How did we get here?
and some myths about madness and badness along the way
Monday 17th November 2003
Consultant Forensic Clinical Psychologist
Nottingham Forensic Service
Nottinghamshire Healthcare NHS Trust
Author: Violence in Society - The reality behind violent crime
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
- ‘OTHER’, US and THEM
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.
- 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
- 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’
- 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