Article
Change
Freedom
Mental Health
3 min read

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

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

Nick is the senior editor of Seen & Unseen.

An arched gateway to a prison sits behind a low raised wall. No windows are visible
First opened in 1842, Pentonville Prison serves a large part of central and east London.
Ben Sutherland via Wikimedia Commons

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

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

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

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

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

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

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

Robbie*, a prisoner in the unit says:

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

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

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

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

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

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

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

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

Review
Culture
Film & TV
Mental Health
Trauma
5 min read

The battle between seen and unseen pain

Jesse Eisenberg explores how the generations cope with pain.

Krish is a social entrepreneur partnering across civil society, faith communities, government and philanthropy. He founded The Sanctuary Foundation.

Two male cousins converse across the aisle of a train.
Kieran Culkin and Jesse Eisenberg.

In today’s ultra-developed world, where technological and medical advances have reached unprecedented heights, suffering remains an unsolved problem. While the World Health Organization claims the successful prevention, elimination, or treatment of more diseases than ever before, it also highlights significant increases in anxiety, depression, and stress-related disorders worldwide. This paradox raises questions not only about the root causes of mental health suffering but also about the way we understand its current prevalence and impact. Are today’s struggles any different to those others have experienced before us? Is the pain equally real? As we approach the eightieth anniversary of Holocaust Memorial Day, can we truly equate the silent struggles of contemporary emotional health challenges with the unimaginably harrowing experiences of those who endured the worst horrors of war, violence, and genocide?  

Jesse Eisenberg dares to tackle these complex questions with his directorial debut, A Real Pain, a masterful exploration of trauma, resilience, and the search for meaning. Co-starring Kieran Culkin in a career-defining performance, the film takes viewers on a journey that is part road trip, part comedy-drama, part historical reflection, and wholly compelling. I believe it offers a timely and deeply thought-provoking challenge to consider how we recognise and process pain across generations as well as understand the way pain shapes – and reshapes – our lives.  

In the film, Eisenberg and Culkin portray two estranged Jewish-American cousins, David and Benji, who embark on a shared mission to retrace the steps of their grandmother, a Holocaust survivor. What begins as a simple road trip to Poland quickly transforms into something much more as the brutal reality of intergenerational trauma and mental health struggles rise to the surface.  The film’s themes can be explored through three key lenses: the passing on of pain, the proximity of pain, and the problem of pain. 

The passing on of pain 

At its heart, A Real Pain is a story about legacy—the burdens and blessings passed down through generations. Though their shared grandmother is no longer alive, her story of survival, resilience, and eventual flourishing has left a profound impact on her descendants. Her story draws the cousins in, but it also draws them together and apart in different ways over the course of the trip. There is tragedy and comedy, and poignant moments of connection as well as frustration as Eisenberg explores how trauma echoes through generations, affecting different people in different ways, weighing heavily on those who did not live through the original events. This theme is handled with nuance showing both the strength and fragility that come from confronting a painful past. Ultimately it brings us to a new question – how do we honour the suffering of those who came before us while also finding our own path, or paths, to healing? 

The proximity of pain 

As the cousins delve deeper into their family’s history, the film juxtaposes the grandmother’s resilience in the face of antisemitism, war, and Holocaust with Benji’s struggles. Despite severe loss, grief and trauma, the grandmother went on to live a meaningful life. Benji on the other hand struggles to keep on top of his daily responsibilities, hold down a job, and maintain relationships. He struggles to find any meaning in his life and reveals he has attempted suicide. How, he wonders, did his grandmother find the strength to fight for her life against the backdrop of the Holocaust when he can’t even navigate the relative peace of middle-class America? This question seems to add to his despair. He seems thoroughly beaten.  

Eisenberg does not provide easy answers but instead invites viewers to wrestle with these complexities of life and death, resilience, and vulnerability. He forces us to confront our assumptions about suffering and strength. By making us reflect on which pain is more real, he seems to have found a way to challenge us both to honour the reality of past trauma and recognise the reality of the struggles faced by those around us.  He has certainly found a way to help us empathise both with the millions of people who are currently displaced and traumatised by violence, conflict, and displacement, and, equally, with the millions whose mental health is in tatters.   

The problem of pain 

At its core, A Real Pain tackles the universal question: what do we do with suffering? Do we bury it in the past? Do we pretend it does not exist? Do we insulate ourselves from the pain of others? Do we respond with frustration and anger or with patience and empathy? Do we accept pain as a tragic by-product of existence? Do we struggle under the burden of it? Do we let it defeat us? Do we find ways to learn from it? Can pain make us stronger? Can it make us better people? Does it point to something deeper within us or, indeed, something beyond us? 

Right in the middle of the film, David and Benji meet a survivor of the Rwandan genocide. who provides a stark reminder that the horrors of the Holocaust are not just consigned to history, that even today there are places where entire people groups are being targeted, destroyed, and displaced. This character has clearly found solace and meaning through his faith, in contrast to the cousins’ secular Jewish identities. The tension between belief and unbelief runs through the film and reflects the wider experience of many for whom pain has been a critical factor in their journey either to faith or away from it.  

For C.S. Lewis, the author of the Narnia chronicles who offered spiritual solace to the nation during the Second World War and who was personally familiar with suffering writes: “God whispers to us in our pleasures, speaks in our conscience, but shouts in our pains: it is His megaphone to rouse a deaf world.” Pain, for many Christians like Lewis is supposed to draw us towards faith – it is an urgent invitation to seek meaning and connection in a fractured world. Pain reminds us of our mortality and vulnerability, and our dependence not just on others, but perhaps too on an Almighty being who offers hope, healing and the promise of a life beyond this in a world where there is no more death, no more tears, no more pain.  

With A Real Pain, Jesse Eisenberg has crafted a film that will make you laugh and cry and think and discuss and reach out to others, or even to God.  This film invites you to reflect on the past, present and future, to wrestle with the pain we carry and to seek meaning beyond it. It’s a must-watch for anyone who dares to reflect on life’s most profound questions.  

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