The Limits of Containment: The Myth of Heroism.

David Morgan

In the world of forensic psychotherapy, and clinical work with other severely ill people, we often hear about the story of the therapist as witness as someone who, through patient attention and emotional endurance, can bear the unbearable. We tell ourselves that our task is to remain present in the face of horror, to think where others act, to contain what the patient cannot yet hold. The figure of the heroic analyst calm, unflinching, reliably boundaried looms large in our clinical imagination. But heroism, like any fantasy, may conceal more than it reveals.

It is not always a failure of courage when we do not look. Sometimes, it is the result of having seen too much. In the forensic setting especially where patients present with histories of profound violence, fragmentation, and moral dislocation the mind of the clinician is tested in ways that are not merely technical but existential. What is required is not simply professional training but a capacity for psychic survival.

To fail to bear something is not the same as turning a blind eye I really think that this distinction matters. The former is a psychic limit; the latter, a moral choice. In our eagerness to protect ourselves from the charge of collusion or avoidance, we may pathologise our own need to step back, to not look too directly, to not contain what cannot yet be thought. But sometimes the act of not looking is not a defence against truth it is a defence of psychic life against horror.

Wilfred Bion (1962) famously distinguished between containment and evacuation, between the capacity to process raw emotional experience (beta elements) and the more primitive tendency to expel what cannot be tolerated. Yet Bion also acknowledged that there are limits, an analyst’s reverie is not infinite. When the projected material is uncontainable, which it often is in forensic cases if we are honest, when it breaks down meaning rather than seeking it the analyst may find him or herself not containing but collapsing, not thinking but dissociating. The myth of the heroic therapist does not admit this vulnerability, it encourages a stoicism that borders on omnipotence. An omnipotence that is a defence against the unbearable to protect the self from exposure to what is raw visceral and in the end unknowable.

In forensic work, the omnipotence of the clinician may be subtly encouraged by the institutional fantasy that something reparative, even salvific, is happening. The idea that we are doing something brave, important, and transformative can become a bulwark against the deeper reality, that we are often sitting with the psychically unworkable, with violence that refuses symbolisation, and with minds so evacuated of relational structure that they cannot sustain the conditions for therapeutic growth. In such moments, the heroic stance may actually be a defence, a defence against our own helplessness, our grief, even our revulsion and keeping a job.

Gwen Adshead (2020), writing from her extensive experience in forensic psychiatry, has noted that forensic work “exposes us to experiences of moral injury” (p. 15) that may exceed the reach of ordinary clinical thinking. To enter the mental world of someone who has committed torture, or sexually abused a child, or killed a parent in a psychotic fugue, is not only to witness destructiveness it is to risk internal rupture. My question to her would be should you do it? Why expose your body and mind to such primal horror?

If we over-identify with the therapeutic task, or with the fantasy of enduring it all, we may fail to recognise when our own psychic apparatus is disorganising.

Estela Welldon (1988), too, has indeed warned of the collusive seductions of forensic work. In her seminal text Mother, Madonna, Whore, she draws attention to the analyst’s susceptibility to unconscious enactments show sadism, omniscience, or maternal idealisation may infiltrate the countertransference. The heroic pose may be one such enactment: a refusal to admit that we are affected, overwhelmed, perhaps even contaminated by what we encounter.

To acknowledge that some material is unthinkable is not to give up on the analytic task rather, it is to honour the truth that the mind—like the body has its limits. Edna O’Shaughnessy (1992), in her reflections on thinking and breakdown, reminds us that thought requires containment, and that where the containing function collapses, the possibility of meaning collapses with it. In such circumstances, the analyst’s task may shift and should shift not toward interpretation, but toward psychic survival.

There are moments in forensic psychotherapy and working with disturbing mental states when the most ethical thing we can do is not to interpret, not to delve deeper, but to remain still. To admit that we cannot look at least not yet, maybe even never. This is not cowardice, it is a gesture of respect for the gravity of what we face, and for the fragility of the mind that tries to face it.

There is a quiet dignity in not knowing, in not managing, in not being able to bear it all. And there is clinical wisdom in recognising that psychotherapy is not about absorbing limitless horror, but about staying human precisely where the human threatens to vanish and has in many cases vanished. To work means not colluding with disavowal it is to acknowledge, in Bion’s terms, that some realities must be approached “without memory or desire” and perhaps, at times, without sight or indeed not approached at all.

In place of heroism, we might substitute humility, not the humility of defeat, but the humility of truth: that there are aspects of the human psyche that do remain unbearable, we can see and bear witness but we cannot yet survive their full implications. Not because of not being analysed enough or supervised enough but because our equipment needs us to take care of ourselves.

Clinical Vignette and Response: The Heroic Therapist and the Failure to Mourn

At a clinical seminar, a colleague presented a case she was clearly proud of an encounter with a male patient detained in a secure forensic unit following multiple violent assaults, including an episode of cannibalism during a florid psychotic break. She had been five months pregnant at the time of treatment, and could not disguise her physical condition.

She described the case with a tone of controlled intensity, as though rehearsing a trial she had successfully passed.

The patient said something about the baby inside her.  Laughter rippled nervously through the room. She smiled coolly and continued: “I thought to myself, ‘Yes, that’s the level we’re working on body, hunger, annihilation. I held it. I stayed with him. I didn’t let it throw me.’”

She described her work with the patient over the following weeks as a kind of psychological endurance test. “He would speak in these fragmented, horrific metaphors—body parts, wounds, grinding teeth. I never flinched. I knew I had to be the container. I had to make him feel safe enough to project into me, even if it meant becoming the object of his fantasies.”

There was, in the telling, a certain triumphalism. The story of a pregnant analyst fearlessly facing down psychosis, holding steady in the face of horror. A hero of containment.

When discussion opened, several colleagues offered respectful admiration. One spoke of the “courage” it must have taken. Another praised her for staying “true to the work” even while carrying new life within her.

When I spoke, I found myself troubled—not by what she had endured, but by how she seemed to have not felt it.

“I wonder,” I said carefully, “whether the most disturbing part of what you’re describing isn’t what he said, but that you’re proud not to have been disturbed.”

She looked at me, puzzled.

“I don’t mean to criticise your clinical judgement,” I went on. “But I was struck by how quickly your narrative turned the horror into a kind of analytic success. That you held it, that you didn’t flinch, that you ‘knew what it meant’ and carried on. That sounds admirable. But I wonder if it’s also defensive of us when we use theory to do this? I wonder what had to be disavowed for you or any of us here to keep going in the face of something so disturbing as what’s happening here.”

I mentioned Bion, of course—his warning that containment is not absorption. That to truly contain, one must first feel. And I thought of O’Shaughnessy’s writing on the breakdown of thought: how there are experiences which, rather than stimulating symbolisation, crush it. I had also written a paper some

Years ago called Lost Souls and Broken Spirits (1992) were some people can only get relief from their internal world from breaking the spirit of their therapists, nurses and doctors.

“Is it possible,” I asked, “that we don’t contain these sort of projections at all—but evacuate them in another form, by identifying with the omnipotence they or we might need us to have?”I was talking as much about myself as the presenter including my comment to her.

There was silence.

Then I added: “There’s a cost, isn’t there, to becoming the hero in someone else’s psychosis? A psychic price, even if it’s paid later.”

What I wanted to say, and to say her, but didn’t, was this: that to be five months pregnant and to hear yourself described as the patient did, is not something to metabolise cleanly. It is a psychic injury. And if it doesn’t hurt, that in itself is evidence that something unbearable has, understandably, been pushed aside. Heroism, in such moments, is not a form of courage—it is a refusal of vulnerability dressed as professionalism.

The fantasy of endurance—that we can tolerate everything, symbolise everything, withstand anything—is seductive. I think it was part of the push from within psychoanalysis into previously unexplored territory of forensic and psychotic patients. But it’s also dangerous breeding omnipotence where there should be mourning and can sometimes replace emotional honesty with ourselves and what we can manage, with a performance of heroic control.

Forensic work, perhaps more than any other, teaches us not about power, but about the limits of our powers. The task is not to become impervious, but to remain human in the face of what is dehumanising. And sometimes that means allowing ourselves not to look, not to bear, not to hold it all and yes to say no. I often say that is usually an aspect of these cases in that those that act on others never have had the power to say no, both to what they do and what was done to them.

To mourn, rather than to master.

References

Adshead, G. (2020). A short book about evil: Psychiatry, morality and the mind. Jessica Kingsley Publishers.

Bion, W. R. (1962). Learning from experience. Heinemann.

Morgan,D.H. (1992) Lost Souls and Broken Spirits.  Lecture Series. Tavistock Clinic.

O’Shaughnessy, E. (1992). Enclaves and excursions. The International Journal of Psychoanalysis, 73, 603–611.

Welldon, E. V. (1988). Mother, Madonna, Whore: The idealization and denigration of motherhood. Free Association Books.