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Malignant Alienation – a concept that has not yet arrived?

Handley Cross House, Harewood End, Herefordshire HR2 8JT

I read with interest the article by Graham et al regarding addressing carer attitude to difficult patients (Psychiatric Bulletin, July 2004, 28, 254–256). The uptake of new concepts like malignant alienation into mainstream teaching and practice depends on a number of factors, including usefulness and comprehensibility. We described malignant alienation in detail a decade ago (Watts & Morgan, 1994). Strategies were documented for preventing and managing the alienation process for difficult patients on psychiatric wards with the specific aim of reducing inpatient suicide. However, despite knowing much about the nature of inpatient suicide, malignant alienation is not found in the latest editions of any of the leading standard UK postgraduate textbooks.

My own recent small postal survey of consultant psychiatrists in one teaching area (16 surveyed, 12 responded) found that more than half knew it was not taught to their trainees and a third felt it had not informed their own practice. It seems that the concept is not taught widely and is applied patchily, but why? Malignant alienation is acknowledged as a useful concept from forensic units (Torpy, 1994, personal communication) through to learning disability. The weight of its psychological components may have led to a slower uptake within units where a biomedical approach is prevalent, and this explanation is reinforced from my own survey which suggested the presence/absence of a consultant psychotherapist (or similar champion) was pivotal in psychological concepts gaining credibility or not. Or perhaps avoidance of the powerful negative feelings at the heart of the alienation process itself still continues to explain its omission from standard teaching?

References

WATTS, D. & MORGAN, G. (1994) Malignant alienation: dangers for patients who are hard to like. British Journal of Psychiatry, 164, 11 -15.[Free Full Text]

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This Article Full Text (PDF) Submit an eLetter View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Watts, D. Search for Related Content PubMed Articles by Watts, D.