The Trouble with Honesty
I saw a young man today who was respectful, open, honest, and trusting. It was a disaster of an interview. He is "five weeks to the gate," to parole.
The background: His father left the family early, abandoning three sons. This patient had psychiatric problems and had been taking medication since the age of seven. Most of his special education came via the Juvenile Hall (county jail for juvenile offenders). At age 18, he came home to find blood everywhere, and his mother dead on the floor, having been shot twice in the head and five times in the back. He called 911, the police arrived, put him in cuffs and held him in custody until they figured out and arrested the real murderer. The real murderer got a life sentence. The patient said, "If he showed up here, I'd kill him myself." While I certainly couldn't condone murder, I could appreciate the sentiment.
This was a fairly straightforward interview of someone who had a thought disorder and whose primary symptoms were persecutory paranoid delusions. He emphasized that he didn't routinely trust anyone but his grandmother. He was traumatized several weeks ago by being in the area when an inmate was slashed across the throat by another inmate. He then complained that "they put me in a cell with an old man who disrespects me." He kept saying that it took everything in his power not to "beat the hell out of the old man." Thus said, we entered a discussion of anger management, etc. But he continued, "I'll be honest with you, I hear voices sometimes that tell me to cut his throat." Hmm. We have taken a turn that has to be rapidly assessed: "Do you have an actual plan?" "No." OK
It is ironic that in supervision this week, we mainly discussed techniques of establishing trust and encouraging honesty in order to get the most reliable and accurate information from an interview. He continued, "We've been locked down since the stabbing [you may have read the previous, A Day Without African- Americans], and being locked up in that cell is claustrophobic and increases my paranoia. And I'll tell you honestly, I am afraid of what might happen when I go to the streets, being so paranoid." "Are you afraid for your life?" "I'll be honest with you, I got a weapon, and if anyone comes at me, I'll kill them." SHIT! Why did you have to tell me that? "You know I'm obligated to report that you are in possession of a weapon?" Silence. "Well, I didn't really mean I had a weapon. I meant I had access to a weapon." "Same difference. I have to report you." I told the sergeant, I told the chief psychiatrist, and I charted the event. The lieutenant called me from his housing unit and said the inmate had admitted everything to him, but denied possessing or having access to weapon. They were going to strip his cell when I was leaving.
What I did was the right thing to do. Why do I feel so badly about turning him in? His history, his openness, his honesty? Possession of a weapon is a felony; he would undoubtedly get a new, much longer sentence. Five weeks to the gate. I also think to myself, what if he actually cut his cellie's throat or stabbed an officer? Would I be able to walk in and admit that he had reported possessing a weapon to me? Could I live with someone being harmed just because I wanted to be liked and appreciated by this man? What I did was the right thing to do, and sometimes, this time, honesty had a high price for him and for me.
As I left, I again heard what seemed to be an aviary of birds. This time I looked up to find at least 150 nests woven together with mud and twigs under the eaves of what used to be a gym. They looked like sparrows, flying in and out and singing their hearts out. The world is an irrational place.
The background: His father left the family early, abandoning three sons. This patient had psychiatric problems and had been taking medication since the age of seven. Most of his special education came via the Juvenile Hall (county jail for juvenile offenders). At age 18, he came home to find blood everywhere, and his mother dead on the floor, having been shot twice in the head and five times in the back. He called 911, the police arrived, put him in cuffs and held him in custody until they figured out and arrested the real murderer. The real murderer got a life sentence. The patient said, "If he showed up here, I'd kill him myself." While I certainly couldn't condone murder, I could appreciate the sentiment.
This was a fairly straightforward interview of someone who had a thought disorder and whose primary symptoms were persecutory paranoid delusions. He emphasized that he didn't routinely trust anyone but his grandmother. He was traumatized several weeks ago by being in the area when an inmate was slashed across the throat by another inmate. He then complained that "they put me in a cell with an old man who disrespects me." He kept saying that it took everything in his power not to "beat the hell out of the old man." Thus said, we entered a discussion of anger management, etc. But he continued, "I'll be honest with you, I hear voices sometimes that tell me to cut his throat." Hmm. We have taken a turn that has to be rapidly assessed: "Do you have an actual plan?" "No." OK
It is ironic that in supervision this week, we mainly discussed techniques of establishing trust and encouraging honesty in order to get the most reliable and accurate information from an interview. He continued, "We've been locked down since the stabbing [you may have read the previous, A Day Without African- Americans], and being locked up in that cell is claustrophobic and increases my paranoia. And I'll tell you honestly, I am afraid of what might happen when I go to the streets, being so paranoid." "Are you afraid for your life?" "I'll be honest with you, I got a weapon, and if anyone comes at me, I'll kill them." SHIT! Why did you have to tell me that? "You know I'm obligated to report that you are in possession of a weapon?" Silence. "Well, I didn't really mean I had a weapon. I meant I had access to a weapon." "Same difference. I have to report you." I told the sergeant, I told the chief psychiatrist, and I charted the event. The lieutenant called me from his housing unit and said the inmate had admitted everything to him, but denied possessing or having access to weapon. They were going to strip his cell when I was leaving.
What I did was the right thing to do. Why do I feel so badly about turning him in? His history, his openness, his honesty? Possession of a weapon is a felony; he would undoubtedly get a new, much longer sentence. Five weeks to the gate. I also think to myself, what if he actually cut his cellie's throat or stabbed an officer? Would I be able to walk in and admit that he had reported possessing a weapon to me? Could I live with someone being harmed just because I wanted to be liked and appreciated by this man? What I did was the right thing to do, and sometimes, this time, honesty had a high price for him and for me.
As I left, I again heard what seemed to be an aviary of birds. This time I looked up to find at least 150 nests woven together with mud and twigs under the eaves of what used to be a gym. They looked like sparrows, flying in and out and singing their hearts out. The world is an irrational place.
posted by On the Same Page at 20:18
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