New blog!

I've decided I'd rather not be blogging under my full name.  I'll keep writing the same kinds of things, but in a new place.

Email me for the new address: juliawise07@gmail.com

Mental health resources for weird settings

In looking for written materials on mental health for my clients, I keep finding that the materials out there are not well suited to jail. For example, every written piece of advice on how to cope with PTSD advises people to take soothing baths, go for walks, pet their dog, call a friend, etc. . . . not exactly going to happen when you're in jail.

I've come up with several handouts on various topics, all written at a not-too-difficult reading level. None of them contain references to things you can't do in jail. They would be good for other restrictive settings like hospitals, too.

Documents here. Feel free to use and reproduce them.  Most of the material is gleaned and edited from other people's websites.

Topics:
Grounding exercises (for flashbacks, panic attacks, and anxiety in general)
CBT for anger (this one is written specifically for prisoners)
Grief journaling ideas
Daily affirmations
Coping with traumatic stress reactions
Exercises for anxiety
Money management (intended for people with addictions and/or who have been banned from having bank accounts because of their financial past)

A different kind of startup job

Re-employment after doing time in jail is no joke. Some people are going home to supportive families, but some are leaving to a homeless shelter with only the clothes they're wearing. Then you have a criminal record, which makes any kind of legitimate work difficult to come by.

For men, construction seems to be the best bet. You don't need good English or a clean record — you just need to be able to do the work.

Drug dealing is another business with low startup costs. After a small initial purchase, you retail larger amounts. Of course, this is only profitable if you're not sampling the wares too much.

For women, the options are more limited.  When they need rent, or bail for their boyfriends, or drug money, or groceries, a lot of my female clients turn to the oldest profession.

One woman told me she worked as a prostitute but said bitterly, “My mom thinks I'm a whore.”  I was confused about the distinction, but she explained: a prostitute does it because she needs the money. A whore does it because she likes it.  “And nobody likes it,” she said.

Of course, there are prostitutes who like their work.  Freakonomics profiled one such woman who quit her job as a software developer to make $200,000 a year as a high-end call girl.  She described her job as playing the “ideal wife,” making men feel appreciated and placing no demands on them.  The Honest Courtesan is a blog by another such professional. Those richer women are relatively safe from legal action – they're not exposed in the way that street hookers are.

In Massachusetts you can still be jailed for something called “common nightwalking,” which means you were outdoors at nighttime and appeared to be soliciting customers. Unlike a lot of the old blue laws, this one is actually enforced.

I would love to see prostitution legalized.  Of course, if it were formalized (as in Nevada, with licensed brothels and required medical checks), it still wouldn't be practical as a stop-gap measure for some of the people who are now practicing illegally.  But it would provide some of the more determined ones with steady work, and would hopefully prevent some of the robberies, beatings, and gang rapes I've heard about from my clients.  (I'm including robberies perpetrated by the prostitutes, too — know how easy it is to grab a wallet when his pants are down?)  In a legally-run brothel, both sex workers and their customers would have more recourse to the law.

As a side note, apparently there's been a decline in self-care among Boston hookers.  I heard an older woman complaining: "When I was young, the women on Blue Hill Ave used to look goooood.  They had the nicest clothes, the nicest bags, they had their hair just so, they had their nails done.  Now — uh uh!  They look like the cat dragged them in!"  I haven't heard theories as to why this is.

Valentine exchange

Want a valentine?  Email me and I'll send you one.

Feeling vaguely crafty?  Want to make some valentines and get more than one?  Email me by February 4th and I'll set up an exchange - you make a couple of valentines, mail them out, and receive some from other participants.  It will be great!

juliawise07 at gmail dot com

Tell them.

Last week I complained about a problem. I've been thinking about what the solution might be.

I had never heard of Aaron Swartz until he died, though I used his inventions every day. This happens a lot with famous people – I had never heard of Frank Sinatra until he was dead and suddenly he was all over the radio. Of course, if you're Sinatra, you probably get more attention than you want. But I'm guessing a lot of awesome people, probably Aaron included, don't hear enough “You're awesome, and I'm glad you're doing the things you do, and I want to help if I can.”

I had a friend with a famous father. It struck me as strange that people were so excited about meeting him, because in person he was less interesting than her (possibly because he'd been pursued by too many fans and was sick of meeting people). People just walked up to him and told him how much they admired him and his work, but no one said that to her. I didn't tell her, “You're so fun, and I love your hair, and this spinach you made is really good,” even though I thought it every day.

When people die, we wish we had told them things like that.  And yet it's hard to say it in the course of everyday life.

What praise do we not give, and why?

One reason is the fear other people will think you're weird.  It's true that flattery can come off as creepy. But I think people can usually tell the difference between flattery and honest praise. And accepting weirdness is a good life skill.

Maybe hearing too much praise would make a person conceited after a while. But I think in most cases, it would just make them happier and better at being awesome. I love that as a social worker, I get to give my clients real criticism and real praise, because we're outside the normal realm of social interactions.

And the normal realm does not encourage this kind of thing.  It embraces irony, and geeky subcultures especially prize critique and verbal sparring (see also: Why Our Kind Can't Cooperate).  Which is fine, but that's not all there is to life.

So sometimes there's love and admiration that I don't have an easy outlet for.  It took years of angst before I gave myself permission to be in love with men who were not viable romantic partners. I kept trying to reconcile the love with the impossibility of acting on it. I finally realized I didn't have to act, and I also didn't have to squash the love. It was okay to give up hope and just love them.

With some of them I got to move on from the awkward-non-lover stage to real friendship, and that was great.  And one of them broke up with his girlfriend and married me, and that was pretty great too.

I try to push myself to tell people the things I love about them. It's scary, because there are probably situations where this could go wrong and people would be uncomfortable. But I'd like to move towards a culture where it's not weird.

For well you know that it's a fool
Who plays it cool
By making his world a little colder.
- Paul McCartney

Brrr

Don't glorify suicide

After a busy life of activism and entrepreneurship, and facing possible jail time for downloading academic articles, Aaron Swartz killed himself Friday.  They're calling him a martyr.

But let's remember that the Department of Justice didn't kill him.  MIT didn't kill him.  His death was not some kind of inevitable consequence of their choice to prosecute.  He hanged himself.

My grandfather committed suicide about 40 years ago.   I never met the man, but I saw the repercussions his last act had on his wife and children.  The bitterness.  The gap, where there should have been a grandpa and wasn't.  I grew up understanding that there was nothing glamorous about suicide.

In the grip of depression, that didn't stop me from considering it at times.  I have been where Aaron was when he wrote, “Everything you think about seems bleak — the things you’ve done, the things you hope to do, the people around you.”  But even in that haze, I couldn't ignore what my death would do to my family.  On the day I got married I promised to be a loving and faithful wife, and that meant not leaving Jeff.

And things got better, as I fully expect they would have for Aaron.  For a man who had accomplished so much by age 26, he undoubtedly had more gifts to give the world. Yes, his death drew attention to his cause, which may have been part of his intention.  But I seriously doubt that cutting things off now was the best way to further digital freedom.

I think there are cases where a person really can expect their life to be net negative, and death is their best option. But that doesn't seem to have been the case here.  People are talking about the 35 years he faced like it was a sure thing, but it was likely he'd have gotten a light sentence.  And a jail sentence, as Martin Luther King could have told you, does not have to ruin your life or your cause.

I don't mean to minimize the pain Aaron was in, which I'm sure surpassed anything I've experienced. But I don't think it justifies his action.  It is deeply wrong to hang yourself where your girlfriend will find your body — she will never be the same.  You don't do that to someone who loves you.  And it was wrong to abandon his cause when he had so much to give.

Suicide has a situational aspect and a psychological/biological aspect, but also a cultural aspect.  And we need to think about what we want as a culture.

Our reaction to Aaron's death informs every young hacker's idea of what will happen to their reputation if they follow in his footsteps.  If we really don't want to lose brilliant young minds, we can't glamorize death.

Prison, work, songs

This weekend I heard a presentation of work songs from the prison farms of the early 20th-century south.  Pain, sadness, humor, anger — all were intense in this music.



The vast prison farms were an evolution of the plantations that had been there before. When the 13th ammendment banned slavery “except as a punishment for crime,” Southern whites did the obvious. They imprisoned their former slaves for offenses like loitering and failing to yield the sidewalk.

If you ever go to Houston,
Boys, you better walk right,
And you better not squabble
And you better not fight.
Benson Crocker will arrest you
Jimmy Boone will take you down.
You can bet your bottom dollar
That you're Sugarland bound.

Of course, hearing the work songs of imprisoned people, I thought of the prisoners I work with in a northern, urban jail.

They spend a lot of time watching TV. I think it keeps people pacified, but I also wonder if there weren't something better they could be doing.  Being idle is especially hard for some of the immigration detainees, who have mostly been manual laborers since childhood. “I worked my whole life,” one of them said, “and now I'm sitting here with my arms folded.”

Work is one thing I wish we could have more of at the jail. After you've been there a while, and if you've stayed out of trouble, you can work if you want to. Men work in the kitchen or print shop, running errands, and cleaning things. Women are taken out of the facility to pick trash and paint walls. They earn about a dollar an hour, but the biggest perk is that it passes the time.  There are more inmates who ask for work than get it.

(More work might have the benefit of reducing prison costs. But I'd like to stay clear of actually making a profit, as the labor camps of the old south did. Economic incentive to imprison people is a very bad thing.)

On the way home from hearing these songs, I talked with a friend who had worked with prisoners at Angola Prison in Louisiana (so named after the origin of the slaves who originally farmed that plantation). She said work there was mandatory, and inmates there spent their first months hoeing the collard fields before they had the option of switching to cushier jobs.



Ironically, hoeing collards is the kind of job idealistic college students love to sign up for. I spent my first summer out of college as a part-time farmhand on a small hippie farm. But I chose it, and I worked with other people who wanted to be there. We sang a lot, mostly happy songs, not the slow-burning songs of slavery. We loved eating the fruits of our labor, just as the inmates of Angola Prison feed themselves. Everything is different when it's chosen freely.

(Side note:
I couldn't write about field hollers and not include Stan Roger's parody, the White Collar Holler.  He reframes computer programming as soul-crushing drudgery, presumably in contrast to the old-fashioned fishing and sailing jobs he loves to write about.  The song doesn't resonate for me, because most of the programmers I know have a good bit of freedom and enjoy their jobs.  Again with the autonomy and the work satisfaction.)




The other thing I wish we could have more of at the jail is creativity. The emphasis is on passing time rather than doing anything with it. Some inmates make ingenious things with their hands – teddy bears sculpted from soap and delicately tinted with toothpaste. A Christmas tree from a carefully deconstructed toilet paper tube. And those more frightening creations in the contraband exhibit they show you at orientation: the blow-darts made from staples, the shivs made of toothbrushes and razor blades, the hotwired contraptions used to heat urine to boiling temperatures so it can be thrown in an enemy's face.

That kind of destructiveness is the explanation given for why inmates can't have any materials: no colored pencils, no yarn, no crochet hook, no wood to carve, no guitars. But sometimes I wonder if they'd be less destructive if they had something constructive to do.

Of course, like those older prisoners, they still have word and song. Those inalienable tools are alive and well in the form of rap. I have yet to hear the compositions of any of the inmates I work with, but several of them have explained how important it is to them.

One more song to finish with.  Hear the anger channeled into work:

Finding water

On Christmas Eve, one of my relatives had a re-commitment ceremony. She and her boyfriend had gotten legally married last year, but none of their family was present, and they wanted to have a ceremony with us.

We all gathered in the living room, sat silently for a while, and then the couple exchanged vows. (A Quaker wedding has no clergy; the couple give their pledge to each other without a third person mediating.) The two of them stumbled through the old-fashioned vows, but afterwards they began to speak freely about why they were together.

The bride has always been a black sheep in the family. Since childhood, she's had some serious psychiatric and behavioral problems. She spoke about meeting her husband when they were both in a PTSD treatment center. At the time she met him, she had been wearing pajamas for a month and wasn't brushing her teeth. They both had insomnia and would meet at 3 am to drink coffee and talk for hours. She knew that if he loved her when she was at her worst, he was a keeper.

Her husband spoke simply about meeting and loving someone else who understood pain.

It moved me more than some of the carefully-orchestrated weddings I've been to. These are two people who have suffered greatly. I work with many more people like them, people with trauma histories, people to whom life has not been kind. I thought about all the broken people out there, and I was so glad that two of them found each other.

Tonight, I asked the bride's father for some cuttings from his plant collection. He showed me his cacti and succulents, desert plants that grow thorns and tough hides to protect themselves. Inside, they trap precious moisture.

“I took a cutting of this one and left it in an empty pot for a few months,” he told me, holding up a plump green stem. “No water. After three months it was hardly shriveled at all. It was starting to put out roots, getting ready to grab on as soon as it touched soil.” It seemed miraculous that a plant could survive that long on only the moisture from the air.

And I thought of his daughter, thought of my clients at the jail and all the other people who live in a harsh and deadly environment. About the thorns and tough skins they grow to save themselves from the desert.

Recently a client told me his mind was “like a tape recorder,” remembering every kind word he heard from me and other staff so he could play them back to himself. In the scorching environment of jail, he was saving up those droplets of kindness to stay sane.

Even the toughest, the most scarred, the most bitter of people are hiding a thirsty heart. Sometimes their tendrils are reaching out for it, searching for a hospitable place where they can latch on and get some of what they need so much.

Here's to the couple whose improvised wedding moved me so much yesterday. It's hard to form a healthy relationship when you hurt a lot, and I don't know how successful they'll be. But they've found some sweetness and nourishment in each other, and I hope together they can drink their fill.

Placebos

In the car on the way to the family Christmas gathering, Jeff read to us about a series of studies on placebos. For some conditions, placebos can give significant relief. There's still an effect even when subjects are told "You are taking an inert pill" and given a bottle marked "Placebo." Placebos given by providers who spend more time schmoozing with patients create more relief. (Note that I haven't found the actual studies concerned, so I don't know the effect sizes, etc.)

The three healthcare workers in the car were interested in this. Jeff's mother, the midwife, said that projecting the right comforting image is a large part of her practice. (The innovation I find most interesting in childbirth is encouraging women to believe "this is something my body is capable of" rather than "this is a scary and painful medical emergency." Stress has real physiological effects, and reducing stress can make birth physically easier.) Jeff's father confirmed that making an optimistic forecast is a big part of his psychotherapy practice, too.

Then when we arrived, my mother reported that she is not losing her mind, as she feared. She realized that for an unknown period of time she had loaded her pillbox with calcium tablets instead of her actual medication.

Apparently the day's lesson is that placebos can help you with some things, but sometimes you really should just take your medication.

Reunions

My sister shared this video of one of her second-grade students reuniting with her mother, who's been stationed in Afghanistan for the last year. It's a lovely moment: the moment of realization, then the silence, the rightness of being near each other after too long apart.

It makes me think of the mothers I work with in the jail. A World Apart, Christina Rathbone's excellent book about women in a Massachusetts prison, describes another reunion after two years of separation between mother and son:

“...she ran over and grabbed Patrick, sobbing, almost unable to breathe. Pat burst into tears too, and clung to her. Across the room, her father started to cry, the officer in charge of the visiting room that night started to cry, and one by one the inmates and even their visitors started to cry along with them.”

The male inmates sometimes talk about their children, but not with the same longing the women do.  Many of the mothers describe a physical craving to be near their children, a hunger for the sound of their voices and the smell of their hair.

They worry endlessly about their children's well-being. Have they eaten enough today? Is he doing all right in school?  Will she be mad at me when I come home? How can a toddler understand I didn't leave her on purpose?

They talk about how much they want to keep their children safe from all the terrors of their own childhoods: the sexual abuse, the neglect, the beatings. For some of these women, their relationship with their children is the only non-abusive relationship they've ever had.

The mothers' pain is one side of the coin.  The other side is the children's pain, which I can only imagine.

The United States has the highest imprisonment rate in the world.  That affects not only the people who are locked up, but their families.  Every time we imprison a person, we take away a part of a family.  We should think carefully about whether it's worth it.

Walking

My aunt has lived in Brooklyn for decades and never been mugged. She attributes it to her attitude. I'm not sure exactly what her method is, but for years I've tried to copy it. When I transitioned from the suburbs to the city, I decided that this meant not interacting with strange men.

At first, I applied the same method to walking around at the jail. Passing men in the yard or in hallways, I stared resolutely ahead, ignoring them. I hoped this would make me look like I knew what I was doing. I did the same in the neighborhood outside.

I soon realized it method just made me look scared. And it must feel insulting for a man on a street in South Boston, or in a jail for that matter, to see a white woman in business clothes refusing to meet his eyes. Trying to pretend he's not there, regarding his very presence as a threat.

If someone on the street wants to mug me, they'll do it. Ignoring them is not going to stop them. And all those other people who have no interest in mugging me – we might as say hello when we pass. We might as well say, “Good morning.” We might as well smile.

As if we are not afraid of each other. As if we are just people, walking.

Introducing: Advent calendar

I've been an agnostic for most of my life now, but I still love Advent.

I usually make paper Advent calendars for my family, but this year I'm making an online one for you, too.

For safety's sake?

After Chinatown buses had several highly publicized accidents, Jeff wrote an argument on why we shouldn't make buses safer. In short, buses are much safer than cars. Anything that raises the price of riding the bus will mean more cars on the roads and more accidents.

Last year, we rode a sketchy Chinatown bus to and from Thanksgiving. This year, that company and all the other sketchy companies have been shut down. Fares are triple what they were. So we drove.

Car crashes don't make the news, but mass transit accidents do. And yet they're far safer than cars. Better to allow sketchy services to run cheaply than have more cars on the road.

Pain management, social work style

Since high school I've gotten menstrual cramps bad enough to occasionally send my body into shock: nausea, cold sweat, feeling like I'm going to pass out.  This week it happened at work (and let me tell you, it's awkward to tell your boss in the middle of a staff meeting that you need to go lie down on her office floor before you fall out of your chair).  But I was pleased that my body gave out long before my mind did - I used to be terrified of the pain, but now I can handle it a lot better.

As a social worker, I spend a lot of my workday coaching people on how to cope with stress.  I think I deal with physical pain better now because I know more methods for handling it.

So, when you're waiting for the painkillers to kick in, the doctors to splint your leg, or whatever:

Self talk

Pay attention to whether your inner monologue is "This is horrible. I can't do this!" vs. "I can get through the next half hour, and then I'll go lie down."  Coach yourself through it like you would coach a child. 

Distraction
Sing songs to yourself, do multiplication facts, count ceiling tiles.  Pick an object and describe it in all the detail you can: "That cinderblock has eight dents near the bottom and a grey smudge near the top left corner."   Focus on your breathing.  Repeat a phrase to yourself: "This is going to be okay."

Stimulation

In some article which I now can't find, I read that the brain can only process so much nerve input at a time. So additional sensory input can theoretically reduce the amount of pain your brain is processing.  I found that drumming my fingers lightly on my palms seemed to help.

Placebo effect
Even when the tylenol you just swallowed can't possibly be in your bloodstream yet, try thinking about how very effective and quick-acting it is.  You may get a small placebo effect just from believing in it.

Another hat

 Today I heard we are going to a 1920s themed cocktail party.  I made a hat.

Unfortunately, like all my hats, it turned out very 1950s.  I don't think they were actually wearing hats at cocktail parties in the 1920s.  I'm not sure how to pull off an actual 20s look without bobbed hair or those weird side-buns.

Project: story stones

There are lots of kids' things I realize I won't have time to make when I'm actually a parent. So I'm making them now. The latest project: story stones. They're a starting point for kids to make up stories about the items pictured.

I chose a mix of fanciful items (hot air balloon) and ones that I expect my kids will see often (tree, Red Line train). Once I have actual kids I'll probably make more to suit their interests.

I made the pictures from cut-out bits of magazine paper attached with watered-down Elmer's glue. They're pleasant in the hand.

What are prisoners like?

Last week I started a new job as a mental health clinician at a jail. I hadn't really thought about working in that setting, but I decided to give it a try.

In the job interview, my boss asked what I thought inmates would be like. I said "varied," which apparently was a good answer, because she hired me. I was very curious to find out what the people would actually be like.

Some initial impressions:

- The male inmates are mostly very polite to me. I've never been called ma'am so regularly, nor had so many doors opened for me. I was expecting constant sexual harassment, but it hasn't happened so far.

- I'm allowed to bring library books to the people who can't leave their units. They all want horror novels. The women also read a lot of Nora Roberts romances.

- Most of them were physically or sexually abused as children.

- Exercise is one of the few goal-directed activities that's possible in prison. There are a lot of seriously buff people.

- I was expecting people to claim that they had been framed, but so far I haven't heard that. I've heard a couple of people say they confessed to crimes a relative of theirs committed, because the relative already had a worse criminal record and would serve a longer sentence for the crime. I've also heard people say they didn't commit the particular crime they were convicted of, but that they had done the same thing in the past and not gotten caught. They seemed to feel it all came out even in the end.

- Lots of tattoos.

- Everyone has insomnia.

- They miss their families.

- They're not allowed to have regular pens or pencils, and they all hate the flexible pens the prison provides because they're so annoying to grip. They get excited if you let them write with your real pen.

- When I ask what helps them get through difficult times, many of them say "reading the Bible." Judging from their spelling, some of them are barely literate, so I'm surprised that they get much out of a book as dense and convoluted as the Bible. From a humanitarian perspective, I wonder if the church could advise reading an easier book for comfort and advice? Maybe something in the vein of Pilgrim's Progress? Could we ask Thich Nhat Hanh to draft something?

Gifts for people who have everything

People my parents' age are hard to get presents for. They've had lots of time to obtain the cheap things they want, and if they can't afford something they want, I probably can't afford it either. Some ideas:

- Record an audiobook. Free programs like Audacity let you record and edit. Full-length books take a really long time, so I've done some short stories.

- Jeff wrote me a waltz once. That was awesome.

- Find a project that needs to be done. Jeff and I revarnished his parents' kitchen floor while they were on vacation.

- Go on an adventure. Jeff's father is especially hard to shop for, so for his birthday people take him on a surprise outing. Yesterday we packed a picnic and piled in the car for such a birthday adventure, and Jeff took us on a deliberately roundabout route to prolong the suspense. Rick's guess as to the destination changed at every turn:

"We're going to the restaurant that looks like a cafeteria...except it's not lunch time."
"We're going to Walden Pond! Except you just drove past it."
"Are we going to Abby's house to walk in the cranberry bog?"
"We're going to the Bolton fair!"

Open letter to mental health professionals

A couple of years I came across a book on "parenting with depression" in the library. I opened it eagerly, hoping for assurance that I wouldn't necessarily be a terrible parent.

...and then I realized that none of the co-authors had depression. They had just worked with depressed people. The book contained no material by actual parents with depression.

If you work in mental health or social services, you should be reading first-person accounts of your clients' experiences.

I first wanted to be a therapist when I was fourteen, after discovering a message board for self-injurers. I didn't self-injure, but I spent a year reading and responding to what they wrote. I doubt I was very helpful, but it gave me a sense of the day-in, day-out desperation they lived with.

Later, when I was considering adopting a child from foster care, I read message boards for adoptive parents. I read the things they love and hate about their social workers. I heard the things they don't tell social workers for fear of losing the kids. I'm better at working with adoptive families than I would have been if I hadn't read these things.

Every week I read Post Secret. It's an engrossing read, but it's also a good education. People come out with the pains and pleasures they know aren't socially acceptable.


Norah Vincent's Voluntary Madness, an account of her psychiatric hospitalizations, helped me understand how confusing the legal status of psych patients is. I haven't read Andy Behrman's Electroboy: A Memoir of Mania, but I've wanted to ever since reading "When I'm manic, I'm so awake and alert, that my eyelashes fluttering on the pillow sound like thunder." You don't get that in the DSM.

If you limit yourself to material by observers, you're missing out.

Read something you haven't read before. Read a pro-ana site. Read a pro-suicide site. Your clients do.