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How
do we
fix
a
lunatic?

Bethlem Royal hospital’s Brook ward helps criminally dangerous male patients near the end of their journey to recovery. But with over half of men in
prison suffering from a personality disorder, these are the lucky few.
Joe Cooper spends a day shadowing a psychiatrist in the unit

n what looks like a typical hotel
lounge, I walk in on a meeting coming to a close. I shake
hands with about a dozen men,
all smiling to some extent.
“Who were they?” I ask Dr
Helen Walker,
the psychiatrist guiding me.
“Well, that man was a rapist, that one a murderer, some were paedophiles…”
Shock hits me. These aren’t the convicts I imagined I would be meeting. Some look slightly on
edge, some look rather dazed. None of them look
dangerous. None of them appear to justify the
heavy, locked doors every five-feet of hallway in
Bethlem Royal Hospital’s Brook ward.
I had visited Helen once before, in a different
ward, five years ago, though patients were less
willing to talk there. She isn’t keen on being identified – I’m here from a favour. I don’t feel entirely
certain I’m allowed to be here in the first place.
The wards themselves seem to operate very
differently; patients speak to me of being much
happier in Brook ward over the others. They like
this one’s garden more. It’s small, grey and walled.
I don’t ask how the others are.
It makes sense that they are happier – they are
nearer the end of their treatment. Brook ward is
a medium-secure forensic unit for those ‘close to
recovery’, according to its website.
When I speak to James, a patient who has paranoid schizophrenia, “close to recovery” seems appropriate. He had attempted to blow up Thames
House, MI5’s headquarters, with a homemade
bomb. It failed to detonate.
Six years later, he is looking intently at my feet,
his eyes wide and unblinking, talking to me about
his experience so far:
“I’ve learned that I was sick here. I used to think
I was being watched and that MI5 were watching.
I thought I had to blow them up. I know now that
was what voices told me.”
His leg jitters up and down as he speaks. His
gaze was unnerving at first, but he speaks calmly,
rationally. The words beat his thousand-yard
stare:
“I started a diary to write down how I felt. With
my condition I would feel very dark, it would
build up, so I wrote down how I felt. It made me
calmer. So did reading. I used to read the bible,
but that didn’t help.”
Religion rarely does. Of the five patients willing
to speak to me, three have paranoid schizophrenia. A common symptom is delusions of grandeur, with religion playing heavily into this.
David was no exception. A stout man with a
slight slowed slurr to his speech, he also suffers
from paranoid schizophrenia. He is dressed in a
Brazil football jersey two sizes too small. I go to
his room with Helen to conduct an interview.
He begins by telling me that he is Jesus reincarnated.

I

14 15 December 2015 | The Guardian Weekend

‘I ask him when he learned he was Jesus’

I stifle a laugh as best I can, feeling bad for
finding it funny. This is serious. I’ve known family
and friends who have thought like this. I compose
myself and inquire as to how he knows this.
“When I was in prison for stabbing a man,”
he begins, “I went in the block [solitary confinement] a lot. One time this druid comes and he’s
nice at first. Then more comes and they start
shouting at me, then more. It’s horrible, I ask
them why, they keep shouting… then an angel
comes and it’s so bright, I feel happy, you know.
She eats the druids, then goes into me. That’s
when I first knew I was special.”
He gestures nonchalantly, sluggishly throughout this explanation. The way he moves, he makes
it clear the angel more absorbed the druids than
ate them. I can’t believe I’m making sense of this.
I ask him when he learned he was Jesus.
“Oh that was in bed. I was lying there and Moses, [the angel] Gabriel and Bob Marley come to
me, as spirits. Moses tells me ‘you’re meant to lead
people, you’re chosen’. And Gabriel says ‘Jesus was

black, and you’re god’s son’. Then Bob Marley says
to always smoke weed, ‘because weed is the herb
of life’.”
Not wanting to offend him by poking into his
vision, I instead ask about his druids. He gets up
and looks for a sketchbook, before asking Helen
where it’s gone. She retrieves it from a drawer out
of the room, then encourages him to go through
it with me.
He thumbs through the first few pages: “that’s
a pentagram… that’s like the Illuminati because
they, like, run the world... that’s just a drawing
I did…” before stopping on a page of hooded
figures in a circle and a square in the middle. His
work isn’t very detailed - I have to guess what
most of it is, even with an explanation - but he
pays special attention to the figures.
“These are them,” David tells me, “they were
proper evil.” He won’t say any more. I thank him
for his time and shake his hand once more. Helen
thanks him too, then leads him to a nurse - he is
due more medication.
>>

‘A voice in my head told me “hold him down and rape him, hold him
down and rape him”. I didn’t want to do that, so I stabbed him’
His mention of time in solitary confinement
is not a surprise – according to Prison Reform
Trust, 15% of men in prison report symptoms indicative of psychosis. Those that get into a facility
like Bethlem Royal hospital are the lucky ones.
David made me wonder exactly how broad the
position of “close to recovery” covers. Compared
to James, he’s clearly still deep in delusion. I ask
Helen why:
“Sorry about that, I probably should’ve given
you a bit of warning. Sometimes they avoid taking their medication… they come up with some
clever ways of doing it because they think it’s to
control them and things like that. One guy used
to hold pills in his mouth for ages before he could
go to the loo and spit them out.”
No one is willing to talk to me for a few hours,
so I accompany Helen through more normal
day-to-day jobs. She spends a large amount of her
day analysing blood samples of patients to ensure
their treatment is working. It’s a slow process
involving a lot of online paperwork. I ask her why
Brook ward has locked doors everywhere – these
patients seem harmless.
I am wrong. “It can get a bit dangerous. When
they don’t have their pills, things can go wrong.
Did you meet Jacob?”
I’m not allowed to, properly. Jacob is a towering man with dreadlocks down to his knees.
He smiles at everyone and seems genuinely very
friendly. It turns out that’s the problem, as the
staff discuss in a meeting together.
“Yeah, the thing with Jacob is he’s fine normally, but if he doesn’t take his medication he gets
very friendly with all the male staff. We’ve had
incidents where he’s started taking his trousers
off – that caused a bit of alarm…” Dr Tim Wilson,
the most senior psychiatrist of the ward, reminds
the room.
The meeting is a fascinating sight. Three
psychiatrists, two psychologists, two nurses and
two social workers sit round a giant ovular table.
They calmly discuss their own feelings on the
patient’s progress in their particular field at first,
then break into heated arguments as to how close
a patient is to being ready for release. Talk of how
Jacob is doing takes up most of the hour-long
event.
I learn from Tim that Jacob comes from a community in London with such a strong negative
stance on homosexuality that Jacob’s paranoid
schizophrenia cause him to regularly have to deal
with his homosexual urges in a very real way –
though far from well.
Tim explains in Jacob’s words: “I was walking
down the street behind this guy and a voice in my

head told me ‘hold him down and rape him, hold
him down and rape him’. I didn’t want to do that,
so I stabbed him.”
There are a few seconds of silence. I can feel
the empathy in the room. It’s clear that the more
senior workers care just as much as the junior
ones – time has not hardened them.
The social workers argue that Jacob should be
out of the ward and only have to check in at this
stage, the psychologists argue otherwise. As Tim
calls the meeting to an end, it seems a compromise is reached – Jacob’s next assessment to determine if he is ready will be brought forward.
The locked doors at every turn feel natural now.
I’m accompanied by Helen constantly as I look
for another patient willing to talk to me. The unit
only has fifteen patients, many of them are wary.
It’s 3pm. I was given until 5 – I get the feeling
I’m cutting into her time. She finds me one more
person willing to talk.
John was the only man in the original group I
shook hands with who made me feel somehwat
uneasy, even though he was the friendliest - he
stayed behind to say hello where others walked
off. He has a bald head and a warm smile. He
naturally stoops forward. I don’t know why I feel
unsure around him. I am yet to learn exactly what
he did to get here.
As he begins talking, I realise I was wrong to
doubt him. John opens up fluently and honestly. He has borderline personality disorder. He
speaks in detail of how he was abused throughout
childhood:
“I thought it would be over when I went to
boarding school... that was at age 11. It only got
worse. The older children did awful things.”
He tells of me the crime that got him here, and
he speaks of how he felt in prison:
“I hated myself. I was disgusted by what I had
done. I tried to kill myself in prison a few times,
I mutilated myself… it was only when I got here
things started to get better.” He says.
21% of male prisoners report having attempting
suicide, according to Prison Reform Trust. The
highest percentage ever for the general population has been 6%. The feeling of desperation that
John felt to attempt to take his life is unfortunately a common one in UK prisons - and a sign
of how many prisoners need psychiatric better
psychiatric care.
As John talks to me, he keeps eye contact in a
normal manner. He doesn’t seem sluggish. He
doesn’t jitter. He seems to enjoy sharing his story,
sharing his progress. He tells me he was in prison
for “years and years” before he finally came to
Bethlem.

“I just want to go out and work, now. I don’t
care what I do. I just want to be useful for society.”
He says. It’s both beautiful and miserable to hear.
After two years of treatment, John is extremely close to being fully rehabilitated. His past is
something he has had to learn to stop punishing
himself for, a crime he could not control due to
his mental state. The crime is despicable, so he
cannot fully forgive himself. With his condition,
it’s debatable that ‘he’ did it in the first place.
At the end of my interview with him, I shake
his hand. I’m eager to do so – from what he
tells me, the man has been through an ungodly
amount of hardship.
I ask Helen how long will John likely have to
stay. She couldn’t give me an exact date – the
meeting I witnessed made me understand why –
but she told me he would likely be able to leave in
a few months. “The biggest fear is if we say they
can go and they relapse, so we have to ensure that
won’t happen”, she says.
She congratulates me on the interviews. I ask
her how she deals with hearing this sort of thing
so regularly. “We get support if we need it, so it’s
not too hard.”
Under Section 41 of the Mental Health Act, a
court can rule that a restriction order will affect
a person convicted of an offence that will be
detained in a hospital rather than prison. This
stops them being transferred to another hospital,
given leave, or released without consent from the
Ministry of Justice.
Professor Tom Fahy, Clinical Director for
Forensic Services, states that the average time of
treatment for medium secure care is 18 months.
This is the average time taken to take a patient
from a criminal to someone mentally healthy.
About 40 people each quarter have to wait in
prison for more than three months before transferring to a secure hospital, according to BBC
News. Fewer than one patient in ten re-offends
within two years of being discharged from a
secure hospital.
By comparison, 59% of ordinary prisoners
re-offend within 12 months.
Obviously, not every criminal is suffering from
psychosis - it would be ridiculous to suggest that
all the nation’s criminals should go through a
mental hospital rather than prison.
Yet as the rates for both psychosis in prison
and reoffending rates are worrisome, one has to
wonder how many people are missing the help
they need to truly be rehabilitated.

In order to keep them anonymous, the
names of all patients at Bethlem Royal
hospital have been changed.

The Guardian Weekend | 15 December 2015 15