Sunday 8 February 2015

Prisons and Paranoia

I’ve previously written about mental health issues in our prisons, but in this post I wanted to explore the specific problems of paranoia – including delusional thinking and irrational fears – that can be made much worse by experiences in custody. Having worked as an Insider (peer mentor) supporting fellow inmates who exhibited serious symptoms of paranoid delusions, I thought I could share a few thoughts on the subject.

"Just because you're paranoid..."
Paranoia is often simplistically described as an irrational anxiety that ‘everyone is out to get you’. I’ve certainly lived in close proximity to a number of prisoners who share that fundamental world-view.

Many cons believe that they have been the victims of circumstances beyond their control. Some have come to regard any form of authority with deep suspicion and resentment, even naked hatred. Others suspect that people around them are watching them, spying on them or even reporting what they say and do to the prison authorities in order to cause them grief, especially those on parole sentences since a negative mark on their records can mean a ‘knock back’ (Parole Board refusal) and even more years inside.

In my view, imprisonment can play a key role in fuelling paranoia mainly because prison can be a harsh and unforgiving environment that does little or nothing to encourage any sort of trust between human beings, whether prisoners or staff. Moreover, the experience of being confined to a small concrete box for many hours of each day – in some cases up to 22 or 23 hours – can give inmates plenty of time to stew on perceived slights or injustices, as well as to plan their vengeance.

Paranoia thrives in cells
A wrong word or even a look from another prisoner – or a member of staff – can set off a chain reaction. What is even more frightening is this may not be immediate. Some cons will lie on their bunks over-thinking situations for hours or even days before coming to the conclusion that they have been slighted, mocked or insulted. Once they have arrived at that point, trying to convince them that they are mistaken or have misinterpreted something innocuous can be very risky as this can merely add fuel to the fire of their delusion that everyone is against them or talking about them – including whoever is trying to help.

I remember reading a book about Cat-A (high security) prisons that referred to lifers treating each other with exquisite courtesy and politeness at all times lest a fellow con should come to believe that he had been disrespected – “made a mug of” – and, therefore, feel obliged to respond by inflicting some horrendous act of violence on the perceived ‘offender’ in order to ‘straighten out’ the situation.

Paranoia can impact on almost every aspect of daily life inside and, on occasions, lead to conflict and, sometimes, real violence between prisoners, but also against members of staff. In this present era of chronic overcrowding, staff shortages and scarcity of mental healthcare in our prisons, it’s perhaps unsurprising that the number of violent incidents that are recorded has risen. The latest figures issued by the Ministry of Justice (MOJ) reveal that in the year ending September 2014 there had been 15,763 incidents of violence, including fights (up from 14,207 in the previous 12-month period), while attacks on members of staff rose from 3,178 to 3,470.

When it all kicks off
Of course, a fair amount of violence is connected to the rampant drugs trade in our prisons – including punishment beating of debtors, bullying and clashes between rival gangs – but the sharp rise in the levels of self-harm also point to worsening mental health among prisoners. Recorded incidents during which prisoners had self-harmed in the 12 months ending September 2014 were also up to 24,748, compared to 23,240 in 2013-2014. This data suggests that in general prisoners are at much greater risk of harm from themselves than from other cons or staff.

It is also true that paranoia and anxiety can be made much worse by the use of certain types of drugs – particularly some of the new synthetic substances that are commonly available inside our nicks. Whereas most real cannabis tends to make users drowsy and feel ‘chilled’, some of the so-called legal or herbal highs can cause the opposite effect. Seeing people under the influence of these drugs as they stagger red-eyed down prison landings and corridors, or vomit all over washrooms, can seem like you’ve found yourself on the film set for one of the Walking Dead zombie episodes.

The 'walking dead'
When I was in Cat-B prisons I saw on many occasions how rampant paranoia can trigger violence. I’ll give one example of a lad who was prone to this sort of thing. I’ll call him Smithy (not his real name).

He was a young man in his early 20s who had many complex problems, including coping with the stresses of his sentence through regular bouts of self-harm. In his case he cut his arms with prison razor blades to the extent that he was almost always wearing plasters and bandages. He also lived with various bizarre forms of obsessive compulsive disorder (OCD) and had a tendency to get himself into confrontations with staff, as well as occasional punch-ups with other cons.

Pretty much everyone on the wing was convinced that Smithy was gay. It wasn’t his job as a barber, nor his occasionally effeminate mannerisms, that raised these suspicions, but that fact that when he was either drunk on prison-made hooch or under the influence of drugs he became what might fairly be described as ‘physically over-familiar’ with his mates.

To be honest, no-one on the wing really cared much about Smithy’s sexuality. Prisoners these days can be surprisingly broad-minded. He gave a good haircut and didn’t over-charge for these services (in fact he wasn’t supposed to be charging anything, but such is life in the nick!)

A quick trim from the barber
However, Smithy was absolutely paranoid that people might believe that he was homosexual. One wrong word on that particular subject could easily trigger an explosive reaction and he wasn’t a small bloke, having bulked up in the gym.

One weekend he was cutting hair on the ‘twos’ (first floor landing) during association when he became convinced that someone, somewhere on the landings above had shouted “fat poof” aimed at him. Who knows whether they had or not, but Smithy was absolutely convinced that he had been publicly insulted, his fragile body image slighted and his masculinity mocked. Given his particular rag-bag of obsessions and anxieties this promised to escalate into a really violent situation.

Then a fellow con, probably out to make mischief, managed to convince Smithy that the person responsible for the homophobic abuse had not been a con, but a screw, a Mr M________ who happened to be on duty at the time. Unlikely as this allegation was, Smithy instantly became convinced that Mr M________ had indeed been the source of the insult and stormed off to his own pad (cell) in an absolute rage to plan his revenge.
Up on the landings

Unaware of the trouble that was brewing, I went down to Smithy’s pad to fix a time for a haircut. I found him sitting on his bunk, fists clenched, eyes wide and glassy. I quickly realised that this wasn’t a good time to be making an appointment for his barbering services and instead tried to find out what the problem was in order to calm him down before someone got hurt.

“That cunt M________ called me a fat poof. In front of everyone. I’m gonna kill the bastard!”

At least I now knew the trigger that had started this particular bomb ticking, but defusing it would be another story. Smithy’s paranoia was so all encompassing that trying to convince him that this was pretty unlikely wouldn’t be easy. Unfortunately, at that precise moment, the screw in question pushed Smithy’s cell door open and asked if he was OK. I thought that at that point Smithy would launch himself from his bunk and start bashing a member of staff – never a particularly good idea, but at that moment Smithy wasn’t thinking rationally.

“Smithy’s a bit upset Mr M, mind if I chat to him for a bit?” I said indicating by my eye movements that he had best clear off quickly. By this stage I was physically holding Smithy down on his bunk using both hands while he screamed verbal abuse at the bemused officer.

Screws running to an alarm
The screw – one of the more decent blokes in what was a rotten and dysfunctional establishment – took the obvious hint and made himself scarce. Eventually, after a marathon session of standing in as an emotional punch-bag, I managed to convince Smithy that he’d been the victim of a practical joke by one of his own mates who just wanted to see him  ‘kick off’, maybe even with the aim of seeing him lose his job as wing barber and then get carted off down the Block (segregation unit), all for the sake of having a cheap laugh.

Some cons cope with the mind-numbing boredom of imprisonment by stirring up trouble in the hope that someone will lose their rag and have a fight on the wing. It can easily become a bit of a rather sad spectator sport for prisoners who have nothing better to do than hang around the landings leaning over the railings, shouting and catcalling the lads having a scrap. Even Smithy was well aware of this, so I could see the possibility that this was true slowly crossing his mind.

Once the realisation dawned that he might well have been set up by another con, he calmed down and on that occasion no-one got hurt, including Smithy himself. He even made me a coffee and by the end of association he was taking it all as a joke.

Mr M_______ looked around the cell door again to check that everything had been sorted. He didn’t even write Smithy up for swearing his head off at him, which I thought was quite decent of him in the circumstances. By prison standards that was a good result, but all too often these situations can spiral out of control and violence can be the result.

Perhaps predictably, Smithy did eventually lose his job as inmate barber – one of the most coveted posts on the wing owing to the opportunities for taking backhanders from cons wanting to jump the long queue for haircuts – because of a later run-in with a different screw. I suppose this does go to show that just because Smithy was paranoid, it didn’t mean people were not out to get him.


  1. I recall a couple of similar incidents from my time inside. A former padmate of mine was in a conversation about his girlfriend with a fellow con. It was very light hearted however the other con said his girlfriend will be seeing somebody else - they all do.

    It was a few hours later after bang-up when his paranoia kicked in. He convinced himself she was cheating on him. Being locked overnight in a concrete box there was nothing he could do except get angrier and more distressed. After a couple of days he had enough phone credit to call her - they had a massive row, his paranoia got worse, he argued with staff and eventually found himself on ACCT due to the risk he was to himself.

    Another guy called his girlfriend at the usual time - she didn't answer the call. He went into a rage convinced she was seeing somebody else. The next day he did manage to speak to her and calmed down when she told him there had been a fault on her telephone line.

    It is an awful feeling being locked in a small box with not much to occupy the mind other than concoct scenarios that simply aren't real.

    1. Thanks for sharing your own prison experiences with us. I haven't really covered the paranoia that sets in between many prisoners and their partners or girlfriends. As you rightly highlight that can be another massive source of tension, arguments and potential violence. I have always reflected that the one thing worse than not having a phone call home is having had a bad phone call!

  2. Good stuff - fact is that because of close proximity and limited social opportunities any situation in a prison, including Cat C's & D's where thre maybe a bit more physical space, can result in an atmosphere of exaggerated tension - of the sort most folk only experience occasionally.

    Then there is the impact of earlier experiences, sadly those in prison are disproportionately more highly likely to have come from dysfunctional family backgrounds where the discipline had relationships have been inconsistent and so leaving folk ill prepared to rely on their inner resources at times of heightened emotional tension likely to be found in prisons.

    Then there are the undiagnosed hidden neurological disabilities, that impact on how folk are able to relate. As a probation officer I particularly remember how one man suffered as a consequence of inability to relate to others in ways that others understood as a consequence of Asperger's Syndrome, which was only diagnosed, whilst he was on parole, after having served 5 years in custody, including the first three months in a Special Hospital (Rampton) as a consequence of his psychological reaction after first being arrested. After much assessment he was said to be fit for trial, without the Asperger's being discovered at that stage! Then there are conditions like dyslexia and dyspraxia, which have a neurological and emotional component in addition to complications in dealing with text and movement, and also attention deficit (hyperactivity) disorder (ADHD).

    In my opinion such folk need skilled specialist attention, especially in custodial situations, whereas often those conditions are not even known about, possibly as a consequence of them being, concealed by addictions, which maybe all too apparent and so considered the reason for bizarre or irrational behaviour.

    Yet prison staff are not paid as professionals, but on a similar scale to people doing mundane jobs with little responsibility - a tragedy all round.

    1. Thanks for your kind comments, Andrew, as well as for sharing your personal experiences as a probation officer. Although I've never - mercifully - had any mental health problems myself, I do have a close family member who lives with severe clinical depression, so I have real empathy for others who have mental health needs and their families.

      I was very much aware while I was in prison that there were so many men living with undiagnosed and untreated mental health problems. It's difficult for me to judge the extent to which their conditions - or personality disorders - might have contributed to their offending behaviour, but an educated guess is that in many cases it was a major factor.

      In Cat-Bs I very rarely saw any evidence of decent mental health care on offer and - as HM Inspectorate of Prisons has pointed out in recent reports - in some establishments inmates seem to be expected to self-harm before any referrals to the mental health team are made. Instead, prison staff are expected to administer the ACCT system and act as hospital attendants, psychologists, counsellors and first-aiders. Not easy when there might be two staff for a wing of 170 adult men! Without adequate resources being provided, it is a scandal - but hardly a surprise - when the rates for suicide and self-harm are rising by the week.

  3. I always think its ridiculous that all people going before the courts aren't seen by someone in a position to accurately assess their mental health to ensure that it is appropriate for them to be standing trial in the first place or appropriate if they are found guilty that they are sent to prison instead of a hospital environment.

    People can have a shed load of mental health issues that aren't immediately apparent but which only manifest once they are locked up in prison and subject to the inhumane regime that exists inside which just makes the situation worse. If everyone was assessed before the trial process it is highly likely that the number of people in prison with mental health issues would be substantially reduced.

    I would note for the record that in the female estate you are automatically assumed to have mental health issues even if you don't. Apparently if you didn't, so the prevailing thinking goes, you wouldn't have committed the crime in the first place. Granted a lot of female inmates do have mental health issues but it's also not a good idea for the establishment to assume that you do without any evidence that you do because this can also cause problems. for you progressing through your sentence because of the prejudices involved. You can also end up on drugs you don't need which can make things worse.

    In the time I was inside I got wrongly labelled as having mental health problems (to cover up a formal complaint I had made) by my OS and was moved back to closed conditions. I had never been diagnosed with any such problems either inside or outside and knew I didn't suffer from any. Luckily I was intellectually and emotionally capable of fighting the system: I sought a review by the visiting psychiatrist who assessed me and promptly went on record as stating that my mental health was perfectly normal and made a point of relaying this to the OMU who were the source of the allegations in the first place. But probation continued to trot out the bogus mental health problems and continued to do so after my release. In fact I had to file a formal complaint about my OM's behaviour in this regard because despite being well aware that I had been seen by a psychiatrist and the psychiatrist had given me the "all clear" she persisted in referring to my having mental health issues when there was zero evidence I did and plenty that I didn't. The complaint was found in my favour because she was literally making it up and worse telling third parties in referrals and such that I had mental health problems when she knew full well I didn't. The label is hard to get rid of even when it has been falsely applied it seems.

    1. Thanks for sharing your experiences in the female estate. It is interesting that there seems to be the assumption that every women sent down must have some form of mental health problem. Talk about gender stereotyping!

      In the male estate it seems to be almost the opposite. Men are in prison because they are bad and evil, rather than because they have mental health needs - often unaddressed or undiagnosed. Based on my own experience of trying to help fellow cons with applications and requests for mental health appointments, trying to get a meeting with the mental health team, especially in a Cat-B, is an uphill struggle. In some cases prisoners have killed themselves before they've even been seen.

      I do take on board your comments about the problems caused by an erroneous diagnosis. A friend of mine on an IPP has had all manner of problems because he has been diagnosed, as an adult, with mild Aspergers. Having received this diagnosis, now no-one seems to know what to do, other than assume it's an additional factor which raises his risk. Shocking, but sadly reflective of just how little probation and prison staff really know about this sort of condition.

    2. Yup no woman can be bad as that would offend society in the Victorian way our society still views women. So as we can't be bad we must all be mad to make all the men feel better about women behaving in what men deem to be a socially unacceptable way.

  4. Hi Alex. Thanks for this. I was suffering with schizophrenia and messed up on speed and heroin when I was arrested in 1997. Arriving in prison with all the noise and clamour was and I remember being frozen to the spot in the holding cell in reception. My jaw moving and my eyes flickering uncontrollably. It took me a month to get straight off the gear and recover my normal bearing with the help of antipsychotic medication. Seeings as I hadn't been "myself" for over 6 years, this was a new chapter and turning point in my life. I continued to have bouts of anxiety and fear sometimes justified other times from over rumination. Bit I survived by staying clean and taking meds. And a great deal of gods grace! As I believe it to be.I am still drug free from that time and still on medication for schizophrenia. Really appreciate your article. Joe

    1. Thanks for sharing your own story with us, Joe. As you'll be aware one of the major problems for prisoners is getting the right diagnosis. Mental healthcare resources are now so scarce that many people are going undiagnosed or given inappropriate medication.

      It great to hear that you've turned things right round. Once the right diagnosis has been made and appropriate medication that helps has been identified, it is amazing to see how many people can manage their mental health conditions and live healthy, happy and productive lives. Alex