Crime fiction, which we can also call “murder fiction”, has been popular since the 19th century, when the United States and my home country Britain dominated the genre. The trend continued, although the number of violent crimes in general decreased, and intentionally taking a life became an increasingly unusual way for people to break the penal code. In recent years, along with invented mysteries and thrillers, we have seen the rise and rise of the true crime genre on streaming services and in audio podcasts. It seems that everyone wants to know more about the minds of the killers.
As it happens, this is my daily job; I have spent the last 30 years working with violent offenders as a forensic psychiatrist and psychotherapist. I recently teamed up with playwright Eileen Horne to describe my experience in The Devil You Know: Stories of Human Cruelty and Compassion (Scribner). Our book is an invitation to come with me to sessions where I meet people who are considered the worst among us. With 11 stories of men and women who have either killed or committed other serious crimes such as persecution and sex offenses, we try to fill the void after Netflix or the podcast credits have been rolled once the judge has ruled and the safe doors are locked . What happens next? Can they get help to change?
I have been an avid reader of crime throughout my life, sometimes surprising people who can not help but wonder why I do not want to leave it everything on the office. I tell them that the best detective stories focus on restoring order in chaos, which I find relaxing and reassuring. Over the years, I have noticed that my patients are also interested in crime fiction, even though they are mainly in the form of dramas they watch together on television. I remember a therapy group for perpetrators who especially enjoyed the American series Dexter, with a forensic professional who is secretly a serial killer. I am more ambivalent about watching television and movies in the crime genre because they often dwell on the suffering of victims in ways that I find unmotivated, and I become impatient when perpetrators are portrayed as overtly strange, remarkable, or prematurely wise. As better minds than mine have defined it, evil is banal, even common.
I grew up with the British criminal fictions that made an art form out of the ordinary, the masters and mistresses of the humdrum murder. I have my mother to thank for nurturing this at an early age; it was our weekly treat to walk down to the Barrington Street Library to borrow books and stop to get some oysters from the fish and chip shop on the way home. It must have been she who recommended that I try to read Agatha Christie, whose works were among the first I chose. Of her characters, I have always wished Miss Marple the best because she highlights the importance of being a good observer of human behavior.
Perhaps it was inevitable that when I qualified as a doctor and came to choose a branch of psychiatry, it would be forensic work that attracted me the most. The word forensic medicine is derived from Latin forum, which means a place where disputes are dealt with or a court. My colleagues and I assess and manage people whose mental health issues lead to legal issues that may lead them to criminal or family law. In addition to making expert statements about people’s state of mind, we also take care of the small number of people who have committed acts of violence while mentally ill, or offenders who have become mentally ill in prison, which is more common. I gained an additional qualification as a psychotherapist when I realized I wanted to focus on the human stories behind serious acts of violence.
Carl Jung once wrote to Freud that he felt “the cause of evil in the world is that people are unable to tell their stories;” I have seen firsthand that there is truth in this. The case histories I describe in our book explore my patients’ stories of their lives and what they have taught me about our shared humanity and capacity for both cruelty and compassion. It seems to me that the best criminal writers have traveled the same path when exploring the ambiguities between good and evil.
I’ve heard it said about detective fiction that “when you know why, you know who.” Finding out that “why” is just as important to me as it is to criminal writers who invent a story or to any real detective. Just as narrative causality is the engine of fiction, the “why” provides the basis for forensic approaches to attempted murder. It is not enough for me to tell the court that a defendant had a recognized medical condition at the time of the murder. Their mental state must explain what happened, which makes sense to the meaningless. The jury is then free to accept or reject that story.
“Why” will affect a criminal court ruling on whether the defendants’ agency was diminished because of their mental state, which under British law would make them guilty of murder instead of murder. If convicted after the trial, their story could change in prison. A young woman I worked with, Kezia (who stabbed a nursing worker who she thought was possessed by a demon), moved from thinking “My mental illness made me do it” to “When I was uncomfortable, I thought, that I was in danger, but now I can see that I was wrong. “This is the success of a forensic professional: an opening of the mind that can gradually make a patient take responsibility and move on. One mind at a time makes this world a safer place.
A similarly ambitious mental shift is required of the psychotherapist. As a young intern, I had to reconsider many preconceptions, some of which probably stem from the mystery novels I grew up on. Despite the large selection of compound killers pursuing through English country houses and picturesque villages, Britain’s homicide rate today is around 700 per year in a population of 66 million. In the United States (where the population is five times ours), the intentional homicide rate is approx. 18 times higher, but still not close to the violent epidemic proposed by American crime novels, movies and TV shows.
When I studied the research into violent behavior, I would also find that certain recurring risk factors had to be adjusted, like numbers in a bicycle lock, before someone committed a fatal act. These can include being young and male in combination with things like substance abuse, social isolation and past criminal history. The final number that releases lethal violence will be idiosyncratic, possibly some harmless act from a victim that only matters to the perpetrator. For some of my patients, this may take the form of a simple greeting or a smile.
I learned early on that mental illness was not usually one of those risk factors for “bike lock”. Despite ubiquitous ideas in our culture about insane killers or insane sexual offenders, it is rare for anyone who is mentally ill to harm another person, let alone take a life – unfortunately, they are far more likely to fall victim, and forensic. psychiatrists will not assume that violence is a sign of mental illness.
I recognize that writing crime should be a deterrent, especially in a modern world where social media and cell phones present terrible plot problems, just as they do for real criminals. Who can disappear anymore? Who can not be detected in our time? When I sit with violent offenders in therapy, I try to find out with my patient what the function of their violence is for them. What problem do they think it solves in their lives? I try to keep in mind that how horrible their offense they are, they are generally people with parents, friends, hopes and dreams; they were all children once, like any of us. In the most compelling criminal writing, I have found that the author also allows us to consider the entire life story of the perpetrator.