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Kindle Notes & Highlights
by
Gwen Adshead
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July 23 - August 1, 2021
“We ever but slenderly know ourselves.”
“Psychiatrists are doctors who look after the only part of the body that votes.”)
hating someone else is like taking poison and waiting for them to die.
The law-and-order policies introduced in recent years have contributed to sharp increases in the overall prison population, doubling in the UK since I started training as a doctor, while in the US it has more than tripled. Although crime rates in general have fallen in that period, the steep rise in imprisonment rates over time (which is higher in England and Wales than anywhere in Western Europe) means that the relative number of people with mental health issues who are incarcerated has also risen.3
It was a little disconcerting to read about the medical professionals within their number, who had easy access and the means to carry out their crimes, often going unchecked and unsuspected for years. A cooling-off period or gap between killings is also an accepted criterion, and their victims are not thought to be randomly chosen. Spree killers, who may take the lives of a great many people in one day, tend not to be included in this category, and for some reason I’ve never fully understood, neither do the politicians and leaders responsible for the deaths of thousands or even millions of
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Law enforcement sources don’t publish country-by-country comparative lists of serial killers, but drawing from the same Radford study, the US is at the head of the pack by a considerable margin, claiming nearly 70 percent of all known serial killers in the world, and this is borne out by other sources I’ve looked at, from Wikipedia to various journalistic pieces.
I don’t know why the US dominates in this way, but theories abound, from ideas about the lack of gun regulation there to their decentralized law enforcement to the dangers of American ultra-individualism.
received
perceived ?
The concept of psychopathy is a complex one and first emerged in psychiatric discourse in the 1930s, really taking hold after the Great Depression and the Second World War. There was a rising social concern about isolated men, many of them emotional casualties of economic ruin and war who seemed disconnected from social norms, with callous states of mind that caused them to treat others as “things,” instead of as fellow humans.
Cleckley studied a group of people who appeared “normal” and might even have had a certain charm, but who showed no concern about other people’s feelings. Many of the subjects had been referred by their parents or partners, who complained about their repeated lies, manipulative nature, and emotional shallowness and insincerity, as well as their apparent disregard for social mores or rules.
“If we do not transform our pain, we will most assuredly transmit it.”2
The grim concept of triage is a familiar one in medicine: if supplies are short, you treat the people who have the most chance of getting better.
Today’s statistics indicate that seven out of ten people in the UK are likely to experience PTSD in their lives, but thankfully most will make a full recovery within several months.
I saw that he had been given leave to remain in the UK, probably because he was just seventeen at the time. Sadly, if the same young boy from a war-torn country tried to claim asylum here today, I imagine he would be refused; our current government’s “hostile environment” policy is pretty pitiless.
Here was a manifest reminder that fear and trauma have to be transformed, or they will stay in the mind like an unsheathed knife, a real and deadly blade moving in unreal time, transmitting pain to others.
What if she might actually be “bad, not mad”? Borrowed from a description of Lord Byron (“mad, bad and dangerous to know”), this is somewhat clichéd shorthand for a major academic debate in my field. It is the kind of dualistic thinking we find in relation to other complex philosophical questions: for example, the well-worn nature or nurture question in mental health or discussions about sex and gender. I think such binary arguments dodge complexity and seem to be an attempt to prevent our thinking about what it takes to live together in a group, in terms of our culture, our habitat, our
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Unfortunately, racial discrimination was probably also a factor; historically, much less therapy has been offered by mental health services in the UK to people of color than to their white counterparts.
The U.S. is terrible about this too. Having a racist, fascist so-called POTUS for a hideous four years encouraged all the rednecks to crawl out of the holes they’d been hiding in until he made them think they were acceptable.
“A Freudian slip is when you say one thing and mean your mother.”
After all, he was just a short way into a life sentence, and coming to terms with that is akin to getting a terminal cancer diagnosis.
As a person who has lost several family members to cancer, I am upset a terminal cancer diagnosis is being compared here to a life sentence in prison. One is death. The other still has life. I find this to be a very insensitive analogy.
The concept of narcissism in psychiatry is a complex one, referring not to an illness as such, but to a kind of personality style in which people present as entitled, exploitative, and grandiose.
I would learn many times over as my career went on that it is always a greater act of compassion to empathize with someone you don’t like.
“Anyone who ends someone else’s life also changes their own life forever,” I said.
I had a brief thought that in some cultures, showing someone the soles of your feet is considered highly offensive.
I find feet offensive in general. Always have. Don’t know why.
It is ironic that the only way to maintain a mental health service (both in the community and in prisons) that did not have to bear this risk would be if we stopped offering help to depressed and at-risk people. Some NHS trusts have decided to do just that, to avoid dealing with the difficult legal and social outcomes of having a suicide on their books. This means that when someone is most in need of treatment or a listening ear, they may not be able to access it. The result is achingly predictable.
called
named
Abandon all hope, ye who enter here”
This should be the first thing children are taught. Earth is hellish. Many people are greedy, uneducated, prejudiced, and often hateful.
People who are severely depressed and at high risk of suicide are more likely to describe themselves as feeling numb and emotionally disconnected, as opposed to having feelings of sadness.
I was reminded of Keats’s line “I have been half in love with easeful Death,”
“The greatest misery in adverse fortune is once to have been happy.”
it’s easy for the mind to judge only on superficials, and harder to go into deeper layers of meaning.
son,’
son,
We also know that violent victimization, in all its forms, has increased lately, for the first time in half a century. Intriguing research by American colleagues, including Professor Jim Gilligan and others,1 finds a correlation, particularly among men, between shame and higher rates of violence in times of increased social instability and wealth inequality.
Different countries and societies mount different social and legal responses to the demon “pedo.” In the UK, as in much of the US, it is a requirement for communities to be informed when a convicted CSO moves into the area; this has given rise to some press and community reactions that look a lot like vigilantism. In some jurisdictions, people are kept on registers (signing up with local authorities, restricted from working with young people, etc.) long after they have served their prison sentence and done their probation.
I believe anytime-active pedophiles shouldn’t be allowed near children unless they’re chemically castrated. Or actually castrated. The offending pedophile cannot change its nature, so the prohibition with being near children must and should be for life. I have empathy for children victims. While the pedophile can’t help being what it is, I can find no empathy for it in me, unless it’s taking the medication to stop the behavior.
In this group we saw a recurring script emerge, a “neutralization discourse,” as it is called by criminologists. This entails using language that reduces agency, as all of us do when we feel defensive, from an early age—phrases like “It wasn’t my fault” or “They started it” are familiar examples. The careful constructs I heard in the group also framed the abuse as somehow consensual, with lines like “She flirted with me,” or “She never said no,” or even “I loved her… This was how we showed our love for each other.” There were also overlapping descriptions of how the CSO leveraged affectional
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I reflected on how complicated forgiveness is and how little space there is for it in our justice system,
I can see this author is a wonderful advocate for her patients, but as someone who was sexually abused by a beloved relative for several years, beginning when I was four, I don’t have any idea how she could possibly think offenders would ever be forgiven by their victims. When a person in a position of trust destroys a child’s innocence and changes everything about the way the child perceives the world—no matter how much therapy the child gets—forgiveness is a remarkably unaware thing to expect.
“I’ll be dead soon, don’t worry,” he had told the police a decade earlier, on the night of his arrest. He made good on that promise six months after our last session.
Good.
Long ago, I read a book about the effects of incest and child abuse, memorably entitled Soul Murder.12 I have since heard many survivors of sexual abuse talking about that feeling, the notion that some part of them has died.
Very good description.
love means “to be known,”
Like many women, I found that maternal instincts did not switch on like a light, and I did not always find being a mother comfortable.
Does this really happen? First look—biggest love of my life, for me.
This also reminds me of a comment about psychopaths I heard many years ago: that they “know the words but not the music” of emotional encounters.
As a colleague of mine observed, insanity is building your own castle in the air and living in it; we’re offering to take down the drawbridge.
Britain and most social democracies adopted the idea of social integration of mentally ill and learning-disabled people, transitioning to a system of “care in the community.” This meant that the burden of care fell on the family, since community services were (and remain) drastically underfunded. This is yet another manifestation of the disproportionate and misguided emphasis our society places on physical health over mental health, and possibly the gravest example.
I always stand in awe when someone takes ownership of a life-and-death story and there arises a shared sense of hope that radiates outward, allowing meaning and purpose to come from catastrophe.
But the victim is still dead. What “meaning and purpose” are you finding here? And hope for what, exactly?
It can be discomfiting to be made to think about how little time lies ahead of us compared with what is behind.
“I was adored once too.”
There are few countries in the world where mental health spending is sufficient to meet the needs of the population, because governments are unwilling to prioritize it. I wish for my psychiatric great-grandchildren to look back on this period as if revisiting medieval times, shaking their heads at how our society and medical establishment put so much thought and money into advancements in cardiac care or laser surgery or the wholesale replacement of vital organs, and yet did little to help people heal or rediscover their minds, inside and outside of institutions.
