[The violent patient and institutional counter-violence]

The treatment of violent patients confronts the individual psychiatric professional as well as the psychiatric institution as a whole with a difficult therapeutic task. In order to cope with frightening interactions an "institutionalized system of defense" (Mentzos) is needed to protect the individual staff member. Under unfavourable institutional circumstances the defence manifests itself as counter-aggression. The mutual reinforcement of patient-aggression and institutional counter-aggression is not at all specific for custodial psychiatry. Reformed institutions with a liberal attitude may develop subtle manifestations of counter-aggression to protect the professional identity of their members. The aim to maintain a "good", non-violent psychiatry proves to be an obstacle to any effort to cope with the needs of the violent patient and to reduce institutional counter-aggression to a minimum.