Note: This story was dynamically reformatted for online reading convenience.
 
 ï>¿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 ..."