagine very different arrangements for the practice of forensic psychiatry, free from the cant of ‘public protection’ and beyond our secure unit comfort zones. We must distinguish better than some of our predecessors between desirable ends and unacceptable means. At the very least, we should accommodate Keynes’s warning on this matter: “[i]t is notsufficient that the state of affairs which we seek to promote should be better than the state of affairs which preceded it; it must be sufficiently better to make up for the evils of the transition.”3

1 Duggan C. Dangerous and severe personality disorder. Br J Psychiatry 2011; 198: 431-433

2 Sterelny K. The Perverse Primate. In Richard Dawkins: How a Scientist Changed The Way We Think (eds A Grafen and M Ridley): 213-223. Oxford University Press, 2006

3 Judt T. Ill Fares The Land: A Treatise On Our Present Discontents: Penguin Books, 2011

4 Ricks C. Poems and critics: an anthology of poetry and criticism from Shakespeare to Hardy (ed CB Ricks): Collins, 1966

5 Schulz K. Being Wrong: Adventures in the Margin of Error: 41. Portobello Books, 2010
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