To enter my office, I first go through a row of three heavy steel doors. The lock for each door is controlled from a remote center. I wait for a humming signal that the door has been unlocked before continuing.
When I saw a prisoner for the first time, I was so scared that I wondered if I really wanted to work here. The inmates wear overalls and trousers with wide orange and white stripes. Your shoes close with Velcro because laces can be used to strangle yourself. Everything here is designed to minimize the risk of suicide.
Four of us share an advisory office. The number of rooms in which we can visit prisoners privately is limited, and the rooms are used by others in the prison in addition to the counselors. To see an inmate, you always have to win the competition first to find a room.
Inmates classified as dangerous, disciplinary or on suicide watch are handcuffed and handcuffed. In a room, these inmates are then chained to the wall. Nothing in my training prepared me for the shock of continuing an intensive, personal counseling session with a person in chains.
The people who are held in this detention center are most often referred to by the people who work here as prisoners, inmates or simply men and women. But those of us in the counseling center call them patients. We see it as our job to treat them primarily as human beings.
Introduction to the blocks
inmates are checked when booking, including suicide. Questions asked include whether this is your first arrest, detoxification, attempted suicide, whether someone in your family has died from suicide, whether you have ever been to a mental hospital, and so on. Inmates who are found to be at risk of suicide are placed on suicide watch.
The prison is divided into a series of blocks, a group of two-person cells around a central area where inmates can watch TV, exercise, or play poker for candy bars or cups of pudding. The blocks form a U-shape that surrounds an outside courtyard, where inmates sometimes relax when the weather permits. Half a dozen volleyball balls are stuck on the spiral barbed wire that surrounds the upper edge of the courtyard. S-Block is for sex offenders. Project 103, the internal addiction recovery program, is located in the R block. Immigration and customs officials are held in the K block. As the only Spanish spokesman in the advisory team, it is my job to interview all inmates in the K-Block. The women are housed separately from the men in blocks X, Y and Z. When they walk down the hall to go to the gym or library, the men hit the window and wave and the women look up and wave back.
W-Block is for suicide watch. Inmates who monitor suicide are placed in isolation cells and checked by a security guard every 15 minutes. Their clothing consists of a "turtle suit", a cardboard-like fabric that cannot be twisted into a noose. You only get finger food; Plastic dinnerware is not allowed. Neither books. The sides could be torn out and stuffed in the mouth to cause suffocation. The inmates can watch TV through a window in their cell door. Under observation, they are allowed to shower from their cells for a few minutes every day.
Consultants question patients on suicide watch as soon as this is practical. Some of these patients have a history of schizophrenia. Some detoxify so strongly that they look schizophrenic. Others are bipolar and in a manic or depressed state. Sometimes suicide patients shout or sing loudly, or sing or hit the wall.
It is said that a picture is worth a thousand words. I know the textbook definition of schizophrenia. It is a breakdown in the relationship between thinking, emotions and behavior that leads to incorrect perception, inappropriate actions and feelings, withdrawal from reality and personal relationships in fantasy and deception and a feeling of mental fragmentation. With all of these words, my image of schizophrenia will always be a man who monitors suicide in a green turtle suit and sticks a toothbrush into his back end.
A garbage dump for people in need
Sometimes suicide patients are brought to a psychiatric clinic. Our state used to have an extensive network of psychiatric clinics, but most of these facilities were closed decades ago because of budget cuts. Today, many mentally ill people who have previously been hospitalized are homeless. Sooner or later, many of them end up in prison.
"Rogue and Vagabond" is the legal euphemism for a homeless person. Prisons have become a dump for the homeless, addicted, and mentally ill. Although we do not have sufficient resources to cope with all of these people, it is our job as mental health counselors who work in a detention center to do everything we can to help them.
Our employees include a part-time psychiatrist who can prescribe psychotropic drugs. Hundreds of inmates appear on the mental health radar screen for various reasons. They may have received mental health or psychiatric medication in the past, or they may have had an earlier mental health diagnosis that we learn from the screening form. In other cases, a patient can see a psychiatrist. Patients who are suspected of needing medication are examined by the counselors and we first decide whether they should see the psychiatrist. The psychiatrist determines the official diagnosis. Patients who have been diagnosed with schizophrenia, bipolar disorder or major depression, or who are bizarre, receive a treatment plan and special attention.
Among the general population of the prison, we expect about 80% of them to have problems with alcoholism or addiction. My previous work in addiction recovery has served me well in this environment. I share pictures of Dr.'s brain scans Daniel Amen with the patient. A normal human brain looks like a soft mass of butter. The brain of someone with alcoholism or addiction looks like Swiss cheese, with big "holes" in areas that don't work. The brain of someone who is addicted to heroin looks like a sea anemone, with dangling tentacles of functional areas and large masses between non-functioning areas. Patients are often shocked when I show them how their substance use has affected their brains.
The purpose of drug use is to prevent the brain from functioning properly. Most of the patients that I see have painful memories deep within them – memories that are so painful that they cannot be remembered consciously while living a normal life. It is not difficult to identify the source of your pain. I'll ask about her mother, father, or childhood, and the stories usually come out.
A young man told me that he once hoped to become an astronaut. I asked him why. He said when he was younger he asked his mother where his father was and she told him his father was on the moon. In fact, his father was serving an eight-year sentence in a state prison. After years of longing for his father, the boy's wish came true when his father finally returned home. But instead of seeing a happy reunion, the boy's father beat him up. Is it any wonder why this young man became addicted to drugs?
Another young man told me about addictions and repeated encounters with the law. I said, "I'm going to make a wild assumption that you had a difficult childhood" – a line that I often use to deal with a patient's past.
His answer surprised me. He said, "You are the first person to ever notice it."
Encouragement to look ahead
The disciplinary block is the A block, known in prison as "the hole". If you fight with another inmate, you may have 10 days. If you fight with an officer, you get 50 inches. Inmates in a block receive "23 + 1" or 23 hours a day in their cell, one hour a day in the block, one person each. External contact is not permitted. There are no visits, no phone calls, no participation in the courses that are sometimes offered to the general population.
Isolation is punishment as it should be. As a mental health advisor, my concern with the boys on A-Block is the tendency to decompensate, to go into the deep and dangerous depression that can cause extreme isolation.
A young man who had been on a block showed clear signs of decompensation. I learned that he had been the Valedictorian at his Philadelphia high school before he was arrested in a 24-person drug bankruptcy. He was intelligent. Our talks covered topics as diverse as the Federal Reserve's monetary policy and the use of political power in Niccolo Machiavelli's book The Prince.
When this young man went down emotionally, I decided to find some books from the prison library that could help him raise him again. I finally gave him two books. One was a book with jokes. The other was Viktor Frankl's search for meaning. In it Frankl describes his time as a Jewish Austrian prisoner in a Nazi concentration camp.
Frankl remarked that it is not the external circumstances of our life that determine our fate, but rather the attitudes that we choose towards these circumstances. Frankl resisted his experience in the concentration camp by adopting an observer's stance on how people survive in the most extreme circumstances.
My young patient understood it. As bad as his circumstances were, his mental and emotional state was determined by the attitude he took towards his circumstances. He was thrilled with his new understanding and his excitement was enough to pull him out of his depression. I had gambled with him and won.
One of the most difficult stories I heard belonged to a man in his early 40s who I first met on suicide watch. He was arrested for being a villain and vagabond, was intoxicated during his arrest, and had a history of attempting suicide.
The story of the man unfolded in fragments in the weeks and months we worked together. It was like slowly collecting pieces of a puzzle until a complete picture emerged. As an 8-year-old boy, he was held by one hand of his father, while his father pulled out a pistol with the other hand and unloaded five bullets into the boy's mother. A cousin heard the tumult, came around a corner and shot the boy's father. The father then turned the gun on the cousin and shot him, still holding the hand of his son, who was frozen in shock next to him. Another cousin grabbed the boy and brought him to her house next door. From the living room window of this house, the boy watched as all three victims were loaded into an ambulance. Notably, each of them survived.
However, the boy was deeply affected by witnessing the scene. The nightmares of what had happened continued throughout his life, even during his detention.
The boy grew up, eventually married and had a son. One evening when he was arguing with his wife, he pulled out a pistol and would have shot it in a reenactment of his nightmares if his mother-in-law hadn't intervened and stood between them. Since he could not control himself, he took the pistol and shot in his stomach. This was the attempted suicide noted in his file.
The life of the man was marked by episodes of violence, as was the life of his son. The son was involved in gangs and murdered in a gang fight, almost cutting his neck.
When I met the man on suicide watch, he had a new girlfriend and a second son was born to him. He had a second chance at paternity. He could choose to live in the past or the present. His newborn son needed him.
I said to him: "You can't drive a car if your eyes are fixed on the rearview mirror. At some point you have to be happy." He later told me that the comment was the turning point for him. He realized that he had to stop looking backwards, and if he wanted his newborn son to have a chance of life, he had to look ahead.
He worked hard on his problems and participated in the recovery program. During our months of working together, he was able to speak openly about the events he had suffered. He was recently released into an intermediate house. Maybe the demons in him were finally exorcised.
For the police, he was a drunk man on a park bench. For me, he revealed a life full of traumas and tragedies that was the cause of his behavior. This is our job as a consultant – to help people understand the dark forces that drive them to behaviors that they know are harmful to themselves.
I have heard such stories over and over again. There was a young man who was a bully and was taken from one youth facility to the next until he ended up in an adult prison at the age of 19. He told me the story of how he witnessed at 12, how his cousin was gunned down on the street, and the life of fighting and violence that had followed him ever since.
I have worked with pimps and prostitutes, with people who have molested others, and with people who have been molested, with people who have been caught in unhappy marriages and who have attacked their spouses, and with countless people with addiction or Alcoholism. With everyone, I've heard a similar story of unresolved grief, tragedy, and trauma. Sometimes I can help them. Sometimes this is limited to helping them maintain their emotional balance while in jail. Most seem to be grateful to meet someone who at least hears their story. Sometimes all I can do is give them a chance to breathe.
Sowing
At 5:00 am I go through the three steel doors and leave the prison. I am free to drive to my apartment and wonder about the effects I may have had. I am thinking of the parable of the sower found in three of the four gospels in the New Testament. Part of the seed of the seeder lands on rocky ground or other inhospitable places. But part of the seed falls on fertile soil and is rooted.
We do what we can as consultants. We try to do no harm and pray to do something good. There is a line in the Talmud that says he who saves one life has saved the whole world. And so we do what we can, one person at a time in prison.
In the evening I can have dinner with my children, play my guitars and sleep in a comfortable bed. I can go shopping if I want, lie in the sun, breathe fresh air, go to yoga classes.
Tomorrow I will go through the three heavy steel doors again. The men and women in the orange and white striped suits will still be there.
****
James Rose is a licensed professional advisor who works as a mental health advisor at the Frederick County Adult Detention Center in Frederick, Maryland. He is a graduate of the clinical advisory program at Loyola University in Baltimore. Contact him at [email protected].
Letters to the editor: [email protected]
Counseling Today reviews unsolicited articles written by members of the American Counseling Association. At ct.counseling.org/feedback.
Find access to writing guidelines and tips for accepting an article for publication.
****
It should not be assumed that opinions and statements in articles that appear on CT Online reflect the opinions of the publishers or guidelines of the American Counseling Association.