Elie Godsi - Biopic [here] Press release for new book [here]

How did we get here?
and some myths about madness and badness along the way
 Monday 17th November 2003

Elie Godsi

Consultant Forensic Clinical Psychologist

Nottingham Forensic Service

Nottinghamshire Healthcare NHS Trust

Author: Violence in Society - The reality behind violent crime

Constable (1999)

Madness and Badness?

- How do we make sense of madness and badness?

- Cultural and professional myths

- Understanding personal distress, violence and aggression despite professional training

- The aetiology of violence and personal distress


The relationship between personal distress, self harm and violence and aggression


Adaptations versus abnormalities



Madness and Badness?


Regaining compassion through understanding, understanding through making personal experience central


Understanding as explanation, not as condonement


Limited this presentation to personal not political issues

Cultural views of madness and badness

(Mentally ill) sick(-o), insane, abnormal, pathological, breakdown, cra- y, loony, gon’ potty, nutter, barmy, bonkers, barking, loopy, crackpot, doo-lally, wappy, fruitcake, (3 sheets, sandwich, pudding, crisps, hamster, vouchers), headcase, basket case, not all there, not at home, screw loose, lost their marbles, blown a fuse, cloud cuckoo land, freak, weirdo, schi- o, psycho, deranged, demented, too emotional, irrational, dangerous, violent, scary, menacing, intimidating, frightening, out of control, unpredictable, incomprehensible, inexplicable

Evil, demonic, soulless, possessed, ‘psycho’, remorseless, cold-blooded, callous, fren- ied, immoral or amoral, barbaric, animals, irresponsible, indecent, malicious




Nature or Nurture?


The more a person has suffered, the more severe their distress or destructive behaviour will be and yet the more likely they are to be defined as ill and their life experiences effectively ignored. In other words, the greater the actual contribution of the environment (nurture) the more likely that nature will be used as the explanation for their distress or their behaviour and therefore as a rationale for how best to ‘treat’ them. This leads to an erroneous chain of events that I will call “The Psychiatric Laws of Personal Distress”.


The Psychiatric Laws of Personal Distress


1. The more damaging the environment, (past, present or both) the more extreme the forms of distress (or behaviour) it generates will be.


2. The greater the severity of the distress the greater the likelihood of it being seen as a medical condition.


3. The more medicalised the distress, the greater the likelihood that those damaging experiences which gave rise to the distress in the first place will be relegated to the status of mere ‘background noise’ and the person in distress seen as having succumb to their genetic fate.



Professional ‘othering’


Being Contaminated by the patient’s thinking



“Therapists sometimes fall into the trap of thinking that patients are justified in being depressed, especially when their life circumstances are difficult.” p.202


Chapter 6. “Depression.”     Cognitive behaviour therapy for psychiatric problems - a practical guide. Keith Hawton et al. (1989).


Prospective (forwards in time)


100 physically abused boys


follow their progress in to adulthood: how many become violent adults?


About 10%


Retrospective (backwards in time)


100 physically violent adults


look back in to their histories: were they abused as children?




Continuum of love and violence


Professionals - out-patients - inpatients - prisoners and prisoner patients.


Love and Violence

Stability to chaos

Emotional - physical

Social, cultural and economic power


Sexual abuse cuts across all economic and cultural divides, but not in terms of severity, brutality, duration or ‘normalcy’


Presence or absence of positive, caring experiences



The Myth of the universal killing tendency


Child abuse as a necessary but not sufficient condition for serious violence as an adult:


100% of serial killers in America were abused as children, either with violence, neglect or humiliation - Ressler, R & Schachtman, T. (1993).


1. The Past

2. The Present

3. Circumstance

4. Chance


Central themes for therapy

Interpersonal violence characterised by:


Uncertainty and Threat


Powerlessness and Worthlessness




Issues for the assessment of violent men



Acceptance of responsibility

Primarily an internal as opposed to external attributional style

Ability to consider impact on others (victim empathy)

Ability to consider other people’s needs

Motivation to change (or potential)

Willing to engage and commit to attending

Willing to be honest and open about what they have done as well as experienced (both past and present)

Understanding that there is a relationship between past abuses and present ones


Issues for the assessment of violent men (contd)


Presence of, or development of positives

Is the offender’s behavior congruent with what he says

Is what the offender says congruent with information gained elsewhere

Is the risk of violence related to other factors e.g distress, drugs or alcohol, work pressures etc.

Presence of positive non-collusive relationships with authority - named adults within the family, friends or wider community

Has the offender developed effective ways of managing his anger and ‘relapse’ prevention strategies

Has the offender developed less controlling attitudes in general





Implications for therapeutic space

  • - reclaiming humanity

Moral and ethical responses not just technical solutions

A model of healing rather than ‘treatment’

Hanging on to people’s humanity despite everything

Being fair - respect and compassion

Respect not degradation and punishment

Democratising the therapeutic space

Boundaries not power and control

Offering choices whenever possible


Implications for therapeutic space
- reclaiming humanity


Affirming experience - allowing the truth to be spoken

Validating feelings - the centrality of emotions

Recognising distress - acknowledging pain and suffering

Working with shame without shaming

Recognising resilience in the face of adversity (self-hypocrisy)

Legitimising protest not passive accommodation

We are in it together vs. ‘us and them’


Reclaiming humanity


Is there anyone here who has not been:


abused, beaten, bullied, derided, violated, degraded, humiliated, hurt, rejected, marginalised, excluded, dismissed, devalued, undermined, tormented, cheated, conned, taken advantaged of, coerced, made to do things they haven’t wanted to?


Felt powerless or hopeless or worthless or alienated or despair?




“What people really need today is a damn good listening to”.   Mary Lou Casey


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