Crime and treatment


Karen Kissane – Karen Kissane is law and justice editor

Helping criminals rehabilitate involves looking on them as human beings worth saving rather than monsters, says the clinical head of Victoria’s service for mentally ill offenders.
AS ANYONE working in the trade will tell you, even the nicest people sometimes have the urge to punch their psychiatrist. Professor Paul Mullen works with those who sometimes act on the impulse.
He never holds the grudge. Not when he’s cleaning up his bloodied nose or nursing his bruises; not even at the moment of impact.
Take the time a man came into an emergency clinic late one Friday afternoon claiming to be Jesus Christ.
“Which denomination are you?” Mullen asked.
“Anglican,” the startled man replied.
Mullen said drily, “Are you sure you shouldn’t have told the Archbishop of Canterbury first?”
The man answered him with a punch to the face. Mullen tipped backwards in his chair and crashed to the floor, even then thinking to himself, “If anyone ever asked for it, you did!”
Recalling it now, he says with a rueful smile, “Most times that people have hit me, I’ve actually deserved to be hit. You have a moment of carelessness; you lose concentration and you say something you should have best left unsaid, and somebody hits you. It’s not the worst thing that happens in the world.”
As a forensic psychiatrist and the clinical director of Forensicare, Victoria’s service for mentally ill criminal offenders, Mullen is rather an expert on the worst things that happen in the world. He spends much of his working week shut in a small room talking with people who have committed the kinds of crimes that make us shudder: murder, rape, child molestation. The stalkers are light relief, really.
Mullen is a tall man with a shock of white hair and blue eyes that seem always to look out on the world with wry amusement. He has the kind of genial, unshockable manner that would be useful to someone whose work involves trying to elicit confidences. While his chat seems open and friendly, his pose suggests a man who likes to keep his distance. For the whole of our interview, he sits with his legs crossed and his arms tightly folded across his chest.
Mullen says he was a painfully introverted child. Now he is a professor (of forensic psychiatry, at Monash) and he speaks with the confidence of one who is accustomed to being heard – slowly and at length, his accent high-end Pom, his words placed with the care and grace of a writer crafting a sentence, his funny anecdotes scattered like gold coins along the trail of a treasure hunt. He talks about himself entertainingly, with an engaging mixture of wit, vanity and self-deprecation – and he doesn’t need an observer to tell him any of this. He analyses himself as sharply as he does others.
“It never occurs to me that people don’t want to hear what I want to say,” he acknowledges, with a charming shrug. He puts it down to his “peculiar childhood” as a treasured only child of older parents who doted upon him: “It’s left me with certain vulnerabilities but also certain strengths.”
Mullen has developed strong views over his years of work with people who have done dreadful things. He does not believe in evil, in the existence of the unconscious, or in pedophilia as an illness. But he does believe that a lot can be done to help offenders become people who no longer commit crimes.
He also believes that we are locking up too many people in general, as governments try to win votes by beating the law-and-order drum, and that in particular we are locking up too many people who commit crimes because they are mentally ill and cannot get the medical help they need to keep them stable and safe. “We manufacture mentally abnormal offenders . . . by failing to adequately manage young psychotic patients,” he warned in Forensicare’s annual report, released last week.
Mullen says up to one-third of people in Victoria’s jails have either major depression or a psychotic illness (this does not include those with personality disorders or substance abuse problems). “If you look at violent crime in Victoria, between five and 10 per cent of it is going to be committed by young male patients with schizophrenia, although they constitute only a tiny proportion of the population; about 0.5 to 0.7 per cent of the population have schizophrenic illness.
“The vast majority of people with schizophrenia don’t harm anyone. It’s a small group, which we can readily identify, of young, male, substance-abusing people who do not co-operate with treatment and are living disorganised lives in contact with criminals. Those people are in the mess they’re in, in no small part, because they’re ill. And if you treat them and bring their illness under proper control, they’ve got a reasonable chance of living a relatively normal life and even making some contribution to the community. And certainly, if you manage them appropriately, the chances of them finishing up in prison drop dramatically.”
Mullen was born in Bristol, England, during the war. He came to Melbourne in 1992 to set up what was planned to be a model forensic mental health service. He had spent the previous 10 years working in New Zealand, where he and his family had fled to escape Thatcherism. “The Falklands war was the last straw,” he says.
By the age of eight, he knew he wanted to be a doctor, probably because he had met so many during hospital stays for the operations that cured his childhood deafness. By 14, he had decided upon psychiatry as his specialty. He found his choice as a result of his precocious intelligence being harnessed by teenage testosterone.
“Like any curious, oversexed adolescent, I got into the dirty books – Emile Zola and all that sort of stuff,” he says. “And in the library at Muswell Hill in north London, where we lived by this time, they had this locked case where all these books came from. I noticed there was a book of Freud’s case histories. I read the cases and thought, ‘That’s wonderful, that’s what I will do. I will be that kind of doctor.”
What was so juicy about Freud’s studies?
“There wasn’t much sex, actually. It was very disappointing. But the reason Freud appeals is that he makes human beings seem terribly complex. He flatters us that beneath this banal, superficial ‘us’, are these fascinating depths of unconscious and forbidden desires and conflict.”
Mullen did his psychiatric training at the then world-leading Maudsley Hospital. The motto of its chief was, “Not everyone who’s out of step is able and creative. No one who is able and creative is in step.” Says Mullen, “They had a penchant for selecting oddballs really, as long as you were a smart oddball. I found myself with this group of extraordinary able people.”
Psychoanalysis did not work out for him. He rebelled against the authoritarianism of its teachers, using his then-photographic memory for facts and quotes to challenge them in classes and reduce them to “inchoate rage”. It even got him thrown out of one seminar. The memory still makes him smile. He likes that smart mouth of his. Later, he decided that the idea of an unconscious was nonsense: “We’re much simpler than we like to think.”
Forensic psychiatry – working with criminals – he also wandered into by a less-than-conventional path: the “trip tents” at Britain’s pop concerts in the 1960s. He was a bit of a hippy himself – “Long hair, boots, bells, bangles, the whole thing really” – and used to work in the tents as a doctor offering medical aid to people who had overdosed on acid. “No major pop event was complete without one,” he grins. “And we always removed all of their drugs from them.”
And where did the drugs go?
“Ah well, that was another story.”
That work led to giving psychiatric reports in court on those who were charged – for which he could charge money. By then, he had a young family and liked the extra income. It did not take long for him to work out that he could consult for longer and charge more over serious crimes such as murder. Soon, he became intrigued by the phenomenon itself: “To be honest, it was almost the ordinariness of murder which became fascinating.”
He had to work through the idea that murderers must be monsters, not real human beings, and come to terms with the fact that “it really is people who kill people, and that many of them are not particularly unusual, and very few of them are monstrous”.
To help people, he says, he must try to see them as human beings worth saving, and focus on the roots of their behaviour. That doesn’t mean he has to pull his punches. He says crisply that child molesters are just as able to control their sexual impulses as other people, and that they are not sick.
“It’s very convenient for individuals, or organisations like the church, to say that they or their priests have some kind of illness. They don’t. They’re committing what’s called sin. The sooner the church faces up to that and accepts that it has a responsibility to alter the social and psychological realities of the priesthood so they don’t fall into molesting children, the better.”
If pedophilia is not an illness, how does it make sense for psychiatrists to “treat” it?
“What we’re doing is managing people,” Mullen says. “Many of the people we see, their child molestation arose from opportunistic, unthinking brutality, really. They were drunk, they were frustrated, they had access to a vulnerable child. It isn’t their first sexual preference, it’s just that for one reason or another, that’s how they acted.
“For that group, you have to increase their awareness of the damage they’re doing. You have to increase their empathy for their potential victims, you have to give them some skills to more effectively direct their sexuality towards adults, and to some extent you try and reinforce effective normal sexual behaviour while trying to get them to associate their desires to molest children with painful, distressing ideas.
“You do get a small group whose primary sexual desire is towards children. And for that group, we often think of using libidinal suppressants. These are things which just decrease sexual drive.”
What the Americans call “chemical castration”?
“Only the very insensitive Americans!”
Mullen says he tries to shift a little the kinds of traits in offenders that are destructive to themselves or to others. Stalkers, for example, tend to be obsessive loners who are touchy about their own feelings but indifferent to those of others. “You can’t change them from being rather nerdy, insensitive people into perfect, sociable human beings. But you only have to change them a bit and they stop stalking people. That’s what we do.”
He is not often thanked. A few years ago, Mullen was outside Myer in Bourke Street when he saw a large man rushing at him from across the road, arms outstretched. Mullen was unnerved: the man was a former patient, a serial rapist who had spent his adult life in and out of jail. Mullen had treated him with drugs to suppress his sex drive.
The arms turned out to be affectionate. “He hugged me and thanked me. He was a hypersexual man, very high level of sex drive, very poor personal and social skills. In the previous five years, he’d been working, he’d re-established his relationship with his mother, and he even had a relationship with a young woman – presumably not a sexual one, but one which he valued. And he said his life had been transformed.”
Mullen has the kind of job that would lead one to think about the meaning of life and suffering. Does he believe in God?
There is a long pause while he considers. “Only very late at night,” he says at last, smiling.
And evil?
“Oh God, no. No, no, no, no, no. No.”
Most people use the term “evil” to talk about behaviour they abhor and cannot understand, he says. “But I just don’t think it’s very useful. If you want to stop bad things happening, it does not help to call them evil. It leaves you looking at them as some sort of overwhelming absolute, instead of something which, if you can get a few elements of understanding, you might actually be able to stop happening again.”
Karen Kissane is law and justice editor.
BORN 1944, Bristol, England.
EDUCATED London University.
CAREER HIGHLIGHTS Graduating as a doctor, 1968, and as a psychiatrist, 1974.
FAMILY Married, five children, seven grandchildren.
HOBBIES Reading novels, listening to jazz and modern classical music.
· published in The Age, 10 November 2007