Sounds of Silence from Inside the Jail

Margaret Altman, MSW
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Long before we make our entrance into the world we can feel; the tactile sense is our first sensory experience. We shift our barely formed bodies away from uncomfortable stimuli in a self-protective, reflexive manner. We are programmed to survive. From our first weeks and months of gestation, within the safe environment of the uterus we prepare for a world filled with the unknown and the unexpected and we have to be able to endure all of the forces that will impact us throughout infancy, childhood, adolescence adulthood and old age.

But we do not learn all of the strategies to continue the healthy development of our minds, our bodies and our spirits alone. In order to thrive we require consistent, nurturing attention, we need not only to feel but to be felt, stimulated, attuned to. Our brain, body and spirits are shaped by nature and by our interaction with the people who take our care in their hands .When the care is “good enough” we thrive. When we are completely abandoned, we do not survive. When we are mistreated, neglected, deprived our development takes a myriad of deviant courses and almost always leads to emotional, social and physical pathology. Some of the pathology is self-protective though immature and dysfunctional. Aggression in a violent environment can make one the leader of a gang instead of their victim, alcohol can temporarily soothe and numb an anxious soul; amphetamines propel the mood out of depression. The downward spiral, however, inevitably leads to a desolate cycle of homelessness, locked psychiatric units medical illnesses and to jail where this narrative begins.

I think about a healthy early infancy, about reaching out and being gently held and about the attachment bond that nourishes the mind, body and spirit as I watch the inmate sitting at the table in SuperMax, where the inmates are in isolation due to their high profile status or history of repeated violence inside the jail. It is unnaturally and painfully quiet here, there are no human voices and every sound echoes. John (not his real name) plays with a pencil in his hand, tapping it on the table, grasping it tightly in his fingers, carefully stripping the paper from around its graphite core. This inmate is very muscular with tattoos on his upper arms. He is clean and his jail garb fits him like a second skin. John is expressionless and there is a rigid, defensive tone to his body that telegraphs “keep away I can be dangerous.” I will not touch him and he will not reach out to me.

He is a 3rd strike inmate, sentenced to 25 years to life, housed in SuperMax jail while he awaits his last appeal.  He has been brought down from State Prison and is also on “suicide watch” having overdosed twice on pills that he confiscated from another inmate. John has not been diagnosed or treated in the jail system for mental illness, I am here because he wanted to talk to a “psych” about his case, and he believes that this interview will convince the judge to lighten his sentence. He is not here for therapy. John’s rap sheet reads like a dictionary for the correctional system; it lists every conceivable felony from the adulthood on and I am sure that his juvenile record is just as bad. Although I can predict what his early childhood experiences were he surprises me when I ask about his mother.

‘She was a saint” he says, still not displaying any emotion. He goes on to explain that his mother, a young, single immigrant, worked 12 hour shifts in a factory in order to stay off welfare and that he was cared for by an older cousin who had 4 children of her own. I know that memories of that long ago difficult time will be hard for him to talk about and I am surprised again when he states that he was the whipping boy for his male and female cousins and, until he gained in size and strength, he endured daily abuse at their hands. They referred to him as a bastard, took his food and tormented him at night. He smiles as he says this, a smile that doesn’t reach his eyes. But his hands betray him; he is white knuckled as he grips the pencil making holes in the flimsy table we sit at. I realize that his hands have felt the cold steel of guns, they have been wrapped around the pulsing neck of an inmate he tried to strangle in prison, they have been soaked in warn, sticky blood. When I ask him why he wanted to talk to me he says that he is “depressed” and wants to be court ordered to a mental health treatment facility where he can get help instead of going back to prison. He thinks that my documentation will facilitate this.

John has no conventional way to express his depressed feelings and in this environment he would be at risk if he did; he radiates anger and bitterness, he blames the “system” for his transgressions, he smiles when he talks about abuse and the only evidence I have for his depression is his suicide attempts and his story. I believe that he is depressed and protecting himself from ridicule and abuse by hiding his feelings.  I listen and take notes; he left school in the 7th grade, was conscripted into a gang in South Central Los Angeles, he has never married or had a lasting relationship, he has used drugs and prefers alcohol. He never knew his father but heard that he died in prison. Mother is also deceased; she had diabetes that was never treated. He shows me an old picture of his mother; yellowed and creased and kept close to his heart in his shirt pocket. Finally, I see a glimpse of sorrow on his face but he quickly hides the sadness behind a sly smile and asks me if I think that he needs medication for his depression. In a parting statement, John’s feelings finally surface. He tells me that he was in prison throughout his mother’s illness and when she died. He doesn’t know where she is buried and wasn’t at her bedside to hold her hand. His face becomes contorted and he seems to hold his breath for a moment before shaking the feeling off and standing up to go. The loss of an idealized relationship with his mother and the guilt that he feels are palpable but this leaves him exposed and vulnerable and he quickly resumes his rigid and impenetrable persona.

John has a protective shield around him and has learned not to share his pain, his rage, and his fears. He is a survivor of sorts, emotionally abandoned and stunted, relying on physical strength and street smarts. When the interview is over, the pencil is stuck in a hole, stripped of its cover and John shuffles back to his cell with a deputy.

In my report I eschew the inadequate form that psychologist are given and write my own evaluation. My assessment concludes that John is extremely depressed and unable to verbalize his feelings, he is at high risk for self harm given his prior attempts and he urgently needs mental health treatment. This will, I know, complicate the prosecution’s goal of quickly sentencing him to life in prison without treatment but I take the chance, the opportunity to meet needs that have never been addressed.

There is abundant research that links early childhood abandonment, emotional and physical abuse and neglect to long term pathology across multiple domains (social, emotional, medical). In the U.S 1 in 6 state male inmates reported being physically or sexually abused before age 18 and 56% of male inmates reported experiencing physical trauma in childhood. Traumatic and abusive experiences continue in jail and prison with no relief from the consequent symptoms of depression, anxiety, PTSD and fear.

There is little attention paid to the reality that incarceration is in itself an abandonment experience  and a traumatic separation from one’s habitual environment. The correctional system has its own destructive culture that categorizes all inmates as “guilty” and all mentally ill inmates as “malingerers and dings” and this imposes another layer of abuse upon the inmates who have been victimized, re-victimized

The jail mirrors and escalates the life experiences of the traumatized child who has been harmed in multiple ways. In Los Angeles, the correctional system has historically punished, neglected and allowed harm to come to mentally ill incarcerated individuals. There have been and still are on going Federal  Investigations and law suits and a very recent statement by  the Department of Justice that the mental health system in the Los Angeles Jails system is so bad that it is “unconstitutional.”

One in six jail inmates receive any kind of mental health treatment even though more than half of jail inmates have mental health conditions. (Journal of the American Academy of Psychiatry Law) Treatment for the mentally ill inmate is another cause for concern. The use of medication has increased by 200% from 2009-2012 and “chemical restraints” are recommended for inmates who are “out of control” due to delusions and hallucinations. Deaths have occurred when inmates have underlying medical conditions and are over-medicated for restraint purposes. There is mental health treatment, now, in the correctional system and aside from medication, this is the group therapy modality and it is often court mandated.

Several issues arise from the predominant use of the group modality; research has demonstrated that it does not allow for or encourage the sharing of powerful and private feelings of depression, shame and fear especially in an inmate group. Studies have also indicated that group therapy uses the shame model to induce feelings of shame so that behavioral changes will take place. Re-shaming after multiple childhood experiences with shame is not a positive motivating intervention.

Treatment for PTSD the most common result of enduring childhood trauma continues to be tested and studied across multiple populations; veterans, children, etc. The symptoms of PTSD; dissociation, somatization, affect dysregulation are complex issues for clinicians to treat and a very recent study on the effects of exposure-based cognitive behavioral therapy noted no improvement in depression, general anxiety or physical symptoms (Journal of Anxiety Disorders). Treatment for PTSD will prove to be a costly endeavor for the correctional system to bear.

A recent article in Journal of Psychiatry and Law exposes the following realities “lack of qualified health care professionals to work in prisons, lack of visionary correctional leadership, increasing health care costs” all contribute to the on-going dilemma of mental health in the correctional system.

In addition, public sentiment about the mentally ill and mentally ill inmates is a chronic challenge for any improvement. Although communities across the country, when polled, show some positive changes in their views on mental illness in general, the public consensus remains negative and these populations are deemed less deserving of any form of assistance.

Mentally ill inmates who have a history of abandonment and abuse are voiceless victims in a system that embraces punishment, induces shame, promotes isolation and discourages any expression of depressed or anxious feelings. In order for these individuals to speak freely, they must be able to trust and that is the underlying message.

17 COMMENTS

  1. Well, not surprising given that US has the highest level of incarceration in the world and it is used as an instrument of getting rid of “superfluous population”. Prisons are not good places anywhere but there are countries, like Norway, where they manage to get it right. It makes one think if the miserable state of US justice system is by mistake or by design.

  2. Very well written piece.

    I am surprised how few people know the following statistic:

    The United States has 5% of the world’s population, but 25% of the world’s prisoners. This was a couple of years ago I read this, but I am sure it is still close to this if not worse.

    I was stunned when I read that statistic. There must be many reasons behind it, but it made me think of several things:
    – The war on drugs is largely a failure; it has not erased the drug problem, but has resulted in the long-term incarceration and criminl hardening of millions of small-time dealers and users.
    – The Puritanical system of harsh justice in the US – in which many non-violent crimes receive long sentences of many years, and sentences regularly are double or triple those in other advanced nations – is far too harsh and ultimately unproductive. It results in prisoners getting worse while in jail and reoffending at higher rates when they come out. It is costing us tends of billions of dollars that we do not have. If we adopted a system focused on rehabilitation for most prisoners and long sentences for only the most violent few, we would do much better in terms of recidivism rates.
    – America is to my knowledge the only “advanced” nations in the world to have capital punishment. Yet, we only execute a tiny proportion of criminals; and the process takes decades and often costs millions of dollars per case. This is a waste of resources, and to me reflects American ideology having failed to move beyond the talionic principle (an eye for an eye, kill and be killed) to a more mature position of punishment but with the possibility of redemption, even if in prison.
    – Private prisons in America are becoming an industry which resemble Big Pharma. They profit massively from increasingly number of people being imprisoned. Therefore the increasing number of inmates in the US is driven partly by corporate need for profit. This mirrors how the increasing number of “mentally ill” is driven by the need of Pfizer, Eli Lilly, Janssen etc. for profit.
    – America imprisons thousands of teenagers on life without parole sentences. This ignores every bit of research we know about how the human brain is still developing until the early 20s, and therefore we should not judge people as unable to be rehabilitated (if at all) when they are young teens. Florida and Texas have dozens of 14, 15, 16, and 17 years olds who were that age at their trial (“tried as adults”) and now are condemned to life without parole.
    – Many American prisons practice legalized torture in the form of solitary confinement, in which prisoners live in tiny cells with no windows, alone 23 hours a day. This is one of the worst and most embarrassing things about American “justice.” Some prisoners are emotionally destroyed in this way for years at a time.

    All of these things make me less proud to be an American; we are not a humane nation when it comes to managing crime, but instead are as bad or worse than many much less economically developed nations.

  3. Glad to see an article from an insider’s perspective of the penal system as it concerns mental health. I stand in solidarity with mothers whose children are incarcerated, even for the most heinous crimes, if those children experienced abuse or neglect when they were growing up. Those of us whose children are forcibly medicated and institutionalized for phony ‘chemical imbalances’ should question why we are grateful and relieved that our children are in mental institutions. After all, our children could be in prison, instead. Yes, every time I drive by a prison, I get a sick feeling in my gut that those places of steel and concrete are places of horror, but how different are they really from the abuse and torture that is routinely meted out in psychiatric institutions? If one is under civil commitment like my child, ordered by a kangaroo court to be under chemical restraints, even while those drugs slowly reduce my child’s cognition, hope, and physical health, I should be grateful that it isn’t worse? The prison justice movement in the US is gaining more speed, arguably at a faster rate than the psych rights movement. Perhaps it’s time to admit that there is only a sliver of difference between prisons and psychiatric hospitals so we can get about the important business of merging two movements or at least form a coalition based on overlapping interests and values? For instance, there has never been so much talk about FINALLY changing some of the driving forces behind mass incarceration: voter mandated mandatory sentencing, the phony war on drugs, racism, abuse of power and penal/police corruption, poverty, lack of housing, jobs, etc. There was a hunger strike by prisoners in the CA prison system to protest solitary confinement. That is big. When was the last time psychiatric patients protested for a common purpose? In two states now, NY and WA, pregnant and nursing mothers who give birth in prison can raise their children in prison (at least for several early and developmentally critical years). These are real steps forward as it concerns prison reform. Our movement has nothing to show for it besides more AOT, more children being drugged, more police swat teams killing suicidal Veterans, etc.

  4. I’m going to say something truly radical.

    I really think that the one element of psychiatry that makes any sense is the idea that people are not in their right mind when they behave in a criminal fashion. In fact, it goes against the whole idea of happiness could it be that anyone who behaves in such a fashion is in their right mind: any one who is deemed to be a criminal. And so, I welcome all the statements you make painting the picture of a very broken soul, someone who has lost what it is to express his own humanity.

    I don’t believe there are chemical imbalances, except for what the “medications” cause or other forms of physical trauma. And I don’t believe that disabling a mind with psychiatric medications creates mental well being. I don’t believe there’s any such thing as an organic illness that causes psychiatric conditions the way it’s defined by psychiatry and I know their treatment, their medications cause organic illness rather than to treat it, and I think that if there is physical trauma causing symptoms of distress or confusion it’s most likely going to be overlooked by psychiatry and added to with their “medications.” However, although I don’t believe in chemical imbalance, or magic pills that make a person in themselves behave in a civil fashion, I do believe that a person who has suffered the kind of trauma you highlight in your article is the product of a broken society, a society that fails to see where it leaves people; and in that sense they truly don’t know what they’re doing, and have no ability to relate to the trauma creating the guilt and lack of self worth they are trying to escape from.
    When you look at what Jesus taught about forgiveness or what Buddha taught about compassion, this to me goes long with the idea that those people don’t know what they are doing. Because you don’t solve the problem by adding to what caused it. It’s easy to judge someone when you haven’t been in their shoes, and that you judge them really only means that were you in their shoes not only would you not know how to deal with the situation, but you deny what it leads to. Compassion and forgiveness are something different, it allows you to give them the space to find the humanity they lost, what you would also lose would you judge them. And it actually works, it creates a different society, despite all the fears that everything will fall apart would you stop punishing people as if traumatizing them creates obedience. What it creates is an extremely dark pocket in society with people given such privilege to traumatize others that what people do who are called criminals pales in comparison, and yet that’s what it creates when people with their “saintly” virtues believe in using trauma as a means of mind control.

    • “What it creates is an extremely dark pocket in society with people given such privilege to traumatize others that what people do who are called criminals pales in comparison, and yet that’s what it creates when people with their “saintly” virtues believe in using trauma as a means of mind control.”

      Makes me also think how one reason psychiatrists don’t want to hear what happened to anyone is because they know full well they believe in their business , and plan on using trauma as a means of emotion and mind control. Leaving their written orders like a form of ariel bombing , quickly exiting afraid to look you in the eye lest later you remember who did what to whom. Then you get to talk to a social worker to confuse you further while they monitor whether or not the control has taken hold and whether or not you truly now finally love “Big Brother”.

    • This theme of the value of clear perceptions is also what seemed uniquely powerful for believing in you were you to handle my case, and with my suffering endangering me like your clients’ is putting him at further risk, here. I actually look forward to rereading this very article because of the fresh and original viewpoint that it takes on the intervention you describe.

  5. So many great points in this article.

    I’d just like to add how our punitive, vindictive model of imprisoning people and torturing them with solitary confinement and other vicious abuse, serves no useful purpose whatsoever and only causes much more harm! It must be changed.

  6. This is such a beautiful article, a subtly passionate call for empathy and compassion among and toward different aspects of humanity. You write from the heart, rings totally true to me. Very best wishes in your wonderfully humanitarian work.

  7. What to do about those kids? How to get the parents attuning to them? Deep thought needed for an endless demand, and none of the processes which the allied mental healthcare industries reinforce for the protection of their own mutual entitlements to the receipts from involuntary treatment have the considerations of the youngest within their scope. Instead of reform in psychiatry, we need its abolishment, so that the only attentions placed on the development of psychological and moral incapacitation are not those brought in long after the fact.

  8. Greetings;
    I am the writer/blogger of Voiceless in America for MIA and I have been reading your posts with great interest. I recently contacted author/publisher Robert Whitaker to discuss my goal of putting together the collective voices of the MIA community in a book that would address several vital issues that may be of interest to you. I am enthusiastic about your participation in this project given the critical nature of the issues and your own views and experiences. Perhaps you would be interested in contributing? A collaborative and compelling book might go far in informing and motivating a great number of people.
    The issues are;
    Recognizing the huge and powerless group of voiceless individuals who struggle to exist amongst us;
    1. Those who are abused into silence through child abuse, incarceration, hospitalization
    2. those who are coerced into muteness due to the mental health system’s failure to speak out against psychiatry’s dependence on and use medication and of diagnostic labeling,
    3. Those who are marginalized into silent suffering due to poverty, lack of education and lack of opportunity to speak out.
    4. Those individuals who are shamed into silence due to social stigma and misinformation about emotional distress.
    5. Those who suffer alongside the voiceless population (family, friends, mental health workers)
    Identifying the Voices that have presumed to speak for the Voiceless population and who, with great authority and funding define who they are, tell them what their problems are, tell them what to do and inform them about what they need.
    1. The Organizations; American psychiatric Association, American Psychological Association, the AMA,
    2. The Pharmacological Companies
    3. Political Groups
    4. Social groups that promote prejudice and stigma
    Giving the Voiceless their opportunity to speak;
    This large section of the book would contain chapters from the following
    1. Writers/bloggers within the MIA community who have struggled with and survived the mental health system and can share their experiences
    2. Writers from MIA who have posted their views on psychiatric practices, medication etc.
    3. Interviews with Voiceless individuals outside of MIA who can share their important experiences with medication, incarceration, abuse, hospitalization
    Proposing solutions for these issues