The Devil You Know

by Gwen Adshead

  She suffered only minor injuries in the accident and was soon released from hospital. Grieving and doubtless in need of treatment for the trauma she’d experienced, it sounded like Sharon had not received any such assistance. Instead, she went home and tried to help her dad, who, she said, was ‘worse than useless’; in the following years, he dissolved his grief in alcohol. Eventually, she confided in one of her teachers about this, and social services intervened to move her into foster care. Between the ages of twelve and sixteen she thought she had probably had six or seven different placements. ‘Then, when I left care, well, I was an orphan by then, wasn’t I? I just wanted my own home and family, soon as I could, and then, with Thomas …’ – she faltered there, but gulped in a big breath and went on – ‘ … I just knew something was wrong with him, and nobody was listening to me.’ An echo of her old refrain, I thought – was she going to revert to old Sharon? Instead, she looked me in the eyes and said, ‘I couldn’t do it. I couldn’t take care of him, and it’s true, I did do all that stuff they said I did to him – put blood in his urine, all that stuff. It was true.’

  I had to ask about her second child, the baby she’d had with Jake that had been taken away in hospital. ‘Stephen,’ she said. ‘But I don’t know what they call him now. They say he is loved and cared for now with them, with his new family. I just hope maybe that he – maybe both boys – will come looking for me when they’re big, and I’ll get to explain that I was just …’ She paused and then blurted, ‘I was just fucked.’ In spite of the heavy atmosphere and high emotion we both laughed when she said it. It was a relief. ‘I mean, I won’t put it like that exactly – but I want them to know that back then, I was a mess.’ I gave her a thumbs-up for the amendment, and she smiled wanly and went on: ‘It wasn’t that I didn’t love them, and I need them to know that … I just wanted to give them what I never had. But that’s another thing I got from the group, you know? How can you give anyone what you never had?’ And then the tears came out and she sat there sobbing, hugging the new life in her belly and shaking as she wept. I pushed the box of tissues close to her and waited, thinking of Wordsworth’s ‘still, sad music of humanity’, the sound of lament.

  I thought she might be equating mothering with mourning and could not know if she was crying for her lost boys or for her mother. Her mother’s early death had robbed her of a parent and a role model, but also of care and attention, which she then felt compelled to seek out in other ways. Her chronic fear that her baby might die, however unfounded, was graphically real to her. This might explain why medical reassurance had not helped her, and why she went from doctor to doctor and made all those panicked trips to the hospital. A&E was a place she associated with the pain and loss of her own traumatic childhood event, but also with rescue. The false narrative she’d created for Thomas was part of a cover story about her fear of being trapped and an unbearable longing for care.

  Sharon was talking about the maternal group therapy again, and how deeply it had changed her perspective. ‘Day one, I couldn’t believe it, people were saying things out loud exactly like what I’d been thinking all my life, reading my mind or something. Telling the truth, no matter how bad it was. I realised … we all wished things had been different, and maybe we’ll never be okay with what happened in the past, but at least … I’m not alone.’ We both sat with that idea for a quiet moment and then, to my surprise, she burst out laughing. ‘Alone! As if.’ Her hands were pressed to her stomach. ‘There’s the kicking again!’ She bent her head and spoke to her bump: ‘All right you, that’s enough dancing!’

  There was so much love and care in her body language and words that my final question might have seemed redundant, but I wanted to hear her response. How was she feeling about the new baby? If she’d given me an automatic, beaming ‘marvellous’, I would have worried. I was reassured that she admitted to me she still had plenty of concerns about what would happen when it was born. She was realistic about the ongoing involvement of ‘the social’ and was determined to work with Lisa and with Barbara, the unborn baby’s court-appointed guardian ad litem, an older woman who had been helpful and kind and ‘seemed to know a lot about how babies feel and think’.

  Our meeting was drawing to a close. Sharon took out her phone, which reminded me that she’d not felt the need to fiddle with it during our session. She sent Simon a text to say she was done, and before she rose to go, I asked if she had any questions for me. She thought for a bit, nibbling her thumbnail in silence. ‘Are you going to write this down?’ I set down my pad and pen on the table between us. ‘I worry’, Sharon then said, ‘that I’ll always be anxious about my baby’s health, that I’ll never feel safe with her or that she’s going to be okay. D’you think that’s true?’ It was her first mention of the new baby’s sex. ‘Her?’ I asked. ‘Yeah, this one’s a girl.’ She smiled.

  She was posing such an enormous question to me, and the answer I could provide seemed so small in response. I told her that all parents worry about their children, especially their health, but she must remember that what went on in her mind wasn’t necessarily the truth of the matter. As Kipling wrote, our feelings can deceive us, whether they are of triumph or disaster. This is why we need friends, families and advisers of different kinds (including therapists, sometimes) to help us test reality and explore our emotions. Without that counterweight we can easily get overwhelmed. I told Sharon she could always seek out help, now that she knew its benefits. With a little grunt she eased her bulk out of the chair, thanking me again, before hurrying off to join her partner. I’m glad to say I’ve not seen her since.

  I felt hopeful for Sharon as I sat to down to prepare my third – and final – report on her. I outlined how unresolved grief and PTSD had disorganised Sharon’s mind since childhood, affecting her mood regulation and her relationships with caregivers. But her problems were treatable, and she had got help. I wrote that I felt privileged to have borne witness to her progress, and I made the point that cases like hers testify to the fact that people can and do change their minds, if they get help, and that it need not take years for therapy to make a difference.

  Privately, even though I had no evidence for it, I thought having a daughter might help Sharon to have more compassion for the part of her that still felt like a small, vulnerable girl. We are not Madonnas, those of us who bear children, and we are all works in progress. To prevent the cycle of pregnancy and care orders that Sharon had been through, professionals need to reach out to mothers, and not necessarily after they’ve already lost a child. There could be untold benefits to identifying those pregnant women who might struggle with motherhood and providing them with some therapy, along with their birthing classes and folic acid, as early as their first prenatal appointment. I’m certain the family courts would see their workload diminished and countless lives would be enhanced or even saved. I understand that enacting a measure like this might not be politically convenient or cheap, but as Walt Disney would say, this is the ‘work of heart’.

  NOTES

  1 Adshead, G., Brooke, D., Samuels, M., Jenner, S. and Southall, D. (2000) ‘Maternal Behaviors Associated with Smothering: A Preliminary Descriptive Study’, Child Abuse & Neglect, 24:9, 1175–83. See also Adshead, G. and Bluglass, K. (2005) ‘Attachment Representations in Mothers with Abnormal Illness Behaviour by Proxy’, British Journal of Psychiatry, 187:4, 328–33.

  2 Report on this study: https://www.bbc.com/news/uk-england-london-37048581.

  3 One such US study: Jaghab, K., Skodnek, K. B. and Padder, T. A. (2006) ‘Munchausen’s Syndrome and Other Factitious Disorders in Children: Case Series and Literature Review’, Psychiatry (Edgmont), 3:3, 46–55.

  4 American colleagues discuss this in Angelotta, C. and Applebaum, P. (2017) ‘Criminal Charges for Child Harm from Substance Use in Pregnancy’, Journal of the American Academy of Psychiatry and the Law, 45, 193–203. See my response from a British perspective in Adshead, G. (2017) ‘No Apple Pie’, ibid., 204–7.

 
5 Broadhurst, K. et al. (2017) ‘Vulnerable Birth Mothers and Recurrent Care Proceedings, Final Main Report’, Centre for Child and Family Justice Research, October 2017.

  6 https://www.pause.org.uk

  SAM

  The Thursday Group was just getting going when Sam joined in the conversation. He’d been with us for a few months but had said little so far. He tended to gaze past whoever was speaking, as if focused on something we couldn’t see. Tall and thin, he was in his early forties but had the gangling quality of a pubescent boy and would sit hunched in his chair or stretch his long legs out to their full length in front of him, big feet crossed at the ankles. Conscious or not, the effect was of a barrier.

  After three years’ absence, I’d been asked to come back to Broadmoor as a part-time therapist, mostly to do some training, as well as covering absences. One of the reasons I had agreed was that I would be involved in group therapy. While I was training, I’d learned from Murray Cox, both directly and from his published work, about the importance of group therapy for offenders with mental illness. Not long after I’d started training as a group therapist, I’d attended a conference and visited a psychiatric hospital in Connecticut, where I observed American colleagues working in a therapy group for people who had killed a parent. I’d come back fired up by what I’d seen, with a new understanding of how valuable it could be for people to help each other find words to talk about their similar offences and explore the impact on their families. It took some time but eventually, in co-operation with several colleagues, we did establish group therapy in the hospital, specifically for people who had killed members of their family. These groups had continued and expanded over time, and today I was working with some other therapists who were running one.

  Group therapy is the ‘real McCoy’ for a forensic psychotherapist. It can be more rewarding than working individually because there’s such a different dynamic; for one thing, I’m not the only person trying to understand what’s going on. There are always two therapists in the room (sometimes three), plus the four or five patients working with us. The patients become each other’s experts, in a sense, once the group gets established – the guiding principle is therapy ‘of the group by the group’. I have read that early pioneers of group therapy in the US were known as ‘conductors’, which seems a perfect analogy, including the fact that they keep the group ‘in time’. This also reminds me of a comment about psychopaths I heard many years ago: that they ‘know the words but not the music’ of emotional encounters. Therapists facilitating a group are not fellow musicians, yet we have authority and we guide them, while they create something which can be multi-layered and strangely beautiful. As in many orchestras, a flattened hierarchy emerges over time, which only improves the result. I had always loved working with these groups and missed them when I left.

  *

  ‘I’m telling you, his wife’s gonna find out any minute’ … ‘Yeah, that neighbour will grass them up, you just know it’ … ‘Remember last week, he saw them in the pub …’ Three of the men in the group, Tim, Benny and Kaz, were talking about a television programme they’d all watched the night before. As in most long-stay residential settings, custodial or not, TV is a social unifier between people who may have little in common beyond their identity as patients or inmates. In a secure environment, communal viewing also enables people to share different opinions and even to argue safely. In our group sessions, conversations about TV seemed to allow the men to ease themselves into the work. Usually their talk was of sport, particularly football, but they also liked to watch dramas, with crime being the preferred genre; I remember when Dexter (an American programme about a forensic expert by day who becomes a serial killer by night) was a favourite.

  As the chit-chat went on, Sam looked restless, but he appeared to be listening. Kaz now deliberately tried to include him. ‘You been watching, Sam? This woman … she can’t see what’s in front of her face … thinks the sun shines out her husband’s arse.’ Benny added, ‘It’s all too lovey-dovey for me … there’s no marriage like that.’ Sam cleared his throat, seemingly about to respond. He opened his mouth, but no words came. We all sat waiting, not breaking the moment. Those of us who had been in the group for longer than Sam, therapists and patients alike, recognised the change of atmosphere that can precede disclosure of an important thought.

  I let the silence linger a little, then said quietly, ‘Sam?’ He pushed a thick hank of dirty blond hair off his forehead. ‘I was just … I was going to say … my mum and dad were together nearly forty years. Childhood sweethearts. Never looked at anyone else, I reckon.’ His voice was flat and nasal, his tone impersonal, as if he too was commenting on characters in a drama. Tim, sitting opposite him, looked doubtful. ‘How can anyone know that for sure? I mean, people lie all the time …’ Kaz cut in again, loud and confident in his opinion: ‘Some people just love each other, you know.’ Both comments were revealing of the speakers, but at this moment, I was focused on Sam’s reaction. His face was hard to read. ‘My mum was nearly part of my index, you know.’ I noticed that he used the familiar jargon as a way of keeping the nature of his offence at bay, which wasn’t unusual for people who were new to therapy. He went on, ‘I nearly …’ His eyes met mine and he stopped. I nodded encouragement. ‘Nearly …?’

  He broke eye contact with me, looking down at the floor, and muttered, ‘I was in a hole. I had to dig myself out.’ One of my colleagues spoke up, her soft northern lilt coming in like a harmony. ‘How did you dig yourself out, Sam?’ He threw her a sideways glance. ‘It was … I was ill.’ We waited, but he had nothing more. This was the first time he’d spoken about his offence, the murder of his father ten years earlier. I said that what he’d told us sounded important and perhaps we could come back to it later. His contribution then sparked a thoughtful conversation among the other three men about their own parents’ relationships, and their various emotions thickened the atmosphere, just as a piece of music can.

  As the end of our group’s hour approached, Sam stood up abruptly, shoving his chair aside. ‘It’s time to go.’ My colleague said Sam was right, it was time, but we all wanted to acknowledge what he’d shared earlier with us. ‘It felt like you took a big step today, Sam.’ I thought he might respond to her, but he was spent, done for the day. The men filed out to join the waiting nurse who would escort them back to the ward. I saw Kaz touch Sam on the shoulder as they went and heard him softly say, ‘Well done, mate.’ Sam didn’t respond, but he didn’t pull away; that was a good sign. I hoped he would feel brave enough to tell us more about his parents in subsequent sessions, but I knew it might take some time.

  We cannot insist that people attend any type of therapy in a forensic context. The group was not right for everyone; I recall one man who adamantly refused to join when we invited him, insisting, ‘I didn’t kill anyone. You can dig my brother up and ask him if you don’t believe me.’ Resistance can also come from a fear of the unknown, which is an ordinary kind of human anxiety that we all know. Another patient I had approached to join the group asked nervously, ‘Can you tell me what I’ll know at the end?’ Most offenders will come to realise that talking about their offence with a therapist demonstrates a willingness to try and reduce risk, and some will agree to attend a group to tick that box, to go through the motions. But this is where our group really came into its own. More like an essay than a multiple-choice test, the agenda was set by the group members, and the right answer, or the socially desirable thing to say, was not obvious. Those people who just wanted to tick a box soon dropped out when they realised they would be faced with people like themselves who knew what it was to kill. In Sam’s case, once he had stabilised following his prison transfer, with the help of medication and some time, he had agreed to attend the group. He had expressed some reluctance but chose it in preference to one-on-one therapy. Colleagues told me he had admitted to killing his father but had never talked about its meaning for him. He had spent years in a kind of mental isolation, w
hich must have been painful. As a colleague of mine observed, insanity is building your own castle in the air and living in it; we’re offering to take down the drawbridge.

  I recall some anguished professional debate at the outset about what we should call the group. The first proposal was the blunt title of the Homicide Group, but some people felt that ‘outing’ people’s histories in this way would be difficult and could put patients off joining. The therapy group at the hospital in Connecticut for people who had killed their parents had a poetic name, selected by the members: the Genesis Group. I recall thinking at the time what a hopeful choice that was. Its gifted ‘conductors’, my American colleagues Marc Hillbrand and John Young, have long been inspirational writers on the theme of hope in forensic settings.1 But there were plenty of other therapy groups in Broadmoor with explicit titles – from Sexual Offenders Group to Leavers Group – and so we agreed on the Homicide Group. Later, as demand increased and we began to run two weekly sessions, this evolved into the Thursday Group and the Friday Group. I reckon the ten years or so that I spent involved with these groups were some of the best of my professional life, thoughtful, challenging, moving and not without humour.

  Early on, we could see that things functioned best if we restricted the groups to four or five men at most, as opposed to the ten or fifteen that were more common in group therapy. There was something important about it being a ‘family-sized’ unit. We also decided to have at least three therapists involved on rotation so that we could keep continuity through sickness or holidays. Security concerns required two of us to be in the room at all times, but it soon became clear that our safety was not an issue. Nobody was there to make trouble.