The Curious Case of the classic crazies

In the free world, (that is outside the world of the prison) mental illness is an interesting experience to diagnose and treat. In lay terms, we have not moved much beyond calling folks "crazy." This rather vague category can include your mother-in-law, ex-wife, and the person down the street who keeps saying that someone is coming in their house and stealing their peas. All are equally crazy. Your mother-in-law, because she has never liked you, your ex-wife because she quit liking you and became a raving shrew, and for obvious reasons the person down the street who has found the only burglar in town who craves English peas enough to break and enter.

Most persons and families are ill informed about mental illness and equally ill-informed about the symptoms, causes, and treatment of such illnesses. Treatment in the free world is about diagnosing, educating the person/family, and providing a treatment approach that addresses the broadest range of issues the illness brings.

In prison, it is slightly different. Since many of those incarcerated are there for using/dealing/selling illicit drugs, mental illness takes on a whole new set of twists and turns. And since most of the prescription medications for mental illness work on the same centers of the brain as illicit drugs, there is a whole new culture in prison called "med seekers."

Simply, they want to act mentally ill in order to be prescribed the medications so they can get high or sell them or exchange them for other things of value. So, the mental health worker spends his day dealing with folks who want to get off their medications because they are no longer having symptoms and those who want to get on psychotropic medications because (see above).

I am rather new to the place, but I have discovered when an offender comes into my office and tells me he is hearing voices six out of seven days for a period not to exceed a month, and that these voices are co-existent with his paranoia which has been unabated for a period not exceeding two weeks, while at the same time, he has had delusions and feelings of grandiosity, I suspect someone has been reading their DSM-IV-R--which is the diagnostic Bible of mental illness.

I suggested to our clinicians instead of going through the laborious process of learning everything in the DSM about diagnosing schizophrenia, schizo affective disorder, etc, we should just consult with the "med seekers" to see if the patient meets criteria. They have far more time than we do to get the symptoms right, and they are a walking encyclopedia of delusions, hallucinations, and paranoid ideations.

Course, my co-workers just look at me, shrug their shoulders and say to each other, "he's crazy."