This is a condensed version of an article written by a prisoner in the Philippines based on their experience of managing mental health behind bars. After having first been verified by a doctor, we included it in two parts in our most recent newsletters, sent to all prisoners we are supporting.

We advise the prisoners we support to seek medical advice where possible and to contact consular staff or Prisoners Abroad if they need help accessing medical assistance. Prisoners Abroad’s Medical Fund is available to prisoners in countries where receiving medical treatment or a prescriptions is not possible without payment. Grants from the Medical Fund have been used to purchase mood stabilising drugs as well as medication for anxiety and depression.

Prisoners were also invited to get in touch for copies of the books mentioned in this article, for our yoga publication, and for language learning materials like dictionaries or phrase books. 

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“Extreme stress is a major part of the lives of all of us in prison. Unlike outside, we cannot walk away from unpleasant people and situations. Getting ill in prison is miserable enough, but with a mental health issue, life can feel totally pointless. You can easily imagine never being able to get better - but you will!

This article will focus briefly on mental illness, the psychiatric medications used to treat the main conditions, and effective coping strategies we can employ immediately to deal with this. I hope people not in prison will also find this information helpful.

Who gets mentally ill?

If recent statistics are to be believed, one in four people will experience a mental disorder at some point in their lifetime. This figure is always being revised upwards, and does not include the millions who are never diagnosed. Because of the COVID-19 crisis, I suspect the true rate is higher now. In prison, suffering from a mental health disorder is extremely common, even without a pre-existing condition. It is not a personal weakness or failing or inability to cope. It is an unfortunate nervous overreaction to an extremely stressful environment over which we have no control.

What are the most common mental illnesses? 

Anxiety and depression are by far the most common, and often occur together. The two conditions are closely related. Everybody gets anxious and depressed at times but we are speaking here of debilitating conditions which interfere with the ability to perform even simple tasks like taking a shower or eating. Nobody knows exactly what in the brain causes this; in some cases it was thought to be due to atrophy which is destruction of brain cells by stress hormones such as cortisol. The ‘chemical imbalance’ theory was discredited years ago but even today, doctors will cite this as the reason because it requires no further explanation. Unfortunately, most people around us will have no comprehension of what we are going through, particularly as we may not look ill in the normal sense, and therefore we will receive little of the empathy and understanding we need and deserve.

How to know if you have anxiety/depression 

It is very common for people to know they have a problem which interferes with their sense of well-being without actually understanding what the problem is. There are a multitude of psychological symptoms but the most common are loss of interest in everything, loss of appetite, loss of libido, sudden loss of weight, insomnia, wanting to be alone, no energy, feeling completely worthless. ‘Brain fog’ is another, an unpleasant sensation which feels like having a stone in your head. These may be accompanied by physical symptoms. Racing heartbeat, prickly sweat, churning stomach, trembling, muscle pains, migraine, diarrhoea, frequent urination to name but just a few. Getting a mental illness does NOT mean you are going mad. Although depression always contains an element of anxiety, anxiety can exist without depression. Both are often at their worst in the morning. This is because cortisol levels are at their highest while metabolic rate is at its lowest.

Loss of self-esteem 

Being in prison can wreck our self-esteem, while the effects of mental illness become a double whammy. Our sense of worthlessness is based on that critical inner voice constantly harassing us - but it is wrong. It is not based on reality but is the result of distorted thinking exacerbated by the pain of mental suffering. We do not have to do anything to merit self-esteem. We need to accept ourselves as we are, and stop comparing ourselves to other people. There will always be someone better-looking, richer, and more stable. The whole concept of self-esteem is basically irrelevant self-judgement. 

Seeking medical treatment 

My prison has a clinic with guards and inmate trustees who are supposedly qualified nurses. If you are fortunate enough to have access to a real doctor who can give you something other than paracetamol, you are probably one of the lucky ones. A prison doctor should ideally be a mental health expert but we are not living in an ideal world. Getting access to a good psychiatrist is difficult even for people outside the prison walls. If you think you need medication for a mental health condition but have no way of acquiring it, you need to contact the embassy. I believe that Prisoners Abroad can help with the cost of medications (assessed on a case by case basis). Ask for details of the Medical Fund if you need help with the cost of medication or medical treatment.

Sleep problems

This demands special attention. For me, noise has been my biggest enemy in captivity. For example, inmates staying up all night inhaling crystal meth and gambling generate a lot of it. Then there is the loud music (mercifully daytime only) booming out of other cells on large portable speakers. Tom Jones, Michael Learns To Rock and Bon Jovi. This is a description of hell. No living person should be subjected to that. It was used as psychological torture for inmates at Guantanamo Bay. You cannot knock on the door of a serial killer high on drugs and request him to be so kind as to turn down the volume. I use earplugs to aid sleep. Sleeping pills are not recommended. Like benzos, they are addictive and fizzle out.

Dealing with panic attacks

You will probably know when you get a panic attack. It is horrible. Anything can bring one on. Many people mistake their first panic attack for a heart attack. Fortunately, there is a way through them which requires no medication but a little bit of courage. When a panic attack kicks off, you will experience many of the physical anxiety symptoms mentioned previously. First, consciously slow down your breathing as much as you can. Second, silently urge the panic on TO DO ITS WORST! Like Lieutenant Dan during the hurricane in the movie Forrest Gump, say to yourself something like, “Come on panic is that the best you can do? Bring on more, more!” The panic attack will continue then run out of steam, which it always does anyway. This will not stop you getting a panic attack again, but by using this method, they will become less frequent until you are rid of them completely.”

Self help - meditation

In jail we are limited to what we can do to help ourselves. ‘Fighting’ anxiety and depression by engaging in frantic, distracting activities is a battle we cannot possibly win. We have to accept our pain and surrender to it completely, a lack of action which would seem counter-intuitive. But, sometimes, doing nothing is the answer. An effective mechanism to help us achieve this is meditation. When severely anxious and depressed and practically unable to function, it is one of the last things you will feel like doing but IT WORKS. You just have to do it. I do meditation every day. It is tedious at first and seems like a waste of time but stick at it and you will definitely start to feel some benefits after about one month. After two months you will know for sure it is helping.

Another highly recommended exercise is progressive muscle relaxation. Lying on your back, relax your body as much as you can. Then, starting with your feet, tense them by curling your toes. Hold a few seconds, and release. Then move on slowly to your calf muscles and all the way up to your head, where you will finish by screwing up your face.

Self help - books

The other main self-help method, in the absence of a qualified therapist, is self-help books. In other words, you need to become your own therapist. Try and get hold of the following three, in order of importance in my own opinion. 

• Hope and Help for your Nerves, by Claire Weeks
• Dare, by Barry McDonagh 
• The Feeling Good Handbook, by David D. Burns

Self help - yoga and exercise

Once you have started meditation, the next logical step is yoga. Prisoners Abroad’s newsletters often carry excellent yoga routines with diagrams, and they have compiled a publication which contains lots of previous articles. Yoga may not be your cup of tea but it is a really good muscle workout because it uses your body weight. It gives your body organs a virtual massage too. Any kind of physical exercise is highly recommended for mental health. Even if literally just walking slowly round and round in circles day after day. A walk can also be turned into a kind of meditation by focusing on your breath and the movement of your feet in the wind. 

Self help - other things that help

Keeping a journal is a well-known therapeutic activity. It does not need to be systematic or detailed. A couple of sentences a day is fine, and it serves as your ‘second voice’. In fact, any type of writing is worthwhile because it takes your mind off things. 

Learning the language of the country you are in can be very helpful if you can motivate yourself to do it. Local inmates will appreciate your efforts. I am amazed how few foreigners here can count up to ten in the local language. There is a natural tendency for us to assume we will not be inside long enough to make it worth the effort, plus a hatred of the culture which incarcerated us.

Group activities, particularly of a religious nature, may help you more than you imagine. I had weekly bible study with an outside Christian group until visitors were banned because of COVID-19.

Opening up about your mental health problems to an associate can be beneficial, and what’s more, they might open up to you about theirs. I think it is a bad idea to keep it a secret."

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You can read the full article in our June 2021 and September 2021 newsletters.