NEIL MACKAY'S BIG READ: Disturbing case notes from a Broadmoor psychiatrist: 'When it comes to violent crime, men and women are no different'

Her journey into the darkest recesses of the human soul has given Adshead a unique insight into crime and punishment; insights which challenge many of society’s most deeply held opinions about the nature of offending and how we should treat criminals. The notion of someone being inherently ‘evil’ is absurd to her: we are all, Adshead says, capable of brutal acts of cruelty.

Most controversially of all, though, Adshead believes the differing ways in which we look at offending when it comes to men and women is dangerously flawed. There’s no fundamental difference in what causes men and women to kill - and both sexes should be treated exactly the same when imprisoned. The way society views female offenders is profoundly sexist, Adshead feels - because women can be every bit as depraved as men. Failing to acknowledge that risks damaging any hope of recovery for violent female offenders.

In the current political climate, when much of our public debate centres around treating female offenders differently to men, Adshead uses her decades of experience to fearlessly swim against the tide.

Perhaps Adshead’s most profound insight is that if boys were raised in the same way as girls, then rates of male offending would fall drastically. It’s a paradigm-shifting notion in terms of the public discussion around crime, from one of Britain’s most eminent psychiatrists.

Her powerful, unflinching memoir, The Devil You Know, is just out. The Herald on Sunday sat down with Adshead to explore her visionary take on the causes of violent crime, and what we should do with our worst offenders.

TRAUMA: WHERE IT STARTS

When it comes to violent crime, there’s no real distinction in why men and women offend, Adshead says. Clearly, however, rates of offending widely differ, with many more men imprisoned for violent crime. “If 5% of the prison population is female, that’s about 3000 women. About 30% of them will be convicted of violent offences.” So violent women are a minority of a minority - though the same goes for violent men when compared to males as a whole.

When it comes to men and women offending, however, “the violence is the same”. With women, “there’s a victim who’s helpless in some way, there’s often a difficult relationship between victim and perpetrator, violence is sometimes fuelled by substance misuse and fear and rage - just like men.”

Crucially, “the levels of childhood trauma are very similar for both men and women” in terms of the perpetrator.

Adshead points to HMP Parc, in Wales, where “at least 50% of the men have experienced four or more kinds of childhood trauma”. That could be physical violence, neglect, witnessing domestic violence, or sexual abuse.

There’s differences, however, between men and women offenders in terms of the type of trauma they experience as children. Girls face more sexual abuse; boys are more physically abused than girls. “Both girls and boys are exposed to witnessing domestic violence, which can put both sexes at risk of being both victims and perpetrators of intimate partner violence later.”

SOCIETY’S EXPECTATIONS

However, childhood trauma alone isn’t enough to explain why someone kills in adulthood. Evidently, only a tiny percentage of men and women who experience childhood trauma become violent criminals.

So what explains why some traumatised children become violent - and also the disparity between the levels of male and female offending? That, says Adshead, “is a Nobel Prize winning question”. However, she has her theories.

The answer may lie in “socialisation”, Adshead explains. “Women are allowed to own and articulate emotions, particularly difficult ones. We know that a lot of violence is driven by ‘the afflictive emotions’ - hatred, sadness, rage, panic, fear. If you’re socialised to be able to express those negative feelings, instead of acting them out, maybe that acts as a protective factor.”

In our society, there’s no shame placed on girls for crying, while shame is inflicted on boys. Think of the high number of male suicides compared to female suicides, or the number of young men reporting having few friends. Most women are ‘socialised’ to deal with their feelings, whereas men, traditionally, haven’t been. According to Adshead, the implication is that if men were socialised to be more open with their feelings - more ‘gentle’, more ‘kind’ - then males would be less prone to violence. So it’s not something innately ‘male’ - like the biology of the Y chromosome - driving the number of men committing violent crime. If women were raised as men are raised, they too could very well be filling prisons for violent crime.

TOXIC MASCULINITY

The differing socialisation of the two genders may leave men more “vulnerable” to committing violence, and mean “it takes more to get women to the point where they act out violently”. The kinds of “masculinity on offer for young men, are the kinds of ways of being in the world that are likely to get you into trouble. So, having big competitive fights, issues to do with your masculinity based on honour - that nobody disses you without somebody suffering; heavy substance misuse; not managing your feelings; drinking your feelings away”.

“Hyper-masculinity” is, literally, a killer - the idea, says Adshead, “that I’m a man and I get to call the shots and nobody says ‘no’ to me. A lot of male violence is predicated around ‘you don’t get to say no’. Think of sexual violence in particular, or stalking. Stalking is really an exercise in ‘you don’t get to say no. I’ve a view because I’m a man. You don’t’.”

So men risk being socialised into a sense of dominance - and dominance can trigger violence.

SEXISM AND SILENCE

This all leads to Adshead’s belief that the way society views violent female offenders is deeply sexist - as women, given the right circumstances, can be as violent as men. “I base that position on talking to violent women who’ve done horrible things.” By not addressing female offending “honestly” - by failing to admit that some women have a “capacity for violence” - then society is involved in a “kind of shutting up” of women.

“The trauma narrative dominates for women in a bizarre way because it’s not applied to men. Everything we say about trauma in relation to women - ‘oh, she had a terrible time growing up’ - well pretty much all of that applies to men. It’s extremely similar histories, and so the discourse that trauma explains violence for one sex, but not the other, runs the danger of being profoundly sexist.”

When female offenders are able to speak truthfully “about how they hurt people, how much damage they’ve done” and so “come to terms with their own cruelty - that they had choices, that nobody made them do it”, they fare better in therapy. The act of talking honestly about violence, rather than having it excused away, is therapeutic in itself. It’s necessary for offenders to confront the reality of their crimes for any hope of ‘recovery’.

DAMAGING PASSIVITY

“The only way people move forward is by acknowledging their own agency, and my big worry is that a lot of the discourse about female perpetrators puts them in a position of great passivity, and doesn’t give voice to their own agency,” Adshead explains.

So the way society approaches female offending may well be counter-productive. “It might be very damaging to women to be given a violence reduction programme which only focuses on their experiences of being traumatised,” she adds.

The idea of ‘recovery’ for violent offenders is complex. Adshead calls such criminals “survivors of the disaster they caused”. Some violent criminals can ‘recover’ and go on to live functioning lives outside prison or hospital. Others will never be able to reintegrate into society.

WHEN TO JAIL?

Adshead’s position is that “we shouldn’t be imprisoning people who’ve not committed violent offences”. That move, in itself, would see many women, and men, removed from jail. Criminal justice shouldn’t be “divided along sex lines”, but rather focus on the question ‘why are we sentencing people?’. If we’re sentencing people “for revenge, we probably can’t afford it”. A prison place costs around £40,000 a year.

However, if we followed a policy of only imprisoning violent criminals, then Adshead is clear that must be accompanied with well-resourced mental health programmes, which “addresses their violence, regardless of sex”. Adshead, however, opposes ‘whole life tariffs’ which have tripled in the last 20 years to 66 prisoners.

“We’ve trauma-informed intervention for women in female prisons. Now that’s great, but why aren’t we doing that in the male [prison system] where we know we’ve exactly the same levels of trauma.”

Adshead goes on: “When it comes to women, it’s very difficult to have a nuanced discussion about their responsibility and culpability in the way you would for a man. If a man kills, you’ve a detailed, nuanced view of his culpability and responsibility. But when it comes to women, she’s either a traumatised victim, mentally ill, or a monster.”

HUMAN WRECKAGE

Adshead cites one psychological study which referred to trauma as the primary cause of offending. Sexual abuse in childhood is actually “less predictive than physical abuse and neglect” in terms of later criminality. “Physical abuse is a very potent predictor for men. Boys who are physically abused are at significant increased risk of being violent later, as are boys who witness domestic violence.”

These factors, coupled with “parental substance misuse, parental imprisonment or mental illness” create what some psychiatrists call “downstream wreckage”. Adshead explains the term this way: “Imagine a child on a boat that’s falling apart under them on the river of life, gradually their little bit of security gets chipped away. Their mother goes mad. Their dad goes to prison for assaulting mum. They get taken into care. They’re physically abused, neglected. They start abusing drugs. Any security they had is gone and they’re just clinging to a spar of wreckage. Before they know it, they’ve got in with other guys who are the same. They need money. Drugs is an easy way. Off you go with gangs. You’ve got a weapon. Somebody is dead - and there you are at 19 and you’ve killed someone.” It’s a well-trodden road to hell for offenders.

THE SHIELD OF EDUCATION

Education - especially literacy - is “so protective”, Adshead explains, when it comes to “any kind of criminality but especially violence”. Referring to some of the hospitals she’s worked in, she says: “I could count on one hand the guys who had any kind of education.”

While we “need to get serious about violent offending” and how we deal with it, we also, says Adshead, must remember that “violence isn’t endemic”. Most humans never commit an act of violence. “Homicide is comparatively rare,” she adds.

Nor are levels of female violent offending rising - even though the media may give that impression. There’s very few female multiple murders. In Britain, there’s been Myra Hindley, Rose West and Joanna Dennehy. There has, however, been a series of very high profile female offenders involved in the domestic killing of children, such as the deaths of Star Hobson, aged one; Arthur Labinjo-Hughes, 6; Victoria Climbié, 8; and Logan Mwangi, 5.

Press attention is understandable, says Adshead, as women carrying out such heinous crimes are “rare events”. Most women, however, kill their children “when postnatally unwell”, not because they’re simply cruel.

MADNESS AND TRAGEDY

It’s important not to lose sight of the fact that some of the most distressing violent crimes are committed by people who are “mentally ill” and not responsible for their actions. “When that happens it’s an absolute tragedy,” Adshead says. If, or when, such offenders ‘recover’, and realise the full extent of their crimes - perhaps the murder of someone they love - “the suicide rate is very high. It’s dreadfully sad”.

Clearly, not everyone who commits violent crime can be helped on the road to recovery. Could someone like Ian Brady ever be ‘helped’?

“Sometimes we meet cases which are too severe, the pathology too entrenched, too widespread, for us to do anything but a kind of palliative care. A lot of people we imprison - both men and women - are receiving a kind of palliative care as they’re too high risk to be in the community. For a lot of people, we just got to them too late.”

In terms of ‘recovery’ for violent criminals, Adshead won’t use words like ‘saved’ or ‘redeemed’, she speaks of “people changing their minds for the better”, people who are “less mentally unwell and less risky than they were”. However, no offender should ever be “approached with a lock ‘em up and thrown away the key” attitude.

THE NATURE OF EVIL

The way society discusses such violent crime is deeply flawed. There’s no such thing as someone ‘born evil’, rather, says Adshead: “We all have that capacity, and thankfully most of us won’t get to that place. If we don’t accept our own risk of becoming evil, then we don’t exercise our own agency - and the exercise of agency is a very important part of what makes us virtuous at all: owning our emotions, who we are, taking virtue seriously.”

In a strange way, though, the crude, stereotypical view that much of society projects onto women, “sometimes works to women’s advantage” when it comes to reducing the chance of violent offending, Adshead says.

“Maybe we internalise projections of goodness and kindness enough to protect ourselves - to build up the kind of social relationships that protect against violence. It may be that there’s something about the socialisation of women which means that not only can they express horrible emotions, but also reach out to people when they feel vulnerable. They’re encouraged to build communities with each other and not become socially isolated which we know is one of the risk factors for violence.”

THE CARE SYSTEM

If we want to lower violent crime then, aside from education and tackling substance abuse - including alcohol, a key driver of crime - society must confront the reality of parents causing trauma to children, as that’s the root of the problem.

“We need to offer much more therapy to parents who are neglectful or abusive. At the very early stages, when there’s just a bit of anxiety - when so far nothing terrible has happened - we need to step in vigorously and say, ‘right, we’re going to put you into a programme which you’re going to attend every week, and your daughter or son will go into foster care while you do this. We’re going to get to the root of why you’re shouting and yelling and bruising your child and we’re not going to let you go home until you’ve got a good idea about why you’re doing this’.”

That needs political will and money, however. Though as Adshead points out: is spending £40,000 a year to keep a 19-year-old imprisoned for 25 years “really money well spent”?

Isn’t there are risk, though, that placing children in care will simply create trauma that leads to offending in adulthood. “We will always need some kind of care system for children who have to be removed from their parents,” Adshead says. “The issue then is how to support those children and provide them with therapy, especially at the point that they leave care and become parents themselves.”

Care leavers, she points out, “are over-represented in the prison population and that’s because they were exposed to lots of … abuse and trauma in childhood … So yes, we do need a radical overhaul of children’s services and child protection”.

After such a dark survey of modern crime and its causes, Adshead offers a note of hope. Quite simply, we aren’t become a more violent society. “Across Europe, rates of violence have been dropping for the last 50 years. We should be optimistic.”

Optimism doesn’t mean complacency, though. We must be “vigilant. We all have horrible emotions and we all have the capacity for cruelty,” she says. “It’s not simply the bad guys over there, and the good guys over here.”