Pubdate: Tue, 07 Jan 2003
Source: Charleston Gazette (WV)
Copyright: 2003 Charleston Gazette
Contact:  http://www.wvgazette.com/
Details: http://www.mapinc.org/media/77
Author: Jack Berkley
Note: Dr. Berkley, a licensed psychologist, lives at Shepherdstown.

Depression, Substance Abuse High Among Incarcerated Youths

MISSING THE DIAGNOSIS

I worked as a substance abuse counselor in a Maryland jail for three years 
and later as a licensed psychologist in adult Maryland correctional 
facilities for several years, working exclusively with youths sentenced as 
adults.

Dawn Miller's report of the high rate of mental problems among incarcerated 
youths is in line with my experience. Two additional observations: youth 
substance abuse in prison is underreported, especially by those inmates who 
continue regular or occasional use in prison or those who have buddies 
doing so.

The best chance of knowing the true picture is through counseling 
relationships.

During working therapy, substance abuse reporting increases, compared to 
what inmates report on questionnaires or brief interviews. Why? Youthful 
inmates generally do not trust health-care professionals or others with 
information they fear will result in further scrutiny or charges, unless it 
will benefit them - for instance, if they think it will transfer them to a 
better treatment situation and contribute to earlier release. Therefore, I 
think the substance abuse rate would be considerably higher than what the 
federal government study reported.

Another point I would make is that dysthymic disorder, a long-term 
low-intensity depression, is very common among youthful - and older - 
offenders. Two reasons explain why this is underidentified: First, youthful 
offenders frequently do not identify long-term depression when they have it 
because they have become ego-syntonoic, which means they've been down so 
long it seems normal to them.

Secondly, many professionals miss the diagnosis not only because the youths 
report they are fine, but because depression in youths often lacks the 
display or report of being sad, which most persons regard as the hallmark 
of depression.

Youths may be irritable, touchy, resentful, spiteful or belligerent 
instead. These manifestations of depression (blended with personality 
traits and attitudes) often engender negative reactions in professionals 
that throw them off the diagnostic track.

Especially when combined with substance use and/or prior trauma, many of 
these youths experience alexithymia, the numbing of emotional experience, 
so that they are disconnected from experiencing and expressing their own 
feelings. They cannot report feelings. The clinician is therefore left to 
make inferences about the uncooperative youth's angry depressed mood.

Also, in the past, professionals used to take an either-or perspective 
regarding acting-out youth. The youths either had an externalizing disorder 
(e.g. acting aggressively, as in conduct disorder) or an internalizing 
disorder (e.g. depression). Research and experience confirms that youths 
often have both. They can rob someone on the street and also be depressed - 
even though to most of us, aggressive behavior and depression don't seem to 
mix well.

Many of these youths often display a below-normal capacity for empathic 
regard for others, even though they often express deep concern and loyalty 
for their own mothers, a touching feature that does not erase their 
aggressive actions elsewhere to someone else's mother or child. Both the 
aggressive behavior and the depression must be treated.

Despite their many common experiences before prison, youth inmates are 
individuals, especially regarding their degree of empathic capacity and 
responsiveness to treatment. Early release is no favor to them or to us 
when they have not demonstrated a capacity to change and have no new place, 
education, job training, routine and well-monitored, semi-structured living 
arrangement to which they can return.

One of our studies indicated that a high percentage of re-offenders came 
from the same four zip codes of an urban area. Youths' pre-incarceration 
environments are the training grounds that lead to prison. Returning them 
there retrains them to recycle. Treatment starts in prison, but if it ends 
there without the other features I mentioned, it is often - though not 
always - like a Band-Aid for an internal hemorrhage.
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MAP posted-by: Beth