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Thursday, July 06, 2006

Culture Wars

I met with a kid today ("kid," meaning 22 years old - young for big-league prison) who was pleasant but presented as somehow, "simple." Judging by his vocabulary, he was poorly educated and had a "basic fund of information" that seemed less than what one would expect. There was an incongruence to him: young, healthy Hispanic male, beautiful gang tattoos, but timid and anxious. He couldn't be a gangster. Mental status exam was poor for orientation, memory, and following basic directions. A printed picture of a clock indicating 10:10, he described as "two o'clock."

"Why are you in the mental health program?" "I had no problems until 1998 when we were fighting and a guy hit me in the head with a baseball bat." (Displays indentation and scar). "Ever since then I get dizzy, paranoid, and I'm clumsy." Sounds vaguely neurological, but there is no evidence of formal testing. I went to the usual questions of , "Does your mind ever play tricks on you," and he didn't want to answer. "Why?" "Are we alone?" "Of course." "Look, I hear voices. "What kind of voices?" "Mostly gibberish. I can't understand them. Especially this one little girl who has a mean tone of voice, but I don't know what's she's saying." "Have they ever told you to do anything?" "One single time that I could understand the little girl, she told me to hurt my girlfriend, but I stopped because I knew God didn't want me to be that kind of person."

When I look at his current orders, four months after his arrival, all psych meds have been discontinued (Risperidone in a healthy dose and Sertraline), and he had discontinued all contact with his psychiatrist. "Why did you stop taking your medications." "Are you 'gonna tell anybody?" "I'm going to tell your out-patient doctor." "Nobody in here?" "Not if you don't want me to speak with anyone." "I really need the meds. I've been feeling so crazy. I can't sleep. I'm so afraid." "Why did you stop?" "Gang members don't allow you take meds or see psychs. If you're crazy they'll kick your ass or kill you." So here is his Catch-22: he won't take meds because he's on a general population yard with gang members who intimidate others into refusing meds, and he can't be transferred to a psych yard where he'll be safe because he won't take meds. "I used to go to group therapy, which I really liked, but they yelled and laughed at me and I got too afraid to cross the yard to go for group." "You never told this to your doctor?" "NO!" "And you don't want me to tell her?" "NO!" Paranoid, paranoid delusion, or both?

24 days to the gate. He will live with his father and older brother who will take care of him, insisting and assisting him in taking his medications. Making sure he showers, shaves, and cuts his hair. Driving him to his appointments because, "Once I took the bus and got so lost, I didn't know where I was. I was so relieved when the bus driver told me I was back in my neighborhood." I find out he is now classified DD2 (developmentally disabled to the point where he needs strong prompts to function normally), describing him as "poor at social relationships, easily intimidated, and vulnerable to being victimized." He is diagnosed as Schizophrenic, Paranoid Type. Nobody thought to protect him.

"Is it crazy to be scared all the time." "No, man. You're in a dangerous place and it's appropriate to be careful. We're all afraid sometimes. " "OK." "You promise me you're going to take the meds when you get out?" "My appointment with the doctor is the same day I get out." "Cool, you be safe. I don't want to see you again." "You won't see me again!" Smile.

Please, I don't want to ever see you again.


Blogger Wrkinprogress said...

Bless his heart! I don't know why he was in prison, but I have to wonder if there had been better resources for him on the outside if he would have avoided winding up on the inside. Thank God he has a support system in place when he gets out.

July 07, 2006 10:48 AM  

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