Today, corrections officers face a record number of inmates with mental health issues. Understanding the basic facts of mental health behaviors is the key to effectively handling these individuals. Here, Ruth Nirenberg debunks some of the biggest mental health myths.
Part 2 of a series
Mental health in our prisons, Part 1
By Ruth D. Nirenberg, PsyD
Reality: there is no “face of mental illness.” Every person is unique, with distinct strengths and struggles, and the manner in which mental illness impacts each person varies drastically. For an inmate, this is of particular importance, as they not only face stigma and labels related to their mental illness, but also to their criminal involvement.
The inequity of language within the mental health and medical fields is evident: although it is unusual to refer to someone as a “cancer,” it unfortunately is common to refer to someone as a “schizophrenic,” or by whatever category of offense led to their incarceration.
 Inmates not only face stigma and labels related to their criminal involvement, but also to their mental illness. (AP Photo) |
Since a person is not defined by his mental illness, nor by his legal status, it is important to acknowledge each person as an individual. This provides an environment that begins to reduce the stigma associated with mental health and instead fosters support and encourages growth and independence, regardless of where a person is in the process of his recovery.
Myth: Mentally ill people are either just crazy or faking it. The inmate is trying to get away with excuses.
Fact: Degrees and types of mental illness vary from person to person, but individuals living with symptoms of mental illness are neither crazy nor faking it. In fact, all humans face mental health stressors throughout their life. Mental illness is a vulnerability to psychological imbalance that subsequently interferes with cognitive processes, interpersonal relationships, emotional stability, and consistent daily functioning.
To someone with a mental illness who also subsequently became involved in criminal activity, their symptoms are neither the cause nor excuses for their behavior. When properly managed, most individuals meeting criteria for a mental illness can achieve either a symptom-free life or a quality of life minimally impacted by their mental health symptoms, including reduced recidivism in the jail system.
Myth: Bad parenting leads to mental illness.Fact: While “bad parenting” does not lead to mental illness, surviving an abusive childhood or traumatic experience during otherwise normal development can increase a person’s vulnerability, to and development of, psychological imbalances, including, but not limited to, depression and anxiety.
In addition, abuse survivors face an increased vulnerability to substance use, medical problems, legal involvement, academic and work performance issues, and chronic involvement in subsequent abusive relationships. As much as an inmate may blame their parents for the situation they currently find themselves in, understanding and addressing the underlying symptoms and necessary behavior changes is far more effective and empowering.
Myth: Paranoid schizophrenics are mentally ill. Everyone else is just having a hard time.
Fact: Mental health issues lay on a continuum, ranging in degree of impact on daily functioning. Intrinsic pre-disposition and access to natural supports may impact an individual’s development and management of mental health stressors. However, while someone who lives with symptoms consistent with the diagnosis of Paranoid Schizophrenia may indeed face significantly more challenges in all areas of living, it is important to not minimize the impact that living with chronic depression or being a trauma survivor may have on these same functional arenas.
Particularly in a corrections setting, inmates who struggle with symptoms of mental illness may elicit negative reactions from their peers or front-line professionals, so acknowledgement of their additional layer of struggle can be a helpful means of not only responding to their needs, but fostering their accountability for their choices and actions.
Myth: Only poor people have mental illnesses.
Fact: Everyone vacillates on the continuum of mental health throughout their lives, often fluctuating even within a given day. In response to significant stressors and/or genetic predisposition, individuals may experience and report symptoms of mental illness within this spectrum. However, socio-economic status neither leads to nor protects from mental illness.
In fact, although financial duress may compound existing conditions and vulnerabilities, the reality is that societal stigma impacts the wealthy more than the poor. As a result, poor people may be more likely to report and therefore present with mental illness, subsequently also receiving a larger portion of the community-based treatment and rehabilitation services otherwise under-utilized by their wealthy counterpart struggling with the same psychological disabilities.
Myth: Mentally ill people are extremely violent.
 Fact: Violence is not a typical characteristic of most individuals diagnosed with a mental illness. (AP Photo/Rich Pedroncelli) |
Fact: Unfortunately, there are instances when someone who acts in an ethically unsafe and impulsive manner also turns out to have a mental illness not being consistently or effectively managed. However, violence is not a typical characteristic of most individuals diagnosed with a mental illness. In fact, a common descriptor of the average person who meets criteria for a mental illness is “socially isolative.”
As a result, secondary to symptoms such as cognitive confusion, increased lethargy, and social awkwardness, an individual diagnosed with mental illness is more likely to withdraw from others than be actively violent toward them.
It is important to remember, however, that anyone who is not receiving appropriate care for their symptoms and/or who is under the influence of drugs, alcohol, or even group pressure, could, regardless of mental illness, present as or become involved in, violent or destructive activities, resulting in many individuals with mental illness arriving at jails rather than hospitals.
Myth: Alcohol and drugs cause domestic violence.
Fact: Alcohol and drugs do not cause domestic violence. Homelessness and unemployment do not cause domestic violence. Extreme stress and mental illness do not cause domestic violence. Domestic violence is a cycle of abusive behavior resulting from one person in the relationship believing themselves to be not only allowed, but truly justified in their relentless control over the other person in the relationship’s behavior.
The abusive partner does not have an “impulse issue” and does not “just lose it.” In fact, the perpetrator of domestic violence is extremely controlled toward themselves and others, but has singled out an intimate partner over whom they extend this control.
Although there could be co-existing additional difficulties, such as alcohol and drug use, legal involvement, homelessness or unemployment, or even mental illness by one of the partners in a domestic violence relationship, none of these factors cause the abuse and none of them excuse it, either.
Myth: Kids act out to get attention. If you ignore them, they will grow out of it.
Fact: There is no question that as children achieve and move forward in the stages of normal and healthy development that they challenge existing parental and societal structures. However, there is a vast difference between questioning and testing rules and boundaries, with ultimate achievement of moral understanding of right and wrong vs. chronic and incrementally more severe behaviors and deterioration in areas of daily living for a child (school performance, peer interactions, etc.).
It is important to not minimize this latter pattern, as it holds the key to underlying unspoken issues the child or adolescent is facing. “Kids acting out” needs to be responded to as a child or adolescent’s means of communicating that something is wrong in their world, be it their school or home environment. Ignoring it not only does not make it go away, it in fact makes it get worse.
The criminal justice system is full of individuals who easily trace back their difficulties and steady progress toward incarceration to childhoods marked with depression, academic difficulty, familial discord, and petty legal involvement gone unchecked. If the behaviors instead are acknowledged and responded to in a supportive manner with the goal of problem solving rather than blame, children and adolescents have incredible resiliency and the capacity to resume normal and healthy development, with renewed trust in their world and confidence in themselves.
Myth: Only veterans get Post Traumatic Stress Disorder (PTSD).
Fact: PTSD is actually a category within the Diagnostic and Statistical Manual of Mental Disorders that includes anyone who, in response to having been exposed to a traumatic event in which they experienced or witnessed actual or threatened death or serious injury to themselves or someone else, responded with intense fear, helplessness, or horror (or disorganized agitated behavior in children). Given this definition, it is important to remember that survivors of natural disasters, interpersonal traumas, and acute or chronic abuse may also meet criteria and warrant treatment for PTSD. A paradoxical element within the criminal justice system is that to some inmates, particularly those in jail for the first time or for lesser offenses, the jail experience itself can trigger PTSD-like symptoms, often a deterrent to re-offense.
Myth: Depressed people can snap out of it if they really wanted to.
Fact: On average, 10% of the American population is diagnosed with depression, a potentially debilitating, though not untreatable, condition. Depression, when properly diagnosed, actually describes varying degrees of breakdown in basic psychological functioning, including, but not limited to activities of daily living (eating, sleeping, personal hygiene), concentration and productivity, emotional stability, and motivation. An individual experiencing more severe symptoms of depression may be extremely hopeless and helpless over their lives, increasing his/her risk of self-harm or suicide. Not only is depression not a condition to be “snapped out of”, but also even with the best treatment possible, it is often a long road to recovery and stability.
It is imperative that, particularly in children, depression not be overlooked, as it may be underlying other more overt behavioral problems. Within the inmate population, it is imperative for front-line professionals to be alert to the two extremes of aggression and isolation, as these are common indicators to increased depression and even contemplation of suicide. The more vulnerable an inmate is in their surrounding and/or the more they stand to lose for their criminal actions upon their release, the heightened their potential depression and suicide risk both upon arrest and during incarceration.
Whether a person is early in their recovery or further along, critical factors to successful recovery for someone diagnosed with a mental illness, particularly those within the corrections world, are the belief that progress is possible both from their mental illness and their criminal history, the support of their community in their recovery, and being respected as an individual and not a label.
Readers are encouraged to send in questions or specific examples to be directly answered and addressed by mental health professionals.
About the author
Dr. Ruth Nirenberg is a New York State Licensed Psychologist, distinguished as a trainer on multiple topics related to mental health, professional development, and interdisciplinary work. As a New York State Municipal Police Training Council Certified Mental Health Instructor, Dr. Nirenberg has been an annual speaker at the Office of Child and Family Services (OCFS) Corrections and Youth Services Association (CAYSA) Region IV Conferences and works collaboratively with various police departments throughout Westchester County on training and community service initiatives.