YouSaid · the spoken record

Ben Cave

lines on the record: 38
first: 2022-07-08
most recent: 2022-07-08
sittings or episodes: 1
sources: podcast

Every line below is reproduced as it was said and linked to the record it came from. Nothing here is summarised or generated. Directory · Search · Corrections

“And get the help that you want. It could be drugs, it could be therapies, but whatever it is, get it and get it early. Try not to ignore it. So I want to help shape the narrative that we're now talking about in terms of mental illness and try and reassure people that it's okay to talk about it. We're doing it in medicine a lot more. We need to be saying it in psychiatry loud and close.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“There are treatments, there are good treatments. I suppose part of the reason for writing the book is to help the process of destigmatization and also to make a more nuanced judgment away from the old fashioned mad or bad paradigm. And I suppose I want people to be more sophisticated in their thinking so that they know what mental illness looks like. We've moved, I think, as a society quite rightly towards thinking about mental health issues, but in doing so, I think we've lost the narrative a bit about mental illness, and it still exists and it's severe and it's serious and it's not talked about as much as mental health and maintaining that resilience that we all need in life. So I suppose I just want to redress that balance and say that there is help, there is support. It can be bewildering. It can be difficult for people, but persevere through your GP, get referred to the local mental health services, the community mental health teams, try and find somebody you know and trust in those services.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“I accept there is always a balance to be had in terms of the care we give against the harm we might cause. I think my starting point is let's treat it for what it is. It's an illness that needs assertive management.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“To protect him from intruders, he could barely express himself because he was so thought disordered, he thought people were plotting against him, and his sole purpose in life was to stay alive and avoid his persecutors. And for two or three years this had become his reality. That's what persistent desperate psychosis that was actually schizophrenia in his case looks like in extremis, and he wasn't able to get the help he needed. He'd been kind of forgotten by his loved ones. I don't think his family were around to help him. And he was rotting in the community and getting him into hospital, treating him with medication, kind of coercing him into medication, cajoling him into it, was one of the best things I've done and it made me realize that it's not acceptable to leave people in those environments. Mentalness is a disorder, it needs treatment.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“Certainly, any good doctor, I think, is always on the hump for what they can take from their patients. Sometimes patients have taught me about racism and the problems inherent in that particular societal evil. Patients have taught me about what it means to lose lives, careers through mental illness, and people have taught me very graphically about how difficult it is to accept the medication because it's a tacit acknowledgement that they have a mental illness. And the case I think you've referred to is a particularly difficult young man who I kind of identified with early in my training. And he was a particularly bright chap. He had done very well getting into a top university. And then his life had fallen apart and I found him in a pretty desperate situation that the house was filthy, it was rat infested, there was tinfoil on the wall, there was a small axe or a machete by the front door.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“I've been treating people since I was twenty three. I went into psychiatry when I was twenty four, so I was still a young man. I don't think I had really experienced too much grief. I had a fairly privileged background in many ways. I hadn't lost anybody. And I was suddenly thrown into a situation where people were full of grief, sometimes in the throes of mental illness, and almost always in considerable distress, personal and family problems rife. And I was expected to deal with them, and I suppose that as I've gone through my career and as things inevitably have happened to me, difficult things, bereavements, divorce and such like, we grow em, we mature, and I think I use a discussion in the book about what I've learned from my patients as a microcosm for my own development. And I think that most of us do learn from our patients.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“I can first start off by the assumption that everyone is using cannabis until it's disproven, and I almost, I have to ask, it's part of the job, God knows, but I assume that people are using substances. Does it cause schizophrenia? Possibly, but the association is very weak. Does cannabis adversely affect people who have mental disorders? Yes, absolutely. And I suppose that's the big take-home message. Loads of people use cannabis is not that damaging for some. I'm certainly not advocating it, but it probably doesn't We can give them motivational interviewing, but until somebody wants to change it themselves, it's very difficult to change people's behavior, especially when it comes to what's increasingly recognised as addiction and cannabis is addictive.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“Into the community and care in the community, and quite rightly so, because whilst the asylums had their place for some people, my goodness, they were difficult, damaging, atypical, unusual, pathological environments for most. So it's quite right that we were getting people out into the community, which is where most people are now treated. I suppose in many ways my job in the medium secure services locked forensic psychiatry units, it's a bit atypical. People still spend a long period of there, but I suppose that's the sort of institution that some people still think psychiatry looked like looks like it's not. Most people are treated at home and rightly so.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“Spinning chess, it was something I remember reading about as a trainee. People were spun rapidly in chairs and it was meant to treat their psychosis or their problems. It's completely bizarre. It's absurd and it's meaningless. But when you don't have any treatment for something which is the most catastrophic, chronic, debilitating disorder where people hallucinate are deluded, are thought disordered, literally crying out with distress and anguish. I think that people resorted to anything they could. It was only since the 1950s. I mean, ECT came in in the 30s and successful treatments with antipsychotics and antidepressants that was in the back end of the 1950s. So we actually have a very short narrative of successful treatments and we were locking up countless numbers of people in the old-fashioned Victorian asylums. And over my, they were starting to close down with the movement.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“I think people have always had a misconception about psychiatry, and I suppose in some ways, when you look at the historical narrative of the treatments that we've done from spinning chairs to insulin coma therapy, Possibly it's well deserved”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“Absolutely. When I was going into psychiatry, I don't recall being taught by a single black doctor at medical school. The first time, this is South London, when I was in my early training years, I remember seeing a patient and I rather naively said, would you rather see a black psychiatrist? And he looked at me, raised his eyebrows and said, do you know one? And he was right to say that because actually there were very few and they were coming through the system in Britain as I was becoming a psychiatrist myself. So they are the pioneers of the black minority ethnic groups and I think they're doing a brilliant job at the moment to talk about issues of race and discrimination. And it's never been more important.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“Black patients than probably I should have. And it's an area I touch on in the book. I think the reasons for that excess are complex. I don't think it's because black people per se have more mental illness. I think there is a differential way they are dealt with by systems. I think there is an issue to do with an urban environment, a poorer population, and the way their problems are perceived. So I think there are still issues of huge importance of racism in psychiatry. Colleagues like Shabbaladi Smith and Kambui who are doing great research in these areas and calling us out on it and quite right to.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“There is sadly still, and I think it's probably still true, that there is an overrepresentation of black minority groups within psychiatry. I think we need to state that very clearly. They are on community treatment orders longer than they should be. More of them are put on community treatment orders than there should be. They go into hospital under section more often than they should, and they stay in hospital longer than they should. And I think it's increasingly recognized now by the Royal College that this is a problem. In effect, I think we're sort of waking up as the policing world did in the post-Steven Lawrence inquiry into the world of institutional racism. And I suppose that as I was seeing that changing landscape over my professional lifetime, I would accept that I've seen far more”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“Health service, but in a neighboring service, and I would treat people for those issues of depression, of sometimes stress, and the burnout that sometimes goes with the work and seeing one problem too many beyond our coping strategies. And it's very difficult, and it was fascinating, but difficult work. I would encourage anyone in that situation to talk about it, to not try and accept the burden of blame themselves, which is the underlying feature of guilt. We feel responsible for things which really isn't our fault. Couldn't be our fault and isn't. So I think we need to talk about it openly with loved ones. Possibly more as a society.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“Yes, it does. Guilt is one of those very difficult emotions, and I think anyone who cares sufficiently about their fellow man will feel guilt when there is something going wrong, and I think it's a very difficult and sometimes insidious emotion to deal with. I've seen a lot of colleagues who have been really taken apart by the loss of patience. I've had patients who have killed themselves and I've seen I've had patients who have killed others and it's the most difficult thing for general and forensic psychiatrists to deal with. It's horrifying. It's harrowing. It's difficult. It's traumatic not only for the loved ones of the patient but also for staff. And I think we need to look at that. I remember working in occupational health as a visiting psychiatrist. I would see people in not my own.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“It's been wonderful. Yes, cathartic, revealing. I've learned about myself. I've thought about my family. And I've thought about the patience. And I suppose I've come away from it perhaps slightly older and slightly wiser. I hope the reader does as well. It's the distilled essence of what's made me the psychiatrist and the doctor I've become.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“What I did wrong, and naturally it's a complex environment, we make mistakes and we need to be able to talk about it safely and openly and privately. I was always little suspicious of that process and it was when my appraiser, actually a very talented psychoanalyst, wanted to hear about the cases, I thought, well actually it's time to overcome that inhibition, it's time to talk about what I've done. And I talk quite openly about some of the areas where I could have done things differently. I don't think, thankfully, it reaches negligence, but mistakes. Yeah, we've made a few. I think any doctor who denies that is deluding themselves. So part of the reason for the book was to overcome that sense of inhibition and talk about what's important and why we do what we do and how to overcome the mistakes and learn from it.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“I'd like to see it built in, particularly. I think nurses are probably better at it than doctors, if truth be told. I think they've got a better track record of looking after their own. I think that what I've seen over my professional lifetime is that we were taught to man up in old-fashioned vernacular. And I think it's the only way we could cope. I don't think we had systems or structures. And frankly, we didn't have the recognition of the post-traumatic stress or the stress issues that we're dealing with. And I think we need safe outlets rather than smoking, drinking, whatever it is that people find to cope with their particular stress. I wrote the book in part after a five-year appraisal every few years. We have an appraisal process. It was very much one of the reforms in the post-Shipman world. And we discuss cases. And I was always a little bit suspicious about exploring the minutiae.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“And I'm not here to preach, and I'm not here to try and change things. I'm a writer, and I suppose I just want to invoke some debate. We need more help in a proactive way, and we need to be bought to a situation where we can talk safely, privately with colleagues, with people we trust, and not to be judged by our feelings, because I think it's very easy to have negative feelings to some of the patients that we see. And I see people drinking too much. I see relationships break down. I see mental disorders in colleagues, sometimes just irritability, a shortness, a brusqueness that isn't them, and I think it's part of the pressure of the job. I think that's probably applicable to psychologists, to doctors, to nurses, to HCAs. We were dealing with very difficult, sometimes highly demanding, sometimes very dangerous people.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“I think it's a very significant issue. I suppose when I was working in a major prison for a couple of years as a research fellow, I kind of Lost my mojo. I started to think that everybody was either a murderer or a rapist or a paedophile or an arsonist or someone who had committed serious offences, and it kind of dents your confidence in human nature rather sadly. As I then continued my career and went into frenzic psychiatry, I think it's very important to have some outlets for me. For a time it was triathlons and then long distance triathlons and I got into that in a big way. I love getting away. I think it's important that we all have our escape routes. Mine's a little place in France where I go to recover myself. It's my little bit of heaven. And Iodors skiing and open water swimming now and continue to do both actively. So we need our escape routes. The difficulty is that I don't think we really notice when things are going wrong for us. We kind of get lost in our own little worlds. And I would like to see...”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“And they end up going to prison. So, still, the overwhelming number of people who have mental disorders, the risk is to themselves, not to others. And that's a big point I'd like to make and reinforce. The risk is always suicide. I've had a very distorted, biased view of psychiatry by dint of working in mentally disordered offender and forensic field. But that's not psychiatry as a whole.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“We used to say mental illness doesn't cause crimes. Actually, the reality is it does, but not very much. And it's not as bad as you think, sort of thing. If you look at the stats of, say, homicide, which is one of the neatest things to study because the cleanup rate by the police is very high. So we get most murderers. It's around 11% consistently of people charged with murder who have an active mental health defense. So we know that probably one in ten, and this is the point I make in the book, that there's one in 10 people thereabouts who have some sort of mental disorder that could explain their violence. That sadly means, though, 90% of people don't have a mental discount.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“And all the tragic consequences of that. So, in a sense, it was, he did have an underlying mental disorder, but there was also a psychogenic aspect, I think, in his particular case, his delusion, and it was that children had been abducted, it was self-serving, it was comforting, it was the comfort of madness in the best and worst of ways.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“It can be very difficult and damaging, and I suppose in the red pill sense, I was using it very much in the literal way that I think it was used originally in the film that people are given a pill and wake up to this monstrous, terrible reality. So I'm not using it in perhaps the way the term has morphed into. But I think that it was a very stark reminder of that when I treated a chap who had lost his daughter. She had died in a road traffic accident with her boyfriend, and he couldn't accept that and he had constructed a delusional system that kind of insulated him from that desperate reality. And I remember being involved in reviewing and changing his medication. The medication change worked. It was an off-licensed medication that we got from the US, and it seemed to suit him and rather tragically, as he recovered, he started to regain insight into the fact he had lost his daughter.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“Into their disorder or condition. So that's really where the interesting part of treatment starts after people have regained insight into their condition. And that's when we can let the psychologists do their work on what's the more discursive part of their treatment approach. So I help people get back to some sort of stability where they can then engage and start recovering in a more productive way.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“Get a bad press, and I think what I'd like to say is that by and large, most people respond pretty well. Sure, there are side effects, sometimes very difficult, debilitating side effects, but we can try and manage those. And throughout my career, we've actually had a whole swathe of new second, third generation medications. I can mostly treat people and on the whole, they will recover, sometimes with relapses. And I suppose it's also important to say that doctors often deal with chronic debilitating conditions. Very few people are cured from diabetes, from rheumatoid arthritis, hypertension. It's a disorder, it's a disease that we live with, and it's controlled by doctors. with varying degrees of success. Psychiatry is no different. It's just another branch of medicine. And sure, there are psychological treatments, but fundamentally my job is to try and get the person back to some sort of reality where they can have some insight.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“I started off doing general psychiatry and I became a specialist in general psychiatry so I was treating people who had not committed serious offences and then I effectively retrained I went into forensic psychiatry which is that branch of psychiatry that deals with mentally disordered offenders and that's where I've spent most of my professional career ever since I think treatments”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“As she recovered and regained insight, she basically woke up to the awful realization of what she had done. And I suppose that was the most heartbreaking thing. And that's why I chose to write about that particular case. It was tragic and her recovery and she did recover was slow and it was hard won.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“Also, and I suppose it's the whole point of the book in many ways, it's not their fault. So when you talk about the moral side of the argument, I think I want to debunk that because there is no case that I've come across such as the ones we've just discussed, where I would hold the person culpable or to blame in any way, shape or form. And I think we need to remember that mentalness changes as fundamentally when we're deluded, hallucinated, when our brains aren't working as they should, as we expect them to on a day-to-day basis. It changes us and it makes us do things which other people perceive to be mad. And I use the term advisedly, psychotic, and it changes as irrevocably. It changes us during our illness, and we do things which we will regret. One of the stories which you've mentioned in the book, it was about the desperate challenge that the woman had to recover.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“Yeah, it's interesting. I'm not sure that when you're dealing with it and in the thick of it, you stop to look at the moral aspects that much. It's a complex area, it's a complex legal and ethical arena. I think one has to put one's morals to one side. And I do talk about two cases where women have killed their own babies, both for very different reasons, but ultimately both because of mental illness, and one went on to take her own life, and that was in fact a colleague. The point I want to make in it is not that mental illness or schizophrenia or manic depression is linked to violence, whilst there may be a small increase risk for violence in schizophrenia, people with those disorders are mostly at risk to themselves, not to others. That's the big point I'd like to make. So what I'm dealing with is a minority of cases.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“suitably anonymized. I've spoken about some cases which I have been involved with and I've used real names and real situations. But that's really when the case has been in the public domain to begin with. So that's why I've used Bencave. I think it's a healthier separation for me and for the patients.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“I wanted to maintain a degree of separation, to be honest, partly for me, and partly for my patience. Ben comes from my father, a cave that I've actually adopted my wife's name. So that's where Ben Cave comes from. I think it looks better than my real name, also on the spine of the cover. I don't think my real name's particularly good for an author. I think Ben Cave's a lot snappier, but that's an aside. The real answer, though, I sit on tribunals, which is part of the judiciary. I think that if I were known to be an author, I think people would always be trying to process that information. I think also, I think it's only fair to try and maintain a degree of separation. Cases I've spoken about, there are anonymized, they're not real cases.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“Mental illness, and I've had my share of sort of the anxiety and black dog days of depression, nothing quite as bad as I would see in my patient group, but I kind of can empathize with some aspects, and certainly by the time I was 13, 14, I had a good-going case of obsessive-compulsive disorder. And it just felt natural to go to want to do psychiatry. I wanted to help people. It was an area that I naively at the time thought I could understand and make a difference. And I suppose if I have any abilities, I do have some empathy and I like talking to people and hearing their stories. So I suppose that's the roundabout way of how I came into psychiatry. It's been a fascinating journey.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“Very good question. I went to medical school. Naturally, psychiatrists have to become doctors first, and I was one of that relatively rare breed who went into medicine in order to do psychiatry. I decided I was going to be a psychiatrist. When I was about 14, I was having a chat with my dad is how I open the book, just a fairly innocent conversation where he says, Ben, what are you going to do when you grow up? And he went through a list of possibilities and I just seized on the possibility of medicine. kind of just made sense it clicked and thankfully i've never regretted it not for a moment um why i suppose i grew up with what i now understand to be a mother who was pretty depressed pretty anxious and she had lost her brother to suicide so i think that i grew up in the shadow of that and i didn't really quite appreciate the gravity of it until i was getting older and”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“to forensic services. And that's where I ended up working. He went to the same unit where I later trained and then became a consultant.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“He believed that he had syphilis and he thought that, well, he was being charitable to his girlfriend, he became chaste, and he decided that he would not engage in sexual activities with his then-girlfriend because he thought he had syphilis. Now, quite why he believed he had syphilis, nobody knows, but he persistently went to the GU genitorinary clinic for treatment. He persisted, he hassled them, he harassed them. Effectively, he was stalking the members of the clinic and then he put matches through the letterbox. So eventually he was charged with arson. And it's a rather gory story. I'm not sure you really want it on the podcast, but he ended up amputating the end of his penis to get rid of the syphilis. Naturally, it's just a psychotic thing to do, but ultimately he was being transferred from general psychology.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“Obviously, particularly in the case, I suppose, in cases of jealousy where people act on their delusions, that's very much one of the pushes towards forensic psychiatric care.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT
“Yeah, it was a tragic case, really. I suppose, first of all, we need to understand what delusions are. They firmly hold beliefs which persist despite evidence to the contrary. And they're held outside of people's normal social, cultural beliefs. So religious beliefs, beliefs in horoscopes, that's absolutely fine. But I suppose it's more to do with why we believe anything. And the sad reality is that when people are deluded, you can't talk them out of it. It is a by definition a delusion. So people are not amenable then to talk therapists, psychotherapists, cognitive behavioral work. And at that point, we have to rely on drugs, usually antipsychotic drugs, and hopefully the delusions then remit. The case you refer to, it was tragic because the man was chronically deluded despite really quite good treatment. And I think he ended up acting on his beliefs.”
2022-07-08 · Intelligence Squared · A Life in Forensic Psychiatry, with Dr Ben Cave · IDENTIFIED FROM THE TRANSCRIPT