Tag Archives: jail

Antisocial personality disorder in prisoners

(I’ve been sitting on the raw material for this post for almost two years and finally wrote it up.)

When I worked in the jail, I asked myself fairly often whether my clients had anti-social personality disorder.  Supposedly almost half of male prisoners have it, and in that setting you do have to constantly ask yourself whether someone is trying to take advantage of you in some way.

“Anti-social” almost seems redundant in a jail, but it’s not clear what the term should mean. It’s also been called sociopathy and psychopathy, and people don’t agree about whether those are actually different things. The seminal work on the topic is Hervey Cleckley’s The Mask of Sanitywhich describes psychopaths as not truly experiencing emotions, especially love. Lots of other books give advice on how to avoid such people.

The DSM IV-TR, which we were mostly using at the time, required three or more from this list for a diagnosis of antisocial personality disorder:

  1. failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest;
  2. deception, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure;
  3. impulsivity or failure to plan ahead;
  4. irritability and aggressiveness, as indicated by repeated physical fights or assaults;
  5. reckless disregard for safety of self or others;
  6. consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations;
  7. lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

Jails obviously have a lot of people with these characteristics. But they are also full of people with addiction and trauma histories, which can explain almost all the symptoms:

  1. Everyone in jail has been arrested, so that’s a given.
  2. Lying and conning for personal benefit are probably adaptive behaviors in harsh environments like the foster system, abusive relationships, and homelessness. (As my supervisor told me the first time I had my feelings hurt by a client who successfully conned me into making a phone call for her, “This is how she’s survived.”)
  3. Impulsivity and failure to plan ahead: A ton of people are in jail because of this. Executive function is not the strong suit of prisoners. You see a lot of ADHD, a lot of traumatic brain injury, and a lot of substance use (which is both cause and effect of impulsivity).
  4. Irritability and aggressiveness: again, aggression can be adaptive in a dangerous environment. A lot of young men learn this as a way to avoid being victimized. The irritability could also be substance use or withdrawal.
  5. Disregard for safety: A common response to trauma.
  6. Irresponsibility: I read this as “often unemployed,” which isn’t surprising in someone coming out of an unstable family and/or a broken school system. Also would be pretty predictable as a consequence of substance abuse.
  7. Which leaves us with lack of remorse: the only one I can’t explain away even in this population.

I met very few clients who obviously met the “no conscience” model. They were particularly likely to be pimps, I guess because that’s a career particularly well-suited to remorselessness.

The most obviously low-on-conscience guy I worked with got offended once when I asked why he did the right thing in one case when it didn’t seem to benefit him, which made me think he had occasional moments of decency and maybe thought of himself as a decent person. But there were so many other examples of him doing the non-decent thing whenever convenient that this might have just been a front.

Another client was terminally ill and decided during his last weeks that he’d like to discuss his life history with someone. He told me about a variety of horrible things he had done (starting with arson) with no apparent remorse. But he appeared to have genuine love for his dog and spoke fondly of how he hoped to be released in time to go visit it.

At one point I went over my client list and picked the last 60 clients that I had talked with enough and remembered well enough to have an idea of whether they seemed to have a lack of empathy or remorse. 11 (18%) had said something that indicated this (though again, not consistently so—everyone in the sample at least appeared empathetic in certain situations). Another 10% were maybes in that they seemed to maybe have done really callous things but I wasn’t sure. And the remaining 72% didn’t seem to be deficient in empathy. They were mostly locked up for things in the “poor impulse control” department.

I came away from this feeling that:

  • a lot of the diagnostic criteria only make sense for someone coming from a basically ok background where you wouldn’t normally expect to see survival-type lying, violence, etc. The DSM 5 criteria seem much better in this regard, since they now ask you to rule out socio-cultural environment, substance use, and head trauma as causes.
  • this thing seemed a lot more like a spectrum than like a separate category of people.
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Anger management curriculum for prisoners

When I first led an anger management group at the jail, most of the curricula I could find seemed pretty terrible: preachy and unrealistic. After leading the group several times now, this is what I’ve come up with. A few things are gleaned from the internet but much of it is my own. Feel free to use an alter any of the material that don’t have an author listed.

It’s an eight-week group meeting for one hour each week. Some of the classes don’t really last an hour, but people are fine with getting out early.

Session one: Intro
Group policies (attendance. responsibilities of facilitator and group members)
Discuss quote: “Usually when people are sad, they don’t do anything. They just cry over their condition. But when they get angry, they bring about a change.” – Malcolm X
How can anger be used productively? List positive and negative applications of anger.
Discuss different ways of expressing anger (assertive, aggressive, passive aggressive, bottling up).
Homework: anger inventory

Session two: Neuroscience of anger
Explain that by looking at people’s brains with scans, scientists can tell that different parts of the brain are more active when people experience different emotions.
Flight or flight” handout – discuss positive and negative applications of this reaction (e.g. rescuing someone in danger or escaping danger vs. fighting someone over a minor problem)
How anger works in the brain” handout
Discuss other factors that affect how the brain works (sleep deprivation, hunger/low blood sugar, caffeine, alcohol, drugs) and how they affect anger
Discuss how general stress level predisposes you to overreact
Homework: anger incident

Session three: Anger scale
Introduction to anger scale. Draw scale 0-10 on a poster. If someone is at 0 anger, how do they feel? At 3? At 5? At 7? At 10? What might they do at these different levels? Discuss difference between the anger you feel and the actions you take: someone at 8 might feel like throwing punches but doesn’t necessarily do so.
Checkin: what was the highest you got on the anger scale this week? How did you handle it?
Activity: pass out slips of paper, each with a scenario that might make you angry. Each person reads theirs (allow people to pass or hand these off to a neighbor in case they’re uncomfortable reading). Discuss each scenario: How mad would this make you? What’s your interpretation of the situation? What would you do?
Homework: anger incident with anger scale

Session four: Hidden and open emotions
Check-in with anger scale: Each person (including facilitator) says the highest number they reached on the anger scale during the past week. They can tell about the situation if they want.
Group activity: each group has a poster with a scale of “least OK to show in jail” to “most OK to show in jail.” They have post-it notes with emotions (happiness, sadness, hate, love, homesickness, fear, humor/fun, anger.) As a group they position the notes along the scale. Whole class discusses why they placed the notes where they did.
Discuss how everyone experiences the above emotions in jail, but some are more acceptable than others. Fear or sadness may get expressed as anger because that doesn’t make you as vulnerable to being taken advantage of.
Homework and List of emotions

Session five: Resentment and forgiveness
Check-in with anger scale
Difference between in-the-moment anger and ongoing resentment/grudges
Reading aloud: Nelson Mandela on forgiveness. This reading is unfailingly popular because the group members are impressed with the horrific details of Mandela’s 27-year imprisonment and the fact that he then went on to be the leader of a nation.
Discussion of what it takes to move on emotionally from the experience of being imprisoned.
Discussion of how to handle long-lasting anger (e.g. against family members who neglected or abused you in childhood – many inmates have had this experience). When do you find you’re able to move on and still interact with the person? When do you decide it doesn’t work to have this person in your life?
Homework: grudges

Session six: Apologies
Check-in with anger scale
Dicussion: how can you tell when someone’s apology is fake? What makes you feel an apology is sincere? Can give examples of politicians’ or other famous people’s “non-apology apologies”, ones that lay the blame on other people for being upset rather than taking responsibility for their own actions.
Read aloud/summarize: The fake apology
What makes an apology go well or badly in your experience? How do you make amends when you have hurt someone? How do you reconcile when both people have wronged each other?
Homework: read Anatomy of an apology

Session seven: Anger in relationships
Check-in with anger scale
Reading aloud: Fighting fair: Rules for couples
Discussing this reading easily takes most of the hour. Try to focus the discussion not just on what participants’ partners have done wrong (this is where the conversation naturally goes) but toward how to handle unfair actions a partner has taken, how to handle your own impulses toward unfair behavior. What constitutes abuse? When is it time to break up? To me this is the saddest session because it becomes clear how few of them have been in a reasonably healthy relationship or even see that as a possibility.
Homework: What advice would you give to a young person on how to handle disputes with their partner?

Session eight: Anger and children
Check-in with anger scale
Discussion: For those who are parents, how do you handle anger towards your children? Amazingly to me, someone often says that children are too young to know better and he couldn’t get mad at his child. (I suspect many of my group members who are fathers have not spent much time, if any, with their children due to incarceration and separation from the children’s mothers.) I give the example of a toddler sticking their finger in your eye. Even if they’re too young to know that it hurts you, it still hurts and you’re probably surprised and angry for a minute, and it might take some effort to respond appropriately to the child. I also ask if anyone present believes their parents never got angry at them. If all of our parents got angry at us when we were kids, we will probably get angry with our kids too.
How do they feel about physical punishment? What’s the difference between spanking and beating? (Expect this to bring up strong feelings for some people, as it would be very unlikely to have a group of prisoners in which no one was physically abused as a child.) If you choose to spank your child, how do you keep from going overboard? To me, the upshot is that the parent has to be in control of their own behavior. Don’t spank your child if you’re too angry—whatever discipline you give must be for the child’s well-being, not for venting your own frustration. Time-out is not just for children; you may need some time to cool down before you’re able to respond appropriately to whatever your child did.

Presentation of certificates
Discussion: suggestions for improvements to the class.
Thank class for participating actively in discussions.

Some other bits that get tossed in as appropriate:

A brief moment of CBT: It’s not just the situation itself that makes you mad, but your interpretation of it. If someone bumps into you and you think it was on purpose, you’re madder than if you think it was a mistake. At times we assume the worst and get angrier than is called for. How can we check our perceptions?

A frequent topic during check-ins is: why are some correctional officers such assholes? A good time to introduce the concept: “Hurt people hurt people.” If someone comes in to their job and acts rude and difficult, it’s probably not because all is going well in their life. We can’t know what’s going on, but we can guess they’re not feeling good inside. It doesn’t excuse their behavior, but it may help us understand better.

Self-disclosure on the part of the facilitator is really tricky. In the weekly check-ins, I don’t want to be the only one who doesn’t share. But I also can’t talk about a lot of possible causes of anger—disagreement with coworkers or my husband are off the table, for example, because they’ll start picking apart the mental health team or my marriage and none of that ultimately helps them trust that I am a person competent to help them. Also, a lot of the causes of frustration in my life are ones they would love to have. I’m grumpy because the baby was teething all night? They haven’t seen their children in weeks, months, or years. Traffic was bad? They dream about being free to drive again. Etc. I’ve found the safest strategy is to just give a number and be vague about the actual cause (which they are free to do also) or to have a gripe about my in-laws. Everyone is pretty much on the same page there.

Expect that some topics will bring up strong emotions. Anything about children is emotional for parents separated from their children. Topics about relationships are difficult for people who are worried about their partners leaving them while they’re locked up. In the exercise with slips of paper with anger-provoking scenarios, I recently had someone react very strongly to the slip he drew, which I thought of as something pretty minor. It turned out to have been a situation that kicked off a melee in which he was stabbed.

Address other topics as needed. The week that two buildings of people were crammed into one building while renovations were done, their anger about that was our main topic. The week of the Baltimore riots, we talked about how a situation that suddenly erupts may be a product of a long-simmering anger, and what makes a public expression of anger productive or unproductive.

Wrists

The other night I watched my client as an officer told her he would have to put her in a segregation unit for the night (which involves being handcuffed). She protested at first but he explained the reason and she got up from her chair and placed her hands behind her back. “Okay, I got it,” she said. He walked out of the room and she followed him, hands still poised behind her back, and turned to present her waiting wrists to the other officers who held the handcuffs. There are many sad things about her life but somehow this gesture was the saddest to me, her casual familiarity with preparing her own hands to be cuffed before anyone asked her to.

One of the stranger sights on a segregation unit is an Italian-American having an animated conversation while in handcuffs. One hand will gesture freely while the other follows limply behind.

A while ago I was walking to meet my client in the non-contact office (like you see in movies; two little boxes with plexiglass between). He was sticking his hands through the little slot in the door to let the officers un-cuff him. His wrists, pudgy from his antipsychotic medication, suddenly reminded me of Lily’s pudgy baby wrists that I pull sleeves over every day. His mother used to pull his sleeves over his arms, I thought. She cared for him like I care for Lily. Of all the thousands of ways we are all human together, I had never noticed this one before. Every person in the jail once was so young and helpless that someone helped them pull their sleeves over their arms.

Two snow moments

Two moments from the recent snowstorms:

I was coming into work at the jail as the storm got bad. Rather than the usual crowd of visitors waiting in the lobby, there was only one young man. Wow, I thought, he must really be desperate for this visit to come here in such terrible weather.

As I went in through the sally port, an officer was bringing out a young woman. Inmates who have completed their sentences are released in the morning, so an afternoon release meant she was a detainee who had just gotten bailed out. I realized why the young man had come.

The steel door slid open. The woman flew out through the metal detector and into the arms of the waiting man.

…..

Later that night, I was in the infirmary watching a man walking from a medical appointment back across the yard to his unit. All inmates must be given access to fresh air, which mostly means a “rec deck”—a semi-enclosed porch with a basketball hoop. Walking across the yard is the only time most of them are under the open sky. (I had one client who signed up for a class in another building just so he could walk there and back every day.)

The man crossed the yard as slowly as possible without actually stopping, stretching his arms wide to the storm, face up to the swirling snow.

On switching places

I’ve been reading some of the discussion on Scott Aaronson’s comment on his difficult youth as a shy geek with a very conscientious style of feminism. An excerpt:

My recurring fantasy, through this period, was to have been born a woman, or a gay man, or best of all, completely asexual, so that I could simply devote my life to math, like my hero Paul Erdös did. Anything, really, other than the curse of having been born a heterosexual male, which for me, meant being consumed by desires that one couldn’t act on or even admit without running the risk of becoming an objectifier or a stalker or a harasser or some other creature of the darkness.

Someone replied, essentially, “You can’t really mean you would trade places with truly oppressed people.” Aaronson replies:

I feel incredibly lucky to have gotten to a place in life where I’m happy to be who I am, with a wonderful wife and daughter and a job doing what I love. But with a slightly-different roll of the dice? I would absolutely have traded places with any of the people you mentioned—the poor black kid, the gay kid, any of them. I wouldn’t even have to think about it. Are you kidding me?

I wouldn’t have written what I did, if that wasn’t honestly how I felt. And I wonder if this isn’t the crux of so many people’s failure to understand me: the only possibility they can contemplate, is that I can’t grasp how badly other people have it. That I would’ve gladly traded places with them, despite knowing how badly they have it, is a fact they won’t assimilate no matter how often I say it.

Which got me thinking about how different people’s experiences can be wildly different even within the same group.

One noticeable thing about jail is that people react very differently to it. Most everyone is miserable, but some of them put together a semblance of normal life (working out, writing letters, conducting intrigues, reading all the Game of Thrones books). One of the most charmingly normal things I ever saw on a segregation unit was two women playing “battleship” from their respective cells, calling out coordinates through the cinderblocks.

Recently a client on his first real incarceration told me he wasn’t sure what was so bad about jail. There was nothing that really felt like punishment to him, no physical torture. His childhood was worse: “I was always getting beat and stuffed in closets, so this ain’t a big deal to me.”

But some people lose their minds. Some people (especially immigration and other non-criminal detainees) can’t handle the loss of status, the shame of wearing a uniform and shackles. Some people have panic attacks. Some can’t eat or sleep. Some lose touch with reality.

The same circumstances can have vastly different effects on different people. So to say, “I would rather have been poor or gay or black than geeky and shy” doesn’t make a lot of sense. Who is the you that is being transformed? Is that person still shy? Is that person still prone to feeling horribly sad and ashamed? Because you might just have a terrible time in whatever group you land in.

Prison wishlist

Short of revamping the entire system, here are some changes I would make to the current system:

  • Age segregation. Currently corrections starts sending prisoners to adult facilities at age 17 or 18. In addition to teens and older adults, I would like a third category for young adults. A 20-year-old on his first incarceration should not be housed with 50-year-olds who have done dozens of sentences; it is educational in the wrong way.  The old guys would like this, too—they’re always complaining about the young hooligans running around being noisy, youth who “don’t know how to conduct theyselves as a convict.”
  • Additional food. My jail gives the same meal tray (around 2,500 calories) to every inmate, from the 6’4″ young man who works out all day to the 5’1″ grandmother who watches TV all day. The women become fat and the men struggle to maintain their muscle. If inmates have spending money, they can buy snacks (mostly junk food) from commissary. But if they have no spending money or are in a unit where they’re not allowed to buy commissary, the men get hungry. When clients complain of boredom in segregation, I encourage them to exercise, but many of them say they get too hungry if they exercise. Trying to figure out how to give people extra food without creating weird incentives is difficult. Something nutritious but bland (perhaps not as bad as nutraloaf) seems like a good compromise.
  • More nutritious food. There’s some evidence that providing prisoners with vitamin and omega-3 supplements reduces violence (presumably by helping their brains function better?) Vitamin D deficiency is rampant, particularly among dark-skinned inmates, because they get so little access to sunlight.
  • Cheaper phone calls (though this is better than it was.) Many children aren’t able or allowed to visit their parents in jail, since parents often “don’t want them to see me like this.” The ability to talk on the phone is crucial to maintaining some relationship with an incarcerated parent.
  • Housing for mothers and newborns. Separating mothers from their babies immediately after birth is cruel to the mother and unhealthy for the baby, since it makes it impossible to do even the first few days of breastfeeding. I recognize that most facilities aren’t set up for this, but new mothers should have the option to transfer to a facility that is.
  • The ability to send home prescriptions. My experience at a psychiatric hospital is that doctors could send 30-day prescriptions home with patients who were leaving, so that when it was impossible to find a quick psychiatry appointment outside they wouldn’t be screwed. At the jail where I work, you get whatever happens to be left on your medication card (anything from 3 to 30-some pills), which probably isn’t enough to last until you can see a prescriber. So you go off your psych meds a few days after leaving jail, when you’re in the throes of trying to find a place to live and a source of income. It’s a recipe for disaster.
  • Providing every inmate with the option to get free long-term birth control before release. I don’t think sterilization would be a good idea, but reversible options like IUDs, Depo-Provera, or eventually intra vans devices would be great. Again, the time after release is chaotic, and people are not super likely to make it to the doctor’s office and the pharmacy before reuniting with loved ones/random strangers.
  • TV programming chosen to be educational and calming. One of my clients said she preferred to watch the Nature Channel to “calm down instead of watching Maury, people talking about they baby daddies.” Another client, originally from Southeast Asia, tried to watch TV with the others but found the programming too frightening.
    I’d like to see some combination of educational programming, emotional literacy material, documentaries, and nature footage with white noise (ocean waves or similar). I would particularly like to air documentaries about Nelson Mandela and Malcolm X, who I think are stellar examples of how to use your time in prison well. A few hours of sports and news programming each day would be fine, since I think those help inmates feel connected to the larger world. From Avi Steinberg’s Running the Books:

    The most popular genre among male inmates was nature documentaries about carnivorous animals. . . . even from the other side of the library, I’d know the lioness had finally pounced when I’d hear inmates yelling at the screen, “Get ’em! Get ’em!” Once, and only once, I heard an inmate take the gazelle’s side and cry out, “Run! Run!”

Thoughts on inmate jobs

There aren’t as many jobs available at the jail as there are at larger prisons. For women, the options are cleaning the showers and handing out meal trays. Men can have those jobs, plus working in the kitchen, the laundry, the print shop, the paint crew, or outside doing trash pickup and snow shoveling.

There are not enough jobs for all the inmates that want them. You earn something like a dollar a day, which for some inmates means they can afford a few candy bars and phone calls home without asking their families for money. But most of them say they want the jobs to keep busy. Anything is better than lying on your bunk all day or pacing the unit aimlessly.

The paint crew is an especially obvious make-work program, because the jail only needs so much painting. The hallways get painted several times a year, and to add variety, a different color is used every time. In the places where the paint gets banged up, you can see layers of tan over purple over teal over magenta over mint green.

Some of the guys signing up for jobs inside the jail are on disability on the outside, usually for a mental illness. I suspect some of them actually could hold a job but have managed to pass for more disabled than they really are. But I think some of them are able to function only in a very structured environment, where a job application consists of signing your name on a list and where you’ll have immediate punishment if you don’t show up for work. I suspect the process of applying for jobs (and being rejected from most due to a criminal record), figuring out the bus schedule, getting up every morning and making it to work on time, and not using drugs is too much for them.

But staying home isn’t particularly good for them, either, because “staying home” usually leads to wandering the neighborhood, which usually leads to relapsing on drugs. When I ask clients to tell me about a time when they were doing well, they almost always use the phrase “staying busy.” Either caring for small children, attending an intensive drug rehab program, or working. The causation might go the other way—if you’re not doing well, you lose your kids and your job—but I’ve never heard any client say they were just staying home relaxing and doing well.

Something like an expanded Job Corps might be a good idea for these people, basically offering the same kind of structure they had in jail (maybe including van pickups and drug tests). It would probably cost more than disability payments, but less than re-incarceration.

(While I’m dreaming, a quick link to the Danish open prisons.)