The devil you know

Mike Guilfoyle
Thursday, 8 July 2021

The forensic psychiatrist Dr. Gwen Adshead comments with striking professional humility in a coda to her recent remarkable book, The devil you know.

'The many life stories I have heard in the course of my work,' she remarked, 'have given me an infinite respect for the mind's complexity.'

As I finished reading her book, I reflected on one of the more challenging supervisory encounters I experienced when working as a probation officer. Having been allocated statutory responsibility for Ezekiel's (not his real name) probation order with a mental health condition after a protracted period of bail remands to prepare a psychiatric assessment, I recall our initial meeting at the probation office being one of worrying professional uncertainty. Our verbal exchanges were terse and interspersed with periods of angry silence.

The index offences related to an unprovoked assault on a stranger in a public setting. The psychiatric report had noted that Ezekiel needed 'consistent and regular monitoring' and his volatile behaviour might, if left unsupervised, occasion a potential for 'further violence' especially so if his regime of anti-psychotic medication was to stop.

One of the welcome features of our professional contact was his high level of compliance with his weekly reporting to the probation office. I continued to liaise with his Community Psychiatric Nurse (CPN) and aimed to offer Ezekiel a safe space in which to better understand and address the context of his offending. I wanted to forge a constructive and empathic professional relationship to ensure that the prospects for a safer resolution to his personal difficulties would be improved. 

During this period, Ezekiel was accommodated in a hotel often used by his mental health team, I recall having a sinking apprehension as I walked to the hotel from the probation office. On arrival, the receptionist seemed untroubled by the noises of discordant voices coming from several of the rooms. A loud and intrusive radio was blaring out tuneless melodies and making oneself heard above the din proved quite difficult. I breathlessly ascended the five floors of the hotel to what appeared a poky garret, to find Ezekiel preparing a meal.

After finding somewhere to sit in what was an oppressively confined space, I sensed that he was too preoccupied to focus on anything but the practical tasks of living day-to-day. I came away from our meeting no clearer as to how I might proceed with the order. But I was perturbed by his unprompted reference to standing outside a nearby school to watch passers-by. Something in his voice and presentation, gave me a viscerally charged feeling. His expressions of paranoid alertness and excited concern, felt uncomfortably close to the heightened emotions which had played a part to the commission of his index offence.

I shared my misgivings with his CPN who agreed to increase his level of contact and bring forward a planned case conference to discuss his increased potential for risk of harm to others and possibly to amend his aftercare plan. A week or so later I was notified by phone that Ezekiel had seriously assaulted a stranger in a public place not far from the hotel. Following his appearance at the local magistrates' court he had been remanded in custody.

The next few months were consumed with a frustratingly high number of postponed court hearings as I pressed hard for the preparation of a report from a specialist forensic psychiatric unit to aid in sentencing. The probation order had by then expired. Ezekiel was eventually made subject to a Section (37) Hospital Order at the Crown Court and his treatment then fell within the purview of the mental health services.

On receiving notice of this outcome, my thoughts returned to the moments we spent together in the cramped and airless room at the hotel when Ezekiel in almost silent but knowable communication, as I nearly missed hearing his words with the incessant background noise buzzing around the hotel, kept muttering to himself,' They know I am not evil'. Those words came back to me with chilling clarity when I was reading Dr Adshed's The devil you know.

Mike Guilfoyle is a retired probation worker