Article

Change

Freedom

Mental Health

1 June 2023

3 min read

Coping in the chaos: Pentonville’s neurodiverse unit is changing prison life

A radical and caring prison experiment has changed both prisoners and wardens. Nick Jones visited London's oldest prison.

Nick Jones

Nick is the senior editor of Seen & Unseen.

An arched gateway to a prison sits behind a low raised wall. No windows are visible

First opened in 1842, Pentonville Prison serves a large part of central and east London.

Ben Sutherland via Wikimedia Commons

A London prison has seen a reduction in violence among prisoners and improved staff morale thanks to a new neurodiverse unit.  Pentonville prison’s new unit identifies and treats prisoners with autism, brain-injury, learning difficulties and even dementia.

Jo Davies, Pentonville’s managing chaplain, helped set up the programme after conducting many regular prisoner reviews with colleagues. She noted that there was an apparent higher incidence of autism among prisoners than the general population.

Prison is a challenging environment for those with autism. Routines are imposed, vulnerabilities are exploited by others. Frustrations can boil over into violent and self-destructive behaviours. Non-verbal behaviour also makes each interaction with other prisoners and staff a potential flashpoint leading to protesting behaviours or withdrawal.  All against a backdrop of a harsh white noise. Metal doors slam, Conversations and challenges are shouted, all constantly echo through the four open floors of each wing of the prison.

Other neurodiverse conditions are present in prisons. An ageing prison population even has prisoners suffering from early onset dementia. Some forget the circumstances of their imprisonment.

Teaming up with prison officers and support staff like psychologists, doctors and teachers, chaplain Davies notes that “now staff make it their business to work out how to work with these prisoners”. The unit has capacity for 45 prisoners in single cells. They share a common area for eating and other activities. Staff spend 10 weeks assessing the prisoners who can then benefit from up to 12 weeks of additional support.

Ruth Hipwell, who leads the new unit, says: “it’s good to have a place in prison for those people who can’t cope.” Support ranges from little things like teaching a prisoner how to make a cup of tea or providing earplugs to reduce noise, to helping prisoners make better plans for coping and learning – both in prison and outside.

On the wall of the unit is a timetable of events, illustrated by pictograms. Sessions include how to handle familiar tasks in the unfamiliar environment of prison: how to buy things or use the telephone, getting clean clothes and even how to handle being unwell.  Other sessions include accessing learning and getting a job.

Robbie*, a prisoner in the unit says:

“It relaxes you. It’s wicked. The difference is the support.”

The unit started work in October 2022 and the difference it made was spotted fast. It transformed staff, recalls Hipwell. “They have found their purpose. We have a level of multi-agency integration others can’t match.”

Ian Blakeman, Pentonville prison’s governor, identifies additional benefits. “It frees up staff time and staff export skills to other parts of the prison.” These positive effects also help him keep good staff. A major challenge in London’s competitive labour market.  Other programmes reinforce this change in culture across the prison range from addiction treatment to rebuilding family relationships affected by gang affiliations.

Pentonville now has the lowest self-harm rates in the country and is the least violent prison of its type in the UK.

With prisons a low political priority, it’s even more remarkable to learn that Pentonville’s neurodiverse unit required no additional budget. Its win-win results are a flicker of hope in a bleak landscape. Times columnist Matthew Parris recently wrote:

“Every generation looks back and spots an outrage. Today, when we think of slavery, child labour and lunatic asylums, we wonder how our ancestors could have been so cruel. What will horrify our own successors is our disgraceful prison system.”

In response to Parris’s column, Jonathan Aitken, a former prisoner and now a chaplain at Pentonville who works with the neurodiverse unit, wrote to the Times.  

“The real disgrace lies not inside our prisons but in the failure of both public and private rehabilitation efforts to help prisoners into jobs, housing and law-abiding lives after their release. The good work done by prison officers, managers and governors is underreported… We are on a roll of improvements… But such advances are like clapping with one hand if they are not met by comparable efforts to rebuild the lives of prisoners after they walk out of the gate. Correcting the failures in this area should be a high priority for our politicians and for our society.”

Column

Change

Masculinity

Psychology

26 October 2023

7 min read

The crying man and the content of sadness

In the latest in our series on men and masculinity, psychologist Roger Bretherton reflects on what he learned about being a man from his own mid-life crisis.

Roger Bretherton

Roger is Associate Professor of Psychology, at the University of Lincoln. He is a UK accredited Clinical Psychologist.

A person stand looking out a wide set of windows covered in rain.

Daniil Onischenko on Unsplash.

My midlife crisis began with crying. Alone. In the car. In the study surrounded by books. Curled up on the bathroom floor. Waves of sadness crashed over me, and I couldn’t hold them back. So sudden and inexplicable was this lapse into grief that I felt the need to keep it to myself. It was shameful. It took a month before I finally told anyone and even then, my hand was forced by bursting into tears in front of them. They wondered if it was hormonal. Maybe I was eating badly or sitting still too much. But I knew the sadness had content.

I was slowly being crushed by the feeling that I had failed to be, or missed the opportunity to become, the man I was supposed to be.

It is difficult to make sense of such sadness though. It doesn’t come labelled with its own meaning. It fails to announce itself. It doesn’t ride into our consciousness on a unicycle waving a sign that reads: you are now sad about getting old and feeling like you have failed as a man. It takes a bit of detective work to find out what it all means. But in the end, I had to acknowledge that I was slowly being crushed by the feeling that I had failed to be, or missed the opportunity to become, the man I was supposed to be. In the three areas of life that mattered most to me, family, work, and church, I was a failure. I knew that’s what I thought because my tear ducts started twitching whenever I said it aloud. Of course, I couldn’t get anyone to agree with me. It’s not a fact. It is a massive unrealistic incapacitating overgeneralisation. But apparently the poor twisted neurones of my emotional brain had failed to get that memo.

Every feeling of failure implies a vaguely defined sense of the success that could have been ours but has been lost. If I had failed as a man, what kind of man was I supposed to be? I came to realise that I had unintentionally imbibed a seductive model of masculinity that was ultimately unachievable. For want of a better term I came to call it the man-at-the-centre. The man-at-the-centre game is really easy to play. It is a simple rule of thumb for what any man should be. It works in any context you can think of, and goes like this…

What should a man be at work? He should be at the centre of a team of adoring colleagues.

What should a man be at home? He should be at the centre of an adoring wife and family.

What should a man be at church? He should be at the centre of an adoring congregation.

The man-at-the-centre game requires that every situation a man enters should immediately configure itself into a picture postcard in which he holds pride of place.

Obviously, this view defines masculinity entirely in terms of power. And not even the kind of power that makes any sense. Not the power to be wise, or brave, or generous, or fair, or honest, or loyal. But the power to force other people be exactly as we would like them to be. The insistence that social life is only acceptable if made to conform to our exact specifications. The man-at-the-centre equates masculinity with being in charge, and even the tiniest lapse in control as a failure to be a man, a surrendering of one’s right to exist as a male. Kierkegaard summed up despair in precisely these binary terms, the desire to be Caesar or nothing.

A one-way ticket to Blametown

I can’t be sure if this insight is true of ALL men, some men, or just me. Maybe it has nothing to do with masculinity at all. Perhaps I’m just describing my own narcissism. But either way, it’s embarrassing to admit that I even thought this. I don’t even know where this belief came from. It goes against everything I have stood for in support of women, and in collaboration with men. It is quite frankly a ridiculous thing to believe - and yet there I was, just as surprised as anyone else to find myself believing it. It turns out the old church billboard was right:

You are not what you think you are; but what you think, you are.

And I don’t really want to chalk it up to The Patriarchy. Whenever anyone starts on about The Patriarchy, I have the ominous feeling I’m about to be blamed for something. It reminds me how I used to feel when I worked in mental health services in the NHS.

Two- or three-times a year it seems the national media are obligated to run a story about the inadequacy of care for people with mental illness. Usually based on a report about people being let down. The catastrophic failure of care for young women with eating disorders, or young men with depression, or women on the autistic spectrum. The stories are heartbreaking, and everyone agrees that something must be done. As a lowly frontline worker, nobody blamed me, but I knew that in the weeks that followed I’d be subjected to something that felt very much like blame. No one said it was my fault, but the demands, the hours, the targets, the scrutiny, the bureaucracy would proliferate. None of it would solve the problem, but those who were trying to help would not go unpunished.

So, as a one-way ticket to Blametown, I’m not keen on too much talk about The Patriarchy. But when I consider my hardwired tendency to think of masculinity as the man-at-the-centre, and the despair that accompanies the failure to definitively accomplish this, am I not describing something a little bit like patriarchy? A social system that offers men such a restricted view of what it means to be male, that almost no one can be happy confining themselves to it. An invitation to inhabit a narrow bandwidth of conversations, interests, clothing, emotions and sitting positions so as not to score an own goal for the men’s team by betraying weakness. It’s not like any of this is working for anyone but, beyond exorcism, what can we possibly do about it?

The real Man-at-the-centre

It's not a huge surprise that this midlife crisis struck when it did. Every crisis has a context. Every breakthrough starts with a breakdown. Sometimes I feel like I invited it, because for the last five years I have been practicing contemplative prayer. Twice a day – on a good day – I hole up somewhere alone. Sometimes the study or the bedroom, my office at work, a bench in the park or a seat by the window. I pray in the same places I cry. The twenty-minute timer on my smart phone begins and ends with the sound of a monastery bell. And when it is set, I close my eyes and follow the simple rule of contemplative practice: lifting my heart to God with a humble stirring of love. And for twenty minutes that is all I do. In response to every distraction or entertaining thought, I turn from the noise of my mind back to being lovingly present to the mysterious Presence in the present moment.

Among all the well-intentioned ideas, initiatives, and apps that promise a solution, this is the only answer that has truly addressed the crisis of my own masculinity.

One of the central tenets of contemplative prayer is that when we make space for God like this, we not only meet Him, but we also meet ourselves. I don’t think my insight into needing to be the man-at-the-centre would have been available to me, if I hadn’t been practicing its polar opposite several times a day. In the discipline of contemplative prayer, we decentre the ego, we step over our self-absorption, we fill our consciousness with something that is not us. My experience of it is that when I turn to God with love, I find myself held in a vast field of loving attentiveness, infinitely greater than my own. And over time, this creeps into every corner of life, infecting every moment of contact with family, friends, colleagues, and students with the supreme joy of simply being there for that unique unrepeatable moment of their existence. Whether I am the man-at-the-centre of home, work or church becomes an irrelevance. What matters is not what these situations give to me, but what I can give to them.

This speaks to the supreme paradox at the heart of Christianity. One that is in constant danger of slipping through our fingers. If we grasp it too hard it crumbles in our hands. It stems from the fact that there is a man-at-the-centre of the Christian religion. Arguably the most famous man of all time. Depicted in icons, brushed into frescoes, melted in stained glass, moulded in sculpture, and portrayed on camera. His face appears everywhere, and if we are not careful, we may mistakenly assume that we are celebrating his fame – the greatest influencer ever born. But what makes Jesus the man-at-the-centre is not the ingenuity with which his publicity machine crowned him king of the hill, but the absolute giving of self that characterised his life. The real Man-at-the-centre is the radically de-centred Man.

Personally, I find there to be a seamless continuity between the Jesus I meet in scripture, and the Spirit that animates the life of prayer. Among all the well-intentioned ideas, initiatives, and apps that promise a solution, this is the only answer that has truly addressed the crisis of my own masculinity. Not a humiliation of masculine power, but a profound transforming and redirecting of it. It is the only thing I have yet found that can truly photosynthesise the carbon-dioxide of fear, rage and self-hatred that suffocates so many men, into the liberating oxygen of joyful loving strength that is their birthright.