Mourning in Prison: Mission Impossible?

Diane H. Schetky, MD

The author's interest in the issue of mourning in prison is twofold. As an active hospice volunteer, she became involved with bereavement work, which sensitized her to the issues of loss encountered upon joining the staff at the Maine State Prison. More often than not, the inmates with whom she met had unresolved issues of loss. The impetus for a grief support group came from an inmate who had experienced the death of five relatives during his period of incarceration; he commented on how difficult it is to mourn in prison, and he worried about how he would deal with all his losses when confronted with them upon his release. The author raised the possibility of a support group and the inmate offered to help organize it. This article describes the author's experience with such a prison- based support group and what she has learned, through this experience, about mourning in prison.

A search of the literature yields very little loss for many inmates, and several au- on the topic of mourning in prison. thors discuss the impact on children.475 Kaplan describes a peer support group for Sack et a1.' note that divorcing or bitter women in prison for the death of a child.' spouses often keep children away from She notes how the group helped them their incarcerated fathers or feel that the overcome their silence and sense of iso- children should not see their parent be- lation. The inmates in Kaplan's study hind bars. Unsuccessful marriages were commented that prison psychiatrists had common in their sample population, as not been very sympathetic to their losses, was also true in a larger study of English which they had caused, and that shame prisoners.' The current author was not over their crimes had made it difficult for able to find any articles dealing with the them to process their losses and move on topic of complicated bereavement in pris- with their lives. Articles by otter^ and oners. sease3 discuss separation from children The process of mourning involves ac- brought about by incarceration as a major cepting loss, experiencing feelings related to it and letting go of them, and reinvest- Dr. Schetky practices forensic psychiatry in Rockport, ME, and is Associate Clinical Professor of Psychiatry at ing in new relationships. Successful the University of Vermont (at Maine Medical Center, mourning requires developing coping Portland, ME). Presented at the 28th Annual Meeting of the American Academy of Psychiatry and the Law, skills, a degree of emotional maturity, and October 25, 1997, Denver, CO. Address correspondence to: Diane H. Schetky, MD, P.O. Box 220, Rockport, ME a supportive environment. Factors that 04856. may complicate grief include denial, am-

J Am Acad Psychiatry Law, Vol. 26, No. 3, 1998 383 Schetky bivalent attachment to the deceased, "un- dying, which might help prepare them for finished business," traumatic death, guilt an imminent death and allow the oppor- or shame over a death, preoccupation tunity for a good-bye visit. Showing emo- with the caretaker role, lack of prior ex- tion in prison is risky. Outward expres- perience with death, and a low tolerance sion of grief or any loss of control may for pain and anxiety. The term patholog- result in being put on suicide watch, cell ical mourning is used by siggins7 to refer placement, medication, or being sent to to situations in which "elements which the maximum security prison known as ordinarily constitute mourning are present Supermax. Confiding in a trusted friend but the process is abnormally delayed, may be misinterpreted, and other inmates protracted or undone." Symptoms of may conclude they are being talked complicated or pathological mourning about. Caution is the norm when it comes may include heightened sensitivity and to getting close to other inmates. When vulnerability, hyperarousal and the need there is no opportunity to invest in new to keep busy, death anxiety, constricted relationships, inmates may cling to their affect, fear of intimacy, self-destructive lost ones. or self-defeating behavior, numbness, The unwritten code of behavior in alienation, and chronic anger. prison is antithetical to the mourning pro- ~indemann'was one of the first to call cess. Tears are not readily accepted in this attention to the relationship between loss macho environment where "Guys don't and hostility. Loss is not only physical, do grief, guys get mad." Basic rules of but may involve loss of status and self survival include: (I) don't get involved in esteem. As is well known, rage in re- other people's business; (2) don't sponse to loss is often observed in per- "squeal" even if you are a victim; (3) sons with borderline or narcissistic per- dominate, lest you become the underdog; sonality disorders. Gilligan9 believes that (4) size up other inmates' weaknesses and much violence is provoked by shame and use them to your advantage; (5)act bad as humiliation and that violence is an effort a way of gaining respect or getting people to undo "loss of face." He notes that to leave you alone; and (6) don't trust violent offenders often feel they have no people who are nice to you. other means of warding off feelings of Inmates are often subject to repeated shame and low self esteem and that they humiliation and sadistic assaults, either lack the feelings that normally inhibit act- physically violent or verbal, from other ing on these impulses. inmates or guards. This type of environ- The obstacles to dealing with loss and ment is not conducive to healing nor to mourning in prison are formidable. In- letting down one's armor: it also perpet- mates are cut off from family and often uates the cycle of shame and violence. from the rituals that surround a death. Many prisoners, if they pose security The Group risks, are not allowed to attend funerals, Maine State Prison is a medium secu- nor are they allowed contact with the rity prison, which runs at full capacity

384 J Am Acad Psychiatry Law, Vol. 26, No. 3, 1998 Mourning in Prison with 400 male inmates from all over the group evolved into an ongoing group. state. The inmate who was instrumental The author was forced to abruptly leave in starting the grief support group (the the group when the new administrator of group) was in protective custody (PC). As the prison's managed care contract de- inmates in PC are not allowed to mingle creed that the contract did not permit psy- with the general population, group mem- chiatrists to do therapy with inmates, only bers had to be drawn from the PC popu- evaluations and medication management. lation of 16. Inmates in protective cus- Although inmates may be thought of as tody have usually committed heinous a captive audience, this did not guarantee crimes such as murder or sexual abuse of attendance in the group. The inmate who a child, have turned state's witness and started the group quit because it was not testified against inmates in the general being run the way he thought it should be. population, or in some cases, have opted Several inmates who had not trusted him to be there to avoid sexual victimization. promptly joined the group. Another in- Our group included all of the above types mate got transferred to the Supermax for of inmates. a trivial infraction of rules, and when he A notice about the group went out to all returned six weeks later there was no the men in PC, and those who expressed room for him in PC. He was returned to interest were screened for appropriateness the general population amid taunts of to the group. Only one was turned down. "baby killer" but was allowed to continue The census of the group ran between five attending the group. One inmate who was and eight with an age span of 30 to 60 a member of the group got released, and years. All of the men were either single or two awaited imminent transfer to another divorced. Several men had life sentences. prison. It was agreed that the group could Four men in the group were seriously ill, not function without a critical mass, and three with cardiac disease and one with a each time the census dropped inmates degenerative muscular disorder. As with began recruiting and eventually took over many of our inmates, few admitted to the screening of prospective members. being guilty of the crimes that brought They all protested that an eight-week them to prison. group was not long enough, and changing As PC inmates are confined to a special the group to a PC support group was area of the prison that does not lend itself discussed as a way of keeping the num- to a group meeting, we met in the staff bers up. The inmates, however, insisted lounge of the hospital around a large "This is a grief group not a gripe group." kitchen table. The author was the only Several times, members dropped out of female in the group. Initially, another the group as a form of protest but most hospice volunteer served as cofacilitator. returned to discuss their issues. When he moved away, he was replaced by a male staff social worker. The group Loss in the Prison Population met for one hour a week. What was con- It soon became apparent that the in- ceived of as a time-limited, eight-week mates had endured cumulative losses but

J Am Acad Psychiatry Law, Vol. 26, No. 3, 1998 385 Schetky had little experience with grief. It was feel in control and protect him from hurt. naive to think that such a group could By acknowledging his own hurt he was possibly meet its goals in only eight able to let go of some of his armor. weeks. Loss of children and loved ones Loss of a child through death, adop- often followed incarceration. Some in- tion, or alienation was shared by several mates were shunned by relatives shamed members. They noted that the hurt never by their crimes; men lost contact with leaves and how much harder it is to deal children and, in some cases, had their with the loss of a child. parental rights terminated. Some lost all Other losses associated with incarcera- contact with siblings with whom they had tion included loss of self esteem and per- once been close and had no knowledge of sonhood, sexual relations, autonomy, pro- family of their whereabouts. Several had fessional identity, choice of medical care, terminally ill relatives and described the and material possessions. Humiliation in- frustration of trying to get through to flicted by guards was an ongoing issue. them on the prison phone system. Others Two group members had served in Viet- described their anguish at being informed nam. Well into the group, they tearfully of the deaths of loved ones only after their shared some of the atrocities they had funerals. This led them to wonder committed there and their shame for what whether they had been excluded from fu- they had done. neral services because they were consid- Losses that occurred in the course of ered security risks or whether their fam- the group included transfers of inmates, ilies were avoiding the embarrassment of absences of the cofacilitators due to va- them attending in shackles. cations or professional meetings. deaths Childhood losses and abuse were com- or terminal illness in family members, mon. One inmate was dealing with his moves by family members. and the deaths adoption and reconciliation with his birth of several inmates. In addition, inmates mother. Another related how he had were permitted only one session with the never been allowed to grieve as a child. author to deal with her abrupt departure He commented that "the only emotion we from the group. were allowed to show was anger." He began the group as an angry, vindictive Group Dynamics man and joked about how he terrorized Trust As in any group, trust was a people. His demeanor gradually began to major issue. The group leaders initially change, he shaved off his leonine beard, were viewed warily as extensions of the began to listen rather than rant, and prison administration. They were quite started to show his caring side. He was clear about exceptions to confidentiality able to let go of his anger with his ex-wife (suicidal or homicidal behavior or escape whom he held responsible for his incar- plans). They were also emphatic about ceration because he believed she had the need for respect and nonjudgmental falsely accused him of child sexual abuse. attitudes in the group. Inmates often crit- He noted that terror had allowed him to icized the quality of medical care in the

386 J Am Acad Psychiatry Law, Vol. 26, No. 3, 1998 Mourning in Prison prison, and the author managed not to get a guard. When asked what her motive for too defensive about this. They com- doing so might be, he replied "humilia- plained of feeling as if they were being tion." When asked if she seemed like the treated like second-class citizens and type who enjoyed humiliating others, he were upset by their lack of choice in said "No, but how you act in group may seeing specialists and by restrictions in be different than how you are on the the hospital formulary. Typically, the fa- outside." cilitators would respond with empathy Patterns of Grief Two patterns of and doses of reality, pointing out that grief were common. Many inmates under managed care things are not much seemed stuck at the point of not being better in the outside world. able to let go of losses. Endless unpro- Many inmates had been taught not to ductive hours in prison foster dwelling on trust as children, and experiences with hurts and planning revenge. Interestingly. spouses and ultimately the justice system with group support the more angry and had reinforced their lack of trust. There vindictive group members were able to was also the issue of how much to share own up to the hurt that lay beneath their with persons one had to live with 24 angry veneer. Some reached the point hours a day and concerns that affectively where they could stop and reflect when laden material might spill over into the the anger welled up, whereas in the past cell block. Transfers to Supermax were they would have automatically struck out. common occurrences, and many of these For example, an inmate related how he inmates had spent months there in isola- felt like smashing his television set when tion. The constant threat of this disciplin- his family didn't show up at the appointed ary measure served to dampen potential time for a long-awaited visit. He was able conflicts, and inmates rapidly learned to to put these impulses on hold and discuss keep some things to themselves. the old feelings of abandonment that the Confidentiality Several major fall- incident triggered in the next group outs occurred around alleged breaches of meeting. confidentiality. "Double bookkeeping" as Sharing their hurt and recognizing that to what had been said in group as opposed others had endured similar traumas made to on the cell block became a complicated their hurt more bearable. In normal issue. Several members used alleged mourning, decathexis is followed by re- breaches of confidentiality as excuses to investment into relationships. This is ex- defect from the group. Others saw the ceedingly difficult in prison, where there need to discuss these allegations in group, is limited opportunity for intimacy and and after lively discussions the remaining contact with family. Members noted that group would reconstitute. As a whole, the risk of getting too close to another members seemed hypervigilant to trust inmate is that of having to endure another issues and, at one point, an inmate even loss. They joke that there are three ways wondered if the author might have dis- out of prison: standing up, lying down. or cussed something disclosed in group with transfer. The inmates with life sentences

J Am Acad Psychiatry Law, Vol. 26, No. 3, 1998 387 Schetky

seemed to find it easier to get close to one other. Several members took a rather pa- another knowing they would not be sep- ternal attitude toward an illiterate. mildly arated by release or transfer. They also retarded older member of the group tended to be more solicitous of one an- named Joe, who was an active listener but other's health problems, which likely re- rarely spoke. Offers were made to help flected concerns about loss as well as him locate his long-lost brother and to get advancing age. him a lawyer for his paternity suit. Joe Talking about painful feelings was a noted poignantly that he had never heard new experience for many, who in the past anyone say they cared about him before would have attempted to numb their sor- he came into the group. As the group rows with drugs or alcohol. For some it became larger, Joe dropped out, most was a matter of learning a new language. likely because of his discomfort and dif- Equally challenging were two group ficulty with cognitive processing. Mem- members who "found religion" in prison bers continued to look out for him and and purported to have come to terms with worried when he became even more with- being there. They seemed to handle their drawn. With their encouragement, Joe re- losses with reaction formation or repres- joined the group. They then worried sion. They tended to be very supportive about him being transferred to the general and to have a calming influence on the prison population and whether he was group. However, members ultimately capable of defending himself there. They challenged them for not being real and advised him on how to ignore taunting owning up to the magnitude of their and went to work finding seasoned in- losses. These two members, both in for mates who might look after him. Joe life sentences, were also highly defended spoke of how he wanted to come back to and avoiding talking about their heinous PC to be with his buddies. As he slowly crimes, yet they faithfully attended group. became more comfortable in the group, With support, one finally shared his on- he became more verbal and began to re- going grief over his stepson, whom he ciprocate the care he had received from said he had been falsely accused of killing. group members. A younger inmate spoke Resistance to Grief Work Resistance of his only remaining family with whom to doing grief work took many forms he had contact moving across the country. including not attending the next meeting While he tried to minimize this loss, Joe after a particularly emotional session, zeroed in on it and quietly said "I'll adopt griping, getting into the victim role, get- you for a price." When asked what that ting off the topic, and attempting to con- price might be, he smiled and said "Cup trol the group. of coffee." When, six months into the group, a Caring and Sharing member requested transfer to another One of the surprising things to emerge prison to be closer to family, the group from this group was the amount of caring reacted with sadness and openly shared the members began to show for one an- their feelings about him and what the loss

388 J Am Acad Psychiatry Law, Vol. 26, No. 3, 1998 Mourning in Prison would mean to them. Similar feelings of Discussion loss and missing were expressed by the It is possible that the self-contained group member who had a six-week hiatus placement of these men on PC fostered from the group while he served time at more feelings of family and that they felt Supermax for a smoking infraction. safer there sharing feelings about one an- Concerns about one another's health other than they might have in the general were often voiced, including the need to prison population where there are differ- look after one another because they did ent unwritten rules of conduct. A Bud- not always trust the nursing staff to re- dhist inmate, not in the group, shared the spond appropriately to medical emergen- dilemma he experienced upon finding cies. One member used group to deal with that compassion and self protection are the fact he only had several years to live often incompatible in prison, where kind- and was challenged to think about how he ness may be viewed as a sign of weak- would like to be remembered and what he ness. Certainly, the experience of support, wanted to do with his remaining years. caring, and safety were major factors in Several men were able to cry in the allowing members to begin to deal with group without being belittled. They noted unresolved grief. Membership in the that this was impossible elsewhere in the group also permitted shared intimacy in a prison, where tears would invoke taunts structured setting, which in turn encour- of "baby," batterings, and possibly feces aged investing in new relationships. Joe. and urine being thrown in their cells. who was nonthreatening and intellectu- They noted that the only other time that it ally limited, seemed to be a safe person was safe to cry was after lock-down, and about whom the group members could care. then only if one did it very quietly. One Having a female, motherly coleader member noted that "you are either part of (the author) may have helped with the the group or you are the problem" and grief process. Her serving coffee allowed that most inmates are very threatened by them to feel nurtured by her, and they anything that reminds them of their own took pleasure in the fact that she was the weaknesses. only person who waited on them in Loss of self esteem was a common prison. They were very patient with her as thread, which was often fueled by being she tried to understand what life in PC humiliated by guards. Inmates felt that was like. Several times they suggested the security staff treated them like little she try it out for a week, and one offered kids, which often led them to respond like to move into the shower so she could children. Humiliation and taunts from have his cell. Having male coleaders who other inmates were daily occurrences. were in touch with their own feelings and Sometimes this was done in jest, some- able to refute traditional male stereotypes times out of boredom. and almost always provided valuable roles models. In addi- out of the need of the persecutor to feel tion, group members had the opportunity "one up" on his victim. to observe the therapists working together

J Am Acad Psychiatry Law, Vol. 26, No. 3, 1998 389 Schetky in a supportive, respectful, nonexploitive atrists working with this population to relationship. inquire about losses and help inmates find The author learned much about herself constructive ways of dealing with them. through this group including her ability to As two members of the group were suspend judgment and care for these men contemplating transfer to another prison. despite the brutal acts that had brought they talked about starting a grief group them to prison. This was not easy for one there and wondered if the author would who has spent much of her professional be willing to drive three hours each way life working with and advocating for vic- to facilitate it. She asked if they thought tims. Each member of the group had their experience was worth replicating in something of value to offer and demon- other prisons, and they were unanimously strated a capacity for change. Treating in favor of it. They readily gave their them with kindness and respect, along consent to write about their experiences with setting firm limits, helped catalyze in group. the group. The author subsequently volunteered to A long-term group allows for the grad- run a time-limited (12-week) Hospice Be- ual evolution of trust and the display of reavement Group for men in the general vulnerabilities, along with caring. It also population of the same prison. This was a permits the group members to process younger group of men with closer family separations and loss as they occur within ties. They spoke of not being able to "let the group, the prison, and their families. down their guard" because they had to be Secondary benefits of the group were that strong for their families and help hold it provided a forum for conflict resolu- them together. Many inmates were with- tion, which led to decreasing conflict on out fathers and were the oldest surviving the cell block, and taught the inmates new males in their family. Over the course of verbal skills and greater respect for one this group, the men were more open, another. trusting, and higher functioning than As noted by ~illigan,~much violent those in the PC group. They were quite behavior results from the inability to han- intellectual and often delved into issues dle loss, shame, and narcissistic injury. A such as the meaning of life, suffering, and group such as the one described herein death, and cultural attitudes about death allows men to look within and start to and dying. They also addressed their own acquire some tools for dealing with loss. issues of loss. Several men joined the Therapists considering running a grief group because they wanted to learn how support group need to be alert to the to help bereaved inmates. With their en- unique conditions that exist within a couragement, the author submitted a pro- prison population, which complicate be- posal to start a Hospice Volunteer Train- reavement. Unresolved grief is almost the ing Program in the prison. The program norm in prison populations but is likely to would train inmates to do bereavement be masked by other behaviors, particu- counseling and also to work with dying larly disruptive ones. It behooves psychi- inmates. Several such programs are al-

390 J Am Acad Psychiatry Law, Vol. 26, No. 3, 1998 Mourning in Prison ready in existence in prisons across the 4. Sack W: Children of imprisoned fathers. Psy- country, and they hold much promise. chiatry 40: 163-74, 1977 5. Sack W, Seidler J, Thomas S: The children of imprisoned parents: a psychosocial ex- References ploration. Am J Orthopsychialry 46:618- 27, 1978 1. Kaplan M: A peer support group for women in 6. Martin J, Webster D: Social Consequences of prison for the death of a child. J Offender Conviction. London: Heinemann, 1971 Counseling Serv Rehabil 13(1):5-13, 1988 7. Siggins L: Mourning: a critical survey of the 2. Rotter J: In prison women are different. Cor- literature. Int J Psychiatry 3:418 -32, 1967 rections Magazine 4: 14-24, 1978 8. Lindemann E: Beyond Grief: Studies in Crisis 3. Sease S: Grief associated with a prison expe- Intervention. New York: Aronson, 1979 rience: counseling the client. J Psychosoc 9. Gilligan J: Violence. New York: Vintage Nurs Ment Health Serv 20:25-7, 1978 Books, 1977

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