Tuesday, September 26, 2006

Liar! Liar!

Well, it's finally happened. This morning I officially discontinued treatment on more inmates than I provided treatment for during my morning clinic. Policy dictates that if you don't show up to take your medicine for three days in a row, it gets stopped. If an inmate signs a refusal form, treatment gets stopped.

I'm still trying to figure this out. These guys come in from court complaining about how prison "isn't going to help me." They get screened for medical and mental disorders at the front door. They get enrolled in chronic care clinics for medical and mental disorders. They're provided treatment and all of this is done automatically, without having to ask for it, totally for free.

And then they drop out of treatment.

All they have to do is go to the pharmacy window to pick up their medicines. All they have to do is keep their appointments. All they have to do is show up. Treatment requires almost no responsibility on their part.

And they drop out of treatment.

I suppose I should be more sympathetic. I know that a decision to accept or reject treatment in a correctional facility is a complicated one. Accepting treatment means taking the risk that someone else may find out you're 'crazy'. It means potentially being turned down for institutional jobs or other programs because you take medication. It means having to admit that you really do have a disease that you'll have to deal with for the rest of your life. It means dealing with the frustration of coming down for Pill Line every day. And it's not like my patients are known for their good judgement.

But before I even start treatment I talk to these guys about all this. I ask them if they're willing to do it, and they promise me they are. Then they stop taking their medicines a week later. I wish I had some way of knowing who was being sincere or not because then I would be able to focus my resources on the ones who truly want help. If they said to my face that treatment was a waste of time and they didn't want it, I'd respect that decision. I'd remind them of the consequences of noncompliance and how to get back into treatment when the time comes, but I'd respect the decision.

So some of my patients lie to me about their compliance. Liars? In prison? Shocked! I'm shocked, I tell you.

I just wish it didn't require so much paperwork.


Dinah said...

Greetings from Free Society. So glad I don't have to terminate with every patient who is non-compliant for three consecutive days.

MT said...

Taking psychoactives and opening what drives you to debate is the ultimate act of surrender. What these guys see and wear and eat--and when they do it--all are dictated to them. The only thing free, they hope, is their minds. Even as they behave obediently and conform I bet most probably cherish the ambiguity of why and what it means to them. Also, to the extent avoiding harm requires you to look self-assured all day and every day, I imagine you don't want to discover flaws in your deepest premises. Having to deceive others without deceiving yourself is a huge handicap.

MT said...

i.e. "cherish the ambiguity" that their behavior presents to others re: why they slavishly obey and conform to prison rules or concede to pass the ketchup to the scary guy in the corner.

MT said...

Also, why should a prisoner trust a prison-assigned shrink? How many have a model from their own lives that they can apply to what motivates a prison shrink and conclude "all she wants is to make me happy"? Especially when I think what'll make me happy is to go fuck people up and steal money for a fancy car. That's what it's all about on TV (the fancy car part, at least).

ClinkShrink said...

Re: "Having to deceive others without deceiving yourself is a huge handicap."

Well said. And yes, getting over the distrust is a huge hurdle. Fortunately it is possible to do, if you treat them with respect and keep your word.