To be effective and enjoy working as a psychiatrist in any setting requires unique personality traits. Likewise, to be effective and enjoy any type of work in corrections requires unique personality traits. But, working as a psychiatrist AND doing so in jails and prisons narrows down the field even further.
For the right candidate it can be a very rewarding career. For others, frustration and ultimately burnout may result.
Here are a few personality traits that I believe are important:
1. Having a Strong Sense of Independence: One needs to be able to organize and prioritize many different tasks without having to ask for advice and reassurance often.
2. Having Patience: Prisons and jails work on their own schedules. The primary priority is always security. Health care is an ancillary service in corrections, not the primary mission. There will be frequent delays and inconveniences that arise. One must be able to shift gears, adapt, and still make the best use of the time available.
3. Having a Sense of Humility: Psychiatrists make more money than most workers in correctional settings and also must work hard to earn the respect of other staff since those providing “help” in corrections are often seen as enablers. Walking in with an attitude will assure a psychiatrist even higher doses of resentment and passive-aggressive behavior from security staff as well as hostile, adversarial relationships with inmates. Working conditions can be far from ideal. One may need to evaluate inmates in noisy and almost always Spartan environments. Life will be difficult for those who think they are special!
4. Having an Ability to Work Alone: Professional isolation is a reality in corrections. I once spent a couple of years working in an HMO setting with a group of psychiatrists. While there were many things about HMO life I didn’t like, at least I spent a lot of time around colleagues. In prison, though, one often needs to work alone.
5. Displaying a Secure, Confident, Relatively Calm Demeanor: A psychiatrist who comes across as indecisive or not self-confident will be taken advantage of by inmates. The reality is that all of us who work in correctional health care are taken advantage of by inmates to some degree, but life will be more challenging for the meek in prison. One must also be able to be in the midst of chaos or hostility and not lose ones temper or appear excessively anxious.
6. Having a Good Poker Face: One needs to be able to deal with seeing and hearing the bizarre, outrageous, and vulgar without reacting to it. Likewise, although most inmates are not malingerers, when a psychiatrist suspects malingering, it is crucial not to show any emotional reaction. (Please see this recent post on malingering for details.)
7. Having the Ability to Set Limits and Maintain Professional Boundaries: Those unable to set limits with patients probably shouldn’t practice clinical medicine and definitely should not work in corrections. Patients everywhere, but especially in jails and prisons, will tell their psychiatrist what they want. What they want may or may not be what they need or what is appropriate. Likewise, those who tend to want to rescue others and easily become overly-friendly with patients will be the guaranteed victims of numerous setups. (Read the post on the book about this, Games Criminals Play, for more information.)
8. Being Thick-Skinned: Not callous, just not overly-sensitive. Psychiatrists need to be able to have inmates yell names and threats to them on a segregation unit without it getting to them. I remember in my early days several inmates on a segregation unit were angry because I wouldn’t drop what I was doing and go talk to them that minute. One was yelling out at me that I was a “fucking white-ass bitch” and that he was going to “kick my ass” as soon as he got out of prison. Such threats are not a part of everyday work for me and have diminished considerably over the years. Most inmates actually are reasonably polite, but on a daily basis I see the more subtle attempts at manipulation where inmates attempt to make the psychiatrist feel guilty or inadequate for not giving them what they want. Fortunately most patient encounters go quite smoothly without any such issues.
9. Being Kind and Compassionate: Please note that one can be thick-skinned, skilled at setting limits and professional boundaries, AND still be kind and compassionate. Sadistic people don’t make good correctional psychiatrists! But, those who care about their fellow human beings, take seriously their professional duty as physicians, and at the same time can set limits and not take things personally are likely to do well.
10. Having a Sense of Adventure and a Sense of Humor! Much of it actually is fun, if one has the right attitude. Taking things too seriously (prisons and jails are serious places) will increase the likelihood of burnout. Laughter at the appropriate times is good and necessary! Being curious about life and humanity and being able to focus on the positive all make the job more interesting and enjoyable.
Do I do all of the above all the time? Of course not. These are the ideal traits, not the ones that every successful correctional psychiatrist will have. And certainly some days are better than others.
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