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March|April 2004
The Problem of Prison Rape By Daniel Brook
Captive of the System By Jennifer Gonnerman
Lifers By Sasha Abramsky
The Last Supper By Brian Price
The Cuckoo's Nest By John Douglas
The Tinderbox By Don Cabana

The Cuckoo's Nest

By John Douglas

I'M A PSYCHIATRIST AT PELICAN BAY, the infamous California supermax prison for the worst of the worst. It consists of grim concrete structures surrounded by a high-voltage fence between two chain-link fences topped with razor wire. The general population of inmates is housed on two maximum-security yards, but the most dangerous inmates—who have committed serious infractions in prison or are known gang members—go to a more confined area, the Security Housing Unit, or SHU.

Prisoners diagnosed with severe mental disorders—those who are bad and mad—don't fare well in the general population. But in 1995, a federal court forbade the California Department of Corrections from sending mentally ill prisoners to SHU because of its harsh conditions. Now a mentally ill prisoner who commits a serious violation is sent to the Psychiatric Services Unit. Prisoners there undergo treatment and may leave their cells for at least 20 hours every week. I work in PSU and am also on call about once a month in the infirmary.

When I do rounds there, I decide which psych patients should go back to the yard, which should stay for treatment, and which should go to the hospital for mentally ill prisoners at Vacaville, six hours south. Inmates say Vacaville has better food and younger, prettier nurses. But the inmates who really need to go there almost never ask to.

IT IS FEAR OF OTHER INMATES that drives nearly half the patients at the infirmary into inpatient care. That's why Mr. Brewer (I've changed inmates' names) was admitted. He was convicted of molesting his girlfriend's daughters. Now he avoids the yard, because child molesters, rapists, and the murderers of children are "in the hat"—marked to be beaten or stabbed by other inmates, perhaps with a sharpened toothbrush. "I'm suicidal now and I'm gonna be fucking suicidal 'til those parole board faggots release me," Brewer shouted recently.

Mr. Jones, convicted of armed robbery, has been admitted to the infirmary 17 times in the last six months. He has exhibited no signs of any mental disorder but claims to be suicidal. While there, he often masturbates while ogling the nurses.

I asked Mr. Jones why he has only been diagnosed with antisocial personality disorder and malingering (faking an illness). "How do you know I ain't hearing voices right now? How do you know I'm not going to kill myself in the next minute?" he responded. "There ain't no way you could know."

He's right. The mind of an individual is ultimately unknowable. My creed is that mental illness comes in syndromes—symptoms and signs that go together—and that a single symptom never exists in isolation. That convinced me that Mr. Jones was lying. But five years ago, after two inmates killed themselves following psychiatric evaluations predicting they wouldn't, the Department of Corrections informed psychiatrists of a new "zero tolerance" policy about suicide. I couldn't risk being wrong.

Once I'm satisfied a patient is not mentally ill, I often tell him that just as a soldier must face danger in war, so must a prisoner face danger on the yard.

This technique worked with Mr. Sanchez, convicted of having sex with two underage girls. Mr. Sanchez said that he would rather kill himself than wait for a random attack, and he ended up at the infirmary during his first month in prison. Though not mentally ill, he couldn't adjust to the prison environment. I encouraged him to suck it up and to follow the "program"—which means maintaining a job, keeping clean, and staying out of fights. After a few more infirmary visits, Mr. Sanchez had beefed up and shaved his head. He was out in the yard, protecting himself and being a prisoner.

THEN THERE ARE PRISONERS who remind me why I became a psychiatrist, like Mr. Sampson, convicted of attempting to kill his wife. During my rounds at the infirmary, I knocked on his cell door and shouted his name. No response. I could see through the window that he was wrapped like an overstuffed burrito in his no-tear blanket as he lay on the floor. In one corner was a large pile of torn-up bread, which he later told me was an offering for the demons so that they would leave him alone. Earlier, he had covered his body in feces to keep the demons from touching him.

Mr. Sampson took antidepressants, a mood stabilizer, and antipsychotic medications, but I didn't make real inroads into his psychosis. He remained convinced that demons visited his cell at night to tug on his genitals and finger his buttocks.

I didn't feel disappointed in myself or him that he didn't improve more. There is such a thing as chronic, incurable psychosis. I'm not able to help every patient—it's an occupational hazard. I ended up sending Mr. Sampson to Vacaville.

John Douglas has been a psychiatrist at Pelican Bay State Prison for five years.

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