Sunday, May 11, 2008

C is Back

C is without doubt my favorite violent schizophrenic.  At his worst, he smears himself with his own shit and attacks anyone who comes near.  At the mid-level he walks in circles, never making eye contact with anyone, every muscle tense.

He was my 'project' for a long time. When he started 'decompensating*' I'd get a call, "Sarge, see if you can talk to C.  He's about to lose it."  So I would walk in long circles with him, usually not talking any more then he did.  He eventually started talking a little and then a lot.  One custody, he shared a goal with me. He wanted to work in the jail kitchen.  That probably doesn't seem like a big goal to you, but for him it was huge.

He had to work his way from Severe Mental Housing to Mental Housing to Mild Mental to General Population and then to the worker dorm.  That meant that his behavior had to continually improve until he wouldn't 'ping' the radar of the other inmates in custody at the level he was going to.  He had to stay on his meds. He had to consciously watch and modify his behavior. C took it very seriously and we wrote a contract, which was actually more of a list of things that he needed to learn how to watch: a cheat sheet for faking normality (and are any of us normal? Is there a difference between faking normal and being normal?)

The problem came in the transition from Mental to Mild Mental.  I was talking to him every day.  He seemed to be doing really well.  At the bi-weekly meeting of the Mental Health Team I made the case for moving him on... it was soundly rejected.  I thought he was doing better. Everyone else thought he was losing ground fast.  I made the case at the next meeting and the next... it was imperative that he didn't get the idea that we were manipulating him.  He had to learn from this that controlling his behavior worked- it got what he wanted.  That goal setting and planning worked.  It would be a huge disaster, and play nicely into some of his paranoid delusions, if he came to believe that the people who had developed rapport with him had only done so for our own purposes, to make him easier to manage.

I made the case again and one of the deputies sighed. "Sarge, he's complaining about bugs everywhere.  We can't send him to Mild, much less General, if he's seeing imaginary bugs."

Crap. "I'll tell him," I said.  So I did. I went up to his housing unit and told him that as long as he was seeing things, we couldn't move him.  Maybe a medication change...

No.  He was adamant.  There really were bugs and no one would listen to him.  I sighed. 'No one listening' fell right in with the paranoid aspect of his schizophrenia. "Show me." He brought me up to his cell.  It was crawling with little maggoty bugs.  The only cell in the whole jail.

Sometimes the bugs are real.  It was a good lesson for all of us.  Everyone had seen what they expected to see and stopped looking when they saw what they expected.  He made it all the way to the kitchen and did a good job until his release.

C is back in custody.  He's looking really good, keeping himself clean, holding a conversation. I even saw him play cards with other inmates.  Is he better or faking it? Does it matter?

*Mental health has almost as many cool euphemisms as law enforcement.  They don't say "Getting worse" or "Going off the deep end" the use "decompensating".  And restraining someone by force is a "physical intervention strategy."  Cool, huh?


Steve Perry said...

When I did a tour of the mental hospital at Jackson, LA -- a place that could have been the model for Cuckoo's Nest -- we got to sit in on patient session wherein they were being evaluated for furlough. The shrink told us that they coached each other for the process, telling patients what to say or not-say to get the pass.

Guy came in, Bill. Smiled, sat, greeted the doctor.
"How's it going, Bill?"

"Great, Doc! I'm feeling much better, I'm taking my meds, doing good."

"Great to hear, Bill. How are your anger issues?"

"Fine, no problem! I just count to a hundred and let them pass."

"Great, Bill."

"So, you think I can have a pass?"

"Well, I don't think you are quite ready for that, Bill."

"Goddamn motherfucking bastard!" Bill said, whereupon he stood and stomped out of the room

One of the nursing students looked at the shrink. "Wh-What's his diagnosis?" she asked.

"Bill, oh he's crazy," the shrink said.

Never forgot that.

Dave Chesser said...

When I worked on the pysch ward I had to constantly keep in mind that just because they were crazy didn't mean that they were wrong. As your example proved, sometimes the bugs were real.