Punishment or treatment: prison or hospital?

Psychodynamic perspectives on staff response to inpatient misdemeanour

“…Super-ego and conscience are developed through parental influence and the reasonable parentalism of staff is vital to the treatment of those who have been damaged by parental figures. These themes were clearly expressed by the forensic psychiatrist Peter Scott (1970):…”

Escapes and absconding from secure psychiatric units

“…Security itself may be seen in a therapeutic context, both in terms of therapy improving (relational) security, 6 and safe containment being essential for treatment. 6,7 The use of leave, too, is inherently therapeutic in secure hospital units and the means by which otherwise sterile risk assessments are gradually tested out in a controlled fashion, something alien to the culture of the closed prison system. Patients are encouraged gradually to resume responsibility for their behaviour and they demonstrate that by adhering to the boundaries of leave.…”

Treatment or punishment? A nineteenth-century scandal

“…But at a much later date physically unpleasant methods -what Reil (1803) called 'non-injurious torture' -were still seriously advocated as a means of bringing a patient under control or to his senses. In fact, as Scott (1970) has pointed out, punishment and treatment are not the opposites that they seem to be. Whether in operant conditioning, or in the institutional management of the socially disordered, some form of punishment is inescapable, but must be applied in accordance with clearly stated principles and not out of a personal vindictiveness.…”

“…Whether in operant conditioning, or in the institutional management of the socially disordered, some form of punishment is inescapable, but must be applied in accordance with clearly stated principles and not out of a personal vindictiveness. However, 'it is easy and unhappily gratifying to punish wicked people and, if they turn nasty, lock them up and go home to your tea' (Scott, 1970). The use of treatment as punishment is particularly tempting to those who deal with violent patients, and who may be attacked by them: retaliation is an understandable reaction, as has already been acknowledged (Davies, 1973;Watkins, 1971).…”