On the face of it, there might seem every reason to resist this book. Gwen Adshead, a forensic psychiatrist and psychotherapist who has worked at Broadmoor, the secure psychiatric hospital where some of the UK’s most notorious criminals are detained, knows this. In her opening pages, she describes chatting on airplanes with strangers and feeling tempted not to reveal what she does for a living to forestall reactions such as: “What a waste to bother with such monsters.”
She has even toyed with lying for a quiet life and saying she is a florist. But I’d advise anyone with their own version — compelled and repelled — of being the stranger in the adjoining seat to keep an open mind: Adshead’s warm intelligence, curiosity and nuanced understanding of her work inspire trust in what turns out to be an unmissable book.
Once a criminal has been sentenced and drops out of the news, that is — for us — the end of their story. But for Adshead, it is the beginning. The first question she asks patients is: where does your story start? It is the question of someone who values narrative above psychiatric diagnosis. It is her unsensational enterprise to show that people who do monstrous things are not necessarily monsters. She knows it is more comfortable to dismiss a murderer, arsonist or pedophile as an aberration than to acknowledge any damaged humanity.
“Over the years, I’ve come to think of my patients as survivors of a disaster, where they are the disaster and my colleagues and I are the first responders,” she says.
With the skilful help of dramatist Eileen Horne, case histories are reconstituted to disguise identity but the details that count are real.
“Tony” is a serial killer whose co-workers in a gay bar were stunned by his arrest as he was “popular and diligent.” His story illustrates an unfathomable Jekyll and Hyde existence that Adshead endeavours to understand, uncovering a childhood of violent abuse.
“Gabriel,” an asylum seeker from Eritrea, is sentenced for an “unprovoked stabbing.” He has been described by onlookers as a “deranged immigrant.” He suffers from PTSD. It takes time and patience to get to grips with his devastating story.
“Lydia” is an oddity: a middle-class stalker, romantically obsessed by a man who was once her therapist. When he refuses to collude in her fantasy, she persecutes him, attempting to poison his dog by slinging rotten meat into his garden. In therapy, Lydia presents as too well-behaved to be true but Adshead has, fortunately, learned to listen to her intuition as well as her intellect.
The chapter describing “Ian’s” case history is particularly harrowing and illuminating. Ian abused his two sons. Adshead shows how the “grotesques of tabloid fantasy” are not necessarily psychopathic — sometimes they are empathic. It is a difficult truth to digest. She unpicks the nature of warped desire, of forbidden fruit. Ian appears to be at once ordinary and extinguished — a high suicide risk. Remembering the moment of his arrest, he tells her he knew “it was over.” She asks quietly: “What was over?” He replies: “Life.”
The concluding case history focuses on one of Adshead’s own profession, a doctor with an unsavory manner to whom she offers therapy outside the prison context. After it eventually emerges that he is addicted to violent child pornography, she is obliged to report him to the General Medical Council.
One of the most difficult aspects of her job, she observes, is to find the compassion to empathize with people she does not like. Yet it is precisely her gift for empathy that offsets the desolation of much of what she describes. Morally robust, she knows what reforms are needed. She argues for more specialized therapy for complex conditions and reminds us of the disproportionate emphasis society gives to physical over mental health. She stresses the irony that sick people are often given therapy only after a crisis has occurred — the importance of early intervention needs no laboring.
Sometimes, as one reads, the struggle to understand feels at odds with a reflex moral outrage. You might want to retort: “This story doesn’t excuse it!” (Whatever “it” might be.) But The Devil You Know is not a book of excuses. It persuades us that it is only through understanding why horrific crimes happen that mental health services and the judicial system can have any chance of being improved. This revelatory book encourages us to see that it is our responsibility to consider the worst of humanity – and of ourselves. And while we are at it, it urges us to hang on to Adshead’s most powerful imperative: “the duty of hope.”
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