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.
