Dr Jonathan Tomlinson Law And Justice Interview – SoundCloud

4 responses to “Dr Jonathan Tomlinson Law And Justice Interview – SoundCloud”

1. maureenjenner | May 28, 2018 at 5:05 pm | Reply

   An excellent online interview, but it was very difficult to listen to because the sound quality was so poor.

2. elspethc | May 30, 2018 at 3:53 pm | Reply

   So good to hear this human understanding. My only caveat?? concern?? uncertainty?? is that trauma is often only identified with the awfulness of serious stuff – drunken beatings, sexual interference, deaths etc. etc. This is trauma of course, and I hope that Adverse Childhood Experience continues to get attention. However, my experience leads me to think of examples where the child’s experience of more ordinary unhappiness or carer’s mistaken views of ‘good’ upbringing has effects more or less similar to trauma. This is not a place for blame of carers, or judgment on their actions, but we need awareness of the similar problems of disbelief in reasons why “the body keeps the score” and reluctance to put mindful reflective practices alongside attention to the body in pain. In one example, a family where one child had a disability from birth, parents were in a situation where the older, but still very young child, had to watch her baby sister scream, had to tolerate as best she could being ignored, had to be left with various other carers during appointments etc etc. No-one has done anything ‘wrong’ except maybe failing in awareness, and at the time, problems didn’t surface. This coment is long enough, could go on, thank-you for this and your blog.

3. Paul Ang | June 9, 2018 at 11:07 am | Reply

   Having sound trouble with the audio? You could send it to me, i can try to process it and send it back to you.

   I’ve got a computer to try to transcribe it… Sorry I haven’t got time to proof read it:

   You’re listening to law and justice on ucc ninety eight point three fm. I’m jane mulcahy it’s, the twenty seventh of march twenty eighteen. Next up i have an interview with dr jonathan tomlinson, gp and hoxton in the uk in london, we spoke about a range of issues including health, justice and injustice, deprivation, the embodiment of trauma on what can be done to begin the complex task of healing from it. And indeed, the reluctance on fearfulness off the mainstream medical practitioners to engage with the complexities of drama and childhood adversity. And i’m a gp, a practice in hoxton and me in eastland, and i, i’m an educator, training GP trainees and medical students on dh recently has been running works up to teach gps on gp trainees about the impact of trauma on patients on dh the ways in which they present in general practice. So why are you devoting time and effort being such a you know, in a busy practice where no doubt you have people coming to you in various states of ill health and distress ? Why are you spending so much time and effort spreading the word by trauma online in your excellent blogged and by way of training efforts to other medical practitioners ? Born out of frustration actually be my thing that the block which is a better and a test dot net originally it was a political blogger was about privatization andi undermining of the test but i would use patients stories to illustrate by i thought that a publicly provided health care service was important which is really to do with vulnerable patients and something called the inverse care law which was those people who are most in need of care on mostly needed the best quality care were least likely to receive it where you had market incentive and i was arguing that where that happens you tend to dover resources away from the people who have the greatest health needs on what really attracted reader’s attention with stories about the patients that i was seeing which were very carefully anonymous lies to protect patient confidentiality but nevertheless but quite sort of rich descriptions of people will realize that they lived as i did this i realized i was writing about the patients that i found most challenging for people with chronic pain chronic anxiety clinic, the passion medically unexplained symptoms and lots of social problems and lots of mental health problems on dh they began to get readership of other gps and educators on dh i realized that we all share the same kinds of frustrations and the thing that really shifted the away some on overtly political blogging to writing more about form it was realizing the lots of patients were reading it and we’re very interested in in particular and what my doctors like me felt the way we did our patients and i think the turning point was when i wrote a block about how doctors respond to chronic pain and just generally generally people would i would write articles medical press about how doctors should treat chronic pain or what’s the best education of chronic pain or what’s the best therapy but and i was interested in why the doctors respond in a particular way on both began with me describing banging my head on the desk in despair feeling hopeless the whole interest kind of really began and that was in two thousand eleven i think quite a long time ago but you see that’s so human jonathan you know that made you see more of a human than a doctor which you know isn’t it but suddenly there were hundreds or even thousands of patients with chronic pain who started writing to me and keep making suggestions and i mean a lot of them have said this is so true to my own experience and it’s so refreshing to hear a doctor to say i want to admit that they feel the way that we know you feel because you always give us that look when we come to see you that look of why are you here and what do you expect me to dio please go away please go your nose and is very strong feelings and being honest about that i think was, you know, humbly sort of day i think we’re fairly kind of refreshing and and original and those who really do want to make a difference and and actually i did those interested in burnout and resilience in doctors and realized that look on my cheney’s i found it very, very hard to work in my practice in particular because of the amount of this kind of emotional labor, okay ? And therein lies the link with separation way have a very young and relatively deprived and very sort of unequal populations some people very well off, but it looks very, very disadvantaged and remember one don’t you be working the late district with a very, you know, well to do population ? And he said, every patient i see in your practice is at least two or three times more difficult and challenging and complicated, okay ? And he spend a lot of the day with his head on the desk. I just have to do something about that. Yeah, that’s where is where it started ? Story began with the problems the doctors had of coping on dh with the kinds of problem is the patient’s presented and it wasn’t actually quite a few years of really thinking about it that i actually worked all the way back to trooper okay. And then you wrote this excellent piece call. We need to talk about trauma. I think i read it on twitter somehow. It came up in my feet. S o can you tell our listeners a little bit about trauma on brain development, maybe, and why it manifests in the body as it does, or how it manifests in the body as it can ? Yes, way, kind of start with the the manifestation or the aftermath or the long shadow allow the scars that tumor leaves of people. And i think that’s quite important, if you begin my starting about warmer than people immediately say, well, i know somebody he was like that in there, okay ? Or stuff like that ? Really ? And i’m all right to me. And it kind of doesn’t make sense that if you start at the other end, which is how people are suffering, which is how, which is what gts and represented within what patients the symptoms, then then it kind of makes more sense that way in ways, and what i realized is the commonest things people present with one is an over riding sense of anxiety and fearfulness and it’s for that detached from anything to be fearful off, okay, this is where we use the word chronic in describing things like anxiety or depression of pain, it means that the symptom is unknown, hinged from the original course. Ok, so say, for example, a fear of heights or spiders or dog places, or, oh, cats or dogs, or whatever. There’s, a specific thing in the sense that, you know, if it wasn’t for that thing, i wouldn’t be fearful. The fear off that comes as a consequence of trauma is an overwhelming on dh, enveloping fear of almost everything. In other words, you can’t take something away or change. Where they are makes the anxiety go away. Something that’s, just the kind of part of their all day, every day and all night on dh. Then, with chronic depression, people will come in and people. I’ve got nothing to be depressed about anything. In there. Okay, i just don’t know why depressed on people with pain would say repeatedly to adulthood, but why am i in pain all the time ? Why ? What is this ? You know what is the cause ? Why can’t i have another blood test bike on abbas can what kind of doctor are you ? You can’t tell me why i’m in pain and confronted with all of that doctors responding one weighs in total display, they say, i just don’t know i can’t help you another one and say, please go away, i can’t go with it, no one is to keep doing test after test off test we’ll keep referring to different specialists keep describing drug after drug, keep trying to types of therapy, anything to keep the patient from coming in, reminding them just how used the sale because they can’t do anything about it to anyone fearfulness combined very often with chronic depression on very often with chronic pain, usually with chronic insomnia as well. And then i realized it’s a cluster of other symptoms that go with it one is irritable thousand, we go to toilet all the time, a little bladder sometimes so bad you having continents, feelings of shame and, you know, like an acute embarrassment, that’s even worse that you can be seen by people can if you want and patients would be trying to avoid doctors or b you know i have this constant sense of being humiliated and put down which is also part of an internal dialogue than no feeling that they’re not good enough to deserve to be looked after and the only way we begin on my daughter’s face with and we know trained to kind of think very far back so we tend to treat the symptoms at face value you give drugs for anxiety took a irritable bowel drugs irritable bladder drugs help people sleep drugs to treat depression bit out joining the dots and thing that this is all manifestations of the same underlying set of experiences so if you imagine growing up in an environment of constant fearful is to say your dad is an alcoholic he comes home drunk and beat human beat you because this or if you’re being sexually abused in childhood or something else awful then you lose or you develop in a state of constant hypervigilance you’ve always got to be on the lookout because you never know when the next abuses going i hate you you never know the next time that something terrible you know awful is gonna happen and when that happens you’ll know the system from being constantly around can you ever settle down so it’s like being stuck in the traffic lights with your foot on the clock to the accelerator at the same time all the time all the time, so exhausting term you’ve got away. You no longer living in that dangerous situation. Your nervous system, which has developed under those conditions, continues to fire on all cylinders all the time on that makes you that constant hypervigilance. Thank you can’t sleep means always jumpy. It means your heart pounding, you’re sweating bladders overactive about their overactive and nervous systems over stimulated to your hyper sensitive to touch pain who other sort of sensations, loud noises until and to be in a state ward of the time is absolutely exhausting. What people often days not only did they feel fearful and anxious, but they’re also in pain and also constantly exhausted rice on when they think but anyway, that was the shit that happened, whatever you know twenty years ago, it just doesn’t make sense that something that’s so far in the past could have a bearing on what’s happening at the moment. That’s that’s one of the problems on dh so if mainstream medicine just treats each individual symptom separately, is that approach not only quite costly, safer the n h s r o r for the individual if they’re paying for all these individual treatments, but then also costly because it doesn’t reach the root cause. Yes, you can bring down the cost, so this one cost referrals so often people is being referred to lots and lots of different specialists. So you take somebody in their forties or fifties, but you’d often then you begin to realize that’s just being on this tv told they they know the hospital g p notes will be very, very sick, really sick because of all the referrals on investigations that they had them so they’ve often heard endoscopy is to look inside the barrel of the gun. People had dozens of blood test does scans possibly so do its trying cure that chronic back pain they’re often on a combination. Painkillers on that very interesting thing about drugs to treat chronic pain is that they’re entirely un selected for the pain for emotional pain. Traumatic came on somatic physical pain. They make new distinction, and they do a little bit, but not very much for all of the different kinds of pain on often like the communist drugs for chronic pain and chronic anxiety also have a license to things like epilepsy. So what are they doing there ? Just suppressing the overactive nervous system without either the patient, a, ll, the daughter being conscious. But what they’re treating is an overactive know the system. That’s overactive, because it’s a state of constant hypervigilance because of what happened in the past, which is fascinating. But it was that these are incredibly dangerous drugs in over those people whose experienced warmer have a very high risk off suicide. And it can be really yourself by suicide, using the kinds of drugs for that treating the symptoms that, you know, the driven by the same underlying causes, which leads people to do that so that’s, very dangerous as well. And so, jonathan, in terms of mainstream medical practice and training, why do you think there is so little awareness of trauma ? So a lot of reasons one is there’s a very long history of disbelief controllers for one hundred years ago sigmund freud presented the beginning of his career a paper i think it was eighteen cases of mysterious and these women you had what these days would be called a personality disorder with all of the kind of symptoms that i described already of paying overwhelming anxiety also an inability to self food so they were emotionally well i suppose unstable or might be labeled these days is emotionally unstable personality disorder medically unexplained symptoms functional neurological symptoms and he interviewed them a great length and then presented to be any psychological society his findings which were in every case there was a prior history of child sexual abuse and the psychological society was so horrified because some of these women from the same social classes themselves that they told him that the women must be making it out it couldn’t possibly be true and he had to go away and find another theory and then one hundred years later in the state vincent netting colleagues were looking after women who was severely overweight you couldn’t lose weight discovered there that the majority of the women they were saying you weren’t able to these weight had experienced child sexual abuse is oil that my main presented their findings america beastie association they responded exactly the way that being the psychological society had responded a hundred years ago and they said no, the women of making it up it’s just excuse go away and find another theory onda until very recently that pretty much bean the attitude off the medical profession. We just don’t believe you always need jonathan. Is it because the stories the’s incest stories, this child abuse experience is just too painful and too commonplace almost two hundred around you’re wanted by the book in studying how doctors have kind of written about and responded to describe pain of the last hundred years have said that it’s, not the pain, is so hard to describe. In fact, you know they’re incredible planks, descriptions of pain, it’s the pain is so hard on the listener to it’s so hard to hear these stories like it hurts the people who have to bear witness to it, they can’t do that emotions labor and i would just hate to be reminded that in a way, your drugs aren’t gonna work because it’s not that you know, it’s, not that kind of thing. So they ended it makes doctors feel powerless on dh. Also, for some doctors, it would trigger their own path exposures ? Yeah, yeah. And make them feel very vulnerable at the same time. And therein lies one of the differences or one of the reasons why deprivation and disadvantage teo trauma and this has been really since the first world war looking at survivors of conflict, but also children who survived concentration camps is that there are factors that enable people to go through appalling former and come out without that kind of aftermath of anxiety and shame and pain. So, i mean, this is good saluted genesis so this is the kind of protective factors, and that includes things like a long term relationship with an emotionally stable had old social security of housing, employment, income, education and having a sense of of comprehension to make sense of what happened on d meaning and purpose in your license on if you put all of those things in place, you’ll probably be ok no matter what has happened. But if you haven’t, you probably won’t on there in that’s kind of, you know, the room was my thing. Well, you know, i had a pretty she told her buying kind of ok, but you probably had those saluted genic protective factors that the people you’re seeing a patient didn’t have and yet, though, even if you managed to become a successful doctor, you might still be bearing the trauma in your body on becoming sick. I guess from it is, is part of the findings from the ace studies. Would that be correct ? Adverse childhood experience studies that you might be more at risk for heart disease or high blood pressure are harmful things like that, even if you have the protective factors, yeah, very hard, tio quantified. You know, to say that if you have this protective that little protected by such and such a percent nice by seen doctors as patients who are aware of their traumatic past two asked for certain tested to look illnesses because they know that that’s, brenda’s amid high risk, really snow positive. You know the framework we used for assessing risk, right ? So if you’re thinking about our disease, you might ask about blood pressure, family history, smoking history, buddy that’s index cholesterol. But at the moment you don’t ask about must. Be insulted even though we know that first started experiences triple your risk of heart disease, quadruple your risk of type two diabetes, hew to the increase the risk off cancer, but also increase the risk of auto immune diseases because constant stress these is the level of hormones like cortisol and adrenaline. And there are only really just beginning to learn the science of the biology of told children, which is fascinating, and then, since learning this, being an awful lot of people i’ve seen you have. These also mean diseases like rheumatoid arthritis, politis, connective tissue diseases, star disease, celiac disease. You could have a huge tumor and that’s, the biological presentation that pretty well adjusted people who were doing very well in many of their lives. But the body keeps the score, but he keeps the school. Yeah, it’s. It is super fascinating and jonathan so what ? The training that you’re doing now, how receptive are the doctors who were learning about trauma with you ? Actually, one of the most gratifying and enjoyable bits of training i’ve done in fifteen years of medical education. And you start by sharing a ll agreeing that you’ll find the same kind of patient presentations really talented. You start from a position. Yes, we all feel absolutely exhausted and pretty hopeless about this and find it very hard to make sense of it. And then you say, you know, instead of having to deal with, you know, whatever, ten different conditions, actually, these little manifestations of the same thing is extraordinarily helpful, like it’s, a kind of thing that doctors intuitively know if their experience, they’ve been doing it for a while. But there’s, just not until this sort of trauma research is gonna have not had a framework that kind of putting it all together again. Yeah, there was no science to prove it for them. Your medical science, which is often, you know, you think, for example, chronic pain, you think pain pathways you think fast fibers and slow fibers you think receptors in the nervous system, you think different types of painkillers, but you’re not thinking what life experiences might have done to another system on then on the other side, if your tv in particular you will be, you’ll spend your life listening to patients stories, and they’ll be telling you about stuff that happened. But it’s, not until now that you’ve been able to combine the narrative history with the biological science to make something together with the patient that then makes sense. Rice on that’s what was beautiful about it. A lot of what we do with patients is trying to make sense of stuff. Okay, so we’ve been stuck for years and years and years thinking i can’t quite doing these, you know, the narrative, the biology together, and now we can and that’s that’s really, really powerful, you know, it’s empowering her booth patients together. She not only the people you know, you you dreaded you now looking forward to seeing because he’s just got a completely new way of thinking about things you mentioned before that you work in in an area that is by and large, it kind of a disadvantaged area. So do you think that there is a link between childhood adversity and social disadvantage and poverty ? Or are people from poor communities more lightly tio to be exposed to an overdose, a trauma the least which started helping patients to them with the world the way back ? Now to thomas, the kind of things that count as trauma are in childhood. The loss of somebody within you’ve got a very strong emotional attachment so parents separated or sibling who died so suddenly died or moved away. I’m at a very early age. I came is traumatic losses would be one thing or separation or being taken away from somewhere just be made to feel that you’re not wanted, that you’re useless, that you’re not good enough a ll the time want to be a certain pressure that’s traumatic and then, you know, being neglected guy had it down to who was looking after who’d being totally neglected by her very busy dr parents were working all day, seven days a week in the only way to get attention with the b stick, the only time you know they were worthy of that. And then, you know, even as an adult, the only way to kind of get anybody’s attention was it kind of fall into the sick role it was as if that was the only thing that it was worthy of anybody paying attention to you but hadn’t made the link between the recent since so this has to do with attachment in early knife on dh then this stuff that’s more obvious, you know, witnessing violence, living in terror so parents who are fighting even if it’s not directed at you could be traumatic pilots is directed that he sexually thought obviously all of these things on also if you’ve got one so you’re living in a violent household that you’ll probably exposed other things nice to know for example, criminal behavior druggies mechanism is directed at you violence directed at other people around you, the one type of former once you got moving tool to you’re likely to get even more okay men, it has that up, but the other thing to remember is not old trauma is chanted so we talk about at first started experience but in fact women whose experienced domestic violence often present with exactly the same types of symptoms as children who had trauma ok, so you can’t tell from the presentation whether it’s relating to domestic violence which may be in the past wrong going whether it’s really told it all right is that a form of ptsd then for women ? If it’s in the present it’s a good point so when people live experience violence in childhood very often getting tired and relationships later on that awful kind of tragedy of of targeted trauma is that you very frequently, you know, end up having formulated in your life and if you’re saying somebody used being through of our relationship and their symptoms just don’t seem to get better and then you inquired backwards there’s often a preceding counted history of troller which is kind of just every time something you happens, it rekindles the earliest kind of experiences which makes it very hard if you think about war is being people living in a household with violence and criminal behavior or with parents unable to meet their children’s emotional needs and then you think about deprivation and people who have deprived and supported who themselves are having to deal with, you know, destitution for near destitution, the constant threat of homelessness, the constant threat of debt collectors, you know, in their own mental health problems it’s very hard to be a zillion visible fewer children, which is this really had it is desperately sad but it’s also important because if there’s a risk we’re thinking about former the parents are blamed took the things were kind of under their control, right ? Maybe it’s not out of your control, people beating your children, but if you’ll life is intolerably stressful, very hard to remain calm all the time and to be, as i said, if you’re in mental health is in a very poor state, you may already be feeling huge amounts of guilt in tune with that your inability to care is available and emotionally attacks you told me you’d like to be, and if they grow up with symptoms of torment than you’re doubly, you were probably is not necessarily parents is the lack of social security, and so is there a need then for greater investment in in all our social services and early years, services and health screening, and that type of thing, early intervention and prevention ? Yeah, yeah, yeah, i mean, it is kind of a rhetorical question that but it’s an empirical, imperiously testable question as we’ve looked at it, i say we researchers have looked at thean impact of interventions in social intentions in early life for vulnerable on disadvantaged families, the benefits and lifelong yeah, the amazing study in nature from last year about where they took a cohort, about two thousand students born in south new zealand into need in thirty nine years ago, they blew that almost every single tart, with very few exceptions for thirty nine years, amazing and the deprivation at the age of three years predicted with always eighty percent certainty to kind of problems that they would run into in later life, like whether they would have chronic health conditions, whether they end up serving time in prison, whether they be on benefits, whether they’d be out of work, whether they were overweight or taking drugs or abusing alcohol. You know. So if you can intervene in the three years of life, you can make a difference for a nice non hokum. This it’s so important, and jonathan is a g p how do you go about helping your patients to recover from trauma, childhood adversity ? So on the one one level, i think people who have bean deprived most of their life of an emotionally stable adult who believes who is kind to them and khun bear to be with him. If you can do those three things, then you can literally save somebody’s life and it’s incredibly therapeutic without actually being therapy. So that’s one thing that we do all the time, and they need to do that. It sounds simple, but clearly it’s national lesson told doing crackles. Once all this makes sense, it’s much easier to do it in a way. I normally conclude my workshops on dh this was told me by a patient who was on the point to suicide and had stopped eating because of her anorexia which is a very common aftermath of tumor and and she was really on the point is taking her own life and she met this young doctor who was kind and believed her on dca tolerate her in in her distress on dh she wrote to me and said please tell your trainees back because it did save my life mr there’s one thing anybody can do another thing is to be a social advocate and to learn how to write the good deals somebody’s benefits how to write good housing letter on how to campaign for the social determinants of health and social security which is you know the difference between just about managing and being destitute to think about the social determinants and then the other approach i have if you imagine hand the little finger is mind so what helped encourage patients to deal with what’s in their head that past experiences and their feelings and emotions publicly therapy second time would be their body which means being in touch with the body was fundamentally feels out of control and that things like movement years ago singing don’t exercise something creative you do with your hands it takes you have to go ahead on your biology the food and drink alcohol, drugs, medications paying attention to that on the fourth one is human relationships. Everybody needs somebody in their life. He was with whom they have a meaningful long term relationship to a good friend. I didn’t two or three good friends, but that’s probably the end. And then the sun would be the social security, and then the risks would be prices planning, because there’s always crises and had you spot them. How do you prepare for him ? What can you do that then ? And that’s quite easy to remember. Yes, quite a bit to talk about. Yeah, yeah it’s about to say it. So my own special area of interest is prisoners and i’m looking at trauma and how to better understand it and deal with it in the in the prison context or among offenders in prison. A lot of people will obviously have dis regulated stresses items that might have led them to commit great acts of harm, and they’re very entrenched, maybe in fight and flight behaviors, and have maladaptive coping strategies out their ears. I could addictions, that type of thing. Jonathan wash can be done anything in a secure prison environment to assist them. Tio understand on dh. Better deal with underlying trauma. I think it’s a whole, like everybody needs to be on board in my own practice, but what i’ve done, this awareness raising, teaching, we moved absolutely everybody from the receptionist to on the front line to secretary, right ? You know, letters about patients, trauma to people who do that, then you have to deal with patients who won’t turn up for their appointment. So i think everybody needs to understand what’s going on will be my first thing just prisoners is like everybody from, you know, the person on the gate to the staff, everybody need toe have shared understanding of what’s going on, that would be one thing. The second thing is to remember that the embodied a bit of it for a reason, like people sitting around talking about their told done very often, people can’t always told them, one do clean, just waffle, you know it’s, often a source of shame, and people don’t want to share things that they’re saying for, like domestic knowledge, no talking cure for thus you can’t you can’t just go in and say let’s, all talk about what you want. To so that’s not kind of waiting start but being aware that it is part of it one of the our perfect settlement that isn’t necessary health related is an inability to self sees you in the first three years or five years of life probably first three years you learned kind of calm yourself down there and you learn that with three secure attachments with your care givers and if you don’t learn that then it’s pretty hard to make up for it later on okay not impossible but it’s pretty hard to do that and understanding that that’s part of what’s going on and then if you’re interested in shouting at people why can’t you behave yourself is kind of how it will started doing it from the time you know from the moment they were born yeah i think i think it’s not they didn’t want event it isn’t gonna work now see unequal sophisticated stuff other things i would say i think mormonism all this difficulty is a lot to do with how you relate to other people so i think the group work it’s got to be a large part of it and you don’t want one to one but actually you’ve got to be a you know it’s one thing to deal with your own with yourself on your own you feel about yourself for that is important for you ls that need to be able to deal with other people so how to connect and relation with other people self soothe ok, somebody to kind of help with what you going bean you’re going so other interventions have been used in prison. We’re actually being in prison is quite useful because you couldn’t probably persuade the kind of people that end up in prison to turn up to a yoga class enhanced id. Ruiz wants people a captive audience. You probably could get them to do some of that kind of stuff. I can be helpful. And yes, so is trauma therapy is about reconnecting with your mind with your body. Then how do you reconnect with your body ? Is three things like yoga ? You reconnect with your mind is through stuff like reflective practice, whether that’s, our hope you’re talking therapies connecting with your body used three things like yoga heavy exercise i don’t think quite does the same thing. It’s awesome destruction have been dealing with so things like wait listing you you mean maybe it’s probably good for taking your mind off of stuff, but it’s an excellent channels aggression that way, but it doesn’t make you feel by connected your body, the way they’re doing something more slow and controlled that’s ok, i think it’s probably a good thing and also that social element is probably useful i think you’re paying it instantly biology’s we’re going to the fingers again the mind the body the biology like thinking about food and online food prisoners are having an evening being super strict on drugs yeah richard i think is you know it’s really important to people is another thing that it’s for my people are unused drugs did associate in other words to cut them selves off from the traumatized better than the one they want to do with you to ignore the pain is so yeah exactly the anxiety and so on so those drugs at asu predicted to be told very things that are very angst anxiety reducing so alcohol, heroin pre traveling and so on so paying attention to the food, drugs, medication keeping medications and an absolute minimum right so now pumping people full of benzodiazepine taking the problem that’s just, you know, putting it to the side of a wall pretty addictive well and then doing stuff that helps people think about human relationships and some of the interesting stuff that’s done is is for example theater where people can safely explore different expects of themselves by putting themselves in somebody’s shoes if you’ve got a bit of yourself to you that you can’t deal with you don’t want to confront then you can deal with it by acting a particular role i think that’s really interesting stuff about theater in in prisons, on no expert in this but intuitively he is thinking about the science of former and what’s going on in your inability to deal with your former thyself to cope with your emotions and other people’s emotional world. It seems pretty obvious that theater is a brilliant way into that. Yes, that’s one way of dealing with the relationship kind of stuff prison, visiting, sustaining family contact spending, family contact is absolutely vital, really important, especially when children are involved in their prison, visiting scenes where long term prisoners have volunteers will visit them. I think that’s really important, especially if they don’t have any family members or important significant others, and they’re very lonely, you know, one of things that former it makes you incredibly lonely and isolated, and then some of these prison visiting teams give people for the first time in their lives and, you know, it sustained relationship with an emotionally stable adult. Yes, you know what i ask my patients about that it is that they’re nice and they look at me and people, you you think that it’s literally in the love, but it’s, you know it’s incredibly, it is incredibly sensitive, you know that, and you’re the go to person, yes, a destroyer there jonathan this morning if you if you look at the lowest rated down, then the potential for prisoners to be doing good work around former what must be enormously present. It is huge. You think you know it’s, it’s reasons to be quite excited, inclined and typos. Tipperary, you understand, what’s going on. Do you think actually, this and it’s, not massively costly, difficult intervention, just needs, but it will, in imagination, re tweaking and re emphasis. If you’re thinking people are going to come out of prison, less environment and they’re able to cope with their emotions, less likely to, you know, kind of exploding in the back in prison is gonna be a good thing. Very last question. Jonathan on the social security and and do you think it’s an absolute necessity that when people are getting out of prison, that their basic needs are met so they have access to some sort of decent housing. They’ve money in their pockets that they have, you know, medical assistance that they need. Yeah, i mean, i think that’s, essential folk for absolutely everybody. I mean, it’s. Interesting that social security was removed from the language of the official, you know, political document somewhere in the mid nineties and replaced with welfare, you know, six social security. It has to be secure, andi insecurity that makes people who are already rendered anxious by their past, former, even more anxious. It is so harmful for them. So, yeah, i mean, i think it’s important for everyone to see everybody, yeah.

4. abetternhs | June 10, 2018 at 7:48 am | Reply

   Thank you very much for this Paul. I’ll proof read the text and ask Jane if she has the original files. A few people have complained about the quality. This is really kind of you
   Jonathon

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