Authors: Carlos Fishman and Stanley Ruszczynski
The Portman Clinic began in 1931 as the Psychopathic Clinic and was the clinical arm of the Institute for the Scientific Treatment of Delinquency, later to be called The Institute for the Study and Treatment of Delinquency (ISTD) (Glover, 1960; Dicks, 1970). The Institute was founded by a small group of people impelled by the research of Dr Grace Pailthorpe, a psychiatrist and\psychoanalyst, who had worked as a doctor in the trenches during\the First World War. After the war she worked in Birmingham and Holloway Prisons. She became interested in the personality of women prisoners and wrote Studies in the Psychology of Delinquency (Pailthorpe, 1932). Her approach and her research attracted like-minded psychoanalysts including Edward Glover and Kate Fried-lander, and their shared interests and, more importantly, Edward Glover’s impetus and dedication, founded the Institute and with it the idea of developing a Clinic. Glover was already developing the understanding of sexual perversions, criminality, and addictions, and had also been Director of the London Clinic of Psychoanalysis.
Grace Pailthorpe during World War 1
Later, when writing about the beginnings of the Institute, Glover stressed that “The first concern of the ISTD (was) to make a thorough examination and the second to arrive at a provisional diagnosis. The diagnosis should be sound enough to permit of a satisfactory recommendation of disposal; the examination should be comprehensive enough not only to exclude diagnostic error but to permit of subsequent . . . research” (Glover, 1960). So, from its very inception, the Portman Clinic had as its purpose assessment, treatment and research. In addition, Glover wrote that because delinquency and crime are social phenomena they appropriately attract the attention of a variety of disciplines including social workers and social psychologists. However, in his view, “. . . the most fundamental approach to crime, pathological or otherwise, is that of psycho-analysis” (Glover, 1960). This view remains central to the work of the Portman Clinic, which, whilst fully recognizing the necessary teamwork between the various disciplines involved in the care, treatment and containment of delinquent, perverse and violent patients, takes upon itself the task of refining and developing the in-depth under-standing of the unconscious forces operating in the psychic make-up of its patients and of the patients of those professionals who approach the Clinic for consultation or teaching.
Perhaps it is not surprising that the Portman Clinic was born at a time in the history of the twentieth century that was particularly stormy. The period between the two great wars saw the birth of Communism, the rise of National Socialism and important developments in the move from fascism to democracy. Most of those who were associated with the early days of the Portman Clinic shared a particularly idealistic view influenced no doubt by the enthusiasm which Freud’s theories of the mind encouraged in the early days. One can glean from documents that refer to the early days of the Clinic the belief that perhaps “treatment” might replace “punishment”. Over seventy years later, and with the accumulation of substantial clinical experience, that idealism has certainly been modified and has evolved into something more realistic and therefore more hopeful. Portman clinicians treat individuals with complicated and severe psychopathologies using psychoanalytic psychotherapy, believing that, as Glover wrote, “. . . so long as the existence and power of unconscious motives is disregarded, we cannot learn anymore about crime than an apparent common sense dictates….However speculative and uncontrolled some psychoanalytic views on crime may be they do at least promise to uncover the fundamental flight from reality that leads to pathological and possibly all forms of criminal conduct” (Glover, 1960, p. xiii). This under-standing of the disavowal of reality as being at the heart of much perverse, violent and delinquent behaviour sustains much contemporary clinical practice in the Portman Clinic today.
Early vice-presidents of the Institute for the Study and Treatment of Delinquency included Alfred Adler, Havelock Ellis, Sigmund Freud, Ernest Jones, Carl G. Jung, Emmanuel Miller, Otto Rank and H. G. Wells among others. One can see that the founding members of the Institute obtained the support of important intellectual figures of the time. As with many such ventures, funding was a major difficulty and apparently seeking charitable donations for the study and treatment of criminality was not easy, and there were serious struggles in this respect in the early days. It is very likely that support of such figures did help to secure some funding.
Dr Edward Glover was the main promoter of the Institute developing a clinical arm. The idea was that through a clinic the treatment aims of the institution would be complete. Initially, clinicians volunteered to see patients referred to them through the Clinic in their own consulting rooms and at much reduced fees so as to fulfil the charitable purposes of the Association. The Clinic saw its first formal patient on the 18th September 1933, “a woman, 47 years of age, noted as having a violent temper, charged with assault on her woman employer” (Saville & Rumney, 1992). At that time the staff of the Clinic included Dr Bion, Dr Eder, Dr Aubrey Lewis (one of the pioneers of psychiatry in the UK), Miss Barbara Low, Mr Adrian & Mrs Karen Stephen, Dr John Rickman, Mrs Melitta Schmideberg and others, many of them pioneers of psychoanalysis in Britain.
Later on, in the mid-thirties, the arrangement at the Clinic changed. With the help of Emmanuel Miller (the founding father of the first Child Guidance Clinic and an early supporter of the ISTD) the Clinic secured a room at the Western Hospital. The doctors, lay therapists, psychologists and social workers worked without payment. The clinic room was available mornings only. Five shillings had to be paid to the Western Hospital each time it was used. The physical examination was carried out by the hospital and psycho-metric examination by a psychologist on the Clinic staff. Where psychotherapy was necessary, it continued to take place in the therapist’s own rooms.
The Portman Clinic at 8 Portman Street
The Institute for the Study and Treatment of Delinquency and the Clinic found their first own home at number 8 Portman Street, London W1 in May 1937, and the Clinic centralized its services there starting in February of the following year. The present Portman Clinic carries its name after the street where it was first located, and replaced the earlier, rather contentious, name of “Psychopathic Clinic”.
During the Second World War the staff of the Clinic was reduced considerably due to many joining the military. Despite the war clinical work continued, in a limited way: only assessments and short-term treatments were undertaken. Most of this was under-taken by a small group of psychiatric social workers that staffed the clinic during this time.
After the war the Clinic moved again, this time to Bourdon Street in Mayfair, and it seems that at the time the Clinic was located between a residence for nuns on one side and a brothel on the other! It was just before and after the war that many well-known psychiatrists and psychoanalysts, such as Dr John Bowlby, Dr Wilfred Bion, Dr William Gillespie and others, joined the staff of the Portman where they spent a part of their early psychiatric career.
With the coming into being of the National Health Service Act of1948 the Clinic was formally separated from the ISTD and became part of the NHS. It was at this time that the Portman Clinic formally took its name, although it was still housed with its parent organization. After the Clinic joined the NHS a number of very creative developments occurred. Many of the staff who have contributed significantly to the literature of the psychoanalytic understanding of sexual perversions and delinquency gradually joined the Portman. Major works of Dr Glover and later Dr Glasser, Dr Limentani, Dr Weldon and others emanated from their work at the Portman. Classical papers of Edward Glover, contained in his book The Roots of Crime (1960), and also The Early Development of Mind (1956) were influenced directly by his work at the Portman. In the same vein, Mervin Glasser’s seminal papers: “From the Analysis of a Transvestite” (Glasser 1979b), “Some Aspects of the Role of Aggression in the Perversions” (Glasser, 1979a) as well as “On Violence: A Preliminary Communication” (Glasser, 1998), were all based on his clinical work at the Portman Clinic. Adam Limentani’s contributions included: “Clinical Types of Homosexuality” (Limentani, 1989c), and “A Re-evaluation of Acting Out in Relation to Working Through” (Limentani, 1966). Estela Welldon’s work on female perversion Mother, Madonna, Whore (Welldon, 1988) was also based on her clinical work at the Portman Clinic.
In 1961 the Portman Clinic organized a conference as a contribution to the celebration of the World Mental Health Year. This successful two-day conference resulted in the publication of the first edition of the well-known volume on the pathology and treatment of sexual deviation, Sexual Deviation, edited by Ismond Rosen (Rosen, 1964).This volume has seen two subsequent editions. The second edition (1979), probably the most widely quoted, includes a greater number of major contributions by the then staff of the Portman Clinic.
The Portman Clinic, 8 Fitzjohn’s Avenue
In 1970 the Portman Clinic moved to its present location in Fitzjohn’s Avenue, London, a house adjacent to the Tavistock Centre. Together with the Tavistock Clinic it was at the time under the management of the Hampstead Health Authority. The Portman was a vibrant institution staffed, as always, along multi-disciplinary lines, having Clinical Psychologists and Psychiatric Social Workers, as well as Consultant Psychotherapists and a Consultant Physician. Most had trained as either psychotherapists or psychoanalysts. During the eighties a serious review of the role of psychotherapy was undertaken by the NHS and the special and dedicated work of those at the Portman Clinic and the Tavistock Clinic was organized under a special sub-committee of the Hampstead Health Authority. It was partly due to the standard of clinical work of both the Tavistock and Portman Clinics that the Seymour Report found that psychotherapy did have a continuing role to play in the NHS despite opposition (Seymour Report, 1985). Because of their standing as providing psychoanalytic psychotherapy services and training in the NHS, the Tavistock and Portman Clinics joined forces, and, as part of changes in the structure of the Health Services, the two jointly became an NHS Trust in 1994, and a Foundation Trust in 2006, whilst maintaining their separate identities.
During the late eighties, but principally during the beginning of the nineties a major change took place at the Portman Clinic. So far the staff had comprised doctors, psychologists and social workers, not all trained as psychoanalysts or psychoanalytic psychotherapists. In the late eighties the Portman Clinic was one of the first mental health institutions in the UK that created posts for non-medical adult psychotherapists and later on, in the early nineties and in recognition of the clinical work that non-medical staff did, all non-medical staff took the title of Adult Psychotherapists. Since then the clinical staff consists of Consultant Psychotherapists, Adult Psycho-therapists and Child and Adolescent Psychotherapists and all are now trained as psychoanalytic psychotherapists or psychoanalysts.
The founding of the International Association for Forensic Psychotherapy was another of the major developments that the Portman Clinic was involved in during the nineties. This international organization was formed in recognition of the need for a dedicated forum for those psychotherapists that work with individuals suffering from criminality, sexual perversions and violence. Its origins lay in the European symposia where colleagues mainly from Holland, Belgium, Austria and Germany would meet with Portman staff to exchange views on the treatment of patients who had been involved with the criminal justice system because of their psychopathology. These symposia took place bi-annually, mainly under the leadership of Mervin Glasser, then Chairman of the Portman. Developing on these clinical exchanges Estela Welldon, a Consultant Psychiatrist, Psychotherapist and Group Analyst, who by then was already recognized internationally as an authority in the understanding of perversions in females, became the driving force behind the creation of the International Association of Forensic Psychotherapy. Since its founding, the IAFP has had ten international conferences in different parts of the world. Portman Clinic staff continue to play an important role in this association, contributing regularly to their international conferences.
It is perhaps because of the efforts of Estela Welldon and other members of staff of the Portman Clinic that the somewhat controversial title of Forensic Psychotherapist has come to exist.
Among many short conferences and courses initiated at the Portman Clinic for a variety of professionals in the mental health field, as well as the justice system, Mervin Glasser initiated a course on the Psychodynamic Understanding of Perversion and Delinquency. Estela Welldon then expanded this course into a two year, one day a week day release course for professionals working in the forensic field leading to a Diploma in Forensic Psychotherapeutic Studies. In addition, the Portman Clinic has been very involved, since very early in its history as a NHS institution, in the training of junior doctors who wanted to train as consultant psychotherapists. At present the Portman is involved in an imaginative arrangement with the educational authorities of the Royal College of Psychiatrists whereby junior doctors can do the double training as Forensic Psychiatrists and Psychotherapists, the forensic psychotherapy aspect of it being done at the Portman.
Finally, since being founded, the Portman Clinic has seen over twenty thousand patients and the substantial scientific contribution of the Clinic has been based on this clinical experience. A number of books and numerous papers and book chapters have emerged from the Clinic. We have referred to some above and many others will be referred to in the following chapters and in the bibliography. There is a further body of work to be edited as well as newly written, and published. This volume is the first of a series which will build on the work of our predecessors and further contribute to the psycho-analytic understanding of violence, perversion or delinquency.
David Morgan, and Stanley Ruszczynski. Lectures on Violence, Perversion and Delinquency. Routledge, 2007.
Dicks, H. V. (1970). Fifty Years of the Tavistock Clinic. London: Routledge and Kegan Paul.
Glover, E. (1956). The Early Development of Mind. London: Imago Publishing.Glover, E. (1960). The Roots of Crime. London: Imago Publishing.
Glasser, M. (1979a). Some Aspects of the Role of Aggression in the Perversions. In I. Rosen (Ed.), Sexual Deviation (2nd Edn.). Oxford, New York,Toronto: Oxford University Press.
Glasser, M. (1979b). From the Analysis of a Transvestite. International Review of Psycho-Analysis, 6: 163
Glasser, M. (1998). On Violence: A Preliminary Communication. International Journal of Psychoanalysis, 79: 887–902.
Limentani, A. (1966). A Re-evaluation of Acting Out in Relation to Working Through. International Journal of Psychoanalysis, 47.
Limentani, A. (1989). Clinical Types of Homosexuality. In Between Freud and Klein: The Psychoanalytic Quest for Knowledge, Ch. 7, pp. 102–113.London: Free Association Books. [Reprinted London: Karnac Books, 1999.]
Pailthorpe, G. (1932). Studies in the Psychology of Delinquency (Medical Research Council Special Report Series). London: Medical Research Council.
Rosen, I. (Ed.) (1964), Sexual Deviation. Oxford: Oxford University Press.
Saville, E., & Rumney, D. (1992). “Let Justice be Done!”: A History of the ISTD. London: Institute for the Study and Treatment of Delinquency.
Welldon, E. (1988). Mother, Madonna, Whore: The Idealisation and Denigration of Motherhood. London: Free Association Books/ The Guildford Press.