Mental illness or unchangeable habits?

One of the most confusing and troubling aspects of my work is differentiating between what I can work with and what I can’t.  This shows up most often when students are starting to struggle and I have to determine whether it’s learned behavior, or something deeper and more serious.  If they are running into old, dysfunctional patterns of self-sabotage, there’s a solid chance I can help them, if they’re willing to do the work.  If it seems that I’m dealing with undiagnosed or untreated mental illness, there’s often nothing I can do until they self-destruct.

The level of ambiguity and lack of clarity in these situations is jaw-dropping.  I often have nothing to go on except my knowledge of the student, and my intuition.  DOC is extremely limited in what it can do, or offer, with regard to mental health and illness, and I have access to none of that information.  If an inmate isn’t an immediate danger to herself or others, they are treated as if they are “stable”.  If an inmate doesn’t have a previous mental illness diagnosis, the chances of getting one while incarcerated are almost nonexistent, which means no treatment.

DOC offers little cognitive therapy and that only to the most severely mentally ill inmates. Those who can get mental health services (a minority of inmates) are largely treated using DBT (Dialectical Behavior Therapy), not cognitive therapy.  This means their counselors help them deal with their immediate situation – strengthening their coping and rational thinking skills.  While this is necessary, it does nothing to relieve the underlying reasons why they continue to make bad decisions, or the chemical and biological causes for depression, mood swings, and erratic behavior.

About a year ago, I had a student in her early 20s.  She’d gotten caught up in some shady stuff her mother was doing and ended up getting a seven-year sentence when she was 18 and a first time offender.  Her mother got only five years, but that’s another discussion.  I accepted this young woman into my program late, when another student dropped.  The New Student (NS) had to do a lot of work in a short period of time to catch up and she did – we were all excited and pleased because she was off to a good start.

She managed to maintain herself for a while, but then we (my program clerks and I) started to notice a cycle of behavior.  She consistently had trouble with acting out while under stress, even with extensive coaching and new tools, and about every six to eight weeks, she’d have a major blow up.  We’d have a debrief, a big discussion, create a plan with specific goals and steps, and discuss consequences.  This happened maybe three times and when the cycle began again, I knew something had to change.

I don’t remember exactly what happened, but NS was headed toward another blowup and, hoping to stop the cycle, I brought her into my office to talk.  Because she’d started the program late, she was still finishing up the first module after the rest of the class had graduated and gone.  She was the only student working, and we were prepping for the next class and finishing up interviews.  She only had another three to four weeks max until she’d be done with the entire course, and I had hopes we could help her hold herself together long enough to finish.

One of my clerks was with us, and the discussion progressed.  This time, though, something was different.  NS had a harder edge, was more aggressive than she had been and before I knew it, she had slammed her head backward into the wall.  It wasn’t hard, but it was on purpose and far, far beyond the norm of acceptable behavior.  I immediately called security and two officers came.  One, a calm woman who has since retired, stayed in the room and the other, also steady and calm, stood right outside.

I continued my conversation with NS, hoping she would de-escalate and pull herself together, so I wouldn’t have to see her walked out in handcuffs.  She managed, but not until I told her she could either throw herself on the floor and have a real tantrum, or go back out and continue working like a grown adult.  I was not sure what choice she would make and almost expected her to throw herself on the ground and start punching the floor. She decided to go back to her seat, so I let her and left further conversation for another time.  I didn’t feel that anything was resolved, but I hoped her choice was a good sign.

It might have been, but making one right choice wasn’t enough to stop her from completely sabotaging everything she’d worked so hard to build.  Within a week, she’d gotten into a serious fight with one of my newly chosen students and both were taken to Medium, to Segregation.  She was lucky she wasn’t beaten more badly, and I suppose I dodged a bullet with the incoming student.  But the whole incident was horrible and it felt like all that work with her had just swirled down the drain, mixed with the blood running from her cut face.

To this day, I don’t know if her behavior was a sign of a mental illness, or an attention-seeking behavior so deeply ingrained she just couldn’t pry it loose.  I’ll probably never know, but it drove home for me that every single person I interact with has a complex, hidden self that I know nothing of, but that influences and permeates every interaction, choice, and behavior.  While this behavior seems shocking, it isn’t.  Teachers all over the world have to deal with students who are violent, aggressive, sick, mentally unstable, and mentally unwell all the time.

For me, this is another demonstration that these women are human beings.  They work and find ways to deal with the issues that come up for them because they feel they have no choice.  To give in and act out in their old, self-destructive ways isn’t an option for most of them any more, so they manage, then take another step forward. Given their limited access to resources in such a stressful and negative environment, I also believe they have the strongest desire to change their lives that I’ve ever seen.

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