Dr Gwen Adshead“It’s possible to have a kind of radical empathy for people.”

As heard on The Ryan Tubridy Show

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Dr Gwen Adshead described her work in Broadmoor, the secure psychiatric hospital where some of the UK’s most notorious criminals are detained, as sad, rather than scary. When people ask what she does, they often get outraged that she’s helping people who’ve committed appalling crimes, but Dr Adshead, a forensic psychiatrist and psychotherapist, told Oliver Callan – sitting in for Ryan Tubridy – that the aim of her work was to improve the mental health of inmates and try to prevent them reoffending:  

“What we’re really trying to do is provide therapy to disturbed people to improve their mental health, which we also hope will reduce their risk.” 

The patients in Broadmoor have all committed serious, violent offences. The key difference between them and the offenders who have been sent to prison is that it’s thought that mental health problems have been a contributing factor in the violent behaviour. 

“So the people that we look after are people in general who’ve committed acts like murder, manslaughter – serious violence.” 

Dr Adshead has co-written a book with dramatist Eileen Horne, called The Devil You Know: Stories of Human Cruelty and Compassion, which she hopes will explain the nature and the value of the work she does. It’s the sort of work that she questioned the value of when she started doing it, but she’s convinced of its importance now.  

“As I’ve gone on in my work, I’ve realised that it’s possible to have a kind of radical empathy for people, to feel a kind of compassion for people who’ve done terrible things, while also maintaining a little distance.”  

Oliver posed the question that many people suffer from mental health issues and most of them don’t commit violent crimes, so why do the people who Dr Adshead has treated in Broadmoor become violent? Dr Adshead and Eileen Horne came up with a theory to explain what happens. They call it the Bicycle Lock theory: 

“In order for an act of violence to take place, you probably need a lot of risk factors in place, all at the same time. And things like substance abuse is one thing, having previously committed violence is another risk factor and occasionally, just occasionally, paranoid states of mind can be risk factor.” 

Add alcohol and/or illicit drugs, along with, say, extensive childhood trauma into the mix and some people with mental health problems will have a much greater risk of acting violently. But, Dr Adshead firmly believes, it’s in all our interests to invest in helping the people who commit terrible crimes: 
“We can all benefit from making sure that people who’ve done horrible things get the support and therapy they need.” 

The book consists of mosaic-type stories, based on cases Dr Adshead worked on. So everything in it actually happened and all the details are clinically accurate, but no single crime or offender is recognisable from the text: 

“From an ethical and legal point of view, I couldn’t use people’s actual stories in a book, that would be wrong on many levels. So, what I needed to do was take tiny fragments of people’s stories that were completely unidentifiable and, with Eileen’s help, weave them into a narrative.” 

You can hear Oliver’s full conversation with Dr Gwen Adshead – including Dr Adshead’s dislike of the true crime industry and why child and adolescent mental services are so important – by going here

The Devil You Know: Stories of Human Cruelty and Compassion by Dr Gwen Adshead and Eileen Horne is published by Faber. 

Niall Ó Sioradáin 

© The Listener 2021

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