Central to this book are the interviews with men in Broadmoor Hospital who have a diagnosis of antisocial personality disorder. They were carried out in conjunction with parallel interviews by the Broadmoor psychiatrist Dr. Gwen Adshead, with the support of her able research assistants Sarah Nicholson and Chris Brown. Gwen was a delight to work with, and I learned an enormous amount from her. I am grateful to Val Pancucci for transcribing the interviews. I also want to thank those who were interviewed. They were often willing to tell me very personal things. I thank them for agreeing to be interviewed and agreeing to their (anonymized) comments being used in writing up the project.
The Wellcome Trust funded the project. They have had to wait a long time for any published results from my part of it. I thank them for their support and patience.
Part of the Wellcome project was a parallel set of interviews with people with a diagnosis of frontotemporal dementia, a condition that also can lead to antisocial behavior. This came from a generous invitation from Professor Martin Rossor of the National Hospital for Neurology and Neurosurgery. I will never forget sitting in the corner of his office for a morning, while at regular intervals patients came in to be told that their diagnosis was this form of dementia. Martin was the ideal doctor: sharply focused on the results of the imaging, and also honest, clear, and calmly supportive. My interviews were much less good. Some patients were at an early stage of dementia. Asked about ethics, they gave fine answers belied by their reported behavior. Most of the others were too far gone to understand the questions. I was not creative enough to find ways of dealing with this. I gave up on this part of the project. I wish I had managed a better response to Martin’s imaginative idea.
As well as quoting from the Broadmoor interviews, I have quoted a lot in the book from the growing number of first-person accounts of psychiatric disorder. One of the main themes of the book is the way accounts from the inside should help in redrawing the psychiatric map. I thank all the people whose published accounts I have quoted.
Art is also a way into the inside of these conditions. I have been particularly struck by the art of Laura Freeman, as it appears on her website. I thank her for permission to use several of her powerful pictures.
“In Praise of Limestone” by W. H. Auden is copyright © 1951 by W. H. Auden and renewed 1979 by the Estate of W. H. Auden; from W. H. Auden Collected Poems. It is used by permission of Random House, an imprint and division of Random House LLC. All rights reserved. The Gold Cell by Sharon Olds is copyright © 1987 by Sharon Olds. It is used by permission of Alfred A. Knopf, a division of Random House, Inc. Any third party use of these materials, outside of this publication, is prohibited. Interested parties must apply directly to Random House, Inc. for permission.
This book also grew out of “Towards Humanism in Psychiatry,” my 2003 Tanner Lectures on Human Values at Princeton. I am grateful to the Trustees of the Tanner Lectures on Human Values, and to Princeton’s Center for Human Values, for the invitation to give the lectures, and for permission to use material from the lectures in this book. I thank Princeton University and the Center for Human Values for generous hospitality, and for inviting the very distinguished team of Peter Brooks, Antonio Damasio, Jonathan Lear, and Jennifer Radden to be the respondents to the lectures. I learned a lot and enjoyed the discussions enormously.
I have been writing this book on and off for a number of years, mainly while I was director of the Centre of Medical Law and Ethics, in the Law School at King’s College London. From that time I have many warm memories of the generosity and friendship of colleagues and students alike.
This book has been influenced by colleagues in the Centre, either by their general support or by their own thoughts or research on psychiatry. These include Jennifer Bostock, Jill Craigie, Sue Eckstein, Bobbie Farsides, Don Hill, Penney Lewis, David Lloyd, Genevra Richardson, Rosamund Scott, Suzanne Shale, and Leslie Sherratt. Pat Walsh ran a group on ethical issues in autism, culminating in an outstanding conference run by Pat herself with Virginia Bovell and Francesca Happé. I have been influenced by them and by other speakers at the conference.
I am grateful to my successor as director, Leif Wenar, and to four successive heads of the Law School—John Phillips, Raymond Plant, Tim Macklem, and David Caron—for keeping me on to do some teaching after the standard retirement age. This has postponed what will be a great loss in my life. My students have no idea how much they have given me.
When I arrived at King’s, a great stimulus was the warm welcome by the Institute of Psychiatry, especially by Channi Kumar, Robin Murray, George Szmukler, and Simon Wessely. I have learned from all of them. My Tanner Lectures grew out of the 2002 Aubrey Lewis Lecture I gave at the IoP at the invitation of George Szmukler. Another stimulus was the invitation to help colleagues at the IoP and in the Philosophy Department in setting up and teaching the MSc course in Philosophy of Mental Disorder. Among those I learned from are Derek Bolton, Bill Fulford, David Papineau, Mark Sainsbury, and Richard Samuels. I also introduced and taught a psychiatric module in the MA in Medical Ethics and Law run by the Centre of Medical Law and Ethics. I am grateful to those (too many to name) in the courses for the special kind of stimulus that bright, responsive, and argumentative students give to their lucky teachers.
Among those whose thoughts, criticisms, experiences, or suggestions have influenced this book are Natalie Acton, Richard Ashcroft, Emma Baldock, Simone Bateman, Linda Begbie, Walter Bilderback, Felicity Bryan, Virginia Bovell, John Burbidge, John Campbell, Patrick Casement, Ann Davis, Heather Dyke, Ivan Eisler, Rai Gaita, Simona Giordano, Anita Grandy, Jim Hopkins, Monique Jonas, Richard Kanaan, Lucien Karhausen, Elleke Landeweer, Ruth Macklin, Dan Moros, Thomas Nagel, Gunilla Oberg, Christopher Peacocke, Liz Pellicano, Priscilla Roth, Alan Ryan, Thomas Schramme, James Stewart, Jim Strain, Jacinta Tan, Nadia Whittaker, Guy Widdershoven, and Charlotte Wilson.
My thanks to Clare Sainsbury, once an undergraduate I taught as part of her Philosophy, Politics and Economics course at New College, Oxford. More recently she has been a friend who in turn has taught me a huge amount about Asperger’s syndrome in particular and about psychiatry more generally. My thanks to Tony Hope, who, much earlier, I once taught as part of his Philosophy, Psychology and Physiology course at New College. For many years he has been both a friend and the sort of psychiatrist and then ethics teacher his patients and students must have been really lucky to have.
Bill Ruddick has read much of this book and has commented on it with generosity and perceptiveness, in many subtle ways influencing it for the better.
Hanna Pickard has read the book and made valuable suggestions, especially about addiction, that I have followed up. At a point when I felt low about the book, her support for it was a lifeline.
Richard Keshen has read and commented on the book. He has done this with most of what I have written since I was his graduate supervisor in Oxford many years ago. Some of my best students end up teaching me. He has influenced me over the years more than he can realize. While I was writing the section about William Blake, one of the pleasures was going with Richard and Mary Keshen to look at places in London with Blake associations. (At that time I thought of writing also about Virginia Woolf’s psychiatric illness, an idea I gave up when I saw that I would not be able to do it nearly as well as Hermione Lee in her Virginia Woolf biography. But it was still a great pleasure to go with Vivette and with Richard and Mary to the Woolfs’ home at Monk’s House.)
Ian Malcolm, at Harvard University Press, has been an ideal editor. He has improved the book a lot through constructive critical comments. He has been wonderfully supportive of the book, to an extent only its grateful author knows.
Finally, my family. It is now impossible to disentangle the different strands of their contribution: intellectual, emotional, critical, and supportive, as well as through shared experience. Vivette, Daniel, David, and Ruth all have different angles on the questions discussed in this book and have influenced me enormously. In different ways Daniel and David have greatly influenced my thoughts about what to say and about how to say it. In recent years Vivette’s research has been in biological psychiatry. Ruth is a child psychotherapist. I have been inspired by the work they each do. Their ways of seeing these matters are overlapping but different. To some extent I have internalized both perspectives. Have I really got good evidence for this claim? Is that comment a bit crude and unperceptive about the person discussed? The combination of the skeptical questions and the inspiration has improved the book a lot.
I dedicate the book to my grandson, Sam, in gratitude for many interesting conversations lit up by his lively, humorous, and questioning approach to life.