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LEVELS OF VIOLENCE AND MEDICATION IN A SPECIAL PRISON UNIT.

1986 - 1995

Dr Bob Johnson,
MRCPsych, MRCGP, PhD, MA, MBCS,
DPM, MB, BChir, MRCS.

[Apologies for imcomplete tables]

INTRODUCTION:
Violent disruptive prisoners pose a sharp challenge to any prison system. Society locks violent citizens away, the prison service itself has fewer options. For, as one Home Secretary put it,

"The mood and temper of the public with regard to the treatment of crime and criminals is one of the most unfailing tests of a country [being the] sign and proof of the living virtue in it".
Winston Churchill, Hansard, 1910.

Violence is an increasingly serious social disease. Murder is already the commonest cause of death in women at work, and the second commonest for men in the U.S. [Dept of Labour Report,1994, Economist, Dec 3, 1994 P 67]. It is set to rise inexorably in the UK according according to a recent monograph [Oliver James, "Violence Against the Person", Free Association Press,1995.]. A great deal more is known about its origins than is generally supposed, as Oliver James [op.cit.] makes clear.

In England in the early 1980's an enlightened penal policy led to three Special Units being established, whose principal objectives was to remove especially disruptive prisoners from the general system, while obviating the need to condemn them to long periods of segregation or solitary confinement. The Special Unit at Parkhurst Prison was opened in December 1985, and provides the data presented here.

Barlinnie was a Special Unit established in Scotland in 1973. Professor David Cooke's analysis [Brit. J. Criminol. spring 1989;129-143] showed that the regime there reduced assaults form an expected 105 to 2. The Barlinnie Special Unit was closed in December 1994.

From July 1991 to the present, every prisoner in the Prkhust Special Unit who consented, was seen on a weekly basis by the consultant psychiatrist (currently all of them). The approach deployed was to pursue and attempt to disentangle the long-term effects of child abuse, essentially an extension of Post Traumatic Stress Disorder (PTSD), along similar lines to those pioneered by Alice Miller ["For Your Own Good", Virago, 1980. ].

METHOD:
Research was regarded from the outset as an important component of these Special Units. Detailed records of inmates' ill-discipline were recorded on a monthly diary sheet. These form the basis for the data presented although "diary data" is inevitably incomplete and inaccurate. Actual physical injuries, either of inmate or staff, are significant enough to attract notice and ensure greater accuracy in recording.

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Medication records are less complete. Only since late 1992 has the pharmacy kept dispensing data on computer. The 1990/91 figure is therefore an extrapolation from the prescribing patterns as recorded in June 1991; the 1992/93 data is based on the first 6 months of 1993; 1994 is an extrapolation of drugs dispensed to the end of January 1995. The 12 month periods run from July 1st in each year.

RESULTS:
The numbers of inmates in the Special Unit throughout this period did not vary widely, usually in the range of 14 to 16, with a maximum of 18; a total of 54 men passing through in 9 years. Currently there are 15, all lifers except one serving 16 years, and all for murder or attempted murder, except one for firearms offences.

The inidence of actual physical assault on another person is shown on table 1. Graph 1 groups this data into two year bands. Attacks on property are omitted.

DISCUSSION: This data is interesting for two reasons in particular. Firstly though measurement of mental health is essentially subjective, happiness for instance being notirously difficult to define, weighing the drugs dispensed in this relatively closed Special Unit (only four newcomers per annum on average) xomes close to objectively measuring the subjective mental health of the inmates.

Secondly the conventional view that symptoms of violent disorders should be tackled by increasing medication has been stood on its head. Here a group of violent, unstable, ill-disciplined lifers have had their tranquillising medication consciously cut by 95%. This has not led to an increase in violence. A reduction of one assault per inmate per annum in 1986, to zero in 1994. should do more than encourage the team surrently working on the Unit. A reduction of around 5 thousand pounds in sedative drug costs annually for 15 patients would, if applied nationally , represent savings of several million pounds.

It is clear that the staff on the Special Unit are now adept defusing violent incidents and for the most part containing them within the Unit. They provide an indespensable supportive ethos which alone permits the weekly psychiatric therapy sessions to function. Sensitive areas simply could not even be discussed, let alone explored without it

Psychopaths are widely regarded as untreatable - and clearly they commonly are, when the treatment offered is either unfocussed psychodynamic counselling, or sedative medication. The fantasies, symbolisms and "free association" favoured by Freud have little relevance to the harsh realism of amximum security prisoners - indeed, on occasion they can be counter-productive.

What severe Personality Disorders require is a positive emotional involvement, together with a proactive approach in undoing the buried terror remaining form childhood trauma. This terror distorts thinking, and is therefore difficult to resolve unaided. It freezes the individual at the emotional age of five or thereabouts. By gently teasing out the implications, "value therapy" demonstrates that the original trauma is now over, and will not recur in adult life. Mature social strategies therefore become available, and violence is seen to be both socially maladaptive and emotionally immature. The target is to eliminate it altogether, an aim shared by all participating inmates, who now, for the most part co-operate with the Unit staff in reducing it.

Subjective clinical impressions are that most prisoners, once over their initial shock, warmly welcome the opportunity to disentangle their childhood traumas, in the safe, supportive atmosphere that this Special Unit currently provides. The results suggest the possibility of a method to reverse the rising tide of violence which besets society at large and prisons in particular.TOP


Bob Johnson
February 13th, 1995.
Orchard Hospital, Fairlee Rd.,Newport, Isle of Wight,
PO30 2EP UK.