this is bbc news. we'll have the headlines and all the main news stories for you at the top of the hour as newsday continues, straight after hardtalk. welcome to hardtalk with me, zeinab badawi. how should society deal with the perpetrators of horrific crimes — the child killers, the serial murderers, sadists and those who commit acts of extreme sexual violence? well, a starting point

is whether such people are inherently evil or whether they are sick. my guest today has spent more than three decades trying to treat some of the most violent offenders here in the uk. dr gwen adshead is a forensic psychiatrist as well as a psychotherapist, and has worked across a range of secure hospitals, prisons and in the community. why does she urge compassion and understanding for those who many brand as being simply evil? dr gwen adshead, welcome to hardtalk. thank you very much, zeinab. why did you decide to choose

a career where you provide counselling and therapy to people who've committed acts which many brand as simply being pure evil? well, i first got interested in this career because i was interested in law and ethics. that very interesting question of how should we treat people who've done terrible things? so i started by assessing those people and giving evidence in court and really beginning to try and understand how people came to commit acts of violence. and once i got into that a bit more, i felt that i actually wanted to offer therapy to them, partly in order to understand them better, but also partly to try and reduce their risk, if i could. you trained as a doctor and then you moved into psychiatry, and then you also trained as a psychotherapist and moved into working with sexual offenders. you say you're interested in what makes the person

who they are, but i have to put it to you that perhaps there's a bit of a morbid fascination you have? i don't see it as a fascination. i think that it's more to do with the universal interest that people have in violence and cruelty. i mean, i think the very fact that we have a huge interest in true crime, in terms of television and books and programmes and podcasts, i think the truth of it is that all of us are interested in what makes and that's partly, i think, because we all wonder whether, deep down, we might be capable of that. so, you do have a morbid fascination yourself. there is perhaps an element of prurience about it, as far as you're concerned? i mean, people may be interested, but you actually go up close and work with these people. i don't experience it or see it as prurient in any way. it's fascinating and it's human. all humans have the capacity for great cruelty and great evil. and the more we can understand

about that, by getting up close and trying to offer human understanding, the better off we'll be in terms of trying to prevent such things in the future, because we might understand the roots of such cruelty better. so, let me ask you, because you've worked in secure units, broadmoor, where we have had some of the most extreme offenders, serial killers and that kind of thing. do you not worry about your own personal safety when you are just one to one, in a room on your own with these people? no, not at all, and that's really for two reasons. one is, and this may be a surprise to people, which is that most people who've done horrible things are not in a cruel and violent state of mind all the time. it's not that they spend every waking minute looking to hurt somebody. often, their cruelty and their violence arose in a very particular context, and i'm not in that context. and the other thing is that i work in secure settings where we expect violence risk to be around, and so we take steps to manage it. we have alarms and i let people know where i am and i think

about the potential for risk. and it's my part of myjob to keep myself safe in order to get the work done. so, no, ithink, infact, the general community is a much, much more dangerous place to be. let's just look at what makes people commit... i mean, you said everybody has the capacity, but mercifully, most people don't actually realise that, you know, and kill people. but those who do, the serial killers, the child killers and the rest of it, what motivates them? do they always have a personality disorder of some kind? that's a really interesting question, and it's a complex one to answer simply. but i think one of the things that i've tried to describe in my work is the idea of a number of risk factors lining up, like numbers in a bicycle lock.

and if the risk factors all line up in the right way, then the possibility for violence can happen. and i think that you see it's important to distinguish different kinds of killing. there's killing in a political context, there's killing in the context of drug crime, for example, and then there's the killing of people that you're close to, people you've been in a relationship with, killing parents or children. killing in the context of a close relationship, that's a bit different, and you can't run them all the same. so, sometimes i've met people who've killed simply for profit, for example, the person who killed his wife for the insurance. and that's kind of fairly straightforward. but there are other situations, those very rare occasions where people kill when they're mentally unwell, and often they might kill a family member. it's interesting, dr gwen adshead, because you're saying people do this, people do that. but the fact of the matter is that 90% of homicides are committed by males and 80% of the victims are males. so, essentially, we're talking about male—on—male violence. and you have said, bluntly, most violence in the world is committed by young poor males.

i just want you to unpack that, socio—economic factors and poverty, you're saying that that is relevant? and then what makes the male mind more inclined to commit violence than the female mind? well, i think we have some really good—quality evidence emerging over the last ten years in particular that disparities of income are a potent risk factor for increasing homicide rates — and suicide rates, interestingly — among men. but the interesting question of why it should be that some men seem to be more prone to violence than others — because, of course, although most offenders, violence perpetrators, are male, most males are not so the question is, what is it possibly about masculinity, about the kinds of masculinity that are on offer to young men, young men who have grown up in social adversity and psychological adversity? maybe we need to look at those risk factors.

and, of course, substance abuse. but there are lots of people from comfortable, well—off backgrounds, men, and they go on to commit horrific deeds? i think the trouble is that there aren't lots. i mean, for example, if we think about the homicide numbers in england and wales, they haven't changed in a0 years. and they're about between 600 and 700 each year. that's far too many people, numerically, of course, that's 700, 600 lives lost every year, and that's terrible, but in a population of 60 million people, actually, homicide is a very rare and unusual event. and it is unusual, very unusual, for well—off people to do that. so, being brought up in adverse circumstances, be it abuse or be it poverty, whatever, you're saying, is a necessary condition, on the whole. it seems to be. but, i mean, there are lots of people who have had really difficult upbringings and, as you say, they don't go on to do this. and in your book, the devil you know, which hasjust come out in paperback,

you talk about cases — you don't give them their real names — but you read them and these people just strike you as simply being evil, regardless of what their background has done to them. i mean, tony, for instance, a serial killer who decapitated his first victim and killed probably several people. and, you know, you talk to him. gabriel, who stabbed a person in a london cafe, i mean, you know, one could go on and on. these are really horrible things committed by people, aren't they just evil? no. i think it's important to distinguish the act from the person, partly because it's such an unusual thing to do. and also because, when you're looking at someone as a human being, you have to look at them in their totality and to look at their potential

for goodness as well. and tony is somebody... tony is a composite of various men i've met who committed repeat homicide. and what is striking about them, i think, is that they were often men who had double lives, that they had aspects of their life that were good and positive and ordinary and pro—social. but the cruelty and the violence came out in very particular contexts, and then they kind of lost control of it. and many of the men i've seen in this context were glad to be caught. but i mean, it's a very live debate, you know, to put it simply, you know, are they mad or bad? i mean, that's not a good way of looking at it, but it's a very live debate. i'll tell you what rob whitley, professor of psychiatry at mcgill university, in canada, says. he says, "many are too quick to attribute evil acts "to mental illness rather than to a complex web "of causation, which may include moral turpitude, "extreme ideology and social resentments." we can'tjust explain these things away by saying, oh, you know, they've had episodes of being mentally ill

or whatever, you've got to take responsibility for your actions. absolutely. and i would encourage people to think about a spectrum of mental difficulties and mental disorganisation, if you like, or mental disturbance and frank mental disorder of the kind that gets you admitted to hospital under the mental health act, say. and there are degrees of criminal responsibility that go with that. and not everybody who suffers a mental illness and who kills kills in that context can be considered to lack responsibility. and that's why we have criminal trials to test out that evidence carefully. and it's open to judges to send people to prison, even if they have been found to be mentally unwell at the time of the killing. but you won't accept the term that this is just an act of pure evil or a sin or whatever? you don't like to present it in those terms. i just think that evil is a kind of state of mind that

all of us can get into. it's better understood as an adjective rather than as a noun. and as a state of mind that we can all get into, i'm interested, as a doctor, in what are those factors that get you into that state of mind, rather thanjust the label in itself. ok, so some factors — and some people say extreme ideology is one factor. so, if you think in 2011, of the case in norway of anders breivik, who killed nearly 80 people in one horrific killing spree. psychiatric evaluations showed he was not psychotic but driven by extreme far—right ideology. i mean, explain that for us now, because that sounds like it's somebody who has been influenced by things they've they've read, things they've seen, what they believe. breivik is a particularly interesting case, and i think... and obviously it's interesting because it's so unusual. and obviously, it's interesting because it's so unusual. but i mean, he did have a history of childhood

disturbance, as it happened, and he had a very difficult childhood. but that's enough to understand, is it? imean... well, it might be one of the risk factors that might take you down a route in which you're in which you're interested in ideologies about male supremacy. and i think, and again, i think we have quite a lot of evidence that young people who are rootless and stateless, who don't have a kind of secure family background, may be more at risk of being drawn to a kind of rigid certainty that gives primacy to male supremacy, and also gives, encourages people to think that you can just destroy people who you disagree with. but, i mean, it sounds... i mean, you speak in this vein and in your book, you talk about how some of the offenders you've worked with express shame and distress. and you say you see them as, "survivors of a disaster "and my colleagues and i as the first responders." and it seems that everything you're saying, the tenor is that you're more concerned about the perpetrators

than their victims. no, i don't see it that way at all. and the full quote is that they're survivors of a disaster where they were the disaster. and it's absolutely vital to the work that i do that we take people's cruelty seriously and their identity as perpetrators seriously. my work is all about talking with people about what they did and how they came to let themselves do it. but i actually see that working with perpetrators is an investment in preventing more victims in the future. and it also has to be respectful of the victims that were hurt. and i also bring that into my work as well. when i'm working with perpetrators, we don'tjust talk about their dreadful childhoods or their dreadful trauma. we talk about the fact that they caused trauma to other people, and that's a very important part of the work, because unless they can take responsibility, how can we help them to be safe in future? but isn't that sufficient? why do you have to say things as you have in your book? "i could feel great compassion

and respect for his honesty." when somebody is basically telling you that they've gone around killing people in the most awful way. is the compassion necessary? i think so. why? because i think it grounds... i think it grounds us in a context in which we don't add to the hate. i think those of us who are working with perpetrators of violence need to be sure that we don't contribute to creating a culture of cruelty and revenge. if all that happens with people who are perpetrators is that we take revenge in the most cruel ways possible, then actually we're making our cultural milieu worse, not better. and that's an investment for the future. so what do you do with people when you try and treat them? so, what do you do with people when you try and treat them? i mean, how can you... you say that, you know, the objective is to try to make sure that they don't repeat these offences, and so on. so, i mean, how do you go about working with somebody like that? well, what we do is to start by creating a trusting relationship which encourages a person to talk about

what they've done freely and without minimising. and that takes quite a long time often to achieve. and that's partly why we sometimes do it in groups. so for example, just yesterday, i was having a conversation so, for example, just yesterday, i was about setting up a therapy group for people who killed a parent when they were mentally ill, which, of course, is very unusual. but we found that it actually helps to put people in a group because they can actually talk to each other in honest and authentic ways about what they did and call each each other out when they feel that people are minimising ortrying to avoid responsibility. but how do you go about assessing whether you've succeeded or not? when can you release somebody? and ijust cite a case, in 2012, a french psychiatrist, danielle canarelli, was found guilty of manslaughter and given a one—year suspended jail sentence because one of her patients hacked an elderly man to death. and the judges said she had committed the grave error of failing to recognise the public danger posed by her patient.

although thejudge said, "we're notjudging the entire "psychiatric profession, butjust this particular case." so you can get it wrong, can't you? well, i think that psychiatrists and all mental health workers are very invested in trying to keep the public safe, as well as the patients that they work with. so we spend a lot of time and trouble over assessing risk. and that particular case is a bit unusual because the doctor in question was seeing the patient on her own in a kind of private therapeutic capacity. she wasn't working in a team with other people where we could put together lots of different kinds of information from different resources. and the other thing... so, you've never got it wrong, you, yourself, any case you've been involved in? well, i think it's notjust a question of me making a decision, because these decisions are made by teams in the context of what's legally possible. of what's legally possible — a bit like the parole board. before we make... before anybody gets released into a less secure circumstance,

we spend a lot of time investigating whether somebody is at risk. i personally... but things do go wrong. of course. i mean, i'm thinking of the case in 2019, because we have care in the community for people who are mentally ill funded by local governments, when this young man threw a six—year—old off the top of a building, 30 metres, and he was found guilty of attempted murder and given 15 years in prison. i mean, you know, the way we approach this whole thing, releasing people into the community and so on, we don't always get it right. and it's people like you, working in a team, who have to try and get this absolutely correct each time. the risk assessments are complex, and you put your finger on something really important, which is about having integrated health and social care systems put together, because where and how people are living is a very important part of what keeps them safe. and i don't know anything about that particular case, apart from what i read, but that's. .. from what i've read, that's a really good example

of what happens when there's a failure of integration of care between mental health and social services. but the other thing i would say is, again, that although these are disasters, and they are disasters when they happen, they are comparatively unusual. for all the people that we rehabilitate safely, these kind of disasters are statistically quite unusual. but we have to take them very seriously. we interrogate what happens afterwards, and we're always learning lessons, always to learn what we could do better. but what do you say to a lot of people who say this person has committed the most heinous, you know, violence and murder or whatever, just lock them up and throw away the key? why should somebody like anders breivik, for instance, ever be released after killing 77 people? i think with cases like breivik, it's really very difficult because, and particularly because it's not clear that he has, a, any insight or, b, any remorse into what he did. and there may well be some

people in our prison systems who are so dangerous that they can never be released. i think that is true. but otherwise, traditionally, our legal system has always allowed for the possibility that people who are violent can do time, can accept responsibility, and commit themselves to living violence free in the future. violence—free in the future. and i think we should be working towards that. that is still a goal that's achievable for most violence perpetrators. and when it comes to very young criminals, and i'm thinking particularly here of 1993, the case, the notorious case ofjamie bulger, who was killed, a two—year—old boy killed by two ten—year—olds. and at the time, they were the youngest people in english history to be convicted of murder. they were released at the age of 18. i mean, do you think that we should make exceptions for very young people, because one of them did actually go on to recommit, not murder, but did go back into prison? yes, and i think that's a really good example

of the importance of rehabilitation interventions. rehabilitation interventions, particularly because the perpetrators, very young perpetrators of violence, are incredibly unusual. again, it's statistically incredibly rare. so, when you've got a case like that, it's actually the rehabilitation package has to be really good and really in—depth and has to continue, i think, for a long period because they're hard cases to understand and monitor. 0k. we're talking about, as you say, these rare extreme cases, and the fact of the matter is that we know the vast majority of people who are mentally ill do not commit acts of violence against others. are you worried they could be stigmatised by the few violent ones? absolutely. it's a big worry for all of us in mental health, because if things go wrong, then there can be a kind of focus on staff getting it wrong. it's notjust the patients that get stigmatised, but it's also the mental health staff. and we have a real concern about recruiting people to work in a system where they may be under a lot of very

negative scrutiny if something goes wrong. and how do you overcome the taboos of talking about mental health? i mean, you yourself suffered from chronic post—natal depression. so, how does society go around saying, look, we should talk about these things openly? well, i think we've made giant strides, actually, in talking about mental health. and i think it's... i think for those of us who have had problems with their mental health, i think it is helpful to just remind people that mental... periods of mental ill health are not unusual in a long and happy human life, and good treatments exist that help to promote recovery. and i can vouch for that. so, i think the more of us who have those kind of experiences talk about them, need to do so, if only to highlight how different those cases are where we can't do anything. finally, dr gwen adshead, you know, you've been a... it's a tough job. i mean, the role of a forensic psychiatrist addresses how a society responds to and treats people

who break the criminal law. to and treats people you know, your work, as we've been discussing, raises fascinating ethical and legal questions about responsibility, agency and blame. but it's a toughjob, and you've said your experience... you've experienced transient fear, sadness or irritation, but what impact has working for decades in this field done to you? i mean, there are things that you can't unsee, images. no, what i would say is the thing i've come away with is a greater interest in human goodness and the human capacity for change. i think i've become more interested in hope and the importance of hope and the importance of people committing to taking goodness seriously as much as they take evil seriously. and do you really think that you can persuade people to show more compassion and understanding behind the headlines of, you know, the serial killers, the mass shooters and all the rest of it? i think that...

i think that human beings have a great capacity for goodness as much as they have a capacity for evil. and i think it's up to all societies and all persons to help build each other up in terms of that goodness. and that means developing our capacity for compassion. compassion for ourselves, compassion for victims, and, yes, compassion for perpetrators too. for perpetrators, too. and it would be a better society then, you think? i think it's more likely. dr gwen adshead, thank you very much indeed for coming on hardtalk. thank you. hello there. i'm sure many people have been making the most of this

generally dry weather with some sunshine — we had a lot of sunshine actually around on tuesday, and we've got more of the same for today. we start, though, with temperatures on the whole in double figures early on wednesday morning. but it'll be a bit colder, i think in the northeast of scotland, could be down to 3—4 celsius here. now many places will start wednesday, dry and sunny, but there's cloud coming in off the north sea to bring a few showers into the far north of england, and with the cloud bubbling up in eastern england, there could be the odd, light shower here. but on the whole, it'll be dry for england and wales. quite windy in the south, especially through the english channel. not as windy for scotland and northern ireland, a sunnier day than it was on tuesday — but temperatures not changing very much, so again, we're likely to make 2a in southern parts of england and south wales. now high pressure extends all the way down from the arctic circle, and that's keeping it generally fine and dry. the fly in the ointment on thursday is that area of low pressure and weather fronts that threatens to bring some heavier showers, notjust for the channel islands, but now perhaps into the far southwest of england. 0therwise, some lengthy spells of sunshine, some patchy cloud

bubbling up here and there, probably not quite as windy for southern areas. it may be a bit warmer widely, temperatures into the low—to—mid—20s on thursday. so, we've got a couple more days of this quiet, largely dry weather with some sunshine, but by the end of the week and into the weekend, things may look a little different — we've got some rain in the forecast. and that's because pressure will be falling — we've got this low pressure heading up towards the english channel weather fronts sliding in from the atlantic, and the two sort of bumping into each other and combining. so, we'll find some patchy rain coming into the northwest of the uk. these showers, though, moving up from the south, from the english channel, look a little more widespread. some of them could be heavy and possibly thundery. there'll still be some sunshine away from those showers, and those temperatures peaking again at the mid—20s. now, we started the week with high pressure, we'll end the week with low pressure — and that low pressure will be dominant into the weekend, as well. central and to the west of the uk, a couple of weather fronts on the scene. no doubt those will come

to rest in a slightly different place, but you've got this idea of a couple of bands of wet weather that could be heavy and thundery. some sunshine either side of that and a bit of warmth still, but some stronger winds will keep most of the rain away from scotland. 20 celsius here, 2a in the southeast. is finally set to approve the so—called abortion pill, something that's been france since 1988, and britain since 1991. japan's health ministry says women will still

need the consent of their partner.

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