The Prisoner's Resource State

He was in his twenties and did not seem to know a great deal about crime when I met him on one of the yards of a California state prison. The general physician of the yard had correctly pegged him as a scared kid (age 24) who really did not even know how to get along in the prison. He looked pale and sad. He was in for drug charges. Not just possession; he had been trying to make some money by trafficking. He said it was to pay his mother’s medical bills. He may have spoken truth, or he may have been a liar. Sometimes I can’t tell, at least not right away, and sometimes that is simply not the most important thing to know. He was sad, and had said something about suicide. When he found out that such statements were taken very seriously in the prison and could lead to a solitary cell, he recanted quickly and thoroughly, and ended up sitting in a room in the medical clinic part of the yard, with me, and with a student of osteopathy who had no previous exposure to psychiatry but seemed incredibly eager to learn.

It did not take much questioning to figure out he was an obvious candidate for antidepressants. He had what they call the “neuro-vegetative” signs. Trouble sleeping, trouble with has appetite, trouble concentrating on reading, low energy level when he tried to get some exercise. Although he admitted to having used drugs in the past, it had been more experimentation than chronic use. He did not seem to have been using any drugs at the time I saw him. No mania, no abnormal mood swings, no psychosis (at least not hearing voices nor seeing things, nor any obvious delusions or false beliefs). I had some screening blood tests drawn and they were normal. Meanwhile I had started him on fluoxetine (Prozac) because it was, in my opinion, the most robust of the antidepressants available to me in that setting. I turned aside to the osteopathic student, and explained quickly what I had done, and why.

Most of the time an antidepressant takes more than a few days to make its presence felt. Appetite, sleep, usually get straightened out first. Then concentration, energy. We were watching him as closely as we could, since I felt he had been sincere when he had first mentioned suicide.

I wanted to do something to help him before the antidepressant kicked in. I did not like to see him suffer.

I remembered the notion of a resource state from my brief training in Neuro-Linguistic Programming. I asked the patient’s permission to cheer him up with past memories, and told the student he was going to see something a “normal” doctor or psychiatrist would probably not have done.

I asked the patient where and when he had been the happiest in his life. He was so open, it was easy to get his mind back to the place. It was a small town in Mississippi, of which he assured me, correctly, I had heard nothing. The name was something like Bowdoin, Mississippi. He remembered he was with a girlfriend, out behind her father’s farmhouse. It was spring.

I made him describe that scene in detail, until a pink color came into his cheeks, and almost a bit of a smile on his lips. Usually I have to prod people to come up with this sort of thing, but he had a great imagination and it was not hard to get him going on his own. His eyes were closed and his mind was in Mississippi.

He was lying in the fresh green grass, the first grass of spring, and the birds were singing and his girlfriend came to join him. The sun was gently warm, and the grass was dewy, barely damp, and there were squirrels, playing, storing nuts, and he loved watching them scamper about, and there were flowers. By that time he got to the smell of the air after maybe a little bit of rain.

His mind was in Mississippi, until he opened his eyes. My student was staring open mouthed in amazement and I was smiling, too. But suddenly a tear, a patient’s single tear, went down his cheek.

“I don’t think I’ll ever see Mississippi again.” I told him he was too young to think that, his sentence was not forever, nor was his parole, and if his folks were in Mississippi, maybe he could try to get it transferred.

He started going on about things prisoners rarely share with their psychiatrists. Gang involvement intrigues that put him under constant pressure and constant fear, subjugation by other prisoners. His life had been threatened. He did not expect to survive long after he left prison; might not make it out. I took notes on the back of one of my usual medical note sheets, for I did not even know if this kind of stuff belonged in a medical chart. I carefully documented what he told me, putting only a single summary sentence in his chart. “Inmate discussed possible gang involvement and internal prison stressors with this examiner.” I told the prisoner what I was doing and he was really scared. I reassured him as best I could. I only knew one way to reassure him that could work.

“This is the best way for you to see Mississippi again.” Until, then, he wondered what he could do. “Mississippi is in your brain forever,” I told him. I explained that all of life’s experiences have places in the brain where they are stored forever, and any time he wanted to think about Mississippi, he could be there as much as he had been there with me for a few minutes in the office. He was worried he would be picked on or interrupted, if he sat somewhere with even a hint of a smile on his face. I just told him to do the best he could, that I would be working for him. He said he could only believe me now, and I told him I would say whatever I had to in order for him to believe he could trust me, because he could. My osteopathic student sang my praises, which strangely enough helped a lot–even though I had not spent much time with him before this encounter and would spend little in the future.

I told the student to share these revelations with nobody; he agreed, and I had no reason to doubt his words. I was able, somehow, to get him into some kind of protective custody immediately. I told my supervisor what was going on and went to an office on the yard where I had never been. A kindly officer reassured me that this situation was not without precedent, and would be handled. He would talk in confidence with the prisoner right away, and he would indeed be protected. I was told the prisoner I had reported would be transferred for his own safety, and would do just fine.

I suppose he did, for I never saw him again. I commented about the case to a friend in psychological services, who told me I should never do hypnosis with prisoners, because this was inappropriate with prisoners and took away their free will. It was not hypnosis, at least not in the strictest sense. I suppose every time someone watches television and gets involved enough with what they are watching to forget where they are, you could call that “hypnosis.” I could have argued that the inmates were hypnotized when they watched television, which they did often. I had taken away no free will, but rather I had actually helped someone who was frightened regain his self hood, maybe even his life. The response of that friend that was typical of the kind of attitude that made me leave the prison system. After that experience, I did not bother to tell other staff members about it. Most of the time I said or did anything and discussed it even offhand with other staff members, they would see me as naive and idealistic, even if they grudgingly accepted me as knowledgeable. Of course, I did have the reputation of being “unflappable.” I could handle horrible things without expressing horror in an obvious way. I guess that is at least part of why I ended up doing a fair amount of work for the state prison system.

Sometimes I even had flashbacks to my first day in the prison system. My then supervisor, a master of politics who insisted he got more done in his conferences with the warden than I ever would seeing patients, was always correct. He told me on the first day that I needed to accept that I would never cure anybody. He told me I had to understand and accept the power of the custodial personnel. I quickly appreciated his words.

I did all kinds of paperwork for my young patient, and he was quickly transferred. I asked to know when, and it was less than two days. I have taken care of a few patients in prison who were subjugated and abused by other prisoners. Usually a supervisor notified me; this patient is the only one I can think of right now whom I found all by myself. I was impressed that folks in the prison system generally tried hard and were dedicated. The prisoners generally thought of the health professionals and friends and allies. I did paperwork several times in my prison career to get the subjugated transferred to units where they could be safer. I always had to do extra work in order to do it, usually paperwork which I hated more than anything, but I found the system really helpful in this kind of situation. Of course, I never saw these prisoner patients again after I got them transferred. I was really nothing more than a cog in the wheel.

They call it “third party psychiatry,” or at least they did then. In prison as in the military, maybe even during my admittedly brief time with an HMO, I have worked for systems as well as for the patient. It is not as “pure,” somehow, as when I am in my private office, alone with a patient, where my abilities to help my patient seem limitless. Actually, there are always third party factors, employers and families who are not in the room with my patient and me, but I can definitely do a lot more for folks if I am not part of a “third party.”

Sometimes, the greatest satisfaction is that of having been a cog that actually worked, even for a little while.