James Gilligan Interview: Working with Violent Offenders in Prison Se... http://www.psychotherapy.

net/interview/gilligan-violence

by Rebecca Aponte

Renowned Harvard psychiatrist and violence expert James Gilligan offers insight into working with violent
offenders in prison settings. Learn about the tragic childhood origins of violent behavior, as well as the
fundamental principles of psychotherapeutic treatment of forensic clients.
Why Violence?

Rebecca You worked with highly violent individuals for many years. Most people are not particularly
Aponte: inclined to work with those kinds of populations. What drew you to work with this
population?

James That's a good question. I think the ultimate answer, as with most major life decisions that people
Gilligan: make, goes back to my earliest childhood. I grew up in a family with a father who was quite
violent toward my two brothers. He was only violent toward me when there was a medical
excuse for it—he was a surgeon. But my brothers he would really whack around. He would
knock them across the room to the point where I was really scared he would accidentally kill one
of them.

Now, it's true, the level of violence didn't reach the extremes that I later became familiar with
when I worked with prison inmates who were often the children of fathers or mothers who
actually had killed a family member. My father didn't go that far. He was never arrested, and
nobody ever made a complaint of child abuse or anything. That was in the days before people
even had a concept of child abuse. The whole concept of the battered child syndrome wasn't
articulated and expressed until around 1963 in the Journal of the American Medical Association.
Before that, people didn't even talk about child abuse.

So this was, you might say, "invisible," even though it was happening in a small town in
Nebraska where everybody knew everybody else. People could see the bruises on my brothers,
but nobody would say a word.

So without consciously intending this at all, I became interested in becoming a peacemaker and
trying to figure out how to prevent violence—how to get it stopped, or how to prevent it from
happening in the first place. I wouldn't say that I consciously articulated that to myself at the
time, and not until years and years later.

But when I became a psychiatrist, I was not at all interested in working with violent patients. I
wanted to work with people more or less like myself.
I wanted to become a psychoanalyst and work with
When I became a
the ordinary neuroses that everybody has to one
degree or another. psychiatrist, I was not at

1 of 18 14/01/2015 15:52
James Gilligan Interview: Working with Violent Offenders in Prison Se... http://www.psychotherapy.net/interview/gilligan-violence

all interested in working

When I was in my residency training at the Harvard with violent patients. I
Medical School, the teaching hospital was paying me
wanted to work with
such a small salary that I couldn't afford the expenses
I had, because I already had a wife and three people more or less like
children. I needed to supplement my salary, which I myself.
learned I could do by spending one day a week in a
state prison doing something I had never heard of
before and had no interest in, called prison psychiatry.

So I went into this project with no high hopes. I thought it would be an exercise in futility. I
thought it would be boring. And I had been taught up to that point that the kinds of people who
wind up in prison are totally untreatable—they have no motivation to examine themselves, no
motivation for introspection. They wouldn't tell you the truth. They would try to manipulate you
by lying to you so that you could help them get an early release date, and on and on.

I was taught all of this and believed it. Then I went into the prisons and discovered that almost
everything I had been taught was wrong. And I discovered that it was the most moving
experience I had ever had in psychiatry, because I was face to face with the deepest human
tragedies on a daily basis. And I mean not just the tragedies these criminals had inflicted on their
victims, but also the tragedies they themselves had been victims of in the course of their lives.

What I found was that the most violent among them, and many of those who weren't even at the
highest level of violence, had been subjected to a level of child abuse that was beyond the scale
of anything I had even thought of applying that term to. As I said earlier, the most violent people
were really the survivors of lethal violence, either of their own attempted murders at the hands
of one of their parents, or the actual murders of close family members who were often killed by
other family members right in front of their eyes.

... Continue Reading Interview >>

In the Danger Zone

RA: You have said that the first prerequisite for a therapist working with violent patients is to learn how
not to become their victims. How do they do that?

JG: Let me just say two things I would emphasize there. One is simply a practical matter of common
sense, which is when you are dealing with a dangerous population, make sure there is plenty of
security around. [quote:One of my mentors said, "If you don't realize how dangerous these people are,
you are more out of touch with reality than they are."

RA: Aside from the fact that prisoners are obviously in a situation where they are being humiliated so
frequently, do you find that therapy with regular people and therapy with violent individuals is really
all that different? Or is it very similar?

JG: That's a good question, because throughout the time I was doing this work in the prisons, I was
working probably between 70 to 80 hours a week, but I had a very active private practice, too, with

2 of 18 14/01/2015 15:52
James Gilligan Interview: Working with Violent Offenders in Prison Se... http://www.psychotherapy.net/interview/gilligan-violence

people more like myself—Harvard faculty members, Harvard graduate students, local professional
people, and so forth.

First of all, the basic principle of respect certainly is universal—that is part of all therapy. But the main
difference is the prison work was much more skewed toward crisis intervention. That is, the prisons
are the environment in which crises are not just an everyday occurrence, but a several-times-a-day
occurrence. Prisons are in a state of chronic recurrent crisis. So when I was actually talking with
people in the prison, it often was in order to resolve a current crisis.

What I learned was, however, that when you learn how to deal with the crises, a lot of very
constructive work can be done. The prisoner, for example, can learn how you can resolve a crisis by
talking rather than by using your fists or a weapon, because they would see how we did it—and that, in
fact, it was more effective than their way of trying to solve a crisis, which was to hit somebody, or try
to strangle them or stab them.

So a lot of useful work got done that way, but certainly the prison environment and also the
personalities of the kinds of people who wind up in prison were different enough from my ordinary
private patients that we were certainly not even in any way attempting to mimic a lot of the ordinary
routines of psychotherapy or psychoanalysis. We certainly didn't have people lying down on the couch
five times a week, free-associating.

We were much more face-to-face, dealing with a concrete reality. But in the course of that, as we got
the crises resolved, the prisoners then became capable and motivated to talk with us about their
lifelong issues, and could talk to us about the most painful and formative experiences in their earliest
childhood and so forth.

Common Misconceptions and the Meaning of Attention

RA: And you have trained a lot of therapists to work with violent individuals, haven’t you?

JG: Yes, I did, and I and many of my colleagues, over many years.

RA: Do you find that therapists have any general misconceptions about working with violent individuals?

JG: Oh, yes, I really do—just as I did before I first started working with violent people. I was full of
misconceptions. One of the commonest, actually, was one I didn't share quite as much, and that was a
total fear of working with people who had a history of violence or were at high risk of it. Every time I
worked in the prisons, I was working as a member of faculty of one of the Harvard teaching hospitals.
And we would try to make sure that part of the training of the psychiatric residents—or sometimes
even medical students and forensic psychiatry fellows, along with clinical psychologists, psychiatric
social workers—consisted of spending a certain number of months as clinicians in either the state
prison mental hospital or the prisons themselves.

What we found was that we got a lot of resistance. Many of the people who were very happy to see
mentally ill people at, say, Maclean Hospital or the Massachusetts Mental Health Center, the Harvard
teaching hospital, didn't want to go near a prison or a prison mental hospital, and were scared to death
of it. We tried to convince them that ironically, in some ways, because there is so much security, the

3 of 18 14/01/2015 15:52
James Gilligan Interview: Working with Violent Offenders in Prison Se... http://www.psychotherapy.net/interview/gilligan-violence

prisons and prison mental hospitals can be some of the safer places to work, as long as you know how
to do it.

So that was one misconception—that this population was too dangerous to work with. The other was
the misconception I had had, which is that they were untreatable. I found it totally untrue. In fact, I
would go so far as to say that, while I frequently had the experience of meeting somebody in the prison
or the prison mental hospital who I thought was untreatable at first, I came to the conclusion, over the
course of working for 25 years, that nobody is
untreatable. I wouldn't give up on anybody. I saw people
I came to the conclusion,
who seemed intractably violent, and in some cases
intractably psychotic, in the case of the mentally ill over the course of working
prisoners. And I reached the position that everybody can for 25 years, that nobody is
be brought to a point where they stop being violent untreatable. I wouldn't give
toward other people. They just do not use that as a means up on anybody.
of trying to solve their life problems anymore.

RA: Going back to what you were saying about people being afraid to work with these populations, I'm
wondering about the times that you were assaulted when you were new to this. What do you think
went wrong?

JG: In the 25 years I did this, I was really seriously assaulted about three times—I mean, punched in the
face. I didn't get a broken nose or a broken jaw, though I easily could have if I hadn't been lucky. That
was really it. And when I asked myself, "What happened? What led to this? What could I learn from
it?" I began to realize that each of these incidents had occurred under almost identical circumstances.
Namely, it was late in the afternoon, I was getting tired, I was eager to get home to see my wife and
family. And what occurred to me was the analogy that skiing accidents typically around 4 o'clock in
the afternoon, when the sun is going down and you want just one last descent along the ski slopes
before you go home—people are tired, they are distracted, and that's when the accidents happen.

I found that that was what was happening, and I realized that the prisoners, in fact, were correct that
they thought that I was really not giving them my full attention, that I was a little distracted or
impatient, I wasn't really completely listening to them, and they succeeded in getting my attention.
That's how you do it—you hit somebody, you sure get their attention.

And I realized another thing about it: the German word for attention, "Achtung," also means respect.
And it struck me that paying attention to people is a form of showing respect for them. And not paying
attention to them is a way of disrespecting them. In fact,
that's one reason that I think that psychotherapy is one of
The German word for
the most profound forums of showing respect toward
another human being, because the therapist is sitting attention, "Achtung," also
there giving that person his or her entire unadulterated means respect. And it
attention. That alone is part of the curative therapeutic struck me that paying
process, I'm convinced. attention to people is a form
of showing respect for
But I also realized that what I was doing in the prisons
them.
was I was not giving them my full attention, and I was
disrespecting them. What I heard from the most violent
inmates over the years when I would ask them why they had hit somebody—not myself but
anybody—they would say, "It is because he disrespected me." And they used that term so often, they

4 of 18 14/01/2015 15:52
James Gilligan Interview: Working with Violent Offenders in Prison Se... http://www.psychotherapy.net/interview/gilligan-violence

abbreviated it into the slang term, "He dissed me." It struck me that anytime a word gets used so often
it gets abbreviated, it tells you how central it is in the moral and emotional vocabulary of the person
using it.

Disrespect is central to the ideology of violence. When I became a victim of violence, I would say I
had provoked it by inadvertently, unconsciously disrespecting the people I was supposedly talking
with.

Confronting the Horror

RA: I want to talk a little bit more about that role of disrespect or shame in violence. When you are
working with the prison population, how do you balance your sense of respect and dignity for them
with the serious and grave impact of the actions that landed them in prison?

JG: Again, that's an excellent question I asked myself many times. I have tried to make the distinction,
when I think about that, between the horror and the outrage that one can't help feeling when you
realize how horribly this person mutilated somebody else or caused them horrendous suffering. So
when I talk about respect for this population, I don't mean pretending that you respect somebody for
that part of their behavior.

What I mean is something much more basic than that. First of all, no matter how horrified I am about
the behavior that led them to be sent to prison, I'm not there to humiliate them about it. I am there to
try to understand what caused this behavior on their part.
I am an investigator. It is a scientific process. I am a
No matter how horrified I
physician that is a part of science, and I am there to try to
learn something from them. So it is precisely the most am about the behavior that
horrendous offenders who I regarded as my teachers, and led them to be sent to
I was their student. I was trying to learn from them what prison, I'm not there to
had led them to behave in this way, which of course I humiliate them about it.
found just horrendous. So when I say I would treat them
with respect, that doesn't mean I respected what they had
done. But on the other hand, I also felt it was not my job to punish them or humiliate them for it. My
job is to try to understand what had caused them to do it.

The other thing—in my first book on the subject of violence, called Violence: Reflections on a
National Epidemic, one of the epigraphs was a quotation from a book by a political scientist who said,
"Of human beings, none are good but all are sacred." Now that is, in a sense, a religious way of putting
it. But actually you don't have to commit yourself to a particular form of religious belief to believe that
some things are sacred and that, just being human, there are some things we just don't do. And I felt
the one thing I would not do, no matter what the person was in front of me had done—I was not going
to strip that person of their human dignity. They still were human beings no matter what they had
done.

And that there was something about the human personality or the human soul or psyche, whatever you
want to call it, that is sacred. There are just some things that you don't do to a person's psyche.

RA: But you must have negative feelings from time to time towards the person that you are working with.
How do you manage that countertransference?

5 of 18 14/01/2015 15:52
James Gilligan Interview: Working with Violent Offenders in Prison Se... http://www.psychotherapy.net/interview/gilligan-violence

JG: I will tell you about one of the most horrendous case that affected me personally, that really forced me
to confront that in myself. This is a man who had raped and murdered a 14-year-old girl who lived in
the house next door to him, and he then buried her body in his basement. He dug a hole in the dirt floor
of the basement and buried her in it. Then he went upstairs and watched a football game on television,
and waited until his wife and daughters got home, and acted as though nothing had happened.

When her family realized she was missing, a group of citizens was formed in the community to have a
search party and try to find her. He joined the search party as if he did not know where she was. He
finally was caught and apprehended, and convicted of murder.

RA: That's chilling.

JG: When he told me this story I felt literally sick in my stomach. I thought I was going to throw up. I was
so offended. The whole story was so horrible. How can you sleep after hearing something like this?
And I felt a sense of compassion for this girl that is just endless. How much more horrible can
anything be?

Then I realized, "Well, I have experienced that feeling before." When I was a medical student, we
learned anatomy by dissecting a cadaver that smelled of formaldehyde. And you worked very hard in
medical school. Sometimes people had to eat lunch while they were dissecting a cadaver. It would
make you sick to your stomach. And then in the pathology lab, the same thing. We would be doing
autopsies and dissecting disease tissue, tumors and so forth. And, again, totally disgusting. I would feel
sick in my stomach.

But when I was in medical school, the attitude I took was, "Well, okay, that's a normal response to
something that in fact is a source of illness in pathology. And, yes, you should be disgusted by it. It's a
normal, human, biological response. But I will tolerate the disgust and nausea in order to learn what
caused this person to die—in order to learn more about the pathology that was involved." So I realized,
with this murderer, I was doing the same thing—but as a psychiatrist, not as a surgeon or pathologist. I
was, in a sense, dissecting his soul, which was full of pathology, and it was disgusting. It was horrible.
It made me nauseated. But I said, "Again, I am doing this
in order to try to learn something. I'm trying to learn
I am doing this in order to
what was the pathology that killed this girl." And that
was the only way I could do it—by tolerating the sense try to learn something. I'm
of nausea in order to try to learn something. trying to learn what was the
pathology that killed this
girl.

RA: If the person that you are speaking with is expressing remorse, do you find that your own sense of
disgust is mitigated by that?

JG: I would absolutely say that. And I think it's true for several reasons. One is, when a person has a sense
of remorse, I am less worried that they are going to be likely to repeat the same behavior. I feel that
also there is more to work with. They are more treatable. One thing that I learned over the years,
though—I would see people who had committed murders and felt no sense of remorse whatsoever.
They felt totally justified. They felt they were the victims, and on and on.

6 of 18 14/01/2015 15:52
James Gilligan Interview: Working with Violent Offenders in Prison Se... http://www.psychotherapy.net/interview/gilligan-violence

Finally, when they began to realize what they had done, how much human suffering they had caused to
other people, when they finally reached the point where they could recognize how much pain they had
caused, then they would begin starting to feel remorse and say, "Oh my god, what have I done?" And
at that point I was dealing with a suicidal person, because the remorse is one aspect of feelings of guilt.
When people feel guilty, they typically have a need to punish themselves. In many cases these were the
people who would kill a family member, a wife or a child, and minimize it at first. Then, finally, when
they were able to face what a horrible thing they had done, they really were seriously suicidal, and the
staff and I would spend a year or two trying to prevent a suicide before the prisoner could finally
integrate what they had done, who they were, and where they could go from there.

Once they had learned to live with the remorse and not kill themselves over it, the one thing they
seemed to find that made life livable for them was when they found out how they could be of service
to other people. And when these men in the prison, who otherwise just seemed unremittingly suicidal,
realized they could actually be useful to other people, they had something to live for.

It might be as simple as they could teach other inmates how to read or write. A lot of prisoners are
illiterate, and those who knew how to read or write could teach the others to read and write. Another
person might become the librarian at the law library in the prison, and kind of be the jailhouse lawyer
and help prisoners to write up a legal brief for themselves and so forth. Or they might help out with the
school educational programs, or cooking things in the cafeteria. It almost didn't matter what they did,
but if there was something that was useful and had a useful place, they then had something to live for.

What struck me about that was, after all, in a sense, that is true of all of us. What makes life
meaningful and worthwhile for anybody is the sense that actually they are useful to other people.

RA: Once someone has reached that point of experiencing remorse, is it dangerous to bring that up, to try
to treat it directly? What do you do at that point?

JG: At the concrete level, we would certainly put them on suicide precaution and try to make sure that they
didn't have access to anything they could hurt themselves with. But I would talk with them. I would try
to acknowledge their pain—the pain of realizing how much pain they had caused others—and try to
talk with them about how they are actually not helping anybody if they kill themselves. They are not
undoing anything. In fact, maybe they could find a way to, so to speak, try to make up for what they
had committed. I would certainly try to steer them in the direction of finding some way to make their
own lives useful to other people.

But I was certainly aware that they were dangerous to themselves, for often a year or two. In fact, the
only suicides that I did see happen in this world were of people who had reached that point, who had
originally felt totally justified in the homicide they committed and then later realized that they really
weren't—there's no justification for killing somebody else.

The Point of It All

RA: As you know, the “bread and butter” of psychotherapy is to help people reduce anxiety and depression
and adjust to new life situations. What are typical treatment goals in working with violent offenders?

7 of 18 14/01/2015 15:52
James Gilligan Interview: Working with Violent Offenders in Prison Se... http://www.psychotherapy.net/interview/gilligan-violence

JG: First of all, to prevent further violence. That's not the ultimate goal—that's just the first step. But we
would have to reach that point before we could do anything further. In other words, as long as violence
was continuing, any other therapy was a waste of time. It's beside the point. So the first goal would be
to help them to reach a point where they would stop using violence as their optional tool for solving
life problems.

A second one would be to give them the tools they needed and the resources they needed in order to
gain the sense of self-respect, which they simply had never been able to develop. The reason they were
hypersensitive to being disrespected by others was because they were so lacking in self-respect, and
that means lacking in the precondition that any of us need in a given day to be able to respect
ourselves.

For example, everybody gets humiliated at one time or another, but most people never commit a
serious act of violence in their lives. And I would say one reason for that is because most people have
enough internal and external resources available to them that they can restore their self-esteem, even
when they have felt humiliated. You have an education, you have some skills, knowledge that you can
respect and that other people will respect. The guys in the prison, almost all of them had none of those.
They were often illiterate. They had often been unemployed, homeless. They have been abused and
treated as worthless from the time they were born. I mean, their self-respect is zero.

I learned that if we gave them the tools they needed, they could gain self-respect just through the
process of education and development. For example, I always regarded education as a therapeutic tool.
Education can serve a lot of purposes—people can get better jobs if they have a good education, and so
on. But I felt it was therapeutic for this population to gain a set of knowledge and skills that they could
respect themselves and treat other people with respect.

In fact, we found that the single most effective therapy in the prisons in preventing violent recidivism
after people left the prison was prisoners getting a college degree while in prison. We had a program
like that that had been in effect for 25 years. Professors
from Boston University taught courses for credit, and the
We found that the single
prisoner could get a college degree from Boston
University. most effective therapy in
the prisons in preventing
We found that over a 25-year period, several hundred violent recidivism after
prisoners had gotten a college degree, and not one of people left the prison was
them had been returned to prison in that time. When we prisoners getting a college
extended the study to 30 years, we found that two people
degree while in prison.
had been returned. That was much less than a 1 percent
recidivism rate. Phenomenal compared to the usual
recidivism rate of 65 percent in three years—this was less than 1 percent over 30 years.

But, for me, the reason was they built up their self-esteem. They could respect themselves.

RA: So preventing future violence and tools for self-respect—are those the core of the work that you are
doing?

JG: Certainly that was, at the level of emotions, prerequisite to everything else. For example, I felt that
certainly one thing that had been missing that had made it possible for them to commit serious harm to
others was their lack of a capacity for empathy with the suffering of others, and a lack of the capacity

8 of 18 14/01/2015 15:52
James Gilligan Interview: Working with Violent Offenders in Prison Se... http://www.psychotherapy.net/interview/gilligan-violence

to care about others or to love others.

But what struck me was they couldn't respect other people or treat other people with esteem if they
were lacking in self-esteem and self-respect. So helping them reach the point where they gained
self-respect and self-esteem was really a prerequisite to their being able then to care about others
enough so that they would not violate the rights or inflict harm on other people.

But that is all at the emotional level. At a more cognitive level, one major thing that we did in the jails
of San Francisco when I worked there over a ten-year period was to focus on cognitive issues
—namely what we call the Male Role Belief System, which we felt had underlain the violence these
men had committed. And by that we meant all of the assumptions they had been taught as to how you
define masculinity and what you need to do in order to be a man, what you are entitled to do, what you
are obligated to do, how should women treat you, how should you treat them, and on and on—the
whole set of assumptions that almost all men in our society are raised with. The assumption underlying
this very skewed patriarchal, somewhat misogynistic view is that the social universe, that is, the whole
population, is divided into the superior and the inferior. In that division, men are supposed to be in the
superior part and women in the inferior part. And, in fact, the really superior man has also got to be
superior to other men. So they are also inferior.

This is a recipe for violence because most people don't want to be cast into the role of the inferior.

RA: And it is a roadmap for feeling disrespected.

JG: Exactly. So we engaged in intensive group therapy with these jail inmates—all of them were in for a
violent crime. I was amazed how quickly they grasped that point. And not only did they get the point,
they began to say things like, "I've been brainwashed by the society I have grown up in." They would
want to then start educating the new inmates about what they had learned.

So we said, "Great," and we would train them to lead the groups themselves, kind of like Alcoholics
Anonymous where the people suffering from the problem are sometimes the best therapists. So we
trained them to lead these groups, and we found the level of violence in the prison dropped to zero, and
the level of recidivism after they left the prison was down 83% compared with people who had been in
an ordinary jail without these kinds of programs. So that
is a concrete example.
We found the level of
At a more abstract level, we were trying to increase their violence in the prison
ability to be self-aware, to recognize their own dropped to zero, and the
motivations, to recognize how they were behaving in level of recidivism after
ways that were really self-defeating—this wasn't helping they left the prison was
them get what they really wanted. In fact, their behavior down 83%.
was often costing them relationships that they actually
wanted to maintain.

So, like any psychotherapy, you are ultimately trying to get at the greater sense of self-awareness and a
greater degree of self-control that comes from the self-awareness. If you are lucky, that is what will
happen. The goals of therapy and the methods of therapy did share those features in common with
psychotherapy with any population.

9 of 18 14/01/2015 15:52
James Gilligan Interview: Working with Violent Offenders in Prison Se... http://www.psychotherapy.net/interview/gilligan-violence

Violence in Childhood: Bullying and Corporal Punishment

RA: I want to transition into talking about the earliest possible interventions. We know that violent
behavior begins fairly early in life. How do you think that child and school counselors should be
responding to bullying? Do you think parents are to blame? Should they be involved in the response?

JG: First of all, I certainly think that bullying is a prime example of the kinds of experiences that stimulate
violence. That is hardly an original observation on my part, but I think people in general are
increasingly aware how much school violence and violence out of school is caused by bullying.

I would like to see a truly cooperative effort on the part of schoolteachers, school administrators, and
parents to identify and respond to a bullying situation and to get it stopped. Whenever there is a
bullying situation, there are three parties involved. It's not just the bully and the victim. The third party
is the bystander, the witness, whether that is a schoolteacher or whoever. I really think that it is vitally
important that nobody take this as just normal. Many of the people I saw in prison, for example, would
talk about how they had been bullied in school, come home and tell their parents about it, and the
parents, instead of going to the school and saying, "This is a problem we should work together to
solve," would tell their son, "You go back and beat him up, and if you don't beat him up I will beat you
up myself."

That's how you teach children to be violent.

RA: Do you feel that the chronic victims of bullying are at a similar risk for violence as the chronic
perpetrators?

JG: That's a good question. I don't want to give you an answer that would imply that I am sure I know what
the answer is. That is one I am not sure off the top of my head. Very often, bullies also have been
victims. They aren't necessarily just one or the other. Often you find they are overlapping categories.

Without being able to be sure how I could predict which of those groups is most dangerous in the
future, I would share pretty much an equal sense of concern for both. I would want to pay just as much
attention to one as to the other—to the bully in order to get the bullying stopped, and to the victim in
order to make sure that the victim doesn't ultimately turn into a bully.

Whenever I see a situation like that, I would want to intervene. But I would like to do so in a way that
is not aimed at humiliating or at punishing, but is really aimed at restraining, in the sense of saying,
"This is not permissible. You can't do this. We will not tolerate this. But we are not going to bully you
ourselves. We are not going to beat you up or spank you. What we are going to do is limit your
freedom to do this until the point you can stop yourself. If you can limit yourself from doing this, then
fine, we don't need to do anything."

In other words, the only way to stop violence is with nonviolent means. That doesn't mean you don't
need restraint, but it does mean that I would make a sharp distinction between punishment and
restraint. I think parents who have two-year-old children running in front of traffic need to restrain the
children so they don't get hurt. But that doesn't mean they have to hurt the children themselves. The
whole point of restraining them is so the children won't get hurt.

10 of 18 14/01/2015 15:52
James Gilligan Interview: Working with Violent Offenders in Prison Se... http://www.psychotherapy.net/interview/gilligan-violence

RA: You mentioned not using spanking. Every time there has been a new movement to try to outlaw
spanking, it has been met with quite a bit of controversy in the name of parental rights. What would
you say to parents who think that spanking is a necessary tool?

JG: First of all, I think most of the empirical research on this subject has found that spanking is
counterproductive. Over the last 60 or 70 years, there have been literally dozens of studies, if not
hundreds, about child rearing and child development. The whole process of child development is so
complicated and there are so many variables that not very many generalizations have been almost
universally replicated. But the one conclusion on which there is the highest degree of consensus is that
the more severely a child is punished, the more violent the child becomes. Using violent means to limit
violence is just self-defeating. Violence stimulates violence. Obviously, you can talk about different
degrees of spanking, and you talk about it so that it is not really painful—not going to cause bruises
and so forth. But just the sheer idea that an adult can do something to a child which would be called
assault and battery if they did it to another adult—I mean, the legal system recognizes the difference
between a violent and a nonviolent intervention. And I just don't think an adult is doing anything
except stimulating violence. To me, that is what the empirical research has shown. From my
experience working with prisoners, I have already mentioned the most violent prisoners are the ones
that have experienced the most violence at home. If violent punishment would prevent violence, then
the people who wound up in the prisons would never have become violent in the first place, because
they had suffered as much violent punishment as you could inflict on a person without actually killing
them. As I said, many of them were the survivors of their own attempted murders.

I understand people who believe in spanking and say, "Well, we are not attempting murder." One
problem is that people who have studied child abuse have found over and over again that it often starts
just as so-called harmless spanking and escalates—parents get carried away.

I have treated parents who came to me in my private practice because they were afraid they were
losing control and they were going to really injure the child more than they intended. They couldn't
stop themselves once they got started. I would recommend that the United States follow the example
of an increasing number of nations around the world—I think Sweden was one of the first, but by now
there are at least a dozen if not more—who have made it a law that corporal punishment of children is
assault and battery. [editquote: I would recommend that the United States follow the example of an
increasing number of nations around the world who have made it a law that corporal punishment of
children is assault and battery.

Intervening with Victims of Violence

RA: I'm wondering also whether you have any insights from your work with violent individuals that would
be helpful to therapists who primarily work with victims of violence, maybe a battered spouse or adult
children of violent parents.

JG: First of all, I would begin the work I do with the victim of violence with the unequivocal assertion that
violence is not justified. Nobody deserves to be victimized by violence. It is important that they realize
that they weren't the cause of this. No matter what they did, that doesn't justify the person who harmed
them.

The second thing is that, precisely because nobody deserves to be treated this way, it is vitally
important that they do everything they can to protect themselves from it and to make sure that they

11 of 18 14/01/2015 15:52
James Gilligan Interview: Working with Violent Offenders in Prison Se... http://www.psychotherapy.net/interview/gilligan-violence

don't expose themselves to the risk of further violence of this sort. If they are involved with somebody
who does not appear to be capable of renouncing violence as a form of trying to influence the person
they are involved with, it is vitally important that they separate themselves from this person.

Otherwise, you have to then shift the focus to the question of, where is their need for punishment
coming from? I would really focus on trying to prevent violence there by trying to prevent their
victimization. You have heard of the Tarasoff Rule and the Tarasoff Warning—the legal rule that if the
therapist has reason to believe that a patient of his or hers is at risk of being injured by someone else,
they have a legal obligation to inform the patient of their concern and to clarify who it is they feel they
are in danger from, and to recommend that they do everything that they can to separate themselves
from that person and to protect themselves.

We had a terribly tragic situation in Massachusetts when a man was sent to the prison mental hospital
because he had been threatening a woman he had had a love affair with, and he would keep breaking
up with her and then wanting to get back together. Finally she got tired of it and said, "No, forget it, go
away." And he couldn't, he was obsessed with her, and would keep threatening her. He was sent to the
prison mental hospital for the crime of threats, which he had been convicted of.

We reported to the court that we thought this man was indeed dangerous to her. We also sent her a
letter saying that we thought he was dangerous and she should do everything she could to escape from
him, to not let him know where she was, and to leave. The letter went to the judge, it went to the
sheriff of the jail this man went to. But the man was not psychotic. We couldn't commit him to the
prison mental hospital on grounds of insanity because he wasn't insane. And he got sent to the jail with
the letter in which the judge ordered the sheriff to notify the police in this woman's hometown when
this man was going to be released from jail, because the maximum sentence for the crime of threats
was only six months.

So this guy, after only six months, was released from jail. The sheriff screwed up and didn't notify the
police in her hometown, didn't notify her, and the man went to her home and killed her.

It was a tragic, tragic case where the victim could have been saved. On the other hand, you might say it
is one of the difficulties in our legal system that this man could only be locked up for six months
according to the law. I could understand this woman's sense that she wouldn't want to be going into a
witness protection program like where the FBI puts informants against other criminals or something.
She would literally have to change her social security number, and move to the other end of the
country or something, change her name—literally, because this man was obsessed with her and was
very dangerous, and was willing to do something.

He now has a natural life sentence. He will never be out of a prison in his life. So clearly he didn't
care; he wasn't restrained by anything. You talk about dealing with the victims—that was the worst
case I think I have ever seen. It was not just frustrating, but horrendous. It was appalling. The Boston
Globe reviewed all the circumstances and concluded this could have been avoided if the sheriff and the
police had provided some protection as the judge had ordered. But it's even more complicated than
that. [quote:It's a very difficult thing to help the people who have been victimized to realize how much
danger they may be in.

How to Abandon the Prison System, and Why

RA: I want to give you a chance to talk about your more recent work, which is violence prevention at the

12 of 18 14/01/2015 15:52
James Gilligan Interview: Working with Violent Offenders in Prison Se... http://www.psychotherapy.net/interview/gilligan-violence

societal level. You have said that prisons should be demolished and replaced with secure residential
schools, colleges, and therapeutic communities. I wonder if you could briefly outline your theory
behind this.

JG: The modern prison system is a fairly recent invention. It was only in the late 18th to early 19th century,
starting in countries like England and the United States, to some extent Italy and other European
countries, that prisons became long-term residential facilities for purposes of punishment rather than
being short-term settings just awaiting trial, and at the outcome of the trial they would either be
executed or tortured and mutilated, or acquitted and just let go.

But what we have now, where people come into prison and spend years there, or maybe the rest of
their lives—that is a new development. It is a well-meaning experiment that has failed. It was well
meaning because it was originally developed as an alternative to torture and execution. It was an
attempt to protect people from such horrendous experiences. But in fact, it does not work in its stated
purpose, which is to make society safer, except insofar as it certainly serves purposes of restraint. I
mean, you keep somebody violent from the community—that I am in favor of, and I think we do need
to do.

But if you want to look at the long-term effect on society, more than 90 percent of the people who get
sent to prison are back in the community within a few years. They would have to be, or otherwise the
prisons would be ten times larger than they are now, and they are already something like 7.5 times
larger than they were in the mid-1970s on a per-capita basis.

Humanizing Predators

RA: Aside from the cost of doing something like that, probably the biggest resistance to that idea would be
the conventional wisdom that there is a certain subset of people who are true sociopaths who are not
going to be helped. You said earlier that nobody is untreatable. Is the "predator personality" a myth?

JG: Well, in one sense it is. But let me make clear, too, that I do not mean to imply that I am so optimistic
about everybody that I think everybody that comes into the prison, no matter how violent they have
been, can necessarily be returned to the community.

What I am saying is they can be rendered nonviolent. But I certainly have known people that I think
should in fact remain institutionalized, because I think they have been too damaged. I will give you a
case example. We had a man sent to us when I was running the prison mental hospital in
Massachusetts, an African-American man who had been a pimp of a stable of prostitutes. He killed
several people in the community, including some of his own prostitutes, was arrested for multiple
murders and sent to the Charles Street Jail in Boston to await trial for murder.

He promptly killed one of the other inmates. So they realized he was too dangerous to await trial there.
He had to be sent to the maximum-security prison to await trial, even though that is where you would
normally be sent only after being convicted. And he killed an inmate in the prison. So they sent him to
me at the prison mental hospital.

Now this man, when he came to the door, was mute—he was like a zombie. He was paranoid. He
couldn't relate to anybody. Everybody was, of course, scared to death of him, knowing his history. And
he seemed equally terrified and suspicious of everybody. When saw this guy, I thought, "This is

13 of 18 14/01/2015 15:52
James Gilligan Interview: Working with Violent Offenders in Prison Se... http://www.psychotherapy.net/interview/gilligan-violence

someone who is untreatable. He is actively violent. You can't do psychotherapy with somebody who is
mute, with his kind of history. The best we can hope for is to limit the violence that he would commit."
So I had him put in a maximum-security residential unit we have where he would be in a locked
bedroom at night so he couldn't hurt anybody and they couldn't hurt him. And I told people during the
day to just keep a six-foot invisible wall between him and everybody else so that nobody would crowd
him. One of our staff wanted to try to engage him in psychotherapy and I said, "Don't even bother.
That he would experience that as a violation of his space." I said, "Give him space."

And after a month or two of this he didn't harm anybody; nobody harmed him. He found that there was
a profoundly retarded 18-year-old man in the same residential facility there, same dormitory building,
and this kid was so retarded he could hardly tie his shoelaces. He really needed somebody to look out
for him. This multiple murderer took this guy under his wing and would walk with him to and from the
dining hall and make sure that nobody abused him, robbed him, raped him, assaulted him, anything.
He protected him.

And from the moment I saw this happen I said, "Thank god. This may be this guy's restoration to
humanity." But I wasn't sure. He still didn't seem treatable in any conventional sense. But we let this
go on, and for several months he was the caretaker of this kid, and still not talking much to anybody.

Finally he reached the point where he was relaxed enough that he did start wanting to talk. I sat down
with him several times, and he basically told me the story of his life. His childhood was horrifying,
blood-curdling. But he got this off his shoulders. By the way, we gave him very small doses of
medication as he came in looking paranoid, but actually, he wound up to be more depressed than
anything else. And we gave him very small doses of an antidepressant. As far as I know, he is probably
still taking it.

But it was minimal medication involved. He really wasn't psychotic. Once he got to the point of
talking, he was perfectly sane. But he had had horrendous child abuse in his lifetime. He still is at the
prison mental hospital. He has several life sentences. He will never be out of prison. He will never be
back in the community. Frankly, I don't think he would know what to do if somebody sent him back
into the community.

So when I say that I wouldn't give up on anybody, I don't mean that this is somebody that is really
going to be fit to return to the community and live in it. I think he is too badly damaged. But on the
other hand, I think we don't need to keep punishing him. We can provide him a place where, for
example, he has a job in the hospital. So, again, he is of use to other people. He gets some degree of
self-respect from that, and people are grateful. He has filled a useful role in the hospital. When I come
back to visit from time to time, he will smile and say, "Hello, Dr. Gilligan, how are you?" You know,
behave like a normal human being—no longer mute, paranoid, menacing. And he has not harmed a
hair on anybody's head since coming to that prison mental hospital.

So when I say I don't give up on anybody, this was somebody who was still killing people even after
he was sent to prison. He has been there for 25 years now, and hasn't harmed anybody. And to me,
that's success. I don't care if he goes back into the community. I think he would die if he went back into
the community.

Discipline, Not Punish

RA: In a therapeutic community in a prison setting, how are rules enforced? Obviously you would have a

14 of 18 14/01/2015 15:52
James Gilligan Interview: Working with Violent Offenders in Prison Se... http://www.psychotherapy.net/interview/gilligan-violence

no-violence policy. Does that mean that somebody can be ejected from the program or not be allowed
to do certain group activities that they like? How do you do that in a way that manages respect but
also enforces rules?

JG: I would try to focus on attempting to learn what was motivating the person to break the rules,
including the most important rules, which would be rules against violence.

Again, let me give a case example to illustrate how I would approach it. We had a fellow at the state
prison mental hospital who, on a regular basis, would engage in what we called sucker punching. That
means hitting somebody just out of the blue with no provocation, no warning—being in an ordinary
conversation with them, and then just suddenly punching them in the face, and sometimes really
injuring people.

When that would happen, he would be immediately removed to a locked individual room where he
would be isolated from other prisoners so he couldn't hurt anybody. Then a therapist would go over to
talk with him repeatedly, day after day, until we figured out whether he was ready to come back into
the community and not hurt people. After awhile, he would come back in and then he would be
nonviolent for a couple of weeks or a couple of months, and then he would repeat the same behavior.

Finally, we sat down with him and said, "What's going on here? Why are you doing this? You know
you get locked up when you do it." What we learned was that he wanted to be locked up. There were
times that he just felt either he was losing control and felt he needed to be locked up, or he was afraid
other people were dangers to him and he wanted to be saved, locked up. I think he was more afraid of
himself than of others, but he knew that this was a way that he could get locked up for several days
and feel safe. But everybody around him was safe.

What we said to him was, "Look, you don't need to hit anybody in order to be locked up. If you just
tell us that you feel you need to be locked up, we will do that. We will put you in this room and lock
the door, and we will keep the door locked until you can tell us you feel ready to come out again."

And what was amazing was that worked. He stopped sucker punching. He would tell us that he really
wanted to be locked up. We said, "Fine, we will do it right now." And then we would go and talk to
him about why he felt the need to be locked up. We wouldn't deny him the wish.

That would be one way in a therapeutic community that one would deal with rule violators. It's try to
learn why they are breaking the rule, and to approach it not in the spirit of, "We are going to punish
you for doing that," but rather, "We are going to try to help you to reach the point where you don't need
to do that in order to get what you want"—and try to clarify what their goal is.

That's only one example, and I'm sure we can think of a hundred others that might not be so easily or
neatly resolved. But the basic principle is you restrain people from hurting other people, absolutely.
Clearly there are some people not ready to be in the group, like I mentioned with the multiple
murderer. I didn't want him in a group at first. I thought he would experience that as an assault on his
living space. He needed to be separate from other people for a while. So my emphasis would be less
what are the rules than on what is motivating this person, what is his current mental status, to what
degree is he in control of himself, what are his goals—in other words, a very psychological approach
to everything, rather than a kind of rules-based approach.

I don't mean to say you don't need rules. You do need very clear rules, something that is acceptable to
others. That does need to be made clear and unambiguous. But a violation of them should be not

15 of 18 14/01/2015 15:52
James Gilligan Interview: Working with Violent Offenders in Prison Se... http://www.psychotherapy.net/interview/gilligan-violence

punishment but rather, first of all, restraint, and then inquiry and an attempt to learn, what was going
on? Why did this happen?

Never a Boring Day

RA: You have obviously had a career full of very challenging work. What has been rewarding to you about
it?

JG: That's, in a way, almost too easy to answer. It has been constantly rewarding. I have felt so fulfilled by
this work. I felt so fortunate to be able to engage in it.

First of all, it satisfied my curiosity. I was able to learn a lot about things that I didn't understand earlier
and I wanted to learn about. Secondly, this wish of mine that goes back to childhood to try to find
ways to limit violence or prevent violence—I have certainly been able to gratify that wish through this
work.

The third thing is I have talked to many of my colleagues who went into an ordinary psychoanalytic or
psychotherapeutic career and finally, after 30 or 40 years of that, would tell me they were feeling
bored—they were just doing the same thing over and over again, but they weren't learning anything
new. I felt sorry for them, because I felt I have never had
a boring day of work in my life. I look forward to every
I have never had a boring
opportunity to engage in this work. It's endlessly
interesting, gratifying, moving. And I would recommend day of work in my life. I
it unreservedly. And I mean I really recommend it. I'm look forward to every
not like Freud, who, when the Gestapo arrested him in opportunity to engage in
Vienna and required him to write a note telling how well this work.
they treated him, ended it by signing, "And I would
recommend the Gestapo to anyone." It's probably ironic
and sarcastic, so I don't mean it in that sense. I mean that I really would recommend this kind of work
to anybody.

I would love to see the mentally ill moved out of the prisons, where they really don't belong, and back
into the mental health system. But I also want to see the prisons themselves really turn into therapeutic
communities rather than being just places for punishment.

I think one of the biggest mistakes we have made—and when I say "we" I mean all of western
civilization—over the last two or two and a half centuries has been this mistaken belief that
punishment would prevent violence. I think in fact it just stimulates more violence. But that doesn't
mean we should unlock the doors and let everybody run free. I do believe in restraint—in restraining
those who hurt others, stopping them from hurting others through coercion and restraint and
constraints and force—when necessary. But that doesn't mean violence and punishment. That is the
vital distinction I would like to make.

RA: Do you have any final thoughts that you would like to share?

JG: I want to thank you for your interest in this work. Let me say one thing that I think applies to all
psychotherapy. Again, what I have talked about is certainly very, very different from the population

16 of 18 14/01/2015 15:52
James Gilligan Interview: Working with Violent Offenders in Prison Se... http://www.psychotherapy.net/interview/gilligan-violence

that 99 percent of therapists work with. But I do think it is worth recognizing that psychotherapy is a
modern invention, a great social experiment in self-education. Sure, it has roots in everything from
confession in the church to philosophic introspection and so on. There are antecedents for modern
psychotherapy, but nothing really comparable.

It is a great, unprecedented social experiment, and I think we are only beginning to realize how
important it is and how valuable it can be. When I first was trying to decide whether to become a
psychoanalyst, I talked with a friend of mine, the late Peter Newbauer, who was a psychoanalyst in
New York. I said, "Peter, if I become a psychoanalyst, I can only treat a few hundred people in my
whole lifetime, and yet the need for this is so overwhelming. There are six billion people on this
planet, and all of the psychoanalysts in the world can't treat more than a tiny handful. How can I think
about this?"

He said, "Of course, you are right." But he said he felt that the ultimate benefit of psychoanalysis
would come not simply from the actual treatment of individuals you are seeing, but from what you
learn from treating them that could then be applied in other contexts such as in child rearing, in
education, in the criminal justice system, and so on. Even in ordinary medicine—psychological
insights have transformed so much of what we do in medicine.

When my children were born, I wasn't allowed in the delivery room. Nowadays people bend over
backwards to try to increase the bonding between parents and children and to protect the bond between
the father and mother and so on. That is one of gazillions of examples. The way children are treated in
hospitals now is totally different from what it was when I was a medical student. These are examples
of applying psychoanalytic knowledge into completely different contexts. So I have often felt that
what I have done is applied psychoanalysis. It is not psychoanalysis as such—we don't put prisoners
on the couch and have them free-associate five days a week—but we apply what we know from
psychoanalysis in that different context, and then we can learn more things.

© 2011, Psychotherapy.net, LLC

James Gilligan, MD, spent more than 30 years serving on the faculty of the Department
of Psychiatry at the Harvard Medical School, where he led a team of colleagues from
Harvard teaching hospitals in providing mental health and violence prevention services
to the Massachusetts prisons and prison mental hospital. He is the author of Violence:
Reflections on a National Epidemic and Preventing Violence: Prospects for Tomorrow.
His latest book, Why Some Politicians are More Dangerous Than Others, is devoted to
his research into how rates of both suicide and homicide in the US change based on
which political party is in power.

Rebecca Aponte was the Operations Manager for Psychotherapy.net from 2008-2012.
She earned her BA in Psychology from Holy Names University in Oakland,
California and is currently working toward her PhD in Counseling Psychology at
Colorado State University. She was heavily involved in research on cult behavior and
apocalyptic beliefs that was presented at the 2012 Pacific Sociology Association
Annual Conference, with several publications in the works.

As a therapist who is doing research and training in the prison population, I found this article very
informative and helpful for breadth and depth of understanding and gaining knowledge.

17 of 18 14/01/2015 15:52
James Gilligan Interview: Working with Violent Offenders in Prison Se... http://www.psychotherapy.net/interview/gilligan-violence

Dr. Anne Swanson-Leadbetter

This article has brought a lot of insight into my life. I was born to parents who had experienced violence in
there homes of origin. My father witnessed his mother being gorged eyes by his father (my paternal
grandfather). My paternal grandfather was very abusive to my grandmother and her children. My mother
also came from an abusive family. I state this to show how successive generations can perpetrate the abusive
culture. My father ended up being brutal both to his family members, his children, wife and outsider. He
ended up in jail and when he was released he did not last two years before he died of pneumonia. My mother
was also very violent toward us , although she did not bring us up because we later ended up in a children's
home. Where the conditions were relatively better. My parents ended up in divorce and thus going separate
ways. I got reunited with my mother when I was twenty one years but never really connected. I am full of
anger towards her. I keep on swing towards forgiveness and acceptance and anger. I am aware of this anger
but do not seem to get rid of it. I have also directed the anger towards my children which is sad. I regret it
and tell myself I should have done something to avert it but it seems bait too little to late. However, I have
seed them for do a certificate course in the hope of them gaining insight and not repeat the same to their
children. Thank you for this great article.
Sylvana Mbuli
A great article and extremely useful. I'm considering prison work myself as a trainee psychotherapist and
have been filled with the many myths and felt discouraged until I read this today. So thank you.
Amrit S (London, UK)

CE credits: 2.5
Learning objectives:

Understand the childhood environments and experiences common to violent offenders

Describe a diverse range of therapeutic strategies for prison inmates
Explain the reasoning behind prison reform directed toward an education-focused model

18 of 18 14/01/2015 15:52