I worked as a psychiatrist for thirty five years.
One of the most difficult problems which a psychiatrist has to face is deciding whether someone is 'bad' rather than 'mad'.
That decision is multifactorial and depends not only on the assessment of the mental state with the presenting facts and past actions, family history and information from relatives, but if and how a patient will or can co-operate.
Never, at any time, is it psychiatrically sound or ethical to make a decision based on emotion.
Sometimes this could be difficult, but my belief was always that we were not there to like or dislike the patient or to be liked or disliked ourselves, but to assess with knowledge, expertise, impartiality, experience and integrity.
If there was any suspicion that there was a possibility of harm to either 'self or others', the first line of action was - 1) To offer voluntary admission into a psychiatric ward for assessment.
If this was refused but the patient appeared to present a real threat either to 'self or others', then - 2) A three day compulsory 'admission for assessment' section was enforced.
After three days, if more assessment was necessary or the threat persisted this would be continued into a - 3) One month long compulsory admission for assessment and treatment.
After the month had passed, a decision had to be made regarding discharge.
If this was not considered safe, then - 4) A long term 'section for treatment and continuing assessment was enforced, during which a patient could apply for a review.
These compulsory decisions, after the first three days, required more than one consultant and a social worker to agree.
In other words, in needed time, effort, expertise, and knowledge, from the patient and his/her relatives to find out the likelihood of dangerous actions to 'self or others' and to assess the mental state of patients presenting as a potential threat..
Early in my long career, I heard Dr Peter Scott, an eminent forensic psychiatrist, lecture on the subject of 'dangerousness'.
He said, 'you cannot know what someone will do until they have done it, but once they have, they have the capacity to do it again.
' Knowing what someone is likely to do is one of the greatest challenges of any psychiatric career.
In the recent case of Mr Moat, who killed a man and injured others by shooting, his actions resulted in dreadful trauma and death.
He is dead by his own hand.
What he did was totally wrong and no one can say different to that.
There is/was a page on the social network 'Facebook' showing sympathy and making him into a 'hero'- of a kind.
On the other hand, the Prime Minister, a man now responsible for making the decision, which many do not agree with or support, to maintain a war in Afghanistan where young men are fighting and being killed, feels able to make a statement saying 'he was a callous murderer'.
If the comments on 'Facebook' are 'sick' so, to my mind, is the 'other' as I ask 'how do they know' to make these judgements about Mr Moat? As a psychiatrist of 35 years experience, I know what I have heard and read, but could not give any opinion as I do not know enough and quite simply - these people do not have the information necessary for their comments or writings.
Nowadays, there are populist views, widely expressed, based on ignorance and emotion instead of knowledge, information and expertise.
This is a dangerous road to travel and the media hype encourages this increasingly bizarre behaviour.
Mr Moat was the main news on the TV channels for nearly a week.
For the bereaved family and for the injured, yes, this was the most important event - not only for a week but for the rest of their lives.
But, with the moment of 'excitement' gone, the channels move on to other topics.
There will be many investigations of the rights or wrongs of this case and whether the tragedy could or should have been prevented, but the fact remains that Mr Moat will now never be able to explain his final week's actions here on earth.
He will never discuss the nature or intensity of his thoughts to an experienced psychiatrist or the reason why he left 'normal' behaviour and took a life and injured others, or no-one will ever be certain whether he was totally aware and responsible or not.
In other words, was he 'bad' as the Prime Minister's statement implies, or was he 'mad' as others may wonder? His family and friends knew him, he left tapes and letters, but the truth of his actual mental state died with him.
I nearly died and 'reached the gate' four years ago.
I spent some time there, while unconscious for five and a half hours, but, despite intense and prolonged earthly suffering, I was told to return, that I would recover and I must write what I know.
Since then I have written a book 'Beyond Mercy' about a life in the 15th century.
I was given this information and I believe the story will be proved to be true - in 2012 in a time and place which I describe in the book! I gained knowledge of the 'here after' during my visit to the 'unknown', knowledge that is different but not affiliated to any religious belief or doctrine.
Hence, I can say, without doubt, that Mr Moat will already be facing his 'true' justice.
It is a justice outside this earthly plane and I know that every human will have to face that justice (however the system works) whether we are good or bad, mad or sane.
However, in that plane his actions will be totally and fully known and all intentions and reasoning behind his actions will be understood, without bias or emotion, whether bad or mad, following which his eternal destiny will be his to face.
Each person on this earth will eventually die and no one will escape their destiny by pretence or denial as all life's actions are known.
So, I suggest that the words of sympathy and support are given to and for the victims and the bereaved families on both sides of this very sad and tragic event.
That would be preferable and more apt as their trauma will last for a long time, long after the knee jerk words for popular support or emotive writings for dubious effect have vanished into oblivion.
Copyright©ACoatesworth.
2010 Author of 'Beyond Mercy' and the poetry book, 'A Spiritual Journey'
One of the most difficult problems which a psychiatrist has to face is deciding whether someone is 'bad' rather than 'mad'.
That decision is multifactorial and depends not only on the assessment of the mental state with the presenting facts and past actions, family history and information from relatives, but if and how a patient will or can co-operate.
Never, at any time, is it psychiatrically sound or ethical to make a decision based on emotion.
Sometimes this could be difficult, but my belief was always that we were not there to like or dislike the patient or to be liked or disliked ourselves, but to assess with knowledge, expertise, impartiality, experience and integrity.
If there was any suspicion that there was a possibility of harm to either 'self or others', the first line of action was - 1) To offer voluntary admission into a psychiatric ward for assessment.
If this was refused but the patient appeared to present a real threat either to 'self or others', then - 2) A three day compulsory 'admission for assessment' section was enforced.
After three days, if more assessment was necessary or the threat persisted this would be continued into a - 3) One month long compulsory admission for assessment and treatment.
After the month had passed, a decision had to be made regarding discharge.
If this was not considered safe, then - 4) A long term 'section for treatment and continuing assessment was enforced, during which a patient could apply for a review.
These compulsory decisions, after the first three days, required more than one consultant and a social worker to agree.
In other words, in needed time, effort, expertise, and knowledge, from the patient and his/her relatives to find out the likelihood of dangerous actions to 'self or others' and to assess the mental state of patients presenting as a potential threat..
Early in my long career, I heard Dr Peter Scott, an eminent forensic psychiatrist, lecture on the subject of 'dangerousness'.
He said, 'you cannot know what someone will do until they have done it, but once they have, they have the capacity to do it again.
' Knowing what someone is likely to do is one of the greatest challenges of any psychiatric career.
In the recent case of Mr Moat, who killed a man and injured others by shooting, his actions resulted in dreadful trauma and death.
He is dead by his own hand.
What he did was totally wrong and no one can say different to that.
There is/was a page on the social network 'Facebook' showing sympathy and making him into a 'hero'- of a kind.
On the other hand, the Prime Minister, a man now responsible for making the decision, which many do not agree with or support, to maintain a war in Afghanistan where young men are fighting and being killed, feels able to make a statement saying 'he was a callous murderer'.
If the comments on 'Facebook' are 'sick' so, to my mind, is the 'other' as I ask 'how do they know' to make these judgements about Mr Moat? As a psychiatrist of 35 years experience, I know what I have heard and read, but could not give any opinion as I do not know enough and quite simply - these people do not have the information necessary for their comments or writings.
Nowadays, there are populist views, widely expressed, based on ignorance and emotion instead of knowledge, information and expertise.
This is a dangerous road to travel and the media hype encourages this increasingly bizarre behaviour.
Mr Moat was the main news on the TV channels for nearly a week.
For the bereaved family and for the injured, yes, this was the most important event - not only for a week but for the rest of their lives.
But, with the moment of 'excitement' gone, the channels move on to other topics.
There will be many investigations of the rights or wrongs of this case and whether the tragedy could or should have been prevented, but the fact remains that Mr Moat will now never be able to explain his final week's actions here on earth.
He will never discuss the nature or intensity of his thoughts to an experienced psychiatrist or the reason why he left 'normal' behaviour and took a life and injured others, or no-one will ever be certain whether he was totally aware and responsible or not.
In other words, was he 'bad' as the Prime Minister's statement implies, or was he 'mad' as others may wonder? His family and friends knew him, he left tapes and letters, but the truth of his actual mental state died with him.
I nearly died and 'reached the gate' four years ago.
I spent some time there, while unconscious for five and a half hours, but, despite intense and prolonged earthly suffering, I was told to return, that I would recover and I must write what I know.
Since then I have written a book 'Beyond Mercy' about a life in the 15th century.
I was given this information and I believe the story will be proved to be true - in 2012 in a time and place which I describe in the book! I gained knowledge of the 'here after' during my visit to the 'unknown', knowledge that is different but not affiliated to any religious belief or doctrine.
Hence, I can say, without doubt, that Mr Moat will already be facing his 'true' justice.
It is a justice outside this earthly plane and I know that every human will have to face that justice (however the system works) whether we are good or bad, mad or sane.
However, in that plane his actions will be totally and fully known and all intentions and reasoning behind his actions will be understood, without bias or emotion, whether bad or mad, following which his eternal destiny will be his to face.
Each person on this earth will eventually die and no one will escape their destiny by pretence or denial as all life's actions are known.
So, I suggest that the words of sympathy and support are given to and for the victims and the bereaved families on both sides of this very sad and tragic event.
That would be preferable and more apt as their trauma will last for a long time, long after the knee jerk words for popular support or emotive writings for dubious effect have vanished into oblivion.
Copyright©ACoatesworth.
2010 Author of 'Beyond Mercy' and the poetry book, 'A Spiritual Journey'