In using attachment theory to
analyze and think about forensic psychiatry, the authors of in A Matter of
Security offer new ways of thinking about mental disorders in offenders.
Whether readers are new to attachment theory applied to forensic settings or
whether they are already familiar with it, the variety of topics offered in its
four-partite structure — Theory, Clinical Issues, Institutional Issues and
Research — makes A Matter of Security valuable to practitioners and
researchers of forensic psychiatry alike.

The contributions included in the
first part alone are worth the purchase of A Matter of Security. This
theoretical section focuses by and large on conceptual aspects of attachment
theory in forensic psychiatry.  Thomas Ross for example, untangles and
clarifies, in Attachment Representation, Attachment Style or Attachment
Pattern: Usage of Terminology in Attachment Theory, the convoluted mesh of
terminology used to talk about attachment- and his piece would therefore have
made an excellent first chapter. Nonetheless, Ross’ concise clarifications,
recommendations and dismissals of terminology are invaluable to any reader
interested in the topic. 

Another excellent piece in this
first part is an essay titled "The Developmental Roots of Violence in the
Failure of Mentalization" by Peter Fonagy. Using attachment theory
as framework for interpretation, Fonagy accentuates and explicates the effects
of brutalization of intimate and affective interpersonal relationships on
abnormal personality development as well as on the development of pathological
interpersonal relationships and interpersonal violence. He provides insightful
thoughts on this violence on an individual level, but draws implications for
large scale and collective violence such as Nazism and ethnic cleansing as well.
While Fonagy’s gaze might be a little too fixed upon psychoanalysis ability to
rectify or adjust collective imbalances at the root of such forces, the point
that furthering this specific area of attachment theory research (how it
applies to large-scale and collective violence) is important, is well made, a
point which is also, and further stressed in Gwen Adshead and Friedemann Pfäfflin’s
conclusion of A Matter of Security.

The second part, Clinical Issues
consists of a case study titled The Link Between Childhood Trauma and Later
Violent Offending, by probation officer Paul Renn. Renn presents a case
study of therapeutic work in probation settings in which he uses attachment
theory to connect and explore the care-giving contexts in which childhood
trauma took place with the subsequent violent offending. Renn also offers
suggestions as to how to employ attachment theory to assess risk in forensic
settings. While included in another section — that of Clinical Issues — this
practical question as to how to match internal psychological security with
security and safety in the community is also pursued in an essay titled Forensic
Mental Health Nursing by Anne Aiyegbusi. Other essays in Clinical Issues,
such as that by Mark Parker and Mark Morris as well as that of Gwen Adshead
pursue questions related to the attachment paradigm in the therapeutic
relationship between practitioner and patient in the context of a therapeutic
setting of a prison and or forensic hospital. 

The essays included in the Part IV,
Research Data, are least convincing. Some essays build on unexamined
assumptions (for example that women who are seeking refuge in shelters for
battered women do so in order to "avoid criminal escalation") while
others state the obvious ("when interpersonal conflicts end in a deadly
disaster…there was an underlying lack of reflective function and ability for
constructive conflict resolution"). Nonetheless, the authors of these
essays all gesture towards new and diverse ways in which attachment theory in forensic
settings can be explored further. One of those areas lies in as already
mentioned by Ross, the application of attachment theory to explore the driving
forces of grand-scale and communal violence. Another area, left unexplored in A
Matter of Security but articulated by Gwen Adshead and Friedemann Pfäfflin
in the conclusion, is the relation between the linguistic means available to
the person and the ways in which attachment is experienced, remembered and
known.

All in all, A Matter of Security
is an invigoration collection of essays in which attachment theory is used as a
framework to explore a variety of issues in forensic psychiatry. The variety of
content and methodologies makes A Matter of Security an invaluable
resource for anybody working in or thinking about forensic psychiatry.

© 2005
Gerda Wever-Rabehl

Gerda
Wever-Rabehl holds a Ph.D from Simon Fraser University, and has published
extensively in the areas of social science, philosophy and philosophy of
 education.

Categories: Ethics, Psychology