Psychiatrist for UK’s Most Dangerous Prisoners Campaigns for a Trauma-Informed Justice System

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From Shaun Attwood: Psychiatrist Bob Johnson, along with his wife Sue Johnson, speaks about his years working in the UK’s prison for its most violent offenders, and how, rather than give his forensic patients drugs, he led them into telling of their traumatic histories, which ultimately ‘cured’ them, allowing them to give up their need for violence. The prison system, government, and psychiatry, however — far from supporting his remarkable, transformative work with the prisoners — tended to sabotage it and cut short the progress that was being made.

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Dr. Bob Johnson: What happens is they put the trauma in a box and they’re the only people who can open the box. Now if they open the box prematurely — that’s the end of them, they’re dead. So they don’t open the box. Now my message to them [is], the box is empty, you know . . . Do they trust you, do they believe you? . . . If you can open the box and blow it all away, it goes 100%. But . . . there’s a whole lot of stuff in between. And it’s a skill. You go in there and you read the signs, that they’re pushing you back — so you go back, and you put it into third person, or you dilute the message. But basically, what I want them to do is to say, ‘You can’t do that anymore, I’m an adult’ — whatever it was — ‘You can’t do that anymore, I’m an adult’ — and they don’t believe that. They do not believe that things have changed from the age of two or the age of three or whatever it was, they do not believe it. So that’s an insight on my part, that I have, to convey to them.

. . . The child thinks, ‘This is the end,’ and they close down. I’ve recently called it sort of an emotional anaphylactic shock. It’s like an allergy. You go thunk! And just as your antibodies attack you when you have anaphylaxis to some allergen, this is a self-defense mechanism that’s gone wrong. You go crunch! And your frontal lobes go offline, your speech center goes offline, you cannot talk, you cannot think, you cannot verbalize. And it’s the verbalizing that does it.

Sue Johnson: It’s truth, trust, and consent. That was the sort of soup in which it all swam. If that wasn’t there, they couldn’t even begin to start nibbling away at it.

. . . Bob: I’m not moving without consent. I mean that was absolutely rock solid. And looking back, what the consent does is to empower them. It’s what I would call now ‘agency.’ They’ve never been asked permission before; they’ve been said, ‘Do this, do that, do the other.’ Prisons, of course, are doing that all the time; prison destroys agency. And unless they’ve got agency, they can’t stop doing bad things. But once they’ve got agency, now ‘I don’t need that, I don’t need . . . the violence, I don’t need the addiction, I don’t need whatever it is,’ once they’ve got the agency. And so what’s happened with the child trauma, the child abuse, the childhood neglect, whichever way you want to put it, is lack of agency in the adult. Lack of self-esteem, self-confidence, self-empowerment. They don’t believe it. They’ve never, never been taken seriously.

. . . Sue: But what an indictment of a prison service. It spent the last 30 years creating special cages for these men that Bob was treating. Waste of resources, waste of —

Bob: Must be half a million pounds a year, 6 officers to unlock —

Sue: Terrible, terrible for the prison officers to have to look after them in such terrible conditions, terrible for the men themselves, terrible for society, total waste of money, total waste of resources, total indictment of an approach.

Shaun Attwood: So people who are watching this, then, who trust the government and trust the system, are perhaps wondering at this point: What would the motive be, if you were getting a serial killer to not be violent and not have to need medication and to become a more peaceful person — what would the motive be for the system to take that person away from you, and then for his tendencies to flow back up, for example?

Bob: I’m surmising, but… sort of jealousy in a way. They’ve got the systems for dealing with dangerous people, so they have to keep them dangerous — bit sort of macho on the part of some of the members of government. But I also have to say that the psychiatry — psychiatrists — are dead against anything that cures a psychopath.

Attwood: Why is that?

Bob: Well. There was a prison inspector’s report — her majesty’s inspector of prisons came around, and lots of preparation in Parkhurst, October ‘94. And the psychiatrist associated with that agreed to see me on a Wednesday; pulled me out of a meeting on the Tuesday — pulled rank — and said ‘The idea that it’s doing any good is totally anecdotal.’ Right? And the prisons inspector report came out, and I was the only person named — and I was slagged off brutally. And other parts of the report said ‘The prisoners on C-wing — it’s very good here . . . [but] Dr Johnson has to be reprimanded for doing A, B, and C, has to be put on a contract,’ and all this sort of stuff. Later — wait for it — later, I was looking through the hospital library, and [the same] man had written this book on psychopaths. And even later again when the Royal College of Psychiatry was formed in 1973, he had agitated for a forensic branch — which was later established — on the basis that psychopaths are totally incurable… And here they were, changing.

. . . Sue: The DSM, the diagnostic and statistical manual, where it identifies personality and psychopathic disorders, I think they call it ‘disorder of personality,’ that they’re born with. So this is a medicalization of the ‘born evil’ mantra . . . there’s a sort of popular idea . . . that there are certain categories of person that are just ‘born evil,’ and what can you do? What we found, really, is that there are things you can do; that people are born sociable, lovable, nonviolent — tiny… tiny babies. They’re not born with a personality, a disordered personality.

Bob: As a doctor, you go into a situation and you try very, very, very, very hard to change people, and they say, ‘Get lost.’ You get nowhere at all. You say, ‘Well, that’s not my fault, it’s their fault.’ In fact when we were medical students we used to joke that the doctor would make the diagnosis of ‘psychopath’ when his treatment wasn’t working. And that’s writ large. So you can understand the frustration of a well-intentioned doctor going in there, going to the front door, and the person is blocking, as I’ve described. You can access it by going through the side door, but you cannot do with the front door. You say, ‘Well, what was your childhood like?’ ‘Lovely, it was a lovely childhood.’ But underneath, that’s because they’re not telling themselves. Like this woman, I was nine months talking about childhood, since she never mentioned the one significant thing. And that was my breakthrough. The fact is that the lesion, the pathology, is the blockage. I mean, what happened 20, 50 or in one case 80 years ago — one of my patients was 82 — what happened 80 years ago should have faded. But it hasn’t — because it’s never been processed. And the reason it’s not been processed [is that] it was too frightening… too frightening to think about unaided. Now that’s the key, unaided.

So my task was to show: I’m here, I understand, I’m not frightened of your dad, or your mom, or I’m not frightened of what happened, and I’m not going to abuse you, I’m not going to all these things. And if you give them the aid, in that sense, emotional support, then they open up. And underneath you find that we’re actually a social species; Homo sapiens exists and is not extinct (so far) because they cooperate, they work together and they plan together.

Attwood: So you’re saying then, out of all of your cases, none of them were born evil, it was a — they were going after parental figments or people who’d abused them, it was all to do with trauma. There wasn’t just anyone purely born evil, had a great upbringing by the parents, but then turned into a serial killer.

Bob: It’s not possible, it’s not possible . . . it’s not possible to do that.

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