Christopher Scanlon

Personality Disorder and Homelessness: Membership and ‘Unhoused Minds’ in Forensic Settings

Although not all homeless people are personality disordered, many are offenders and all are de facto anti-social, either in their orientation to the world or in the eyes of the beholding world. We re-define and re-locate the problem from the social fact of the actual homelessness into the interpersonal and intrapsychic world of the ‘unhoused mind’, and explore the complex reciprocal relationship between the housed and the unhoused. The article concludes by discussing the impact on individual workers, staff teams and organizations who are tasked with attempting to help such people.

Housing ‘unhoused minds’: inter‐personality disorder in the organisation?

We begin with a discussion of the psychosocial concepts of ‘personality disorder’ and ‘homelessness’, and then seek to re‐define and re‐locate both from the internal world of the patient/client to the psychosocial ‘dis‐memberment’ associated with what we have called the ‘unhoused mind’. We then explore the complex reciprocal relationship between the ‘ordered’ and the ‘dis‐ordered’, the housed and the unhoused, and consider some possible implications for individual workers, staff teams and organisations tasked with attempting to house and/or to care for and support such people.

‘Defacing the Currency?’: A Group-Analytic Appreciation of Homelessness, Dangerousness, Disorder and Other Inarticulate Speech of the Heart:

In their work with the homeless, the dangerous and the disordered, helping agencies and the workers they deploy are faced, on a daily basis, with the task of engaging people whose essentially anti-social stance is, or is construed to be, one of a refusal to join in. The premise of our discussion is that, despite considerable attention over recent years having apparently being addressed to the problems of the socially excluded, there remains, and will most likely always be, a group of people who refuse to be engaged. It is our contention that even if the best efforts of our most experienced workers were channelled into addressing these problems—and this, in our experience, is rarely actually the case—there would always remain a group of people who refuse to play the game and resist all efforts to bring them ‘in from the cold’. We argue that mental health and social policy directives that optimistically, or cynically, envisage a future when all such people will be ‘socially included’ involve an equally stubborn and dangerous societal refusal to face up to the reality of these problems: a denial of their essential complexity and the part that society itself plays in perpetuating the very problems they seek to alleviate. We will contend that this systemic refusal is dangerous because, no matter how ‘politically correct’ the policy, or how sophisticated the needs assessment tools, such belief systems are setting up socially excluded people, and the workers charged with trying to reach out to them, to fail. We will then share our perspectives on how this experience of failure exacerbates a sense of exclusion in the excluded and increases, sometimes to breaking point, a pervasive sense of disaffection and demoralization in the workers. The central problem which we therefore face is how to relate to the refusal that is at the heart of these difficulties—how to relate to offensiveness without becoming offended—and how to do this without the egalitarian ‘we’ quickly collapsing into an us and a them. In making our case we would like also to suggest that we need to side-step ‘old-fashioned’ allegiances to one or another particular school of thought or practice that includes/excludes others’ contributions on the basis of dogma or prejudice and to join with others to dare to tell the truth and if necessary, to deface the falsely discriminating currency of our times.

Cosmopolitan minds and metropolitan societies: social exclusion and social refusal revisited

In this paper, we examine the dynamics of social exclusion from a psychosocial perspective, taking the system of care, representing society-as-a-whole, as a perverse system that excludes whilst simultaneously seeking to include. Our focus is as much upon the predicament of the system of care as it is upon the plight of the troubled ‘refuser’ who takes up the antisocial position and refuses to join in. We revisit the legend of Diogenes the Cynic to explore a particular kind of ideological clash in the encounter between the in-group and the outsider. We explore the nature of the transaction between, on the one hand, ‘metropolitan’, ‘city-state’ systems of care, which defensively and, we argue, offensively define their boundaries in ways that exclude (or that set unacceptable terms for the invitation to include) and, on the other hand, the excluded, ‘cosmopolitan’ seekers (or avoiders) of different kinds of asylum: ‘citizens of the uni-verse’ who withhold their allegiance to any particular earthly power. In doing so, we explore the nature and quality of the relationship between ‘us’ and ‘them’ that is established across a boundary by the particular ways in which the boundary is defined. We observe that the very real psychosocial problems associated with the homeless, the dangerous and the disordered are complex and chronic; and go on to explore the ways in which ‘we’, the safely housed and socially ordered, have a collective and shared responsibility for the co-creation of our shared problems. We conclude with an invitation to conceptualise more ‘cosmopolitan’ forms of hospitality for those who refuse to ‘come in from the cold’ on the ‘metropolitan’ terms more usually offered.

Disturbances of “groupishness”? Structural violence, refusal and the therapeutic community response to severe personality disorder

Abstract We explore the problematic dynamics in the relationship between societal systems of care and the chronically excluded, with particular reference to severe personality disorder and the “difficult-to-reach” patient. The individual who “refuses” is often met with a violent response: yet his violence must be understood as related to an experience of being violently excluded. We reformulate personality disorder as a disturbance of “groupishness” and suggest, as a paradigm for the problem of refusal, the story of Diogenes the Cynic, who “holed himself up” in a barrel; and of his legendary encounter with Alexander the Great, who tried unsuccessfully to persuade him to “come in from the cold.” We suggest it may be as important to focus on Alexanders violence as on that of Diogenes, and we examine modes of violence deployed by society against the excluded outsider, with particular reference to the hostile attribution of intentionality to the personality disordered individuals acts of violence and self-harm. We conclude by considering both the merits of the democratic therapeutic community model as a response to severe personality disorder and the dangers, inherent in this model among others, in an unconscious identification with Diogenes in his barrel.

On the Perversity of an Imagined Psychological Solution to very real Social Problems of Unemployment (Work-lessness) and Social Exclusion (Worth-lessness): A Group Analytic Critique

This article explores some ethical and professional implications of social policies that aim to achieve social inclusion through Improving Access to Psychological Therapies (IAPT) for the un(der)employed (the work-less) and the ‘socially excluded’ (the worth-less) in the UK. A major ethical concern at the heart of this critique is that such policies establish a boundary between domains of inclusion and domains of exclusion that perversely maintain the very problem they are designed to solve. The article explores how we, as a society, are invited to live in a split world and to hold contradictory conceptualizations about un(der)employment, (workless-ness) and social exclusion (worthless-ness). On the one hand we seem to know that these problems are a consequence of the vagaries and vicissitudes of national and international economic policies, yet on the other hand are invited to believe that these problems are a result of individuals’ psychological failures. In these ways dissembling conversations about an ‘imagined’ psychological depression replaces conversations about the very real socio-political and economic ‘depression’ that underlies it—and ‘psychotherapy’ is in danger of becoming the medium through which this dissembling is operationalized.

Psycho-social perspectives on the dynamics of inclusion and exclusion in groups, organisations, communities and in society

This Special Issue gathers authors from different communities of practice working in the field, to offer associations to the idea of cosmopolitanism first put forward by Diogenes, the Cynic philosopher, when he claimed to be ‘a citizen of the world’. Our task has been to pursue a collaborative psychosocial enquiry into the vexed and vexatious question of what happens when the irresistible force of the out-reaching societal in-group encounters the immovable object of the excluded outsider’s refusal to ‘come in from the cold’ on the terms that are offered. Inclusion, then, is on whose terms? At what cost – and to whom? In the UK, at the time of writing, these issues are in the public domain in many different ways. The latest in a long line of ‘rough sleepers’ initiatives still hopes to clear the streets of London of its homeless population in time for the Olympic Games of 2012 (as did most other capital cities who have hosted major international sporting events in recent years); although many of the 205 ‘famous faces’ specifically identified as chronic rough sleepers have other ideas about what constitutes an appropriate place to sleep. Action for Happiness, a campaign led by, among others, the economist Lord Layard and the Master of Wellington College, Dr. Anthony Seldon, would include the depressed and unproductive in a happier view of their situation – if only they could cheer up and learn to be a bit happier. Lastly (to name but three political instances), the Prime Minister David Cameron, with truly Etonian chutzpah, has sought to link those two great demonised ‘others’ of both old and neo-conservative mythology: those reckless ‘foreigners’ who ‘refuse’ to learn English and those feckless ‘natives’ who ‘refuse’ to work. We shall let him speak for himself: