Can a violent psychopath ever be cured? The doctor behind Killing Eve thinks so

On the first day of his new job, psychologist Dr Mark Freestone received an unnerving lesson in just how easy it is to be manipulated by a criminal psychopath. He was taking part in a government scheme that saw him visit Britain’s most notorious psychiatric hospitals in a bid to understand the minds of their most dangerous inmates.

Two months of training had taught him how to incapacitate an attacker without leaving a bruise, and instilled in him a fear of letting a psychopath trick him into causing a security breach – a blunder that could well end his career.

That worry was top of  Freestone’s mind as he walked onto the secure admissions ward at one hospital and saw a fellow psychiatrist in a well-fitting charcoal suit, reading a newspaper. Feeling shy, Freestone approached him and noticed he wasn’t wearing any NHS identification.

“He must have been terribly important,” he recalls thinking. The other man, who introduced himself as ‘Tony’, said: “I expect you know who I am, everyone else around here does.” Freestone was instantly worried he had made a “dreaded cock-up” by forgetting the name of an important superior. But a nurse suddenly appeared at his shoulder. “Come on Tony,” she said, “you know you’re not supposed to be wearing that suit after the ward round has finished.”

With a sinking feeling, Freestone realised the man he was speaking to was a criminally psychopathic inmate – one who had duped vulnerable victims out of their money by setting up a series of fraudulent companies and Ponzi schemes in a bid to become an “international playboy conman.” Clearly, he was pretty convincing.

“When I first started I thought, these guys must be terrifying, Hannibal Lecter-style manipulators,” remembers Freestone, a lecturer at Queen Mary University of London, who worked between 2004 and 2013 on the Dangerous and Severe Personality Disorder programme – a government project to understand and potentially change the behaviour of dangerous criminals. He recounts his experiences in a new book, Making a Psychopath.

Our modern understanding of psychopathy was pioneered by Dr Hervey Cleckley, who in 1941 studied 15 criminal patients in the US and identified a series of common traits, including pathological lying, superficial charm, a lack of empathy or guilt, and grandiose delusions. He argued that psychopathy is not a mental illness, and to this day it has never been listed in the authoritative Diagnostic and Statistical Manual of Mental Disorders handbook. Instead it is described as a “personality disorder”, one that is thought to affect as many as one in 100 people.

Although Freestone cannot be specific about people or places (he uses pseudonyms in his book, and some details are an amalgamation of different patients) we know that his brief stretched across Broadmoor, Frankland and Whitemoor, institutions that have housed the likes of Charles Bronson, Moors murderer Ian Brady and Yorkshire ripper Peter Sutcliffe.

The experience taught him just how bizarre and complicated psychopaths can be, a group he thinks are too often presented on television as “Machiavellian supervillains”.

And he would know. In 2018, he advised Phoebe Waller-Bridge on the script for Killing Eve, helping her to shape a realistic female psychopath in the form of assassin Villanelle, played by Jodie Comer. In one scene, Villanelle bursts out of a bedroom to surprise her handler, Konstantin, dressed in an identical outfit to his own. This was inspired by a patient Freestone worked with in a high-security young offender’s institute, who decided for one of their meetings to wear a white shirt, corduroy trousers, brogues and a patterned gilet – exactly Freestone’s outfit.

Criminals like Villanelle certainly exist, Freestone adds, but he thinks fictional characters do not convey the sheer variety of psychopathic behaviour. The disorder is caused by some combination of nature and nurture: many psychopaths are born with a genetic predisposition (a lower-than-average propensity for fear, perhaps), which is then activated by an abusive or traumatic upbringing. It is often “diagnosed” using Dr Robert Hare’s classic 1970 checklist, repopularised by Jon Ronson’s book The Psychopath Test, which asks a person to rate themselves from 0 (no match at all) to 2 (a reasonable match) on 20 personality traits, including ‘Do you display a lack of remorse or guilt?’ and ‘Do you fail to accept responsibility for your own actions?’.

A psychopath scores at least 30 out of 40. But Freestone points out that there are more than 15,000 different combinations of answers that could still give you that total: “It’s a broader church than people imagine.”

Take ‘Danny’, who Freestone remembers in his book as a pale young man who “looked as though he might fall over from the breeze.” Abused by his father, Danny’s “absorption with his self-loathing made him curiously dispassionate to, even callous about, the pain he inflicted on others,” writes Freestone. He ended up behind bars when he attacked a vicar who was trying to help him. His psychological profile certainly seems different to that of ‘Tony’, a cooly confident huckster whose “personality was like cellophane: a tissue-thin, reflective mask that he could rip, change or just dispose of depending on the situation.”

Then there is the curiously rare case of the female psychopath, a group Freestone admits “terrifies me far more than men”. Of the 2,040 criminal psychopaths identified by the UK government in the 2000s, only 40 were women. They are usually depicted on-screen in the style of Villanelle – a glamorous femme fatale who uses her sexuality to manipulate men. But female psychopaths exhibit exactly the same arrogance and self-delusion as their male peers, Freestone explains. He looks in his book at Angela Simpson (the inspiration for Villanelle) who in 2009 drove a three-inch nail through the head of a disabled man in Arizona.

In a 2012 interview, he recalls, Simpson “presented herself in the same way as a male psychopath”, exhibiting the same “intense eye contact and disinterest in emotionally engaging with questions” as serial killer Ted Bundy in his own infamous confession tapes.

But with the right help, Freestone thinks, even the most bloodthirsty of psychopaths can be reformed. He mentions ‘Eddie’, a schoolboy with abusive stepfathers who became a violent young man, committing a series of sexual assaults. But he straightened up after volunteering for an in-prison mental health programme with a noted psychotherapist. While researching his book, Freestone met Eddie in his north London home, with his two dogs, where they drank espressos. His life is now violence-free and he has been in a stable relationship for nine years.

Freestone accepts that such cases are rare, but thinks they could be emulated if Britain adopted the Dutch system, in which criminals are given a single point of psychiatric contact throughout their lives, rather than moving from therapist to therapist.

Some will feel uncomfortable with attempts to medicalise what they see as plainly wicked behaviour. Does Freestone worry that policies like his are blurring the divide between right and wrong? “Because of a neurological dysfunction, psychopaths do not learn from punishment. If you put them into a punitive system they learn absolutely nothing, which means they’re just as likely to reoffend,” he says.

“It’s so easy to write off an angry violent man as a lost cause. But nobody is defined entirely by being a psychopath: there is always an individual human with a history, wants and needs underneath that callous exterior.”

Making a Psychopath: My Journey into 7 Dangerous Minds by Dr Mark Freestone. Buy now for £7.99 at books.telegraph.co.uk or call 0844 871 1514