Diagnosing the Trauma of Incarceration

Years ago, while walking laps in the dining hall at Clinton Correctional Facility in upstate New York, a tough guy stopped me. We’d argued earlier. He wanted to invite me to a knife fight. “You want to get into something over words?” I asked. He nodded. “Well, I don’t.”

Since I didn’t want to fight, he demanded I pay him but I refused to be extorted. Later, he and a friend jumped me. To live in prison, you either have to fight, pay, or sign into protective custody. I chose to fight. Over the next few weeks, I fought him and his crew several times.

Experiences like these leave lasting psychological scars, contributing to what researchers call Post-Incarceration Syndrome, or PICS. Yet despite decades of evidence, PICS remains unrecognized as a psychiatric disorder. As a result, millions of formerly incarcerated people are released into society undiagnosed and untreated, with little access to therapy, medication, or protection.

PICS develops from exposure to the extreme violence and stress of incarceration. The term was coined in 2001 by addiction specialist Terence T. Gorski to describe the persistent psychological harms faced by formerly incarcerated people. Although the more specific terminology is relatively new, studies have highlighted the negative psychological effects of incarceration since at least the 1950s. Unsurprisingly, spending decades locked in a cage often leads to irritability, aggression, social–sensory disorientation, feelings of alienation, and serious mood and anxiety disorders. The Bureau of Justice Statistics’ latest Survey of Prison Inmates—last published, unfortunately, in 2016—found that 56 percent of state prisoners had some indication of mental illness.

Many long-term or life-sentenced prisoners are likely to experience symptoms consistent with PICS upon release. Since roughly 90 percent of prisoners are eventually released, it is critical to provide treatment for them before they return to society. Otherwise, individuals will continue to be released back into their communities undiagnosed, without the care they need for successful reentry.

The damage is cumulative, built day by day in an environment defined by threat and survival. Speaking with the men in my facility, the seeds of PICS are evident: all around me, men struggle with persistent mistrust, have difficulty forming or maintaining relationships, and display profound desensitization to violence. I once saw a man get stabbed to death in the yard at Clinton, and as his body jerked, someone shouted, “Man, hurry up and die already.”

If PICS were formally recognized as a psychiatric disorder, it could improve access to medications and therapy by making treatment eligible for insurance coverage. Formal recognition could also provide protections against discrimination in employment and, in some cases, housing under existing disability laws, including the Americans with Disabilities Act for individuals whose symptoms substantially limit major life activities. Over time, such recognition could even begin to reverse the social stigma of incarceration in the U.S. consciousness.

In nearly half a century in prison, I’ve bled and drawn blood. I’ve been beaten with batons, enduring blows until all I could do was curl into a ball. I’ve spit out teeth after COs kicked me in the face with steel-toed boots. I’ve seen men forced to crawl under their beds while bullies and gang members stole all their belongings. I’ve witnessed stabbings, slashings, rape, and murder.

As a result, I’m conditioned to live in a constant state of alertness. I watch the prisoner with his hand in his pocket, scan every room I enter for exits, find a position easy to defend, and place my back against the wall. Eerie silence in the yard tells me violence is about to erupt. These spider senses have kept me safe in prison, but I imagine they’ll frighten people in society.

My neighbor, thirty-three-year-old Adam “AD” Saalfield, an Army veteran who spent almost four years in Afghanistan and Africa, explained to me that war, tours, patrols, and combat are usually short-lived, despite the serious psychological effects they produce. The American Psychiatric Association (APA) and its Diagnostic and Statistical Manual of Mental Disorders V (DSM-5) recognize trauma war or torture as criteria for PTSD. However, they still do not recognize prison-related trauma as such, even though it can cause similar psychological harms, and often over much longer periods of time. (It is worth noting that many of these categories overlap: for example, according to the Council on Criminal Justice, recent veterans are twice as likely as non-veterans to face incarceration.)

A 2006 study by researchers, including Lisa Cosgrove at the University of Massachusetts Boston, found that 56 percent of DSM panel members had financial ties to pharmaceutical companies. The people shaping the manual are largely academics and clinicians, not people who have lived inside the systems they diagnose from a distance. In order for PICS to gain the recognition it deserves, we need voices on the panel with lived experience, like Dr. Trevor Adrian Griffiths, one of relatively few formerly incarcerated people with a doctorate in social work.

I met Dr. Griffiths when we were in Clinton together in 2004. We were in the same industry shop and neighbors for several years, and we talked every day until his release. After serving twenty-four years in prison, he has achieved the highest academic honors. His work, which advocates for recognition of PICS as a disease, has the potential to transform the health-care system.

Through his research, Dr. Griffiths realized that the psychological stressors faced by incarcerated people and war veterans are similar. But society sees war veterans as heroic and the formerly incarcerated as villainous. Once those labels are stripped away, the root causes of major anxiety disorders in both groups are the same: trauma.

After forty-three years of incarceration, all I feel is a disconnect from the human condition. My only concern now is relearning how to love myself (if I ever did), go home, and live my remaining years in peace.

I’m lucky to have Dr. Griffiths to call whenever I feel overwhelmed.But what about the millions of currently and formerly incarcerated Americans struggling with prison-related trauma without access to mental health professionals? We want the same thing as everyone else: to live safe, meaningful, and productive lives.

To continue releasing incarcerated individuals suffering from major anxiety disorders back into communities undiagnosed and untreated is cruel and irresponsible. It’s a disservice to us—and to you.

_{Image: Shubham Dhage / Unsplash}

Contributors

James A. Sheffield James A. Sheffield is a writer serving fifty-two years to life for second-degree murder at Sing Sing Correctional Facility in Ossining, New York.  A junior studying behavioral science at Mercy College, his writing also appears in the Appeal.

Topics

• Futures

Tags

• conditions of confinement
• health care
• incarcerated and formerly incarcerated authors
• mental health
• reentry