Pioneering British psychiatrist and psychotherapist Dr Gwen Adshead has spent more than spent 30 years working inside prisons and with offenders at Broadmoor Hospital - where some of the UK's most notorious criminals are detained.
The case studies in her book, The Devil You Know, are drawn from many individual cases, including serial killers and stalkers.
Dr Adshead tells Kathryn Ryan that she has come to think of her patients as survivors of a disaster.
Dr Adshead trained as a doctor in London and was drawn to forensic psychiatry due to her interest in moral philosophy and ethics in medicine.
“It often involves going to courts and giving evidence but it also involves looking after people whose mental disorders – and it’s a rare group of people – have led them to be violent toward others.
“It’s really that combination of interest in psychiatry, in moral philosophy, and in the law that got me interested in becoming a psychotherapist.”
Early in her career at Broadmoor, Dr Adshead had an encounter with one of the most notorious criminals in contemporary British history.
“I think I was still a trainee and I was walking around the hospital and walked into one of the buildings and stopped to let a group of patients go past – mainly men in their 60s, including a biggish guy with a beard who looked just like Father Christmas. The nurse who was with me said, ‘do you know who that was’? I said, ‘no I don’t’. She said, ‘that was Peter Sutcliffe.’”
Sutcliffe, dubbed the Yorkshire Ripper, was found guilty of murdering 13 women and attempting to murder seven others.
“I thought the most interesting thing about that was that there was really nothing to see. We tell these stories of these men and, very rarely, woman, but often there was actually nothing to see.
“Most of the time it’s really not a scary place, it’s a sad place. It’s a place for people whose mental illness has really been devastating and has caused them to devastate not only their own lives but the lives of others.”
Dr Adshead says there’s often a big gap between public and media perception of these violent criminals and their actual state as they face up to the consequences of what they’ve done.
“Really why Eileen [Horne] and I wrote this book was to try and help people see what happens after that, what happens after the trial, what happens after people are sent to prison or sent to a psychiatric hospital. I wanted to bring people along with me, to see the world that I see and see the men and women that I meet and see that they’re not monsters but they are people who’ve done terrible things and have then to spend the rest of their lives really coming to terms with that.”
She says that for many violent criminals, but not all, the roots of their violence lie in their experience of trauma and violence when they were children.
“That’s been an important lesson for me to learn.”
One criminal Dr Adshead talked to told her that one can become an ex-bus driver but one cannot become an ex-murderer.
“One of the terrible things about killing somebody is that you destroy your own life as surely as you destroy theirs and you can never go back to the kind of life you had before. For some people that will be a very long time in prison or, for people who’ve killed when they’re mentally unwell, in psychiatric hospital.
“Often people will come to the end of their time and prepare to go and live in the community in a highly supervised and supporting environment. A lot of the psychological work we do is to try and help them think about what kind of life their going to have in the community given what they’ve done and it’s hard, it’s really hard.”
Another misconception that comes from popular media is that serial killers and violent offenders would try to trick or con the people who treat them.
“In my experience, it’s rare because 98 percent of the people I see want to see me and they want to talk, so they’re not interested in messing me about or conning me. If they do that, they’re denigrating themselves as much as they’re denigrating me – I get to walk away, it’s my job.”