Donut Hole

I am a social worker who works in a men's psychiatric prison in the Texas Department of Criminal Justice system. However, I am not employed by TDCJ, but by Texas Tech University Health Sciences Center, which is a contract provider to TDCJ.



Currently, I am assigned to a ward which houses 50 patients in single man cells, which is referred to as Administrative Segregation. What many used to think of as "solitary confinement." Additionally, there are two seclusion cells that are nothing more than concrete walls, floor and ceiling. A drain. A door and an outside window. No padding....



The ward where I work is populated by some of the sickest patients, and by some of the patients who show extremely bad behaviors, intentionally. They have what we call characterlogical disorders. Some of these intentional behaviors include such things as self mutilation by cutting with anything sharp that can be (illegally) acquired: razors, paint chips, tile, pieces of concrete, staples, wire, plastic. Other behaviors include stabbing oneself, inserting things into the rectum or penis, overdosing, hanging, swallowing things. Additionally these patients do things like spitting, throwing feces, urine, dirty water, blood, food or what have you. The smear some of the same things. They stop up drain pipes and cause flooding. They cover their windows with paper so their safety can not be ascertained.



Sometimes, these patients act out in such a way as to result in the security staff having to use physical force. Sometimes, the patient's intention really is to hurt security, sometimes, amazingly, the patient's intention is to get security to hurt the patient.



A favorite pastime of many of these patients is masturbation. This act is seen by staff for what it is: not an attempt at gratification, but an act of aggression.



This ward has one row, composed of 8 cells, in which some patients with "extreme" behaviors are monitored closely, in an effort to decrease the likelihood of their self-injurious behaviors. The patients have few privileges, but their privileges are reviewed weekly by the treatment team. The intent is to increase privileges, but still have the patients be able to be safe from themselves... As you can imagine, the patients housed on this row may not always be very happy.



The treatment team is composed of a nurse, provider(psychiatrist or PA), social worker, a ranking security officer, usually a Sargent, and a clerk who manages the paperwork. The social worker tends to do much of the preparation of the report, and can take responsibility for notifying patients of treatment team decisions, although security and nursing do so, also. For my ward, I provide a written notification, with reminders, information about upcoming reviews, and comments about expected behaviors. Most of the patients take this for what it is, but some personalize it as coming from the social worker, not the treatment team.



I work closely with the security staff and nurses on this word. We have to communicate frequently and, sometimes, at length about what is occurring. We have to coordinate and support each other. And, we have to trust each other's expertise in their area.



The security staff with whom I work are good men and women. They are subjected to verbal abuse regularly, and can not let it affect their professionalism. I have to believe there is a special place in Heaven for prison security officers. They have to move patients for me regularly, so the patient can be placed in an area in which I can safely interview them. This means a day room or consult room partitioned with expanded metal so there is no opportunity for physical contact by the patient. For the interviewer's safety. This actually affords the patient some modicum of privacy, as a security officer does not have to remain present for the interview, although, I have the discretion to request that, if I feel it is needed. Rarely, I do. But I do.



These security officers do their job well. They like to tease some, and frequently "campaign" for Krispy Kreme donuts. If you are not familiar with Krispy Kreme, think Dunkin' Donut, but richer, lighter, and with more intense flavor. Well, I do from time to time bring the officers some donuts.



Recently, some of the "extreme" patients on the closely monitored row have taken to call me "donut hole." It is true that communication is only 7% the words we speak, the rest being tone and volume, and non-verbal cues. I did not know that two innocent sounding words could take on such a vulgar sounding tone until these patients started calling me "donut hole." The intimation is that I am siding with security against the patients, and possibly in some ways they imagine that are inappropriate. It is meant as an insult, of course.



It makes no sense, to deliberately antagonize me, because I sit on the treatment team that makes decisions about their treatment, privileges, and programming. I am the clinician who offers psychoeducational programming for these patients. I do my best to be professional, fair and consistent with all of the patients assigned to my ward. I find myself advocating for someone who has threatened me, spit at me, or called me names. These patients chose not to know that they are creating their own problems by their behaviors, which is consistent with the fact that they did things to get themselves sent to prison.



Fortunately, there are just as many patients on my ward who are seriously working on their programs. Whose behaviors have noticeably improved, changed for the better, and who are benefiting from their efforts to help themselves. Most changes are small, but all are meaningful... I once had a supervisor who said if you can help one client a year, you can consider yourself successful. Maybe her expectations were too small, but that idea keeps me going...



I lost it last night, after work, thinking about the phrase "donut hole." The disrespect, disgust, and intonation with which it was being said was obvious to me. In the light of day, I realize that if I let it get to me, I run the risk of sinking to the same level as the persons saying those things.



This is the world in which I choose to live. I do feel I have made a difference, and I feel I can continue to do so...