David's story
When you're in my line of work, you have to expect to be scammed. A few months in here is considered heaven compared to where these men come from, and a reduction of the sentence is what they're all after, so they put up their best face at all times. In this particular case the best face is the face of insanity. It is our job as psychiatrists to distinguish between the real and the fake. It's quite interesting to know that one of the best ways to separate the mad from the fraud is to look at them as they arrive. There are exceptions, of course, but on the whole the sane will pretend to look mad and unreasonable, whereas the mad, the truly insane, will remain calm and pretend nothing is the matter.
I was standing by my window, regarding the new arrival. The prison psychiatrist wrote to me telling me that it was genuine. He also wrote to me that I ought to be careful. I was young, new, keen and very curious to see him. He was taken out of the van by two guards who expected the man in chains to cause a struggle. They got none. All they got was a stern look. He was calm and collected. Serene almost. It was most peculiar. Utterly sane, some might think. Utterly resigned, it struck me. Utter façade, the psychiatrists’ letter had warned me. He shot one look upwards and directly to me, as though he knew exactly where to find me. I doubt that he could actually see me, as I was standing safely behind the voile curtains, but it caused a chilly sensation to run down my spine none the less. Those eyes, deep, dark and empty would stay with me for the rest of my life.
My first session with Harry Starks was similar to all patients’ first sessions, with me telling him how it all worked and him not replying anything. The one difference was that most patients pretended to be mad or bored and Harry pretended neither. His face had no expression, his eyes showed no sign of life. It was quite uncanny.
A few sessions later I suggested he start talking. It didn't matter about what, as long as he talked. He told me about an inmate friend of his who got out of his sentence by pretending he was mad. He pretended he had lost the ability to talk and only whistled, like a bird. Earned him the nick-name 'the Bird'. The guy thought he'd make a joke and said that that was more Harry's sort of nick-name. So, he said, and I quote, 'I decked him'. I gave some mild sedatives. Not as much because of the story, but because if I didn’t put people on some prescription the board would think they were sane and sent them back in a few days without enough time for proper assessment of sanity or ailment. I didnt’ care who they were or where they came from; if they were mad they deserved proper treatment. The board didn’t see it like that. For a board of psychiatrists they were quite paranoid.
Next session I asked him if the drugs had done anything for him, if he felt any better. 'Nah', he told me. 'This place is like prison; you don't get better'. Was that regret? Was he faking? Was he depressed? 'But you are calmer,' I asked. He confirmed with an apathetic nod. I wondered then if the sedatives I had given him were too strong. But I didn't diminish his dose.
Two days later I had to visit him in an isolation cell. The guards advised against it, but I went in. He was surprisingly cooperative.
"Shouldn't have done that. I know. Lost my temper,", he said as I walked in. He was sitting on the floor, in the far corner, looking at the wall, arm crossed over his chest in a straight-jacket. I wasn’t a fan of straight-jackets, but I wasn’t a fan of being strangled either, so I didn't argue the decision. I asked him if he knew what had happened to the guard he attacked. He looked at me. I told him he was in hospital, gravely injured. He didn't reply, he didn't even blink. Didn't he care? Or was he numbed by the drugs?
I put him on different sedatives, something a bit more anti-depressive.
After a few fits of pure rage more throughout the next month, I decided to diagnose Harry with undefined psychosis. I witnessed his last outburst myself. It was lunch-time. I don't know who started or what was being said. All I know is that two patients, one sitting next to Harry and the other in front of him, were having a conversation. The conversation itself was not of an aggressive nature; it even involved laughing and nudging Harry to have him join in the amusement. No sooner had he been nudged or Harry had stabbed a fork in the patient's hand. It was the end of collective lunches for Harry and the end of the presence metal cutlery in the building.
Psychosis it was. I prescribed something a bit more aggressive to go along with the anti-depressants. I confronted him with the word in a session, told him that he suffered from psychosis. He didn't answer. I prescribed him the pills and he took them without a word. Resigned again. Depressed and psychotic. It was a nasty combination.
I confronted him again a few days later. His hands were balled into a fist, a sign of intimidation. I told him that he should try to calm himself, not to rely only on drugs. I told him he was too aggressive, that his hands balled into a fist and that it breathed hostility and intimidation. If looks could kill, I would have been dead. He glared at me and darkly said that I hadn't seen him aggressive. 'I'm trying to keep the trembling out of them. The trembling your bloody pills are causing.' I tried to tell him that it was a natural side-effect and that he would lose the tremor when he got off the pills eventually, but he went for my neck before I could open my mouth.
So, I put him in isolation. Again. And that depressed him. Again.
A week later he came to another session. I told him he wasn't going to get better unless he talked to me. He sat down folded his hands and looked to the floor for about five minutes. Then he spoke. 'I'm losing.' That was all he said that session.
After that, Harry became more comfortable talking. It was a great step forward. Only the more he talked, the more paranoid he got. He looked at the pills on the tray in front of him. Intense blue, pink and yellow. Anti-depressants are always coloured brightly. 'Think you can make me happy with bright colours?' he asked. It was another great step forward in my book. Harry was coming to terms with the state of his mind that was his problem.
That afternoon it was visiting time for all the patients, even for Harry. We had to put up a front of openness towards the outside world. A man came to visit him, whom he later referred to as his accountant. The man acted as his doctor too. I heard them talk. He told Harry to 'tone down on the drugs, they're making you wonky'. Harry didn't reply. It was the first time I felt sad for the man. Those eyes no longer seemed intimidating and empty, but dismal and sad. It was the first and only time I ever felt truly sad for a patient.
'You're depressed, Harry' I told him. 'It's your pills. They give me the shakes. All you give me to eat is soup and I can't even hold a spoon.' That was true, it was soup and plastic spoons for Harry only, since the episode at lunch. 'I can't eat my food. Everything's blurry. How is that supposed to make me happy? How is that supposed make me better?'
We had more sessions and he became more open. I was pleasantly surprised. One day I didn't even need to start the session. He began himself. 'Send me back,' he said, and it sounded like a plea from a desperate man who was afraid to show it. 'I don't think you're ready-', I tried. 'It's not helping. None of this is helping.' He looked me right in the eye. 'Five more months and I've done my time, I'll get out, get on my two feet again. That's what I need. I need my life back.' He reached into his pockets and produced a little bag with pills. 'I haven't been taking them. I am getting better.' He looked at me expectantly and those two eyes were suddenly full of hope. I believed him. He had been talkative, cooperative, he seemed in control and he hadn't attacked anyone in months. So I signed his release form.
Well, not his release form, but a 'go to jail' card. I caught him on the way out, and held out a hand, which he shook with both of his, out of great gratitude. I snuck him some pills ‘just in case’ and he thanked me, lowered to my ear (a moment that caused me great inward fear) and whispered that he owed me and if I ever needed something, he would be out of prison soon and I had only but to ask. I smiled and said that wouldn't be necessary, but he insisted and I said I would.
I never did.
A few months later, when I was doing my yearly inventory of pots and pills I realized that pills were missing from three pots. Harry's pills. It couldn't be a coincidence. He had taken them with him. He had probably bagged them and shown them to me on the day he asked me to get him out. I thought he hadn't been taking them; he had fooled me. I realized then that I should have asked for his hands. They would have been shaking. That's why he shook my hand with two hands on the day of his release. To prevent me from noticing the tremor. I suppose I should have felt foolish, unprofessional, or betrayed at least, but I found myself thinking it funny instead. I'd been scammed.
I was standing by my window, regarding the new arrival. The prison psychiatrist wrote to me telling me that it was genuine. He also wrote to me that I ought to be careful. I was young, new, keen and very curious to see him. He was taken out of the van by two guards who expected the man in chains to cause a struggle. They got none. All they got was a stern look. He was calm and collected. Serene almost. It was most peculiar. Utterly sane, some might think. Utterly resigned, it struck me. Utter façade, the psychiatrists’ letter had warned me. He shot one look upwards and directly to me, as though he knew exactly where to find me. I doubt that he could actually see me, as I was standing safely behind the voile curtains, but it caused a chilly sensation to run down my spine none the less. Those eyes, deep, dark and empty would stay with me for the rest of my life.
My first session with Harry Starks was similar to all patients’ first sessions, with me telling him how it all worked and him not replying anything. The one difference was that most patients pretended to be mad or bored and Harry pretended neither. His face had no expression, his eyes showed no sign of life. It was quite uncanny.
A few sessions later I suggested he start talking. It didn't matter about what, as long as he talked. He told me about an inmate friend of his who got out of his sentence by pretending he was mad. He pretended he had lost the ability to talk and only whistled, like a bird. Earned him the nick-name 'the Bird'. The guy thought he'd make a joke and said that that was more Harry's sort of nick-name. So, he said, and I quote, 'I decked him'. I gave some mild sedatives. Not as much because of the story, but because if I didn’t put people on some prescription the board would think they were sane and sent them back in a few days without enough time for proper assessment of sanity or ailment. I didnt’ care who they were or where they came from; if they were mad they deserved proper treatment. The board didn’t see it like that. For a board of psychiatrists they were quite paranoid.
Next session I asked him if the drugs had done anything for him, if he felt any better. 'Nah', he told me. 'This place is like prison; you don't get better'. Was that regret? Was he faking? Was he depressed? 'But you are calmer,' I asked. He confirmed with an apathetic nod. I wondered then if the sedatives I had given him were too strong. But I didn't diminish his dose.
Two days later I had to visit him in an isolation cell. The guards advised against it, but I went in. He was surprisingly cooperative.
"Shouldn't have done that. I know. Lost my temper,", he said as I walked in. He was sitting on the floor, in the far corner, looking at the wall, arm crossed over his chest in a straight-jacket. I wasn’t a fan of straight-jackets, but I wasn’t a fan of being strangled either, so I didn't argue the decision. I asked him if he knew what had happened to the guard he attacked. He looked at me. I told him he was in hospital, gravely injured. He didn't reply, he didn't even blink. Didn't he care? Or was he numbed by the drugs?
I put him on different sedatives, something a bit more anti-depressive.
After a few fits of pure rage more throughout the next month, I decided to diagnose Harry with undefined psychosis. I witnessed his last outburst myself. It was lunch-time. I don't know who started or what was being said. All I know is that two patients, one sitting next to Harry and the other in front of him, were having a conversation. The conversation itself was not of an aggressive nature; it even involved laughing and nudging Harry to have him join in the amusement. No sooner had he been nudged or Harry had stabbed a fork in the patient's hand. It was the end of collective lunches for Harry and the end of the presence metal cutlery in the building.
Psychosis it was. I prescribed something a bit more aggressive to go along with the anti-depressants. I confronted him with the word in a session, told him that he suffered from psychosis. He didn't answer. I prescribed him the pills and he took them without a word. Resigned again. Depressed and psychotic. It was a nasty combination.
I confronted him again a few days later. His hands were balled into a fist, a sign of intimidation. I told him that he should try to calm himself, not to rely only on drugs. I told him he was too aggressive, that his hands balled into a fist and that it breathed hostility and intimidation. If looks could kill, I would have been dead. He glared at me and darkly said that I hadn't seen him aggressive. 'I'm trying to keep the trembling out of them. The trembling your bloody pills are causing.' I tried to tell him that it was a natural side-effect and that he would lose the tremor when he got off the pills eventually, but he went for my neck before I could open my mouth.
So, I put him in isolation. Again. And that depressed him. Again.
A week later he came to another session. I told him he wasn't going to get better unless he talked to me. He sat down folded his hands and looked to the floor for about five minutes. Then he spoke. 'I'm losing.' That was all he said that session.
After that, Harry became more comfortable talking. It was a great step forward. Only the more he talked, the more paranoid he got. He looked at the pills on the tray in front of him. Intense blue, pink and yellow. Anti-depressants are always coloured brightly. 'Think you can make me happy with bright colours?' he asked. It was another great step forward in my book. Harry was coming to terms with the state of his mind that was his problem.
That afternoon it was visiting time for all the patients, even for Harry. We had to put up a front of openness towards the outside world. A man came to visit him, whom he later referred to as his accountant. The man acted as his doctor too. I heard them talk. He told Harry to 'tone down on the drugs, they're making you wonky'. Harry didn't reply. It was the first time I felt sad for the man. Those eyes no longer seemed intimidating and empty, but dismal and sad. It was the first and only time I ever felt truly sad for a patient.
'You're depressed, Harry' I told him. 'It's your pills. They give me the shakes. All you give me to eat is soup and I can't even hold a spoon.' That was true, it was soup and plastic spoons for Harry only, since the episode at lunch. 'I can't eat my food. Everything's blurry. How is that supposed to make me happy? How is that supposed make me better?'
We had more sessions and he became more open. I was pleasantly surprised. One day I didn't even need to start the session. He began himself. 'Send me back,' he said, and it sounded like a plea from a desperate man who was afraid to show it. 'I don't think you're ready-', I tried. 'It's not helping. None of this is helping.' He looked me right in the eye. 'Five more months and I've done my time, I'll get out, get on my two feet again. That's what I need. I need my life back.' He reached into his pockets and produced a little bag with pills. 'I haven't been taking them. I am getting better.' He looked at me expectantly and those two eyes were suddenly full of hope. I believed him. He had been talkative, cooperative, he seemed in control and he hadn't attacked anyone in months. So I signed his release form.
Well, not his release form, but a 'go to jail' card. I caught him on the way out, and held out a hand, which he shook with both of his, out of great gratitude. I snuck him some pills ‘just in case’ and he thanked me, lowered to my ear (a moment that caused me great inward fear) and whispered that he owed me and if I ever needed something, he would be out of prison soon and I had only but to ask. I smiled and said that wouldn't be necessary, but he insisted and I said I would.
I never did.
A few months later, when I was doing my yearly inventory of pots and pills I realized that pills were missing from three pots. Harry's pills. It couldn't be a coincidence. He had taken them with him. He had probably bagged them and shown them to me on the day he asked me to get him out. I thought he hadn't been taking them; he had fooled me. I realized then that I should have asked for his hands. They would have been shaking. That's why he shook my hand with two hands on the day of his release. To prevent me from noticing the tremor. I suppose I should have felt foolish, unprofessional, or betrayed at least, but I found myself thinking it funny instead. I'd been scammed.