Prozac in Prison

Once a week I climbed the metal stairs to the third-floor office of the mental health counselor.  The stairs ran up the outside of the building like an oversized fire escape. They were wrapped in chain link and topped with a corrugated metal roof. I suppose the chain link was to keep guys like me from jumping. I was being treated for depression.

The counselor’s office was familiar.  There were charts piled high on the desk and motivational posters on the wall. “The longest journey begins with a single step.” 

The contrast with my cell block was stark. The office smelled clean with a hint of patchouli.  It had comfortable chairs and throw rugs. Sunlight streamed through a narrow window that faced the street.

The counselor would smile and greet me by my first name. We would exchange pleasantries. Then she would ask, “So, how are you doing?” It was weeks before I could get through one sentence without breaking into sobs. The weight of my failures pressed down on me. I grieved my betrayal of people I cared for.  I grieved the pain I had caused. I grieved the shame I brought on my family. I grieved the loss of my friends, my profession, my hopes for the future. The counselor would listen respectfully, hand me a tissue and speak kind words. Sometimes she would make suggestions.

“I think we should increase the dose of your anti-depressant.” 

“What’s the use,” I choked out. “No amount of pre-synaptic serotonin is going to give me back my life. Am I supposed to feel happy about being in prison?”

“I think it will make you better able to cope with your situation,” she observed while making a note in my chart.

At the end of the hour I would dry my tears and walk back across the prison yard to the grey, fortress-like Hancock Building and my concrete cell. There are so few places in prison where it’s safe to cry.

I read recently more than thirty percent of state prisoners experience a persistent numb or empty mood, the loss of pleasure in activities, feelings of worthlessness, decreased ability to concentrate – all the symptoms of clinical depression. [1] This doesn’t surprise me. Psychological pain is the tool the state uses to punish those sentenced to prison. By law, the prisoner must live in a world shrunk to the size of the prison compound, even smaller if his privileges are restricted. He is cut off from family, friends and meaningful work. His surroundings are intentionally drab and spare; his possessions few and subject to search and seizure at whim. Even his naked body is not safe from the official gaze and the probing finger.

More painful than loneliness and boredom is the pain of moral rejection. It may be true that an innocent and quiet mind can make of stone walls and iron bars a hermitage, but we have been tried and found guilty. Societal rejection turns what might be a hermitage into a cage. Only those who have given up on human connections can avoid the demons of shame, self-condemnation and regret that lurk within these walls. It’s no wonder so many prisoners sink into despair. 

There are other, long term threats to the psyche of captives. Prison is a dangerous place from which there is no escape. The only way to avoid harm is to never let your guard down. I learned to keep my mouth shut around anyone whose crime and sensitivities I did not know. Fear was my constant companion. But, it’s not safe to let anyone know you’re afraid.  After a while, most of us develop a prison mask, unrevealing, aloof. Sadly, your mother was right, “keep doing that and your face will stay that way.” After years of living on edge and emotionally disconnected, we go home changed.  Our friends and families are disappointed when we find it hard to drop the mask and fully engage.

Of course, the prison administration would deny it intentionally inflicts psychological pain. After all, prisoners are by law provided the necessities of life: food, clothing, shelter, medical care, and, yes, psychological care. In some way the conditions of prison reflect what sociologist Gresham Sykes described as “a sort of half-hearted punishment,” [2] meant to inflict emotional pain without causing permanent psychological damage, even though that is the natural result. 

So when the prisoner does become clinically depressed, the state will provide him a modicum of psychiatric care. And if the need arises, it will give him Prozac.

[1] James, Doris and Lauren Glaze, Mental Health Problems of Prison and Jail Inmates.

[2] Sykes, Gresham, The Society of Captives. Princeton University Press. Princeton, NJ. 1958.