“Can anyone hear me? Will anyone break these chains?
Who will free me from this dark place? I’ve slowly given up
all hope, given in to this sleepless bed. Inside these bars I feel so scared”
From Beautiful Slave, by Take No Glory
Inside of the clamorous jails, in the single beds of locked in-patient psychiatric units, and in the noisy streets and quiet homes across this country there are people who have no voice. They have been rendered mute by terrible conditions; physical and emotional abuse, incarceration with dangerous criminals, numbing medication and threats of long term hospitalization.
Whether their inability to communicate their fears, their desperation, and their frustration comes from an early history of abuse that traumatizes them into silence or is imposed by an environment that punishes expression of feelings, the results are the same. They are voiceless at a critical time in their lives. Without the means of communicating how they feel, what they are experiencing and what they desperately need other people trained or untrained in the clinical professions will diagnose them, label them, medicate them and plan their future course. The terms that are used to describe them will not come from the person’s own and relevant description of his or her emotions but will be imported from current practice. These terms include “seriously mentally ill,” “psychosis N.O.S” “major depression” and they often do not reflect or do justice to the inner experiences of the person. When this writer uses these terms it will be restricted to quoting or paraphrasing what has been documented in research articles.
The voiceless population, of which we speak, has traditionally been hidden from view, forgotten and they continue to be victims of a cycle of abuse, homelessness, incarceration and endless suffering.
I have tried to be one “voice” for some of these people; in the L. A. Jail, in the locked psychiatric unit of a large county hospital, in the ERs and with the Suicide Prevention Center. I tell their story and I hope to have others join in the effort. The cases that I describe are real and may inspire a discussion that leads to reform.
The “Kite” that I found under my office door in the LA County Jail was meticulously folded into a small square. Kites are messages from inmates and are carried by inmate workers who, by virtue of connections, are allowed to do chores for the deputies in the jail. The message read “Pleez see me. John B, 501C” I knew that 501C was a dormitory that housed the “mentally ill” inmates in Tower 1 along with hardened criminals who were thought to have “mental problems.” This was the population that I was evaluating one by one as they came into the jail in order to identify potentially “suicidal” inmates. There had been a rash of suicides in this population and a flood of lawsuits that resulted in my new set of responsibilities.
Inside the cavernous room that held 6 glass walled dormitories I found a deputy who had been less restrictive with psychologists and would allow more time for interviews. There was a new flood of inmates inside of 501C, some of them pressing their faces up against the glass walls looking anxious and disheveled. I had looked at John’s rap sheet in the sheriff’s data base; he was 18 years old, Hispanic, incarcerated on a charge of 211 (Robbery). No other charges were listed, there was no home address, no contact numbers and one defining word “mute.” That was why he was put into the mental health dorm.
The deputy brought John out and handcuffed him to a chair across from me. We were separated by a table on which I put paper and crayons (pencils and pens are considered potential weapons and are not allowed) I asked the deputy to release one of John’s hands and he complied. John was a very thin, young man, with smooth olive skin and no visible tattoos. His straight black hair was combed back from his face and even though his jail uniform was hanging off of his slim frame he looked fairly neat. His face was a portrait of utter fear. There was a look in his eyes that, had I not known better, could have been interpreted as rage or a drug induced state but I recognized that this youngster was terrified. His free hand was splayed on the table, and trembling as were his lips. I began with a few general questions; how are you doing? Have you been in jail before? Do you have a public defender yet? He was silent. The deputy was hovering nearby and I asked that he move away to give us a bit of privacy. John looked quickly at the cells behind him and then back with an even more frightened expression on his face. I asked several more questions, and got a nod when I asked if he had sent me the message and wanted me to do something for him. This was a beginning, I knew that he needed to trust me if I was going to have any communication with him and I was aware that responding to his need quickly might open a door. I placed a sheet of paper and a crayon in front of him, he looked at it and at the deputy before writing; “Call Jeanette 213 456 2232).” I placed the paper under my clipboard and asked “Can you talk when you are with Jeanette?” John shrugged and looked sad.
Our time was up and the deputy uncuffed his hand and led him back to the dorm. Before he entered he gave me a last desperate look and then was swallowed up in the crowd. In my office I wrote up my initial report deliberately avoiding a diagnosis that could result in a course of medication. I had little information on John; I didn’t know if he was mute or afraid to talk, I sensed that he was not ‘psychotic” or suicidal though he was desperately afraid. My report indicated strongly that I needed to re-evaluate him which would give me another opportunity to help him. I called the number that he gave me and a very young voice came on the line almost immediately. Jeanette turned out to be his girlfriend and they had met in a line at the food bank a year before. She told me that John had helped her leave an abusive pimp and that he had been physically abused as a child and pre-teenager in foster homes. He had deep scars on his back and legs from whippings and had suffered broken bones and almost lost the sight in one eye from being punched repeatedly as a little boy. The foster family he was placed with used gagging as a punishment, binding his mouth with duct tape and putting him in a closet for long periods of time. His family was scattered, he had no contact with anyone but her. John had difficulty speaking; he usually gave one word responses and shut down completely when asked about his early life. She had slowly uncovered the abuse information about from him after his frequent nightmares. John had no police record; he had been sitting in a car that had been used in a robbery when the police picked him up. He was waiting for Jeanette and could not talk to the police. Jeanette was his “voice” and he was helpless without her. She was willing to bring in identifying documents, to be a witness and to talk to the public defender. Together we would work towards getting John out of jail and finding resources that would help him survive; he needed to find his voice. I met with John again several times before his release and he began to trust me more with each visit. Still, the environment and his early experiences were strong barriers to communication. John was finally able to say “Yes” and “No” and that he was innocent of his crime and “thank you.” It was a beginning.
The usual course of events for inmates like John would be a diagnosis of “depression” or “autism” or “psychosis N.O.S” and then medication and a long wait for a public defender who would not be able to communicate with him. There would be long delays in getting a court date, months of torture for this terrified youngster who was housed with hardened inmates and then possibly a sentence in jail, probation and release to the streets. John would be more broken than when he entered the correctional system; re-abused, re-traumatized, and he would be coming off of whatever medication they put him on. He would carry a powerful, inaccurate psychiatric diagnosis along with a jail record with him into a society that would judge him harshly and offer few resources.
John was not the first person that I encountered in the jail and locked psychiatric ward who had no voice, no way to express and describe feelings and no trust to allow them to begin to communicate. Individuals who are abused, traumatized and are in unsafe unprotected and violent environments cannot and do not openly talk about how they feel. In addition, they lack the language of emotional expression. They have not been taught how to describe what they feel, what words and phrases to use. Early trauma, unsafe environments and lack of skills conspire to render this large population mute, helpless and at great risk.
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“Human difference was never meant to be reducible to an exhaustive list of diagnoses drawn carelessly from a psychiatric manual. It takes all types to make a successful tribe and a full palette of emotions to make a fully lived life”
– Allen Frances, M.D from Saving Normal
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.