Saturday, February 28, 2009

A Forensic Homage to Professor X


Above: Photo of Chester Gillette & Grace Brown
Below: Theodore Dreiser

“Life's little ironies are not always manifest. We hear distant rumbling sounds of its tragedies, but rarely are we permitted to witness the reality. Therefore the real incidents which I am about to relate may have some value.”[i]

My college history professor killed himself. He had bipolar disorder, stopped taking his lithium and his life ended tragically. His classes were among the most popular on campus and included enough humor, drama and multimedia to routinely fill the 200 plus seat auditorium. I was never quite sure what to make of him, and this was well before I really knew what bipolar disorder was. I went to all his lectures faithfully – not just because of his captivating lecture style, but also because he never failed to say something outrageously controversial, and I simply did not want to miss out. It was a rare lecture that did not send one or more students stomping out in disgust. In truth, there were many times when I wanted to stomp out in disgust. But I didn’t.


I couldn’t. I was transfixed, I believe, for a number reasons. The most obvious to me was that I had the unnerving sense that something about this man was driving him towards his own personal apocalypse, and I did not know what to do other than bear witness to it. The more subtle dynamic that compelled me involved the search for truths about the human condition. Professor X, as I shall call him, was a true renaissance man. His lectures and assigned readings were sprinkled with literary gems unknown to most college students. One of these gems, which became a sacred find to me, was Theodore Dreiser. Dreiser was an American writer who is most known for dealing with the gritty, raw reality of life. His novels often focused on themes of social inequality.


Professor X was obsessed with social inequality. He beat you over the head with social inequality. But in doing so, he exposed you to some human truths which, if you had patience and tolerance, you might glimpse. Dreiser’s prose contained many of these truths, and Professor X had slipped them into some of his teachings so casually that I might have missed them. I didn’t miss them, partly because they demand to be contemplated in all of their sad and sobering veracity. I later bought an out of print copy of Dreiser’s poetry, and was again transfixed. His short poems were raw, honest and arresting. I am forever grateful to Professor X for the gift of Dreiser. As it turns out, Dreiser had a bit of forensic psychiatrist in him. One of his most famous novels An American Tragedy, was based on the notorious Gillette murder case of 1906, which grabbed national attention just as the Scott Peterson case did in 2005. In preparing to write his novel, Dreiser researched the Gillette case extensively.



The Gillette case bears striking similarities to the Peterson case: Chester Gillette was convicted of murdering his pregnant, 20 year old girlfriend, Grace Brown. The murder trial drew international attention, particularly after Brown’s poignant love letters to Gillette were read in court. Gillette was convicted of the murder, and executed by electric chair at Auburn prison in NY. Dreiser’s adaptation was a novel of naturalism that presented a man struggling against psychological, social and environmental forces. It dealt with subjects most found too uncomfortable to consider at length, such as abortion and capital punishment. Through his novel, Dreiser dared to shine a light on a darker side of the Horatio Alger myth – a side that revealed a national obsession with social and economic “climbing” which promoted greed, selfish ambition and inequality.



In a sense, An American Tragedy is an unflinching examination of the dark side of desire and ambition.
[i] In it, as in all of his work, Dreiser tells us not to turn away from parts of the human psyche that we would rather not see. Stand in awe if you must, says Dreiser, but don’t dare turn away. As a naturalist writer, Dreiser always tried to present life exactly as it is, without sermonizing or judgment. In this respect, naturalism overlaps with forensic psychiatric principles. A naturalist writer tries to be objective and detached, while realizing that “pure” objectivity is but an ideal, and next to impossible to achieve.[ii] To the well grounded forensic psychiatrist, this should sound familiar.



I believe that the instincts compelling me to remain open-minded to the example of Professor X were among the same that led me to a career in forensic psychiatry. I now recognize those instincts as: a desire to face and not turn away from the objectionable, and a need to explore the human condition. Why repeatedly and daily bring oneself into contact with the “gritty,” tragic aspects of life unless, among other things, you are in search of some truths? Certainly, some might point to the voyeuristic gratification, which in itself lies a truth of sorts. But voyeurism alone cannot be the answer. It is insufficient to sustain more than mere episodic visitation to the lands of human tragedy. “And what of masochism?” some might ask. Let us temporarily allay this issue by noting that psychiatry is not the only medical discipline who must reckon with this line of inquiry. Further, medicine has a long tradition of making discoveries by examining biological processes that are dysfunctional, or otherwise in extremis. This was how we learned what we needed to in order to defend against disease and suffering. It also how we comforted ourselves – by giving ourselves the illusion of victory over death.


We have a desperate need to deny the reality of death. Throughout the life span, the giving over of one’s cultural values, ideals and sense of meaning is, in essence, a masking over of anxiety about death.[iii] It is no easy task to acknowledge and live with “the full extent” of one’s helplessness and “insignificance in the machinery of the universe.”[iv] But after a point, the flight from reality may become devoid of inwardness and filled with “certainty” in an attempt to avoid tragic reasoning and knowledge.



Tragic reasoning is “the ability to preserve those facts we are reluctant to confront because of the pain they involve and connect them with other facts that escape detection because they would extend and magnify that pain.”
[v] Tragic reasoning exposes the fraud of all ideologies and guarantees. It challenges all our ways of knowing and of being. It enables one to glimpse the cruelty and destruction that is in our nature – our heritage from the ancestral struggles of our evolution. The importance of the tragic is that it gives life one of the very few meanings we can discern when we step outside of our own imposed system of guarantees. It is our point of unity: “The tragic is the situation that all subjects face insofar as they are subjects.”[vi] For it is the fact that we can die from within that makes us human, and life can only be lived by internalizing “death so deeply that it becomes not that thing that will happen at some distant point in the future nor that intrusive thing we spend most of our lives forcing out of our consciousness, but that finality that must enter into and transform all of our choices in a way that fully delivers us over to our finitude.”4


Certain aspects of my travails in forensic and correctional psychiatry have always seemed to taunt and mock with the question: “Can you find the beauty in absolute ugliness?” Poetry and writing became one of my attempts to answer this question. I must concede that there have been occasions in which, try as I might, there was no beauty to be found. Still, Dreiser’s message was there for me – “Don’t turn away. Don’t you dare turn away…” And perhaps it is simply in the act of bearing witness where the beauty may be found.

“We toil so much, we dream so richly, we hasten so fast, and, lo! The green door is opened. We are through it, and its grassy surface has sealed us forever from all which apparently we so much crave—even as, breathlessly, we are still running.”1

References:

[i] Dreiser T: W.L.S. In: Twelve Men. 1919. At: http://www.gutenberg.org/files/14717/14717-h/14717-h.htm#WLS
[i] Lingeman R: Introduction to: An American Tragedy by Theodore Dreiser. New York, NY: Signet Classic, 2000.
[ii] Cummings M: Plot summary for An American Tragedy: Study guide. At: http://www.cummingsstudyguides.net/Guides4/Dreiser.html#Top accessed on: 9/14/2008
[iii] Becker E: The Denial of Death. New York: Free Press, 1973.
[iv] Freud S: The Future of an Illusion. J. Strachey, Ed.; New York, NY: W.W. Norton & Company, 1961.
[v] Davis W: An Evening With JonBenet Ramsey. Lincoln, NE: Authors Choice Press, 2003.
[vi] Davis W: Death’s Dream Kingdom: The American Psyche Since 9-11. Ann Arbor, MI: Pluto Press, 2006.



Thursday, February 26, 2009

Lifers & the Meaning of Life


“He who has a why to live for can bear almost any how.”


- Nietzsche (Twilight of the Idols)[i]



“For the mind is its own place, and can make a hell of heaven, or a heaven of hell.”


- Milton (Paradise Lost)
The process of adapting to prison life, or prisonization, has been described as exerting a dehumanizing effect that may result in feelings of hopelessness and alienation.[i] The psychological effects of prison are believed to vary according to the individual. However, it is within the context of imposed institutionalization that the inmate is vulnerable to the development of harmful attitudes such as a negative self-concept, devaluation of life and other generally destructive cognitions. It might be hypothesized that inmates serving life sentences (“lifers”) spend the longest time in prison, and would therefore undergo the greatest degree of prisonization. Whether the life sentence results in an attitude characterized by nihilism or adaptation is unknown at present; however, one could speculate that an individual’s pre-incarceration coping skills and overall constitution play a role.
Persons serving true life sentences (life without the possibility of parole) are a group of individuals living under a unique set of circumstances. Lifers must somehow adapt to the reality that there will be no future release date to sustain hope or a sense of purpose. Because they have been subject to an extreme form of permanent social exclusion, one might speculate that they would have an increased degree of hostility, mistrust, and nihilistic attitudes. However, correctional staff can attest to the fact that this is not always the case. Lifers often have the regard of their fellow inmates, and may be respected for having met the challenge of surviving in prison. Veteran correctional authorities note that some lifers “seem to mature into acceptance of their situation. Many take on a leadership role, setting a positive example…for other inmates.”[i]

To be sure, lifers are also in a position to use prestige and a “nothing to lose” attitude to control and/or manipulate other inmates in less than helpful ways. I will not be so na├»ve as to ignore my experience that some true lifers with nothing to lose may act as so-called “shot-callers” of inmate gangs. The existence of organized crime in corrections is an unsettled and unsettling dilemma. In fact, U.S. attorneys have had to prosecute leaders and members of highly sophisticated organized crime syndicates operating out of the nation’s prisons. Aryan Brotherhood gang members have been convicted of running an extensive criminal enterprise from behind bars that involved murder, narcotics trafficking and conspiracy in an effort to rule the nation's prisons.[ii] In some worst case scenarios, incarcerated gang leaders have ordered the murders of individuals living in the community. In a study of offending during incarceration, it was found that 40% of inmates were “chronic or extreme career offenders even while incarcerated.”[iii] Further, a small cadre of inmates accounted for 100% of the murders, and 75% of the rapes in prison.

These individuals, by and large, would appear to be fundamentally different from the rest of the prison population. Sure, there will be some overlap. But in general they are different – different from inmates with severe mental illness, and different from non-mentally ill inmates who have a desire to rehabilitate themselves. Further, their impact on the correctional environment, and what is left of rehabilitation, can be substantially damaging. Besides creating a climate of fear which undermines rehabilitative efforts, there is the issue of abusing vulnerable, mentally ill inmates. Psychiatric hospitalizations may be directly precipitated by such abuse. Other very sad cases involve impressionable or otherwise vulnerable mentally ill inmates being “recruited” into gangs so that they might serve as pawns for a gang’s strategic maneuvering. I could go on, but you get the point – these are drastically different populations of individuals, and it is not clear that intermingling them serves a legitimate penological interest, ethical or humanitarian interest.

But let me assure that there are, in fact, a good many lifers with a more pro-social, positive disposition. Little is known about the psychological structure or psychiatric morbidity of lifers from a research standpoint. Even less is known about effective treatment or programming approaches to lifers who struggle emotionally and are otherwise unsuccessful in finding purpose to their “new life” in prison. Why one lifer chooses a more positive path and another a more negative one is interesting to consider. My primary interest in lifers has stemmed from personal observations that life meaning and/or purpose in life appears to influence inmates’ coping styles and, in some cases, their risk of suicide. This interest next led me to the writings of Viktor Frankl who was the first psychiatrist to emphasize the importance of studying meaning in life within a psychological context.[iv] Frankl’s experience as a Nazi concentration camp prisoner led him to conclude that a primary motivation for humans is a “will to meaning,” or a drive to find meaning and purpose in life. A failure to find meaning and purpose may result in feelings of hopelessness, suicidality[v] and other self-defeating actions.


Based on the work of Frankl, the Purpose-in-Life (PIL) Test was constructed to assess or quantify the construct of meaning in life.[vi] Surprisingly, there is little research on this subject as it relates to prison inmates. What research does exist was done primarily in the 1970’s, and much about the correctional landscape has changed since. A 1973 study found that recidivists scored significantly lower on the PIL than did first sentence prisoners who, in turn, scored significantly lower than normal controls.[vii] In a 1977 study, inmates (who were not serving life sentences) were found to have scored significantly lower than normal subjects on meaning and purpose in life.[viii] Subsequent research has found an association between the development of substance abuse problems and a lack of purpose or meaning in life.[ix]


One might speculate that the current abandonment of rehabilitative programming in corrections has only served to further re-enforce the inmate’s diminished sense of self-worth and personal value. Ultimately, feelings of diminished personal worth lead to a questioning of purpose. I have observed that once an inmate reaches some individualized level of nihilism, he demonstrates a greatly reduced ability to participate in and benefit from rehabilitative and treatment efforts (ie., no meaning = no purpose or reason to change). In addition, when an inmate has strong nihilistic beliefs, there is often little motivation to self-regulate behavior.


These empirical observations of the adverse effects of nihilistic beliefs in inmates are consistent with research findings in non-incarcerated populations. For example, social rejection has been found to increase feelings of meaninglessness, and decrease self-awareness and the ability to self-regulate behavior,[x], [xi] and ultimately to suicide and/or self-destructive behaviors.[xii] This theory has been called the “escape theory” to denote the individual’s motivation to escape from aversive self-awareness. The “escape” theory may have relevance to the psychology of inmates, particularly where the inescapable structure and discipline of a prison reduces their ability to use prior maladaptive coping mechanisms to avoid aversive affect and self-awareness.
What Frankl called the “will to meaning” is a highly personal and individual endeavor. Achieving happiness through one’s life purpose often involves an outward focus – that is, it is “other” directed. Admittedly, prison life appears to do little to encourage outward focus, especially in terms of healthy social and societal alliance building. Yet it is precisely through such “other” directed engagement that the stagnating bonds of self-absorption can be loosened, and toxic feelings of societal “persecution” can be overcome. One may wonder if ignoring the opportunity to emphasize life meaning and “other” directed interests may simply foster some inmates’ tendency to go into a “behavioral deep freeze” where misbehavior is reduced during the prison term, only to reemerge in society after release.[xiii]

References

[i] Nietzsche F: The Portable Nietzsche (W. Kaufmann, Ed.). Maxim no. 12 in Twilight of the Idols, p. 468; New York, NY: Penguin Books, 1982.
[i] Stinchcomb J: Corrections: Past, present and future. American Correctional Association, 2005; Versa Press, East Peoria, IL.
[i] Bruton J: The Big House: Life Inside a Supermax Security Prison. 2004; pg. 157. Voyageur Press; Stillwater, MN.
[ii] Richards T.: Aryan Brotherhood Leaders Are Convicted in Murders. The New York Times, July 29, 2006.
[iii] DeLisi M.: Criminal Careers Behind Bars. Beh Sci Law 2003 21: 653-669.
[iv] Frankl V: Man’s Search for Meaning. 1959; Boston, MA. Beacon Press.
[v] Edwards M, Holden R: Coping, Meaning in Life, and Suicidal Manifestations: Examining Gender Differences. Journal of Clinical Psychology, 2001; 57(12): 1517-1534.
[vi] Crumbaugh J, Maholick L: Manual for Instructions for the Purpose-in-Life Test, 1969; Munster: Psychometric Affiliates.
[vii] Black W, Gregson R: Time perspective, purpose in life, extraversion and neuroticism in New Zealand prisoners. British Journal of Social and Clinical Psychology, 1973; 12:50-60.
[viii] Reker G: The Purpose-in-Life Test in an Inmate Population: An Empirical Investigation. Journal of Clinical Psychology, 1977; 33(3): 688-693.
[ix] Waisberg J, Porter J: Purpose in life and outcome of treatment for alcohol dependence. British Journal of Clinical Psychology, 1994; 33: 49-63.
[x] Twenge J, Catanese K, Baumeister R: Social Exclusion and the Deconstructed State: Time Perception, Meaninglessness, Lethargy, Lack of Emotion, and Self-Awareness. Journal of Personality and Social Psychology, 2005; 85(3): 409-423.
[xi] Baumeister R, et al. Social Exclusion Impairs Self-Regulation. Journal of Personality and Social Psychology, 2005; 88(4): 589-604.
[xii] Baumeister R: Suicide as Escape From Self. Psychological Review, 1990; 97(1): 90-113.
[xiii] Bruton J: The Big House: Life Inside a Supermax Security Prison. 2004; pg. 157. Voyageur Press; Stillwater, MN.