I believe that addiction is not a weakness of character or lack of willpower or absence of moral fiber, as society likes to portray it. It is not a choice. It is a response to several adverse factors over which we have far less control than is generally believed.

Unfortunately, society treats addicts as scum. The public can be forgiven for their harsh attitudes because of the way addicts are portrayed on TV. Addicts often cause much grief to their families and friends. It is no surprise that large numbers end up in prison for numerous reasons. I am writing this for addicts themselves and all persons with compassion who wish to help someone suffering from addiction. This is no easy task.

Many are victims of trauma such as sexual or physical violence in childhood. On the other hand, the opioid crisis in the USA affected people of all races and from all walks of life, including folk brought up with loving care. Most were given the drugs to treat painful injuries (arguably another sort of trauma), unaware of the consequences. Many military veterans returning from duty in the Middle East returned as opioid addicts where the drug was freely distributed for first aid use.

Addiction is not just about substance abuse with drugs, alcohol, sugar, junk food or nicotine. It can also be behavioral, as with gambling, porn, sex and technology. The type of addiction and severity is different but the underlying causes are not.

Is addiction a disease?

The model of addiction as a neurological disease is still controversial but slowly gaining acceptance. Brain imaging techniques show exactly what changes take place in the brain. The central nervous system is affected and concerns a neurotransmitter called dopamine, the body’s natural reward system that makes us experience pleasure. We evolved that way and the body releases dopamine to let us know a particular action is good for our survival and to remind us to do it again. 

The evolutionary aspect explains a lot. A kind of hierarchy of survival was established with food at the top followed by water and sleep. Food releases more dopamine than the next two. Drugs, alcohol and junk food can actually fool the brain into thinking that those substances are so important that they replace essential functions in the hierarchy. That’s why so many drug addicts are thin and pile on weight when they recover. 

In short, the brain’s reward system becomes so over-stimulated and demanding that the person can only give in to their harmful urges and impulses. 

Addictions to online games and our smartphones may not seem like a big deal but often prevent us doing more important things and can harm our jobs and relationships. Judgment and memory are also impaired as with substance abuse. What looks like a choice to other people is anything but. Habit takes over from conscious thought. The brain is essentially hijacked.

Medications such as buprenorphine (for drugs) and disulphiram (for alcohol) are used to help with withdrawal effects, but I’d be surprised if many prisons outside Scandinavia supply inmates with these. In any case, medications alone are not enough without psychological support and talk therapy.

The experts who disagree with the disease model usually do so on the basis that the classification itself is not helpful to an addict and stigmatizes them even more. If it is a disease, it sets them up for a relapse. The effectiveness and necessity of medications is disputed. They claim that the brain changes all the time and that addiction is only another pattern of learned behavior which began with a choice to smoke the first spliff or drink the first beer. 

What they fail to do is suggest an effective alternative treatment method which does not involve the medical profession. The vast majority of addicts would agree that willpower alone is next to impossible.

What makes a person an addict?

There would appear to be different factors at play here. The most important is genetics. When someone says they have an ‘addictive personality’, this is often more than just an excuse and true for well over 50% of all addicts. This does not mean they will definitely become addicts but they drew a short straw. As with other mental illnesses, persons with bipolar disorder (formerly known as ‘manic depression’) often inherit it from a parent and are particularly vulnerable to addictions. It is often found in sex addiction.

The second is social environment. A person who has a stable relationship, a good social life and is doing well in their job will be getting plenty of natural dopamine reward without needing to seek out more. However, a withdrawn person without a lot of positives in their life is far more likely to succumb to drugs and alcohol.
The third is development. The frontal cortex of our brain is not fully formed until our mid-20s. This makes teenagers especially prone to risk-taking and vulnerable to unnatural releases of dopamine. There are many calls for more intervention among under 21s. 90% of addicts become addicted while in their teens because their brain is not fully formed therefore more susceptible to getting hijacked.

Teenage years are stressful for the vast majority of us, male and female. We are struggling to find our identity. Even in families without emotional or sexual abuse issues, poverty is rife these days. In addition, parents may be constantly fighting, be addicts or have mental health problems themselves, and have little time or energy to forge a good relationship with their children. This can lead to feelings of neglect, worthlessness, social anxiety and many other problems. School is rarely a barrel-load of fun and made worse by factors such as bullying and bad grades. Alcohol and drugs can become the only escape and from that point on, things just get worse.

How to help someone with an addiction problem in prison

It is not unusual for hard drug addicts to be thrown in prison and left to go cold turkey. It is difficult to think of a more horrendous torture. Personally, I have suffered withdrawal effects in the clink from benzodiazapines (a prescription drug for anxiety). Walking up the walls is not an apt description. Aural and visual hallucinations are terrifying, and can continue indefinitely. Tolerance/dependence always sets in before addiction, so that you cannot just stop without avoiding those awful withdrawal symptoms. 

In addition, the ease with which illegal drugs find their way into so many of the world’s prisons is shocking. It is the worst possible environment to try and get clean (not the soap joke). What’s more, inmates who never took drugs before can become addicts inside and the problems that leads to can be far worse than on the outside.
The first thing the addict needs to do is to want to stop. There are milder addicts who simply do stop using willpower, but their number is tiny compared to those who cannot stop because they have already lost control. To enable an addict to stop, they need to be listened to and treated with sympathy. With the right support, it is possible. The listener needs a lot of patience and understanding. It is unlikely many of us are trained psychologists or counselors, so we can only do our best. Time is on our side. The addict needs to know that they can be cured if they are willing to set the process in motion.

Activities that can help an addict

Self-help activities for addicts are the same as for anybody with mental health problems. I will list a few:

1) Physical exercise

If your prison has a gym, you should consider signing up to use it. If not, there are many exercises you can do in your cage, starting with just walking on the spot. Squats would be the next best, regardless of age, although dependent on an individual’s mobility. If you cannot squat down to a parallel position, then even just a little way is better than nothing. Make sure your knees do not protrude over your toes. Push-ups are great upper body exercises for strength. If you are fit with no back injuries, ‘burpees’ are also excellent. None of these exercises require much physical space, which is in short supply in many prisons.

2) Yoga and breathing exercises

The Prisoners’ Abroad newsletters contain excellent yoga workouts. Exercises should be done in the order suggested, and each position can be held for a number of breathing sequences.

One recommended breathing pattern for both yoga and meditation is known as diaphragm or ‘belly’ breathing. It can be done lying on your back.

Breathe in very slowly through your nose. As you do so, inflate your stomach. It feels very unnatural at first, but with increased practice it can become your default breathing pattern. So, breathe in slowly for a count of 5, inflating your stomach as far as it will go. Now, hold your breath for a count of 3. Finally, breathe out through your nose or mouth for a count of 8, deflating your stomach as you do (there are slight variations to the count. This is the one that works best for me. Just make sure that the outbreath is longer than the inbreath).

3) Creative things

Art, writing, even making objects from scrap materials can be done in prison. Motivating yourself to do them is the hardest part, but such activities can provide a lot of useful distraction and satisfaction. Regular yoga and meditation will help your motivation.

4) Group activities

Any kind of group activity, whether religious, study or creative, will enhance your sense of belonging. If it is something you are truly interested in, you will meet other inmates you may be able to make a connection with.

5) Talking about your trauma

You cannot get rid of trauma unless you face the past. Many addicts feel a deep sense of shame and are often reluctant to talk about it, so may need to be coaxed gently. Many inmates are unwilling or unable to provide psychological support, but giving support is in itself psychologically beneficial to the supporter. 

6) Meditation

I kept meditation until last. In the absence of trained counselors, it is the most effective way of dealing with trauma and can be done at any time, just lying on your back.

When starting, aim for five minutes. Build up gradually to 25 minutes, or more if you wish. Use the belly breathing method I mentioned for yoga. Concentrate solely on feeling your breath. Other thoughts will enter your mind. This is normal. Notice the thought, and return to your breathing. The aim is to learn how to look at thoughts objectively, without attaching yourself to the painful feelings they evoke. Acceptance is a word often used.

When you become better at meditating which will take a few weeks for sure, you can start doing a common and effective visualization technique known as ‘loving kindness.’ Instead of listening specifically to your breath and the counting, picture all the people who have ever caused you grief floating out of your body in miniature form, with a large heart attached to their chests. Watch as they disappear slowly and gently up to the sky and are lost beyond the clouds, out of your life forever. Of course your demons will not disappear as easily as that but they’re on the right track, even if moving in the opposite direction to where we want them to go. If you do not feel a prat for saying it, you can add a simple ‘I forgive you’ to each person you visualize.

The principal aim of this meditation is to forgive everybody, including yourself, unconditionally. ‘How can I possibly forgive him/her for what they did to me’, you may ask. Well, you should, for your own benefit not theirs. By the power of forgiveness, we free ourselves from the grip certain individuals and past events have over us, and from the self-destructive feelings of bitterness and revenge. It makes it far easier for us to move forward positively and cast aside that burden of continual suffering. As if we don’t have enough of it already right here right now in the calaboose.

I am surprised how many inmates do actually recover from their addictions inside. It is not easy, but not impossible either. Why not start now.

Herbert Mitchell, Philippines 

It is impossible to be in prison and not feel sorry for yourself. We have far too much time to overthink and draw incorrect conclusions. Why me you tell yourself, there are far worse folk running around free outside doing much worse things than I could ever dream up.

Hard cheese. Life is unfair. The world is not the way we wish it were. The sooner we accept the reality of our situation the better, which is no easy task.

Feeling sorry for ourselves is very human. The term self-pity is less kind but more accurate. The problem is that it does not help us. In fact, it can unleash some very strong emotions which are not just unhelpful but can be extremely destructive. It is far more than just retreating into a dark corner and crying. Big boys do cry and it’s quite alright to do so depending on who’s around. The gig here is that we need to deal effectively with these feelings as soon as possible, because they can escalate rapidly into reckless behavior and chronic depression. Brooding on matters can only make everything worse.

As I find myself precisely in one of those moments right now, I decided to put pencil to paper immediately. I know this will help me because it’s a common occurrence, and hopefully it will help you too.

The kind of feelings I am dealing with may be familiar and are as follows:

• Frustration and anger against the whole world, directed also at certain individuals who I rightly or wrongly blame for my plight. Heaven help the next person who accidentally bumps into me.
• Resentment and a desire for retaliation and revenge, related to the above.
• Sometimes feeling negative towards my  parents for their behavior towards me as a child back in ye grand olde days. Also, blaming my spouse and other loved ones for not showing enough concern, even though they have no way of showing it because of the distance and lack of communication opportunities.
• A desire to make others feel bad by wanting to punish myself. This is like drinking poison and hoping someone else will croak.

The first thing we need to do is get a handle on these negative feelings. The best way to do this is through a breathing technique known in the trade as diaphragm or ‘belly’ breathing. 

To do this, lie on your back. Try and make yourself as relaxed as possible. Close your eyes. Notice the parts of your body where you are feeling the most tension. Then apply as much additional tension as you can, before releasing it all with a strong outbreath.

Next, breathe in very slowly through your nose. As you do so, inflate your stomach. It feels very unnatural at first, but with increased practice it can become your default breathing pattern. So, breathe in slowly for a count of 5, inflating your stomach as far as it will go. Now, hold your breath for a count of 3. Finally, breathe out through your nose or mouth slowly for a count of 8, deflating your stomach as you do (there are slight variations to the count. This is the one that works best for me. Just make sure that the outbreath is longer than the inbreath).

This can be done as many times as you wish, particularly when tension arises. When better times come along, you can make it part of your daily routine with 25 minutes or more every day. By becoming mindful i.e. concentrating and listening to your breathing, you are in fact meditating. 

When meditating, your mind will wander because it’s what minds do. Par for the course. When you realize you’re doing it, ever so gently bring your attention back to your breathing and the feeling of your stomach moving up and down. It is impossible to fail at meditation because it is not a test. 

When you become better at meditating which will take a few weeks for sure, you can start doing a common and effective visualization technique known as ‘loving kindness.’ Instead of listening specifically to your breath and the counting, picture all the people who have ever caused you grief floating out of your body in miniature form, with a large heart attached to their chests. Watch as they disappear slowly and gently up to the sky and are lost beyond the clouds, out of your life forever. Of course, your demons will not disappear as easily as that but they’re on the right track, even if moving in the opposite direction to where we want them to go. If you do not feel a prat for saying it, you can add a simple ‘I forgive you’ to each person you visualize.

We also need to do a similar meditation where we forgive ourselves. We can do this by conjuring up the image of the person we love most, feel the love, hold on to it and apply it to ourself. We are not perfect either. Like everyone else, we are products of our environment and DNA with the addition of some diabolical bad luck.

The principal aim of this meditation is to forgive everybody, including yourself, unconditionally. ‘How can I possibly forgive him/her for what they did to me’, you may ask. Well, it helps you come to terms with the past. By the power of forgiveness, we free ourselves from the grip certain individuals and past events have over us, and from the self-destructive feelings of bitterness and vengeance. It makes it far easier for us to move forward positively and cast aside that burden of continual suffering. As if we don’t have enough of it already right here right now in the calaboose.

A second useful tool is exercise. It does not need to be of Olympic qualifying standard. If you can, go outside for a slow walk and try using the same breathing technique as when meditating. Feel the wind blowing and notice anything else inherent in nature. Ignore the taunts from other crims telling you you’ll never get into the army.

Since walking activities are often out of bounds or not even possible at all for some of us, what we can do is stand up and walk on the spot. Briskly or slowly, whatever feels right. If you have the energy, you can add arm movements or even squats, clasping your arms over your chest or extending when you go down.

A third useful technique is writing. Start by writing down a list of all the things that are currently grinding your gears. Here are some examples:

• My wife informed me about financial problems I have no way of dealing with in my current situation. Why didn’t she just keep quiet about them.
• A fellow inmate annoys me so much I want to batter him.
• I should not be in prison. Even if I was guilty, I should have been let out ages ago.
• I can’t stand this situation any longer. I want to harm myself.
• My father was unnecessarily brutal towards me and is the source of many of my problems. I wish I’d shown him less respect and hit back.

Here is what you could write as a set of balancing statements:

• My wife cares about me more than anyone else in the world. The financial problems are not that serious anyway. She was just reporting, not berating. I would rather owe a few squid than be stuck in the clink.
• The inmate is autistic. I am not the only person who he annoys. As is so often the case here, they say his family got him thrown in prison because they couldn’t handle him.
• I can do nothing independently about being in prison. My new lawyer is excellent and working hard on my behalf. I can leave things up to him with confidence and optimism.
• I do not have to listen to that nagging little barsteward’s voice in my head. It does not represent reality. It is wrong anyway.
• My father was a good man and did the best he could. He had a lot of problems of his own. He treated me the same way his father treated him. He knew no better. Hitting back could have given me a huge guilt complex for the rest of my life.

If you have a person you can talk to about your difficulties, then why not talk to them. There is a very high probability they are experiencing exactly the same things, especially if they are also a foreigner. It is inconceivable that these feelings are exclusive to yourself.

I have two stray cats I communicate with more frequently than with any humans. They eat better than I do. When I am distressed I ask them for help but the only reply I ever get is “Me? ‘Ow??”

If you genuinely have no loved one or friends or pets in your life, don’t forget that there is someone who cares. These are the wonderful people who work tirelessly for Prisoners Abroad with help from other supporters. They understand the problems we face and will always do their very best to help, without judgement. As Brits, we are extremely fortunate to have access to this support because most other foreign nationalities don’t get a bean.

When I finally get out of this rat-infested hell, I intend to repay their life-saving kindness in as many ways as I can.

Herbert Mitchell

Philippines

All of us will be aware of the importance of doing regular exercise in prison, and the health risks of not doing any at all. Motivation is the key factor, but it can be devilishly difficult to find any if you are  depressed, suffering from an ongoing illness, or debilitated in any way which could include common injuries.

It must also be stressed that working out too intensely can be dangerous. Around 5 hours a week of moderate exercise is recommended by most leading health authorities. Daily exercise is good, but one or two days off a week will not be an admission of failure. The best advice you can give yourself is ‘listen to your body’ and recognise your limitations according to age, mobility and general health.

Inside prisons in developed countries, you probably have an exercise yard and gym. However, in a third world country it is possible you have neither. In my clink there is not enough space to swing a cat (but plenty of stray cats to swing).This means if we want to exercise regularly, we have to improvise.

Below is a list of activities you can do either on or beside your bed/mattress/flattened cardboard box which are unlikely to disturb anyone.

Yoga

The health benefits of yoga have been well documented. Most yoga poses stretch your muscles for flexibility and ‘massage’ your internal organs, while others use your body weight to build strength. Possibly its greatest benefit is supplying more oxygen to the heart. This is particularly important for any of us who have experienced breathing problems from contracting covid.

Our Prisoners Abroad newsletter frequently contains very good yoga workouts. The exercises should be done in the order they appear in the diagrams, since each one leads on to the next. You can hold each pose for as long as you wish. You can also make it a meditation by concentrating on your breathing. A common pattern is breathing in through your nose for a count of 3-5, holding your breath for 3, and slowly out through your nose or mouth for 8. There are of course variations and you can find your own method, but the exhale should always be longer than the inhale.

If like myself you have a lower back injury, you need to avoid any yoga pose which involves forward bending. With a knee injury, you should never put weight on the bad knee.  If any yoga pose causes you real pain, you should stop doing it.

Weight training without weights

Even without weights, it is possible to build muscle and burn fat just using your own body weight. For upper body, you can do press ups, paying attention to the spacing between your hands while keeping your body straight. Hands together will hit the triceps; shoulder width apart the chest; wide apart the shoulders. For any exercise, breathe out on the ‘effort’ part.

For lower body, squats are the best because you use so many different muscles at one time. With a lower back injury, you can start seated on a bed or chair which prevents you coming down too low. Knees should not protrude over your toes, and the weight should be felt on your heels. You can cross your arms over your chest or swing them outwards on each repetition.

The other good leg exercise is lunges. Start by kneeling on both legs. Plant one leg in front of you bent at right angles. Then stretch the other leg back. Using the ball of the foot on the back leg, push up and down a few times. Try and keep your back straight and do not move the front knee. Then do the same switching legs.

Walking on the spot

An interesting piece of trivia is that treadmills were invented in England as a punishment for inmates, while at the same time being used to pump water or grind corn. The word ‘screw’ for jailer was used originally for the treadmill supervisor who was able to make the inmate’s work harder by tightening a screw on the machine. This was a fate which befell the playwright Oscar Wilde.

Walking on the spot is not exactly a barrel load of fun either but moving your body around for a few minutes a day is definitely better than doing nothing. You can make the workout more intense by speeding up your walking pace and lifting your knees up higher. You can also use your arms, extending alternately as if punching, or curling as if using dumbbells. For variation, step from side to side. If you can do this to music, it is far less monotonous.

When restarting exercising after a long layoff, you should take it easy to begin with  and gradually build up fitness.

Finally, you do not have to do all your exercise in one go. Doing 4 times 10 minutes a day is arguably more efficient than a single block of 40 minutes, because of the frequent recovery periods you can allow yourself. This has particular value for older inmates like myself.

When I entered prison, I did not imagine being here 7 years later, or still alive. People talk about how it feels to hit rock bottom but this was a dimension below even that, like Orpheus in the underworld. I owe part of my survival to the amazing support I have received from Prisoners Abroad working through our embassy, and friends and family on the outside. The other part I owe to a complete mental readjustment I have had to make. This has been possible not only through the reading of mental health self-help texts and the practice of meditation and yoga, but by acquiring a basic understanding of different philosophies which have sustained those in the most terrible situations throughout the course of history.

I wish to share some of them with you and hope you find beneficial. I appreciate that not everyone will agree with the ideas outlined here.

1) Choose your friends carefully (Plato)

The works of Plato are still being read after 2400 years. His mentor was Socrates, who was given the death penalty for corrupting the youth of his day and refusing to worship the gods. Socrates, although the true founder of western thought, did not actually write anything.

An important lesson from Plato was to choose our friends carefully, since bad ones can exert a lot of negative influence over us. A good friend will always support us come what may. I would be surprised if there is a single prisoner anywhere who has not been abandoned by someone he had always thought of as a good friend, partner or relative. In prison, we are in a uniquely difficult situation since we cannot just walk away from our cellmates. However, we can choose to be cordial with everyone without compromising ourselves. We should also try to become reliant on ourselves rather than on any one person. A lot of us will have experienced that feeling of loss and sadness when a close associate is released.

Plato also wrote that there are two kinds of problems: problems that we can solve, and ones that we can do nothing about. If a problem is one of the latter types, we need to accept the fact and adjust our lives accordingly.

2) Change is inevitable (Buddhism)

I should start by saying that Buddhism is as much a philosophy as it is a religion. Many westerners use it as a guiding principle without ever entering a temple or monastery.

We have all heard the famous saying ‘and this too shall pass’. Buddhism teaches the impermanence of all things. Nothing is fixed in life or in the world. We know this also from modern physics – quantum mechanics teaches us that at the level of atoms and molecules, there are no fixed entities, only a perpetual flux of processes. A lot of unnecessary suffering is caused by holding on to a fixed view of ourselves and of how things should be. If we let go of that, and accept the truth that everything is constantly changing, then we stop trying to reach some mythical place where ‘everything is always fine and dandy’. This helps us to accept and deal with our present situation with equanimity and a greater sense of realism and insight.

For myself, the knowledge that the universe is not static is very helpful. Nobody can foretell the future but unexpectedly good things can happen. New evidence can get a wrongful conviction overturned; the Appeals Court can rule in our favour; early parole can be given; pardons can also be granted. We should never, ever give up hope of a positive change to our misfortune.

The Buddha was a prince from a wealthy family in northern India/Nepal who abandoned a life of leisure to learn and teach others the meaning of suffering through mindfulness meditation. He believed that suffering was caused by cravings and ignorance. Anything that causes cravings can bring only fleeting happiness and only leads to dissatisfaction. Ignorance does not mean lack of education but an inability to see the truth. Only by banishing cravings and ignorance can we attain lasting happiness (nirvana) through wisdom.

It is important to stay in the moment rather than dwell on the past or future. We should be generous and compassionate to others.

Meditation teaches us that we are not our thoughts, and we can train our mind to detach from the negative thoughts that cause our suffering. ‘Loving kindness’, a simple visualization type of meditation, can teach us to forgive ourselves and those who have harmed us (but this does not mean we have to like them).

From dirt grows a beautiful lotus flower; from misery, we can find happiness.

3) Conflict resolution (Stoicism)

Stoicism goes back 2000 years to the time of Marcus Aurelius, the last ‘good’ Roman emperor. His teachings are particularly useful for the situations in which we as prisoners find ourselves.

We should start by accepting that we are surrounded by difficult people, so we need to take them for what they are instead of wishing they could behave differently. Our expectations will influence our emotions, so we should expect conflict and be mentally prepared for it.

That fellow inmate giving us trouble will without doubt have his own problems with which he is failing to cope, and responding to hate with hate will only drag you down to their level. Just like external events, we cannot control what people say.

When somebody insults us, our reaction to the insult harms us more than the insult itself. A good way to deal with it is to recognize that it really does not matter. Let it go. We should not act impulsively but can just refuse to engage. The best revenge is no revenge at all. If we choose to respond to insults, we can use self-deprecating humour, or look at the offender with an expression of compassion.

Silence is a virtue, and we should refrain from talking too much, gossiping or judging others. ‘Actions speak louder than words is not only true but can inspire those around us to behave better. Helping others, even those who hate us, is one of the greatest virtues, and we should not expect praise or anything back in return.

The grass is always greener. We can live happily anywhere if we cut out the negatives. You need to ‘count your blessings’ and be grateful for what little you have. We must eliminate envy and realize that happiness lies within ourselves, not trying to achieve what others have already done. They could lose everything tomorrow – I know I did. Instead of comparing yourself to others, whose success you may covet, compare yourself to how you were last week and how much you may have improved since then.

Finally, we all have the choice to endure far more hardship than we think we can. It can only make us stronger.

4) Finding a meaning for living (Logotherapy)

Some of you will have read Viktor Frankl’s powerful work ‘Man’s Search For Meaning’. He was a clinical psychiatrist and Holocaust survivor, spending three years in Dachau and Auschwitz where the chances of survival were almost 1 in 50. He is founder of logotherapy, a type of psychoanalysis.

He saw his fellow prisoners as belonging to one of two groups. The first group was composed of those who gave up and either took their own life by clinging to the electrified fences, or succumbed to malnutrition and serious illness, particularly typhoid. The other group were the survivors. What he noticed regarding the survivors was that they were frequently not the strongest and fittest, but those who had found a way to cope mentally with the everyday horrors they faced. They had found a reason to live, a meaning to life.

This meaning is illustrated by two inmates he was forced to do hard labour with in the harsh, freezing conditions of a Polish winter. The first wanted nothing more than to be reunited with his son. The second was a scientist with unfinished works he wanted to share with mankind. For Frankl himself, it was to be with his wife. Even though he had no idea at the time she had already died, he said the vivid image of her in his mind would always sustain him. In other words, if you have a reason to live, you are far less likely to succumb to serious illness and deprivation and can put up with anything.

This leads to his second theme, that love is the highest goal to which a person can aspire. As prisoners, the image of our loved ones should always be with us. If you do not have a loved one, you can invent one, the person you want to meet in the future.

5) Accepting suffering (Existentialism)

The mid-20th-century French writer Albert Camus is a leading proponent of the philosophy of existentialism, also known as absurdism (he himself rejected this label, to distance himself from his contemporary Jean-Paul Sartre). He believed that we live in a chaotic, aimless, indifferent world. In contrast to Plato, he believes we are not born with an ‘essence’ which determines the person we become but are born without an essence which we need to find ourselves. The absurdity of life is perfectly illustrated in his essay where Sisyphus from Greek mythology spends all day pushing a heavy boulder up a hill. When he gets near the top, it rolls back down again.

The process of just repeating the same mundane action can itself become a source of happiness, which should be made an immediate not a distant goal. Most people strive for happiness through marriage, a house, a well-paid job, but this will never give us security because we will always want more. Sisyphus is an analogy to the modern age but we can think of him as being happy.

Existentialism may sound pessimistic but once we accept that life has no meaning, it gives us the freedom to ascribe to life any meaning we want. This meaning can be changed at any time, depending on life circumstances especially those over which we have no control.

Camus believed that ignorance is the root of all evil and that a little knowledge only is dangerous. We can see that today in the dissemination of fake news and misinformation. We need to educate ourselves to the fullest. This will enable us to enhance our critical thinking and reasoning skills so that we can come to a better-quality conclusion when dealing with any type of problem.

The existentialist view of pain and suffering closely follows the Buddha and Sigmund Freud. We are born to suffer, caused by our own body, the external world, but worst of all, our fellow man. However, suffering is a great teacher and gives us valuable insight into how to live our life. To deal with suffering, we need to
rebel against the expectations society has of us and find our own independent path. To help us to do this, we need to spend time alone in the moment to get to know ourselves better. The successful rebel is the one who has accepted that suffering is an inevitable part of life but refuses to let pain control them. When we hit rock bottom, the only way is up. Suicide and irrational faith are signs of a failure to get to grips with the vagaries of life.

6) Minimalist living (Ikigai)

As prisoners, we have hardly any possessions. Could this actually be a good thing? Is our value as a person based on how much we own? Does having many possessions really bring lasting happiness? Being a prisoner is not so far removed from a monk or hermit with nothing, living in a cave. The difference is that they have chosen to live that way.

Ikigai is an ancient Japanese philosophy. It emphasizes immersing yourself in activities you enjoy and going with the ‘flow’. To do this effectively, you need to set yourself a meaningful objective without getting obsessed with it. For prisoners, this could be something as simple as a friendly conversation with another inmate we find a connection with. Reading, writing, and making things are more obvious examples.

Ikigai also puts much value on eating just enough to satisfy yourself, and avoiding excesses of any kind. Any challenge we set ourselves should be made in small steps. It is not impossible to live happily in a small space, and it helps our mood to keep it clean and tidy.

If I can emerge from prison a better man, my suffering will not have all been a cruel waste of time.

Extreme stress is a major part of the lives of all of us in prison. Unlike outside, we cannot walk away from unpleasant people and situations. Getting ill in prison is miserable enough, but with a mental health issue, life can feel totally pointless. You can easily imagine never being able to get better – but you will!

This article will focus briefly on mental illness, the psychiatric medications used to treat the main conditions, and effective coping strategies we can employ immediately to deal with this curse. I hope people not in prison will also find this information helpful.

Who gets mentally ill

If recent statistics are to be believed, one in four people will experience a mental disorder at some point in their lifetime. This figure is always being revised upwards, and does not include the millions who are never diagnosed with one. Because of the COVID-19 crisis, I suspect the true rate is much higher now.
In prison, suffering from a mental disorder is extremely common, even without a pre-existing condition. It is not a personal weakness or failing or inability to cope. It is an unfortunate nervous overreaction to an extremely stressful environment over which we have no control. That is not to say everyone will fall prey to a disorder. But as foreigners, we generally have it a lot harder than the locals and face additional stigma because of it. Our misery can be compounded by seeing inmates who actually appear to enjoy life in prison.

Incidentally, a number of UK celebrities have ‘come out’ with mental illness. These include Frank Bruno, Kate Middleton and Prince William, Stephen Fry, Ed Sheeran, Zayn Malik, Marcus Trescothick, Peter Crouch, Danny Rose and Alistair Campbell. 

What are the most common mental illnesses

Anxiety and depression are by far the most common and often occur together. The two conditions are closely related. Anxiety can be sub-divided into general anxiety, social anxiety, agoraphobia, claustrophobia, panic disorder, health anxiety, insomnia, paranoia etc. but all are part of the same recognizable beast. 
Everybody gets anxious and depressed at times but we are speaking here of debilitating conditions which interfere with the ability to perform even simple tasks like taking a shower or eating.

Nobody knows exactly what activity in the brain causes them, but it is thought to be due to atrophy which is the destruction of brain cells by stress hormones such as cortisol. The ‘chemical imbalance’ theory was discredited years ago but even today, health professionals will cite this as the reason because it requires no further explanation.

Unfortunately, most people around us will have no comprehension what we are going through, particularly as we may not look ill in the normal sense, and therefore we will receive little of the sympathy we need and deserve.

How to know if you have anxiety/depression

It is very common for people to know they have a problem which interferes with their sense of wellbeing without actually understanding what the problem is.

There are a multitude of psychological symptoms but the most common are loss of interest in everything, loss of appetite, loss of libido, sudden loss of weight, insomnia, wanting to be alone, no energy, feeling completely worthless. ‘Brain fog’ is another, an unpleasant sensation which feels like having a stone in your head.

These may be accompanied by physical symptoms. Racing heartbeat, prickly sweat, churning stomach, trembling, muscle pains, migraine, diarrhea, frequent urination to name but just a few. 

Getting a mental illness does NOT mean you are going mad. 

Although depression always contains an element of anxiety, anxiety can exist without depression. Both are often at their worst in the morning. This is because cortisol levels are at their highest while metabolic rate – the rate at which our body converts cells into energy – is at its lowest.

Loss of self-esteem

Being in prison can wreck our self-esteem, while the effects of mental illness become a double whammy. Our sense of worthlessness is based entirely on that critical inner voice constantly harassing us – but it is wrong. It is not based on reality but is the result of distorted thinking exacerbated by the pain of mental suffering.
We do not have to do anything to merit self-esteem. We need to accept ourself as we are, and stop comparing ourself to other people. There will always be someone better-looking and richer and more stable. The whole concept of self-esteem is basically irrelevant self-judgement. What matters is self-respect, not self-esteem.

Seeking medical treatment

My prison has a clinic with guards and inmate trustees who are supposedly qualified nurses. If you are fortunate enough to have access to a real doctor who can give you something other than paracetamol, you are probably one of the lucky ones. A prison doctor should ideally be a mental health expert but we are not living in an ideal place. Getting access to a good psychiatrist is difficult even for people outside the prison walls. The only, visiting, prison doctor I ever met was a very knowledgeable and thorough practitioner but behaved like a ferocious boarding school headmistress. A good doctor also needs to be sensitive and sympathetic to their patients’ condition. 

If you think you need medication for a mental health condition but have no way of acquiring it, you need to contact the embassy. I believe that Prisoners Abroad can help with the cost of medications on a case by case basis.

I have no idea how outside medical consultations are arranged in prisons in other countries but will assume some are similar to here. Your lawyer or the prison has to apply for a court order signed by your judge. It can take up to three weeks to receive which is highly unsatisfactory when you are in constant pain. Here, you have to stop breathing before you can be rushed to the hospital without one.

In the many months, I have been in the clink, I have seen 7 different psychiatrists (they rotate them far too frequently) as an outpatient in handcuffs at a public hospital. One was excellent, two deserved their salary and the remainder would not even be accepted as volunteers at a refugee camp. One was so bad that I had to write the prescription for her.

One very useful thing to do is always ask for two prescriptions, one with no date on. In fact, it is not a bad idea to accumulate a bunch of dateless prescriptions. This is because your scheduled monthly or bi-monthly visit can easily get cancelled. I had one visit scheduled by court order for Boxing Day even though we all knew it was a public holiday. At the start of another trip, my escort guards saw two young chaps lobbing contraband items over the prison wall so shot one of them in the back as they tried to flee on their motorbike. The injured guy was bundled into the meat wagon with us and we had to return to base for the shooter to write a report.
For dental treatment, a particular inmate will pull out a bad tooth with a pair of pliers for a small fee. His mate will hold your head to stop it moving. No point in asking how he got a pair of pliers inside when toothbrushes with a long handle are banned.

Psychiatric medications

Some people believe that psychiatric medications can permanently alter brain chemistry, or even cause irreparable damage to the said organ. Others say that the chemical imbalance theory was propagated by drug companies to promote their product. These views are all good examples of conspiracy theories. Even if the above were true, these medications have saved countless lives and that is all that matters.

Antidepressants are the first line of defence for both anxiety and depression. The most commonly used are called SSRI and SNRI, but some new types have appeared in recent years. 

Antidepressants work by increasing the activity of neurotransmitters in the brain, namely serotonin and noradrenaline, and building new brain cells. This does not happen overnight.

The problem with antidepressants is that they take 4-6 weeks to kick in. Because of the sudden increase in neurotransmitter activity, a spike in anxiety is a very common side effect which may last for 2-3 weeks, after which it gradually goes away of its own accord. This can make the waiting for the medication to take effect a tormenting process. There are other less unpleasant side effects which you soon get used to. 

The second problem is that the first antidepressant might not work, requiring a switch to another one. It depends on each individual’s physiology and there is no way of knowing in advance if it is the best one for you. In the USA you can pay for DNA testing which is still unreliable. You have to give a new antidepressant six weeks to know for sure it is ineffective.

However, once you find an antidepressant which works for you, it will continue working for a number of years, usually at the same dosage.

Even when on antidepressants, it is possible to experience a recurrence of depression due to adverse events in your life, but these episodes are nearly always short so you should not panic that your medication has suddenly lost its effectiveness.

If a doctor suggests starting you on an antidepressant, you should ask the following questions. It will do no harm to appear knowledgeable on the subject:- How long will this take to kick in? What are the possible side effects?- Am I guaranteed a constant supply?- If it does not work, what would an alternative be? It is usually recommended that you continue taking an effective antidepressant for a minimum of nine months.
The other main psychiatric drugs are tranquillizers, known as benzodiazepines. Doctors in the UK are renowned for being very reluctant to prescribe them because of the potential for addiction and concern that these drugs might find themselves for sale on the street.

The more compassionate doctors will prescribe ‘benzos’ for at least a period of three weeks, particularly if you experience acute anxiety side effects with antidepressants. After about three weeks, most (but not all) patients will become tolerant/dependent which means you need to increase the daily amount to maintain the same therapeutic effect. This is the same as for heroin and other hard drugs. In prison, addiction is a terrible path to find yourself on and the withdrawal symptoms after going cold turkey (take it from someone who has been there) are absolutely indescribably terrible. Walking up the walls is not even an apt description. 

In reality, many people have taken benzos for years because they are so difficult to taper off. Common benzos you will have heard of include Ativan, valium and Xanax. The only real difference between one benzo and another is potency and length of time they take to act, also the number of hours they remain in your system. For example, Xanax is very fast-acting therefore is the drug of choice for curbing panic attacks.

A big problem with benzos in prisons is that they are very popular with other inmates and you stand the continuous risk of them being pilfered then having to suffer the withdrawal effects until you can get a new supply.

A third type of psychiatric medications is antipsychotics. In contrast to what the name suggests, they are also used for a sleep disorder (low dose) and anxiety/depression (medium dose). At high doses, they are used for bipolar disorder (previously called manic depression) and schizophrenia. They are not addictive. It will take three or four days for your body to get used to them during which time you may feel like a zombie.

Some people like myself can find themselves on a cocktail of three different medications. It is not an ideal situation and should be viewed as a temporary fix.

Incidentally, the most commonly used psychiatric medication in society at large is alcohol. Alcoholism can be considered a mental illness too.

Sleep problems

This demands special attention. For me, noise has been my biggest enemy in captivity. For example, inmates staying up all night inhaling crystal meths and gambling generate a lot of it. Then there is the loud music (mercifully daytime only) booming out of other cells on large portable speakers. Tom Jones, Michael Learns To Rock and Bon Jovi. This is a description of hell. No living person should be subjected to that. It was used as psychological torture for inmates at Guantanamo Bay. You cannot knock on the door of a serial killer high on drugs and request him to be so kind as to turn down the volume.

I use earplugs to aid sleep. Sleeping pills are not recommended. Like benzos, they are addictive and poop out. 
I still use antipsychotics for sleep. The problem with them is that prolonged use can cause diabetes. A far safer alternative is antihistamines, which make you drowsy. A very safe and effective one for sleep is called hydroxyzine. Unfortunately, I cannot obtain them but would willingly switch if I could get a regular supply. I have thought of tapering off the antipsychotics completely but I know from past experience it would result in a fortnight of no sleep at all until the brain adjusts to life without them.

Dealing with panic attacks

You will probably know when you get a panic attack. It is horrible. Anything can bring one on. Many people mistake their first panic attack for a heart attack.

Fortunately, there is a way through them which requires no medication but a little bit of courage. When a panic attack kicks off, you will experience many of the physical anxiety symptoms mentioned earlier. First, consciously slow down your breathing as much as you can. Second, silently urge the panic on TO DO ITS WORST! Like Lieutenant Dan during the hurricane in the movie Forrest Gump, say to yourself something like, “Come on panic is that the best you can do? Bring on more, more!” 

The panic attack will continue then run out of steam, which it always does anyway. This will not stop you getting a panic attack again, but by using this method, they will become less frequent until you are rid of them completely.

Self-help

In jail we are limited to what we can do to help ourselves. ‘Fighting’ anxiety and depression by engaging in frantic, distracting activities is a battle we cannot possibly win. We have to accept our pain and surrender to it completely, a lack of action which would seem counter-intuitive. But doing nothing is the answer.
By far and away the most effective mechanism to help us achieve this is MEDITATION. When severely anxious and depressed and practically unable to function, it is one of the last things you will feel like doing but IT WORKS. You just have to do it. The reason I know it works is because I was able to write this article. I had been intending to do so for months but was in a very bad place.

I do meditation every day. It is tedious at first and seems like a waste of time but stick at it and you will definitely start to feel some benefits after about one month. After two months you will know for sure it is helping.
There are many different techniques but I believe one taken from Zen Buddhism is all you need by virtue of its simplicity. You can do it lying down, but it is more effective done sitting on a chair or on your mattress with legs crossed. Try and keep your back straight and head up. Rest your hands on your lap and close your eyes. Breathe in and count 1. Then breathe out and count 2. In for 3, out for 4 until you get to 10, then start over again. After a while, you can just count the out-breaths. The breath tends to slow down and quieten of its own accord once you get going. It is better to breathe in and out through your nose unless it is blocked.

When you first start, it is natural to drift off into a long chain of thoughts and lose track of where you are. There is nothing wrong with this. Notice it, and resume the counting of breaths. Don’t beat yourself up over it.
Do for just 5 minutes to begin with, twice a day if possible. Then slowly increase the length of time. For me, 45 minutes twice a day is enough. It took me around two months to get there. There is no ideal length of time or limit to the length of a meditation session but 25 minute guided audio sessions are common. 

You do not have to be a Tibetan monk living in a cave eating shrubs to do meditation, despite the similarities in our situations. Meditation works because, through its calming effect on the brain, you become able to distance yourself from the unhelpful thoughts that are the cause of the problems. ‘What if ….’ is nothing more than a thought, not based on reality because it is impossible to predict the future. 

“It’s not the event, it’s how you react to it”. By doing meditation you will not only become a much calmer person but will avoid overreacting to unpleasant situations and acquire a more tolerant and non-judgemental attitude towards some of the associates you are locked up with.

Another highly recommended exercise is progressive muscle relaxation. Lying on your back, relax your body as much as you can. Then, starting with your feet, tense them by curling your toes. Hold a few seconds, and release. Then move on slowly to your calf muscles and all the way up to your head, where you will finish by screwing up your face.

If you are allowed access to a DVD player, you could ask someone to download guided audio meditations from the following free site :
www.freemindfulness.org

The other main self-help method, in the absence of a qualified therapist, is self-help books. In other words, you need to become your own therapist.

Try and get hold of the following three, in order of importance in my own opinion. There are hundreds, and many of them are suitable for one purpose only. I know the embassy working through PA can help with this but it may take time. My own comments are in brackets.

• Hope and Help for your Nerves by Claire Weekes (written in the 1960s but still a lifesaver).
• Dare by Barry McDonagh (a modern version of Claire Weekes)
• Feeling Good by David D. Burns (about 500 pages of CBT – Cognitive-Behavioral Therapy)

Alternatively, to speed things up you could ask someone to download and print out these books for FREE from the site www.b-ok.org

Once you have started meditation, the next logical step is yoga. The PA newsletters often carry excellent yoga routines with diagrams. See if you can get hold of back copies. Yoga may not be your cup of tea but it is a really good muscle workout because it uses your body weight. It gives your body organs a virtual massage too. 
Any kind of physical exercise is highly recommended. Even if literally just walking slowly round and round in circles day after day. A walk can also be turned into a kind of meditation by focusing on your breath and the movement of your feet in the wind.

Keeping a journal is a well-known therapeutic activity. It does not need to be systematic or detailed. A couple of sentences a day is fine, and it serves as your ‘second voice’. In fact, any type of writing is worthwhile because it takes your mind off things. 

Learning the language of the country you are in can be very helpful if you can motivate yourself to do it. Local inmates will appreciate your efforts. I am amazed at how few foreigners here can count up to ten in the local language. There is a natural tendency for us to assume we will not be inside long enough to make it worth the effort, plus hatred of the culture which incarcerated us. If you become proficient, you will realize that the creepy loudspeaker announcements are devoid of useful content and wonder why you bothered studying the language at all.

Group activities, particularly of a religious nature, may help you more than you imagine. I had weekly bible study with an outside Christian group until visitors were banned because of covid. I am not particularly religious and do not agree with most of my pastor’s ideas, but I was motivated to read the bible from cover to cover – twice – and that in itself is a personal achievement. My pastor is a genuinely caring person and has helped me immensely to recover some self-respect, and remind me that there are still good people around. He ended up becoming my helper, the person to who my wife sends money and medications from our home country.

If you believe in a higher spiritual being, it can bring comfort to think you are being taken care of. If not, you can still see yourself as part of a cosmic plan, destined to spend time in prison to experience a unique form of suffering which will help you grow in stature as a human being and make you a better person by the time you get out. You will probably be one of a minority.

Opening up about your mental health problems to an associate can be beneficial, and what’s more, they might open up to you about theirs. I think it is a bad idea to keep it a secret. However, you need to be very careful who you choose to confide in. Prison walls also have ears with a defective built-in google translator. 
An inmate who met me for the first time had been told I had 6 inch fingernails and long straggly hair. I’m as bald as a coot. 

Autism

Unlike the rest of this article which has a solid factual basis, the following is speculative. It is based entirely on observation, a lot of reading, and past participation on online mental health forums. Plus my own understanding of mental illness after many years of personal suffering. I do not know if I am right and cannot do scientific research to support my theory, but you may find some valid points here.

I have observed at close hand the small number of foreign inmates and am convinced that most of us have a diagnosable mental health condition which actually contributed to our predicament.

ASD (Autistic Spectrum Disorder) is not really a mental illness but a medically incurable neurological genetic condition very few people, in general, are aware of, yet many people possess without realizing. Men outnumber women 4:1. It is a vast spectrum. At one extreme are ‘high-functioning’ autistics who are often very successful and intelligent men (‘Asperger’s Syndrome’ is a term also used). They have very schematic mathematical brains. At the other end of the spectrum are the ‘low-functioning’ individuals we may think of as ‘loonies’ who get off the tube at every stop and announce the name of the station. Whereas male autistics lack empathy, female autistics can have too much of it and be scared of causing offence.

Those neighbours from hell, that geezer who is always getting into arguments and fights, the boring chappy with no personality, that grumpy miserable bar steward, the unapproachable inflexible boss at work  …… we should perhaps look for signs of autism. 

There are many outward signs of autism. A very common one is not listening to what people are saying, and talking in a very flat robotic voice. When that person forgets something you have already told them, it may well be that they were not listening in the first place. Another sign is extreme sensitivity to noise, smell, light and taste.

Autism can, in extreme cases, make a person feel different from everyone else to the point of believing they are one of the chosen few. Their distorted self-image and consequent reckless behaviour are what lead to their downfall. Similarities with ‘narcissistic personality disorder’ are impossible to ignore.

People with ASD often develop other mental health conditions, due principally to their own frustration at their lack of communication skills and inability to form meaningful relationships. Most common are OCD (Obsessive Compulsive Disorder, the slave-to-habit syndrome), anxiety and depression. Around one-quarter of persons with ASD are also bipolar, itself a primarily genetic condition. When I meet psychopaths I see a severe form of ASD, and I am not talking about inmates here.

Then I look at the locals, more difficult to understand because of cultural differences, but inevitably have come to the same conclusions. I detect a lot of ASD, particularly in those accused of serial rape and various types of scams. They are unable to comprehend the effect of their actions on their alleged victims or their victims’ families, or ‘imagine’ a real situation such as the consequences of their actions. Understanding what makes them tick may help us put up with their unpalatable behaviour, even forgive them, and there is very little we can do about it anyway. 

For people who have been diagnosed with autism, behavioural therapy is used and teaches them how to live a satisfying life. Being diagnosed as autistic later in life has helped many because it provides them with a reason for their feelings of estrangement.

In countries where an unusually high percentage of the populace are behind bars, it may have less to do with high crime detection rates than with the ease at which any member of the public can inform (pay) the police to have another person arrested.

I digress here, but I no longer believe in the concept of good and evil. There is a disturbing tendency in modern society to see everything and everybody in terms of black and white. I’d like to end with a quote from the famous Soviet dissident author Alexsandr Solzhenitsyn, who spent years imprisoned in a labour camp :
“If only it were all so simple! If only there were evil people somewhere insidiously committing evil deeds, and it were necessary only to separate them from the rest of us and destroy them. But the line dividing good and evil cuts through the heart of every human being. And who is willing to destroy a piece of his own heart?”

I hope this article may help all who are suffering in prison.