Drawing Time: Art Therapy In Prisons

David Gussak, PhD, ATR-BC

Florida State University

126 MCH

Tallahassee, FL 32306-4480

Ph (850) 645-5663 Fx (850) 644-5067

Note: Many of the case vignettes and photographs in this paper are from cases already published in the author’s book Drawing Time: Art Therapy In Prisons and Correctional Settings, and are done so with permission from the publisher, Magnolia Street Publishers.

Summary

This paper is based on art therapy in prison. As mental health facilities continue to close and more prisons are built, mentally ill patients who commit even minor crimes are becoming criminalized. At the same time, prisons often exacerbate already existing underlying psychiatric problems. Accordingly, the treatment setting for the mentally ill continues to shift towards correctional settings.

There are major challenges that therapists face working in forensic settings. There is an inherent mistrust for verbal disclosure, and a well-grounded fear of other prisoners taking advantage of others’ voiced vulnerabilities, resulting in rigid defenses built to achieve basic survival. Thus, art therapy can be one of the more beneficial approaches to allow needed expression in such a non-therapeutic environment. This paper will present eight specific advantages of art therapy in prison, which will be supported through several case vignettes.

Introduction

As mental health facilities continue to close and more prisons are built, mentally ill patients who commit even minor crimes are criminalized (1). Simultaneously, prisons often exacerbate already existing underlying psychiatric problems (2, 3). Consequently, the treatment setting for the mentally ill continues to shift towards correctional settings.

There are major challenges that therapists face working in forensic settings. There is an inherent mistrust for verbal disclosure, and a well-grounded fear of other prisoners taking advantage of others’ voiced vulnerabilities; rigid defenses are built to achieve basic survival. Thus, art therapy can be one of the more beneficial approaches to allow needed expression in such a non-therapeutic environment. The advantages for art therapy in other settings are well known, but this paper will briefly present and expound upon the specific advantages of art therapy in prison.

Setting and Population

The author worked on the psychiatric unit in a moderate to maximum state penitentiary in Northern California. The unit’s primary purpose was to stabilize and socialize the inmates diagnosed with a psychiatric illness before discharging them back to the prison’s general population. The inmates ranged in their crimes and their sentence length of time, including life without parole. Their average length of stay on the unit was between 6 to 8 weeks. Their crimes ranged from drunk driving and assault to armed robbery and homicide. The diagnoses of those admitted to the unit covered a wide range of Axis I diagnoses, including various acute psychoses and suicidal ideations. Many of them had dual diagnoses and personality disorders.

The Benefits of Art Therapy In Prisons—Case Vignettes

In general, many of the residents of a prison maintain, within varying degrees, sociopathic tendencies. Even if they are not purely sociopathic upon incarceration, they must learn such traits if they wish to survive; they must adapt to the culture to which they now belong. Incorporated is the notion that they cannot trust anyone, including nosy therapists. “If a therapist tries to break through necessary barriers, the inmate/patient may become dangerous even if initially charming and cooperative. The inmate’s defenses take over, making him anxious and angry, perhaps even violent, to a much greater extent…than clinicians are accustomed to with the general population” (4). Thus, a therapist must be prepared to work with their clients in prison in a manner that does not elicit suspicion or vulnerability; in other words, talk therapy is not always conducive for healthy therapeutic development.

Mr. V was in prison serving a life sentence after an unsuccessful bank robbery attempt. Although he and his partner developed an intricate robbery, the silent alarm was tripped. He and his partner shot at the police with military assault rifles, hitting an officer in the leg, and shooting and killing a tied-up kidnap victim. He later indicated the victim deserved to die since he was “stupid enough to get caught.” He was admitted to the psychiatric unit after several serious suicide attempts, including a medication overdose that left him comatose for three weeks. He believed he was smarter than those around him, and would try to assert his superiority, and enjoyed arguing with people. He also made it clear that he did indeed want to die, and that “the staff was too stupid and inadequate to stop him.”

Mr. V’s robbery went awry because of poor planning for which he blamed others. Ultimately, like his victims who were killed, and the staff who he believed were extremely stupid, he felt inadequate after the botched robbery, and thus he deserved to die as well. However, not only would he never reveal this, he would continuously mock others in verbal groups. Despite his well-established defenses, his art pieces clearly revealed his sociopathic dynamics. Mr. V participated in an art therapy group. One session was spent making art constructions out of handmade paper. On top of a wrinkled piece of handmade paper was a warning not to lift the paper. However, once lifted, the “victim” is faced with the message “Bite me” (Figure 1a and 1b). When he described the piece, he indicated whoever disregarded the warnings gets what they deserve.” The warning not to lift the paper was equivalent to society’s warnings not to break the law—not only did those who lifted the paper get what they deserved after disregarding the message, but he deserved to be punished as well.

In prison where mental illnesses are more prevalent and the inmate/patients do not often have intact cognitive skills to adapt to the prison setting, a therapists’ job may be to aide in their adaptation to the prison sub-culture. In many cases, the low level of education, illiteracy and/or organicity frequent in this environment reduces the inmate/patient’s ability to discuss or understand the issues and psychiatric illnesses with which they must contend. The art allowed the inmate/patients to express themselves even with the absence of ability. It allowed the expression of the problems without vulnerable disclosures that can later prove threatening or dangerous.

Mr. Y was in prison after he attempted to use his automobile “as a deadly weapon”, and for resisting arrest. Upon admission to the psychiatric wing of the prison Mr. Y was yelling, deemed “out of control” and threatening to hang himself. He was given a diagnosis of Bipolar Disorder. He was scheduled to parole within several months.

Soon after his admission and the beginning of his medication regime, Mr. Y became quiet and withdrawn—he began to “disappear” on the unit, as he attracted little attention to himself, and did not talk about what was bothering him. In a prison such inmates can become lost; it is usually the loud and acting out inmates that attract attention. Inmates like Mr. Y “slip through the cracks” and may not get the care they need. Mr. Y also completed an art piece out of handmade paper. Mr. Y’s art piece (Figure 2) was constructed from two identical pieces of this handmade paper. He cut one of them into small pieces, and glued them to the surface of the other. If seen from the top, the small pieces blend in with their background, and almost become invisible. If the piece is angled slightly, it is only then that the top pieces can be seen.

This piece seemed to clearly reflect Mr. Y. Because of his slight build, any tendency to call attention to himself, by asking for help, could result in dangerous repercussions from others on the unit. Consequently, in prison he learned to be quiet and unobtrusive. Unless looked for, or even looked at from a different angle, Mr. Y would become lost in the background. Once the art piece was presented to the rest of his treatment team, and how it possibly reflected his dynamics was explained, Mr. Y was given other forms of attention, including individual sessions with the social worker. He soon began to interact more with others on the unit, and displayed signs of stabilization. His art clearly communicated what he could not say out loud.

Mr. W was a gregarious and talkative inmate, in prison serving a parole violation. His parole was violated after a disagreement with his parole officer. Previous violations were generally results of being uncooperative with the rules of his parole. He also had a history of “mouthing off” to his parole officers. He was admitted to the psychiatric unit because he was preoccupied with religious delusions; he did not make sense upon admission as he was “talking in tongues.” He stabilized quickly after taking medication, and was scheduled to parole again within the next two months. Mr. W had been in art therapy before, and generally did not invest himself in the tasks at hand, remaining superficial in his approach. However, during a mask-making project, in which the clients were asked to make masks from paper plates (allowed within the rules of the institution—real mask-making is a violation and is seen as an escape attempt) he actually became quite involved and created Figure 3.

Made with tissue paper on a paper plate, he created a face with a large piece of black tissue paper covering the mouth area; when asked at first he said he did not know why he had done that. He then admitted that perhaps he was gagging himself to avoid further trouble, and that he was real fearful of coming back to prison because of his “mouth.” It was not until after he completed the art piece was Mr. W able to express what it was he was frightened about. From this project, Mr. W gained some insight into how he can get into trouble by being verbally inappropriate, and the remaining two months prior to his parole focused on self-control, appropriate means of interaction and problem-solving. This mask and his admission also led into insight on his tendency to “speak in tongues” upon his admission—if no one could understand what he was saying, it is less likely that he would get in trouble.

The art expressions provided the trained art therapist a means to guide the therapy so that the inmate/patient addressed their issues on an unconscious level. It can even diminish pathological symptoms without verbal interpretation. In many cases, art therapy allows treatment to continue without a need for the client to even know, admit or discuss what the art has revealed. The art also allows the bypassing of rigid defenses, including pervasive dishonesty. “Because of the fear of self-disclosure…very little dialogue may occur between the therapist and the [inmate/patient] during the group session. If the inmate/patient does disclose personal information, it is not clear if he is being truthful…although inmates are cautious with words they may allow themselves to be expressive using art materials” (5). As well, the act of creating art allows for a more acceptable form of expression by the correctional establishment.

Creative expression is already prevalent within a prison setting (6, 7), and many inmates naturally spend their time creating. This is understandable; the act of creating art has been directly linked to the primitive instinctual impulses found in prison—aggression, sexuality and escape (2). Art and sex are “each primal behaviors that have become elaborated in the essential service of affiliation and bonding (8), whereas “the impulses that drive some people to create are perhaps alike primarily in the fact that both can be considered expressions and agents of feelings” (8) the art may very well be a by-product of the sublimation of aggressive and libidinal impulses (9, 10). As well, the act of creating allows the inmate to “escape” and retreat, if only for a few moments or hours, into his created world. It allows a diversion from bleak surroundings. Understandably, these impulses are greatly feared by the prison establishment if expressed in their pure form; thus, the redirection of these instincts into the art is more acceptable to the establishment, even if the institution is not aware of such redirection. Using the art permits the inmate/patient to express himself in a manner acceptable to both the inside and outside culture.

Mr. M was a forty year old, obese man who had a history of an extensive drug history, fire setting, mayhem and second-degree robbery. He was sexually abused as a child, subjected to incest, and forced to have sex with visitors to his stepfather’s home. He was at times forced to have sex with his five stepbrothers and sisters. The term he was serving at the time of his latest incarceration was for castrating a fellow transient after beating and robbing him.

Mr. M was admitted to the unit after he made serious suicidal gestures; he was given an Axis I diagnosis of Dysthymia, and an Axis II of Borderline-Antisocial Mixed. He generally remained quiet on the unit, rarely speaking unless spoken to. The one activity Mr. M seemed to willfully partake was the art therapy sessions. He generally worked with chalk pastels and would often draw without prompting or direction. He rarely spoke during the sessions, but worked for the entire hour quietly.

Figure 4 demonstrated a style that he had incorporated in past drawings many times. The picture shows an unidentifiable, androgynous humanoid staring into a blank mirror. There is no recognizable background. Although unable or unwilling to speak about his problems, this image seems to clearly reflect a poor sense of self and sexual identity, and a lack of connection with his surroundings.

Figure 5 was completed with another art therapist on another unit, but was included because it clearly illustrates Mr. M’s internal anguish and pain. The only recognizable features are the large head and ten hands that emerge from the genital region. The origin of the arms and hands that seem to be dragging what Mr. M referred to as a “Munch-like figure” down. Perhaps Mr. M was symbolically revealing the sexual rapes and abuses that he had experienced as a child. Mr. M, seen as weak and unassuming by others, dared not speak these issues out loud for fear of being ridiculed or taken advantage of by others on the unit. Creating the art was an acceptable form of expression of his sexual and aggressive impulses that he had previously displayed inappropriately. What is more, such expressions of sexual dysfunction may not have been seen as acceptable by the correctional environment, but creating the image was. As well, the act of creating provided Mr. M a means of escape, if only temporarily.

The Eight Advantages-A Review

In summary, there emerged 8 specific advantages. Art therapy:

  1. utilizes tasks whose simplicity may result in the expression of “…complex material which would not be available for communication in any other form…”(Kramer, 1958).
  2. has the advantage of bypassing unconscious and conscious defenses, including pervasive dishonesty.
  3. promotes disclosure, even while the inmate/client is not compelled to discuss feelings and ideas that might leave him vulnerable.
  4. supports creative activity in prison and provides necessary diversion and emotional escape.
  5. does not require that the inmate/client know, admit, or discuss what he has disclosed. The environment is dangerous, and any unintended disclosure can be threatening.
  6. permits the inmate/client to express himself in a manner acceptable to both the prison and outside culture.
  7. can diminish pathological symptoms without verbal interpretation.
  8. is helpful in the prison environment, given the disabilities extant in this population, contributed to by organicity, a low educational level, illiteracy, and other obstacles to verbal communication and cognitive development (4, 5).

An art therapist in an outside facility such as a psychiatric hospital or school may help clients adjust to the society to which they will be discharged. So does an art therapist in a prison. However, in this environment societal norms are different, as weakness is exploited and survival of the fittest is the rule. Thus, it behooves an art therapist to learn the conventions of the prison sub-culture to best provide services that would not run contrary to the correctional institution’s norms while still meeting the mental health needs of his or her clients.

References

1. Gibbs, J.J. Symptoms of Psychopathology among jail prisoners: The effects of exposure in the jail environment. Criminal Justice and Behavior, 14(3). 1987. 288-310.

2. Fox, W.M. The hidden weapon: Psychodynamics of forensic institutions. In D. Gussak and E. Virshup (Eds.), Drawing Time: Art Therapy In Prisons and Other Correctional Settings. Chicago, IL: Magnolia Street Publishers.1997. 43-55.

3. Morgan, C. Developing mental health services for local jails. Criminal Justice and Behavior, 8(3). 1981. 259-262.

4. Gussak, D. Breaking through barriers: Advantages of art therapy in prisons. In D. Gussak and E. Virshup (Eds.), Drawing Time: Art Therapy In Prisons and Other Correctional Settings. Chicago, IL: Magnolia Street Publishers.1997. 1-11.