Head Games

At least one out of every five Colorado prisoners is mentally ill -- some violent, some undetected or untreated. How did the Big House become the Bug House?

When Anderson continued to press for a psychiatric evaluation, the same mental-health worker accused him of engaging in "narcissistic entitlement" and "manipulation of issues" in a ploy to get Ritalin. After several months, a psychiatrist decided to try him on an anti-depressant, imipramine, but Anderson complained that it "messed him up" and soon stopped taking it. "Irritable, pressured, angry, threatening lawsuits," the psychiatrist wrote in a follow-up visit in July 2004. "Threatens potential for assault."

He didn't see a psychiatrist again for months. His efforts to be considered for other possible medications were viewed as the scheming of a "manipulative narcissistic extremist," in the words of his mental-health worker. As the months dragged on, Anderson told the worker he was angry at the psychiatrist for not helping him and not even coming back to see him. Asked if he was having thoughts about harming himself or others, Anderson replied that he wanted to kill the psychiatrist. The worker reported him for making threats -- prompting Anderson to file a grievance. "How can he ask me a question like that and write me up for it?" he asks. "That's insane."

His relationship with the staffer continued to deteriorate. "Having a good time playing chess," the latter observed in one particularly snarky entry. "His ADHD must have disappeared for awhile."

In July 2005, another psychiatrist recommended that Anderson be evaluated for "appropriate medical intervention." Subsequent entries in his records show that Anderson, psychologist Peggy Steele and others made multiple requests for such an evaluation over the next ten months, with no success. Steele was sufficiently concerned about Anderson's "escalating" symptoms to upgrade his psychiatric rating. Her own assessment of his condition seemed to shift with each visit: "Paranoid personality...ADHD...maybe bipolar...possible frontal lobe injuries...OCD-like symptoms...borderline personality disorder, narcissistic personality disorder, antisocial personality disorder...frequent mood changes, hostility, grandiosity."

"They're tossing out diagnoses like confetti, aren't they?" says John Macdonald, a retired forensic psychiatrist who reviewed documents from Anderson's prison mental-health file for Westword."I've never seen a case like this."

The author of numerous books on investigative procedures, Macdonald has performed court-ordered psychiatric evaluations of hundreds of violent criminals, dating back to John Gilbert Graham, who blew up an airplane in 1955 to collect an insurance policy he'd taken out on his mother. He laments the increasingly impersonal care that mentally ill prisoners receive as the system has grown larger and more bureaucratic.

"In the old days, I could wander around the prison and talk to anybody," Macdonald says. "That made a hell of a lot of difference. Now, you're lucky to get a few minutes through glass with someone. There's no depth of relationship. I think they're probably all scared of this inmate, and I don't blame them, really. But not dealing with him is increasing the problem."

Stefani Goldin, Anderson's attorney, points out that he has a record of cooperation and no violence at the supermax for the past five years -- except for the disputed "threats" report about wanting to kill the psychiatrist. Yet this clear demonstration that he can control himself in lockdown has resulted in diminished mental-health services and no increase in privileges. Anderson's history of violence has defined him, regardless of what he does now.

"He's no closer to getting out of ad-seg than he was five years ago," Goldin says. "From a management perspective, you have to wonder what CSP is thinking. What's his incentive to continue with good behavior? If he's left to believe that he's just going to rot in CSP the rest of his life, why shouldn't he be a problem?"

Anderson finally saw a psychiatrist last week, only days after Westwordinquired about the fourteen-month delay. Michaud denies that the inquiry had anything to do with the appointment scheduling; he blames the lag time on a system-wide staff shortage that has left his psychiatric providers playing catch-up for months. "My guess is that Mr. Anderson was not seen as a very high priority," he says.

Although the patient has waived confidentiality, Anderson's actual treatment providers refuse to discuss his care -- or defend it. But after one visit, Steele noted in the file, "I told him that medication alone would not cure his anger."

Anderson agrees that he needs more than drugs. But he sees Steele only once a month, he writes, and sometimes not that often. So what officials know about him is what is in the file: his psychiatric rating, record of assaults, his score on the Resource Consumption Scale, medications prescribed. "Every time I have been turned down [for transfer], we discuss the fact that I am not on meds," he writes. "They told me at my last hearing that they won't approve me because they know it's not a matter of if I stab someone. It's when. Period.

"I know I need help. Talking about things helps. Have to trust to do that. That's really hard in here."

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