The Devil You Know Page 14

  I reassured her that she’d done the right thing and wasn’t about to be fired. I checked that she hadn’t actually called him an asshole, which would have been a boundary violation that I would have had to report. I’ve seen and heard much worse; it’s not common but it does happen, and helping staff to do better is part of my job. We sat and talked for a while about her concern and about how these kinds of negative feelings towards patients are not ‘facts’ about us or the patients. They tell us something about the patients’ minds as well as our own, and only become a problem if we act on them. We always need to think about what the communication might mean for the other person. Sometimes people are unlikeable because they don’t like themselves, a truism that extends well beyond forensic settings.

  I was glad that I’d had this conversation with Amanda. When I went over the incident later with Marcus, he was rude about her in just the way she described, and I felt a surge of contempt for his selfishness and his lack of care or ability, especially relative to what I knew about Amanda’s diligence and compassion. In our next team meeting, I would tell his therapist how I’d wanted to snap at him, ‘How dare you? You have no right to criticise anyone after what you’ve done!’ I had felt superior and entitled to attack him, to make him feel small, just as he probably had with Amanda – and with Julia. I wondered aloud to my colleagues whether he was feeling as helpless as they were. I would learn many times over as my career went on that it is always a greater act of compassion to empathise with someone you don’t like. It became clear that my feeling of contempt could be a resonance with Marcus’s contempt for his own vulnerability and despair in the face of his life sentence.

  In the room with him I simply commented that it was interesting that he seemed to want to humiliate and punish a young woman, and I asked if it was possible this conflict with Amanda might have a link to his offence. At this, he dropped his head and twisted his hands together, looking defeated – a new posture for him. ‘Why do you always keep on about it?’ His voice was so low I had to lean in closer to hear. I reminded him of where we were and that he had confessed to and been convicted of Julia’s murder. He shrugged, as if that didn’t matter. I went on. ‘But it seems this truth is difficult for you to look at, as if it’s easier for you to be hard on those who are trying to help you do that.’ He lifted his head then, his voice angry and bitter. ‘They – you people – you really don’t care if I kill myself. No one cares.’ I let that rest a moment, and then I saw that he was crying. Colleagues had told me he’d cried before in front of them, in a noisy and demonstrative way, but this was silent weeping, his shoulders shuddering, his cheeks wet. I made no attempt to stop him by offering words of comfort or tissues.

  It was a long ten minutes before he stopped. He looked up at me and said, ‘I needed that, I think.’ I met his gaze and said, ‘It’s so important to get what you need, when you need it, sometimes.’ He smiled at that, but it was a genuine smile, free of the mocking condescension I’d seen from him in the past. Then he said something quite unexpected: ‘All I wanted was to be beautiful.’ I was so taken aback by the statement that I had no idea what to say. I once had a patient who told me, apropos of nothing at all, that she had been ‘considering how the world is like a grapefruit’. Sometimes we just have to allow the incongruity of a word or idea and wait for it to make sense – or not.

  Marcus was trying to tell me more, but he was struggling to find words, all his former fluency gone. ‘I do know … I have to go back to prison … do my time and … I just don’t know … I can’t imagine life when I come out, you know, I’ll be bald, I’ll be fat, unfit, nobody will look at me. It’s not fair …’ He came to a halt. ‘Not fair?’ I echoed. ‘I just never thought … a thing, something like this, could happen to me. I mean … I know I’ve done wrong but I’m not a bad person … and now I can never put this right.’ I was conscious that we had been talking for nearly an hour, an emotionally taxing one for Marcus. He probably needed a break, and I needed to go and think about what he’d said and talk to the staff and his therapist. For the first time, he thanked me as he was leaving, and when he got to the door he turned back, offering what is known among my colleagues as a ‘door-handle moment’ – a final thought that might be quite revealing. He said he’d just had an idea about the support workers, staff like Amanda. ‘They aren’t so bad really. It’s just they’re young and have their lives, right?’ I only just suppressed my astonishment that he could notice another person’s experience and agreed that he was probably right.

  After that, I set aside the idea of sending him back to prison just yet. I needed to further explore what he meant by that striking comment about wanting to be beautiful. It raised questions about his early attachments in childhood, but I knew we lacked that kind of personal history.

  Over time, after much fruitless calling around and dead ends, our team did manage to obtain his early medical records, which I reviewed with interest. They told us he’d been diagnosed with depression at a young age, sufficient to be kept out of school on more than one occasion. He and his family had been referred to what was then called ‘child guidance’ and is now known as Child and Adolescent Mental Health Services (CAMHS). Some therapy notes from the few sessions he had back then indicated an emotional bleakness to the family dynamic. He had a silent father who seemed absent and a mother who was preoccupied with three younger siblings. I was interested to see that he’d been adopted at the age of one; then, a few years later, his adoptive mother had been able to conceive with the help of fertility treatment and went on to give birth to her biological children, twin boys and a daughter.

  Early separation from or loss of parents is a common cause of insecure attachment, and adoption is one version of this. It is quite common: at least a third of the population have experienced some version of insecure attachment with their parents or carers in early childhood. We did not have any details about Marcus’s adoption, but I had to consider the possibility that he’d been removed from his birth parents because of abuse and neglect. If so, as I knew from my study of attachment, it would have had a significant developmental impact, especially if Marcus’s adoptive parents had also failed to give him the parental care he needed. They may not have been bad people; they may have been overwhelmed with the demands of their expanded family, or Marcus may have been as challenging as a toddler as he was in adulthood. The notes from the child guidance clinic suggested that his parents refused to take part in family therapy for long. After a handful of sessions his mother had apparently said she didn’t have enough time to continue with it, and his father had been uncooperative and even dismissive throughout the process. Marcus had been left emotionally stranded.

  I also noticed that from a young age he had lots of treatments and consultations for minor medical problems. It looked like his mother did pay attention to him when he was physically ill. During his first recorded experience with depression, she had repeatedly brought Marcus to the GP after he complained of pain in his back, stomach and neck. This phenomenon of unexplained bodily pain is common in people who struggle to express emotion and aligns with the theory that all emotions begin in the body. I have seen how people with established risk factors for violence manifest painful feelings in the body, but they can also turn to causing other people pain because they are unable to articulate their own. It is only through action that they can express themselves.

  It is not that we thought Marcus’s adoption and issues with his parents had caused his later violence; these certainly aren’t ‘bicycle lock’ risk factors, since we know that of the millions of people with similar childhood experiences, few will ever go on to harm anyone, and certainly not to kill. But there was probably something in his early life that might give us an insight into the meaning of his violence for him, and everyone felt frustrated by all the unfilled blanks. Again, there is no central filing system tying together police or medical records, social services history and so forth. For all the ‘sleuthing’ I might do, I knew that, unlike a
detective in fiction, I wasn’t going to end up with all the information I needed. Above all, I wished I could find out in what context Marcus had first understood the idea of beauty, with its link to love and desirability. I doubted I would ever know.

  We talked in our team about whether his murder of Julia might be linked to unresolved anger over a dual rejection by the first women in his life, his two mothers. There has been extensive research into rejection and its relationship to hostility, and how this can extend from childhood into adult life.6 Marcus’s anger had been like the proverbial dormant volcano, until it erupted with Julia. She was probably not his target, but just the wrong woman at the wrong time. Her act of showing him her ‘other men’ online may have been perceived by Marcus as Julia laughing at him, while also rejecting him. But this still didn’t unlock what he’d meant by that wistful idea that he only wanted ‘to be beautiful’.

  *

  Ten years later, I would be reminded of Marcus and that wish of his, when a high-profile news story broke which would illuminate his case for me in a new way. In 2014, there had been another spree shooting across the Atlantic, as shocking and dismaying to me as all the others that had come before it. In the sleepy college town of Isla Vista, in southern California, Elliot Rodger, a twenty-year-old student with a history of depression, murdered his flatmates, then jumped into his car and drove through the sunny streets with a small armoury of weapons he’d acquired, firing indiscriminately from his car window, killing and injuring random strangers. Rodger videoed himself throughout, talking his audience through the massacre. When the police closed in, he posted the video online and then turned the gun on himself. Later, a long autobiographical screed was also found on the internet, as well as many other videos, which he had taken the time to publish before the deaths he planned for others and himself.7 Both the manifesto and his videos had a central theme: he was entitled to take revenge on a world where women were allowed to reject his wish for closeness and sex. Much like Marcus had taken no responsibility for Julia’s murder because she made him jealous, so Rodger took no responsibility for his actions and declared ‘they’ had forced him into involuntary celibacy and violence.

  It’s rare that one has the opportunity to read the views of a multiple homicide perpetrator, written in their own words, so I took the time to go through Rodger’s one-hundred-and-fifty-page manifesto. It was dreadful to read, hopeless and mind-numbing in its tedious detail and repetition, but it powerfully reminded me of Marcus’s incessant complaints. They had bored into the space between him and his carers, leaving us powerless to help him, while he smarted from a sense of grievance. For both of these men, women were not real people in their own right but supporting players in a dreary drama. I found in Rodger’s writing (and in his many videos, which showed a variety of different looks, including changes of hair colour) a repeated yearning to be attractive. It occurred to me that he was echoing Marcus’s wish ‘to be beautiful’.

  After that revelation had come from Marcus, slowly things began to change. He became less arrogant with the staff and other patients, and less querulous; his suicidal threats decreased in frequency. In time, he was able to come back to his ‘beautiful’ comment and explore it further in therapy. He spoke about how he became overweight after he started school and was teased for it by his siblings and schoolmates. He grew increasingly depressed over his appearance, feeling unwanted and unloved, and it occurred to him that his birth mother must have given him up for adoption because she did not like what she saw when she looked at him as a baby and did not want to see how he might develop. This was as searing as it was irrational to hear, and I could only tell him that I understood how that feeling must have been painful for him. As he reached adulthood, Marcus said he adapted his appearance, working out and changing his diet until he felt he was pleasing to women. He devised a strategy of lying to them about who he really was; it had been important to keep a string of women on the go, he said, in case one should lose affection for him and he needed another. This was his way to feel in control, so that he could never be abandoned.

  Ironically, as Marcus began to accept and speak about the reality of his past, for the first time in our care he developed obvious symptoms of clinical depression, including tearfulness, low mood, insomnia and weight loss. He withdrew from activities and barely spoke to others, answering only that he was ‘fine’ when asked. He was not overtly suicidal, as he had once been, but I remembered the suicidal man, long ago when I was in training, who had also maintained that he was ‘fine’ – up to the point where he took his own life. I thought silence from Marcus was more ominous than any ostentatious threats, and it reignited a worry about his suicide risk. It took another six months and the help of medication and more therapy before he would slowly emerge from his depression.

  We had given him a chance to resolve his inner conflict by caring for him, allowing him to talk about his needs and his anger towards people who had failed him early in his life, and encouraging him to grow up enough to fully grasp the reality not only of his experience, but of other people’s thoughts and feelings. This enabled him to take responsibility for his choices and recognise that it was his job to stay alive and do his time, or as he put it, to ‘pay his dues’ for taking Julia’s life. Eventually, he told me that he now felt he had a chance to take a new approach to life, and we talked about how sometimes it is necessary to be stripped down in order to rebuild. A placement was found for him in a prison not far from where his wife lived. I was told that by then she had decided to divorce him, but she wanted to continue to offer her support and visit him regularly. This generosity of heart had a powerful effect on Marcus, and he was able to show a real appreciation of her loyalty, accepting it as a gift instead of taking it as an entitlement. He returned to prison, and to my knowledge he has not been referred again to secure psychiatric care. I hope it is of some comfort for Julia’s family to know that he is facing up to and serving out his sentence, as he should.

  A thoughtful colleague of mine, Professor Shadd Maruna, has described this creative process of change after tragic events as ‘making good’.8 I recognise it can be difficult for people like Marcus to ask for or even access this kind of psychological help until it is too late, but I wish the overweight, distressed and isolated teenager’s thoughts about his need to be beautiful had been heard much earlier in life. I do recall reading that Elliot Rodger had multiple therapists and interventions in his youth, yet he was still undeterred from his fatal violence; there are no easy answers or certain solutions when a mind is disordered. It is possible that as a young man, Marcus might also have been incapable of being curious about his mind or unable to trust others, and he might not have accepted or been helped by therapy. I was glad I had the opportunity of working with him as an adult, to witness the way he became willing to open his mind in order to start healing past hurts. Everyone has that option, both inside and outside of forensic settings, though many will not take it. It is true that Marcus had tested the limits of my tolerance and even provoked me enough to mirror his hostility, and everyone on our team had grown weary as he held us hostage to his repetitive and self-aggrandising performance of despair. But we had come through it to arrive at something better, and seen, not for the first or the last time, that it is only through a staunch belief in the possibilities of every human heart that we move forward, even if we go haltingly and sometimes stumble.

  NOTES

  1 Dixon, L. and Browne, K. (2003) ‘The Heterogeneity of Spouse Abuse: A Review’, Aggression and Violent Behaviour, 8:1, 107–30.

  2 Liem, M. et al. (2009) ‘Intimate Partner Homicide by Presence or Absence of a Self-Destructive Act’, Homicide Studies, 13:4, 339–54.

  3 Pfäfflin, F. and Adshead, G. (Eds) (2003) A Matter of Security: Attachment Theory and Forensic Psychiatry and Psychotherapy (London: Jessica Kingsley).

  4 Bowlby, J. (1969) Attachment and Loss (New York: Basic Books).

  5 Browning’s poem can be found here: https://www.poetryfound
ation.org/poems/43768/my-last-duchess.

  6 One such study is Leary, M. R. et al. (2006) ‘Interpersonal Rejection as a Determinant of Anger and Aggression’, Personality and Social Psychology Review, 10:2, 111–32.

  7 The full manifesto can be found here: https://www.documentcloud.org/documents/1173808-elliot-rodger-manifesto.html.

  8 Maruna, S. (2001) Making Good: How Ex-Convicts Reform and Rebuild Their Lives (Washington DC: American Psychological Association).

  CHARLOTTE

  All prisons are noisy, but when I go to work in a female prison, I’m greeted by a richer acoustic than the usual clang of percussive gates and jangling keys turning endless locks, mixed with that low bass hum of constant human movement on metal staircases and cement flooring. The atmosphere is a cross between a girls’ school and an aviary filled with raucous tropical birds calling out to each other as they hover singly and in groups in common areas of the geometric cell blocks, some of them chirping ‘Miss! Miss!’ at me as I go by.

  A new government had come into power in the UK in 2010, in the wake of the global economic crisis, and there was dramatic change afoot in the NHS and all public services, including massive cuts to mental health care. A painful external review process had begun at Broadmoor, which would ultimately lead to a change of gear for me. I continued to work in forensic services within the NHS, but I left the hospital and began working in the community with the probation service, as well as in prisons. At the women’s facility, I joined a health care inreach team. Our work included assessing prisoners to ensure that those who were mentally ill and needed treatment were identified early, and those who were in distress received some kind of support. At the time that I met Charlotte, I was taking part in a specific initiative to try and support those women whose mental health problems had led to extended stays in prison.