Backward Facing Therapy gives you behind-the-scenes stories from my time as a therapist and therapy client. It’s soulful and transformative mental health content from my couch to yours.
It was 3 p.m. on a Friday when I pushed the number four on the jail’s elevator panel.
I had been evaluating inmates at this jail for about six months and the majority of my interviewees were usually located on the violent offender or minimal security wings.
I had heard stories about the fourth floor. It was where inmates were sent when they were suicidal, physically violent, had severe medical issues, or had major mental health issues.
The stories whispered in the halls of the jail spoke of inmates stripped of their clothing and placed in restraints. Inmates who would gleefully sit in their urine or feces while they howled like wolves or paced their cells like wild animals. Inmates who would try to bite the guards or spit on them.
The fourth floor was not a place I was looking forward to visiting, but I had a duty to do my job and I would do so with compassion and an open mind.
As I exited the elevator, I was immediately hit with an odor of disinfectant combined with feces and urine. It took me a few seconds to gather myself but I continued walking to the guard station and requested an attorney room for my evaluation.
“There’s no attorney room on this wing.” the guard explained. “You’ll have to interview your client at the lunch tables. It’s our safety protocol” he elaborated.
After I sat down at the table and prepared my documents, I scanned the room. There were about 20 individual cells and each one had a hard plexiglass-type window that the inmates could look out of (and the guards could look into).
In one cell there was an inmate completely naked standing in front of the window rocking back and forth. His eyes were closed and he did not appear to be affected by his nakedness.
Next to him was an inmate who stood in front of the window in what appeared to be a state of catatonia. His eyes were wild like his hair but he was stiller than a statue. It was alarming, to say the least.
In the cell behind me, I could hear someone speaking in gibberish with random curse words thrown in. He was very loud and kept pacing back and forth. In the cell next to him was a woman who looked incredibly angry. Her face and eyes were red and she hurled insults at anyone that walked by. In between the verbal outbursts she pounded on the door and window and I could see blood on her knuckles.
“Would you like some menthol for your nose?” the guard asked. “It helps with the smell.”
His voice brought me out of the bizarre reality I had found myself in.
“No thank you,” I replied. My nose had already acclimated to the smell but that noise. Oh, those noises. If I dared to close my eyes, I could have sworn that I was in a wooded forest surrounded by howling, growling, angry animals.
“Breathe, Kim,” I said to myself. “Just focus on the client. Listen to her words. Focus on her.”
“She’s on her way!” the guard yelled to me.
I pulled out the assessment sheet to see what had caused Ms. S to be placed on the fourth floor.
She’d been diagnosed with Paranoid Schizophrenia in her teens. She was now in her thirties.
Schizophrenia Symptoms
Schizophrenia is characterised by significant impairments in the way reality is perceived and changes in behaviour related to:
persistent delusions: the person has fixed beliefs that something is true, despite evidence to the contrary;
persistent hallucinations: the person may hear, smell, see, touch, or feel things that are not there;
experiences of influence, control or passivity: the experience that one’s feelings, impulses, actions, or thoughts are not generated by oneself, are being placed in one’s mind or withdrawn from one’s mind by others, or that one’s thoughts are being broadcast to others;
disorganized thinking, which is often observed as jumbled or irrelevant speech;
highly disorganised behaviour e.g. the person does things that appear bizarre or purposeless, or the person has unpredictable or inappropriate emotional responses that interfere with their ability to organise their behaviour;
“negative symptoms” such as very limited speech, restricted experience and expression of emotions, inability to experience interest or pleasure, and social withdrawal; and/or
extreme agitation or slowing of movements, maintenance of unusual postures.
People with schizophrenia often also experience persistent difficulties with their cognitive or thinking skills, such as memory, attention, and problem-solving. Source
This would not be the first time I came face to face with someone diagnosed with Paranoid Schizophrenia. Years earlier when I worked as a counselor in a Victim’s Services office, I was assigned a client who had been shot and beaten with a gun.
During our initial visit, he told me that his friend didn’t mean to shoot him. It was the government that made him do it because “they are after me.”
“It’s the reason I don’t have a phone in my apartment. They listen in.”
“And they’re still trying to poison me which is why I won’t eat at restaurants. The government has a special poison they give to people in restaurants just for me.”
I ended up referring him to the local mental health hospital because I discovered that he was not medication-compliant. He had refused to take his anti-psychotic medication because he thought the pills were listening devices.
“What the hell have I gotten myself into?” I thought.
My interviewee, Ms S sat down at the lunch table across from me.
“It’s very nice to meet you,” she says after I explain to her why I’m there.
After I verify her demographic information, I jump to her psychological/psychiatric history.
“I’m here because the clinic wouldn’t give me my GEODON. They said there was a problem with my insurance. When I don’t get my GEODON, the voices in my head tell me to hurt people. I didn’t have GEODON for three days and I ended up punching a cashier in the head because the bad man in my head told me too.”
GEODON is a type of prescription medicine called a psychotropic, also known as an atypical antipsychotic. GEODON can be used to treat symptoms of schizophrenia and acute manic or mixed episodes associated with bipolar disorder. Source
“So that’s when you got arrested?” I ask.
“Yes.” Ms. S replies.
“Are you hearing any voices now? Are any voices telling you to do something?” I ask.
“No,” she answers.
“Are you seeing anything that you suspect isn’t real?”
“No, Ms. Kim. I have my GEODON now. I’m totally fine.”
“I see you have a part-time job at XYZ store. Will you be going back there after you get out of jail?” I inquire.
“Yes. I just got off the phone with my boss. He said I can come back when I get out.”
“Are you still sharing an apartment with R.?”
“I am. And before you ask, my rent is paid up.”
“I’m so glad to hear that Ms. S.”
After I finished the interview, and Ms. S was standing up to go back to her cell, she said to me, “Don’t let these people in here bother you, Ms. Kim. I used to be one of those crazy ones. I’ve tried over twenty-five different medications and GEODON is the only one that works for me. They just need to find these guys the right medication.”
“I’m glad that you’ve finally found the right medication,” I tell her with a smile.
As I approach the fourth-floor elevator, Ms. S yells, “Don’t forget about us up here!”
“I won’t!” I yell as the doors close.
On the drive home, I vowed not to ever again let myself fall into the trap of, “One paranoid schizophrenic is just like the other.”
Hmmmm…
“That still doesn’t work,” I say to myself.
No human diagnosed with paranoid schizophrenia is just like the other.
“That’s better,” I say out loud.
Let us always uphold and see the human(ity) in mental health care (even when it’s hard to see).
Especially when it’s hard to see.
Be well,
Kim
P.S. Ms. S, I told you I wouldn’t forget you. Thank you for teaching that young therapist a thing or two.
Thank you, Leon. Too often when people hear the term “paranoid schizophrenia”, they automatically think of a tortured character they’ve seen on TV. That’s a worst case scenario and not reflective of the entire population.
I’m so glad you’ve overcome your own self-prejudice. We’ve got to speak kinder to ourselves. ❤️