Dr. Gwen Adshead, MBBS, FRCPsych
Forensic Psychiatrist, Southern Health Foundation Trust, Southampton, United Kingdom
If you type "Broadmoor" into a common search engine, two residential centers will be recommended to you. One is a luxurious spa in Colorado, with cheerful and enthusiastic testimonials (“I shall certainly stay at the Broadmoor again!”). The other is a maximum security psychiatric hospital, the subject of the picture above and my essay.
The hospital stands on a hill, above an ordinary English village. I first came to work there as a senior trainee in forensic psychiatry, and was disconcerted to find that the hospital did not appear on any map. This turned out to be a security issue (now rescinded) but the consequence was that I got lost and had to ask for directions. Because the name is associated with grisly images of offenders and Gothic accounts of murder and violence, asking the way (Q: Please, can you tell me how to get to Broadmoor?) invites bleakly humorous responses; a parody of the question about how to get to Carnegie Hall (A: Practice, dear boy, practice). No-one would want to practice the dark skills that get one admitted to Broadmoor.
Broadmoor Hospital was built 150 years ago and was named after a local hill. It was hoped that "Broadmoor" would become a term of art, replacing the stigmatizing "criminal lunatic," but sadly, this linguistic window dressing completely failed and "Broadmoor" has come to be a term synonymous with horror and permanent exile from society. However, it is wrong to say that patients never leave Broadmoor. An early example is Edward Oxford, who shot at Princess Victoria with an unloaded pistol. Perhaps because of his lack of political motive, or indeed any explanation at all, Mr. Oxford was found not guilty of treason by reason of insanity and sent to Broadmoor, where he remained for many years. He was perfectly behaved and did not seem mentally ill, and in or around 1888, the Home Secretary permitted him to leave Broadmoor as long as he then went directly to Australia. This Mr. Oxford did, after changing his name to Mr. Freeman: arguably evidence of both psychological health and a sense of humor worthy of his new nationality. In Australia he married, joined a church community and worked as a journalist until he died: a tribute to the beneficial and rehabilitative effects of privacy and freedom.
It is hard to imagine a modern day Mr. Oxford succeeding in rebuilding a new identity quite so successfully. Public vengefulness, though human and understandable, tends to invest offender identities with a sticky quality, so that Broadmoor patients who have done terrible things are fixed in a toxic amber that includes not only their offenses, but also their image as they were then. They therefore need to discover a new identity, one that recognizes the past but can invest in the future. The philosopher Jonathan Glover studied moral reasoning in Broadmoor patients and found in them not an absence of moral identity but a high prevalence of what one might call a disorganized or incoherent moral identity, full of contradictions, lapses of reasoning, and a sense of unreality about personal experience and choice. What these patients need are opportunities to "grow" a new moral identity, just as Edward Oxford did over 100 years ago.
There are plans to build a new hospital, probably still to be called Broadmoor. It is said that the old Victorian buildings are, in that ugly phrase, "not fit for purpose;" that there is no good purpose in having high ceilings that are cool in summer and confer an air of space (important when two hundred disturbed men are living together in close confinement); no good purpose in having a long terrace on which to take exercise and where a man might lift up his eyes to the far-off hills for a helpful sense of perspective; no good purpose in having a kitchen garden where people can grow flowers and vegetables and where once an astonishing amount of rhubarb (16000 lbs.) was grown each year. There has not been much discussion of how these new buildings will contribute to the development of a new moral identity as part of the therapeutic care plan; how like Lazarus, each man will be raised to a new life after the social "death" that is long-term detention in secure psychiatric facilities. We can only hope that each patient will get help to think and reflect not only on who he has been in the past, but as one fourteenth century mystic put it, on "what thou wouldst be."
GWEN ADSHEAD, MBBS, FRCPsych, is a forensic psychiatrist at Southern Health Foundation Trust, Southampton, United Kingdom.