The Devil You Know: Encounters in Forensic Psychiatry

by Gwen Adshead

My experience is that there are many perpetrators who are ashamed and traumatised by their offence, and many victims who really struggle to manage their understandable feelings of rage and vengefulness. Both victims and perpetrators need help for their psychological pain; as beautifully articulated by the American philosopher/priest Richard Rohr, ‘If we do not transform our pain, we will most assuredly transmit it.’

The words of a colleague of mine came to mind, a man who speaks of the ‘strange and terrible beauty’ of our work and of the honour it is to bear witness to our patients.

have a therapist colleague who uses a beautiful phrase – ‘judicious self-disclosure’ – as a way to speak about the value of choosing to share our human emotional response with a patient. Such connection is the essence of therapy, but it has to be different from the sharing a professional will do with friends and family because the mutuality is different.

it bolsters the pernicious concept that it is somehow ‘normal’ for men to be destructive and violent, and that victimhood is part of the essential identity of a woman.

Sometimes this will be for life, which is not the case for a range of other serious or even fatal crimes; this is another way society reinforces the notion that child sex offences are the ‘worst’ evil. It has occurred to me that this extreme level of commingled interest and disgust about the sexual abuse of children might have a quality that is hard to articulate. C. S. Lewis spoke of a ‘felt evil’ for things that have an exciting ‘tang’ about them, precisely because they are forbidden.

Instead, it denotes a primary sexual attraction for children, and not all those who have this desire act on it; in fact, many define themselves as actively ‘anti-contact’.

A recent study by a leading American researcher in this field, the sociologist David Finkelhor, showed that in the fourteen- to seventeen-year-old age bracket, ‘most offences are at the hands of other juveniles (76.7 per cent for males and 70.1 per cent for females), primarily acquaintances’, and of that number, girls are four times more likely to be the victim than boys.5 It appears that while media and public interest is intently focused on the idea of the ‘typical’ CSO as a creepy adult stranger targeting a prepubertal victim,6 the most common victim of child sexual assault is a teenage girl, her assailant a teenage boy.

The erotic is easy: it is the use of sex to express intimacy and attachment, and primarily it is playful and profound, messaging, ‘I want you as you, and you and me as we.’ The sensual is shallower and may involve little mutuality or connection, but it can be comforting, if only because touch expresses a message of ‘I’m with you’. Many heterosexual prisoners will talk about this when describing their same-sex relationships in prison. Carnal desire is not playful, and it is uninterested in co-operation or exchange; it is about appetite.

Keeping Ian in prison had done what, exactly? Our society had shown him and the world how much we hate the crime of sexual assault on children. But ten years of imprisonment had cost us the best part of £500,000. Could we have achieved the same result or better by keeping Ian in a community house for offenders, wearing an electronic tag? Resources might have been allocated to giving both him and his whole family, separately or together, a lot of therapeutic time to work through this grievous assault on their security and love. Such therapy would not assume reunification or even forgiveness. However, it would have ensured both father and sons got the help they needed, and the terms of the sentence would still have controlled Ian and conveyed societal condemnation of his actions. I have to think that spending a decade in prison was a contributing factor to his story’s conclusion.

To prevent the cycle of pregnancy and care orders that Sharon had been through, professionals need to reach out to mothers, and not necessarily after they’ve already lost a child. There could be untold benefits to identifying those pregnant women who might struggle with motherhood and providing them with some therapy, along with their birthing classes and folic acid, as early as their first prenatal appointment.

Mental illness is a family affair; can we make risk management more of a co-operative effort between all those affected by it? This case forcefully brought home to me that for all the lip service paid to care in the community for the mentally ill, it still seems to be nobody’s job to look after their carers and family.

Of course, not everyone turns to organised religion as a response to distress and crisis, but even a brief study of the place of religion in world history demonstrates how spiritual transformation often comes about when people feel that their worlds are falling apart.

‘Abdullah told me, “In the eyes of Allah there is no such thing as a bad seed. There’s only bad soil, and faith and love can help us to grow, like water and sunlight.”’

Those who are suspicious of organised religion often point to the way it is used to justify antisocial acts, including violence and cruelty. Some atheists might go further and suggest that faith is prima facie evidence of irrationality, if not madness. But philosophically, faith rests on reason and doubt, not the psychotic certainties attending certain kinds of mental illness. For Jimmy, his introduction to Islam had provided an exit route from the chaos, loneliness and pain of his life up to that point, and it had been good for him, at least initially. He had found a ready-made, protective social group, the first family he had ever known.

Far more than punishment or sanctions, recognising common humanity can change minds for the better. We need improved legislation and allocation of public resources, promoting measures that encourage pro-social attitudes and reduce childhood adversity. Among our interventions should be more and better help for people with addictions and the socially isolated, and assistance for parents with mental health problems; we also need greater investment in specialised psychological therapies for complex conditions.