What kind of people are these who torture, rape, and murder? A forensic psychiatrist says: They are no different than us.

Gwen Adshead, you once said that you don't like telling strangers what you do for a living. Why not?

When I told a seatmate on an airplane that I was a therapist and worked with people who had committed serious crimes, many reacted with shock and said, "People like that don't deserve help. They should be executed." These days, I prefer to say I'm a florist. I enjoy that profession; perhaps I'll learn it after I retire.

You've worked as a forensic psychiatrist for over 30 years and have treated some of the UK's most violent criminals. Are there any patients who stand out in your memory?

I remember mostly positive stories. For example, a man I worked with for ten years to overcome his cruelty. He was successfully reintegrated into society and, although he is still under surveillance, hasn't committed any more crimes. He painted a beautiful picture for me, which I still keep. In it, he processed what it feels like to be a patient in a secure psychiatric institution.

Were you never afraid of your patients?

Before I see a patient, I ask the nurses how they're doing. If they tell me they're not feeling well, I cancel the session. But you have to know: the majority of patients are very interested in working with me. They don't want to terrorize me. That only happens in movies. My patients have little in common with Hannibal Lecter, the psychopath from "The Silence of the Lambs."

We find it hard to believe that you don't have bad memories.

In over thirty years as a therapist, I've only had to interrupt a session twice. Patients threatened me or my family, but I usually dealt with such incidents quickly. I know that when patients are upset, they don't mean me personally. They're angry about their situation and are taking their anger out on me.

What kind of relationship do you have with your patients? Do you have to understand them or even like them in order to treat them?

It's rare that I develop strong feelings for the people I treat. As a doctor, I've learned to put aside my personal reactions. I don't have to like my patients, just my work. I manage to do this even when I know I'm dealing with a very violent person. I try to be impartial in a way that's both warm and detached. I call this radical empathy.

Isn't it difficult to be empathetic towards mass murderers and rapists?

It's not about feeling goodwill. It's about being interested in the person. To understand who they are and why they are the way they are.

How does it feel to sit across from a serial killer?

Of course, what these people have done shocks me. But it's my job to work with them, and I want to fulfill that job to the best of my ability. I meet the perpetrators in a different context than their victims. I work with them in the protected environment of a prison or a clinic. In these situations, they are no longer frightening people. They have lost their power.

How do you work with offenders?

In therapy, I make it clear from the beginning: "Jim, you've done something terrible." But I want to understand, not judge or shame. Most of the time, people already feel bad. I'm there to help them become less dangerous and support them in refraining from violence. Studies show that therapy reduces the risk of relapse.

Can you give an example?

I had worked with a young man named Jacob, who had a history of violence and killed another man with a single punch. It wasn't intentional killing. The two argued, Jacob struck, and the other man fell and died. Jacob spent eight years in prison. When he got out, he was no less dangerous. Only after meeting his victim's family and undergoing therapy did he change. He began to take his violent tendencies, his drug addiction, and his criminal background seriously. Today, he works in prisons and is involved in the rehabilitation of offenders.

What interests you about the biographies of perpetrators?

I'm fascinated by how people find themselves in situations they later regret or are ashamed of. The idea of ​​making a decision that one later can't understand isn't foreign to me. Even though I've never committed a serious crime myself, I can understand the emotional logic behind it. The human psyche is complex and fascinating. I compare it to a coral reef.

With a coral reef?

The brain is often compared to a computer, but in my view, that's inappropriate. The human mind is more complex and harder to penetrate. It doesn't lie on the surface. You have to dive deep to understand it, like a coral reef. And even then, much remains hidden. We often know ourselves less than we think. We also like to suppress our capacity for cruelty.

You hear terrible stories every day. How do you switch off at night?

I work in secure psychiatric hospitals and prisons. When I leave these institutions, I take off my heavy key chain, go through security, and pick up my cell phone. This ritual helps me leave the workday behind. Even the 40-minute drive home gives me time to gain emotional distance.

You've published a book about your work. In it, you write about a father who abused his two sons. And about a young homosexual man who killed three sexual partners and then beheaded one of them. Many would call such perpetrators monsters. They say they're people like you and me.

I reject dividing the world into "the bad guys" and "the other people." A look at history shows that every human being is capable of doing terrible things. No one is immune. Anyone can enter a state where they feel the desire to hurt or humiliate others. I call this the "evil state of mind."

What kind of condition is this?

In such moments, you lose all sense of other people's vulnerability. You're in a daze, wanting to be cruel. But once the daze is over, the evil state of mind disappears. It's rare to see someone sitting at the police station grinning and saying, "Hey, I killed someone, that's great."

This "evil state of mind" sounds like a mental illness. Is it?

No. Most of what we know about the "evil state of mind" comes from studies of National Socialism. During the Nazi era, it seemed acceptable in Germany and the occupied countries to commit cruel acts because the regime encouraged them and like-minded people encouraged each other. These people weren't mentally ill. But whatever violent tendencies they had were socially activated.

So you're saying there is no such thing as pure evil?

People aren't inherently "evil." It's not an innate trait like eye color or left-handedness. In my opinion, we're not born "good" either. Kindness is something we have to work on. We're born with predispositions—with the potential for great kindness and great cruelty. Kindness and empathy develop through nurture and conscious choices.

Philosophers and theologians have been debating evil for thousands of years, and you say it doesn't exist?

The big question that has always preoccupied us humans is: How should we live? What makes a good person? And why are people capable of unimaginable cruelties? People believe in good. And anyone who believes that good is real must also believe that what is not good is real—and that means thinking about evil.

We humans seem fascinated by evil. Violence dominates the entertainment industry. A large portion of today's films, TV series, podcasts, and books are crime thrillers and true crime stories. Why do they appeal to us so?

We're interested in crime because any of us can enter an "evil state of mind." We ourselves could be the one doing terrible things. Humans have been telling horrific stories for entertainment for thousands of years. Think of Greek tragedies. They were extremely popular and featured incest, rape, and murder. Aristotle said these narratives of such atrocities were a way to explore those disturbing emotions within us. There might be something to that.

In TV series, perpetrators are often portrayed as monsters, as psychopaths who torture for pleasure or pure lust. Like the handsome bookseller in the Netflix series "You." He obsessively seduces and kills young women. In your experience, how common are these forms of violence?

Serial killers are rare in real life. Most cases occur in the USA, but even there, the number has declined significantly in recent decades. In 2015, 45 serial killers were arrested in the USA—not many in a population of 300 million. Most people who commit serious crimes are also nowhere near as charismatic or intelligent as they are portrayed in films. I'm always amazed at how ordinary murderers often are and the banal reasons they kill for.

Who poses the greatest danger?

In very rare cases, perpetrators lie in wait for strangers to torture them. Most murders occur within families or relationships. Statistically speaking, the person you currently share a bed with is the greatest threat to your life.

Why does the entertainment industry present us with murderers who hardly exist in real life?

A writer once explained it like this: Crime stories are often about bringing order back to the world. In the end, good triumphs. The sequence of events is usually similar: something bad happens, someone sets out to find the truth, finds the culprit – and they are brought to justice. In this way, the chaos is resolved and justice is served. We learn why the terrible thing happened and are not left perplexed. On television, we are almost always presented with a conclusive ending. In real life, it is different: there are rarely good answers to violent crimes. And sometimes none at all. Like last summer here in Southport.

What happened there?

A 17-year-old stormed into a dance school with a knife, killing three girls between the ages of 6 and 9 and injuring ten others. We have no answer as to why he did this. It's simply a terrible story with a terrible beginning and a terrible ending. And there's no resolution.

Many people believe that such murderers don't deserve sympathy and should simply be locked away. They argue otherwise.

The devil we know is less dangerous than the one we don't. If we want to reduce murder and other acts of violence, we need to learn as much as possible about them. This also means talking to those who commit serious crimes—rather than just speculating about what drives them. We need to understand what's going on in the minds of perpetrators in those moments.

In the foreword to your book, you say you tried to decipher the code of evil. Did you succeed?

At least partially. I work with the so-called combination lock model. It states that our capacity for cruelty is fundamentally locked. That's the good news: Most of us never resort to violence, so it's not an inevitable part of human life. But for some people, the combination lock opens, and something terrible happens.

What is happening at this moment?

The more risk factors coincide, the more likely the lock will open. The first two numbers are sociopolitical in nature and reflect attitudes toward masculinity, vulnerability, or poverty. To be clear: Most violent crimes in the world are committed by young, poor men. The next two numbers relate to personal, biographical aspects of the perpetrator, such as drug use or traumatic childhood experiences. The last number, the one that opens the lock, is the most fascinating.

Only she triggers the cruel act?

Yes, and it's difficult to predict. Often it's something the victim says or does. A sarcastic comment, an offhand remark, or even a smile. I was recently involved in a case where a young man killed a young woman. She was his ex's best friend and had come to pick up her belongings from him. During an argument, she said something like, "My girlfriend is too good for you." She didn't know that the young man was extremely ashamed and angry, and that a knife was within reach. Did he intend to kill someone that morning? Most likely not. But the young woman is now dead, and he will likely be sentenced to life in prison.

You said that childhood trauma can also lead a person to become a murderer.

Physical abuse, emotional abuse, and neglect in childhood significantly increase the risk of later violence. We know this because the proportion of people who experienced traumatic childhood experiences is above average among prisoners.

How high?

Approximately ten percent of all people experience four or more forms of trauma in childhood, such as psychological, physical, or sexual abuse, neglect, domestic violence within the family, or drug- and alcohol-dependent parents. This proportion is the same in almost all countries where studies have been conducted. However, in prisons, whether in a youth center in Florida or a prison in Wales, around half of all violent offenders have experienced a high degree of childhood trauma. That is, around five times the average for the population. Therefore, it must be assumed that traumatic experiences play an important role.

Which ones do they play exactly?

If children experience fear and pain in the early years, or receive too little closeness and attention, this can impair their ability to empathize with others. Be it in kindergarten, at school, or later in relationships. They perceive others as less sentient beings. The first people a child forms a bond with are usually their parents. If their parents frighten or neglect the child, they will probably tend to withdraw internally and shut down emotionally. If physical violence occurs, the child feels helpless and develops anger. But young children do not yet have the emotional maturity to deal with these strong feelings. They lack the psychological tools.

Such people have trouble being empathetic?

Yes, because empathy means being interested in the thoughts of others. To develop this ability, you need a stable sense of your surroundings and self-confidence. If both are lacking, social thinking lags behind. At best, it's weak; at worst, it's destroyed. Then you might believe that other people aren't real.

How can this affect later life?

For example: If you experience multiple traumas in the early years of life, you often have difficulty learning how to deal with fear and stress. During puberty, you may then turn to drugs or alcohol to reduce the unpleasant feelings. These affect the brain, which is already reorganizing itself under the influence of sex hormones. Drug abuse greatly increases the risk of violence. If you then join a group of people who are just as bad, the danger is even greater. Anyone who constantly gets into arguments, especially while intoxicated, runs a high risk of killing someone sooner or later. The vast majority of homicides are committed by young men against young men - usually under the influence of alcohol. In England and Wales, 90 percent of perpetrators and 71 percent of victims are young men.

Why are prisons all over the world full of men?

Anyone who knows the answer to this question would win the Nobel Prize. I can't answer it. It's remarkable that there isn't a culture in the world in which men don't commit at least 80 percent of violent crimes. This is related to our understanding of masculinity. The American psychiatrist James Gilligan describes a certain form of masculinity in which showing oneself vulnerable is considered unbearable. That's why some men try to suppress the feeling of vulnerability completely. They tell themselves: We don't think about it. We don't talk about it. Instead, they seek strength by humiliating or hurting others. In these moments, they feel powerful, but this feeling of power comes at an enormous price.

However, most men never become violent.

Violence is something extraordinary, even if many of us don't perceive it that way. Murder, in particular, is very rare. I don't know how high the rate is in Switzerland.

In Switzerland, there were a total of 45 homicides in 2024.

. . . and in England and Wales, there are around 600 murders a year. That's undoubtedly 600 too many. But we have a population of 40 million people. So the probability of becoming a murderer is infinitesimal. The probability of being murdered by someone is also infinitesimal. In Europe, violent crime has been declining for over fifty years.

Why is that?

We take violence more seriously today than we did a hundred years ago. People used to say, "That's just how people are." Today we say, "No, that's not how people are." Violence is the behavior of a few. And we strive to understand why they became violent.

Aren't there also psychopaths who torture and murder for no reason?

Yes, they exist. But identifying them isn't easy. Those who have committed multiple murders are probably among them. The problem, however, is that antisocial people in particular don't even come to therapy. They don't want to feel vulnerable under any circumstances. Most other perpetrators are open to therapy, and we can learn a lot from them.

What have you learned from patients yourself?

In therapy groups, I learned a lot about child sexual abuse. It was striking that most perpetrators shared similar narratives. They were less concerned with an abnormal sexual inclination than with the desire to have complete control over someone. When you completely control someone, you can do whatever you want to that person. They are unable to say no. This kind of thinking is at the heart of many forms of human violence and cruelty. I learned something different from murderers.

What?

They all create their own story. It's about why their actions were inevitable or justified. Some enter a dreamlike state during the crime, which makes it difficult for them to remember the details afterward. This makes it easier for them to think, "Nothing happened." Therapy is about understanding this story and then gently unpicking it. People need to learn that what they thought was real isn't. Often, this involves realizing that they had a choice and chose something terrible.

How do murderers react to this?

I can't force patients to accept this realization. But I'm continually amazed at how many offenders dare to do it. Those brave enough to look deep within themselves can change. But it's hard work.

Is it easier to serve your time in a cell?

Yes, because thinking about what you've done hurts. It's easier to deny the crime or shift the blame onto others. Imagine if I told you: For the next eighteen months, we'll meet every week. Each time, we'll talk about the worst thing you've ever done and how bad you feel about it. I'm pretty sure you wouldn't be looking forward to it. I remember one murderer who told me: "Actually, it wasn't my fault. If the psychiatrist had taken better care of me, I wouldn't have committed such a terrible act." This man didn't want to take responsibility. Not surprisingly, he struggled with therapy.

How long does it take for someone to make progress in therapy?

We find that most patients need at least a year before we can even begin working with them properly. For one thing, many perpetrators have very complex personalities with serious mental illnesses. For another, most of them have never really thought about what's going on in their heads. Sometimes they are barely able to recognize a feeling or a thought and put it into words. They have to learn how to do that first. There are no quick fixes. Psychiatry is the same as general medicine: the sicker someone is, the longer the treatment takes. Sometimes perpetrators begin to feel really bad during the course of therapy when they honestly confront their crime. It also happens that they consider suicide.

How many of your patients regret what they did?

Almost everyone who undergoes therapy eventually feels deep remorse. That's the horror of killing someone: You can never make it right. Even if you dedicated your entire life to doing everything you can, it would still be insufficient. Taking a life changes the fabric of the world.

But what about those who are not willing to work on themselves?

These are the truly dangerous offenders. They claim, "Everything's fine, I don't need help. When I get out, I'll just get on with my life." Such people remain a risk because they don't learn anything from their time in prison. Upon their release, they pose just as much of a threat as before. That's why we must try to work with violent offenders while they're in prison. Simply locking them up wastes resources.

They criticise the fact that mental health is still neglected in Great Britain and other European countries.

My colleagues and I work in a difficult environment, especially in prisons. The massive budget cuts of recent years have exacerbated the situation. Few violent criminals receive psychiatric care, even though investments here would save costs in the long run. It's important to convince people of the importance of a better balance between physical and mental health.

Do you worry about the future of your work?

I hope that our psychiatric great-grandchildren will one day look back on our time as if they were looking back at the Middle Ages. That they will shake their heads at how much effort and money we put into cardiac research while virtually ignoring mental health. A society is only as healthy as the minds of its people.

But what do you say to the father who says, "I don't want my daughter's murderer to be treated well. I want him to suffer and be locked up forever?"

Of course, people affected by a violent crime have thoughts of revenge. We should also help these people cope with their anger and grief. But there are no long-term support programs for the families of murder victims. They have experienced the worst loss imaginable. So I understand the question: "Gwen, why are you helping these criminals?"

And what do you answer?

No therapy excuses violent crimes. Our goal is for perpetrators to learn to live without violence. And we are prepared to do everything we can to accompany them on this path.

In your book, you wrote that there's too little room for forgiveness in society. Do we need to forgive more? Should we forgive everything?

It would be nice if everyone could forgive one another. There's a reason why forgiveness is highly valued in almost all faith traditions. There is no religion that doesn't expect it of its believers. But forgiveness belongs to the one who has something to forgive. It's a gift. It's not something the law can prescribe. Not everyone can or wants to forgive. But there is evidence that people who can't forgive struggle with their own mental health.