Primal fear

I got COVID many times during the pandemic. On one particular occasion, I really should have been hospitalised. But I was out in a remote-ish part of Asia. So instead I opted for a week of self-doctoring in bed with an oxygen cylinder for company. To be honest, for me the worst thing was that I was too ill even to read! For mental distraction I was forced to resort to Netflix on heavy rotation - whenever the dodgy internet permitted, that is! And its algorithm quickly diagnosed me as a woman with a strong interest in mentally ill detainees! So cue a review of Primal Fear…

Who killed the bishop?

Released back in the mid-90s, this great film starring Richard Gere and a young Edward Norton is now 30 years old. Yet the issues at its heart are still red hot relevant to the criminal justice system.

Long story short: a vulnerable young man is found covered in a much-loved bishop’s blood, and the prosecution is gunning for the death penalty. But the hot shot defence lawyer doesn’t think he did it. He enlists the help of a non-forensic psychologist who decides that he’s got split personality disorder and that likely he killed the (it turns out paedophilic) bishop whilst in a dissociative state. Cue lots of courtroom drama and everyone coming to be convinced that the poor lad is ‘mad’ rather than ‘bad’. But is there even more to it than that?

I won’t spoil the ending of this film for you. It’s thought provoking, well acted and not too incredible from a medical point of view. So do watch it! But I would like to just leave you with this reflection…

Forensic psychiatry

It’s really vital that healthcare professionals interacting with the criminal justice system stick within their fields of expertise. I’m a prison GP who happens to know a lot of general psychiatry. But that doesn’t make me a consultant psychiatrist, yet alone a forensic psychiatrist. Similarly, psychiatrists and psychologists may know a lot about their niche fields within mental health, but that doesn’t make them experts in - as is needed in this film - personality disorders and their interplay with serious crime. No, such cases require forensic psychiatrists - doctors who deal with the interaction between mental illness and the law.

In so many lands, we lack appreciation of the very fact of mental illness. Health systems lack sufficient numbers of even basically trained psychiatrists, yet alone highly trained forensic ones. Prison doctors, if they exist at all, are insufficiently versed in general psychiatry. And so many nations’ legal systems fail to make any allowance for the indisputable fact that severe mental illness - including psychological trauma such as child sexual abuse - is a major factor in many crimes. As a result, countless people languish untreated in prison rather than receiving the help they so desperately need… and yes, a very few guilty folk are able to manipulate well-meaning non-experts.

So folks, let’s take every opportunity to fly the flag for forensic psychiatry.

Dr Rachael Pickering wrote the original version of this article in July 2023. It had a minor edit before republication in October 2025.

…let the wise listen and add to their learning,
    and let the discerning get guidance…
Proverbs 1:5