A couple years ago, Lori Gottlieb’s book “Maybe You Should Talk to Someone,” which detailed the stories of some of her patients in therapy, became a bestseller. It was funny, well told and elicited sympathy for the clients and admiration for the skill employed by a good therapist.
Dr. Gwen Adshead’s “The Devil You Know” similarly describes patients in therapy, except that they have committed terrible crimes—including murder. It’s not funny, but other than that, it exhibits all the virtues of Gottlieb’s book.
Adshead, who teamed with co-author Eileen Horne on the book, describes 11 patients she has worked with in prisons, mental hospitals, halfway houses and other settings. Her patients’ crimes include killing, stalking and molesting; their diagnoses range from narcissism to paranoid schizophrenia. Woven throughout is an interesting discussion about research and mental health care and how it’s changed over the years (primarily in the U.K., where she lives), and the difficulty in getting appropriate funding for mental health.
Considering the complexity of the human mind even in a healthy person, the fact that one person can get another to know, understand and change their thinking merely by talking is quite a feat. And how much more of a feat is it with the mentally ill or with those who have suffered terrible abuse? As Adshead relays what unfolds in these conversations, one cannot help but be impressed by her ability to read the patient, to know when to probe further and when to back off, and to know how to lead the patient to discuss the horrific thing they’ve done, which they’ve often never spoken of to anyone.
Adshead doesn’t brag, though, and is just as forthcoming about her missteps and failures as she is with her successes. She also presents her opinion on controversial and sensitive issues in a way that is refreshingly humble.
Many, though not all, of the stories end with breakthroughs. Some of her patients have served their time and can now reenter the world with a new capacity to understand their crimes and therefore the ability to make amends with the rest of their lives. The book itself, though, is Adshead’s attempt to create a breakthrough with readers, who tend to view criminals as “monsters” completely different from themselves.
Wendy Migdal is a freelance writer in Fredericksburg.