 So what I think is interesting about Charles Bronson is that he was actually, when he first got incarcerated, he was only actually in there for seven years. I mean I call them psychopaths but you could equally, I mean they may well equally be an associate part. He's called Rocky Bennett. So Peter Suckler for the Yorkshire Ripper, what's interesting about him is that I think that he was psychotic. Dr Das, how are you, sir? Really good Chris, thank you so much for having me on, really looking forward to our chat. Ah, absolutely. An area of life that so many people are shielded from, so much stigma around it as such. And yet it's utterly fascinating. I think many people, I think it's quite a sort of, it's quite well known these days that most people have suffered some form of mental unwellness from on very advanced degrees. I know I certainly have from chronic addiction to psychosis and all the other kind of, you know, other conditions in between. But before we talk about that, do you want to just hit us with what's the sort of worst case you've been involved in? So yeah, good question. I think the most extreme case or the most emotionally draining case was when I gave evidence in a criminal court case for a murder charge. So this was an 18 year old girl, we'll call her Yasmin, that's not her real name. And she was unique in that she had no history of mental illness, no previous criminality, no drug and alcohol use, so there were no risk factors. And completely out of the blue she became psychotic and she smothered and killed her three year old nephew who she was babysitting for. So obviously it's such a tragic case. At the time she had these, she was harboring these delusions. So she believed that the nephew had demons inside of him and that she needed to save him by smothering him. And she believed that she could reincarnate him. So this all happened around 2014 I believe and obviously the police came around when the rest of the family discovered what was going on and she went into remand at what was then Holloway prison and that's where I assessed her. And I eventually got transferred over to the medium secure female unit where I was working and assessed her over a period of a few weeks and I gave evidence at the Old Bailey for her murder trial. For me it was such an impactful case for so many reasons. First of all, obviously the actual nature of her offense was completely horrific, inexplicable. It seemed sort of random, came out of nowhere. But then also it was quite educational for me because I was a junior psychiatrist at the time and I got to give evidence in terms of not guilty by reason of insanity, which I'm sure you've probably heard the phrase, psychiatric defence. And the other thing was that part of her rehabilitation, so basically upon my evidence she ended up going to hospital rather than prison, which is the right place for her because she was completely psychotic. And then part of her rehabilitation was reconnecting with her family, including her older brother, who was the father of the child who got killed. So I was kind of sat in a room during this family therapy, which was like on a weekly basis over many months. And just yeah, just being part of that, of the emotional struggle there was just really heartwarming and kind of eye-opening for me. Gosh, it's just my heart goes out to everyone just hearing that story. Because of course we live in a society where, as I mentioned earlier, stigma is it's always an issue. And in a case like that, there'd be so many people, to them it's black and white. Well, she's evil, lock her up, don't know that. Really not understanding that it's nothing to do with a moral decision, whether to commit an evil act, it's completely out of her control. And that she is actually the equal victim in this equation. How did the family, did they accept to back it back into the fold? So before I answer that, I'll just sort of expand on what you said. I think the patients that I assess, the defendants during their criminal trials, you could argue that they're kind of doubly stigmatized. Because as you say, they've got a mental illness and most of them have committed some sort of horrific violence. So yeah, it really is a kind of side of society that nobody really wants to, people want to ignore or lock away, lock up and throw away the key. I think in this particular case, Yasbin was really lucky because her family was quite understanding. They're very tight knit, ethnic minority family. So they all lived together, like she lived with her siblings before this all happened. And her rehabilitation was, you know, it took a long time. So she was in hospital for about three or four years altogether. And it took about a year and a half of medication just to help cure her psychosis. So her family were quite understanding. I think her parents were, how do I put this, they were a bit, I mean, I never met them before this incident. So it's hard for me to make a comparison. But they seemed at least on the surface willing to take her back home. But there wasn't much interaction. So I don't know whether that was just their natural dynamic or whether despite them taking this magnanimous step, they still harbored, you know, an unspoken degree of resentment. I don't really know. Gosh, and she of course got to live with that for the rest of her life as well. So what happened was it took about 18 months before we found the right combination of antipsychotics. Part of that was because she refused medication initially, which means that we had to use the powers of the mental health to physically detain her and inject her a few times before she agreed to take tablets. And after about 18 months, her psychosis finally lifted and then, as you say, her acts came crashing into her reality. So she finally understood after all this time the consequences of her action. And as you'd imagine, she just, this massive wave of depression came over her. So that was like the second part of her treatment phase. So what is it then because, and for friends at home, we're going to come on and tell Shahan's story. But I just wanted to go straight in with sort of some of the fascinating stuff so that perhaps people who wouldn't ordinarily watch this kind of podcast will just stick with us a bit longer. But in my case, it was quite black and white. I took a load of really strong chemicals and I took them for way, way, way too long. And the way I describe it to anyone is the fine synapses in my brain started to, you know, rather than fire co-cohesively, if that's the right word, or in order, they all started getting higgledy-piggledy. And as such, my thoughts became rather delusional. Just as an aside, I've been, people have tried quite often to put me straight on that note, Chris, when you behave in this way, you open the door to demons or gins, so evil spirit, which from a metaphorical point, I'd exactly agree with. But whether I actually, this is where it gets complicated between... I don't know if people mean it really, even though there's not a word, or allegorically. So for me, I knew what caused it. And when I stopped taking the drugs, the psychosis just would leave me within sort of 24 hours. But what do we feel brings it on, then, in somebody that's, let's just say, living a fairly regular life? So psychosis is, it doesn't have, it's multifactorial. It doesn't have one direct cause, but there's lots of potential factors that contribute. So as you'll probably know, it runs in certain families. But the way that it, it's in clusters of genes. So it's not like an autosomal dominant trait, which means that if your father has it or your mother has it, you definitely have it. It's not as simple as that. Because there's clusters, by having more first or second degree relatives with some sort of severe mental illness like schizophrenia, that increases your chances. So that's one massive factor. You hit the nail on your head yourself with another massive factor, which is drug use. So certain drugs like skunk cannabis, as opposed to ordinary cannabis, amphetamines, crystal meth, are far more likely to cause psychosis compared to, for example, heroin or alcohol, especially if people use them in their adolescence for long periods of time. So those are probably the two biggest factors. And then outside of that, there's things like trauma, so childhood trauma and also trauma when people are older, when they flip into psychosis. And there's also factors that are not as well known about, but there is some kind of weak link. So infection in your mother during her pregnancy is a big factor. So studies have shown that mothers with certain viruses during pregnancy will increase the chance of their offspring having schizophrenia. So yes, there's lots of different factors. And to be honest, it's random. You can have somebody that has all of these factors and stays quite well and you can have somebody that doesn't seem to have many of those factors. Like Yasmin is a perfect example who suffer from psychosis completely inexplicably. Gosh, do you think or how much it has been shown that diet plays a factor? I wouldn't say that diet itself plays a big factor in terms of psychosis. So that's just for your viewers, for those who don't know, because I think psychosis is a term that's often misunderstood. It kind of gets mixed in with violence or people acting erratically. Psychosis is a period of mental illness. So it's not like a personality disorder which is entrenched. It's a separate period which is different from somebody's baseline. And it's usually in the forms of hallucinations. So hearing voices is very typical in something like schizophrenia or delusions which are fixed beliefs that will not change even if evidence is given to the contrary, mostly in the form of paranoid delusions in schizophrenia. So diet in itself doesn't really make that much difference but diet can make a difference in your overall well-being and your overall mental health. So if somebody's prone to depression, for example, then it's more likely to cause a relapse into something like depression rather than psychosis. And you've got a wonderful YouTube channel. Do you want to just give it a shout-out so everyone can find it? Yeah, I'd love to. So it's called a psych for sore minds. And it's basically me talking about what I do for a living. So I talk about mental illness and I talk about criminality and like the crossover between the two. So sometimes I talk about high-profile, true crime cases, some people that everybody would have heard of, like for example, you know, Charles Bronson, Ronnie Cray, my own personal psychoanalysis. Sometimes I talk about recent news events. Sometimes I talk about ex-patients, like I've done a video on Yasmin. Sometimes I talk about individual diagnoses. So we've been talking about drug-induced psychosis. I've got a video up there about a real-life story of a Wu-Tang clan affiliate member who got a drug-induced psychosis and actually cut off half of his penis. So that literally happened about seven or eight years ago. So yeah, I have lots of different angles that I explore. They're about sort of 15 to 20 minute videos, quite short and pithy and snappy and I think entertaining, hopefully. So please do check it out. Yes. Gosh. Getting cut off half your winky. You better make sure you've got enough to cut off in the first place, gentlemen. Not recommended. And let's talk about Charles Bronson then from my limited sort of knowledge, I think I saw the film that was made about him or at least one of them. He seemed a victim of the system to a certain extent, didn't he? So what I think is interesting about Charles Bronson is that he was actually, when he first got incarcerated, I say incarcerated because he jumped between hospital and prisons numerous times. So he was in a bit of both. He was only actually in there for seven years for armed robbery, which is not that long a period of time, especially for compared to most people who end up in Broadmoor, which he did. But what's interesting about him is his actions after he got locked up, have kept him locked up. And I think that he, well, it's obvious that he just loves a punch up and he loves violence. Anyone can tell you that. But what I think is unique about him is I think he actually used violence to increase his status and to make him a celebrity because he is very charming and lots of people know who he is. And that's because of his violence because he does such outlandish things from beating up prison guards to taking multiple people hostages to, you know, having rooftop riots. He was friends with Reggie Cray, sorry, Ronnie Cray. They made a film about him, as you said. In fact, I think they've made a couple of films about him. He even got married when he was behind bars. He's released exercise books while he was behind bars. And in my opinion, all of that is basically, is tethered to the fact that he is such a celebrity and he used his fists to get that notoriety. So I think he's actually used violence to become famous. And I think he kind of, he loves the attention that gets him his celebrity friends, that gets him these interviews. And so if he stopped being violent, then he would lose his mystique, he would lose his celebrity. So yeah, that's what I think makes him unique compared to most other patients in Broadmoor or most other prisoners. Would we say he has a mental illness or is he just like, just as a pawnshomp of violence? So he was diagnosed by some psychiatrists having schizophrenia and some say that he didn't and others said that he had psychopathy. So he was a psychopath. From what I know about him, the schizophrenia is hard to judge because he has had some very odd beliefs that could have been delusional, very odd behavior. But you could argue that he did that for attention. But I do think he's probably a psychopath and I'll tell you why. So the term psychopathy again is sometimes misunderstood. I think people only associate it with, you know, people that break the law and are violent, which isn't actually the case. In fact, most people who break the law and who are violent are not psychopaths. To be a psychopath, you have to not only lack empathy, not care about the difference between right and wrong, not care about the law, but you have to be quite charming and manipulative. And I think Charles Bronson absolutely was those things. So if you see him in interviews, there's something very attractive about his personality. He flirts with female interviewers. He keeps you engaged. And I think you could argue that he is manipulative in a way because he's manipulated his environment. He's manipulated the opportunity to be violent, to become a celebrity. So I think he's a classic psychopath, absolutely. Let's explore, Ben, the area I'm fascinating in, again, is psychopaths and sociopaths, because I'm trying to always make sense of what the hell is going on outside my window and anyone that looks at the behavior, let's say, of politicians for the last 18 months, but then whoever's controlling these trillion-dollar corporations that quite clearly are controlling the politicians, at what stage does it just go from being naive, greedy, stroke power-hungry to sort of a mental illness? So I mean, I call them psychopaths, but they may well equally be an sociopath. Yeah. Okay, so there's a few things there. I'm just going to write this down so I don't forget. So first of all, I'll tell you about the difference in a psychopath and a sociopath, and then I'll tell you about exactly what you talk about. So CEOs and big multi-organization leaders and how that all ties in. So the term psychopathy is a clinical term. So it's used in forensic psychiatry. It's used in the kind of reports and evidence that I give in court. Whereas being a sociopath is more of a kind of informal term. So what I'm saying is if you asked 10 forensic psychiatrists what a psychopath is, they'll give you the same answer. Whereas if you asked 10 sociologists what a sociopath is, they might give you slightly different answers because there's no strong definition. But what they've got in common is that they, some of the things I mentioned before, they're both manipulative. They both don't care about the law and they will use other people for their own advantage and they don't have empathy. So they don't care if they hurt people. The difference between a sociopath and a psychopath is the psychopaths are more cunning and more manipulative. So if you pissed off a sociopath for any reason, he is more likely to react there and then. He'll get angry. He will shout at you. He will lose his temper. He might attack you classically. Whereas a psychopath is much more calculated and you could argue much more dangerous. So they won't necessarily lose their temper at you but they'll remember it and they'll harbour that ill feeling and they'll wait for the perfect opportunity to get you back and it might be weeks later. It might be months later. So a lot more calculated. And psychopaths tend to be a lot more cold and be able to contain their emotions as opposed to being reactive. So that broadly speaking is the difference although there's a huge overlap. What I think is quite interesting about what you said is that it's well known that psychopaths make really good CEOs. So psychopaths, there's a kind of classic trope that they're all violent offenders and actually they're not. Some do really well in the corporate world because they're willing to do whatever it takes to kind of stab their colleagues in the back. I've done a whole series of videos on my channel about psychopaths and I talked about working for a boss and who in my opinion was a psychopath because some of his actions just were not only were they really deviant and mischievous but they were frankly illegal and this man was like a CEO of a company. Was there something else that you asked me? I've kind of lost my train of thought, Chris. No, I find the whole thing... Oh, sorry, I remember what it was. Sorry. You asked about where does it become a mental illness and my answer to that would be that psychopathy is a personality disorder as opposed to a mental illness. So as I was saying before psychosis is stepping out of your baseline so it's when you're different and you're having different experiences from your baseline self. Whereas a personality disorder psychopathy being the one we're talking about but you've probably heard of borderline personality disorder antisocial personality disorder, narcissistic, etc. a personality disorder is entrenched so it's not something that's a chemical imbalance it's not something that I can fix by giving you tablets it's something that's part and parcel of who you are and it's born from childhood experiences and your moral compass as your maturing. Gosh, there's so much I want to unpick and explore here and I don't want to lose people. Would we be right in saying so it was always explained to me that associate path so a psychopath is somebody that's born, as you said with a personality disorder. Not quite born Chris, I wouldn't say they're born with it but their early experiences so throughout childhood adolescence can form psychopathy. So they can be relatively normal as a child I'm not saying they all are but it's not unusual for somebody to be relatively stable then there might be a change in their circumstances classically that their parents divorce and they go to live with an evil stepmother who treats them horribly and that's where their personality disorder develops. Yes, and sociopath could it be said that if you've never known love then you can grow up and not be able to extend you don't possess empathy. Yeah, absolutely, I fully agree with that so they say that sociopathy is a little bit more even though there's a huge overlap it's more about learned behaviour than psychopathy so people or children model what they see so if they're growing up in a household that's full of domestic abuse, full of violence full of aggression, hostility then they model that they think that is the correct way to resolve conflict and they think there has to be some sort of power dynamic in all relationships in the future so people, children copy that pattern of behaviour and they find it hard to lack empathy. Yes, and do you think society I have this theory that when we lived in what my son will call the olden days so more community based small villages, this sort of thing that if you had a psychopath amongst you I think you'd soon weed them out their behaviour, their manipulative behaviour I'm guessing would be seen as some sort of wizardry people would realise that they have the ability to make people do stuff that's just not nice and I think they would have been cast out of the village Yeah, well I think psychopaths are very good at hiding their true natures and they're very good at being manipulative so I think you're right, eventually the village would cut it on but I think it would take a long time so going back to what I was talking about before as I talked about in one of my videos on my channel when I worked for this boss I didn't realise that he was I didn't fully understand why everybody else seemed so scared of him he seemed so friendly and charming to me and it took months for me to kind of get that some of the things he said to give you some very brief, specific examples it was a housing association he would change minutes of meetings that he wasn't there because he didn't like what was being said because he had an idea so he would literally ask me and other people for the drafts of our minutes change them without saying anything and then kind of put them on the shared drives that's just one very small example but my point is that I think in your analogy the village would eventually learn but it would take a while because psychopaths are very good at what they do plus I think you could argue that the average psychopath might get bored of village life and go on to make a name for himself whatever that is, you know, CEO celebrity, actor or, you know, murderer, whatever it is they usually tend to be quite successful so they'd probably leave the average village Yeah I just kind of had this theory that now that we don't live in these close-knit communities in fact we could argue we've got zero community at all now living from our home cocoons and of course everything's gone online has this created an environment where psychopaths can flourish? Yeah, good question Chris I've never really thought of how psychopaths would flourish in the social media kind of world but yeah, I think so I think so because it's just easier to move on isn't it like you said if you're if you eventually get caught in a small town or a village that everybody's wary of you but if you can just anonymise yourself either online or say in, you know, a populated city then absolutely you can manipulate people get what you need and then move on without being outed Do I think you're right? Yes And do you know any people that you think might be psychopaths or that you've worked with or that you've, you know, gotten to know of your life? Um, so gosh I've certainly been made aware of other people's bizarre behaviour that probably like yourself I was quite naïve to I mean a guy that I'd say, ah, he's alright and someone else would go oh, he's like a real bully Really? Oh, he's really nice to me I just didn't see also had someone, I won't say who they are but someone very close to me was going out with I don't know psychopath or narcissist is how interchangeable those terms are but one day he just broke down in front of me and said, my God, you didn't, you know, I was he went for therapy about it for a lot of stuff and he broke down and it was really awful because I hadn't I've been quite oblivious to it all but when he told me about this, it was a girl and her manipulative behaviour it was just bizarre and I guess everyone's response is why did you put up with it but the answer is that you don't realise it's done so under the radar so cleverly at the time am I on the right Yeah, that does sound like something that could be a psychopath I suppose gaslighting might be what you're talking about so it's kind of a manipulation to make somebody think that they're crazy for questioning behaviour of a psychopath, yeah Yes, see I was a substance misuse specialist or worked in a clinic three years in this role and it'd be quite interesting I'd have a client and I might say I can't think of a good example but I'd say one thing I don't know, maybe it's this approach clearly isn't working for you then the next time I saw them they'd say, do you remember you told me last time Chris that I'm way too smart for this kind of treatment I'm like, no I didn't oh yeah, and you said that thing where people try to nail you down on something that you only sort of said I mean I've had it on the podcast I can't say the person's name because I think people would be quite shocked but had someone phone me up and say right, when's our podcast coming out and I had to sort of break it to them my manager would be the decider of that thank you, no no no you said Wednesday I'm like, what are you talking about why would I tell you when I'm, how I'm going to run my business life that you don't even factor into it unfortunately yes you did, you said I said no, you're referring to the fact that you probably said when's our podcast coming out and I would have said something like oh, you know try and get it out this week if possible but I didn't you didn't commit to it do you get what I'm saying and they've taken it literally that I might have said maybe even in a couple of days and they've gone right, Monday, Tuesday and then to them to this individual he just thought I told him oh, yeah it was quite interesting especially when I told him to fuck off but yeah, strange yes what was the pressure on you to become a doctor we kind of associate Asians with that parental you know, doctor, lawyer, accountant unfortunately, yeah I exactly was the stereotype yeah, so I I think it's fair to say I was quite immature when I was a lot younger so around the age where you have to decide what you're going to do for the rest of your life in terms of university courses so around GCSEs I couldn't care less I had no kind of plan, no idea didn't even think about the future and I was fairly smart so my parents they did I think it's fair to say pressurized me into doing medicine got into medical school when I was 18 just messed around the entire time didn't really have any kind of plan almost failed all my exams when I got there because I went a bit kind of crazy with a lot more freedom but just about I was like percent one or two percent away from having to reset the entire year for my first year but then started taking it a little bit more seriously and then after I finished medical school I just had again, no kind of plan of what I was going to do for the future I actually did a year of working as a surgical house officer and then I did a year of A&E out in Sydney and while I was out in Australia I got offered to do a six month placement in a psychiatry ward as a junior doctor and I just instantly fell in love with it and I think I fell in love with it because there's something a bit fascinating about going into other people's delusional world so I speak to these people with diagnoses like schizophrenia, schizoaffective disorder and it's just, yeah there's no other way for me to put it it's just you're like stepping into somebody else's obviously wrong delusional system plus we saw a lot of people that would be at the lowest ebb so post suicide attempts would be a classic reason for somebody being admitted and I felt to my surprise I was quite good at just connecting and showing empathy I didn't really ever get my empathy tested to be honest I never was in a situation where I had to express it so I didn't even know I was good at it but I was to my surprise and if I'm being perfectly honest with everything that I lacked in medical knowledge so I passed my degree but I wasn't the hardest studier for everything that I lacked in psychiatry it's more about your communication and your patient skills, your bedside manner and I had that more than I had all the knowledge that I should have accumulated over the years so I just had a natural affinity to psychiatry and then fast forward a few years when I came back to the UK to do my training within the placements you get there's subspecialty so you know there's child and adolescent psychiatry old age psychiatry and forensics is one that's not really known about it's kind of slightly secretive slightly dark there's not that many forensic units compared to general adult units because as you'll know they're reserved for the highest risk most dangerous patients and I kind of did a six month placement there on a whim as a junior doctor before I had to decide what to subspecialise in and I was just fascinated by the backstories so every single person there had a reason why they had become a criminal and had a reason why they had become mentally unwell often the same factors you know poverty, homelessness, drug use really bad parenting from their caregivers and I think I've always been fascinated with criminality from listening to gangster rap to you know watching gangster films and mob films when I was a kid so it all kind of for the first time in life it all came together and I finally came across something that I wanted to do for a living so I worked in a forensic unit friends at home I was on what they called the staff bank for the NHS but I was on and off for three years and that just meant that when they needed someone they'd call me and I'd say yay or nay to taking a shift and a few of the shifts I did was at one of these I would have called it a severe mental health unit but I guess it's the forensic unit that you're talking about and basically most of the men in there had killed their wives and was that a coincidence because that seems like a very specific kind of offence like was it a unit especially for people with that presentation? Yeah I don't think it was I just think that maybe I got my maybe I'm getting false memory syndrome but it certainly was an issue in as far as they hadn't gone out actively to find someone and kill them as say maybe the Yorkshire Ripper however in a domestic environment it had come out that they killed their partner and I don't know how much of I'm going to plead insanity on this one or how much of just I'm guessing if you're severely mentally unwell you have that a period of that in your life the person who's probably first to suffer is going to be your partner isn't it because you're under the same roof with them perhaps it was that Can I ask you what did you make of the patients the reason I'm asking this is because something I get asked often is what are the people like especially people who have committed such horrific acts so what did you make of them did you find them to be difficult, hostile or normal, calm? No, not hostile at all although there was one chap that was seriously unwell to the point where it made you feel uncomfortable as a human being to see someone that unwell by far the majority of the rest if not all just on first appearances just came across as absolutely normal human beings until we're mentally normal and so one chap I sat down with and you have your TV room don't you and you try and have a bit of a a yat with your patient and it started off we were having a chat it was all fairly normal and then in the next breath he said yeah so President Bush is visiting the city next week to open the dockyard and yeah I'm going to be petitioning him about it rolled off his tongue so much it took me a second rest, hang on he's just gone completely delusional and you know not an issue but what happened next did become an issue it's that he for whatever reason our chat ended and we went our separate ways the next thing I know one of the female staff was tapping me on the shoulder and she said Chris are you all right with this and I said sorry what do you mean she said this and I turned around and I've been oblivious to the fact this guy had gone away and what we term in the profession he was on one right you know and then I realised he was screaming down the corridor at me and when I started to focus and pay attention I become the focus of his delusion or his behaviour and the next thing he just ran down the corridor and the nurse had purposely shut the the shockproof glass windows you know it's like almost like bulletproof level glass and the guy just slammed into it smashed you know the glass which all held itself together and then just proceeded to smash himself into that then he turned and started to smash himself into the window I won't even say the stuff that he was saying because it was just poor guy you know poor guy but it was all lots of sexual stuff was coming out so was he did he have like parallel delusions against you specifically so he thought you did or said something it was like he developed a fixation on me I don't mean sexual or anything just like I'd become the object of his look at me Chris Chris look at me smash and he smashed into the window and so and I was I've seen a bit of the world so I'm just you know what can you do I took it on a chin and I said to this fellow nurse I said no no I'm fine I'm just you know obviously not nice for this gentleman so what happened in the end do they have to like give him some PRN medication or inject him well I don't remember that particular instance and what I will say is that I only ever saw someone injected once and it was a horrible experience I didn't like it and I didn't know if I really thought it was necessary it was kind of a a culture in the units I worked in of what I call like bovaboot culture where I always used to wonder why a mental health work nurse is all wearing Doc Martins it just didn't seem I just wore the trainers right and they're all dressed like they think they're in the army or something and when I saw it kick off and I saw everybody it was almost like they couldn't wait to all dive on this 70 year old lady and you know it just looked like what I would call small man syndrome but going back to this other client I rocked up for work a few days later again accepted the shift went into the office where as you know the doctor gives a briefing before the shift commences go through every starts going through the patient and I just turned around and said oh how's John and everyone I just realised everyone had just turned to look at me and one of the nurses went oh John took the train I went oh what gone to see his family some of them had despite this series some of them had day release and stuff I said oh I've gone to see his family they went no it's a euphemism and I realised what they were saying he'd thrown himself in front of a train wow it was he dead did he kill himself and this is the same guy that you were talking about that got agitated wow so in a few days between this happened and I guess it's that thing where when you become lucid again and you can look back and realise oh my god I was behaving like that and I had no control over it and I don't want to behave like that and the the upset of it all meant he went and topped himself wow that's really sad do you mind if I just cover a few issues that you've raised for your viewers I know you'll know this but I thought when people get injected and when people have lead yeah please do so I mentioned before about this girl Yasmin who we had to inject against her will when people are detained under the mental health act in these units then if necessary we do have the power to restrain them and inject them it's not ideal and as you said it doesn't particularly help with the patient-clinician relationship so medication is always the best way but if somebody completely lacks insight into themselves and to other people then you either do nothing in which case that will never change they're going to be there potentially for the rest of their lives or get worse or you have to bite the bullet and physically restrain them and give them depot so there's sort of two different types of injections as you're a quick acting sedative which is just to calm them down in that moment so it sounds like the man you were talking about John might have needed that at that time and then there's a longer acting depot antipsychotics which stay in your bloodstream and they build up over time and they're usually about every two weeks or every four weeks and then in terms of leave so most people especially in secure units when they very first arrive as you all know Chris they don't have leave straight away but if they're deemed to be settled and if they're engaging in therapy I wouldn't say their symptoms have to be completely assuaged but at least if their symptoms are controlled with the right medication then they're usually given small periods of leave so it can either be escorted which is with a nurse or two nurses within the sort of town centre or the local area or unescorted if they're a bit more stable so when you were telling your story I did have to wonder like was it the right decision to allow this man to have leave if he was that agitated if I was the consultant in charge I would have, well I've got the opinion for the rest of my team but I'd be very much of the opinion that if somebody's that agitated and that paranoid then they shouldn't be having leave until you can at least see them settle for a number of weeks Yes very much Well I was just going to say the environment is also, that particular unit was quite nice because it was a small unit it didn't have the sort of horrible kind of miasma that you had when you worked in the main hospital and the main the annex of the hospital that's the mental health unit is what I'm trying to say and in there you permanently had this kind of smell of urine everyone seemed to chain or not everyone but a lot of people just seemed to want to chain smoke and I was there when you could smoke indoors and also when they started to ask people to go outside and I guess what I'm getting to Shaham is it was a very sad environment very sad not a pleasant place to work Well I think maybe my perspective is a bit different from yours potentially Chris because I think if you were doing bank shifts you were probably coming on towards and seeing sort of snapshots of patients in between days and you're right it can be a bit slow the turnover is slow, the progress is slow and it can be depressing I suppose I've had the advice because I've been doing it for a while because I've had a regular job as a consultant psychiatrist on these wards I have seen some patients eventually progress and leave hospital to get to discharge and it's slow you know the average admission in a medium secure unit might be anything from say three years to five years but when you look at how they were when they first arrived they were very very dangerous had extremely severe symptoms probably had committed quite serious violence and then when they when they leave at the point of discharge almost by definition they're kind of reintegrated they've gone through all this therapy a lot of them have gained qualifications in hospital so I guess what I'm trying to say is I can understand why it does look a bit solemn and I have experienced that myself but I think you have to look at the rehabilitation process as a whole and realise that the system's there for a reason Yeah, now I more was getting to the point that like I reckon if it was in Sweden it would look more like a four star hotel quite sort of dated in that hospital Yeah What's the situation then with they say black men statistically experience a higher proportion of mental unwellness? I'm going to answer that question and then remind me, I want to tell you about a case of a black man who actually got killed by a nurse restraint but I'll come on to that so yeah you're absolutely right there's been quite a few inquests about the treatment of black people within the mental health services and black men have a much higher rate of being detained through the criminal justice system so instead of your typical journey in to psychiatric ward which might be seeing your GP if you're feeling unwell or be taken to A&E for example if your family are worried that you're suicidal there's a much higher proportion of black men that go in because they're brought in by the police that's one issue the amount of restraint and medication is much higher once they're on psychiatric wards and also the type of therapy they're given is much more likely to be chemicals and medication than it is to be talking therapy and psychotherapy so I think there is this huge disparity that exists I think the problem with that is that it makes some black communities very suspicious about mental health services well about all authority whether it's police, psychiatrists mental health services and the problem with that is that it means that when people are starting to become unwell whether it's depressed flashbacks from PTSD to psychosis they are scared of what might happen to them they're scared of being sectioned so they don't seek help which is just such a tragic shame because it's potentially if they were treated at that point they might have avoided hospital rather than becoming really unwell months down the line when they're so unwell that they need to be sectioned so I completely agree there is this disparity and lots of inquests have shown that but the case I wanted to talk about was somebody that I've done a video about on my channel he's called Rocky Bennett and I believe it's 1998 in Norwich in a medium secure unit that was killed by prolonged restraint for some nurses so what happened was according to the inquest there was institutionalised racism within this particular unit and he had an argument with a white man about using the telephone and apparently the white man hit him first and they got into a scuffle but even despite that Rocky was kind of punished so he was taken off to another ward and he resisted I think he punched a nurse on that ward and then he was helped out he was restrained well over half an hour and then the inquest found later on that he was actually given a higher dose of medication than was authorised which probably contributed to his difficulty breathing because as you'll know one of the side effects is it slows down your breathing rate and he was held prone with nurses on top of him for so long that he was probably dead for several minutes maybe 10-15 minutes before anyone even realised then they got off him and they realised he was dead so not only is that a horrific case but on top of that the hospital initially tried to cover it up so they didn't phone his family this happened in the evening they didn't phone his family until the next morning and the first nurse that spoke to the family said that it was for breathing problems so they kind of lied or well at best twisted the truth hugely I mean it was technically breathing problems but they didn't tell him that he was you know they didn't tell them that he was killed in a restraint until it got investigated later so you know I think we do have to acknowledge and I acknowledge as a forensic psychiatrist that there are people that act in just unforgivable ways in some places and within these units yes what's the situation with skunk then and also is it what's this synthetic weed that they smoke in the prison spice isn't it yeah what's this doing to people's brains and is it you know what can it be permanent is it really wrecking people's lives I'm guessing I'm assuming it is so skunk is like as you'll know is like a hydroponic really strong strain of cannabis and it does predispose people to psychosis more than other cannabis does if people smoke it from adolescence from a really early age then it's known to kind of shrink or thin the frontal prefrontal cortexes so on both sides the front of your brain which helps with things like memory and forward planning and concentration so this is heavy amounts from a young age I'm not talking about the average social user and as I was saying before it's one of the chemicals that predisposes to psychosis it's not the only smoking skunk will cause psychosis but if you have other risk factors like trauma like a family history then it's one more risk factor that makes it more likely and then spice is like a totally different kettle of fish so spice is a synthetic cannabinoid and the reason it's so popular in prison the number of reasons first of all it's really cheap so you can get quite a lot for not a lot of money also it is almost undetectable within drug tests so when it first arrived in prisons the drug tests couldn't just didn't have the chemical compound to catch that particular molecule and eventually the chemist caught up with the drug producers to find the tests and then of course the drug producing chemists always one step ahead so they change the molecule slightly so they don't get caught up but I have seen a couple of prisoners who have been on spice and I have to say it sounds horrific it looks horrific to me they don't seem to be having any kind of fun in any way at all I've been around drugs, I've been to festivals and raves and people I get why people take drugs, I can't formally say that I endorse it as a psychiatrist but I can certainly understand it people are having a good time, they're chatting they're high but when I've seen people on spice they just look really really agitated they look kind of seized up, fearful paranoid which begs the question why do people take it and I'm not sure that I fully know the answer to that I think for some people being wasted in some kind of way is better than being sober so their lives are so miserable or their time in prison is so slow and so boring that they would rather be agitated than sober and the other thing about spice I should mention is it's a lot easier to sneak in so you can have spray versions of it so it's been found in children's drawings they spray like a see-through layer on top of children's drawings so it's much easier to sneak in and it doesn't smell compared to something like cannabis gosh and if you've if you've done some damage to your brain through drugs how how repairable does that tend to be and I can use myself as an example here because years ago I took a trip before going into a rave club you know a warehouse evening and I won't go into full details what else I took but did a bit of a cocktail and the next thing I knew I was having the worst trip that you can have it was awful yeah and so much so I just had to leave this club I don't even know how I got in there I I couldn't envisage how I was going to get past the dorm and in the state that I was feeling it was and that in itself was causing you know more sort of fear but I genuinely feel that night that I did some real serious damage and as a result it triggered like a sort of anxiety condition and was that still extant like months later so say like six months or a year later was it still yeah I'd say it was like this before it happened I used to smoke weed like everybody well everybody I knew back then in the 90s in the UK smoked right it was a big part of all of you didn't smoke you didn't go around their house and I never had a sort of issue with it but after this incident I couldn't smoke marijuana on its own because it just instantly sent me into an anxiety attack yeah in fact it probably why I started drinking a lot is I found if I had a couple of beers then it relaxed did something in my brain to relax me enough then I could smoke the joint which is the absurdity of substance misuse but so that that became my thing right let's have a couple of beers then I can smoke my joint and and I thought it would sort of wear off but I can tell you now if I was to go and smoke the joint now I bang it would just trigger and there's no rationalising it either I can't say right it's going to be cool right calm meditate you've got a lovely joint to smoke it's going to be wonderful there's nothing to doesn't work like that the second I was to puff it bang it just triggers that so um yeah I'm happy to give you my best guess at an answer I can't say that I know definitively I think generally speaking our brains are quite neuro plastic which means that whatever changes happen they can heal quite quickly and quite effectively generally speaking it tends to be people who've used substances for a very long period of time that have a high degree of damage where the damage is irreversible so I'm talking about decades and decades of you know drinking or using drugs on an almost daily basis so it'd be quite unusual for somebody to have an experience like you so for one bad trip to change their mentality permanently sure it happens like you know believe your story and I have heard it from other people but it is highly unusual with the paranoia I do wonder if part I'm not saying this is fully causative but at least part of it is when people get older they naturally become a bit more they have more responsibility I guess and more things to worry about whether that's family you know financial responsibilities work so I wonder whether there's something that's just there's more in their mind in general to be paranoid about rather than because the drugs make them more paranoid that makes sense because somebody in their 20s doesn't really have that much to that much responsibility versus somebody in their you know 40s yeah I guess something else we need to factor in here as well it's so I'm I guess what you call a childhood trauma experiencer yeah so my flight or flight has been a bit you know it's been screwed with from an incredibly young age you can say and I believe that that screwing with it I do feel it stays or it's been my experience it kind of stays with you for life and I imagine you'll know this far better than I will Chris but tell me if I'm wrong I imagine that to a degree you must be keeping a lid on that memory and kind of pushing it down and that experience and then I wonder if taking if smoking like quite strong weed might sort of flip it open when you don't want to be open so I suppose my question is do you get like memories pushed to the forefront or would you get like flashbacks when you were smoking weed I think it's more just it unleashes the flight or fight it's not about the memory per se it's about the fact that you've got a sudden rush of whatever you know I would say adrenaline because you can actually buy adrenaline in the chemist in India nor adrenaline I think it's just like taking speed I can't say what it's like because we'll be on YouTube but let's just say it's you know it's ironic that it's not an unpleasant experience but it's it's whatever the chemical is it makes you feel like spooked and shocked and that's I'd say it was triggering that so it won't come as any surprise say I stopped smoking a very long time ago now in fact I stopped pretty much everything it kind of took me about 30 years to realise that life's actually really really great without that stuff yeah so you heard it here first kids yes yes shall we finish then Shahan on let's take the classic case because one of my friends is Richard McCann and his mother was murdered by the Yorkshire Ripper right and that was a fascinating well terrifying and fascinating situation case wasn't it yeah absolutely and what would his diagnosis be do you think so that's a very interesting question and actually I have done a video on him on my channel as well so Peter Sutcliffe the Yorkshire Ripper what's interesting about him is that I think that he was psychotic during the time that he killed that he went on his killing spree he killed not exclusively but he often killed sex workers and he had a number of bizarre experiences that he reported so he reported a voice telling him that he had to kill sex workers even after his arrest he expressed some bizarre delusions I think he said that he believed he met the queen in the pub and he had experiences of like meeting people that he thought were related to the devil and significantly he didn't just say this during you know his trial when he was being assessed consistently even after he'd been arrested and sent to prison so what was unique about his case is that a number of psychiatrists said that he was psychotic that he had schizophrenia and that he wasn't criminally responsible for his actions and despite that the judge overruled that and he basically didn't take the advice of the psychiatrist and said that he was criminally responsible so he ended up going to prison but then he spent a couple of years in prison during which time as you might know he was attacked by a couple of inmates and then about two years later he was deemed psychotic and he was transferred to Broadmoor which is a high-secure psychiatric hospital and to me it doesn't make sense that somebody is seemingly psychotic diagnosed as psychiatrist as psychotic then suddenly becomes well during his trial then becomes psychotic two years later and is sent to Broadmoor to me it makes far more sense that he was probably psychotic the entire time but due to political reasons because what he did was so heinous it was a political decision I think that the judge thought well you know the public are paying for blood here so he has to be seen to be punished so I think that he had schizophrenia and I think he was psychotic doesn't mean he wasn't criminally responsible he probably I couldn't say definitively without assessing him personally he probably did know what he was doing did know what he was doing is wrong which is the basis of the insanity plea but probably arguably should have been sent to Broadmoor which I think some people is just an easy ride but it's not, it's not a prison but it's a hospital but it's still geared up for rehabilitation but it's still locked to secure environment so I think he should have gone there in the first place Yes, you can imagine judges don't always make the best decisions do they? I think they probably feel a lot of pressures on them to be seen to do what they believe then of course you've got the fact that most people don't understand mental illness and yeah and a decision just sending someone to prison to be nasty and show the public that's not helping because that's just setting a president that we're not prepared to understand people that are unwell for no fault with their own are we? I think sometimes it depends like this shouldn't be the case but I think it is the case it kind of depends on the sympathy that the average person has for the perpetrator so I mentioned before I keep coming back to this case of Yasmin this 18 year old girl who killed her nephew it's very easy to be sympathetic toward her because she had no history of offending never never hurt anybody before no drug and alcohol use what she did was completely completely out of character, completely inexplicable so it's easy for us when I say ours I mean me, the public, the judge to believe that she's mentally unwell when it becomes more complicated is when you get somebody like Peter Sutcliffe who has done something horrific so many times over a long period of time it's easier for the average person to accept that mental illness might be driving that it's easier to say well what he did is horrible lock him up and throw away the key and I get that, I can understand that way of thinking but as you say it doesn't help us really get down to the root of the problem and it doesn't help us cure those that need curing no two things I wanted to cover where I've got your professional expertise at hand one of them is what's your thinking on why somebody commits suicide well I think it is complicated and you have to take it on a case to case basis a little bit I guess like we were talking before about becoming psychotic I think it's multi-factorial and there's so many different factors so it could be related to actually having a mental illness like depression so contrary to popular belief actually quite a lot of people who commit suicide don't necessarily have a deep depression so I mean, you know, something that's dark and pervasive that has been there for months or years sometimes it could be a reaction to an event so having a serious mental illness is another massive factor childhood trauma the social support they have at that time obviously individual life events like losing a job or breaking up with a long-term partner for example plus flashbacks of childhood trauma they might have experienced so I think I don't think there's one particular cause but I think there's lots and lots of different causes but I think maybe probably the biggest psychological process is helplessness for the future so if you don't see that your future is going to... being low or being depressed is one thing but if you're low and you don't see it ever getting better whether that's reality or you know, clouded by depression I think that's probably the biggest factor that leads to somebody taking their life Yes What do you think? Well it's an interesting one quite a lot of people kill themselves now and sometimes it really is a case of oh my god just did not I mean one of my friends killed themselves very recently I'm sorry to hear that Yeah and it... sometimes it's a case of oh my god now it's happened I see the build up I can see the signs but you don't see them we're also bloody busy in this trying to make sense of this life aren't we and earn our crust and take and it's really not not aligned with looking after your mates all this constant hours that we have to put in and it's ironic considering we've got all this bloody so-called social media we're not more sort of social but I suppose another issue is it's not always obvious if there are warning signs right because not everybody's some people especially men because of you know masculinity because of the archetype of being you know big tough strong guy we're not always open to discussing our mental health and telling people if we're not feeling 100% Yeah of course I mean heaven forbid but if I was feeling suicidal sure you'd call me out and say right Chris I'm absolutely fine mate and then you just take yourself off and kill yourself you know there's no I think there's no you sometimes can't predict these things just for the nature that there's no real sort of logic to it but it's a bit of a morbid topic but if you're interested Chris one of the very first videos I did on my channel was interviewing a great man called John Clark who was an ex-cop who suffered PTSD from the stuff that he saw in his line of duty and he attempted suicide ended up being stopped by his very colleagues that he worked with literally came and cut the rope down and saved his life and then he got a section to psychiatric unit so I interviewed him about his whole experience and the whole process so he talked about a lot of the things that we're talking about about not being able to ask for help and all these pressures of life and work and yeah fascinating you know it's just a way to go that it really is just inherently sad friend of mine worked for the Met Police and he had to go and cut someone down once and when they broke into the flat the chap had simply read like and it was he'd obviously put it on repeat play so he's hanging there and he's got holding back the years just on repeat now my friend's got to live with that he's got that in his mind now for the rest of his every time he hears that song he obviously can't help but think about this poor poor chap the other thing as well is PTSD which obviously being ex-military and well and then as a trauma person myself is a big thing and I spend a lot of time explaining to people that although you can have traumatic experiences in the military might not even be what you think it might be that you got bullied you know or it might be people close ranks and you didn't get the promotion that you you deserved or whatever but I tried to explain that most of us joined up with trauma from what I and or a significant percentage it kind of goes hand in glove with then wanting to prove yourself in the military or and then I've no doubt that situations you can experience in combat maybe compound the issue but it's more the fact that when we leave the forces and we leave that secure cocoon and we hit real life where no one's paying you mortgage for you and you free healthcare no one's putting up when you when you want to drink to cure all your woes which is what we were taught to do and then you've got to work for a civilian employer who to you is just a dick is that the rules are different the rules are very different the loyalty that you may or maybe you may not have known can be different and it takes some real adjustment I mean one thing we kind of always chuckle about is it is as a civilian you can't just go and punch people that was how we sorted things out you know I remember I nudged into someone on the basketball court once and we had a bit of like yeah yeah go on when I was having you know I got out the chair and I was just getting dressed and the guy just walked in bang like that and the next thing you know you're in a fight that's just how we how we did so but going back to the point I was making is it there's not enough focus on the childhood trauma that's driving this behaviour that's then leading to so many service personnel taking their own lives and the public have almost a romantic view or a heroic view that this is all about combat that you've seen and I'm not saying that that doesn't happen and that's not horrendous but that we're probably missing the more important factor here yeah I agree so I've not really got that much I do have experience of people from the military who have got PTSD who've gone on to commit offences I've done some of those assessments the first person that's talked about having childhood trauma that was kind of added onto or accentuated those later traumas I think there's a few things that make it really difficult one of the issues is that most people when they're kids they won't we talked about men not talking about their feelings it's even harder for a child to talk about their feelings of trauma because they might feel like they're betraying their parent or whoever was involved in that trauma and I suppose another issue is that the child and adolescent services the CAM services are really squashed and the waiting lists are getting so long that unfortunately only children with very severe mental illnesses tend to get the attention and the service that they need so people with what might be seen as less severe and obviously it's got potential to build into something more severe like PTSD in the future but we don't know that at the time unfortunately they get kind of swept under the carpet so you can see how it's a perfect storm for people to be in your situation where things escalate over time yeah and the issue here and I've done obviously done a lot of thinking about this I was too young to understand what was happening to me so I didn't have the mental faculties at that age to be able to make sense of it all and as such I think my brain then so it compartmentalised it and made it about me oh I've done something wrong this is something about me that deserves this behaviour and you tuck it away in such a deep place in your brain at that young age that you don't have set you can't rationalise it out as an adult if someone hurts you you can go well listen he's probably having a bad day or he had a bad childhood himself it's not me personally he probably would have done this to anybody yet you have that ability to rationalise but of course when you're maybe 2 years old 3 4 you don't especially if in a culture like when I was young adults people didn't recognise this sort of stuff it wasn't something you talked about I remember a gypsy at the fairground once come up and punch me in the ear I think it was a mistaken identity I think he thought I've done something to his ride something or his amusement and it wasn't I was just walking on and his gypsy come out and went BANG and so when I hooked back up with my mum and I was about I don't know about 10 or 12 years old by that stage and I'm holding and she said what are you holding your ear for I said that bloke just hit me she said what why didn't you tell me well Shaham I didn't tell her because I didn't know that wasn't normal I didn't know it didn't occur to me to tell her I'm just like oh basically it's got happened again sort of thing that's very sad so where's your future where did your future lie well it's a big question I think in terms of my professional work so you know working as an expert witness I'm pretty happy where things are really I don't particularly want to change anything I'm getting a decent amount of cases I find it interesting I'm getting a good throughput of work my plans are to try and grow my media profile which I've only been doing actively I'd say for a year and it's a massive struggle to crowd in market places I'm sure you can attest to so yeah just trying to get more attention with my youtube channel trying to make videos regularly I release two a week I've got a book coming out which is going to be published by Sphere Publishing in March of next year and I'm doing little bits and pieces of documentaries I'm on channel 5 this coming Thursday giving sort of sound bites for programs here and there and I think we talked about this before we went live but right now it doesn't feel like it's worth it because I'm just really busy and it takes up a lot of time but I acknowledge that I have to be a bit more patient and that these things do take a while to build up so I've got to stop thinking about the results for now and just putting in the effort and yeah just be more patient I guess so that's my future a failed media star yeah so you're doing very well I think if I ever was if I ever was ill again I was on the doctor who was as nice as you to come and treat me I'll give you a discount yes thank you and you certainly got the presence for the media so I think keep the faith if what my friends say there's a much higher power going on here and we're just a channel for that and if you ever doubt that try to imagine how you got this big if you say to people how did you get to you know 5 for 8 6 for 200 pound whatever they'd say what I ate starting no no how did you actually like build yourself you know what molecule did you you know what I didn't and it's like yeah you literally didn't do anything did you and yet you went from an egg and a sperm to this incredible creation and so you have to acknowledge that there's something much bigger going on here isn't there so I've got that philosophy now with everything I just do my best I don't sweat the small stuff and I think if you've got a good heart and you clearly have the rest gets taken care of that's very nice of you I hope you're right we'll see give it a couple of years hope I'm right too Shahan maybe we do a live show one Friday night or something and I'm sure that my subscribers will have lots of questions and it's always quite fun it's a bit like a Friday in a pub without actually being in the pub absolutely I'll be up for that in the YouTube pub but yes it's been wonderful having you on the show thank you for your commitment and your insight and like I say let's chat soon it's been an absolute pleasure Chris thank you for having me on and also for sharing your story it was very magnanimous of you for telling us some of your experience experiences I can't imagine that's easy well to be honest there'll be an overlay over this podcast if I point there I think it is there's two of my memoirs is eating smoke which is my Hong Kong story when I got addicted to Christopher from the K-Mill but more fascinating is 40 nights is the memoir of how I sort of moved on from now I don't like words like recovery because I think life is just a series of experiences and we should make the most of them all let's say but for anybody out there if you're looking for any answers then they might be able to help you and talking of anybody out there if you could like and subscribe thank you so much for joining us again and we'll see you next time all the best Chris thank you goodbye everybody