Or, as Morrissey pithily put it: "Is evil just something you do... or something you are?"
The debate about whether particular criminals are 'insane' is a contentious one. On one side are allied the forces of psychiatry, who believe that they can cure people who have committed terrible deeds and ensure that they won't perpetrate further crimes on their fellow citizens. On the other side lie politicians and the public - who often fail to see any such psychological subtleties.
One famous example if that of Peter Sutcliffe. Housed today at Broadmoor hospital, he was diagnosed as a paranoid schizophrenic and placed in the care of a hospital, rather than within the regular prison system. To much of the public, his protestations at his trial that he was driven to commit his crimes by "the voice of God" were simply calculated gestures to minimise his culpability or to avoid prison altogether. Nonetheless, medical opinion ultimately came down on the side of Sutcliffe, and to much tabloid outrage he is held as a patient, rather than a criminal. Today, some argue that Sutcliffe is well enough to be released into the general public. Needless to say, public mood and the twitching political antennae of those in charge of the prison service make this the most distant of prospects.
How complex the issue can get can be seen in the case of Ian Brady. Declared insane, he has fought a twenty year legal battle to be declared sane, in order that he can be released into the main prison population. As a patient at a hospital, doctors are free to make judgements about his welfare and as such have force fed him throughout much of his hunger strike. If Brady should ever win an appeal and be declared sane, he could starve himself to death and prison officers would be unable to force feed him.
It is in these medico-legal-ethical grey areas that the secure hospitals operate. Their names - particularly those of Broadmoor and Rampton - loom large in the public imagination as home to those who have committed the most heinous acts of evil. But within their walls also lurk those who have never committed any criminal wrongdoing, but are judged to be in need of the most intense medical care.