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Abruzzi, W. (1975). Severe Personality Disorders in an Institutional Setting. Am. J. Psychoanal., 35(3):269-277.

(1975). American Journal of Psychoanalysis, 35(3):269-277

Severe Personality Disorders in an Institutional Setting

William Abruzzi, M.D.

One of the major mental health problems of our culture is the treatment of so-called character disorders, or severe personality disorders. The typical adolescent delinquent—unable to control his own behavior and verbal reactions, unable to conform to any kind of societal expectation pattern, and either unable to gain the insights necessary to accept responsibility for his own behavior or unable to utilize those insights constructively once they have been gained-is familiar to anyone who has worked in the mental health field in the last decade or two. Most of these patients fit into one or another personality-disorder category (e.g., inadequate, passive-aggressive, schizoid, passive-dependent, etc.).

I should like to report on the thousands of such young people I have observed over many years, the theoretical and programmatic impression received from these observations, and the conclusions I reached as to how such young people are best handled (for their own psychic well-being, as well as for the well-being of the institution, program, family, or therapist involved with them). I should also like to report on an attempt that has been made to put those tenets into operation in a residential setting. The goal of this paper is to encourage others to try this approach with sociopathic, delinquent, personality-disordered, or “borderline” children and young adults (I use these labels only to identify such patients to all of us who use descriptive titles in our work).

My original impressions were derived from dealing with adolescents and young adults for many years. This involvement included working in a college health center, running a college health-education program, speaking on hundreds of college campuses, and acting as a public-school physician for many years. I have also been involved in setting up and directing health facilities at youth festivals whose participants totaled more than a million; in initiating, consulting in, and continuing sixty-five crisis-intervention centers; and in treating many young people in my capacity as consultant to “sit-ins,” civil-rights marches and demonstrations, and the peace moratoria. My initiation and direction of drug-education programs for national, state, city, and community groups and my participation for twenty-two years in ambulatory detoxification of drug abusers provided more data.

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