High security psychiatric hospital Broadmoor Hostpital in Berkshire where Gwen Adshead worked as a forensic psychiatrist. Photo / Getty Images
High security psychiatric hospital Broadmoor Hostpital in Berkshire where Gwen Adshead worked as a forensic psychiatrist. Photo / Getty Images
Gwen Adshead has spent her career trying to understand what drives her patients to commit their heinous crimes. She reveals what she has learnt.
"One of the many problems with killing somebody is what to do with the body," the forensic psychiatrist Gwen Adshead tells me. We are discussing Tony,one of the many violent offenders she has treated over the past three decades while working in Britain's prisons and secure hospitals.
In her role as consultant at Broadmoor, the psychiatric hospital in Berkshire, she came face to face with some of Britain's most notorious patients. There is little about Adshead — calm, blonde, composed — to suggest a life spent not just talking to sex offenders and murderers but opening up the box of horror and trying to make sense of what she finds inside.
She has now written a book about her work. It is an extraordinary tour through the psyches of the criminally disturbed, every bit as discomfiting as it is fascinating. Tony was a serial killer she treated at Broadmoor who was serving a sentence for the murder of three people, one of whom he had decapitated. "There had been much lurid public speculation about the 'profile' of the monstrous mind that had done such a thing," she writes, but Adshead was about to discover his reasoning was actually quite prosaic. The head had been so heavy it was "like a bowling ball", he said, and he had to cut it off in order to get it out of the house.
As he explains this, she is conscious of the need to remain expressionless. "Freud likened the work of therapy to surgery, and we wouldn't think much of a surgeon who opened up someone's abdomen and ran from the room, crying, 'There's cancer everywhere in there!' " So she sat listening politely. "To anyone passing by … we might have been chatting about the weather."
Our interest in good and evil is an inherent part of being human, Adshead says. "Humans have the capacity for great goodness, but we may also find ourselves doing something horrible — what takes us there is what drives the interest; deep down we wonder, could it be me?"
Born in Christchurch, New Zealand, Adshead, 60, trained in the UK as a doctor, then as a psychiatrist, and completed a master's in medical law and ethics at King's College London. She was always interested in ethical questions such as "What is the proper response to someone who has killed?" Forensic psychiatry — working with people who have broken the law — "just seemed to fit", she says. She later trained as a psychotherapist and was employed at Broadmoor from 1998. Her job was to try to help patients accept responsibility for what they had done. As one patient put it, "You can be an ex-bus driver, but you can't be an ex-murderer." She now does the same work at Ravenswood House, a medium secure unit.
It hasn't always been enviable work. She recalls hiding in a cupboard while a patient "growled with fury" and gouged chunks out of a colleague's door but, she adds, she usually isn't at risk. Cold-blooded killing is normally the preserve of organised crime. The people she has worked with tend to be highly disturbed individuals, whose violent episodes — the result of extreme mental disorder — can come and go. "People kill their wives and bury them under the patio and still go to Sainsbury's to buy a pint of milk," Adshead says.
High security: Broadmoor psychiatric hospital, where Adshead has worked as a consultant. Photo / Getty Images
She describes her patients as survivors of a disaster, where they are the disaster and she and her colleagues the first responders. She has to help them come to terms with their actions. It is the humanity in the stories that makes her book, written in collaboration with the dramatist Eileen Horne, so extraordinary. Marcus, who has killed one of his lovers, was adopted by parents who were violent and neglectful. "All I ever wanted was to be beautiful," he weeps as he recalls how he felt ridiculed when his victim showed him her profile on a dating app. She tells of an encounter with Ian, a middle-aged man who sexually abused his two sons. He is weighing up whether to agree to meet one of them 15 years on. "He talked about wanting his son's forgiveness but even then he knew it would not be enough. How could he ever forgive himself?" Six months later Ian took his own life.
Working with people like this requires "radical empathy", Adshead says, a kind of detachment that allows you to see the offender's point of view without losing sight of the crime and its impact on the victims. Without it "you can get swept away into a black-and-white world where victims are in one camp and perpetrators in another, and they can never have anything in common, which is just not true".
Does anything horrify her any more? "Yes, it does," she says. "If it didn't, it'd be time to stop." She finds convicted rapists particularly difficult to work with, "because rape is a very disturbing offence, it is very rare for it to be associated with mental illness. It is an offence that is about terror and humiliation."
There are those who would argue that the people Adshead works with do not deserve therapy or understanding. That instinct for revenge is one she understands. "In a busy, confusing, scary world it makes us all feel safer to think the good guys are over here and the bad guys are over there," she says. But "people who do horrible things are not monsters, they are people for whom all the bicycle-lock numbers came together into a catastrophe, and they are standing there and somebody is dead and they are thinking, how the hell did this happen?"
It is only by attempting to understand the factors that cause violence that we can prevent them from happening again.
The vast majority of violent offenders are men but Adshead points out that most men are not offenders (her book is dedicated to her two sons). There are, however, known risk factors — substance abuse is one of the key ones, as is childhood adversity. Adshead says she has seen the same themes come up again and again: "Terrible violence often seems to be related to memories of trauma; unresolved stress, unresolved hatred, unresolved terror. If we understood that better, perhaps we could intervene much earlier."
There is also a practical reason to try to make sense of these crimes. In the UK we imprison more people than anywhere else in western Europe, and more than a third of our prisoners report having mental health or wellbeing issues, ranging from depression to psychosis — though the actual proportion is estimated to be far higher. Most will not get any kind of treatment or support before they are released again. Adshead says we need to reconsider our approach: "You are going to have to let people out eventually, so we had better get good at trying to help them not to offend."
Rehabilitation is almost always possible to some extent, though it depends on whether the ultimate goal is release into the community or some kind of secure halfway house. In rare cases such as Lydia (below), who stalked her therapist, there is a real chance that the person will never be cured — because it is the delusion that is keeping her stable. This is a real problem with treating stalking behaviour. "If they were to give it up they might disintegrate with the stress and become completely overwhelmed," Adshead says.
