The Dark Side of the Mind

by Kerry Daynes

  I asked him to sit down – gesturing him to the usual uninviting plastic chair, wondering privately if it would hold under Gary’s considerable load. We went through the cursory introductions. I noticed his speech was quite poorly articulated, with noticeable derhotacization, meaning he had difficulty pronouncing ‘r’ sounds. He was Gawee, not Gary.

  I asked him how he was and rather unexpectedly he launched into a diatribe about his legs. He was very concerned about them, they felt weak and wobbly. As he talked I wrote notes, and whenever I put my pen down he picked it up and started to doodle the same thing repeatedly, his full name and an outline rendering of a stripy cat. I had to keep asking for my pen back and wait for him to finish his masterpiece before returning it. He didn’t seem to remember not to do it. This is ‘utilization behaviour’, where someone uses the appropriate behaviour associated with an object, but at an inappropriate time. He was only doing what everybody does with a pen, but his timing and understanding of the context was off.

  As with any job, in psychology part of being effective is knowing where your skillset ends and someone else’s is required. I’m not a neuropsychologist – someone who understands brain health and the way it impacts behaviour – but I began to wonder if perhaps Gary’s problems were more physical than purely psychological.

  I had asked to see his medical records, but the prison had nothing on file. When he had arrived at reception in his first prison, Gary hadn’t been able to tell them which GP he was registered with, and it looked as though the matter had been left at that. No one knew his medical history, so anything that had happened before prison had essentially been forgotten. (This isn’t an unusual scenario by any means – it’s not how it should be, but it is how it is. Our creaking, overburdened public services don’t always succeed at the fabled joined-up thinking.) He’d gone through the standard quick screen for mental health issues – nine questions in all – on three occasions and he hadn’t reported anything significant on each. There were a few notes from visits to the prison GP but they were in connection to his vague complaints about his legs and minor injuries. I noticed he’d had cigarette burns on his legs and severe bruising on his back – things that had been done to him by other prisoners.

  I knew I needed to get a clearer picture of his background if I was going to understand what was driving Gary’s disinhibited behaviour. But the in-depth clinical interview with him that I wanted wasn’t coming easily. I couldn’t get any meaningful information from him. He just kept talking about his legs, and the fact that his cell door didn’t have a handle on the inside, just a metal plate where a handle ought to be. When I probed for details about his life before prison he’d say, ‘Mum knows. Ask Mum.’ He deferred to her almost every time I asked him anything: ‘Have you ever had a job, Gary?’ or ‘Which school did you go to?’ He would repeat, ‘Mum knows.’ It was clear he had relied heavily on her, even as an adult. I needed to meet his mum.

  *

  Having an independent practice allowed me to make that sort of call. I had achieved a freedom of my own; I was mistress of my own schedule and could keep the hours I wanted to – useful for me at that stage as I could work around a Ménière’s attack if I had one. Useful for my clients, too, because I could provide the sort of individualized service I wanted to give them, and do things like get in the car and visit someone’s mum. As an employee there had rarely been the time, the money nor the outside-the-box mindset that allows for the sort of investigative approach I felt was needed in Gary’s case.

  The flip side, of course, is that as a private practitioner you have less time to build therapeutic relationships with clients. You helicopter in at your moment, conduct your interviews, make your recommendations, and often you are out again just as quickly. You have the satisfaction of a job done thoroughly but it can feel isolated, you miss out on the longer-term connections and day-to- day interaction, not only with your workmates, but also with your patients and clients.

  So the following week I found myself pulling up outside Gary’s mum’s house in Bolton. I’ve been inside plenty of people’s houses with my work and met many a concerned and caring parent, but it’s hard to remember a more homely visit. Standing at the front door, the brass knocker beyond shiny, I saw Ann pull the net curtains in the window to one side to check it was me. She opened the door but kept it on the chain and said: ‘Is that you Kerry, love?’ – like I was a long-lost daughter she couldn’t quite believe had returned at last. I held up my ID card through the gap but she was opening the door by then.

  Inside, she had a wall plaque that read: ‘This home is clean enough to be healthy and dirty enough to be happy’. My grandmother had the same one on her kitchen wall and for a moment I was transported back to her house. Even though I’d never been there before I was immediately full of nostalgia in Ann’s home.

  She’d gone full hostess with the nest of tables fanned out in a decadent flourish and a pot of tea and a plate of custard creams all waiting for me, the whole tableau unfathomably swathed in layers of kitchen roll. We sat down and the pain poured out of her like tea from the pot: she had obviously been needing to talk to someone for a long time. She didn’t understand the IPP sentence and why Gary was still in prison four years later. He wasn’t a sex offender; how could they call him that? Tears sprang from her pale green eyes as she asked me this. She obviously found that particular reality very difficult to deal with.

  It’s easy to forget that offenders’ families experience their own kind of trauma when their loved ones go to prison. Feelings of bereavement and isolation, shame and guilt, are all part of the unhappy mix. Matters were made worse for Gary’s mum as he was being held in a prison so far away from her. Gary’s dad had died, and she didn’t drive, so she barely saw her son at all.

  One year, she told me, close to Christmas, she’d made the journey to see Gary with some presents for him. When she got there he was in segregation, so she couldn’t see him. She tried to leave the gifts for him. Handing them back to her a prison officer had said: ‘Sorry, he’s been a naughty boy.’

  I asked her about Gary’s past and his medical history and she told me that he had been ‘very poorly with cancer’ as a child. Here was something, at last. But it was clear she didn’t have an in-depth understanding of his problems or what they might have meant for him as an adult. She just wanted me to know that she had done everything right. She talked about looking after him and caring for him when he had chemotherapy as a boy. I got the feeling she’d been well-meaning but also possibly smothering, so determined to look after her child that no one else was allowed to. She got a box of photographs out and showed me pictures of him as a child, in the garden with his grandad, his school portraits in the generic brown cardboard frame that I recognized from my own school pictures. Gary had got his five GCSEs. She had given him as normal and respectable a childhood as she could, and she really needed me to understand that.

  Although she couldn’t tell me much more she was able to point me in the direction of the family GP practice, and I was then able to begin gathering together the full details of his medical history. It’s not an aspect of my job that requires any psychological insight or judgement, but hunting down paperwork – medical files, police records, witness statements from previous offences, care records, school reports and educational assessments – is a significant part of doing it well. Back then this was especially true, because as a private practitioner I had only my own resources to rely on and couldn’t easily access patient files. It’s a surprisingly time-consuming and mentally draining task, often dealing with desk staff who consider sharing any kind of information a personal failure, and who are working under strict regulatory guidelines about patient confidentiality. Emails must be sent and confirmations received and permissions granted, not just from the person concerned but often from multiple people, some of whom no longer work where you want them to work or who are too busy and stressed to spare time for a stranger, especially one who is asking about someone they
haven’t seen or thought about for 20 years.

  It took me nearly two months to finally have the medical files I needed in my hands. The collection of papers and documents I eventually sat down one evening to digest was 14 inches thick. I made notes on his records late into the night, Gary’s story coming into focus so sharply and urgently that I called James first thing the next morning.

  *

  At four years old Gary had been diagnosed with acute lymphoblastic leukaemia, and had received chemotherapy until he was seven. He’d also had an intensive course of cranial radiotherapy – a treatment commonly given to people with his particular kind of leukaemia, as they are at a higher risk of it affecting the brain.

  I’m no neuroscientist but I did some topline research that evening and learned that a potential complication of cranial radiotherapy is damage to the frontal lobe area of the brain, the part that sits just behind your eyes, which can impact and impair almost all aspects of executive functioning – the mental skills that help humans with everything from memory and flexible thinking (making judgements, learning cause and effect) to controlling urges and impulses.

  Gary had presumably sustained damage to this ‘control panel’ area of his brain as a consequence of his cancer treatment, but it hadn’t been detected for years. He attended mainstream schools, but missed a lot due to hospital treatment and struggled to make any friends (a particularly pitiful note from his school nurse described how he’d once been thrown into a wheelie bin by his classmates). He struggled generally to keep up and left school at 16 with five GCSEs, all at the lowest pass grades. I noted he’d been assessed by a child psychologist, when he was ten years old, who gave him an IQ score of around 85: low average. By the time he was assessed again by a neuropsychologist at 25, his IQ had dropped to 72. Something progressive was clearly happening to Gary.

  At one stage he was admitted to psychiatric services following an episode where he’d been found wandering the streets, disoriented and confused. The police had picked him up. He was described as both ‘apathetic’ and ‘hyperactive’ but ‘there are no indicators of mental illness…this young man has behavioural disturbance’. More time in mental health services passed until eventually, aged 29, Gary was sent to his local brain injuries rehabilitation services for assessment. Years before the incident on the bus and Gary’s conviction, he was formally diagnosed with frontal lobe syndrome. Tap this into Google and you learn that symptoms can include over-exuberant, childish conduct and inappropriate sexual behaviour. Sufferers can also lack the ability to switch ideas easily, typically becoming attached to words or gestures long after they have ceased to be socially relevant or appropriate. In addition, a meningioma tumour was growing in the lining of his brain compressing his frontal lobe, exacerbating the changes and deterioration in his behaviour.

  Meningioma tumours are generally benign but the bigger they get, the more problems they cause, so doctors told Gary that they wanted to remove this tumour with surgery as soon as possible. I noted there were concerns about the safety of the procedure due to his weight – compulsive eating is also a symptom of frontal lobe syndrome – and that he suffered with sleep apnoea. However, there was no doubt that Gary needed surgery to remove this growth.

  At that point Gary’s notes came to an end, becoming a series of copies of letters sent to him detailing dates and times of appointments. There were seven or eight saying the same thing: ‘You failed to attend your appointment, please contact us so we can reschedule.’ It was clear he had never had the surgery.

  It seems an obvious point, but the simple inclusion of relatives and families in the custody process can provide such useful information about the behaviour and condition of an inmate. The proportion of people with brain injuries estimated to be in the prison system at the moment is between 10 and 20 per cent. It’s thought that around 30 per cent of all UK prisoners have a learning disability or an autistic spectrum disorder. People aged 60 or over are the fastest-growing age group in the British prison estate, and these prisoners are much more likely to be affected by neurological conditions like dementia and Parkinson’s. British prisons – with the exception of a very small number of progressive institutions – don’t know what to do with them, if they identify the problem correctly in the first place. Not only are those with these misunderstood conditions more likely to find themselves caught up in the criminal justice system, but, once banged up, they can find themselves in a Catch-22 situation; the prison environment makes it almost impossible for them to achieve the squeaky-clean behaviour expected of them. This is especially true for people on the autistic spectrum, for whom the cacophony of light and sound that is prison can be genuine torment. But their families know their stories. A little involvement of relatives could transform the prison experience for everyone involved.

  Sometimes you show up to do a job and you realize that what needs doing is something completely different. Gary didn’t need to see a psychologist, he needed to see a neurosurgeon as a matter of urgency, and James contacted the prison to let them know what had, or rather what hadn’t, happened. My assessment was put on hold while medics got to grips with Gary’s physical problems. I would meet him again post-op and we would continue to work on a risk assessment and possible pathway for his release.

  Two months later I got a call from his mum. Gary had been transferred out of the prison to have surgery, but he had had a stroke while recovering from the operation, and died three weeks later.

  *

  The forensic psychologist in private practice shuttles in and out of people’s lives and stories. I hear of former patients dying from time to time; often it’s suicide, a drugs overdose or just general poor health. I don’t spend enough time with most of my clients to form significant relationships. I’ll often hear myself saying to them, at the end of a piece of work: ‘In the best possible way, I hope we never meet again.’ And it’s often the case that we don’t. It’s the prison and hospital staff, those who work more closely with inmates and patients, who share more meaningful connections. And yet there is always a pause for reflection when a former patient dies.

  I had a clutch of photographs Gary’s mum had given me – the pictures of him as a child that she’d insisted I take with me last time I’d seen her – and I wanted to return them in person rather than send them. Nothing goes against the natural order of things more than the loss of a child, and I felt this woman had reached out to me with a degree of trust when I had visited her. Taking the pictures back felt like the right thing to do.

  The best china was out again when I dropped by. There was a sense that a burden had been lifted. She was chatty, and keen to tell me the story of what had happened since I’d last seen her: it seemed that Gary hadn’t ever told her about the need for surgery. He had obviously been scared, she said, and threw away the letters until eventually they stopped coming. He hadn’t been to the doctor’s for three years before the incident on the bus, so he was obviously not well. What had happened that day was a ‘brain cough’, as she called it. He was poorly and that was why he had done what he did.

  She had constructed a version of events that made everything feel better for her and, although a part of me wanted to, I wasn’t going to pick holes in it at this stage. I accepted that she had found a way to be at peace with what Gary had done. While his brain damage explained his failure to think through the consequences of his behaviour – the hardware causing blips in the programmes it implements – I believe there were other things he could have done, many ideas that he might have acted upon that day, that didn’t involve sexually assaulting a child.

  Reductionism, the idea that our behaviour is determined by nothing more than the biochemical processes of our brains, enjoys a certain amount of popularity in some scientific circles. It’s a compelling notion – that there is ultimately no such thing as free will. That the determined nature of behaviour is just more obvious in those like Gary. For Ann, the explanation that ‘his brain made him do it’ was a salve for her grief. An
d her shame. Ignoring all of the complexities of human experience and environmental influence that combine to create a person’s thoughts and actions was a clean and efficient way to wipe off the stain on his name that she found so distressing. I wish they did, but the cut-and- dry explanations that the families of offenders want to hear rarely exist.

  As I was finishing my biscuit she asked me if I’d like to see Gary’s ashes. I didn’t especially, if I was honest – but before I had a chance to answer, she’d reached down the side of the sofa and pulled out a carrier bag, the brass urn holding Gary peeking out of the top of it. I wasn’t quite sure what to say and I almost patted it, like Gary had patted me. Then I noticed the bag – it was bright orange, with a picture of an elephant on it that looked very familiar. Gary’s final resting place was in his Sainsbury’s bag for life. ‘It’s what he would have wanted,’ she said. And she was absolutely right.

  CHAPTER 8

  A MAN’S WORLD

  Men are afraid that women will laugh at them.