The mad, the bad and the greater good

19 November 2010

 Broadmoor Hospital
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Image: Asylum for Criminal Lunatics, Broadmoor, Sandhurst, Berkshire. Illustrated London News 1867 / Wellcome Images.

It was a strange feeling, pulling up to Broadmoor Hospital in three large coaches full of buzzing Wellcome visitors, ready to listen to A C Grayling speak with Gwen Adshead, Consultant Forensic Psychotherapist at the hospital. As the coaches drove past the hospital and into a neighbouring parking lot, it seemed as if everyone was stretching their necks to catch just a glimpse of the large brick building surrounded by solid walls with masses of wires atop.

Of course, as enthusiastic as everyone was, they didn’t let us near the actual hospital. We could only gaze at it through some trees from a distance as we walked into the ‘Exchanges at the Frontier‘ event inside the adjacent Learning Centre.

Opened in 1863, and known as the infamous Victorian asylum for ‘criminal lunatics’, Broadmoor still upholds its celebrity as somewhere that society’s insanest members end up. Notable inmates have been: Edward Oxford, for attempting to assassinate Queen Victoria; William Chester Minor, former US army surgeon and murderer, who also made large contributions to the beginning of the Oxford English Dictionary; and, more recently, Peter Sutcliffe, the ‘Yorkshire Ripper’.

Upon a windy ridge near the rim of the Berkshire moors, surrounded by trees and towering over the nearby town, it seemed clear that the Victorian architecture and stories of inmates past had definitely stigmatised Broadmoor as a terrifying and unsafe place. More like a prison than a hospital.

What I was hoping this event would focus on, however, was what happens inside the hospital today? How do we medically treat the criminally insane now? Is it really as scary as it might seem? Dr Adshead, a smiling and seemingly thoughtful woman, was quite open and honest about all of these questions and more.

People are admitted to the hospital for three main reasons. One, they have committed a serious offence, but have mental disorders which make them unfit for a regular prison. Two, they have developed a mental disorder whilst in prison. And three, they are so mentally disturbed and at a potential risk of harming themselves or others that their behaviour cannot be handled in other areas of the NHS. The population of the hospital is currently at about one-third of each category. One of the very first key themes to arise in the chat between A C Grayling and Dr Adshead was the idea of ‘dangerousness’. How can one validly assess the risk someone poses?

Dr Adshead made it absolutely clear that as tempting as it would be to class certain disorders with crime, there is no direct link between the two. She went on to say that the public searches for simple and clear explanations for crime, as these are easier to understand and more comforting. Most patients understand that society rejects their behaviour, making them outcasts. One of the main benefits, however, is that since this is how they have always felt, being at Broadmoor helps them cope with finding their identities in a safe community. Patients often need space to think about their actions, how they are going to cope with their behaviour and how they are going to talk about their actions in the future, especially with someone who they may have hurt.

Patients have no choice as to whether they are admitted to Broadmoor or not: the courts do; however it is not a prison. It is considered rehabilitative care for those who are so deeply disturbed that the courts and physicians deemed them better off at Broadmoor than in prison.

 A C Grayling (left) and Dr Gwen Adshead (right)
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Image: A C Grayling (left) and Dr Gwen Adshead (right) Photo: Shannon Harmon

The main aim is to make the patients feel more secure within themselves, and to assure them that one’s sense of self can change, and for the better. Just because they are very disturbed, anti-social and badly behaved doesn’t mean they always have to be. The point, Dr Adshead went on, is not to try and cure patients, but to make them internally secure with an individualised menu of treatments, hopefully making them pose less a risk to themselves and society. From art therapy and CBT to drama and group therapies, Broadmoor has the full range of therapists to help patients articulate their problems, progress and recover.

Knowing they are stigmatised not only by the hospital’s Victorian reputation, but also as a place that is commonly referred to as where some of the most violent criminals of all time have been and still are, most patients realise that the task before them is demanding and difficult. Overcoming not only where they are, but who they are, are both important steps in their treatment. Dr Adshead explained that most of the time the staff’s efforts are met with a lot of resistance. It can take a long time before someone calms down to engage with their therapy. Eventually most patients open up and start to experience a sense of security and attachment within the hospital.

During questions, when asked why she would ever want to work at a place like Broadmoor, Dr Adshead replied that she is mostly interested in what makes people do extreme things. She said that giving compassionate, highly skilled treatment to society’s least loved was important, because it is for the greater good. The level of health in a society can be measured by asking the question: “How do we treat the people we don’t like?”

She didn’t deny what a hard job it is, and one that can be quite painful for the staff. Regularly taking on verbal abuse as well as finding it quite frightening to be in close quarters with the mentally disturbed at the hospital, a lot of the staff undergo some sort of therapy themselves.

With all this in mind, I pondered what being a staff member might be like. I decided it had to be the most difficult, yet rewarding job in the world. Helping people change, as resistant as they might be, is a vital role in rehabilitating anyone, no matter what mental illness they suffer from. It is not about judging the people for what they did, forgiving them or even forcing them to feel bad about it. It is helping them discover a sense of self, deep down, separate from their illness. As Dr Adshead said the work she does “contributes to the greater good” for these people as individuals, as well as for society.

I certainly walked away from Broadmoor knowing that good things happen there, even if the patients inside were, on a social level, considered ‘bad’. I felt I had a better understanding of why certain people don’t belong in prison, and was far more sceptical of the myths and reputation behind Broadmoor itself.

Click here to listen to a recording of this talk on the BBC website.

Shannon Marie Harmon is Assistant Online Editor at the Wellcome Trust.