Ha Song Pham PSYCH 252 02/17/2012 Reaction Paper 1 on Crazy When talking about prison, one usually thinks of two kinds of people, the guards and the prisoners. But nowadays, when 16% of inmates have serious and persistent mental illness, it is not surprising to find psychiatrists working in prisons. The Miami-Dade County Pretrial Detention Center mentioned in Crazy was not an exception. On the ninth for of Miami jail, we found mentally ill prisoners, guards, Dr. Poitier who was the chief psychiatrist of the jail, and the nurses.
The medical staff and the prison officers hold opposite viewpoints about how the inmates should be treated. The great conflicts and complications between the justice system and the mental health system had made the job of the psychiatrists in prisons across the United States an extremely difficult task. Dr. Poitier and nurses on the ninth floor of Miami jail worked daily in a very unhygienic condition: “The air in C wings stinks. It is a putrefied scent, a blending of urine expectorant, persperition, excrement, blood, flatulence, and dried and discarded jailhouse food.
When the jail’s antiquated air conditioning breaks down during the summer, which it often does, some officers claim C wing’s pink wall actually sweats. It’s decades of filth and grime bubbling up, rising through coat of paint”. I wonder how one could be expected to live, let alone work in a condition as such. Under such horrible conditions, I wonder how effective the doctors were doing their job. And even if they were trying to do the best they could, I don’t think the inmates’ conditions could get any better when they did not even get to live in basic living condition which has a standard level of hygiene.
If the states were paying for the psychiatrists to treat the inmates, the first thing they should have thought about was the working conditions of the doctors and the living conditions of the inmates because those played a key role in the efficiency of one’s job and the recovery of one’s disorder. In addition to the poor working conditions, the medical staff were not treated well by both the officers and the inmates. The nurses got screamed at, threatened, and humiliated. In Crazy, Earley told the incident of one nurse having a prisoner toss a cup of feces and urine at her.
Nevertheless, the nurse did not quit the job for she understood that she could not take anything personally at her work. Most of the nurses were women. Inmates frequently masturbated in front of them. They did not get any protection from such hazard because the state attorney thought that it was not a crime that was worth pursuing. Doctors and nurses saw inmates as patients, while officers saw them as prisoners. The officers (or correctional staff as referred to in Crazy) treated the inmates very badly when the doctors were not around.
Due to the opinions that were at two extremes with each other, the efforts to help the inmates by the medical staff turned out to be useless by the poor treatment that the inmates received from the officers. On a larger scale, the psychiatrists received very little to no help from the state government. What’s more, they had to comply with the ridiculous, non-sense regulations that were originally constructed to protect the rights of the mentally ill. In Crazy, Dr. Poitier had no access to resources. The inmates were booked into jail without carrying their medical records.
He had to prescribe medication based largely on what the inmates told him. Plus, he had to follow the Miami-Dade County Public Health Trust’s instruction to prescribe Risperdal first whenever possible rather than Zyprexa, which was much more expensive. He had no freedom to do his job even though he received sufficient psychiatric training, while those people at the health trust were only thinking about the “so-called” economic benefits. Civil right laws such as Baker Act prevented the doctors from forcing inmates to take medication unless they posed an imminent danger or a threat. Dr.
Poitier was very disappointed by the Act. He stated that: “A person who is a chronic schizophrenic doesn’t have the full control over his thoughts. He can’t make rational decision. If you release him untreated back into the community, you aren’t protecting his civil rights. You’re condemning him to stay sick and a horrible life of suffering on the streets. ” The Baker Act was particularly complex when viewing it at different angles. For psychiatrists like Dr. Poitier, it hindered them from treating the inmates. They believed that the inmates were not mentally healthy enough to make ecisions about whether or not they wanted to to treated. On the contrary, public defenders and civil rights attorney felt that they had to protect the constitutional rights of the mentally ill. But what if what the mentally ill chose to do went against the wish of their loved ones, and negatively affected community. “Acting crazy is not a choice”. The mentally ill didn’t choose to be crazy. I couldn’t help but wonder what exactly these attorneys were trying to protect here. Were they trying to say protect a choice that no one wished to make?
But after all, I did not experience a mental illness, which would invalidate any opinions I would have about how a mentally ill person would feel or react. In the end, there was a price to everything. One could not expect to do a thing without having to face a trade-off. The decisions should be made in a way that benefited most people as it possibly could. Even though I was fully aware that the psychiatrists in the prisons were doing their best to help the inmates, I believed it was better if they understood the job that they were doing involved more parties than them and the inmates.
In Crazy, Dr. Poitier pointed out that: “My first concern is restoring this man’s mental health. But that is not the first concern of the lawyers, or of the judge who will be making this decision. This should be a medical matter, not a legal issue”. I didn’t think that was just a medical issue. Doctors alone would not be able to help the mentally ill without the support of other forces. Where would they find the resources such as medication, facilities, accommodation to assist the patients without the regulation or policy that allowed them to do so? It was never one man’s business.
It took the cooperation of a whole system in order to effectively help the mentally ill who also happened to commit crime. Despite innumerable difficulties and controversies involved in their jobs, the doctors and nurses were getting paid much less than the medical staff in mainstream hospitals. For example, the nurses on the ninth floor earned an average of $2,000 per year less then their counterparts in Miami hospitals. Part of the reason was because they were recent immigrants who had received their formal qualifications in a country other than the US.
Working in the section for the mentally ill in a prison was certainly not their first choice nor their second nor their third. It could be the only option that they had. However, they did not complain about their jobs. They did not go on strike. They did not sue the states for providing such little support. Instead, they were doing as much as they possible could to help the inmates. Dr. Poitier addressed inmates as “Mr. ” to show them respect. He asked very common questions that a doctor usually asked a patient: “How are you feeling today? He was treating the inmates as patients who needed help, and did not care whether they were also criminals or not. For him, they were just very ill people who needed medical help. He once said: “Most mentally ill inmates do stupid things, not bad things”. Dr. Poitier believed that the inmates on the ninth floor needed help that they would not get there. I wonder if he ever felt hopeless when he knew these people needed help, and he could give help, but those two things certainly would not happen in the prison. The inmates were unable to understand that Dr.
Poitier was trying to help them because of their dysfunction. Dr. Poitier was fully aware that he would not be able to do much to help the inmates because of messiness of the system and the daily conflicts between doctors and prison officers. They were stuck in a place where no one was better off. The question that baffled me the most was why they decided to stay at their jobs. There must have been something great and meaningful that made them almost irrationally continue their work. In Crazy, Dr. Poitier answered this question for me: “The inmates who end up here have been given up on.
But some can and do get better. And that’s the driving force that keeps me coming to work each day – knowing I can make a difference. Knowing I do make a difference. Besides, if I didn’t do this, who would? ” No matter how much trouble and confusion the job has brought, Dr. Poitier and the psychiatrists in general have managed to put their work ethics on top of everything else. Thanks to them, the mentally ill inmates get the support that keeps them through the days. Otherwise, the prison could actually become the hell hole on earth. It takes a lot of efforts in order to do good in any jobs.
But for the psychiatrists in prisons across the United States, they have to go to extra lengths in order to help the mentally ill inmates. However, their efforts alone are never enough, every other force involved in the system has to do their best as well. In addition, it is importance that they all try to come to understand each other’s job and the reason behind it so that they can make the whole system work for the inmates instead of the current climate when the mentally ill are stuck in the revolving doors of the jails and the hospitals.
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