Speaker 1: 0:15

Hi, this is Umida Shtari.

Speaker 2: 0:17

And Natasha McElhone. Today we're talking to Corinne Min. Dr Corinne Min is a consultant psychiatrist in forensic psychotherapy and psychoanalysis at England's high security hospital Broadmoor. She was also based at the Portnum Clinic, london for three decades, an outpatient psychotherapy clinic for people suffering from problems of violence and sexual paraphilia, both under the NHS Public Health Service.

Speaker 1: 0:44

She chairs the International Psychoanalytic Association Violence Committee and is editor-in-chief of the International Journal of Forensic Psychotherapy. She has published widely and lectures nationally and internationally. Her main focus always remains the rehumanizing of the dehumanized. She doesn't believe in innate evil, but in evil acts that are carried out. Therefore, intervention and treatment is always worthwhile. She's speaking from personal experience whilst not representing any of the aforementioned organizations.

Speaker 2: 1:14

We talk about working as a psychotherapist in a high security prison.

Speaker 1: 1:20

What creates a violent criminal?

Speaker 2: 1:22

How childhood trauma causes disinhibition.

Speaker 1: 1:25

Interventions during the first thousand days of life.

Speaker 2: 1:28

Comparing re-offending rates in different countries.

Speaker 1: 1:32

The prison industrial complex.

Speaker 2: 1:34

The asymmetry of empathy for perpetrators and victims.

Speaker 1: 1:37

Education's impact on recidivism.

Speaker 3: 1:39

Okay let's investigate.

Speaker 1: 1:45

Hi, this is Umida Shtari.

Speaker 2: 1:47

And Natasha McElhain.

Speaker 1: 1:49

And today we have with us Karin Min.

Speaker 3: 1:52

Hi Karin. Hello, very nice to be here.

Speaker 1: 1:56

So I just wanted to highlight that we had an Oval Office conversation between President Bukele and President Trump about what seems to be falsely imprisoned Salvadorian, and the conversation about this person and criminals seems to be very much eye for an eye and slightly dehumanizing in many ways. I just wanted to mention that as the backdrop for our conversation today, which is going to be about your experience as a forensic psychotherapist dealing with violent criminals that you have had in therapy. Let's start off by you explaining to us what does forensic psychotherapy actually mean?

Speaker 3: 2:38

It's a description of a kind of bridge between the world of forensic psychiatry, which deals with mental illnesses and risk assessing, and the criminal justice system. And forensic psychotherapists are small in number internationally. They're usually psychoanalytic in their orientation, in their practice and what they try and provide is individual treatment and assessment, group treatment and assessment, but also therapeutic communities. They work in therapeutic communities. The prison estate is generally populated by forensic psychologists who work very much at the cognitive level, with questionnaires, and that Forensic psychotherapists work differently. They work with a more psycholytic approach which takes the unconscious into consideration.

Speaker 3: 3:40

We're very interested in the psychodynamic understanding of what leads people to act out violent behaviors. They do something to the external world but in our view it is a reflection of what's going on in their internal world. And if we can somehow get to understand that, we could do much better in prevention and we could do much better in treatment and reducing recidivism, and it would be a win-win for society if society ever became civilized enough to not want what you referred to a moment ago, the eye for an eye, the Old Testament approach, which in our view leads to everybody ending up blind Right.

Speaker 1: 4:36

Yeah.

Speaker 2: 4:37

And recidivism is not going back into jail once you've been released, right?

Speaker 3: 4:41

Yes, another word, yeah, reoffending yeah right.

Speaker 1: 4:46

I think it would help for people to understand some of the cases if you give us a sense of what kind of people have you had conversations with, who have you worked with in your capacity as a therapist. The goal here is and I think this is going to be something that we can discuss head on there's people who have done really violent things, right, and I think it's very hard for people to just on an emotional level sometimes then see them still as human beings, right, and what we're trying to do is actually explore this and see how you, doing the work that you do, break through that and come out on the other side and actually discover the humanity within them.

Speaker 3: 5:30

I think it's essential, but there's a real drive always to dehumanize people who do absolutely dreadful things. They're also very convenient recipients for all of us to be able to point the finger and feel very good ourselves, because we are not like that.

Speaker 3: 5:47

Of course, deep, deep, deep in our unconscious we are. But the difference between us and those who carry out those acts is that we have found ways to manage our impulses, to manage those terrible drives, to contain our rages. There's three of us sitting around this table. Not one of us will not have thought once oh, I'd really like to kill him or kill her. No, we don't go and do it.

Speaker 3: 6:14

And that's probably because many ingredients came together very early on in our lives that enabled us to manage those impulses and those instinctual drives, so that we could grow up and have the feelings but contain them and act in much more civilized ways, which would benefit us and those around us, those that we love, those that we work with and society in general. And I mean there are many, many such ingredients. But I think you were asking you know what kinds of cases I mean. Maybe I could start by saying what I think. Many of the cases I've seen who've really carried out horrific things which I hate as much as anybody else, but I try not to hate the perpetrator.

Speaker 2: 7:02

Not to hit the perpetrator. And can I ask you, could you give us examples, perhaps, of patients who have committed horrific crimes and who seem to be in such an altered state when you met them? You speak very clearly about there being no cure but there's treatment, but you yourself thought I can't treat this person, I won't be able to give them any kind of quality of life, because they're too far gone, as it were. Just so that our audience understand the world that you're inhabiting and what you're dealing with, and even the context where it is, maybe and then you can still find humanity within that world, because that, to me, is what's so inspiring, you know.

Speaker 3: 7:43

Know, I'm really glad you asked that question, but I'm almost sad that you've asked it at this point. You know, before I could talk about you know the good outcomes, you know the hopeful outcomes and what we can actually provide, because the Well, maybe we can end with that.

Speaker 2: 7:58

We always like to end on a. That's partly why I wanted to start in the darkest.

Speaker 3: 8:05

Let's think about that now, because it's one of the things that I really struggle with myself and it's almost not allowed in the field of mental health treatment provision, unlike physical health, where any of us can go in and we're physically sick, you know, we get a hip replacement or we get our cancer treated or we get whatever it is sorted, treated, cured. Even In mental health there is an expectation that everybody should recover and we're now focused, at least in the UK, on a system called the recovery model. So there's an expectation that people come in and they're provided with a package of treatment from staff from different disciplines and that they will progress through the system. In the case of my kinds of patients who have to be locked up to protect the public to start with, you know they'll go eventually to medium secure units, from high security eventually low secure units, eventually normal acute psychiatric wards and then back into the community, hopefully supervised. But to come back to the kinds of cases you're asking about.

Speaker 3: 9:27

And back to the kinds of cases you're asking about, there are a small number of people who have been so badly damaged from the beginning, many of them in utero, certainly in babyhood and toddlerhood, that the development of their personality and their mental structure, which is like the scaffolding of the mind, where all the different things that we have to be able to operate, to get out and about and live is so dented that whatever we would offer from all these different packages from psychology, occupational therapy, forensic psychotherapy, medication and so on, they will never be well enough to manage alone, independently in the community. But in particular with my kinds of patients, the public would never be safe from them. So there is a small percentage of patients or prisoners we could say as well who need what I've referred to and I got really scolded for using the term. They need long-term mental health, humane palliative care. But the word palliative, which is allowed in physical health medicine, is kind of not allowed in mental health.

Speaker 2: 10:42

I heard you coin a phrase of psychodialysis, was it so?

Speaker 3: 10:47

there's just this constant which yeah, well, that's the more hopeful where the patients who have really managed to take on and to take in the treatment offered which is often a combination of being heard for the first time, properly being listened to, being spoken to, developing a trusting relationship with somebody constant, somebody who's in their lives for a sufficiently long time because many of them have been taken into care in very early childhood different care homes, many of my patients have had an average of 15 up to 30 something different placements, so they've never had a continuity of care and they just expect to be betrayed, to be rejected and so on. So you have to be able to provide long-term intervention and many of my patients who've done well I've had them in high security for five to 10 years, sometimes longer see them once or twice a week, followed them to their medium secure units and then they came to see me as outpatients once a week and then at some point I could see them maybe once a month, maybe then every three months.

Speaker 1: 12:09

Give us a couple examples of that, because I want again. I want to make it less abstract. I want people to understand what is this world that you're inhabiting. Okay, yeah, so tell me. Let me tell you about one.

Speaker 3: 12:19

I'll tell you about one because he's fresh in my mind, because I saw him recently and he's somebody where I got really angry with the system because the system was against this for the eye, for an eye reason. This was a late 20s man who was in and out of prison a lot, from age 18 actually, actually onwards, and I'll come back to his early years in a moment. He was so angry so not looked after that. He took it out on the prison officers. He took it out on the other prisoners. He smashed up so many cells in prison. He smashed up so many cells in prison. He smashed up entire wings and the prison system. He kept being moved from one prison to another and the prison system actually needed respite from him.

Speaker 3: 13:14

So sometimes when that happens, a high security hospital will relieve the prison estate and the prisoner will come to us for an assessment of whether they have what's called and it's a kind of mental disorder mental disorder is the umbrella term whether they've got a personality disorder. I hate the term, but we have to use what's active at the moment that could be treated. Mental disorders basically come into different categories. There's the psychotic illnesses schizophrenia, psychotic depressions. There's also bipolar illnesses, which used to be called manic depressions. Then there's all the neuroses and then there's the personality disorders and they come in different categories. But I know we have to categorize and classify these things, but it chops up people's minds into different portions, as if there isn't one overall mind that has a big disturbance in it. Anyway, this man comes to our admissions ward in the high security hospital, which specializes in personality disorders. So we have a lot of men, young men, in that ward with mainly psychopathic traits, and they've all acted out extremely violently, killed people.

Speaker 1: 14:35

Psychopathic means in this case no empathy for the suffering of others. Is that?

Speaker 3: 14:42

Well, psychopathic traits, but they might not necessarily fulfill the whole criteria for psychopathic disorder, got it, which is extremely rare? Yeah, but they would have some psychopathic traits or anti-social personality disorder, uh traits. So they, they act out their internal internal world turmoil, uh, violently so, on this, many of them have killed, raped, mutilated, whatever he arrives on this ward. He hasn't actually killed anybody, but he's smashed up a lot of things and beaten up a lot of people. First thing he did was strip off his t-shirt to show his beautifully toned muscles pectorals, biceps and ripples his muscles on the ward to make sure that he can shuffle himself into the position of top dog. This, you know, it's a very prison kind of mentality. There's a food chain right. Bank robbers and killers are usually at the top of the food chain actually at the bottom of the food chain in prisons. It's not what you would expect the paedophiles, it's actually the snitches. The snitches are one below the sex offenders, even the sex offenders against children. So he's on this ward, rippling his biceps, scaring the pants off everybody, and other killers and rapists are cowering in the corner, and he's allowed to be in this top dog position in the corner and he's allowed to be in this top dog position and because I work on that ward and I'm the forensic psychotherapist allocated to that ward since decades.

Speaker 3: 16:12

I go up and introduce myself and I'm immediately told you know, fuck off. And I say well, you know I won't fuck off, but I will come back and see you again. And I go back every week for three months and I'm told fuck off, fuck off, fuck off, fuck off with your fucking psychobabble every time. And after about three months he smiled when I approached him he said I'm not that fucking mad woman again. Do you not understand the term fuck off? And I said do you know what? I don't understand what you mean by it, but why don't we go into that room so you can explain it? And because he was like in a good moment, he actually came into the room and I think he developed a bit of curiosity about why I was so curious in him.

Speaker 3: 17:03

And that was the beginning of us sitting down, initially just for a few minutes, but eventually we had regular weekly 50-minute psychoanalytic therapy sessions and what emerged from that was a young boy who'd been born into a very dysfunctional family with warring parents, domestic violence, you name it, and eventually social services airlifted him out at the age of seven years and put him into a children's home where he was sexually abused, including being raped by a male carer and other physical abuse situations. That went on and he'd never spoken to anybody about it and he was still having flashbacks and nightmares, and it had led to him developing a complete paranoid stance, especially towards anybody in a position of authority, anybody wearing a uniform. So traffic wardens were experienced by him the same as police officers or prison officers or high security nurses or, like me, a high security doctor. We were all just seen as somebody that was bound to abuse him and he had to protect himself first by putting this violent defensive shield in front of him, this violent defensive shield in front of him. So he and I worked for a good two or three years once a week.

Speaker 3: 18:30

But because he was so verbally hostile to the other patients, but especially to the staff, the nursing staff in particular, you know he was extremely sexist, ageist, racist, I mean. He was appalling in his way of speaking. He managed to fulfill his job description, which was make sure I'm hated, because then I recreate the atmosphere that's familiar to me. I know then how to operate in it. So he managed to get most of the nurses to absolutely hate him and to want him sent back to prison as soon as possible. But there was one nurse that liked him and felt sorry for him, and that must be for own personal reasons. Nothing that I would ever know about because that's not my business, but every week in that ward I run what's called reflective practice group meeting called reflective practice group meeting, where mainly the nurses but the other disciplines also come and we just see what patient surfaces that they need to talk about. That's provoking particular responses in them. Now he came up a lot because he was so polarized.

Speaker 3: 19:41

But that one nurse that liked him was really helpful because it enabled me to help that group piece together a more complete picture of what he consisted of and keep him humanized and not just consider him a nasty piece of work who's just got a really bad tongue and he's always going to be violent, and let's just send him back to prison, where he belongs. He doesn't deserve to be treated well or to receive any kind of treatment so that was helpful.

Speaker 1: 20:13

What's going on in your mind? In my mind, as you're interacting with this type of person well, and also was he physically threatening.

Speaker 2: 20:23

I mean, why had he been? You say he hadn't murdered anyone.

Speaker 3: 20:27

He was never physically threatening towards me. He was never actually physically threatening towards anybody in the ward, but it was his demeanor. He looked like he was physically threatening and in fact that reminds me you know another patient on the same ward, but 20 years earlier, was what was his name? That famous boxer, not Muhammad Ali, but the other American guy. Anyway, he looked like, and indeed Tyson, mike Tyson. He was like a Mike Tyson lookalike and when he was brought to our hospital there was a police helicopter.

Speaker 3: 21:08

There were two vans, 16 police in riot gear because he'd been on the run and they'd finally arrested him. They brought him in and it was his demeanor. It was his physical, menacing way of appearing that provoked and or evoked particular responses in everybody, which was he's bloody dangerous. We're not going near him. Oh my goodness. He'll never want to receive any treatment or anything like that. And actually, if you present yourself in a particular listening way, you might well get them into a room. He got into a room with me for 50 minutes after telling me to fuck off for years.

Speaker 3: 21:50

So there's something about the menacing presence which is a defensive shield. It's like a suit of armor, because these are little traumatized boys. They're little traumatized children in big adult hairy bodies. They're little traumatised children in big adult hairy bodies and of course, yes, they can use their big adult hairy bodies to carry out horrific things. But if you keep an eye on the fact that they're also little traumatised boys and something went really badly wrong early on, it doesn't condone what they've done. I hate what they've done as much as anybody else and I do believe that you know there is a certain punishment required. They're unconscious needs to be punished, but I believe that the punishment should be a loss of freedom combined with treatment, right Rehabilitation.

Speaker 1: 22:35

I mean, you'd certainly probably have developed a really strong muscle of compartmentalization, right? Because I don't think that everyone can be in that menacing presence and be able to put that aside and say, oh, it's a little boy in there.

Speaker 3: 22:51

Well, you know, it's not that I'm like some Wonder Woman or super brave or anything like that, not at all. You know, I would not take risks. But what I've become aware of over 30 plus years in the field is that the most frightening of these patients or prisoners are usually the most frightened. And I've learned more from the patients and prisoners than from any educator or trainer. Trainer and you've just reminded me of another one, also in the High Secure Hospital, who he had killed a stranger, a woman, in a public transport situation very late one night and had always said that it was a handbag theft that had gone wrong.

Speaker 3: 23:40

But you know that wasn't in keeping. You know what actually went on. It just wasn't in keeping because it was such a horrific attack from behind A completely defenseless woman who just didn't even know what was about to happen because she didn't see it coming. But anyway, there's a long story that I could tell you about him and how we pieced together, going on an archaeological dig, what that woman actually represented to him, who had been abandoned by his own mother. They crossed paths on an empty carriage of a train and they briefly made eye contact and she must have thought oh, I'm a bit scared of him and turned away and started walking away from him and something in in his unconscious got triggered about the rejection.

Speaker 3: 24:27

And he came back after. So you know it wasn't a handbag theft that had gone wrong, it was something completely else and it was really important for us to work on that for the years that we did, because it completely altered what his actual risk was, what we needed to treat and how we enabled him to eventually get back into the community, which we did. But that was like 12 years later and that wouldn't have been the case had we not gone on the archaeological dig but have gone off at a tangent no, no, tangents are great and we're going to return from this tangent because what society will say is that's fine and great and well done, good work.

Speaker 2: 25:10

But what about the family of the woman that's dead?

Speaker 3: 25:18

Absolutely want to do better is to provide more for the victims of our patient perpetrators, as well as treating our perpetrators, most of whom are victim perpetrators. Yeah, they're victims that have become perpetrators. We lose sight of the victim part, yeah, yeah, but we're acutely aware that we focus so much because there's so few of us on working with the, the people who've acted out these horrendous things, that we don't provide enough for those who are left with the absolute catastrophic tragedy uh, in in in their lives I mean, obviously I can't know this, but I can't help thinking that I would want to know why and that somehow the healing that might happen if I understood better the abused child that you've just discussed yeah, to understand the circle of violence, I think it's about it started somewhere else and that's what you were talking about earlier on is what the press does is take this thing out of context and use this language

Speaker 2: 26:26

where it's very difficult. For, let's say, I've heard about something terrible and my response is God, the poor guy or the poor woman having to do that, and everyone turns and what the fuck are you talking about? They did blah, blah, blah, blah, blah. And you already realize oh, I've skipped two stages which is I am meant to behave in that way, and if I don't, I'm seen as somehow.

Speaker 1: 26:52

Inconsiderate.

Speaker 2: 26:53

Well, also condoning.

Speaker 3: 26:55

Yeah, yeah.

Speaker 2: 26:56

That's how you get attention. You only get attention once you've really disrupted. You don't get the attention when you're stopping yourself from doing so and it's costing you a lot and you're suffering just as much as any of these potential rapists killers whatever.

Speaker 2: 27:13

You've also had a dreadful childhood and you're actually maybe inflicting it upon yourself, so I guess it's a resources thing. Your endeavor with these men is so laudable it's incredible and the investment of time, of decades, and yet how do we level that with people who are maybe on the brink of doing something like that? So I guess I'm talking about prevention.

Speaker 1: 27:42

Yeah. So I would say, let's start by the, the way we can cut all that and go back to. I think it's fine. Let's take a couple steps back here because you know, I think, to paint a broader picture, you're mostly talking about men here, right? Mostly men, I mean in the high school should we ask?

Speaker 1: 27:54

about some of the women I, I wanted, I wanted to just get a bit of a lay of the land in terms of you know what percentage of male, female, and then talk maybe about nurture versus nature and what does the youth of somebody like that look like? You mentioned a little bit of it, but like give us a landscape here of what's going on. I want to understand the before chapter before they end up talking to you right.

Speaker 3: 28:16

Yeah, I think that's important because it's part of what's misunderstood, what Natasha was just describing. But I really want to stress that I never don't think and, same with my colleague, we never don't have in mind the absolute horror that the victims of our patients and prisoners end up living with. I mean, there is a little light of hope in terms of developing restorative justice where we have some trained restorative justice practitioners in some of the high secure and medium secure hospitals, also in prison, where the victim's relatives you know if the victim is dead it would be the relatives or those most closely affected, or the victim themselves, if they're alive and they're contacted to ask if they would want to meet the person who wants to explain to them what they did and to apologize, and those who take it up.

Speaker 3: 29:22

it is so deeply moving. It is so deeply moving because the patient who's carried out the horrendous act, who's often oblivious to what they've done, and detached and appearing very psychopathic. You know, this is why you hear in courts. You know the number of times I've heard judges saying at the summing up and what's more, mr Blah Blah, you have shown no remorse whatsoever.

Speaker 3: 29:53

And I'm always thinking but God, if they had the capacity for remorse, they wouldn't have done it. So yeah, you, god, if they had the capacity for remorse, they wouldn't have done it. Yeah, yeah, yeah. So yeah, you know, there are movements of progress, but the victims are under looked after, as well as the doers, and it's a resource thing. Yeah, it's a resource thing, but maybe, to come back to the before, I mean, where do these people come from?

Speaker 1: 30:21

Male-female split. Where do they come from?

Speaker 3: 30:23

Well, of course there are far more male perpetrators of overt violent acting out than females and in a very generalized way, females tend to act out violence on their own bodies or on the products of their bodies called their babies. And Estella Weldon is somebody who was a paradigm changer and who wrote, I mean, the first time, the first book that she came out with was in 1988, and it was called 1988, and it was called Mother, madonna, whore, and how difficult it is for society to accept that women can be really violent and perverse and take it out on their babies and on their children. And probably it's something to do with the idealization of motherhood. You know mommies are supposed to love their babies and look after them and the idea that they don't sometimes is just unacceptable, but it's a fact. So in terms of violent crimes, of course men far outnumber. I think in England and Wales at the moment it's about 85,000 male prisoners to about 4,000 female prisoners.

Speaker 3: 31:39

And in terms of nature, nurture, you know it always used to be a big debate, you know, is it nature? Is somebody born evil? Were they a little baby psychopath that just grew up into a big adult psychopath? Or is it the nurturing? You know did something horrendous happen to them. It's an intermingling of the two, I would say, with it being more top-heavy nurture of people that I've ended up seeing who've done horrific things with damaged minds.

Speaker 1: 32:20

You know, either severe mental illnesses or personality disorders, which are the adult version of childhood traumas manifest, and so what you're saying is it's very possible that it's the right cocktail of nature and nurture like that. Somebody who would have gone through the same nurture, who wouldn't have had that biology, may have not become violent.

Speaker 3: 32:47

Well, I mean, it's so complicated because we used to think either nature or nurture and it's now an intermingling. And of course, you know a lot of it is based on. We're learning so much more about neuroscience and I am no expert in neuroscience, but I can tell you about a little bit of the research that's been done. You know, apart from all the psychoanalytic research on attachment, for example, it's essential for a baby to be loved, for the baby's frontal lobes to develop adequately and for the middle brain you know where the impulses and all go for those to be calmed down and to be connected with the frontal lobes.

Speaker 3: 33:23

that can regulate the impulses the baby actually needs to be loved and there's a beautiful small paperback by an English neuroscientist called Sue Gerhardt, based in Oxford. It was published over 20 years ago and it's called why Love Matters and it describes for the layman or laywoman the importance and why the baby in the first three months of life cannot be spoiled. You cannot spoil a baby before the age of three months because they cannot regulate themselves at all. You know they feel assaulted by hunger, they feel assaulted by cold, they feel assaulted by dirty nappy, they feel assaulted by being alone A reality, frankly. So you can hold them and nurse them constantly and you won't spoil them. But after about three months you've got to help them to start tolerating many frustrations and so on.

Speaker 3: 34:22

And you know the brain at that point is like a boiling pot of synaptic connecting and developing. It's like a tree you know one of those David Attenborough trees growing, you know, at top speed. That's how it is. And with the little mini frustrations after three months of age, a bit of trimming happens along the way and if you don't get the adequate loving, caring, containing, comforting, as well as the feeding and watering, those trimmings won't happen adequately in the frontal lobes and you end up with a predisposition towards something more psychopathic.

Speaker 3: 35:01

Then there's an extra layer which is being examined and researched amazingly by epigeneticists, and I had the pleasure of meeting an American epigeneticist, professor Stephen Suomi, who took over from Harlow, famous psychologist Harlow, who did all the early research in the 20s, 30s, 40s with the rhesus monkeys. He was one of Harlow's PhD students and then ended up becoming the director of the laboratory, which is a huge space with thousands of monkeys. And you know, of course some people may be listening to my description. They might think, oh, this is terrible, it's animal cruelty and so on. Yes, there are ethical things about it, because they do to monkeys what they can't do to humans and yes, it is cruel. But if I could put that aside and just describe what discoveries he made, it'll blow your mind, I think, as much as it blew my mind.

Speaker 1: 36:01

This is the metal mother versus the fluffy mother. Well, that was Harlow. That was Harlow, right yeah.

Speaker 3: 36:05

Sumi refined it further, right, right. And what he did was he saw that about 10% of the rhesus monkey population was a bit psychopathic in its behavior. And the way they identified the future psychopathic rhesus monkeys was they looked at them growing up and they were the ones who were aggressive to the other toddlers. When they were toddlers they became really badly behaved adolescents. If happy hour was provided for them, which they did with alcohol, they were the ones knocking it back, getting completely pissed. They were also the ones with high accident levels because they would overestimate their capacity to jump from one branch to the other, because they were omnipotent and they were the ones who tended to be kicked out of their tribes. Nobody wanted them, so they'd be kicked out.

Speaker 3: 36:53

He examined the DNA strands of those monkeys that had those manifest traits and he identified a complex DNA strand which genetically predisposed a baby monkey, a future baby monkey, to become like that. So what he did was he got loads of those monkeys with that genetic predisposition and he made them breed. So he made hundreds of these genetically predisposed little psychopaths and he divided them into two groups. I hope you're not going to get loads of complaints about it. Yeah, you will.

Speaker 1: 37:34

It's okay, shall I describe it anyway.

Speaker 3: 37:36

Keep going, it's not that bad. Actually it's a good outcome. Yeah, so he divides them into two groups and one group doesn't get is properly looked after, fed and watered, but doesn't get all the loving care and pled with and affection. The other group is adopted by previously identified super rhesus monkey foster mothers. They're very nurturing, they were very nurturing. They were already spontaneously taken in abandoned babies and so the other half of these genetically predisposed psychopaths adopted by these super foster.

Speaker 3: 38:14

So then they let them grow Right and they examine them again what happens by these superphosphates? So then they let them grow and they examine them again. What happens? Of course, almost 100% of the ones who didn't get proper care became manifestly disturbed and aggressive. The other ones practically 100% of them not quite but near enough became not manifestly aggressive but ordinary, like their adopted siblings, and were loved and behaved adequately and grew into decent rhesus monkey citizens, right. But he didn't stop there. He then looked at that group when they had babies and he examined the DNA strands of the babies, of the ones that were looked after Right.

Speaker 3: 39:03

And the genetic predisposition for psychopathy was switched off.

Speaker 3: 39:09

And this is such I mean it gives me goosebumps even describing it to you because it gives us an idea of how transgenerational trauma is inherited literally onto the DNA Right and how you can change that with proper treatment, interventions, with proper care, proper fostering, adopting, parenting, fostering, adopting, parenting.

Speaker 3: 39:40

There's systems in America, but the one that I'm familiar with is actually a German system called no One Falls Through the Net, and a family professor of family therapy, a psychiatrist who became a friend, called Professor Manfred Chirke, who was based at Heidelberg University, probably over 30 years ago, started this system whereby he brought obstetricians, gynecologists, midwives, gps, health visitors and family therapists together to develop a universal tool so that when a woman first presented with a pregnancy, whatever the situation was, whether she was with a boyfriend, a husband, a girlfriend, a mother, a grandmother or not, nobody, that this universal tool did a thorough assessment to figure out if there were vulnerabilities maybe previous domestic violence or criminality or a cop death or a recent trauma or alcoholism or whatever it might have been, and they would be provided with a specially psychotherapy-trained midwife, two midwives, each psychotherapy trained.

Speaker 3: 40:59

So it started off with a pilot, just in Heidelberg state, and after a few years the results proved to be incredible that these babies that were born, that had been detected as maybe at risk, that were provided with a midwife one of the two midwives would be present at the birth, so already a relationship had formed with the mother. The midwife continued to be the psychotherapist visiting the baby until they became a toddler aged two or three years of age, by which time the cycle the potential cycle of repetition of whatever it was, or transferring something was already getting resolved and the early research showed that these babies that became toddlers and went to kindergarten weren't aggressive and were mingling properly with the other children and weren't getting expelled from primary school and so on.

Speaker 3: 42:02

And they presented their findings I think it was, was it in Strasbourg, at some big EU summit I remember Manfred telling us about it and it led to the German government funding all 16 states in Germany masses of euros to train the midwives in every state as psychotherapists in addition to being midwives.

Speaker 3: 42:24

This is now available in every state in Germany. I don't know whether it's for everybody, but somebody else poor Manfred, lost his life to pancreatic cancer and one of his colleagues, cord Benecke, took over from the research and I hope I've got all this right. But anyways, the broad details that matter and they've been continuing to do the research on the wellness and the progress of these children throughout primary school and now already beginning secondary school, and the rates of violence has gone down, the rates of being expelled has gone down and well-being has gone up. So the whole family benefit, the whole system benefits from this intervention. So you know to come back to something that you asked me earlier if I was able to come back and start again and focus on the first 1000 days of everybody's life, because by the time I see my patients they've already suffered and made others suffer so badly. You know that it's much longer process and their victims have have to live. They learn to live with something that they can never recover from.

Speaker 1: 43:38

So you're saying the majority is locked in after three years of life?

Speaker 3: 43:42

Yeah, at least that's when the resilience is really set down and you reduce the risk or the vulnerabilities of something going askew. You might manage it better Because, of course, nobody's ever going to be free from life traumas. They're going to keep happening. But because they got the basic minus nine months in utero to plus age two or three years solid, properly attached, properly contained, cared for, loved they can cope with what life throws at all of us you see, I'd say the nihilist or the uh, and the person that is maybe a realist, I don't know would would say look, I need to get a mole checked out.

Speaker 1: 44:22

I need to wait four weeks to even get an appointment with the NHS. How is this possible, right? Or you know the same in the US Four weeks, four years. I didn't want to be that down on the NHS here, but you know.

Speaker 3: 44:37

The irony in relation to what you've described is this would be cost effective.

Speaker 1: 44:44

It would actually cost less.

Speaker 3: 44:46

Financially.

Speaker 2: 44:49

I'm a bit alarmed about Germany, given what you just told me, because their recidivism rate isn't quite it's somewhere in the middle right.

Speaker 3: 45:01

I guess it's a much bigger country than Denmark and Norway and all of these, sure, sure, and you know the results. I mean the recidivism rates would be for adults and the research is still at the secondary school stage. So we'd have to look in 10 years' time to see.

Speaker 2: 45:17

Yeah, that's what I was curious about. Good point.

Speaker 1: 45:21

So just for the listeners, the way we can um group countries. We have the nordic countries which are really doing well on the recidivism side, and then we have germany somewhere in the middle, and then the us and the uk, probably a little bit worse, yeah, um and so the staggering statistic was that 25 percent of the world's um prisoners even though it's american, even it's only five percent of the global population. Now it's shocking.

Speaker 3: 45:47

You know that they are, so that incarceration isn't working.

Speaker 2: 45:51

It is outrageous, but but we won't go into that.

Speaker 1: 45:53

There's private there's a lot about that, yeah yeah, exactly money.

Speaker 2: 45:59

It is, yeah, it's become an industry, uh, with so many other things go back to the criminal who kills the woman on the train station who he's never met before and you get to the bottom of why that happened. Then to a patient who's killed his own mother, and then when maybe you backtrack and you see why because actually he did get the right person in his mind, because it's the person who didn't love him, who he didn't get any care from, and I'm sure there's a story as to why she was incapable of doing that. And again it goes back and back and back. Is there less of a sentence for this? Sounds crazy, but is there less of a sentence for matricide in a set of circumstances where there's been real neglect and hardship, or not?

Speaker 3: 46:47

It's completely dependent on which court and which judge and which solicitor the person happened to get and which psychiatrist the solicitor of the person happened to get. It is so haphazard, Natasha, it's not uniform, it's not equal. It's a real postcode lottery. So you know, in the high secure hospital where I work, we have two psychoanalytically oriented groups for homicide offenders and one group is for people who killed strangers. One is for people who killed.

Speaker 2: 47:21

We've changed it from loved ones to people close to them because it's a highly ambivalent thing to just describe them as loved ones, so you've categorised those as that's kind of what I wanted to get into, just for a minute.

Speaker 3: 47:34

Well, actually 20 years ago, when one of those groups was first set up, we put them all in together and we realized very early on that there was a real difference in the psychopathology and the prognosis and indeed the sentencing of those who killed strangers from those who killed ones closer to them, and we ended up separating them because we thought it was going to work better Now.

Speaker 3: 48:06

These were my colleagues, who were psychologist therapists, who started this. I now supervise those two groups. I'm not directly running them but, to answer your question, it is completely haphazard. So one person who killed his wife in that group got a conviction for murder, life sentence. He, in fact, was with us in hospital for several years but has recently just been sent back to prison for no reason, and he was clearly psychotic when he killed his wife and should have received a manslaughter, diminished responsibility and been enabled, you know, to really have proper thorough treatment, which he never did. Another man in the same group also killed his wife, was psychotic and got diminished responsibility with a hospital order rather than a prison sentence. So why Inexplicable, inexplicable, and it's so unfair.

Speaker 1: 49:14

So we spoke about the day-to-day, we spoke about prevention. Let's talk a little bit about rehabilitation. The re-offending rates are relatively high in the UK and in the US comparatively. What can we do better? What's going wrong? Of course, if you had a magic wand and the world would be unconstrained, and then probably more the idea of within the constraints of the system, what would you do? What can we do? What's going wrong? Maybe start there them.

Speaker 3: 49:43

What would you do? What can we do? What's going wrong? Maybe start there. I think, to focus on just punishment.

Speaker 3: 49:45

You know, the retribution, the vengeance and so on is an error, because you know, what always comes back to my mind is one of my mentors from decades ago, uh, was dr patrick golway, who was a forensic psychiatrist and a psychoanalyst and I kind of followed in his footsteps. There aren't very many forensic psychiatrists who also train as a psychoanalyst, but he was one, and I remember going to a talk that he was giving in Brixton Prison when I was a baby psychiatrist at the Maudsley Hospital in Camberwell, and the thing that stood out for me from his talk was well, you know, these people are raised in hell. They end up doing hellish acts and then we put them in hell in a place like this ie Brixton Prison, where we all were, and we expect them to get better you know, to get out and be better. So you know they're not going to get better if you just give them more hell and more punishment and you know it'll sound arrogant, but I think we know what works. But I don't think society's civilized enough yet to want that to be provided, and I can give you an American example, because I think you said to me that you've quite a few American listeners.

Speaker 3: 51:05

One of my favorite people is Professor Jim Gilligan, based in New York State and he's professor of law and professor of psychiatry. Absolutely amazing man did a huge amount of research on male prisoners who had been violent A lot of them had killed, and he wrote the most beautiful small paperback book, simply called Violence, and in a nutshell, what he was getting at was that it was the sense of not just all these childhood traumas, but the trigger for a killing would be experiencing a humiliation, an actual or a perceived humiliation being the provocation. Anyway, about 20 years ago he started another innovative project which was to bring education into the prisons. So he chose I might get the details of some of the research not quite right, but I think it was about six different prisons where they looked at re-offending rates which were generally well over 80%, 70-80%, right, yeah, 82%.

Speaker 1: 52:11

I think it was at the time.

Speaker 3: 52:12

And they brought in education because there's a lot of people in prison that haven't had the opportunity to be properly educated. Some of them are illiterate as well. People in prison haven't had the opportunity to be properly educated, some of them are illiterate as well. So they brought education in at different levels in these six prisons over a few years. So very basic literary skills, secondary school education and even, I think, what you call in America college or we'd call university, third level education. And they did that. And then they looked at the recidivism and I mean it was just so amazing for those who received third level, university, college level education in prison. Do you know what? Their reoffending rates became? Zero, zero percent.

Speaker 3: 52:58

Because they had something to look for and the you know, secondary school education or high school, I think you call it also went massively done, so much so that even before the project was finished he thought of it a bit like a drug trial. You know, if something amazing is there, you cannot wait for all the results to come in. You gotta let people know, and he went to the local senate I think it was a senate that happened to be republican at the time got to let people know, and he went to the local Senate I think it was a Senate that happened to be Republican at the time.

Speaker 3: 53:27

And he presented the findings and immediately the senator said what? We're giving free education to those guys in prison. I think he used the word bastards, but I'm not sure. Stop all funding immediately. That was the end. Guys in prison I think he used the word bastards, but I'm not sure. Stop all funding immediately. That was the end. Five years later, all the reoffending rates back up. So you know, we're just not ready for it.

Speaker 1: 53:49

We just don't want to treat people who've done bad things well, even though it would benefit everybody the other thing I saw which I thought is fascinating, by the way, um, that I saw was a criminal who was reintegrated in society, actually came back to work in the prison, and then was the person who was seeing off the prisoners on their last day, and the one thing that he said that stuck with me was that we we've treated these people like kids for the last 10, 15 years. When they were stuck, they had five decisions to make per day, and now they'll have to make five decisions per minute and they're not ready for this and this is what's going to get them back in here.

Speaker 1: 54:28

Yeah, you know and so, uh, this, this education, and opening up your mind and broaden your horizons, I think the danish and norwegian model is around autonomy and absolutely they cook and they take responsibility and they contribute and I say they.

Speaker 3: 54:43

That's the way forward.

Speaker 1: 54:45

I don't know how you manage. I mean their freedom is taken away, but not their autonomy. That's basically the model in Norway.

Speaker 3: 54:51

You need to build up their autonomy, yeah, exactly, and have regular people looking out for them, and listening to them, but we're so caught up with vengeance that we just want them to have a really hard time when they're in prison. Even though it's going to be a very hard time, you're going to make more victims, yeah, of course economically what's viable?

Speaker 2: 55:10

yeah, in terms of the dedication and devotion that you can spread across. You know however many hours you have in a week and your team and, as you said, the few people that you've mentioned. They are unique in that they got all of that care and attention even within the model that you're describing. So how, how would we manage to upscale this and how do you justify it to the rest of society, in that, as we've just discussed, there's people who are suffering just as much, maybe more, that haven't committed crimes, etc. Etc. God it's.

Speaker 3: 55:43

God, it's such a complex thing, isn't it? Because we have to somehow educate society better. You know that the people who do these horrendous things have suffered terribly and they're really taking it out on society. And if society could only, you know, I always think of it was Winston Churchill, actually, when he was Home Secretary in 1932. He said you can judge I can't remember exactly word for word, but it was something like that you can judge how civilized a society is by looking at how it runs its prisons. And we're just, you know. Coming back to your point, we're not great at running our prisons. Here, I know there's a few fantastic governors, there's a number of fantastic prison officers who go in with the right attitude and wishes to rehabilitate people, but there's an awful lot of people not so including, you know, not that long ago, one of our politicians, when it was the previous government, wanted to ban books from all prisons because they didn't deserve to have reading. I mean, with that attitude, you know what's hope?

Speaker 2: 56:54

Well, you're ensuring that you're creating monsters.

Speaker 1: 56:58

Well, you want the prison complex to continue to thrive because somebody's making money. Otherwise you would not suggest such a thing.

Speaker 2: 57:05

And how do you recruit prison officers?

Speaker 3: 57:08

I think it's a very tough job. I think the I'm not sure exactly if the trainings that they have, but the last time I heard there was like a 10-week training for 18-year-olds to come in 10 weeks. That's what I heard. Now heard maybe one of your listeners will correct me, but that's what I heard recently and there's huge recruitment issues because they're leaving, because it's just they're just not equipped underpaid, underpaid and ill-equipped, underpaid, under-trained because you really need to be quite sophisticated to respond to provocations and to form a rapport and build a trust.

Speaker 1: 57:48

You need to be a very evolved adult to not take this stuff the wrong way and to actually not let your impulses lead you and all that and you don't learn that after 10 weeks, especially if you had some sort of sketchy childhood yourself Absolutely Right, absolutely and Absolutely.

Speaker 3: 58:01

And the same goes for therapists, of course, and policing and nursing.

Speaker 1: 58:07

Yeah, the thing that comes to mind as we wrap is the story I don't know where I heard this, but I really like it and I think you open my eyes to another dimension of this and is if, uh, say, your partner goes on a camping trip and a bear mauls your partner right you're not going to hold on and and begrudgingly think of this bear every night and and think, oh, I want to kill this bear.

Speaker 1: 58:36

This bear has to die. Right, that's not what you're going to think about. But if this is a person who does that, obviously that is the only thing that you're going to think about for the rest of your life, or many people will have that instinct that they want to know why did this person do this? Yeah, and they should suffer, right, you wouldn't have the same emotional reaction to say a bear. It's just in the nature of the bear, like the bear does these things. Now, if you then find out that this person who did this had a massive tumor that was pressing against some part of his brain and therefore did this act, you actually may feel a little bit more at ease with this whole thing, because you you'd actually put the person into the bear category.

Speaker 1: 59:16

You think of blameless, yeah, yeah you'd say that it was in his nature or this tumor unfortunately made made him do this. Now, many people cannot take that next step, and that next step is look, of course, given this childhood and this neglect and all this stuff that this person had to go through and this humiliation maybe that was, you know, a minor incident for another person, but in this person, because of this circumstance, in the constellation of the history of this you know person, led to something that this person didn't have the impulse control to stop and did something heinous. Right, that is still a bridge, maybe too far for a lot of people, but I think you've shown how that is something that you have clearly managed to to get to, and I think you've taken how that is something that you have clearly managed to get to, and I think you've taken us on a really nice journey for us to go there too. So, yeah, thanks for all this amazing work that you're doing.

Speaker 3: 1:00:13

Well, thank you for inviting me for this conversation. You know it's a real pleasure to come along and talk about it, although I am aware that it's a very hard thing to convince people that it's of benefit to everybody. I mean, I like how you've just described that about the bear, but I think sometimes it's even worse than what you described, because we've had cases here, including recently, where somebody clearly completely, completely disturbed, traumatized, who carried out terrible acts, killing little children. We had another case recently where the person was clearly not in touch with reality, absolutely following psychotic delusions and believed persecutions and so on and ended up killing people as well. And I am aware, of course, that there's grieving families and it's very, very difficult for them to even think of what might be too soon to even go there, about what was going on with the person who did these things.

Speaker 3: 1:01:24

One was a teenager, one was a man in his 30s, I think, and there's a push for both of them to have sentences reviewed, reviewed.

Speaker 3: 1:01:38

So even the one who's clearly got a schizophrenic illness and did this in a state of delusionally driven, instead of enabling that person to be in hospital treated, there's a push for an appeal against the sentence for him to be properly convicted of murder.

Speaker 3: 1:01:59

Let's put the schizophrenia aside. You know it was still so vicious that it should be murder. Now, of course, we have to keep in mind that the families and I'm acutely aware that there are really grieving families there that just cannot get their head around, of course, and I'm not in their position, so I can think more objectively about the man and I do think he should have treatment, and the same with the teenager who carried out the killings. But on that occasion there was a real push for bringing back the death penalty for a 17-year-old who was clearly off the rails. We can only understand that in terms of people identifying with those who are affected, but also, I think, something about the whole of society, not just the relatives but the rest of society, being able to point the finger and say ha ha, you see, there we go, let's punish that one yeah, I think it's in our nature to be empathetic with the plight of the victims.

Speaker 1: 1:03:05

Obviously in this case, yeah, but this is one of the dilemmas we have.

Speaker 3: 1:03:09

That if I talk about a compassionate attitude to somebody with an illness or a trauma or whatever that does something horrendous, it's as if I'm condoning it, no, no, or not taking it seriously Of course. And it's not the case'm condoning it, no, no, or not taking it seriously of course. It's not the case at all, and that's what's always misunderstood to me.

Speaker 2: 1:03:24

What I hear when you speak is that you want to prevent it happening again and you want to understand the root causes of it. Yeah, and of course some people just say, let's lock them up or put them away.

Speaker 1: 1:03:33

But I think it's worth pointing out here that it is uh, it's asymmetric in terms of the effort that one has to put into to be compassionate with the perpetrator. It's so easy to be compassionate with the victims.

Speaker 2: 1:03:49

It's a much shorter route.

Speaker 1: 1:03:51

But it requires a lot of energy and work and nuance and discovery, which is worth doing in most topics in life. This is why we have a podcast, definitely worth doing in most topics in life.

Speaker 2: 1:04:03

This is why we have a podcast, definitely, I guess. I guess it's a huge commitment to something that may or may not pay off. Is that right?

Speaker 3: 1:04:08

I mean well, yeah I agree, but that's why I think resources should be put into the first 1000 days. That makes so much sense. And we look at the the numbers and you.

Speaker 2: 1:04:19

I'm sure there's lots of different sources of figures, but what seems to be the case is the more that is spent on rehabilitation well one the less reoffending there is, but also the richer the whole of society, as you've said, will be in the end, because those people will end up contributing and maybe being remorseful and maybe wanting to get involved at the level of rehabilitating other prisoners.

Speaker 3: 1:04:44

Absolutely, and that happens.

Speaker 1: 1:04:47

To break a lot of these cycles that we see that are unfortunately ailing civilization. We need a little bit of investment, but it's good to point out your work and and your faith.

Speaker 2: 1:05:00

That's what I find so inspiring that you're not that many people maybe prison officers go to work every day and get told to fuck off, but still keep going back three months later, in the hope that the person will turn and talk to them.

Speaker 3: 1:05:13

Maybe grown up in northern ireland that is just that is really inspiring.

Speaker 1: 1:05:21

I think doing the work of reframing is what you've done, and I think that's always worth putting the energy into reframing certain things which I often do with other things in society. So, for instance, if I, if I see somebody revving their ferrari so loud, I'm just saying you're just this little kid that's crying in the crib and needs their mom's attention and you're saying the same thing about these people. Yeah, I really want to commend you for being in the arena and, um, it's inspiring what you do thank you thank you.

Speaker 2: 1:05:50

Thanks for sharing your story here yeah, thanks so much for coming and educating us. Bye.