In response to my previous post, I received a number of comments and feedback which included assertions that individuals who engage in repetitive self-injury in correctional settings are “doing it for attention.” That got me thinking. And the more thinking I did, the more I realized that these statements are likely true. But, not necessarily in the way one would think. Let me explain.Continue reading
According to the fitness tracker I wear on my wrist, I slept for 7 hours and 13 minutes last night. I was restless eight times and woke up twice. What does that tell me? No idea. The Centers for Disease Control tell us that adults need seven or more hours of sleep each night. But what if I feel refreshed after five hours? Am I unhealthy? What if I slept 10 hours, am I super healthy?
At the risk of oversimplifying, many incarcerated patients come to us with some manifestation of the following (or a combination of these):
- Problematic emotional experiences
- Problematic thought patterns
- Problematic behaviors
- Problematic relationships
It is important to work with the patient to understand which of these issues is experienced by the patient as most distressing and in need of change. I think back to a patient I once saw who was diagnosed with schizophrenia. She had significant trouble with tangential and disorganized thinking but what she wanted more than anything was having cigarettes at the end of the month. (This was back when inmates could still smoke in the prison.) She often smoked all her cigarettes prior to the end of the month and then had to borrow cigarettes “2-for-1” for the remainder of the month, putting her at a deficit at the start of the next month…you see the cycle. She did not have any interest in meeting with me to improve her thinking. She wanted her cigarettes.