“Help, I can’t breathe,” a prisoner calls out through a fabric mask that was placed over his nose and mouth after pepper spray was shot into his face from inches away.

“You’re Talking, You’re Breathing,” says Captain Welch, in a calm monotone.

Its not easy to deal with people who have mental illness.  They do not always respond in a desired manner, and are sometimes impacted by their medication, or incredibly distorted by their current conditions.  Take a mentally ill person who cut themselves up to the point of being stapled, and then put them into an isolation chamber.  Give them no books nor stimulation.  Perhaps be late with their pain medication, or their anti-psychotic meds. They may not comply.  They may in fact, be so belligerent you dread being around them.  You may feel inclined to take action.

It takes special training to deal with severe mental illness, or even to deal with moderate mental illness in severe conditions.  The most common place for these interactions are behind the walls of American prisons.  Some of these interactions are day-to-day occurrences in the open cell block.  Many of them, however, are away from all eyes except an armored tactical unit, extracting a man from solitary confinement, and bringing him into an even more secluded area so that he may “understand” how to act appropriately.

“We are only trying to help you,” the Captain says in a video anonymously released from the Maine Department of Corrections. Few Americans are privileged to see the “help” a mentally ill prisoner can expect to receive if they are acting out or “decompensating,” to use the medical term.  This incident is nothing special; similar procedures happen in every prison across the nation.  After being maced for obscure retaliatory purposes, he remained strapped down for a half hour before being allowed to wash off.

The incident begins on June 10, 2012, with a 27-year old man, “Paul” in a solitary confinement cell, barefoot in a smock, with nothing but a blanket.  He is a former medic in the military, who was discharged for bipolar and depression.  Paul wants his meds and he wants a book.  Two days earlier, he cut himself deep enough to lose two pints of blood.  Paul has possibly refused to eat his food for days, and complains that he is not getting his Adivan medication to remain, as he says, “somewhat stable.”  The guard tells him to put his bandages back on his arm.   Paul covers himself in his blanket as the camera rolls.  A guard tells Paul that he will need to go to the infirmary so they can re-wrap his bandage, while Paul asks why they can’t come to him.

1987 Ativan advertisement. “In a world where certainties are few…no wonder Ativan is prescribed by so many caring clinicians.” (Photo credit: Wikipedia)

Ativan is an anti-psychotic.  A nurse eventually comes and gives him the Ativan,  Zoloft,  Vicodin (for the pain), and something else.  He continually asks for a book, and he and the guards all go back and forth between politeness, subtle threats of violence, insults, and sarcasm.  The dialogue is quite common for a prison setting.  As is a great deal of medication that is hardly monitored by any mental health professionals.

“Cutters don’t die, we just wait for them to drop and sweep em up,” mocks the guard behind the camera.  Paul, who repeatedly asks for the camera to be shut off, says “Why don’t I spit on you.”  The guard replies, “Go ahead, its an assault.  The camera’s on.”

Ultimately a truce is reached, to not bother each other, while the guard continues to watch Paul with the camera rolling.  Eventually, Paul returns to all he can do: wander the cell.  He even asks if the Celtics won last night.  The guard isn’t sure, so he asks another guard, who replies, “The Black guys.”

A few of the side-effects of Ativan include hostility, aggression, and hyperactivity.  Of course, these are also direct effects of putting someone, or anything, in a cage.  Some wonder whether people go into isolation cells and go crazy, or whether crazy people do things that get themselves in isolation cells.  The more common reality is that people who, with the right course of treatment, can live manageable lives are not given anything close to treatment.  A prisoner may be able to get a prescription for a variety of anti-depressants and anti-psychotic meds.  But this does not qualify as treatment by any professional ethical standard.

“We do have the go-ahead to spray you,” the guard mentions, as the pages of a book or manual can be heard flipping away.  After expressing some concerns about getting in trouble for using mace, “Down here you can spray anybody you want to.  I got it right here in black and white, to spray away.”  He also recognizes that “shit burns in an open wound.”  Admitting that he can’t see if Paul is “playing with” his wounds, the Guard wonders if he should “spray this dude.”

At the 59-minute mark, the extraction team comes, in full riot gear.  Captain Welch gives explicit instructions, and is holding a can of mace the entire time.  Paul gets on his knees, facing away from the door, with hands behind his back.  Paul asks “Whoever’s cuffing me up, please go easy on my wrist.”  Four riot-gear clad guards extract him, with no incident, and strap him to a chair.  He is reportedly bringing him down to re-dress his arm wound, which they strap down to the chair without any particular care.

Anyone who is surprised by Paul’s complaints about the tight ankle cuff, or the contact with his sliced-up arm, have most likely never felt the potential pain of shackles and restraints.  It takes 5 minutes to secure him.  Again, without incident.  Six DOC employees transport him through the facility to a holding cell.

After complaining about his head being held, and his arm being grabbed, he gets maced at 1:06.  At 1:08 they call for medical.  It seems they were not bringing him to medical.  This is central to the 17-minute excerpt video.  A fabric mask is placed over Paul’s face, ensuring that the toxic fumes of oleosporin capsicum (which has been connected to deaths) are contained and inhaled at maximum levels.

While Paul screams that he can’t breathe, Captain Welch is trying to get to the bottom of (1) Why Paul took off his bandages, and (2) why he spit at a guard.  The alleged spitting incident seemingly happened sometime prior to the videotape.  Later, the Captain says he had to send staff to the hospital because he spit in their face.  Paul asks “who says I spit in their face?”  Maybe he did, maybe he didn’t.

At 1:18 Captain Welch tells one of the guards, who was not maced (also wearing a protective helmet) to go wash his face.  Meanwhile Paul is still begging for the mask to be taken off, as the mace is certainly cooking his face and fresh air must first leak through the fabric.  “Just sit back and relax,” Captain Welch tells him.  The Captain is clearly relaxed, seemingly unconcerned that the mace is inflicting anything other than intense pain.

After 15 minutes, the mask forcing him to continually breathe the mace is taken off.  “It hurts?  Its meant to.” Capt. Welch explains.  The nurse watches.

When he begs for his vitals to be checked, the Captain pauses to lecture him on not making demands.  Captain Welch continually reiterates that this painful lesson is to show Paul who is in control, and it will happen again if he does not straighten up.

After an hour and forty minutes, Paul explains that he is so bad because he is “so F’in depressed,” he isn’t trying to just be a pain in the ass.   He explains that prior to this cutting incident he had an agreement to see a psych two times per week, but for the past month he has seen nobody.  He told four officers the morning he cut up, “I am going to cut up,” and the response was “sorry I’ve something I have to do.”

When the guard asks about Paul’s military service, Paul responds that he was a medic, discharged for bipolar and depression.  Without knowing any further details, we do know that Paul is not alone.  The U.S. military has been swamped by the need for mental health treatment.  The Iraq/Afghanistan wars and occupations have gone far beyond Vietnam in social costs to our returning soldiers.  Mental health, substance abuse, and incarceration receive a spike after all wars.

Paul is not a statistic, and this video is not surprising for people who are familiar with prisons.  To illustrate how common this treatment is for our mentally ill, for our veterans in prison, for people in solitary confinement… look at the Maine DOC response to the video.  They are only concerned with how the video was released, not the treatment shown within it.

Sadly, the video actually ends where it begins: with Paul asking for his Ativan.