Assessment considerations

I was asked to consider whether Phoenix suffered from psychopathic disorder, and additionally whether she would address her parenting difficulties in therapy. The court heard that her sister considered her to be a ‘psycho’ and to manipulate and control the responses she created in social services professionals. I was requested to determine if she met the criteria for antisocial or psychopathic personality disorder. In addition to the worries about her capacity to bear her children’s needs in mind and attend reliably to their welfare, the Social Services were also concerned by reports of her involvement in prostitution, engaging in sadomasochistic sex in which she was the dominating partner and reports of animal cruelty in her childhood. There was a description in her medical records of her as ‘displaying cruelty to animals and towards younger children’ at primary school, and describing her tendency to isolate herself from others for extended periods of time, but then flipping into being an outgoing and charming personality with a great appetite for parties and nights out. Social workers involved with Jade and Rosie had described her as ‘manipulative’ and ‘ruthless’, with a capacity for ‘superficial charm’, inadvertently evoking terms that arc often used in descriptions of psychopathy.

It was, in my view, essential to consider in more detail the nature of Phoenix’s internal world, to look carefully at her history of violence and cruelty to animals and younger children and to attempt to draw a picture of the meaning and function of these acts. The familiar scenario of brutality, humiliation and helplessness she had experienced was being re-enacted with her own children. Had she been too maltreated and disconnected from her own mental states to be able to relate to her own mind and the mind of another with empathy and concern? Or was all evidence of need or vulnerability in herself and others to be attacked and obliterated, as too painful a reminder of her own earlier helpless state? She clearly had a strong need to take back power and control and to inflict pain on others, finding some relief in the sadistic sexual practices she had engaged in during prostitution, and also in hurting animals, vulnerable creatures helpless to defend themselves, much like her own daughters, with whom she identified and treated as narcissistic extensions of herself.

Understanding cruelty and danger: psychopathic states of mind

I saw Phoenix as someone who frequently found herself in a ‘psychopathic state of mind’ and felt that the question of her potential classification as a psychopath was unhelpful and distracting. It implied that the ‘answer’ would offer certainty about her prognosis and the likely trajectory of her life, addressing the central question of future risk once and for all.

When I explored her early life with her, Phoenix seemed to come alive, though she found it hard to tell a clear narrative, and it was striking how she moved back and forth in time. At some moments I felt she was telling me about a current situation, rather than a historical one; at others, I believed she was giving me a description of her early life with her mother and younger sister, only to learn she was talking about herself and her daughters in the present. Although this was confusing at the time and served to ‘wrong-foot me’ so that I would need to check, rewind and clarify, interrupting the flow of the story, when I reflected on it later I realised that this confusion of the past and the present is characteristic of trauma - reliving the past as if it were the present, experiencing current events as if they were happening to a younger self in a frightening past state of being. Far from an irrelevant and distracting detail that needed correction, this confusion between past and present was a crucial piece of data, a countertransference experience that offered insight into how Phoenix functioned and how confusing, unstable and chaotic her states of mind were. It was clear that she was devoid of any sense of an underlying, coherent and intact adult self and that at times of heightened emotions she would see her children not as they actually were, but in identification with them, as the child she had been, in relation to the mother she had faced. She would not, at those moments, sec herself as an adult in charge of them, but would, and had, become destabilised by their neediness, their vulnerability and their fear. It was in this state of mind that she wanted to harm them, to silence and subdue them, as representatives of her unmet needs, unheard cries and savage feelings that had found no home in her own mother.

Phoenix’s childhood had been characterised by disruption, maternal absence and cruelty. She was left with an underlying sense of being nothing and no-one, marked by her visible difference and invisible trauma. I considered her aggression to be defending her against underlying feelings of shame and humiliation. She guarded herself against revealing any ‘softer’ feelings and considered these unacceptable, expressing pain through violent actions, taken both against others and herself, sometimes through savage acts of self-harm. Her daughters did not provide the solution she had hoped for to her unhappiness, and the comfort she still longed for. Like many other deeply disturbed young women with impoverished experiences of being mothered themselves, their children function as narcissistic extensions of themselves (Wclldon, 1988). The baby can be seen as the good object which the ‘bad’ woman desperately needs as a receptacle for her projections. In her mother’s fantasy the unborn infant is the embodiment of a loving creature who confirms the mother’s regenerative power and the existence of some good in her. This idealisation can lead to disappointment and depression when the infant is actually bom, awakening rage in the mother.

I outlined this formulation in my assessment and described how a course of forensic psychotherapeutic treatment could enable her to address both victim and perpetrator aspects of herself, without denying her accountability or relinquishing her agency. Such work requires the dedication and consistency of a practitioner trained in psychotherapeutic approaches to working with violent and perverse individuals, informed by a full understanding of the consequences of trauma, and the dynamics that may dominate a therapeutic relationship, such as the invitation to become the harsh judge of the woman’s actions, or, alternatively, to become cither a passive bystander or injured victim of her aggression. Close supervision and proper training enables forensic psychotherapists to resist these (unconscious) traps and enactments, and to offer a neutral space in which women who enter psychopathic states of mind can begin to explore and understand what leads to these lapses in their ordinary functioning.