The human capacity for cruelty with Dr Gwen Adshead

0:04 This is Crappita Happy and I am your host, Cass Dunn. I'm a clinical and coaching psychologist. I'm mindfulness meditation teacher and of course author of the Crappita Happy books. In this show, I bring you conversations with interesting, inspiring, intelligent people who are experts in their field and who have something of value to share that will help you feel less crappy and more happy. Doctor Gwen ad Said is one of Britain's leading forensic psychiatrists and she has spent thirty years providing therapy inside secure hospitals and prisons. She has recently co authored a book called The Devil You Know, and in the book, she takes us into the treatment room and reveals these men and women who have committed violent crime in all their complexity and vulnerability. She speaks to our shared humanity and she makes a powerful case for compassion over condemnation, empathy over fear, and challenges what we think we know about evil. Doctor Gwen ad said, Such a pleasure to welcome you to the Crabby to Happy podcast.

1:19 Oh thank you very much for inviting me, Cass. It's a real pleasure to be here, Gwen. I'd love to start at the beginning and ask how you came to be doing this work? Am I correct in understanding that as part of your psychiatry training you are required to do a placement in a secure facility? Or is this something that you volunteered for? Well, psychiatric training has two phases in the UK. In the UK it hasards kind of early phase where you get do placements and lots of different places, and that might include doing a placement in a forensic post. And I'll explain what I mean by that in a minute.

1:59 But some people decide to specialize in forensic work and they then go on and do well, I actually did four years. They now do three. But I actually did a four year training and then I spend a bit more time in training in forensics. So I mean, just to start from the basics. A forensics a cultist is somebody who works with people where there appears to be some connection between a person's mental disorder, a mental illness, and their criminal behavior of some sort and that tends to be violenced. So forensics a cultists are people who often give evidence in courts, so they're helping courts understand who's this person? How does do they have a mental illness and does that help us understand how they came to offend. That's so that's one way that forensics culturests work.

2:56 That's true also in I mean that's true for forensics sculptures most all over the world, including Australia, America, India. You know, forensics culturists go to court and give evidence, But in the UK and in Australia and New Zealand and Canada, perhaps less so in the States, forensics culturests are also people who provide care, ordinary medical psychiatric care for people who've committed acts of serious violence when mentally ill. So a forensicsicuatrist has those two kinds of roles. So as a junior siculturist, I had a little experience of it, and then I went on to specialize in train and that's what I've done for the rest of my working life and still I am doing it.

3:40 So you were drawn to this kind of work from very early on, and presumably to the therapy side of it. Yeah, so I was first drawn to it. I was actually drawn to it because I had an interest in medical law and ethics. So I'd studied medical law and ethics as a junior psychiatrist. So I was interested in how does the law think about mental illness and interesting and ethical questions like what makes us responsible for our actions? And these are actually not esoterical strange questions. These are question that actually human beings engage with all the time. So for example, you know, if a member of your family is snaps at you, you might wonder if they're a bit upset about something or depressed. And so, actually, you know when we assign, before we assign blame to people or responsibility for things, we often want to know what kind of mental state they're in. And I would was interested in the philosophy of that and as the law of that. So because of our interest, forensics and Chuattery spoke to me very powerfully, so I went into it.

4:49 And then once I got started in it, I thought I could see that forensics a cultures. A lot of forensics cultures kind of case manage teams, which is fine. I mean that's what doctors do. Doctors take to be case managers. I mean they do work directly with patients, but often they act as case managers and overseers of a treatment plan and that kind of thing. And I really wanted to be actually doing the therapy. I just really wanted to be talking to people and trying to understand how they came to be in a situation that they were in, How did they come to let themselves sometimes do something that then was terrible then and they think I was terrible now. So that's how my work started.

5:32 And I started training as a therapist a long long time ago. And that's true many psychiatrists, they don't necessarily work as therapists do the talking kind of therapies. No, I guess I was just curious to get an understanding of really what drew you to this work, because when you think about doing therapy with violent offenders, for many people that would just be not something that they would be remotely interested in. That would be so find that very difficult to reconcile their own personal moral values and feelings, and in the work that you do, you really have to park a lot of that.

6:12 Is that fair, I think so? I mean, it is a complicated question, and there are a number of ways of thinking about it. I mean, one way to think about it, this is a straightforward, old fashioned medical professional and ethical tradition, which is that when somebody comes in with a terrible injury and damage. You don't kind of judge them first whether they're worthy. You get in and you do the work. And it doesn't matter whether they're worthy or not. You get in and do the work. And that's a standard ethical tradition in medicine, going back to Hippocrates. So, you know, so that's one medical view of it. But another view of it is that that actually judging people my own personal moral views have nothing to do with the work. If the work is about helping somebody to become safer in the future, then my personal take on the morality of their actions, which is already you know, kind of clear. You know, there isn't any debate about it, but my personal position is kind of neither here nor there. And actually, if I let it, it might spoil the work. It might mean the work doesn't get done. So that's another strand that's another way to think about it. Where would we be if our doctors event work. Where would we be if we all said, well,

7:46 I think my personal views don't allow me to talk to you. It's kind of very undermining of social bonds generally. But the third thing is that I think that because violence is comparatively rare thing for people to do, especially when they're mentally ill. I think these are people who really need our help. And who's to say that if I had been in their situation, I might not have done the same thing. That Actually the distinction between them and me may not be so great. It's not as simple as the bad guys over here and the good guys over here.

8:28 I think that's a really key theme obviously running through your book and obviously part of the motivation for writing it. So you've presented in the Devil you know essentially twelve cases, twelve individuals who obviously aren't a single individuals. You describe that they are composites, and you tell us the story of the process from you meeting them through to completing often completing therapy with them, and overwhelmingly the feeling is that we I mean, obviously I have a mental health background as well, so, but I don't think I would be the only one to say that your whole view of these individuals and what they have done changes when you have some understanding, which you present so beautifully in the book, When you have some understanding of what led them to that point of committing that crime. Yeah, and this idea that there is there's not necessarily good and evil.

9:21 It is a case that anybody could be pushed to this point within the right circumstance. That's very much my view. And again this is a it's a personal view, but it's also a view which is supported by very long philosophical traditions. Originally, those philosophical traditions are mainly located in kind of faith based texts. If you go back at a couple of thousand years, that's where you find these discussions more often. But actually in other philosophical traditions, I think there's an understanding that people that this idea that there are good guys and bad guys is simply not sustained by the evidence from psychology or biology. And actually an observation that was made, you know, some sort of five hundred years ago that you know, we all have the potential for good or evil.

10:17 It's the question is what circumstances will bring it out. I think has been very helpful to me and my understanding. And actually, if we're serious about trying to reduce people's risk of reoffending, then we really want to get down and deep to understand how they came to be in that situation because that will help us make a plan, help them make a plan for the future so that they don't offend again. And that's in everybody's interest, Whereas just saying, oh, you're disgusting your evil, let's throw away the key in not talk to you anymore is not is not terribly sensible, particularly for those people who are going to be coming out into our communities. Failing to provide them with a kind of thinking space is just not sensible in the community from a sort of community health point of view.

11:14 And Gwen, I think you know, as mental health professionals, we're more likely to be predisposed when we see any sort of behavior to be asking the question, I wonder what happened to that person? I wonder what led to that? We're they're analyzing all of the time, you know, what would have led to that particular behavior as opposed to just the horrible evil person lock them up that kind of mindset. What did you find were the common threads? Like, what were the common themes that you saw amongst you know, hundreds of people that you worked with. The common threads. The first common thread that all forensics charatrists notice is that most people who commit at of violence, not all, and the the exceptions are very interesting people, and we might come back to that, but most people who've committed access serious violence have experienced very high levels of childhood adversity of various kinds. And what's interesting about that is that that was an observation that many of us who work with offenders, both in mental health services but also in the prison system, have noticed. But it's actually taken its research only carried out in the last decade or so to absolutely confirm that we have actual data to make that clear. It's true. It's not just a kind of wooly sympathetic speculation. You know, hard data, hard hard data that shows that the more childho diversity

12:45 you've experienced, the more likely you are to commit access serious violence, and that those that charter diversity probably has an impact not only on how your brain develops in the early years, depending on when the childhood diversity the trauma happens, but it also powerfully affects the way you see the world and make relationships with other people. And those are two aspects of human function that are going to be crucial later on down the line when you're an adult. So it's been it's been very it's been wonderful actually in a way that they're very sad material, but it's been wonderful to say, have this kind of international data, all sorts of countries and cultures have find the same thing. So we know that childhood diversity, particularly physical abuse and neglect the children, can be a powerful predictor for later, for later. I prefer action, interaction, interpersonal action, rather than behavior, I think. I think we need to be thinking of people as mentalizing minded people who make choices.

13:57 But of course you can make choices that are very poor choices, and choices that are kind of what's the world I want. They're not like a nice kind of table with choices set out clearly. It's as if they're options for travel, and they're clouded in sometimes by different kinds of colors or sounds, or distorted the way you see the world is distorted. So that's what's Those are the kind of main themes I think. And the other thing is that we need to make We need to it's helpful, I think, to make a distinction between violence, which is part of a relationship with the victim, and violence which is kind of comes out of nowhere, which is kind of unusual. Is also a communication to the victim.

14:47 But it's often the communications that's that is a bit that is a bit distorted or confusing. So when you have violence within the family, men attacking partners, women attacking their partners, attacking their children, that kind of violence is communicative and relational, clearly. But when you have violence to strangers, there are other variables that come in, like alcohol substances and things like that. But sometimes that's often where mental illness plays in its severe mental illness. So violence as a communication is the other thing that I would emphasize. We now understand violence as a communication to victims, not a great one, distorted one, an unattractive one when we want to stop, not but kind of not meaningless.

15:37 That's really interesting. But you know, when you talk about those kind of random acts of violence, like violence against a stranger, presumably there is some element of just bad luck in that, like just a time and place and situation. They're much less kind of premeditated or like you say, relational, but much more just in that moment, just bad luck, very much so, and. I often think of them as a kind of natural disaster. That's not to take away any accounts of personal responsibility and accountability. That's not where I'm at. But I often think that, particularly for some of our men, are people who've committed acts of terrible advance against the stranger when they were gross when they the Purpechases were grossly mentally ill.

16:28 They are often like a disaster. They're like survivors of a disaster where they were the disaster and that was And that's, you know, something that came out of work that I've been doing with advance Perparchasse for a while, and I had extraorin experience just the other week of a man who killed a stranger when mentally ill was saying something very similar, not having had this conversation with me, and I'm sure not having heard me talk about this, said that he thought that the homicide was like a tornado, that what he'd done was a kind of tornado that ripped everybody's world apart. It caused massive damage. And then he said something very interesting. He said, but you have to look back when the tornado. When the tornado is past, you have to look back at the tornado, and you have to look at the damage it did. You can't just turn your back on what happened, which is really which is a very again, a very powerful metaphor, but I think also captures that moment, that essence that you were just talking about something that is perhaps it happens out of It could happen anytime, any place. It's unpredictable.

17:39 It's unpredictably unpredictable, and a victim could just be in the wrong place at the wrong time. And thankfully this really doesn't happen very often, but of course it's it's noteworthy when it does. It's noteworthy when it does. And so actually some very interesting research down in Australia by some lovely Australian colleagues in Sydney did point this out that quite a number of those cases of homicides by people with mentally ill were carried out by people who were mentally ill for the very first time, that they weren't known to be mentally unwell, and that the mental illness, they're severe mental illness that kind of come upon their mind like tornado, and in that disturbance they'd killed somebody.

18:23 Yeah, Gwen, it occurred to me while I was reading the book and thinking about wow, like you are a really highly trained specialist providing high levels of and very regular therapy to people who have committed violent crimes. And I know, presumably victims of crimes also have access to funding for those sorts of supports and services. But compared to the everyday person walking down the street, you know we have this country is no different from back in Australia. You know, there were limits to the amount of funding available for mental health services. Like people just get lost in the system. People are not able to access public services.

19:04 Private services are unaffordable for people. I just guess I'm curious to ask what your thoughts are about that it's just for the average person. It would seem grossly unfair that this service is available to somebody who's committed a crime that is unavailable to the everyday person who could really use some support. Yeah, and that point is often made to me, and there are a number of ways to think about it. First, there is no there is no pot as it were, that is divided unequally. I mean, the fact that victims of trauma, whether in childhood or adulthood or anywhere else, don't get access to psychological therapy services is not because it's all being spent on offenders. They come from different pots of they come from different pots of money, and the reason that they come from different pots of money that they're funded. That the treatment of offenders is funded.

20:00 And I think this is probably true on a state basis in Australia, and it certainly is in America and also but in this country comes from His Majesty's Prison and probationion. It comes from a fund in the Ministry of Justice. And the reason is is because the primary aim of the intervention is to try and reduce risk. So it's a public good. It's about it's a public good, and actually real attempts are constantly being made to reduce the services. I mean, what really costs a lot in public policy terms is detention. The more we detain people, particularly using prisons but also in secure settings, it's just fabulously expensive. So that's so that's one answer to the question.

20:51 So I don't have any worries that what I'm doing is stopping other people from having therapy. And I also think that the work we do is ultimately in everybody's interest, in my own, if I want to put it at that kind of level. But the much bigger question about the politics I'm afraid is just is just that it's political and in this country we have we've had a government who's been dedicated with the destruction of the mental of the NHS since since they got into power, and it is very profound in mental health services. What's happened to mental health services? I'm a standard, you know, just stop oil Blue themselves to Rhodes. We need thousands of people on the barricade saying what have you done to our mental health services? What have you done? What have you done? And the denigration of mental health services? What happens in mental health? You know, if you have a mental health problem, you get referred, you know, by your GP.

21:58 If you're lucky, four weeks later you might be seen by somebody. You won't be seen by anybody who's had a lengthy training or you're you're unlikely to see anybody's had a lengthy training like mine, or even a basic training like mine. You know, a basic psychiatrist in this country has had six or seven years of training to listen and to think about mental disorders. You know what you'll see as somebody who's much less trained. And that's because this government thinks that mental health is not very interesting or important, and you can you can all go away and sort yourselves out, you know. And I mean, what's happened to cams? Sorry, child and adolescent life services? I mean is I'm just I'm just a standard that people aren't out on the streets. They write hand ringing letters to newspapers, but people just not you know. Oh, yes, it's terrible when and it used not to be. That's the thing is that I have lived through a time.

22:57 I trained at a time when there were large, well established child adolescent mental health services staffed with lots of trained psychiatrists, lots of trained social workers, lots of trained psychologists, and people who were interested in delivering therapy and help to families in trouble. But now, you know, the CAM services just barely exist, and when they do exist, they're overwhelmed and they're not supported to do the kind of relational work that we know really makes a difference, especially for teenagers. And to your point earlier, considering how much of those early experiences, that early childhood trauma is the precipitator to these later violent crimes, how many of them potentially could be prevented?

23:51 Excuse me, well, yes, no, I think that's I think that's right. I mean part of the work that I do now. I don't work full time in the NHS anymore because very few consultants that I just do, but I do a lot of work in the family courts. So I see, I assess parents who have carried out the kind of childhood trauma that we know can result in problems later on down the line. And of course what I want is to try and get help for those women, and they are largely women. I mainly see mothers because of course most again most children in these circumstances, not everybody, but a lot of the children are with mothers, with single mothers who've been exposed to domestic violence. And I see women who urgently need help psychological help for themselves for their own histories of trauma, which you can anticipate there, but also they need help to be able to relate to their children differently. And the interesting thing about the brain in the early years in particular, is that it's entirely possible that small interventions could make a big difference later. So it is in very much all our interests, and there is some data to support this that actually money spent on cam services saves ten times that amount of money, yes, later on. So and it's the the utter refusal, it seems to me extraordinary out

25:23 of political will, the utter refusal and the encouragement of NHS Trust to dismantle services to provide the very bare bear minimum and make us all wait for it. I mean at a time when we can ill afford to wait for particularly for sure for the under fives, mothers looking after toddlers, because that first five years is pretty crucial, and then the teenagers. Yeah, it's it's heartbreaking, but it's also just like you said, it is completely illogical. It is it's costing so much more down the track than what it would cost to put those supports and put those resources into place at the beginning.

26:10 And it's entirely it's entirely a political choice. We can, we can, We can absolutely afford all these things. We would just choose that's what we choose to spend our money on, right, And I think you know, this is about the ethics of choices of resource allocation, you know, And are we a society that wants to put people's mental health right down the bottom of a list of priorities? And this is again another reason why I you know, you know, it's very important for people to understand that, you know, our patients, our patients are not getting something which deprives other people. And in fact, the most saddest thing about our many of our patients is that they only get help when they've committed offenses. We have a significant proportion of people in our prisons and our secure hospitals who, if they had had proper treatment at the time, would possibly not have committed the offense that they did, which is astounding thing to say. And it's all very you know, treat them up to the zoo now now they've done it, but you know that's really sad.

27:15 Yeah, you mentioned before that typically there is significant trauma in the background of the offenders. What percentage, I know you probably can't give me an actual percentage, but what percentage of people would you say really are evil? Oh? None, none, not a single one. Oh easy. I'm going to go I'm going to go for no percent because I think, because I come back to what. I said, I should have said that don't have trauma, that something else is going on for them. Yeah, oh no, I'm still I'm going with mine percent and the reason is this first, that even where you've got lots of trauma, trauma doesn't always explain the violence altogether.

28:02 Because and many people who have maybe listened to your podcasts are possibly shouting as they listen. I know people with drama who haven't done anything violent. Right, That's. Yeah, and that's and that's and that is absolutely right. And nobody and when we talk about early childhood adversity, it's relationship with later violence. We're not saying that one causes the other. What we're saying is it exposure to high levels of fear and stress in particularly in the first five years of life, and processes that undermine a kind of social awareness and capacity for social relationships in the first five years. Those are risk factors that you carry through into adulthood. And then if other risk factors then pile in, that's where you get your violence risk.

28:52 Then increasing of which and the violence and the other risk factors are things to do with the stress of poverty, the stress, substance misuse, addiction. Addiction is a massive respective for violence, massive, massive, massive respective for violence. So that's a kind of another respected to take on board. And then relationship stress is another is another one and and what Eileen and I try to talk about in the book is the model of violence as a bicycle lock, where the violence erupts if all the numbers line up. But you could have a couple of those numbers all your life and you'd never be violent. But then if the numbers are all present and they all line up in the right way, then the violence can erupt. So to go back to your question, then we do meet people who don't appear to have had any kind of exposure to trauma, and that takes us into thinking about evil states of mind in a much broader way. So at this point, when I'm giving lectures about this, the point of the lecturer, which to this very sensible question, I usually put up a picture of the fifteen men who were present at the Vance Conference in nineteen forty one.

30:10 The Vance Conference was held was just is in Germany, just outside I think, just outside Berlin, and it is where the German government of the day planned the final solution. Now, of those fifteen men, none of them had experienced child trauma. They weren't psychopaths, they weren't mentally unwell. They were you know, they were the krem de la Creme of their society. They were lawyers, they were they had degrees, they were high status men, they had wives, they had children. So I think we have to think much more carefully, deeply and broadly into about the human capacity for massive cruelty and trauma can be can be a risk fact and for and serious vans, no question about it. But we do see plenty of people who can get into evil states of mind without trauma being obviously present. And there we start to look at things to do issues to do with human relationships, usually policies around power and control, themes of power and control, and the Vance Conference is really a nice example of you know, the government of the day decided that, you know that the way that it wanted to show how great they were make Germany great again, as they actually saying by We're going to make Germany great again by exterminating a subgroup of the citizenry.

31:44 That's what we'll do. Now, that is at one level you can say that's evil, and of course it is a kind of evil state of mind that produces that kind of idea, but actually they thought they were doing something good. They thought they were entitled, they thought they were justified, and actually what we see sometimes in human beings who don't have the kinds of trauma. Is that similar kind of state of mind of I am powerful, I am entitled. But I don't think it helps necessary to say, oh, they're just evil, because very few people are Evil is the absence of good, and very few people are absent of good all the time. So the idea that there's people out there who are just pure evil no percent, zero percent zero.

32:33 But seduced by power, I. Think so, and excited, excited by power differentials, and often also identified with a culture that denigrates the vulnerable, denigrates losers, weakness, neediness. You know, if you're weak or vulnerable, then I have every right to kick you and hurt you. I think that kind of state of mind is a kind of state of mind which makes real acts of cruelty and humiliation and despolation, desecration possible. You know, I'm great and you are crap.

33:14 Yeah, And therefore you can see how many people can be drawn into that kind of thinking. We've seen it over the last few years, the politics around the world, the them and us, and you know, the othering of people from different cultures or genders or whatever it is. Finding a scapegoat is very important, and actually many people. There was a philosophy and sociologist called Rene Gerard who argued exactly this, that actually, often for human communities to stabilize themselves, if these communities are kind of psychologically insecure or unhappy, they can stabilize themselves by finding a scapegoat group on which to project all all their difficulties. And then you can create these kind of fantastical narratives that if only we could get rid of group X, or will be well. And also if we treat group X badly, we call them terrible, and we treat them badly, we big ourselves up. Then the more badly we treat them, the more sure we are of our own rightness, and that convinces us that we are right and we're doing this for good purposes. And this, of course is what's happening in Iran and Afghanistan, where it's crucially important to treat the women extremely badly in order for those men to feel good about themselves, to big themselves up. The worse they treat them, the better they feel. And that's why those two countries and Afghanistan, it seems to me,

34:46 is a kind of presents an ethical dilemma for the West, which is, I don't know how you solve that. I don't know how you begin to solve that, because those men have nothing to gain by giving up the persecution of their women, nothing at all. When going back to the people that you treated in forensic facilities, obviously the goal is to rehabilitate people and to get them back out into the community as functioning human beings who are unlikely to offend again. Did you see people come back through the system? Does that happen very often? I guess, well, there are lots of kind of variables because often the people, often the people who've done the most severe things, you know, I don't get to see them go out, but occasionally. I mean my work in the women's prison, I've seen more people go out. And and in fact, I was just talking about a case with the colleague yesterday of a man who'd been in prison for sort of fifteen years, ever since, ever since he was fifteen, growing up in prison, and everybody and he was released, and everybody was slightly biting their fingernails about how he would go. Actually he's doing okay so far, but he needs obviously he needs a lot of support.

36:06 But when people like him come back, and when people who've done violent things come back, I think it's important to remind everybody that most people who've done terrible acts of violence are not just kind of put out the door like the cat, you know, you know, with a bit of cash in their pocket, you know. I mean, if you've done serious violence, you're usually on some kind of license or supervision, and particularly if you've killed, you'll be on license or supervision for the rest of your life. So, and it's so it's actually comparatively nut rare for people who've done very serious acts of violence to go out and reoffend. But that's partly because they spend so long in prison and they often The other thing is that they can get pulled back to prison if anybody worries that they that they might be violent. So, for example, someone who's committed a serious violence defense spends time in prison released on license. One of the conditions of their license will be that they don't drink. Right if they start drinking, they'll be pulled back to prison straight away.

37:02 They haven't committed another violent offense, but nobody's taking any chances. So I've seen people come back in those kind of circumstances. But I think you're really talking about, well, for me, my experience, my response to your question, what comes to mind are the women, particularly the women, but not just the women. The women who offend mainly out of poverty. Right, So these are women who steal, and they are thieving out of poverty, and they are thieving out of addiction. And that's a bad combo. Partly the addiction feeds the poverty, but they have but often they've turned to the drugs in order to deal with the pain and anxiety of poverty. So I have certainly seen women come back to prison after serving a sentence because they just couldn't they couldn't function, they had nothing. And I've seen them come back. And you're making me think of a woman who I saw.

38:00 You know, she said, I think, I you know, she's back for the fourth time. I think since I've been there about three years, she was back the fourth time. And you know, I remember saying, you know, what do you think is going what do you think's going on, Janie, what do you think going on? And she said, you know, I think I like it here. I like it here. They know me here they know me as a person. I don't really like getting into trouble with the police, and I probably shouldn't have hit that policeman, but I like it here. Actually, when I asked the question, I was thinking not necessarily of you know, say the rapist who you know is released and immediately goes and attacks another woman and is back in prison, although obviously that must happen sometimes.

38:51 But I was thinking back to my first job when I finished my undergraduate degree many years ago. Was he in child protection and in juvenile justice, and these offending adolescens, who obviously usually had early adverse experiences, we know the general story. And we used to say they'd show up to court and they'd get a warning, and then they'd go back to court and they'd get a maybe a probation, and then they'd go back and or a good behavior bond or something. They'd go back and they'd get a community service, and we'd say, you don't want to go to detention. You can't end up back in court because you'll end up in detention. And it would we really hoped that that worked to keep them from offending, because we knew that the first time they went to detention that was it, because they would get so much more stability, security, three meals a day structure once they got into detention that they don't get back at time. In fact, as I say that, I'm wondering why did we not want.

39:45 The man detention? They're probably better off, But then it was it was almost like then we'd lost them because they they would be on that train. I guess well, and of course, but the other question is is given that we know that most young people who offend, and particularly if they're escalating into violence, have got some kind of psychological disruption going on. I mean, teenagers are how should we say, can be difficult to handle. But the good news is that most teenagers do not act violently and do not act persistently violently. So if you have a young man or woman who is becoming verbally aggressive or verbally hostile, physically hostile, you know these are people. These are young people who are crying out for some kind of help. And the real question is why do we not provide kind of therapeutic communities, possibly with a lock on, I have to negotiate these things, but we don't. Why do we not give vigorous and deep, rich psychological interventions the very first time. They are then right in there. Take this really seriously. This is not you.

41:07 This is not you. You are not your offense. You are capable of doing and being something else, but you don't know what it is yet, so all you can think of is this crappy thing. So let us help you become a man or a woman who doesn't do those kind of crappy things. Would you like that kind of What kind of man or woman do you want to be? It's hard when you're thirteen and your mum, you know, you're just living with your mum and two other much younger half sibs, and you don't have a dad around and all of that stuff, and you're miserable. You're miserable, and puberty is horrible. And these are and we know from the research, and this is quite ancient research from the Cowi studies that were done in the nineteen seventies that children who look a bit delinquent age ten, if you provide them with some kind of support, they may still they may still struggle in their teenage, but actually having one adult who's there on your side, who supports you, somebody to attach to, can make a huge difference if they can reduce the chance and people will tell these stories, So many people would tell these stories.

42:20 I was going off the rails and then mister Jenkins said, don't do that. Come come and play the timpani in my band or you know, or miss Williams said go and play on the netball team, or come and help me with this. And they took me seriously. They saw me. Whereas my own mum she can't see me because she's addicted. She's drunk all the time, and social services are in her case and she's cross with me. She wants me to look after my little brother and sister, you know. And but miss Williams saw me. That's that's what they say. That's what they say. So why not we provide people to see them, Gwen.

43:02 Here in the UK this week obviously the big news and in Australia the big news is Lucy let Be murdered seven found guilty, i should say, of killing six babies in the neonatal ward where she worked as a young twenty something blonde, smiling nurse. Like it just horrifies people that this could be going on. I'm just curious. As mental health professionals, we can't diagnose people from a distance, but you, with your years of experience, when these crimes kind of pop up in the news, I'm curious to know what your thoughts are about those kinds of crimes. You know, through your filter of your experience, what goes through your head when you see things like that.

43:45 Well, you know, like I mean, my first response is are much like everybody else's, which is this is just so awful, awful on so many levels, and it's incredibly distressing to think about for everybody, including you know, including the perpetrator and their family and their family circle. These kinds of homicide cause massive damage to people's lives. Then like a you know, it's Oppenheimer. Those you know, those bombs are kind of nuclear bomb that leaves its trace for ages and causes massive damage. So that's the first thing.

44:35 And of course we're like everybody, I mean, and particularly in my world, where particularly it is particularly intriguing because these are unicorn events. They are they're kind of double unicorn events, really really unusual and so rare as to be able to make it difficult to say sensible things. But what it did make me think of is because I actually have an interest in mothers who who induce illness or give false accounts of illness in their children, and very occasionally those women go on they actually cause illness and children that is fatal. So this use this is a kind of These are the kind of choices and actions that used to be called one child is centered by proxy. But we don't call that. Nobody uses that term anymore because not least of all, because it's completely pointless, doesn't it. But so what we now usually call it is it's a bit clunky, but we usually call it something. The Americans call it medical child abuse, which I think is a better way of thinking about it, because it can be fatal. Like all child abuse, it can be fatal, and like all child abuse, it can involve deception, and like all child abuse, there are degrees of planning, and there are degrees of complexity around the abuse.

46:03 But they child abuse always physical. Child abuse involves the misuse of a child's body. And so the women I see, I see quite a lot of women who they haven't killed their children, but they put their children at terrible risk by inducing illness or even just by giving false accounts of stories of the children's illnesses. And I've certainly seen many women who've given their child opiates for example, that might kill them, and they don't always have apparent histories of childhood trauma. And in those kind of cases, you kind of wonder about where this person got their attitudes towards vulnerability. Comes back to that discussion we were talking about earlier on, something about about what is it where you're in a situation where discrepancies of power and control and something about the vulnerability is kind of exciting but also disgusting. I find myself wondering whether this particular perpetrator found something about very premature babies and their vulnerability and their dependence found it disturbing in some way. And I say that too because there's some nice There are some interesting studies that have shown that women with insecure backgrounds,

47:33 if you put them in fMRI scanners and show them pictures of unhappy babies, bits of their brain light up that are associated with distress and shame and disgust. So there's a few studies like that. So so you know, the diagnosis is not going to help us here. This is about because it yeah, diagnostic boxes that are of no use to anybody here. Something about the relationship with ability and neediness and dependence. That's where you'd have to look. But this particular perpetrator clearly has no way of thinking about it right now. They mislet be clearly, she was pleading not guilty. She went not guilty. She's that hasn't she's been unsuccessful. So she now has her whole life trafin.

48:21 She's got an enormous amount of psychological work to do. She may not understand it herself. Truthfully, Cass, she may not understand it herself. That doesn't mitigate her responsibility, or that's not to excuse her in any way at all, because she knew what she was doing was wrong, but she may not understand it herself. And so we will wait to see what, if anything emerges. But I don't know. I don't know if she'll be off with therapy of any kind. I don't I don't know if she will. No, I was just gonna ask that she's a person who will never be released from prison based on her sentence, So therefore is she a candidate for therapy, like, is that something available to her?

49:10 Well, we're fortunate in this country, you know, they're not as well resources they could be. But We're fortunate to have mental health teams that go into prisons, and we have a very limited amount of psychological therapy that is available to offenders. And we do have psychological therapy programs for offenders, particularly who we think have some kind of personality dysfunction, although I'm not quite sure that it is let be would fit them for that. But so it's not impossible that she'll be offered therapy. The question is whether she will want it, whether she'll be able to use it. And you won't be surprised to hear that, you know, we don't. We don't. Even the Institute Criminology, the wonderful Institute Criminology here in based in Cambridge, even they don't have a lot of data on what it's like to get a whole life tariff because they've only been around for twenty years. But we can imagine that it takes quite a while to get your head around that. Yeah, So if she asks for therapy, there'll be an attempt to provide it, I think, but she can't. I mean, we don't do therapy against people's will, and that's possible.

50:26 But also to what end? Yeah, to what end? Yeah, Gwen, I'm very conscious of your time. I could ask you another twenty questions have you here all day? But I guess to wrap up, I think the theme that really comes through the book is this idea, and the term you use is radical compassion. Can you, for the listeners as a final question, could you explain what you've been by radical compassion? Because I think there is something to take away from that for all of us. Thank you well, I'm glad you think it's an interesting idea. It's not a unique idea. There are people have had similar kinds of idea. But the idea is that in order to if we really want to understand the root of people's offendings so that they don't do it again, we need to go down and deep. And that's where the word radics comes from, comes from the word route.

51:17 So we want to get to the root of things, and we need to go in with I think, prepared to listen compassionately to what people have to hear, and that going in with a kind of cruelty or blaming or hostile attitude is not going to get us where we want to go. It won't allow us to go deep. So the radical part of it is about going deep in with compassion. But the radical part is also about being able to step back and reminding yourself of the damage that this person has done, the great harm that they have done, reminding yourself of the victims who have suffered and the suffering cause by this person with whom you are sharing a compassion piece of work. And that's where it's kind of radical too, because the forensic psychotherapist has to keep all those other people in mind as well as the person they're working with. It's not simple as kind of just coming along and saying, you know, just showing compassion to the perpetrator. You have to keep the compassion for everyone who's been affected in your mind as well.

52:26 Gwen, thank you so much for your time today. I really appreciate it. Thank you for asking me kas. I will be sure, obviously to promote the book far and wide, because it is a really fascinating read. It's an interesting read, but I think, you know, the bigger picture not just of understanding what's going on in the minds of these violent offenders, but this idea of how we view them, I think is a really important. Thanks Gas, been a pleasure to meet you. Gwen's book is called The devil you know, stories of human cruelty and compassion. It is an absolute compelling read. I would highly recommend it if you have enjoyed this episode. If you enjoy the show, please do tell your friends.

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