Counseling in jail

By James Rose

March 2020

To enter my office, I first pass through a series of three heavy steel doors. The lock for each door is controlled from a remote central office. I wait to hear a buzz signaling that the door has been unlocked before proceeding through.

The first time I caught sight of a prisoner, it startled me so badly that I wondered whether I truly wanted to work here. The inmates wear smocks and pants with broad orange and white stripes. Their shoes close with Velcro because shoestrings can be used to strangle oneself. Everything here is geared toward minimizing the risk of suicide.

Four of us share a counseling office. The number of rooms where we can visit with prisoners privately is limited, and the rooms are used by others in the jail besides counselors. Seeing an inmate always depends on first winning the competition to find a room.

Inmates who are judged to be dangerous, who are on disciplinary status or who are on suicide watch are shackled with ankle chains and handcuffed. In one room, these inmates are then also chained to the wall. Nothing in my training prepared me for the shock of trying to carry on an intense, personal counseling session with a person in chains.

The individuals being held in this detention facility are most commonly referred to as prisoners, inmates or simply as males and females by the people who work here. But those of us in the counseling office refer to them as patients. We see it as our job to treat them first and foremost as human beings.

Introduction to the blocks

Inmates are screened upon booking, including for suicidality. Among the questions asked are whether this is their first arrest, whether they are detoxing, whether they have any prior suicide attempts, whether anyone in their family has died by suicide, whether they have ever been in a mental institution, and so forth. Inmates determined to be at risk for suicide are placed on suicide watch.

The jail is divided into a series of blocks, a grouping of two-person cells around a central area where the inmates can watch TV, exercise, or play poker for candy bars or cups of pudding. The blocks form a U shape surrounding an outside courtyard where the inmates sometimes go for recreation when the weather permits. There are a half-dozen volleyballs stuck on the spiraled razor wire that surrounds the upper perimeter of the courtyard. S block is for sex offenders. Participants in Project 103, the in-house addiction recovery program, are in R block. Immigration and Customs Enforcement inmates are held in K block. As the only Spanish speaker on the counseling team, it is my job to interview all of the inmates in K block. The women are housed separate from the men in blocks X, Y and Z. When they walk the hall to go to the gym or the library, the men bang the window and wave, and the women look up and wave back.

W block is for suicide watch. Inmates on suicide watch are placed in isolation cells and checked by a guard every 15 minutes. Their clothing consists of a “turtle suit,” a cardboardlike cloth that cannot be twisted into a noose. They are given finger foods only; plastic eating utensils are not allowed. Neither are books. The pages could be torn out and stuffed in the mouth to cause suffocation. The inmates can watch a television through a window in their cell door. They are allowed out of their cells for a few minutes each day to take a shower, under observation.

Counselors interview patients on suicide watch as soon as is practicable. Some of these patients have a history of schizophrenia. Some are detoxing so heavily that they act schizophrenic. Others are bipolar and in a manic or depressive state. Sometimes patients on suicide watch scream or sing loudly or beat on the wall.

They say a picture is worth a thousand words. I know the textbook definition of schizophrenia. It is a breakdown in the relation between thought, emotion and behavior leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation. With all those words, my picture of schizophrenia will always be a guy on suicide watch in a green turtle suit who stuck a toothbrush up his rear end.

A dumping ground for those in need of help

Sometimes patients on suicide watch get placed in a mental hospital. Our state used to have an extensive network of mental hospitals, but most of those facilities were closed during budget cuts decades ago. Today, many people who are mentally ill who previously would have been hospitalized end up homeless. Sooner or later, many of them land in jail.

“Rogue and vagabond” is the legal euphemism for a homeless person. Jails have become a dumping ground for those who are homeless, those who have addictions and those who are mentally ill. Although we are thoroughly under-resourced to deal with all of these individuals, it is our job as mental health counselors working in a detention center to do whatever we can for them.

Our staff includes a part-time psychiatrist who can prescribe psychotropic medicines. Out of hundreds of inmates, our patients appear on the mental health radar screen for a variety of reasons. They may have a prior history of receiving mental health treatment or psychotropic medications, or they may have a prior mental health diagnosis, which we learn from the screening form. In other instances, a patient may ask to see a mental health counselor. Patients suspected of needing medication are evaluated by the counselors, and we make an initial determination of whether they should see the psychiatrist. The psychiatrist determines the official diagnosis. Patients diagnosed with schizophrenia, bipolar disorder or major depressive disorder, or who act out bizarrely, receive a treatment plan and special attention.

Among the jail’s general populations, we expect to see issues of alcoholism or addiction in about 80% of them. My prior work in addictions recovery has served me well in this environment. I share pictures of brain scans from Dr. Daniel Amen with the patients. A normal human brain looks like a soft buttery mass. The brain of someone with alcoholism or addiction looks like Swiss cheese, with large “holes” of areas that are nonfunctioning. The brain of someone addicted to heroin looks like a sea anemone, with dangling tentacles of functioning areas and large masses between of nonfunctioning areas. Patients are often shocked when I show them the impact their substance use has had on their brain.

The point of drug use is to stop the brain from functioning properly. Most of the patients I see carry painful memories deep within them — memories so painful that they cannot hold them in conscious memory and go about living a normal life simultaneously. It isn’t hard to spot the source of their pain. I will ask about their mom, or their dad, or their childhood, and the stories typically come spilling out.

One young man told me he had once hoped to be an astronaut. I asked him why. He said that when he was younger, he asked his mom where his dad was, and she told him that his father was on the moon. In truth, 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 experiencing 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 shared his story with me of addiction and repeated encounters with the law. I said, “I am going to make a wild guess that you had a rough childhood” — a line I often use to begin digging into a patient’s past.

His response surprised me. He said, “You’re the first person who ever noticed.”

Encouragement to look forward

The disciplinary block is the A block, known in jail as “the hole.” Fighting with another inmate may get you 10 days in the hole. Fighting with an officer can get you 50 in. Inmates in A block are given “23+1,” or 23 hours per day in their cell, one hour per day out into the block, one person at a time. No outside contact is allowed. There are no visits, no phone calls, no participation in the classes that are sometimes offered to the general population.

Isolation is punishment, as it is meant to be. As a mental health counselor, my concern with the guys on A block is the tendency to decompensate, to go into the deep and dangerous depression that extreme isolation can create.

One young man who had been on A block clearly showed signs of decompensation. I learned that he had been the valedictorian at his Philadelphia high school before being arrested in a 24-person drug bust. He was intelligent. Our conversations covered such diverse topics as Federal Reserve 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 jail library that might help bring him back up. I eventually gave him two books. One was a book of jokes. The other was Man’s Search for Meaning by Viktor Frankl. In it, Frankl discusses his time as a Jewish Austrian prisoner in a Nazi concentration camp.

Frankl observed that it is not the outward circumstances of our lives that determine our destinies so much as it is the attitudes we choose to take toward those circumstances. Frankl withstood his concentration camp experience by taking the attitude of an observer of how humans survive in the most extreme circumstances.

My young patient got the point. As bad as his circumstances were, his mental and emotional state were determined by the attitude he chose to take toward his circumstances. He was excited by his new understanding, and his excitement was enough to pull him out of his depression. I had taken a gamble with him and won.

One of the hardest stories I have heard belonged to a man in his early 40s whom I first met on suicide watch. He was arrested for being rogue and vagabond, was intoxicated during his arrest, and had a history that included a suicide attempt.

The man’s story unfolded in fragments over the weeks and months that we worked together. It was like slowly gathering the pieces of a jigsaw puzzle until a full picture emerged. As an 8-year-old boy, he had been held by one of his father’s hands while his father used his other hand to pull out a pistol and unload five bullets into the boy’s mother. A cousin heard the commotion, came around a corner and shot the boy’s father. The father then turned the pistol on the cousin and shot him, still holding the hand of his son who was frozen beside him in shock. Another cousin grabbed the boy and took him to her home next door. From the living room window of that home, the boy watched as all three victims were loaded into an ambulance. Remarkably, each of them survived.

The boy was deeply scarred from witnessing the scene, however. Nightmares of what had transpired continued throughout his life, including during his time of incarceration.

The boy grew up, eventually married, and had a son. One evening, while arguing with his wife, he pulled out a pistol and would have shot her in a reenactment of his nightmares had his mother-in-law not intervened and stood between them. Unable to control himself, he took the pistol and shot into his abdomen. This was the suicide attempt noted on his record.

The man’s life was marked by episodes of violence, as was his son’s life. The son got involved with gangs and was murdered in a gang fight, having his neck sliced nearly through.

When I met the man on suicide watch, he had a new girlfriend, and a second son had been born to him. He had a second chance at fatherhood. He could determine to live in the past or in the present. His newborn son needed him.

I said to him, “You can’t drive a car with your eyes firmly fixed on the rearview mirror. At some point, you have to look forward.” He later told me that comment was the turning point for him. He realized that he had to stop looking backward constantly. If he wanted his newborn son to have a chance at life, he had to look forward.

He worked hard on his issues and took the recovery program. Over our months of working together, he grew able to speak openly about the events he had suffered. Recently, he was released to a halfway house. Maybe the demons within him have finally been exorcised.

To the police, he was a drunken man on a park bench. To me, he revealed a life of trauma and tragedy that was the underlying cause for his behavior. That is our work as counselors — 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 shuttled from one juvenile facility to another until, at age 19, he landed in an adult jail. He shared with me the story of witnessing, when he was 12, his cousin gunned down in the street and the life of fighting and violence that had followed him ever since.

I have worked with people who were pimps and people who were prostitutes, people who had molested others and people who had been molested, people caught in unhappy marriages who had assaulted their spouses, and countless people with addiction or alcoholism. With each, I have heard a similar story of unresolved grief, tragedy and trauma. Sometimes I can help them. Sometimes that is limited to helping them maintain their emotional balance while they do their time in lockup. Most seem grateful to meet someone who will at least listen to their story. Sometimes giving them a chance to vent is all that I can do.

Sowing seeds

At 5 o’clock, I pass through the three steel doors and walk out of jail. I am free to drive to my apartment and wonder about the impact I may have had. I think of the Parable of the Sower found in three of the four Gospels in the New Testament. Some of the seed from the sower lands on rocky soil or other inhospitable places. But some of the seed falls on fertile soil and takes root.

We do what we can as counselors. We try to do no harm and pray to do some good. There is a line in the Talmud that says he who saves a single life, it is as if he saved the whole world. And, so, we do what we can inside the jail, one person at a time.

In the evening, I am free to have dinner with my kids, play my guitars, sleep in a comfortable bed. I can go shopping when I want, soak in sunshine, breathe fresh air, go to yoga classes.

Tomorrow, I will pass 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 graduate professional counselor working as a mental health counselor at the Frederick County Adult Detention Center in Frederick, Maryland. He is a graduate of the clinical counseling program at Loyola University, Baltimore. Contact him at jrose007@comcast.net.

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