Criminal Minds: A Psychiatrist's View from Inside Prison

Few people would choose to spend their time inside the walls of a prison, but it's all in a day's work for David Krassner. As a staff psychiatrist at the California Men's Colony State Prison in San Luis Obispo, Krassner tends to the mental health needs of those locked away by society: men convicted of murder, rape, assault, kidnapping, arson or other crimes.

LiveScience talked with Krassner about why meditation is good for inmates why it's worth it to work with people whose crimes may repulse you.

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LiveScience: How did you come to work in the prison system?

Krassner: I was working in community mental health services for the county and was just looking for a change. I had a friend who worked here at the prison, someone I knew from training. I talked to him and he suggested just coming to check it out. And I did and I liked it, so I signed on.

I never even considered working in a prison before I came over here five years ago, but now that I'm in it, it's like, wow. It's a different world.

LiveScience: What appealed to you about working in a prison?

Krassner: There were a couple things. One is that guys in prison don't have a choice really about where they get their care, so it seemed like good work in the sense of doing service for an underserved community. In addition, it was something different. It was a new challenge.

LiveScience: What sort of mental health issues do you see in inmates?

Krassner: Primarily schizophrenia, schizo-affective disorder [a disorder characterized by episodes of elevated and depressed mood along with many schizophrenia symptoms], major depression. A lot of drug and alcohol use, a lot of personality disorders and a fair bit of malingered symptoms. Patients often malinger symptoms for a gain such as housing, that sort of thing.

LiveScience: How do you tell real symptoms from fake?

We work together pretty closely with both the primary clinicians and custody people. So for example, if a guy comes and says he's having symptoms, we check with custody. If we find the guy is or was supposed to transfer to another place, that gives us an idea if the worsening of the symptoms is real. A lot of it is working with members of the team.

LiveScience: Do the inmates usually admit they're faking illness when confronted?

Krassner: Sometimes! Not always. One thing we have to keep in mind is that they are criminals. They lie to get what they want, and they manipulate. That can be challenging.

LiveScience: You run a meditation group for inmates. How did that get started?

Krassner: I noticed that a lot of guys who I was treating through medication were suffering from problems that medications really couldn't help that much. Distress, the everyday stress of prison, problems sleeping, and dealing with being in prison for long periods of time or having life sentences. There's a kind of hopelessness that goes along with that.

As a practitioner of meditation myself, it occurred to me that these guys might benefit from stress management taught through meditation techniques. So I started the meditation group and it was so successful, based on the feedback I get from the inmates, that I've been doing it pretty much ever since.

I do the meditation groups in a group room with the guys. They're not handcuffed. They're not in cages. There's usually about anywhere from six to 10 guys that come. We go through some stretching, we go through some visualization, we go through some breathing techniques and then I play music for a while and we all meditate.

LiveScience: A lot of people would look at these guys' crimes and say they don't deserve psychological comfort or stress relief. Why is the mental health of inmates important?

Krassner: This may be the most important question of all. The answer is simply this: Being in prison is the punishment for their crime. How they do the time is not the punishment.

Unfortunately, even in the prison system there are people who feel we should make things difficult for them as part of the punishment. But being in prison is difficult enough. These guys live in tiny cells, often two to a cell. It's a very regimented life. And that, to me, that's the punishment, being in prison.

LiveScience: Is it ever difficult to interact with the inmates, knowing the crimes they've committed?

Krassner: Oh, absolutely. Usually we know the crimes of the patients on our own caseloads. And sometimes we have a personal reaction to that. It's very important to deal with that, so that we can give them the care that they need. But yes, I think it's part of being human to have a reaction to a crime when you hear about it.

LiveScience: How do you cope?

Krassner: I do meditation myself outside of work. But mostly it's in talking with colleagues. Everybody who works in a prison deals with these sort of reactions. The psychological term is "countertransference."  As a clinician, you have to deal with that.

LiveScience: Have there ever been cases where you've struggled or had to step away?

Krassner: There have certainly been cases where I've had trouble doing it, but you can't step away. You have to somehow master those feelings so that you can do the work you need to do.

LiveScience: What should people understand about the prison system?

Krassner: I run into misconceptions all the time in talking with folks who don't work in prisons. The first is that prisons are in any way a pleasant place for a prisoner to be. You hear about country club prisons, things like that, but most prisons are not those kinds of places and it's a very tough place to be.

Another common misconception is that prisons are very dangerous places to work. And while it is certainly true that they can be dangerous and that prisoners can be dangerous people, prisons are often safer than people realize. You have to be vigilant of your surroundings and aware of what is going on around you. That's not a bad thing ­— it's just part of working in this environment.

We have a large prison population as a nation in general, and there is a significant need for mental health professionals in prisons. So I would encourage people to look into it, because the need is there.

LiveScience: What do you like about working in a prison?

Krassner: First and foremost, it's a real sense of service. A prison is almost by definition an underserved community. Doctors don't like to work in prisons. They fear for their safety, they have strong feelings about their patients, the inmates. So in a sense I feel like I'm working in a place that not everybody would want to work. And as a physician, one of our primary motivations should be helping out those who are disenfranchised. There is a sense of satisfaction in filling that role.

Every once in a while, I really get a sense that I'm helping a particular patient. But most of the time, I just have to go on faith that I'm, I hope, helping most of the guys — or at least offering them some comfort in their suffering.

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