What We Fear Most by Dr Ben Cave: Emotion-packed rollercoaster ride – book review –

As one of the UK’s leading forensic psychiatrists, his intensely specialised work has taken place in prisons and high security hospitals where he diagnoses and treats some of the most troubled men and women in society.

And now Cave, the pen name of a practising consultant general and forensic psychiatrist, has put pen to paper for his first book, What We Fear Most, a thought-provoking, often haunting but very revealing journey through his life and 35 years of case files.

Working as a prison psychiatrist, community psychiatrist and as a consultant in medium, low-secure and general mental health units, he has dealt with the whole range of psychiatric conditions and continues to make challenging judgment calls on when patients are no longer a risk to themselves or others and can be released back into the community.

Cave decided when he was only fourteen years old that his career would be in the medical profession but he dashed his father’s hope that he might choose orthopaedic surgery and instead something clicked – ‘completely and irrevocably’ – in his head and he declared that he wanted to be a psychiatrist.

And so began a lifetime of care… full of ‘very dark indeed’ moments and a rich scattering of more rewarding and lighter ones. Written as a searing personal memoir as well as a riveting insider’s guide to the gritty realities of forensic psychiatry, Cave takes us from delusional conditions, schizophrenia and steroid abuse to drug dependency, personality disorders, paedophilia, and depression so severe that a mother can kill her own baby.

These are the human stories behind the headlines…the grim reality of a life spent working with patients with the severest mental health disorders, and the tragic and often frightening truth about what happens behind closed doors.

The workplace of forensic psychiatry is a highly emotive environment, and Cave is not afraid to put himself – as well as his patients – under the microscope. And in the process, he allows us to share what they have taught each other, and how it has changed them.

We also share the psychological battle scars that come with a career on the frontline of the health service and learn about the brilliant mental health nurses for whom physical injury and verbal abuse are a daily hazard.

Insightful, moving, shocking, deeply personal, sometimes depressing, and yet possessed of some flashes of humour that will make you laugh out loud, Cave’s emotion-packed rollercoaster ride teaches us much about ourselves… and what we really fear the most.

(Seven Dials, hardback, £18.99)