OCD Inside

A common misconception about Obsessive-Compulsive Disorder (OCD) is that it is primarily about frequent hand washing or cleaning. Although these can be present as manifestations of this anxiety disorder, other compulsions can include obsessive rituals (often involving repeating actions a precise number of times) or a rigid attention to patterns of colours and/or of objects.

Before serving my prison sentence I had occasionally come across people with mild forms of OCD in my professional work, but my experience was limited. However, I discovered that various types of this disorder are quite widespread among prisoners. I’m not a psychologist, but in my view imprisonment has a tendency to make such pre-existing anxiety disorders much more acute. In part, it’s probably because prison can be a very stressful experience, but I also think that some inmates develop a desperate need to control something about their own environment and prison is, above all, a place where prisoners are deprived of almost all autonomy and decision-making.

I first became aware of the extent to which OCD is present in prisons when I came across fellow inmates who compulsively cleaned their own cells. Not just daily, but repeatedly throughout the day, and even the night. Cleanliness is important where a large number of people are incarcerated in close proximity, but these prisoners took cleaning to a whole new level.

I came to know cons who enjoyed the luxury of single cells and who refused to allow any other prisoner to enter. They couldn’t do anything about screws coming in, of course, but as soon as the officer went away, they felt the need to scrub and re-polish the whole floor. Since cleaning products are often very restricted in closed prisons, there was a lively black market demand for floor polish, j-cloths and disinfectant; products that could be supplied – in return for burn (tobacco), chocolate or tinned tuna – by business-minded wing cleaners.

There were other manifestations of OCD throughout the prison. Some prisoners were obsessed with hoarding toiletries and other canteen goods, as if they were anticipating a month-long lock-down during which they would have to survive on packets of instant noodles. Often, these products had to be displayed in a specific order on tops of lockers, windowsills or on shelves.

I initially thought that this was some kind of demonstration of prison ‘wealth’… “Look, I have the money to buy 20 Lynx roll-ons, or 40 cans of tuna.” However, I came to realise that this was more to do with the prisoner trying to exert some control over his own living space by filling it with products he owned and arranged (often by size, colour or type).

I briefly shared a pad (cell) with one lad who insisted that every item had to be placed on colour-coded j-cloths. Drinks (milk cartons, fruit juice) had to be placed only on yellow cloths; food on blue ones; toiletries on red j-cloths and so on. He also had an obsession about repeatedly spraying the entire cell with a dilute solution of fabric conditioner he purchased from the canteen sheet. It was like living in a laundry. Ironically, these OCD symptoms didn’t prevent him chain smoking and leaving ash and fag butts everywhere. It was a strange contradiction.

Another pad-mate frequently changed his clothes during the day. Having got dressed in the morning, he would then select another t-shirt and jogging bottoms from his obsessively neat stack on his shelf above the bed and change again. This continued throughout the day whenever we were in the cell. He would also carefully dismantle his folded pile of clothes and then refold each garment again. I once estimated that he spent several hours each day just folding and refolding his clothing. However, when I asked him whether he thought he might suffer from some form of OCD, he vehemently denied it and said that he “just liked things to be tidy”.

He next developed a serious floor-polishing addiction (perhaps it was the heady smell of the polish which attracted him) and he would polish and re-polish the floor of our pad several times a day until you could – literally – see your face in it.  He traded tins of tuna with the wing cleaners for juice bottles full of contraband industrial floor polish.

Other inmates had a range of other obsessive behaviours. One popular black lad wouldn’t use the wing showers unless he was allowed to have the cubicle on the far right. Even if the other three in the landing shower-room were all vacant, he would prefer to wait until “his” shower stall was free. I once asked him why. After all we were in a C-cat, the atmosphere on the spur was pretty relaxed and, as far as I knew, he had no enemies who would want to “give him a serving” (a violent assault) or to “stripe him” (slash his face or body with prison razor blades mounted into a toothbrush handle). He looked puzzled at first and then replied that he honestly didn’t know why, but explained that he only felt comfortable in that one cubicle. Again, he needed to exert some control over his environment.

Others resort to much more destructive forms of behaviour, including regular episodes of self-harm. Every wing I’ve even been on has a contingent of “cutters”, men who find temporary relief from their depression or anxiety by lacerating their own skin with razor blades or other sharp objects. Some prisoners are reluctant to reveal their arms because of the latticework of scars that criss-cross them; some old and healed, others newer, vivid and recently stitched. There is a perception among some screws that these inmates are just attention seekers, but having spoken to many “cutters” while I was working as an Insider I think the whole issue is far more complex than that.

It seems to me that the number of prisoners suffering from OCD-like symptoms is reflective of the problems of mental health in custody. It is entirely possible that at least some of these inmates had serious anxiety issues before they ended up in custody. However, incarceration certainly seems to exacerbate these obsessions in some people.

As I’ve noted elsewhere on this blog that the impact of prison on mental health is an often unseen cost of Britain’s current penal policy. Many forms of OCD can be treated and brought under control through appropriate behavioural therapy and/or medication, but I’m not aware of such support being available in prisons. Inmates are usually left to deal with these anxieties and obsessions on their own and its often only when they actively self-harm themselves (or, more rarely, others) that they come to the attention of healthcare or psychology. That seems a sad indictment of our prisons in the 21st century and I fear that the problem is set to get worse as the prison population rises, while budgets are cut and staff numbers fall.