“II’m blind because I see too much, so I study next to a dark lamp. “This exceptionally insightful patient quote appears in the introduction to Dr. Gwen Adshead’s collection of 11 patient stories, and sets the stage for a captivating journey to through the corridors of Broadmoor Hospital and beyond, into the correctional system, the community, and the consulting room.
Drawing on Adshead’s vast experience as a forensic psychotherapist, each chapter focuses on a different person. His crimes can make reading uncomfortable, and for good reason. We meet Tony, a serial killer who beheaded his first victim; Gabriel, who stabbed a complete stranger in a north London cafe; Zahra, who enjoyed setting herself (and other people) on fire, and Ian, who sexually abused her two young sons. If this book were a tabloid article, these facts would serve only as lurid headlines; words destined to lure us, to play on our unending and silent fascination with the murderous and the macabre. Perhaps this fascination is due to a growing desensitization, or perhaps it is a strange sense of collective responsibility for the black fruits of our landscape, and the headlines give us a point of control of responsibility. But beyond the headlines, and within these pages, is the true narrative of the patients and, alongside them, the reassuring presence of Adshead herself. “Some things that I will ask you to see will be hard not to see,” he writes. “But I know from my own experience that acquiring knowledge … is transformative, and I will be by your side.” It is this constant and reassuring voice, a voice that does not hesitate to admit its own mistakes and occasional judgments, that makes the book so valuable and absorbing.
Doubt is perhaps the most essential medical qualification of all, and as a physician, Adshead questions her own bias at various points during the stories, challenging her readers to do the same. The templates we often work with – the obedient obedience of an Asian daughter, the moral standing of a boastful GP who plays golf, the look of a child sex offender – provide a rich and dangerous harvest. Even more worrying, these biases can travel beyond our subconscious and lead to misdiagnoses, judgments, and remedies. Several of Adshead’s stories, for example, illustrate society’s preference to explain female violence as a result of trauma (despite the vast majority of the many female trauma victims never becoming violent) and that assumption could leading to different plans of care or the absence of certain therapies offered … The book also recalls an occasion when a female patient became so enraged at her male therapist that she began to yell and growl, and pull pieces out of her office door with a sharp object. Adshead, witnessing this fury and “with speed fueled by cowardice,” jumped into a hall closet and locked himself inside. Then he wondered if he would have been more likely to intervene if the patient had been a man. Having been through an identical experience with a laundry closet in a high-dependency unit, I now question myself. Perhaps the idea of female violence is so distasteful to us as a society that it is easier to just look away.
In contrast, images of motherhood, from the Virgin Mary to the Hindu goddess Lakshmi, intertwine throughout our consciousness, and also appear throughout the book, as the respective mothers of Adshead’s subjects are lost. for them in different and equally painful circumstances. The order in which these stories are told is far from coincidental, and towards the end of our journey we meet a patient who challenges our definition of what a good mother should or should not be. Perhaps, however, the most moving account of maternal loss is found in Gabriel’s story. Originally from Eritrea, Gabriel came to the UK as a young asylum seeker, fleeing the violence and conflict in his homeland, but was separated from his family in the process. With his narrative, and with other chapters, Adshead wishes to convey that while people of color make up 13% of the general UK population, they make up around 25% of the population within safe prisons and hospitals, a proportion which is reflected in the book itself. . Statistics like these, along with the work of theorists and historians, are dotted throughout the pages. But this is not an academic text, and although there is a gentle invitation in the notes to further explore these topics, at no point did I feel like I had returned to a lecture hall. The background and context given to us throughout the stories only add to their breadth and texture, and big credit should be given here to Adshead co-author, writer and playwright Eileen Horne, who has collaborated with Adshead. in this “joint exercise of empathy.” It preserves the voice and experience of the clinician, without danger of losing the emotional investment that the reader has made in the patient.
Horne also manages to weave into a selection of quotes chosen by Adshead, from The merchant of Venice (“Put us on, don’t we bleed?”) To Marvel Comics (“You won’t like me when I’m angry”), which not only slightly punctuates pain and pain within a patient’s story, but also illustrates the many bridges between psychiatry and the arts. Given the importance of language within the specialty, it is not surprising that so many psychiatrists are also writers. Adshead discusses language many times, highlighting the choice of a patient or the absence of words, the use of the present tense when describing a traumatic event, and the difficulties faced when the doctor and the patient do not speak the same language fluently. Even if they are, the results can be frustrating. When asked to elaborate on something, David (the GP who plays golf and brags) repeatedly dismisses Adshead’s questions, not with “I don’t know” or “I’m not sure”, but with “Couldn’t tell” . An interesting phrase choice, which prompts a deeper exploration of what might be silencing it.
This collection of stories joins Nathan Filer’s (This book will change your mind about mental health) and the wonderful forensic psychologist Kerry Daynes The dark side of the mind in the use of patient vignettes to illustrate both mental illnesses and our perception of these illnesses. The devil you know has a well-deserved place on that shelf. Adshead’s words are effortless to read and deeply moving. This is not just because of the patients’ stories, but because of Adshead’s honest and compassionate response to those stories, and his ability to write with such clarity and elegance even around the most distressing narratives. How a therapist responds to his patient is an important part of the therapeutic process, and Adshead experiences transient fear, sadness, irritation, and even drowsiness during the course of their consultations, each for a different reason.
With that therapeutic process in mind, when I finished reading I reflected on how those stories made me feel. I have never worked in forensic psychiatry, but the patients I met through this book made me nostalgic for the wards. Places where we are taught to always sit in the chair closest to the door; where, to an observer, the only thing that distinguishes the doctor from the patient is a cord; where a spoon is missing in the dining room is a grave fact. As in life, the stories in this book do not always have the happy ending we might yearn for. We may feel uncomfortable during a change in our perspective. We can temporarily absorb the pain felt by the patients and other victims we just read about. However, the most overwhelming feeling I had when I finished this book was one of hope, not only for the patients but also for the readers. During the last 12 months, we have all seen too much and therefore perhaps we have gone blind. This insightful, compassionate and fascinating book will help us step away from our blindness and misconceptions and shed light on the stories beyond the headlines, stories that desperately need to be heard.
George is Digismak’s reported cum editor with 13 years of experience in Journalism