Tales from the New Asylum: The Valediction

When the truths of love are planted firm
They won’t be hard to find
And the words of love I speak to you
Will echo in your mind

Without despair we will share
And the joys of caring will not be replaced
What has been must never end
And with the strength we have won’t be erased

...I believe when I fall in love with you it will be forever.¹

Whenever a suicide happens in the New Asylums, a palpable, muted dread descends over the institution. It stays there in full force for weeks and months afterwards, sometimes longer. After that, it is added as another sedimentary layer to the strata and culture of the particular institution. Before things get too deeply buried, it is important to excavate.

Many excavations expose little. One is still left with agonizing, unanswered questions. But on rare occasions, a careful processing reveals a recorded history. The more well preserved these remains, the greater the likelihood they will be preserved in the mind of the excavator. Here then, are some findings from one well-preserved dig.

The prison Investigations Officer had called me early in the morning. The previous evening, an inmate I’ll call Nick, leapt to his death from a 5-story prison dormitory balcony. The investigator’s voice had been curt and official: “Morning, Doc. I have a recording in the phone bank that the Warden said you would be interested in hearing.”

It turns out that all phone calls inmates make or receive in the New Asylums are assiduously recorded for posterity-in most cases, for “security purposes.” I had listened to many recorded calls, all saved on a computer database. The reasons for my having to listen to these calls were never pleasant.

I knew Nick. He was among the caseload the mental health team followed in general population. He was a survivor of many tragedies, most notably the Vietnam War, which had left him battling chronic depression and PTSD for most of his life.^2,3 He had about 3 years left to serve of his 10-year sentence for “accomplice to fraud.” There had been some speculation among mental health staff that he may have “taken the fall” by refusing to implicate his wife Cora, who had remained married to him despite his prison sentence. As far as I could recall, the team in general population had no recent concerns about Nick. He had made good use of treatment and had become a leader in his prison Alcoholics Anonymous group. As I headed over to the investigator’s office, I knew I was likely to find something unexpected and cataclysmic happened in Nick’s life.

Sitting in front of the computer bank, I placed the headphones over my ears. Clicking play unearthed the following conversation: 

Nick: You there baby?
Cora: Yes, I’m here.
Nick: Can’t we please talk about this?
Cora: Nick, I said everything you need to know in my letter.
Nick: So that’s how it is? You won’t even come here to tell me face to face?
Cora: You know that wouldn’t do either one of us any good.
Nick: Baby...12 years...You expect me to just sit in this place and let this happen?! Not try to do something about it? Save something important?
Cora: It’s too late, Nick. Things are... different now. We reached an impasse.
Nick: You....told me...we were forever...
Cora: Everything’s changed now, Nick. You know that...I can’t take it anymore. We both need to be happy.
Nick: Happy?
Cora: Nick...You can’t be the man I need you to be.
Nick: So this is it then? All the plans we had? Moving to the coast? The house...
Cora: I’m sorry, Nick. We tried. I’m sorry it didn’t work out.
Nick: You with another guy?
Cora: That’s not important now, Nick.
Nick: You’re a quitter. I never quit on us. You quit.
Cora: Don’t you judge me. You don’t get to do that any more. I have to go now, Nick. Don’t call me back, I won’t answer. It has to be this way, Nick. Goodbye.
Nick: I... I can’t believe you’re doing this...after everything. I wake up thinking about you and I go to bed thinking about you. You are the only thing that gets me through the day in this place. I...I live for you Babe.
Cora: Goodbye, Nick.

[...Click and dial tone....]

The computer database tells me the exact day, the exact time, this conversation happened-approximately 20 minutes before other inmates reported they saw Nick pacing anxiously on the balcony. Approximately 30 minutes before other inmates say they see Nick climb up over the railing with a look of determined fear on his face. Approximately 30 minutes, 10 seconds before they start yelling at him to stop. He didn’t.

In the New Asylums, spousal loss or divorce gets everyone’s attention. It’s well known that this type of loss, for an inmate, can be a fatal one.⁴ The outside spouse may well be the inmate’s canteen of water in an endless stretch of dessert. A promise from the future that there is still reason to carry hope close to one’s chest. And suddenly it’s gone-and what remains? Only the individual inmate in question can answer with precision, but here are some findings from previous excavations: vanishing of hope, crushing abandonment, searing rejection. But perhaps less well explored-yet equally destructive-traumatic betrayal.

Strange, but betrayal has not been well defined by the social sciences. One attempt has resulted in calling it “the...(biopsychosocial) harm caused by an actual or perceived violation of a psychological contract by person(s) upon which the victim relies for some aspect of his or her...well-being.”⁵ Some have speculated that betrayal is more injurious than physical trauma because of its profoundly destabilizing effects. It upends all our mental schemas, guarantees, and “psychological contracts” we had previously relied upon to understand and respond to life.^5,6 And perhaps herein lies its lesson-unless the individual can rediscover some form of equilibrium, he is thrust, painfully and unwillingly, into a void of precarious uncertainty. With or without assistance, who can say how any one of us might clutch and flail? On occasion, careful excavations may uncover remnants of the struggle.

Shattered dreams, worthless years
Here am I encased inside a hollow shell
Life began, then was done
Now I stare into a cold and empty well.

....I believe when I fall in love with you it will be forever.¹

References:

References
1. “I Believe (When I Fall In Love It Will Be Forever),” by Stevie Wonder. Lyrics at: http://www.azlyrics.com/lyrics/steviewonderibelievewhenifallinloveitwillbeforever.html. Song at: http://www.youtube.com/watch?v=uYJFkLUGbbk.
2. Boivin M. Forgotten warriors: an evaluation of the emotional well-being of presently incarcerated Vietnam veterans. Genet Soc Gen Psychol Monogr. 1987;113:109-125.
3. Wortzel H, Binswanger I, Anderson C, Adler L. Suicide among incarcerated veterans. J Am Acad Psychiatry Law. 2009;37:82-91.
4. Way B, Miraglia R, Sawyer D, et al. Factors related to suicide in New York state prisons. Int J Law Psychiatry. 2005;28:207-221.
5. Hensley AL. Betrayal trauma: Insidious purveyor of PTSD. In: Dougherty GW, ed. Return to Equilibrium: Proceedings of the 7th Rocky Mountain Region Disaster Mental Health Conference. Ann Arbor, Mich: Loving Healing Press; 2009.
6. Freyd JJ, Klest B, Allard CB. Betrayal trauma: relationship to physical health, psychological distress, and a written disclosure intervention. J Trauma Dissociation. 2005;6:83-104.