Remarks on aggression

This paper attempts to draw attention to the difference between the states of mind and inner worlds of neurotic, borderline and psychopathic patients, with reference to different types of destructiveness: anger in the neurotic patient; desperate vengeful hatred in the borderline paranoid; and a cold addiction to violence in the psychopath. Discussion focuses on technical issues and the need to meet the psychopathic patient where he really is, in the inner bleak emotional cemetery he may be inhabiting. Although most patients refuse to stay put in the neat schematic categories outlined, they do seem to appreciate and to need the therapist's recognition of the specific quality of these vastly different states of mind.