There was a typical October drizzle drifting across the car park as I pulled in for the morning, a mist which steadily increased as I pulled my bag from the boot and hurried across to the gate lodge, hunting for my security pass as I did so. Inside, there was the usual Monday morning queue, the process of clearing staff and issuing their keys always taking longer at the start of the week. I'd often wondered if this was due to the guys behind the glass having accrued monumental hangovers in the course of the weekend but finally concluded that it was just yet another example of their bloody mindedness. Believe it or not this is a *hospital* - albeit a highly secure one - but you'd never guess it from dealing with the security staff.

Still. No keys, no access. No access, no job. So grin and bear it.

I'd just reached this zen-like conclusion - as I did, perforce, most days - when I noticed my boss a few places ahead of me in the queue and managed to attract her attention with a well timed wave. I was obviously among the blessed this morning, though, because she promptly dropped back for a chat. Albeit not a friendly social one - Linda was just as focused as you might expect a consultant forensic psychiatrist to be. Especially one who'd been on call all weekend and now, I belatedly realised, had a convenient minion on whom to offload any inconvenient issues that had emerged the while.

Which suspicion appeared to be all too accurate, given that her opening gambit was to enquire about my caseload. 

"Well, you know how it is - you could always do with more time, fewer problems, but generally, I'm coping. I assume that I'm about to get a little extra something, though?"

She had the good grace to laugh, slightly. 

"Nothing too onerous, I hope," she explained. "In fact, I think this one might interest you. A prison transfer we took as an emergency on Saturday afternoon. Good nursing observations from the prison 'hospital', for a change, and I saw him briefly yesterday, but ... I don't know. There's something odd about this one. Not your normal paedophile, I mean - or at least in his opinion. Come over to my office, though ... I'll show you the notes."

She paused as we finally got to the head of the queue, turning to me as she started for the exit.

"You're a bloody good senior reg, Dave. But if you want to make it to consultant ... well, it'll be interesting to see what you make of Dr M...."

  -  -  ---  ----  -----  ----  ---  -  -  

Once through the lodge, keys clipped firmly onto strap, placed securely in belt pouch - all as per regulations - Linda set a rapid pace across the 'campus'. Unlike most clinicians of her status, L's office was within the secure area - behind the four metre concrete wall, in other words - which, as she put it, saved time and got her a higher quality of administrative staff ... many, if not most, of the hospital's clerical types being far too scared of our - umm - *challenging* patient group to come so close to them on a daily basis.

It was one of the reasons I liked her - that and the fact that she kept a stock of excellent coffee and was even prepared to share it with underlings. This morning she gave me a cup as we got into her room, as well as a voluminous file - or, strictly, several files, loosely tied together with prison service tape. Which, taking the hint, I began to read as she turned away to make some phone calls, check through messages and generally prepare for her day.

  -  -  ---  ----  -----  ----  ---  -  -  

So. Dr Pieter M. I knew the name, of course, his trial and conviction having filled a fair few column inches in my morning newspaper. But I'd never expected to see him here ...

Not that the case notes were all that informative - most of the bulk consisted of legal documents, most interestingly witness statements from his trial and copies of the material that had led to his conviction in the first place. I scanned that, of course - its a necessary if distinctly unpleasant part of the job - but I put most of my initial effort into reading the clinical entries. Such as they were - a couple of reports prepared for the Court, the nursing notes Linda had mentioned from the prison hospital wing and, finally, the written referral to us. All of which gave me more questions than answers - not least quite how he'd been thought worthy of a bed here - and as an emergency, to boot - on such scanty evidence.

I was still pondering it all when Linda finished her calls and turned to me expectantly.

"So - what do you think?", she asked.

"I think I probably ought to go and see him. There's not a huge amount to go on, here."

I pointedly didn't mention the fact that she didn't seem to have written up any notes from *her* meeting with him, nor was she sharing her own thoughts and observations. Far be it from me to question, though ...

In any case, I seemed to have given her the answer she wanted, as she replied brightly,

"Good, Darwin ward have got him on 1:1 obs as you might expect" - Darwin had nurses individually assigned to "observe" virtually all of their patients - "but I'm sure they'll find you a room to talk to him. Oh, and I've checked - they've got nothing in the way of transfers or admissions scheduled for this morning, so why don't you toodle off over there now?"

I can take a hint, me. So sod *my* schedule for the morning - I picked up my stuff and headed over to Darwin.

  -  -  ---  ----  -----  ----  ---  -  -  

This place is laid out like a giant clockface, single storey wards arranged in pairs around a slightly squashed circle. For some reason they're all named after scientists - in alphabetical order from Angstrom to Wilkins, since you ask - but in any case Linda's office was round the back of the Perutz/Rutherford block, which made it about as far from Darwin as it was possible to get. And the rain was now coming down with a vengeance.

So I was a bit wet when I got to my destination, my mood not further improved when I let myself through the outer door of the 'airlock' and discovered the vestibule to be full of clinical supplies - for which, read 'drugs' - which it shouldn't have been. But it was, and that meant that I couldn't proceed through the inner door - and onto the ward itself - until all the patients had been safely corralled out of the way. Absurd, I know - the chances of a patient actually wanting to steal the sort of medication we used was minimal, the chances of them getting through the innumerable layers of packaging the pharmaceutical industry went in for before the riot squad - sorry, * Special Intervention Team* - arrived non-existent. But then, on another level, it was sensible. Darwin was a dedicated special care unit, after all, dealing with newly admitted patients considered unsuitable for Angstrom and Bohr, - the formal admission wards - and for others who'd experienced problems on their 'home' areas. So: Better safe than sorry and all that.

Only, just at the moment, I was dripping wet and they'd switched off the heating in the vestibule - must be something temperature sensitive in one of those boxes, I guessed - so I was also freezing and it took bloody *ages* to clear the area and let me in. As a result, I wasn't brilliantly happy when Joe, the ward manager, finally waved me through - and, perversely, my temper *didn't* improve when he immediately showed me into an interview room, presumable having been warned in advance of the purpose of my visit. In any case, I had no chance to express any sort of vexation - however pathetic - and instead found myself face to face with my patient.

  -  -  ---  ----  -----  ----  ---  -  -  

Who was, on first impressions, a slightly shabby looking, fifty-something male. Medium height, rimless glasses, still dressed in prison issue clothing. Definite incipient bald spot, slight paunch. Body language constrained but seemingly confident, hesitating to make eye contact but maintaining appropriately thereafter. Did not offer any sort of greeting, remained sitting in the plastic chair he'd been given as I formally took responsibility from the nurse who'd been with him on my arrival, set my bag down on the table and found a note pad to begin the interview proper. Overall - nondescript sort of bloke, someone you'd have walked past in the street without a second glance. Didn't look like a PhD, for sure. And, yes, that really is how clinical observations are made - whatever the text books might say.

I introduced myself, explained that I was here to do the formal admission - which includes taking blood pressures and a family history and all that stuff, though I have no idea why the nursing staff can't bloody do it - and also to have an initial chat, given that I was part of the team  that would be caring for him.

He let me get through pretty much the entire spiel without interrupting - which was novel - and thereafter the interview, I thought, went pretty well. I mean, working as a *forensic* psychiatrist means that most of my first 'chats' with my punters - sorry, patients - tend to involve either long, complicated explanations of quite *why* they had to chop a sibling or whoever's head off with mum's best carving knife ... or a simple refusal to talk to me, me obviously being - from their perspective, at least - the living incarnation of Beelzebub ... or their particular demon of choice.

Dr M wasn't like that. Once he'd got used to being in a room with just me - realised that he was no longer being 'shadowed' by one of the ward's typically rather *physically impressive* nurses - he opened up completely. Admitted it all. Agreed that all the legal documents were correct, that all the files recovered from his computer were his, that he'd known about them, had deliberately obtained them, that ...

Well, he was pretty co-operative. Except that that was all slightly moot - he'd been convicted, after all, so what *he* thought about it all was hardly the issue - and there was one glaring issue that I felt might complicate our future treatment options.

He didn't think that he'd done anything remotely wrong.

  -  -  ---  ----  -----  ----  ---  -  -  

Linda, when I caught up with her late in the afternoon, wasn't all that impressed. Nor was she remotely surprised, or, to be fair, even slightly critical of me. In fact, as she listened to the recordings - we don't generally publicise the fact that we tape interviews, but we often do - she actually congratulated me on my interview technique, even as she was pointing out a couple of things I might have chosen to follow up on. 

Which all, I realised, meant that this - he - was now *my* case. And I'd done the PSE, ABC and SPA - present state examination, aberrant behaviour check-list and sexual preference analysis, to the uninitiated - and, of course, talked to the bloke on a human to human basis. And it had got me nowhere. I still wasn't sure what he was doing here in the first place, didn't actually have a clue what I was supposed to be treating him for, let alone what sort of treatment to offer ... and Linda was being distinctly cagey about offering me any sort of advice. Which made me think that maybe - just maybe - there was Politics involved.

Which was probably not brilliant news, at least if I wanted my career to continue on its so far moderately stellar course. I went home with a distinctly uneasy feeling about the whole business.

  -  -  ---  ----  -----  ----  ---  -  -  

Next morning, I got into my own office - well, cubbyhole, and that shared with a couple of Linda's even more junior doctors - and found a note from Linda on my desk. Which informed me that she was away for a couple of days, dealing with some bureaucratic shit or other - no surprises there - but which signed off on a slightly odder note.

'Re Dr M', it said, 'Keep up the good work.'

  -  -  ---  ----  -----  ----  ---  -  -  

Dr M was still on Darwin, given that we - I - had, as yet, no idea where a more appropriate placement might be, but it wasn't raining and they'd shifted the junk, so this time I got onto the ward without any hassle. Problem was they had a couple of transfers in progress and no interview room for me to use. I ended up seeing him in a corridor, which was hardly best clinical practice. It also meant that I had no objective record of proceedings.

Which was a shame, given that he immediately took me by surprise by the effusiveness of his greeting. Actually, I thought he might even try to hug me - no staff around to intervene, I noted, side stepping neatly - but he limited himself to a very warm, "Doctor!" before continuing,

"You're a reasonable man," he said, generously, "and you must know that I've done nothing to warrant being in a place like this ... so *please* ... why am I locked up with all these cretins and imbeciles?"

Well, two black marks to Dr M, I thought, bristling. Firstly, its always a mistake to tell a psychiatrist that he/she is 'reasonable' - of course we're reasonable, its our job. And that job tends to involve us talking to people who are more or less away with the fairies, so ... we don't tend to value their personal judgements on *our* sanity all that highly. 

Secondly, we don't tend to work with 'cretins and imbeciles'. Sure, both started out as diagnostic terms with more or less precise definitions, but no more. Not only have we expunged the words from our professional vocabulary but we've also removed the need to detain *people with learning difficulties* in bloody great asylums. And even if that involved transferring them to the tender mercies of social care, the previous history was still something of a professional sore spot. So I bridled, a bit.

"Cretins and imbeciles, Dr M?", I said, pointedly. "Actually, most of your fellow residents on the ward - and in the wider hospital - have really rather high intelligence. In fact, if life had gone just ever so slightly differently for them most of them could easily have PhDs just as shiny as your own."

Which was a bit below the belt, if not actually provocative, but I quickly covered my tracks by getting in a couple of direct questions. Its called seizing the therapeutic opportunity, I think, or, at least, it is when you come to write up the notes afterwards. In any event, I continued without giving him the opportunity to reply.

"One thing I am curious about, though," I said, "is how come the courts convicted you, and convicted you on, what, fifteen counts? - *and* sentenced you to a pretty lengthy prison term, of course - if you'd not done anything at all amiss? Why do you think that might be?"

Which was, of course, the professional equivalent of lugging a 10kg sledgehammer at a peanut - certainly not the preferred course of action this early in the process - but it still didn't get a reaction, let alone provoke a sudden outpouring of delusional ideation, paranoid conspiracies or even the slightest hint of Ideas of Reference. Bloke seemed quite *sane,* really - if you ignored the inconvenient fact that he was also guilty as hell. Nonetheless, I listened to what he was saying as well as how he was saying it - sometimes a useful technique, I've found - and filed it away for future consideration.

And, having listened, terminated the conversation and left the ward. A sadder but no wiser man, as someone once put it.

  -  -  ---  ----  -----  ----  ---  -  -  

Linda was interested. I got to see her pretty much first thing on her return to the coalface - a most unusual thing - and she was, yup, interested.

"So", she said, magisterially, "You're saying, basically, that he's in some sort of denial? That he's aware of his position - well, how could he not be, really - *and* of everything stacked up against him, but he's just not, as they say, 'having any of it'?"

I demurred.

"Well, no," I said, just slightly hesitantly. "Problem is, I don't think he *is* in denial - or not as we usually mean the term, anyway. I mean, its not that his subconscious is aware of stuff that his *conscious* mind would prefer to ignore. To date, I've seen nothing to indicate that sort of inner psychic conflict."

I paused. 

"I know it sounds ridiculous, but I think he's genuine. He really, truly can't see what he's done wrong."

Linda looked grave, but, it occurred to me, not especially surprised. I got the distinct impression that this was a possible conclusion she'd been batting around for a while.

"But," she said, thoughtfully, "you've seen the stuff he had - the stuff he *wrote* for gods sake. He's not an idiot or - what was that phrase? - oh, yeah - a 'cretin or an imbecile', either. He knows all this, knows what happened to his output, his *collection* and he's at least heard of the effects it had, the damage it caused?"

She looked exasperated more than anything. I could empathise, the whole case was frustrating to the point of being annoying. Perhaps more to the point, it wasn't, when you came right down to it, *psychiatry*. We were clinicians, for gods sake - not bloody moral philosophers. Or legislators, for that matter.

But that wasn't getting us anywhere.

"All of which is undoubtedly true," I said, with due consideration. "Its also true that it gets us no further in terms of addressing whatever 'mental health' issues he may have."

I paused and gave her my best ingratiating smile.

"Don't suppose we could just chuck him back to the prison service, could we?

She gave a bitter sort of laugh, interestingly combined with a sort of resigned shrug.

"No fucking chance," she said - Linda *never* swore. "You think I admitted this arsehole because I *wanted* to? Because I saw a *clinical* emergency? Give me a fucking break ..."

Well, I thought. Never in my wildest dreams could I have imagined Linda behaving remotely like *this*. I didn't know what to do - except maybe chuck in my career plans, go find a job as a milkman or something. But she got herself together, cut me off from that particular line of thought.

"Look," she said, "we're stuck with him. I can take him back, as 'my' patient, I mean, if that's what you want - I'm not actually a Gorgon - but just at the moment I'd really appreciate your input."

She paused.

"Actually, I'd appreciate an *idea* at the moment. Where the *fuck* do we go from here?"

  -  -  ---  ----  -----  ----  ---  -  -  

We both saw Dr M, albeit a few days later, both of us having more urgent - or at least more accessible - cases to deal with. In the interim, we'd moved him to Hutton ward - named for the 'father of geology' and, perhaps as an obscure institutional joke, used to house our most intractable and recalcitrant patients. Or people who weren't going anywhere any time soon. Call it a reality check for Dr M, if you like.

And the fact that one or two of the residents had been round long enough to have been victims of leucotomies - another historical mistake we're not particularly proud of - might even have provided a further gentle hint.

Cretins and imbeciles? We can supply them on demand, if you like ...

  -  -  ---  ----  -----  ----  ---  -  -  

At Linda's suggestion, we also arranged to see Dr M, for our joint interview, off the ward, in a room in the Rehab/Recreation building generally known as the 'custody suite'. This was a bit of a misnomer, given that all of our patients were, by definition, already in some sort of 'custody', but it reflected the use to which it was mainly put: Police interviews of our patients regarding unsolved crimes about which they might - often did - have interesting things to say. Linda, as she gracefully explained, hoped that all the police paraphernalia around the place - such as the double cassette deck, the overt video cameras, the bolted down metal furniture - might trigger some memories of our client's initial - and presumably traumatic - contact with the forces of law and order, thereby reinforcing some sort of sense of reality.

I hoped she was right.

In any event, I thought, as we set ourselves up for the interview, this would be an experience for me. Obviously, I'd seen Linda interviewing; equally obviously, she'd observed me. This, though, would be the first time we'd attempted a double act. I was appropriately nervous.

Unlike Dr M: He seemed to be enjoying himself. Well, Hutton patients didn't really get a lot of 'air time' so the walk across from the ward was probably quite welcome. Disappointingly, he didn't bat an eyelid at all the gear around the room, merely looking slightly askance at Linda - maybe he'd forgotten their first meeting - and chose to focus on me.

Well, OK - so it was my meeting. Figures, I thought - my meeting, my patient, my bloody *nemesis*. I gave Linda a crooked grin before turning back to Dr M, kicking things off.

"Pieter," I said - another ruse to disconcert him, we hoped, using the given name we'd so far avoided. And about as successful, on first impressions, as everything else we'd tried. Oh, well. Soldier on.

"You know us both, so I'll skip the introductions," I continued, blithely, to a slight nod from Linda. I wondered where this was going, but carried on on verbal autopilot.

"My colleague and I are really quite curious about your case. Yes, I know," I went on, as he attempted to interject, "so are you. In fact, you don't think you *have* a case to answer ... and the entire process of arrest, remand, trial, imprisonment and even transfer *here* appear not to have disabused you of this notion..."

Linda cut in smoothly, to my considerable relief.

"*Pieter,*" she said, voice dripping scorn. " Let me read you an extract or two from the materials that led to your multiple convictions."

She paused for maybe a heartbeat. That's good technique, too - but it had bugger all effect. Dr M continued to look at us with utter unconcern.

So, Linda began to read. I don't think she found it too pleasant - I didn't and I was just hearing content that I was by now sickeningly familiar with. Nonetheless, she kept her voice calm and free from inflection, not articulating or dramatising the "stories", just stating the contents as matter of factly as if she'd been reading a shopping list.

Except, of course, that it wasn't a shopping list. Dr M sat looking, at least to my eyes, rather smug, seemingly quite pleased with himself, perhaps with his *artistry* but ...

It was all there, all, literally, in black and white. Pre-teen "love" he'd described it as on the websites he'd posted to. Stories detailing abuse, incest - even bestiality - the common, sickening factor being that in every single narrative at least one protagonist was a *child*.

Eventually, Linda finished her reading, whether because she thought she'd made her point or because she'd simply become too revolted to continue I couldn't say. God knows there was enough of this shit to go through. I looked at Dr M and he gazed back at me perfectly calmly. Frustrated, I prompted him for some sort of reaction. Unfortunately, we got one.

"But its all *fantasy,*" he said. "I would never *do* any of those things - I'm merely exercising freedom of expression."

He must have picked up on our incredulity, because he tried to continue.

"Honestly," he said, a pleading note beginning to creep into his voice. "I *respect* children, I'd never ..."

"Crap," said Linda, very quietly but with considerable force. "I suppose its just possible that you may think that's true."

She paused, waived a large wad of printouts at him.

"Clearly, though, you've fantasised at length about the possibility. My psychologist colleagues tell me that would certainly involve - at the very least - *observing* children ... in an unsavoury sense of the word ... if only for reasons of veracity. And its a fact, *Doctor* M, - well established in the literature - that there is a progression in these things. Even you would probably be surprised by how many rapists start as voyeurs, progress through indecent exposure ..."

"Or," I cut in, "how many adult psychopaths started out abusing animals ..."

"Which means *what*, he said, "I've been convicted on the basis of what I *might* do? What is this, 1984?"

"Oh, no," said Linda, leaning back in her chair with complete composure. "You've been convicted for the harm you've *already* done. Maybe you're a unique human being - maybe you can wallow in this sort of filth and not even *feel* like acting on it. But you distributed this stuff, *Doctor*, downloaded stuff written by others, encouraged them as they encouraged you."

"But that's mere conjecture," he said, "I haven't actually *done* anything ..."

"Well," I said, "last time I looked the SOCA database listed five convicted child abusers who had *your* stories on their computers, so I don't think you can plead complete innocence, really, can you?"

He looked a bit punch drunk, to be honest, but Linda once again cut off whatever response he might have been contemplating.

"And," she said, "had you been feeling a little less morally superior throughout your trial - if, in fact, you'd *listened* - then you might have picked up on one crucial point."

"The law," she continued, relentlessly, "prohibits the possession, distribution etc etc et bloody cetera, of indecent images of children."

She paused. He waited, looking a bit like a goldfish, mouth flapping ineffectually. I almost laughed, knowing where this was going.

"Point being," she said, after a moment or two, "*images* - its an interesting word, isn't it? For a start, it doesn't mean - or just mean, at any rate - *pictures*. It means *depictions*."

She smiled sweetly at him.

"Maybe your problem is that you were just too convincing as a writer?"

He crumpled.

We left.

  -  -  ---  ----  -----  ----  ---  -  -  

Later, we sat in Linda's office. She'd produced a bottle of single malt from somewhere - I *had* been sure this was an alcohol free area - and we were ploughing our way through it.

"So," she said, after a while, "Now we've got that out of the way, what's your revised prognosis?" 

"Mine? Well, as a mere registrar, I'd say that Dr M will probably die here. Can't send him back to prison, after all - they won't take him and, anyway, *they* would have to release him eventually ... and the powers that be wouldn't like that. It stinks, but he's our for the duration."

She looked at me appraisingly.

"Yeah. God knows we need the beds - for people we can actually *help*, I mean. And for the next forty years or so he's going to be blocking one."

I thought for a moment, contemplating the ramifications, the *politics*.

"Don't suppose we could just starve the bastard to death or something?"

She laughed, after a fashion.

"Sadly," she said, "even as a consultant, catering arrangements are out of my hands ..."
