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I had a client who did 3 or 4 in solitary during his 24 year stretch for murder.
He said he told the prison doctor "Don't take me off my meds. If I'm off my meds, I become evil." He said they did it anyway due to budget cuts, and he really fucked up a couple guards when his psychotic symptoms came back full force from being taken off his meds cold turkey.
His sentence was originally 20 years, but they added 5 more for the attack on the guards. Most of that additional sentence was served in solitary confinement. He got let out on the 24th year for good behavior and that's when I got him on my caseload. One of our first treatment goals was "I want to have feelings again."
He did a great job turning his life around on the outside and went out of his way to help others. Still hustled a bit.. He has an alzheimer's diagnosis looming over his head, and wants to go out "Being a good person for once" in the maybe 5 year window before he loses himself to the disease.
The truth is, anyone could've ended up in his position with the circumstances that lead to the very heinous act he committed. I learned from that job that we all live in the grey, and black and white thinking is just a construct we lie to ourselves about. Anyone is capable of extreme actions when pushed beyond their threshold and/or influenced by a psychotic episode/drug-induced psychosis.