Treating patients who have been convicted of murder

On April 17, 2010, in correctional psychiatry, by Lockup Doc

Correctional psychiatrists inevitably treat patients who have been convicted of a broad array of crimes. There is a correlation between the security level of the institutions in which one works and the severity of the crimes of the inmates being housed there.

Since I’ve treated inmates of minimum, medium, and maximum custody levels, I’ve had the opportunity to work with people who have been convicted of everything from drug possession to multiple murders.

What’s it like treating patients who have killed other human beings?

First, after one has treated inmates for a while, the crimes that they have committed lose their shock value. It’s neither glamorous nor anything like the interviews of Hannibel Lecter in “The Silence of the Lambs.” However, when working with them, I never forget that because of their past actions, many have the potential to kill again.

While the criminal history of my patients is pertinent to their psychiatric treatment, to me it’s usually just one piece of information that is of varying importance from one case to the next. However, it’s typically not the focus of my treatment of them.

Second, it’s not a simple question to answer, primarily because homicide perpetrators are a very heterogeneous group.

At one extreme are those whose actions have resulted in the accidental death of others, such as those who have caused a fatal motor vehicle accident while intoxicated. At the other extreme would be those who have intentionally committed multiple murders. In the middle would be inmates who may be remorseful for having impulsively killed out of anger, sometimes while under the influence of drugs or alcohol.

While inmates who have killed may be different from each other in many ways, one commonality is that many are serving life sentences and will someday die in prison. This results in a unique treatment situation, even for a prison psychiatrist. How does one help to give a prisoner hope when he’ll never get out of prison?

An article in Psychiatric Times focused on this issue in “Discussing the Meaning of Life with a Lifer.”

The author points out that the rate of mental illness in prison is even more pronounced among lifers (approximately one in four lifers has mental illness).

Consistent with my own observations, he also mentions that some lifers have a “nothing to lose” nihilistic approach to life while others in the same circumstances gradually accept their fates, find meaning in their lives by focusing their efforts on others in positive ways (an outward focus instead of being concerned only about themselves), and ultimately do well.

Not surprisingly, given that they want to better themselves, this latter group typically is the more rewarding for psychiatrists to treat.

I have also learned many life lessons from this cohort as well. One is the great degree to which happiness or life satisfaction is related to the way in which we respond to our circumstances much more than to the circumstances themselves.

It is because of this concept that some prisoners can be “free,” at least in their minds. Likewise, many of us who are not incarcerated may feel imprisoned by our own lives, primarily because of how we process our circumstances. It’s not difficult to understand this concept intellectually, but it is much harder to practice changing how we look at things in our own lives, especially when we face adversity.

On the other hand, treating the more nihilistic, hopeless patients can result in a psychiatrist feeling helpless and ineffective. Nevertheless, many of these patients still need our help even if the percentage who may benefit from our interventions is small.

If you’ve worked with inmates, what have your experiences been?

Photo by remuz

Related posts:

  1. Improve Your Ability to Detect Malingering
  2. How correctional health care professionals can advocate for their patients
  3. Cultivating a Nonjudgmental Attitude
  4. Would I Have Committed Crimes Too if I Had Grown Up Like That?
  5. Ten Tips for Surviving Prison: A Psychiatrist’s Viewpoint
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  • http://www.tsuken.co.nz Tsuken

    I’ve worked with forensic patients of many sorts, including some who had committed pretty dreadful crimes including multiple murders. There was a variation even within similar crimes in that some were directly related to psychosis, and others not. As you say, it becomes simply another part of the history – albeit a pretty significant one.

    I found the most rewarding situation was in a man whose act of homicide was completely related to delusions. After finally getting him well (after many years of others thinking he was psychopathic), there was a well person who could start coming to terms with his act, and begin rebuiling his life. In many other cases though, nothing really shifted. If a criminal has a psychiatric illness, treating the illness doesn’t always stop the criminality.

  • http://www.tsuken.co.nz Tsuken

    I’ve worked with forensic patients of many sorts, including some who had committed pretty dreadful crimes including multiple murders. There was a variation even within similar crimes in that some were directly related to psychosis, and others not. As you say, it becomes simply another part of the history – albeit a pretty significant one.

    I found the most rewarding situation was in a man whose act of homicide was completely related to delusions. After finally getting him well (after many years of others thinking he was psychopathic), there was a well person who could start coming to terms with his act, and begin rebuiling his life. In many other cases though, nothing really shifted. If a criminal has a psychiatric illness, treating the illness doesn’t always stop the criminality.

  • Lockup Doc

    Very interesting experiences you’ve had. Thanks for sharing them. Did you mostly treat those patients on a forensic unit or in a forensic hospital (I’m assuming from your description that the particular patient you mentioned was probably not in jail or prison.)

  • Lockup Doc

    Very interesting experiences you’ve had. Thanks for sharing them. Did you mostly treat those patients on a forensic unit or in a forensic hospital (I’m assuming from your description that the particular patient you mentioned was probably not in jail or prison.)

  • Lisa

    A most intriguing post. I completely agree that a sense of purpose and satisfaction in life can be derived from our given circumstances. I never thought about that in the context a lifer…physically confined and segregated from societly for life…I can’t imagine.

  • Lisa

    A most intriguing post. I completely agree that a sense of purpose and satisfaction in life can be derived from our given circumstances. I never thought about that in the context a lifer…physically confined and segregated from societly for life…I can’t imagine.

  • http://att.net June Taylor

    I read your comments with interest. I have a friend who is a “lifer”. I have found him to be a caring, kind sensitive individual despite what he has done in the past. What angers me is the things the media puts out on TV, newspapers, etc. that ALL inmates are “animals” and should never see daylight again. He has been denied family visits while in the hospital in Intensive Care undergoing major surgery. His family and friends were on his approved visitation list and were told they could see him if he was in Intensive Care but this did not happen. When attempting to contact any elected officials, they will never talk to you about this. They are only interested in someone who escapes.

  • http://att.net June Taylor

    I read your comments with interest. I have a friend who is a “lifer”. I have found him to be a caring, kind sensitive individual despite what he has done in the past. What angers me is the things the media puts out on TV, newspapers, etc. that ALL inmates are “animals” and should never see daylight again. He has been denied family visits while in the hospital in Intensive Care undergoing major surgery. His family and friends were on his approved visitation list and were told they could see him if he was in Intensive Care but this did not happen. When attempting to contact any elected officials, they will never talk to you about this. They are only interested in someone who escapes.

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