Last year Kim O'Donovan died at age 15 in tragic circumstances, reportedly from a drug overdose. At the time, The Irish Times carried reports from her friends and a poignant statement on behalf of her adoptive parents setting the record straight about Kim. They described in ordinary terms how they were in mourning, how she was much loved by her adoptive family and all who knew her and how no one individual had failed her.
Kim herself was a loving, talented girl who - to the grief of those who knew her - was disturbed for all of her short life. An Irish Times editorial (August 26th, 2000) rightly questioned the role of the services which have responsibility for the welfare of troubled children such as Kim. That was the case of Kim, but there have been others, several highlighted by Mr Justice Peter Kelly.
The circumstances of these cases are tragic, but they represent the tip of the iceberg. Challenging another social agency, namely, our criminal justice system, there is, in parallel fashion, the phenomenon of increasing numbers of young out-of-control offenders. Representatives of those who are the frontline providers of services for disturbed adolescents, such as social workers and residential care workers, attempt to explain the practical nature of the crisis. It is not simply a question of financial under-resourcing.
There is a deeper malaise which the overall crisis reflects. There is a pervading sense of hopelessness, an attitude that tacitly concludes there is little that can meaningfully be put in place to radically change the life of a disturbed child. However, there is a professional category that does not have a voice in the current structures. That is psychoanalysis.
If the role of psychoanalysis were understood, it could make a significant contribution in what is at present a bleak landscape. What informs the practice of psychoanalysis has to be taken on board, not only by fellow-providers of therapeutic services, but by concerned administrators and policymakers alike.
For disturbed adolescents in residential care who cut themselves, experiment with drugs or simply abscond from care, their behaviour is the acting out of a drama, the meaning of which, to the adolescent, is hidden because it is unconsciously driven. It is just that - acting out, with no real question of moral choice.
How especially true this is when someone dies at a young age in consequence of an impulsive act. Most of the time the majority of us may not even need to question our behaviour, we just get on with things, live our lives for better or for worse, and hopefully no major tragedy befalls us or those we love.
We can play the hand of cards that life has dealt us. If, however, life deals us a devastating hand, does that hand automatically knock us out of the game at an early stage of life?
This is the sort of question - not fully articulated - that is at the root of the hopelessness that pervades the current crisis in the provision of proper therapeutic services to the most vulnerable in our society, those whom fate has dealt a poor hand. It is presumed that most of these children don't stand a chance. But they need to be given a chance.
The dilemma for all engaged in the welfare of troubled young people is how much openness there is in discerning what any young person's disturbed behaviour represents and how early in that young person's life it can be addressed.
It is obvious that the earlier in a young person's life that a trusting psychoanalytic presence can be put in place the better. It is not unthinkable that psychoanalysis should begin for a child who presents with disturbed behaviour at the age of four or younger.
By and large, the misconception about what psychoanalysts within our healthcare system, prisons and drug treatment centres do is staggering. Recently a colleague reported having to fight hard to continue analytic work with a deeply traumatised young girl. In care, or with foster parents for most of her life, this girl is extremely bright, but is entering puberty and exhibiting so-called inappropriate sexualised behaviour.
Now, when analytic work most needs to be maintained with her, social services might not facilitate this because of changing sectoral responsibilities for children at different ages.
However, there are some encouraging signs. Quite a few motivated young people are seeking to train professionally, primarily as lay analysts, with the specific wish to work in local community-based services.
Senior clinicians who supervise them on placement frequently report on how disaffected young people can more easily take to young analysts in training, not only because of their status of separateness from other professionals, but because they are young.
However, to date there has been no attempt to develop a job description for a lay analyst in the public service, and most often those who work analytically in institutional settings do so without remuneration.
IT IS therefore not a naive proposition to suggest that psychoanalysis be introduced into our institutions on a more formal basis. But it is a challenging one. Psychoanalysis attempts to intervene at the level of the unconscious discourse of the individual.
To avoid any misunderstanding about the magnitude of this intervention, it can be illustrated as follows: if a boy who has been brutalised by his father is now, himself, brutalising someone else, psychoanalysis holds that, through this repetition, he is exhibiting a deferred unconscious effect of trauma. Psychoanalysis intervenes at this level.
By comparison, other non-analytic therapies might encourage the boy to develop insight into the significance and context of his own behaviour and the behaviour of his father before him. Having insight in itself can undoubtedly be very therapeutic.
However, if one were to employ a scale of effectiveness, insight-based therapies can be likened to the direction of a historical play, whereas psychoanalysis is the direction of history itself, the individual's own unique history.
Critically, an informed silent inaction is required on the part of the psychoanalyst where this specialised listening provides a deliberate counterpoint to the individual's speech. This speech, which involves a very particular act of recollecting, has the individual's truth rather than an imposed reality as its pole star.
On the part of the psychoanalyst, the process cannot involve short-term measures. This can mean that if someone were to leave analysis prematurely, and then return to it, the psychoanalyst continues to hold out the prospect of a listening presence to be resumed, even in the face of absence.
And what is the potential outcome of this process? If we return to the example of the brutalised boy, the psychoanalytic process holds out the promise that his act of speech, in the course of analysis, will take the place of the symbolic necessity of acting out.
Is this an unthinkable scenario in the context of our national statutory and voluntary social agencies?
Perhaps as a society we are coming of age. Maybe the public embarrassment we feel at the spectacle of a purpose-built unit for troubled adolescents which is without adequate staff, or the sending of such youngsters to treatment centres abroad, might serve to return us to the utterly human dimensions of speech and listening that psychoanalysis advocates.
Patricia McCarthy is a psychoanalyst and senior lecturer in the Unit of Psychoanalysis at the DBS School of Arts in Dublin