Monday, January 29, 2007

Feline Felons Released to Home Detention

Anybody who knows me will know I can't resist a story like this. It combines cats and prisoners, two of my favorite topics. (If you could figure out a way to work chocolate in there we could have a trifecta.) Here's the story from CBS news:

Vermont Prison Paroles Cats

Apparently the women in this particular prison took to caring for the various strays that took up residence there. It's not clear what actually precipitated the decision to find free society homes for these cats, but they've gradually been giving them away (after appropriate spaying or neutering).

When I first read this story it reminded my of my long-ago post Paws For Reflection where I blogged about my favorite drug detection dogs. (Can you believe our blog was only two weeks old back then?) These cats don't have any institutional responsibilities other than to be loved and adored by the prisoners. Rough life. Don't they know prisoners aren't supposed to be, coddled...even if they do have fur?

My other thought was: "Gee, don't they know that 'cruelty to animals' is one of the diagnostic criteria for antisocial personality disorder?" And indeed, one poor animal did get his fur burned off by an inmate. (What are the chances that inmate was given a written infraction for that?)

And so they are off to home detention. I'll give them the traditional prison send-off:

"Be safe out there."


alwaysthegoodgirl said...

It's me again, the third year med student who is seriously thinking about being a psychiatrist. I have a few questions, and I know they are sort of vague. And I realize you all three do different things. But, what is the hardest part of being a psychiatrist? And what was the most difficult aspect of your training? Are you ever deeply disturbed by your patients and things they have done? Or do you "get used to it" over time?
Any of you who have the time to respond to any of those questions would be greatly appreciated.

Sarebear said...

"Who Let The Cats Out" Meow, Meow-Meow ME-Ow!

Kitty version of that dog song going through my head!

ClinkShrink said...

For me the hardest part about being a psychiatrist is putting up with the stereotypes about the profession, particularly when they come from other physicians. There's still a lot of basic misunderstanding and lack of information about what mental disorders are and why it is so important to treat them.

The hardest part about the training was the part that is common to all specialties---the staying up all night on call part. Granted my residency was a while ago (before the ACGME started putting limits on consecutive hours worked) but I can still vividly remember those 36+ hour stretches in the emergency room. Eeesh. My training program also required critical care experience during internship, which actually I enjoyed because I had a terrific attending and my fellow residents were a stitch.

As far as being disturbed by the things my patients have done, remember that most psych patients never get into trouble with the law and are not criminals. If you work in public psychiatry you'll be working with people in the lower end of the economic spectrum and these folks have substance abuse and legal problems. What you find out eventually is that true evil does exist but it's pretty rare even in prison. My patients get into trouble because they're poor and sometimes not too bright rather than because they're evil.

alwaysthegoodgirl said...

Clinkshrink, thank you for your response. Your comment on true evil being rare, even in prison is sort of what I was looking for. I can see how many would end up there for being poor and not too bright.
When do you interact a lot with physicians from other specialties?

ClinkShrink said...

In the correctional system our primary care docs come from many specialties: family medicine, internal medicine, an ob-gyn doc (in the women's facility of course), and surgery. I do consult-liaison work in the prison infirmary and interact with them there.

Midwife with a Knife said...

clink: Just curious (so I can avoid marginalizing my psych colleagues who do good things for my patients so that I don't have to tear all of my hair out), what do other physicians do that causes you stress? Or, put another way, specifically what is it that gets on your nerves?

Sarebear said...

Hey Clink! There was a prison shrink character on Monday's episode of Heroes.

I thought of you!

They have that multiple personality disorder storyline thingie going on.

ClinkShrink said...

MWAK, I'll give you my classic set-my-teeth-on edge colleague quote:

"I do tests to make sure there's nothing really wrong with them, then I send them to the shrink."

Implying that psychiatric disorders aren't 'real' problems. Or the more classic dismissal: "It's something supra-tentorial." (Translation: I didn't learn enough psychiatry in medical school to even begin naming a diagnostic catergory.)

But on the positive side, they actually are referring these folks.

Sarebear, my favorite TV prison-related character these days is Haywire from Prison Break. Haywire is a psychotic inmate who escaped with the rest of the Prison Break cast. At first he was supposed to be out of control & dangerous but in free society he's turning out to be a good although naive & innocent guy. Very cute story line.

Dinah said...

To Jessica,
I've been thinking about your questions. We have started a 3 blogger post on the good things about being a shrink.

Hardest part of being a shrink: When someone comes for a therapy session and doesn't have much to talk about. It can be a long hour, or one of my asking questions.

I hate it when patients don't show up for appointments, (see my post called No Show from months back), but I wouldn't say that's "hard" just annoying.

Most difficult aspect of training: I agree with Clink: sleep deprivation on call.

I am never "deeply" disturbed by my patient's actions. See old post called The Patient as Criminal, or something like that.

Mostly, patients are appreciative, if they are angry, they funnel their anger elsewhere, but occasionally someone funnels it towards me, and that is unpleasant. See, The Angry Patient. I should look these links up for you, they are just my random feelings, but you asked.....
Periodically, I'll have a patient who needs a lot, meaning many calls a day for a protracted time, and that can be hard. I like being needed, but not too much and sometimes it can be draining.

I don't personally care about the field's stigma. I don't like that it is hard on patients, but Clink takes this particular aspect more personally than I do.

I mostly interact with other specialists at dinner parties. Rare phone calls, the only thing I find annoying is if a primary care doc changes a psych medication and I've trained my patients not to let them do this. If they belittle my work, they don't do it to my face. Most are happy to have the mental health burden lifted.

MWAK: you've mentioned treating post-partum depression. My suggestions: ASK and refer any one who is suicidal, homicidal, hearing voices, or delusional, and people don't volunteer this stuff without being asked. Ask if they think psychotherapy might be helpful (people vary with their desire for and openness to therapy) and refer them if they want it. If you're otherwise comfortable, treat with one medication, long enough at a high enough dose, and if that doesn't work, refer.
dinah's guidelines. don't sue me.

Dinah said...

And note to Clink: at least they did the tests to 'make sure nothing was wrong.'
I love when I get 50 something year old men with cardiac symptoms, preemptively diagnosed with anxiety and sent to a shrink without a cardiac work up first.

alwaysthegoodgirl said...

Clinkshrink- I heard the "It's just supra-tentorial" comment so many times when I was on my surgery rotations. It made me want to smack each person who was saying it.

Dinah- Thank you for your answers. I will have to check out those posts you mentioned, as I only found this blog a month or so ago.

I am doing my Family Medicine rotation now, and the same question keeps popping up in my mind, as it did on my Pediatrics rotation:

At what point should/does a primary care doctor refer a patient to a psychiatrist? I have never seen one do it so far. I had terrible depression and anxiety for years, and one "fresh out of residency" primary care doc told me I needed to go to church, relax, and think about whether or not I really belonged in medical school b/c I may not be cut out for it. I asked him if therapy would help me, and he told me "therapy is pretty useless."

One year and another primary care doctor later, I started seeing a therapist and a psychiatrist. And, guess what? I feel 500% better!

It just kills me that the stigma exists for patients, it is hard to admit you need to see a shrink. But to have other doctors tell you it's not worthwhile...that breeds hopelessness.

Sorry about that rant. But, I appreciate your candor in answering my questions. Your blog is awesome because you represent so many areas of psychiatry. I am going to start reading your archived posts as soon as I get time.

Thanks again!

NeoNurseChic said...

Part of me wonders if having pets in the prison might not be therapeutic for the prisoners... Petting a cat reduces your blood pressure. And everybody needs to know they are loved...and a cat purring is like...instantaneous love. I think that people feeling as if they aren't loved is a big reason why people make bad choices sometimes... (Not generalizing that to all prisoners by any means, but I do think that feeling that nobody loves you can contribute to certain attitudes, actions, behaviors...)

BUT - once you wrote about the antisocial personality and the burning of cats, the other part of me said, "Yeeeeeeeehhh.....get them out!!!" I know I've said this before, but that's the one thing I'll never forget about the peds unit in the psych hospital where I did my clinical rotation. Those children looked so innocent - and then I learned of various things they'd done. One nurse said to me and another student that "pets don't stand a chance in these homes." It really saddened me... I mean - if kids had such pain inflicted on them that the only way they could cope was to inflict pain on another living thing...and the only living thing they could assert power over was a pet....what a sad world. And then the other thing that was really hard for me was that many of these kids seemed fine when they were inpatient. However, they'd go back to their same environment and do all the same things again and then be sent back to the unit. How could things ever change unless some of these kids were placed in different environments, which wasn't always indicated or appropriate? Heartbreaking.... I'm a "fix-it" type person, and that was just really hard to be a part of - a lot of the kids seemed so "normal" when I'd talk to them. And I'm sure the security, safety, and routine of the unit allowed for this more subdued behavior...but how sad to think that many of them would not make it once they returned home, and simply come back again and again and again. And I've heard that people don't like working there because the kids are too wild and too much of a handful, but what I witnessed...compared to what brought them there....these kids seemed like angels. And maybe that's also because I used to volunteer in early intervention, where I saw so many kids with ADHD that it wasn't even funny...

Pooor kitties.... Kinda a funny story that they've been sent out into free society. Hope they can handle it! Every once in awhlie, I think Tony needs a day in juvey to see if he straightens up! haha j/k of course! ;)

Take care,
Carrie :)

sophizo said...

I think these comments show how helpful it would be if you three did some kind of Q&A. Maybe set up an email address (, give us a week to send in questions and then answer some either on here or on the podcast. I'd be curious to see what questions you would get.

Midwife with a Knife said...

Dinah: That's pretty much what I do. I always ask about stuff like suicidality, psychosis, delusions. I encourage people to at least consider psychotherapy referrals and referrals to psychiatrists. I've been surprised at how frequently women have weird thoughts/delusions about their babies, and how common some sort of suicidal ideation is.

I enjoy amateur psychiatry but I'm not delusional enough to think I'm anything other than an amateur psychiatrist.

Clink: I learned nothing about psychiatry in medical school (despite the fact that I tried). I've enjoyed the psych stuff that I make a part of my practice enough that I wonder if I had learned something about psych in medical school if I might have made different career choices. Ah, well. The brain/mind is a fascinating thing. :)

Steve & Barb said...

Sophizo-great idea about answering questions. We would only be able to pick a couple and would not be able to answer any individual clinical questions (eg, could my itchy teeth be caused by my prozac?).

sophizo said...

Roy...I would NEVER suggest you guys answer clinical questions. I'm thinking more along the lines of the kind of questions that were posed here. Some of them I never would have thought to ask, but the answers were very intriguing. That is why I suggested an email address so you guys could pick and choose what you wanted to answer.

As you are well aware, there's a lot of stigma associated with psychiatry and this would be a good way to get some of the truth rather than the rumors. I used to hate your profession with a passion until I worked for a psychiatrist and saw that most of my beliefs were false. I think a Q&A would be quite helpful in tearing down some of these long held beliefs that are wrong.