Tag Archives: jail

The valley of the shadow

I recently saw the inside of cell 19 in the jail’s infirmary for the first time. Staff rarely enter cells, partly because it’s invasive to the inmates but mostly because it would be a good place for inmates to ambush staff. I’ve only ever been inside cells a few times, heavily supervised, to evaluate clients who were too ill to get out of bed.

Of all the cells in the jail, cell 19 is perhaps the scene of the most misery. It’s at the far end of the women’s quarters in the infirmary. Men generally come in through another facility before transitioning to our jail, but many of the women come straight from court or a brief police lockup. Which means the infirmary is where they wait out their detox from alcohol, pills, heroin, methadone and anything else they have in their system. Detoxing is not just horribly unpleasant, it’s dangerous – you can have seizures from suddenly quitting alcohol or some drugs. (Methadone is possibly the worst; I’ve known clients who refuse to take it just so they will never again have to detox from it.) So many of cell 19’s residents have been women sweating, vomiting, shaking, and weeping their way through their first days of incarceration.

But cell 19 is primarily reserved as a mental health watch cell. Mental health watch is the jail equivalent of a psych hospital – it’s where we put people who seem on the verge of suicide or homicide. Unlike a hospital, it makes no pretense at being a place that will help you feel better.  The cell is empty of anything but a sink, toilet, metal bunk, and plexiglass window.  There may or may not be a mattress.  Its sole purpose is to keep you away from razors and sheets until the worst has passed, or until you get lucid enough to lie convincingly to us.

That day, when I went inside the cell to evaluate a woman crumpled on the bunk in some kind of catatonic episode, I noticed a lot of words scratched onto the doorframe. I had stood on the other side of that door hundreds of times talking to clients, but I had never seen their side of the door.

When you work with mental patients, you end up seeing a lot of things scrawled on walls. Some of it is vitriol against staff, some incomprehensible, some tragic. (The most pathetic I’ve seen was “HELP ME” written in a man’s own feces.)

So I wondered what such a long passage could be. What woman, in the throes of heroin detox or madness, spent such a long time etching these words into the paint?

While the officers were busy, I sidled up to the doorframe and read it:

The Lord is my shepherd
I shall not want
He makes me lie down in green pastures
He leads me beside quiet waters
He restores my soul
He guides me in the paths of righteousness
For His name’s sake
Even though I walk through the valley of the shadow of death
I fear no evil for You are with me
Your rod and Your staff they comfort me
You prepare a table before me in the presence of my enemies
You have anointed my head with oil
My cup overflows
Surely goodness and lovingkindness will follow me all the days of my life
And I will dwell in the house of the Lord forever

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Book recommendations in jail

Most of the inmates at the jail can visit the library occasionally, but the ones on certain units can’t go.  So they rely on staff, including me, to supply them with books.  Everything I do as a mental health clinician is supposed to have a clinical purpose – any reading material is supposed to be chosen to help clients cope with stress, etc., and not just for entertainment. But I do it more because I can’t help myself, because I can’t imagine being locked up and having nothing to read.

Currently there’s a something of a racket in Hunger Games books going on. One of my clients has read the first book and got the third from the library, and now he’s holding the third one captive until he can read the second book. Another client told me she read the second book, so I found out who she lent it to and got the second woman to promise to give it to me when she’s done. (She’s likely to help me out because I’ve been keeping her supplied with Twilight novels for a month now.)  Then my first guy can read the second book and the third, and when he’s done I can get the third book to the two women. I will feel so accomplished if this plan works.

I have a client who asks for classics, saying she doesn’t want her brain to rot when she’s in solitary confinement.    Recently I got her Edith Wharton’s 1905 House of Mirth, telling her it’s about a woman who realizes she needs money, so she decides to marry a rich man but has all kinds of problems with relationships and money and ends up with a bad reputation and a drug problem. My client laughed and said she looked forward to reading it, because it sounded exactly like her.

I once came onto a unit bearing a few copies from the Chicken Soup for the Soul series to add to the unit bookshelf. A woman spotted them from across the room and exclaimed, “Oooh, those books are like crack!”  And she would know.

My selections aren’t always so successful.  I brought some Edith Wharton to a man who had begged me for novels and poetry.  He slid it back under the door of his solitary cell with disdain, saying he was only willing to read British literature because he finds American authors have “a dearth of poetic language.”   Never mind that it meant another week with no new books until my next visit.  His standards were firm.

We have a copy of Les Misérables in the mental health office that nobody is brave enough to bring to a client. In its favor, it has lots of characters the clients would love – a good-hearted prostitute who’s down on her luck, an ex-con who tries to do the right thing but keeps getting caught up by a vindictive cop. But it gets passed over due to the huge size and intimidating prose.

Not all the inmates are put off by big books, though. One of my clients is currently enthused about a history book (I suspect it’s Howard Zinn’s People’s History of the United States) that he found being used as a doorstop on his unit.

Another man told me he’d never had time to read much Dickens before.  “I can’t believe how funny it is!”

There’s a lot of demand for dictionaries. Some people use them to check, when they’re using big words in their raps and love letters, that they’re using them correctly. But it took me a year to realize that much of the demand is because some of the illiterate inmates believe they can learn to read and write from a dictionary. There are a few books intended for speakers of other languages, but not much for native English speakers who never actually became literate.

Parenting books are also in high demand. Most parents learn as they go and see their child develop, but a lot of the clients haven’t had custody of their children in a while – it’s hard to jump to parenting a 4-year-old when you basically haven’t seen her since she was 2.

One of my coworkers had a client ask her for a copy of “Men’s Health” magazine. She couldn’t find one, but brought him “Positive” magazine instead, which had some healthy-looking men on the cover. Afterwards he told her kindly that he was able to get the magazine into the trash without anyone noticing, and to please not bring him no AIDS magazines next time. Another coworker had a similar experience with a randomly-chosen novel that turned out to be about gay men. Now we’re careful to evaluate books for gayness, lest we endanger our clients.

For more on the life of books in prison, see librarian Avi Steinberg’s Running the Books.

Doing time

When you walk into a jail, you move from a space where no one has enough time to a space where the residents have far too much time.  Everyone is waiting.

One way to make time pass faster in jail is to change how much you sleep.  Some of my clients who ask for sleep medication report sleeping poorly, but others are sleeping fine and just want to do more of it.  One guy complained he was only getting 7 hours instead of his usual 12.  Another asked if we could give him a medication to help him sleep 24 hours a day until his court date.  (I explained that this is called a coma, so no.)

Jail is especially cruel to insomniacs.  One of my clients pointed out that someone sleeping 4 hours a night instead of 8 has a sentence that’s effectively 25% longer.

The problem with passing time in jail is not just that it’s miserable.  It’s also all the time you miss.  Your high school prom.  Your daughter’s first words.  Your father’s last words.  There’s lots of time for your employer to give up on you.  Time for your girlfriend to find another man.  The holidays and birthdays.  Every night and every morning knowing your loved ones are going about their lives without you.

I hadn’t realized how similar jail is to time-out for adults until I heard how many of my clients use that to explain their whereabouts to their young children.  “You know how we put you in time out when you do something wrong?  Mommy made a mistake, and she can’t leave until the judge says so.”

Except that time-outs are not as popular as they were.  I keep hearing about parents who use “time-ins.”  Toddler is throwing things?  Rather than banishing her to her room, remove her from the scene and go spend time together somewhere else (say 5 minutes cuddling on the couch).  Probably harder for parents, as it means staying with a child you may be totally frustrated with.  But for some kids, it seems to work better.

And timeout is no deterrent for the kid who enjoys being sent to his room because he can just play there. I know a few of these in the jail — young men whose friends from the neighborhood are mostly locked up too.  They spend their days joking and romping, and the lack of responsibility is enough to make up for the terrible food and the difficulty of obtaining marijuana.  Jail time isn’t a big deal to them, by their own admission.

I wonder what time-in would look like as an alternative to jail.  I recognize that community service, etc. would not work for a lot of my clients because they can’t get away from the things that keep tripping them up: their addictions, their lack of job skills, and their lack of life skills in general.  But I think an adult time-in could look like Norway’s Bastoy Prison.  Rather than remove all the elements of normal life, they recreate normal life – not the wheeling and dealing on the streets that likely made up the prisoners’ lives before, but a life based on work and responsibility.  Prisoners shop for groceries, cook their own meals, maintain their dwellings, and work in the farm, bicycle shop, stables, or timber workshop.  Critics call it “cushy,” but it has the lowest re-offense rate of any European prison.

Where there’s life

Today at work, an inmate told me about someone he knew who had committed suicide.  “I just can’t believe someone would do that.  You only have one chance — my mother told me that.  You get one chance at life, and you can never come back.  You can never see your family again.”  He was completely boggled that someone with an apparently good life would want to end it.

It reminds me how differently people’s minds are programmed.  Of course, there are plenty of suicidal prisoners.  But there are plenty who, no matter what humiliations and deprivations they experience, cannot fathom wanting anything other than life.

Recently another client spent a while telling me about how she was homeless, broke, addicted to heroin, and not sure where her husband was.  At the end of the meeting, she gave a dreamy smile and casually mentioned, “And I think I might be pregnant.  I hope I am.  I’ve been trying to get pregnant.”  To me, these seemed like the worst possible circumstances to be pregnant in.  But to her, it was her life, and a baby seemed like one bright spot in a very dingy world.

Triage

I hear that in other countries, people acknowledge the existence of medical rationing.  In the US, we like to pretend it doesn’t exist.

A jail is a microcosm of this: there is only one source of medical care, and the limited number of hours must be divided somehow among all the possible recipients. With 1600 prisoners (many of them with mental illness) and less than one full-time psychiatrist, there are never enough appointments for all the people who want them.

Where I work, the mental health clinicians are the gatekeepers for those appointments.  When one of our clients is in crisis, the mental health clinicians can make an argument to the rest of the team on why this person should see the doctor sooner.  A debate follows about symptoms, history of hurting self and others, risk factors, and whether medication is even likely to help.

During those debates, part of me always wants to say, “Yes, get him the damn appointment! I can’t stand to go back and tell him he’s not getting a med change for another five weeks!”

The other part thinks, “Who will get bumped if I move him up? Is it Angie, whose nightmares are waking her up screaming?  Khalil, who says the voices are getting louder?  Ernesto, who’s having panic attacks every time he leaves his cell?  Can I make them wait another week?”

These are the things that are happening every time we distribute resources, but they’re usually not as visible.

How to impress ex-prostitutes

Yesterday I told some folkdance friends I needed new work shoes and was thinking about getting those Dansko clogs worn by every hippie professional. They told me I should go for it – “Yeah, totally fine! Everybody wears them!”

Except . . . probably a quarter of my clients at the jail have worked as prostitutes. If not formally so, they’ve at least traded sex for housing, etc. Their appearance has been their livelihood. And when they are looking for a competent professional to help them, someone who has her act together, they are not looking for someone wearing clogs. (Unless you’re a nurse.)

They’re looking for someone who looks like she’s good at managing her own life, including her wardrobe. I overheard some female inmates talking about another worker at the jail: “She knows her stuff, and she shows up every day dressed nice. That’s what counts.” After that, I started painting my nails.

The male inmates are looking for something altogether different. Given the lack of eye candy in their lives, they might actually be less distracted if the staff all wore burlap sacks. The jail administration would certainly prefer that female staff were entirely swathed.

I thought about this a lot as an intern at an elementary school – grownups are supposed to put on a neutral face for children, right? So I figured I should just look as unremarkable as possible.

But then I thought, some of the coolest grownups the ones who break the mold.  (Think Ms. Frizzle.)  In her excellent take on social work fashion, Social Jerk writes, “My purple Chucks and matching glittery nails make my teens think, maybe there’s something to this nut who keeps showing up at my school.”

There’s this idea in social work that we’re supposed to be authentic. Professional use of self, right? Being real with each other?

The problem is that sometimes people’s authentic selves are so foreign to each other that we can’t actually get past them and do any real work. I had a client learn that I’d never seen The Departed and react with the same kind of shock and disbelief I felt when learning that one of my clients injects heroin into his eye socket because he’s run out of veins. (Actually, I think I hid my shock and disbelief a lot better than this guy did.)

I think we actually can’t always handle each other’s authentic selves, and if my authentic self is a granola-munching Quaker who doesn’t like movies with guns in them, my clients might not be ready for that. If I want to communicate that I’m a competent adult, I might need to wear cute shoes. As long as I can still run for the bus in them.

Reaching for normalcy

People in jail crave a lot of things: sex, drugs, their families. But in general they crave normalcy.

Take the food, for example. One woman explained how she transforms and redistributes breakfast to the new inmates who are still coming off drugs: “Nobody eats a plain hard-boiled egg — it’s disgusting. The girls will just throw them out.  But those girls that are detoxing need protein, and they don’t get up for breakfast. And I have some mayonnaise packets, right? So I collect the hard-boiled eggs they’re gonna throw out and I make egg salad and bring it to them.”

Birthdays are observed with “cookie cakes.” The inmates order cookies and kool-aid powder from the prison canteen. The cookies are pushed together into a rectangle, then covered with icing made from kool-aid slurry cooked in the microwave.

One of my clients told me that the birthday of his deceased mother was always hard for him.  The day after her birthday, I checked in with him and asked how the day had been.  He said one of the other guys had given him cookies from his canteen order to make her a cake.  I try not to cry in session, but I almost did there.

….

The men’s units feel like a workout room. There are men doing pullups from the stairs, men coaching each other on pushups.  The correctional officers are often into body-building as well, and I sometimes hear them swapping advice on protein shakes with the inmates.

The female units have a more domestic aura. When you walk into a  men’s unit you smell body odor, but when you walk into a women’s unit you smell laundry detergent and the burnt-dust scent of a hair dryer.

The women spend endless hours doing each other’s hair. I suspect it serves several purposes – to pass the time, to show affection, to form alliances, and to create debts that must be returned.  One of my clients came into the office with her hair half-done in lopsided, amateur cornrows. She looked at me apologetically. “I figure I have to leave it in for at least two days. I don’t want to hurt her feelings.”

….

Normally the only animals in jail are the drug-search dogs and the mice in the walls.  But at some point a pair of pigeons somehow got into one of the large units. It was a little surreal, in that skyless cinderblock world, to see birds gliding overhead.  Apparently the guys like having them. Some weeks later I asked an inmate, “Are those pigeons still there?”

“Oh, yeah,” he said, “They’ll never leave. We’re feeding them too well.”

Ashes

Tomorrow is Valentine’s Day. It will go largely unnoticed at the jail where I work – love, while it exists there, is not to be expressed.

Ash Wednesday, however, was observed in full force. A lot of the officers had ashy crosses smudged across their foreheads. Early in the morning I saw the Catholic chaplain, a small nun with a grey habit and an Irish accent, going cell to cell with a black thumb and a pot of ashes. “Ashes for Ash Wednesday?” she asked at each plexiglass window. “Do you want some ashes?”

By 10:30, my boss announced that we were all giving up something for Lent and we had to let her know what it was by 11:00 so she could type it up and post it. Everyone chose something, even those who weren’t especially Christian and including my Jewish coworker.  I chose to go running once a week instead of giving something up, which appeased both my boss and my Jewish coworker, who’s on a running kick.

After work, I went to a church service. Sixteen years after becoming an agnostic, I still observe the cycles of the liturgical year. It gives a pattern to the year; it feels right.

Ash Wednesday is the start of Lent, which feels a bit hopeful in Boston because it means spring is coming. But Lent is a season about vulnerability and ultimately about death.

Jeff’s mother and sister got some bad diagnoses last month. I think about the possibility of death every day. All of us in the family are feeling vulnerable lately.

As I sat in the still, beeswax-scented sanctuary, I felt grateful to have a space that was not about happiness or productivity or solutions. A place to sit with uncertainty and hurt.

And, as sometimes happens when you have time to sit and think, a piece clicked into place. Today I sat with a client who told me I had been pushing him too hard to be okay. He had come into jail terrified and sobbing, and for months afterward I had tried to give him hope and coping skills and all those things I want prisoners to have. And today he told me that he is confused and sad, and I need to back off with the certainty and the optimism and just let him feel confused and sad.

And I heard him, and thanked him for letting me know what he needed. And tonight, on this day that is for remembering we will return to ashes, I was able to sit and feel confused and sad.

The church I went to tonight is one I return to because because it strikes the right balance of ritual and modernism for me. In place of the old-school Confession of Sin, there’s a hymn written by someone who must have struggled with passive aggression as much as I do:

The words of hope I often failed to give,
The prayers of kindness buried by my pride,
The signs of care I argued out of sight;
These I lay down.

The narrowness of vision and of mind,
The need for other folk to serve my will,
And every word and silence meant to hurt,
These I lay down.

The service ended with the Isaiah passage that feels like the mission statement of social work:

God has anointed you
and is sending you
to bring good news to the oppressed,
to bind up the broken-hearted . . .
to comfort all who mourn – to give them a garland instead of ashes,
gladness instead of sorrow . . .
You shall build up the ancient devastation,
repair the ruined cities,
and heal the despair of many generations.

Happiness set points

Happiness research indicates that about half of how happy we are is genetic.  We seem to have a “happiness set point“, rather like a thermostat, that keeps bringing us back to a similar level of happiness regardless of our circumstances.  There’s some evidence that after a paralyzing spinal cord injury, for instance, people are initially very sad but later feel better.  (The evidence on this is mixed, though.  And some events, like being widowed, really do just make your life worse.)

At my job, I assess the mental health of people who are coming to jail for the first time.  And the amazing thing is that some people are fine.  Not that they’re happy – they’re still anxious to talk to their lawyers, talk to their families, and get out as soon as possible – but they’re not falling apart.  Some of this we would call “resilience”, which is more like the ability to go back to your set point after a negative event.  

This is especially noticeable in the immigration detainees, who were mostly arrested out of the blue.  One minute they were going home from work, and the next they were in handcuffs.  There’s a striking difference between the raging, sobbing person and the person who gives a wry smile and says, “Well, you know, I’m hanging in there.  What can you do?”