Inside the mind of a serial killer —
a former Broadmoor psychiatrist reveals all

Gwen Adshead has spent her career trying to understand what drives her patients to commit their heinous crimes. She reveals what she has learnt…

One of the many problems with killing somebody is what to do with the body,” the forensic psychiatrist Gwen Adshead tells me. We are discussing Tony, one of the many violent offenders she has treated over the past three decades while working in Britain’s prisons and secure hospitals.

In her role as consultant at Broadmoor, the psychiatric hospital in Berkshire, she came face to face with some of Britain’s most notorious patients. There is little about Adshead — calm, blonde, composed — to suggest a life spent not just talking to sex offenders and murderers but opening up the box of horror and trying to make sense of what she finds inside.

She has now written a book about her work. It is an extraordinary tour through the psyches of the criminally disturbed, every bit as discomfiting as it is fascinating. Tony was a serial killer she treated at Broadmoor who was serving a sentence for the murder of three people, one of whom he had decapitated. “There had been much lurid public speculation about the ‘profile’ of the monstrous mind that had done such a thing,” she writes, but Adshead was about to discover his reasoning was actually quite prosaic. The head had been so heavy it was “like a bowling ball”, he said, and he had to cut it off in order to get it out of the house.

As he explains this, she is conscious of the need to remain expressionless. “Freud likened the work of therapy to surgery, and we wouldn’t think much of a surgeon who opened up someone’s abdomen and ran from the room, crying, ‘There’s cancer everywhere in there!’ ” So she sat listening politely. “To anyone passing by … we might have been chatting about the weather.”

Our interest in good and evil is an inherent part of being human, Adshead says. “Humans have the capacity for great goodness, but we may also find ourselves doing something horrible — what takes us there is what drives the interest; deep down we wonder, could it be me?”

Born in Christchurch, New Zealand, Adshead trained in the UK as a doctor, then as a psychiatrist, and completed a master’s in medical law and ethics at King’s College London. She was always interested in ethical questions such as “What is the proper response to someone who has killed?” Forensic psychiatry — working with people who have broken the law — “just seemed to fit”, she says. She later trained as a psychotherapist and was employed at Broadmoor from 1998. Her job was to try to help patients accept responsibility for what they had done. As one patient put it, “You can be an ex-bus driver, but you can’t be an ex-murderer.” She now does the same work at Ravenswood House, a medium secure unit.

It hasn’t always been enviable work. She recalls hiding in a cupboard while a patient “growled with fury” and gouged chunks out of a colleague’s door but, she adds, she usually isn’t at risk. Cold-blooded killing is normally the preserve of organised crime. The people she has worked with tend to be highly disturbed individuals, whose violent episodes — the result of extreme mental disorder — can come and go. “People kill their wives and bury them under the patio and still go to Sainsbury’s to buy a pint of milk,” Adshead says.

She describes her patients as survivors of a disaster, where they are the disaster and she and her colleagues the first responders. She has to help them come to terms with their actions. It is the humanity in the stories that makes her book, written in collaboration with the dramatist Eileen Horne, so extraordinary. Marcus, who has killed one of his lovers, was adopted by parents who were violent and neglectful. “All I ever wanted was to be beautiful,” he weeps as he recalls how he felt ridiculed when his victim showed him her profile on a dating app. She tells of an encounter with Ian, a middle-aged man who sexually abused his two sons. He is weighing up whether to agree to meet one of them 15 years on. “He talked about wanting his son’s forgiveness but even then he knew it would not be enough. How could he ever forgive himself?” Six months later Ian took his own life.

Working with people like this requires “radical empathy”, Adshead says, a kind of detachment that allows you to see the offender’s point of view without losing sight of the crime and its impact on the victims. Without it “you can get swept away into a black-and-white world where victims are in one camp and perpetrators in another, and they can never have anything in common, which is just not true”.

Does anything horrify her any more? “Yes, it does,” she says. “If it didn’t, it’d be time to stop.” She finds convicted rapists particularly difficult to work with, “because rape is a very disturbing offence, it is very rare for it to be associated with mental illness. It is an offence that is about terror and humiliation.”

There are those who would argue that the people Adshead works with do not deserve therapy or understanding. That instinct for revenge is one she understands. “In a busy, confusing, scary world it makes us all feel safer to think the good guys are over here and the bad guys are over there,” she says. But “people who do horrible things are not monsters, they are people for whom all the bicycle-lock numbers came together into a catastrophe, and they are standing there and somebody is dead and they are thinking, how the hell did this happen?”

It is only by attempting to understand the factors that cause violence that we can prevent them from happening again.The vast majority of violent offenders are men but Adshead points out that most men are not offenders (her book is dedicated to her two sons). There are, however, known risk factors — substance abuse is one of the key ones, as is childhood adversity. Adshead says she has seen the same themes come up again and again: “Terrible violence often seems to be related to memories of trauma; unresolved stress, unresolved hatred, unresolved terror. If we understood that better, perhaps we could intervene much earlier.”

There is also a practical reason to try to make sense of these crimes. In the UK we imprison more people than anywhere else in western Europe, and more than a third of our prisoners report having mental health or wellbeing issues, ranging from depression to psychosis — though the actual proportion is estimated to be far higher. Most will not get any kind of treatment or support before they are released again. Adshead says we need to reconsider our approach: “You are going to have to let people out eventually, so we had better get good at trying to help them not to offend.”

Rehabilitation is almost always possible to some extent, though it depends on whether the ultimate goal is release into the community or some kind of secure halfway house. In rare cases such as Lydia (below), who stalked her therapist, there is a real chance that the person will never be cured — because it is the delusion that is keeping her stable. This is a real problem with treating stalking behaviour. “If they were to give it up they might disintegrate with the stress and become completely overwhelmed,” Adshead says.

The names of all offenders have been changed. 



Inside the mind of a female stalker

In an extract from her book, Gwen Adshead recalls the moment she realised that a woman who had terrorised a male therapist may now be a threat to her. Lydia’s victim, Dr W, was a therapist in private practice whom she had seen for grief counselling after her father’s death. They had several sessions, which seemed to help her, and her therapy ended after an agreed period. Some six months later Dr W was alarmed to get a Valentine’s card from Lydia expressing her love for him. She “couldn’t wait” to see him, she wrote, as if they’d been having a relationship. He responded carefully, saying he was unable to meet her again, but she could seek therapy from other sources.

To Lydia this refusal was unacceptable. After previously living a crime-free life, she began a campaign of harassment, bombarding Dr W with emails and texts. When he did not reply, she reported him to his regulatory body, claiming he had initiated a sexual relationship with her when she was his patient. Things escalated when he encountered Lydia outside his home and had to insist she leave.

According to the textbook definition, Lydia did not pose a high risk of harm to Dr W, but that was not what he felt or experienced. Her persecution of him was invasive and prolonged, lasting well over a year, potentially impacting his livelihood. Her overriding goal was to be with him in person, even if that meant seeing him in a regulatory hearing; for someone trapped in a delusion, negative contact is better than no contact at all. When that didn’t come to pass, she went to the police with her claim that Dr W had sexually assaulted her while she was his patient, which meant another investigation was launched. When it became clear that there was no case for her therapist to answer, the police cautioned her, but this only fuelled her sense of grievance. She staked out Dr W’s home, damaged his car and put a card through the letterbox addressed to his wife, with graphic descriptions of the rape she had accused Dr W of committing.

He was advised to take out a restraining order at that point, but Lydia ignored it and appeared at his home again, this time throwing rotten meat over the fence, intending that the family’s dog would eat it and die. Such cruelty to a victim’s pets is not unusual, and it is an alarming escalation because it targets a living thing the victim values; they or their human loved ones may be next. Lydia was eventually arrested. She was convicted and sent to prison. Sentences for stalking in the UK have become tougher over the past decade, but at the time Lydia got three years and served two due to her good behaviour in prison and the fact that she expressed remorse for her offence.

I first encountered Lydia just before she was released. We would be meeting after she left prison for a series of five or six sessions, at the request of her probation team. I would be evaluating her risk and exploring the roots of her offence with her: her life experience, personality, how she coped with stress. I had the impression no one on her team was too concerned about the risk to the general public.

At our initial meeting Lydia seemed a picture of serenity and calm. I wonder if someone passing the prison visiting room that day, glancing through the glass walls, would have known for certain which of us was the professional and which the soon-to-be ex-prisoner: two women, both in middle age, of similarly unremarkable appearance. Lydia told me her offence was a “dreadful mistake” and said she had no desire to do anything that might cause her to return to prison. Although she’d been a solicitor “before all this”, someone had suggested she might initially get some work dog-walking, just to ease back into things, no pressure. It all sounded very sensible. It was difficult to imagine this woman making someone so fearful they would ask the authorities to restrain her.

Our first proper session together came a few weeks after her release. We met at the local secure unit where I was doing some work; at first she was as pleasant as she had been in our initial encounter. For this first session I let her lead me, and she meandered along, describing some renovations she wanted to do in her kitchen and commenting about the weather. At the end I felt we’d connected pleasantly enough.

We made an arrangement to meet again. She started to walk away, then paused and turned. “Oh, I meant to say, I googled you.” I nodded, unsurprised. Most people meeting a professional will google them first. “Bye for now,” she called, as she walked away, her back straight and head held high. The word “control” came to mind: the dog walker with a tight leash.

In preparation for my next session with her, I read the psychiatric reports from the trial. It transpired that after her father’s death, Lydia had been disturbed by memories from her teenage years, and she had revealed to Dr W that her father had sexually abused her. She had never told anyone about this before.

I wondered if the painful retelling of this abusive relationship had triggered some deep confusion in Lydia’s mind between her father and her therapist. When she came to our next session, I began with a few general questions about Lydia’s childhood. Her answers were brief, almost terse. I asked her for five words to describe her relationship with her father, with a memory provided for each word. Lydia seemed stumped by the question, and we sat in silence for a few minutes. Eventually she exhaled deeply and said, “Sorry, no. I can’t think of any words. I mean, he was an excellent father in every way.”

“Is there any memory you have to go with that word ‘excellent’?” Lydia furrowed her brow and gave no reply. The uncomfortable silence deepened. In attachment terminology, Lydia’s responses were “dismissing” and detached, “avoidant” of emotion. Forensic psychiatrists are trained to recognise that every emotion we feel in the room is clinically relevant. What I was feeling now was a nagging fear. I glanced at the panel in the door to see if anyone was in the corridor, newly aware of the alarm button attached to my belt. I wondered what I’d said to her to effect this change in atmosphere.

Abruptly, Lydia had twisted in her chair and was bent over a large briefcase she had brought along. What was in there? A weapon? As my anxiety level began to rise, she hauled out a fat lever-arch file, stuffed with papers. She pulled it onto her lap and flipped it open.

I relaxed a little, until I noticed the papers she revealed were densely handwritten and bizarre. Even upside down, I could see the text was full of underscorings, multiple exclamation marks and emphatic capitals, with a manic quality that made me think something was very wrong.

When she spoke again, her voice was colder, with the tone of a sergeant speaking to a subordinate. “What I need to explain, Dr Adshead, is that this has nothing to do with my father. I don’t like your questions, and frankly I find them unprofessional. What you must comprehend is that I have been the victim of a serious miscarriage of justice.” My mouth felt dry, but I encouraged her to go on. She released the binder clip and pulled out a complex flowchart of events and dates, holding it up as if presenting forensic evidence to a jury. “I can show you exactly where the prosecution lied and conspired with my alleged ‘victim’ ” — she almost spat the word — “to have me falsely convicted of a spurious offence.”

She continued: “I will set out the evidence to you that Dr W is a serial sex offender who has preyed on myself and another four unsuspecting female patients, to my certain knowledge. I propose to appeal against my conviction and will see to it that Dr W is charged with aggravated sexual assault. I will prove beyond all reasonable doubt that the prosecution deliberately withheld evidence that would have supported my case.” Thwack — she brought her palm down hard on the thick file to emphasise her point. I tried not to react, but I felt myself flinch.

She seemed to be untethered from reality. I told her I was confused. “When we first met, in the prison, you said you knew what you’d done was wrong, didn’t you? You wanted our support,” I said. She looked askance at me, as if I were the one behaving strangely. “Of course I need your support — in my appeal against my conviction, so I can return to my work as a solicitor. I’m the victim here, can’t you see?”

I realised that rational discussion was now impossible, and if I said anything else she could lose control altogether. I needed to close this down and get on the phone. “Lydia, can we leave it here for today? I need to think carefully about what you’ve told me.” Lydia slammed her file shut, obviously disappointed in me. It was extremely alarming that she had managed to hide the truth of her distorted thinking from every professional who had seen her since her arrest, including me. Lydia’s successful performance was an important reminder of how mental disorder can sometimes be a chameleon, hiding in plain sight. All along she must have been planning to return to her object of obsession at the earliest opportunity. Later I would hear that Lydia went to Dr W’s old office. The young woman who worked at reception explained he’d left months ago. Lydia launched into a bitter tirade, accusing the receptionist of hiding him and of being his lover. The terrified woman barricaded herself in the loo and phoned the police, while Lydia upended furniture, smashing a glass vase in fury.

Lydia was arrested. A swift assessment was made by the local psychiatric service, determining that she was in an acute psychotic state. It was decided that the risk was such that Lydia needed detention in a secure psychiatric hospital rather than a recall to prison under the terms of her probation licence. At least in a secure hospital she would have access to therapy, though I didn’t know if it would help her.

I thought that Lydia might continue in her delusion indefinitely, in order to keep unresolved distress and grief at bay. If she ever became aware of the full implications of what she had done, and what that meant for her future life prospects, she might become suicidal. Paradoxically, it could feel safer to stay in her fantasy world, where she was a well-bred and empowered professional, the daughter of an “excellent man” who just had to find a way to convince the world that she was right and everyone else was wrong. My brief interaction with Lydia happened over a decade ago, and it is likely that she is still in the secure unit today, preoccupied with her charts and her papers, absorbed in the conspiracy that is now her life’s narrative.

Credit: The Sunday Times Magazine / News Licensing.

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