The Devil You Know

by Gwen Adshead

  I had my doubts, based on some of the research I had been doing.1 Far more than with men, there appeared to be a societal need to explain away female violence as the result of trauma, even though most violent men have histories of trauma too, and despite the fact that most traumatised women (and there are a lot of them) are never violent. I also questioned whether Kezia could have hidden her jealousy for so many years, although her RC had mentioned to me that it had taken considerable time to stabilise her mental state after admission, and it was possible she had just been too unwell for anyone to spot this sooner. It was also feasible that she had never discussed her feelings about Mark – or anything else – before now because she’d never been given the opportunity. As I’ve indicated, due to a prevailing idea at the time that trauma was the principal reason for their violence, few female offenders were ever invited to engage in talk therapy, especially if they were mentally unwell. It was unsurprising to me to find that Kezia had not been offered any since her arrival. While this could also be put down to a lack of resources and the rarity of her offence, I was beginning to think women’s violence was generally seen as a topic to be avoided, even in a hospital like Broadmoor; this was partly what motivated my research into gender bias and violence early in my career. I hadn’t heard much about it while I was training, although I had seen some women who scared me. In one instance, while on a placement in a clinic in the community, a woman had threatened a male therapist during a session. When I heard shouts from his office, I ran along the corridor to check what was happening. I rounded the corner to discover that he had barricaded himself in his office, while the patient, whom I can only describe as ‘growling’ with fury, was gouging out chunks of his wooden door with a sharp object. With a speed fuelled by cowardice, I leapt into a hall cupboard and locked myself in. Bleakly comic in hindsight, the situation was resolved when the patient gave up and left, disappearing down the stairs in a flurry of expletives, with no harm done and without any police or legal involvement. But I was left with a curiosity about this woman’s rage and cruelty; if she’d been male, she would have been arrested and probably imprisoned, which made me wonder if women’s capacity for cruelty and violence was a no-go area in our culture. This memory has stayed with me in a way I think it would not have if the raging patient had been male, because male violence seems so familiar. The other intriguing question is whether I would have intervened if I’d been a man, rather than throwing myself into a cupboard. I can’t know the answer to that.

  Kezia’s diagnosis was also a factor in her lack of experience in talk therapy. When she was first treated for paranoid schizophrenia as a teenager, back in the early 1990s, the focus of treatment was on medication, not talking therapies. This was partly related to the widespread belief in those days that people with psychosis couldn’t use therapy, as I’ve touched on in the case of Gabriel, and to try it was generally seen as a waste of scant resources. Unfortunately, racial discrimination was probably also a factor; historically, much less therapy has been offered by mental health services in the UK to people of colour than to their white counterparts. I’m glad to say that the situation is somewhat improved today, but there is still a long way to go. This is a deep-rooted and systemic problem, part and parcel of wider institutional racism. People of colour continue to be under-represented as therapy patients both in the community and in forensic settings.2

  This case was further complicated by the ethical difficulty of my being asked to try and resolve an anxiety in the minds of the clinical team rather than in the patient’s mind, a situation I hadn’t often encountered at that time, though it would happen many times over in the future. I was uneasy about embarking on a course of therapy that might change the way in which Kezia was seen, and I would need to think carefully as I was going forward. This was a major reason why I’d arranged for supervision. When I’d been circling the car park that morning, the quixotic thought had occurred to me that I was being asked to play detective, a kind of mash-up of therapist and Sherlock Holmes, boldly taking a magnifying glass into someone’s mind – as if that were even possible.

  *

  ‘I got your letter,’ she said. Her voice was soft and low, south London with just a hint of the Caribbean. She held out the appointment letter I’d sent, which looked like it had been read many times over, folded and refolded. I started to comment, when she opened her mouth to speak again. ‘Sorry, sorry,’ she said. I told her to go ahead. ‘Nothing, no – you talk,’ she mumbled, more shy than impolite. I launched into my usual speech, thanking her for agreeing to meet me and setting out the parameters for our work. I had the sense of her attending closely, head bobbing as if she understood every word, but the gaze of her brown eyes was unfocused. I had to ask, did she know why she’d been referred to me for therapy? She nodded eagerly, the good student who knew the right answer. ‘They want me to talk about what I did … but it’s such a long time ago. I have to put it behind me and move on.’ I echoed this back, to let her know I had heard her, but also to make sure I understood her meaning. ‘You’ve got to put it behind you?’ ‘Put it behind me, move on, yes,’ she said. ‘But they want me to talk about it first. It was ten years ago, you know. Almost exactly.’ I recalled the date of her offence, having just read about it, and realised it was indeed the anniversary that week. She cast her eyes down, and I followed her gaze. Her hands were in her lap, cradled under her stomach as if it were a large cat, which looked like a form of self-soothing. I reassured her that we didn’t have to talk about her offence that day. She lifted her head, confused. ‘But, Doctor, I think they want me to.’ She was so eager to please, which made me think again about Mary’s enigmatic comment that she was a model patient.

  Maybe she could tell me what she’d talked about with her other doctors, I suggested. She replied in much the same way as before: ‘I was mentally ill and that made me do what I did, and they said I was not guilty because of my illness but I should take my meds and I would be better, so I can put it all behind me and move on.’ She stopped, then added, ‘Is that enough? I think they want me to talk about Mark, don’t they?’ I thought her mention of him was interesting, but I steered her away for now. In training, I’d learned by trial and error – and via a lot of feedback from my supervisors – that it was counterproductive to get into the topic of someone’s offence too early, even if they raised it. It was important to build a rapport first, so I invited Kezia to talk to me about life in the hospital and her interests off the ward.

  She told me she went to classes in the hospital education centre and to occupational therapy, and spoke of some pictures she’d framed to sell in the hospital shop. She also liked to go to chapel regularly and sometimes met with the chaplain, which reminded me that I’d heard about her strong religious faith and her family’s evangelical Christian background. Early on in their careers psychiatrists are trained to be aware of and sensitive to the diversity of beliefs in cultures, because it is crucial to the process of trying to work out whether a person’s thoughts or beliefs are ‘normal’ or evidence of mental illness. Faith beliefs are a good example of the kind of mental experience that psychiatrists have to assess and consider. Academics, philosophers and pundits may argue about their validity, but in a psychiatric sense faiths are not delusions because they are based on reason and an awareness of doubt, as well as being culturally coherent, whereas delusions are rigid and culturally alien.

  I asked if she could take me back to the beginning. ‘Of what? My crime?’ No, I told her, I meant after she was born, the beginning of her life. ‘Ohhh …’ She lit up with a big wide smile, more than happy to talk about her early childhood in Jamaica. Born in her grandmother’s house, in a small village far from the capital, she lived there with her mother and two younger siblings until Mum left them, when Kezia was six years old, to go and find work in the UK. The children stayed in the care of Gran, whom Kezia clearly adored. Her eyes shone as she talked of the games they would play, and how they went running around in the sun with no sho
es on and swam in the sea with giant turtles. She said her best memories were of attending church with Gran, where there was wonderful singing. To my surprise, unprompted she closed her eyes and half recited, half sang a fragment of a favourite hymn, from Psalm 23: ‘He leads me beside still waters / He restores my soul.’

  My thoughts went to her delusions about demonic possession, and whether she had been exposed to other kinds of religious thought beyond the Christian church she described. I knew a little about what that might include; I’d come across patients who had talked about their beliefs in obeah and voodoo, but I didn’t want to make any assumptions. Again, I was working on keeping an open mind, holding myself ‘in the Bardo’. Keats describes the quality of thought this requires as ‘negative capability’, a mental stillness that hovers in doubt and doesn’t settle on obvious answers. This would be a lifetime’s challenge for me, a skill that had to be rehearsed and relearned in my therapeutic practice many times over. Here it was important to pause and think about what the demons Kezia had thought were possessing Mark meant to her, not to me. They might turn out to be symbolically important in her life. By this time, I had seen a lot of delusional patients in the course of my work, but ideas of possession like this were not common. More often, people suffered from ideas of grandeur or inflated self-belief (‘I can kill you with one blow’; ‘I’m a top spy for MI5’; ‘I can read your mind, I know what you’re thinking’); or their delusions were paranoid and they believed that other people meant them harm or that they were under surveillance. I had learned that delusions were never just plucked from the air and tended to arise out of individual beliefs and experience, as we saw with Gabriel, whose paranoid delusions reflected his fears and unprocessed traumatic memories.3

  Kezia was so animated that I simply let her carry on, smiling and nodding my encouragement, without interruption. I waited for her to come to what I knew was the next chapter of her life, beginning with her mother returning to the island when Kezia was ten years old to take everyone with her to live in the UK. There was no mention of a father figure at any point, and I didn’t press her, hoping that that information might emerge naturally. When she got to the point where she arrived in London, she stopped, as if there was no more to say. Her face fell.

  ‘Did it seem very grey here, after Jamaica?’ I prompted. She gestured to the rain-streaked window and the dull sky beyond, as if to say, ‘What do you think?’ She’d never been so cold or wet as she was that first winter. ‘It was like a different planet!’ We both laughed at her tone, and she went on to tell me about school, how difficult she found her studies but how she had hoped to train as a nurse once she was grown up. The family went to church in their new neighbourhood, where her mother found a boyfriend. He was one of many, Kezia said. The picture she painted was of a life with no one steady male presence, just a series of unpleasant men, some of whom were violent to her mother and the children. Social services got involved a few times, but the children weren’t removed from the family home.

  When she was eighteen, she learned that her beloved Gran had died. As she told me this, her voice caught, and I felt her grief like another presence in the room, settling as a kind of coldness over us, a deep woe. She struggled to continue. ‘Then my sickness came. I was sent to doctors and nurses and hospital, and then they gave me medicines, but I hated them. I got so fat. I wanted to be out, to go to college. I promised Gran I would go.’ Her voice cracked with dismay and sorrow. I could only comment that it sounded painful. I thought – but did not say – that this was a lot to contend with, at a time when most young people are full of dreams of what they might do in life. Instead, she had lost not only her grandmother but her grip on reality.

  Just then, I became conscious that I was suddenly feeling sleepy. That wasn’t my usual experience in sessions, but maybe there was something about the rhythm and timbre of Kezia’s voice. I shook myself a little, hoping she hadn’t noticed, swallowing a yawn. It was nearly time for the session to end, and I wanted to discuss the way forward. I put it to her that we could meet again the following week if she wished, and she agreed, asking me bluntly if that’s when we would start talking about ‘her crime’. I assured her we would get to that, but first I wanted to hear more about her life beforehand. We could decide together when she was ready to go further, and I promised I wouldn’t just spring it on her. She rubbed her hands on her thighs anxiously and stood up, as if we’d sealed a deal. ‘I just want to put it behind me and move on.’ We were back to where she’d started. ‘I get that, Kezia, I really do.’

  Before our next session, I made time to meet with Jean-Paul. I asked if he could help me with any more details about what Kezia had said that made him think she’d been in love with Mark, the man she’d killed. Could he recall the actual words she’d used, verbatim? He hedged a bit, saying this was more of a feeling he had, based on comments she’d made to him. For example, she’d told him about a song which she said always made her think of Mark, a love song. He also spoke about his concern that she might develop feelings for him and described to me an angry outburst when she found him talking with another patient on the ward.

  Later, I would consider with my supervisor the importance of jealousy as a motive for killing. This is not an emotion that’s alien to us; most people know that disturbing mix of rage, fear and grief, although few will ever kill as a result, or even countenance doing so. Jealousy has long been a favourite motive in tragic narratives, both real and fictional, and Jean-Paul was drawing on that tradition. My job was to see if that explanation was in any sense true for Kezia.

  I remember once while I was in training discussing a similar case with a group of forensic psychiatrists – all of whom were male, as was often the case back then. Someone referred to ‘Othello syndrome’4 or ‘morbid jealousy’ as a rationale for our male patient’s violence. In Othello, Shakespeare demonstrates how a good man is overcome by a ‘green-eyed monster’; jealousy as a fantastical and powerful force which generates his fatal violence. I commented that I wasn’t convinced that jealousy provided a complete explanation for our patient’s fatal violence towards his wife, given that there are many jealous men who don’t express themselves in this way. To my surprise, one of the most senior of the men responded testily, ‘Only a woman would dismiss a man’s jealousy.’ That shut me up, as it was meant to, but later I wrote to him to try and explain that my objection was based on psychological and legal arguments, not my sex. I still think that’s correct, but I also appreciate that there may be something I don’t fully fathom about masculinity, not having lived it myself.

  The Othello defence is almost always made by men, but then again, they do most of the killing. Among the small fraction of the UK’s total prison population which is female (around 5 per cent, although this figure is on the rise), the majority are serving short sentences for non-violent crime. Only 5 per cent of all homicides in the UK are committed by women, a figure that is similar around the world, as UN and other global studies consistently demonstrate.5 There is no consensus as to the reason for this wide difference between the sexes, but it’s probably multi-factorial. It is possible a male’s Y chromosome increases the risk of violence, but this does not explain why the majority of people with Y chromosomes are never violent. Some theorists have argued (more plausibly in my view) that male role expectations mean that the threshold for the use of violence is lowered, so that it becomes ‘normal’ for real men. A similar argument has been made for women: that it takes more for a woman to kill because it’s somehow unnatural in terms of feminine stereotypes and social norms. It is also suggested that the maternal and caring function of women in our culture might be protective against violence, making them more pro-social, a term which describes behaviours seen as helpful to other people, including sharing, cooperating with and comforting them.

  Ascribing mental illness as a motive when women commit murder may be the easiest response in a society that is ambivalent about women’s capacity for violence and wants to both con
demn and excuse it in a way that doesn’t happen for men. It struck me that the psychiatrists who had examined Kezia after her arrest had probably focused on her obvious symptoms of mental illness, and not so much on her psychological experiences as a young woman who’d migrated from another country and culture. They may also have focused on mental illness because Kezia had been violent before when she was unwell: I’d learned that at the age of nineteen, she had physically attacked her mother during a psychotic episode, leading to an urgent admission to a local psychiatric unit. Her mother was unhurt but frightened and told the medical team that she was not willing to have Kezia return home to live with the family when she was released. This meant that Kezia was eventually housed in the rehabilitation home where Mark worked. I wanted to know much more about all of this, but I knew we had groundwork to do first.

  Over the next six months, she and I met regularly, gradually moving into a more reflective mode of conversation, where I would not ask questions but instead let her start our session with whatever was important to her that day. We talked more about her past, about her friendships and hobbies growing up in Jamaica, and the ups and downs of her family relationships. She commented that nobody had ever wanted to know about this side of her life before. I was never bored, but I did notice that the sudden strange sleepiness that had affected me in our first session would return sometimes and I always had to be on guard, ready to stifle a yawn or pinch myself. I realised this occurred whenever Kezia lapsed into talking about grief or loss, and repeated her familiar litany about ‘putting it all behind her’ and how she had to ‘pick up the pieces and move on’. As if hypnotised by her words, I would feel a profound weariness rising within me. I can only describe it as a sensation of being ‘knocked out’, which I fought off and hid from Kezia as best I could. I would have to think about this with my supervisor.