One of the big challenges in addressing TBI in prison populations, and beyond, is that it is not as easy to diagnose as a broken bone or a blood-borne illness. Symptoms are by no means unique to the injury and can be co-occurring with other mental health conditions. To make things even tougher for those hoping to track the disability, no two brain injuries are alike. "Two people can have the same injury and have a totally different set of impairments," Gordon says. "One can be fine, and one can be not so fine—but we don't know why that is yet." He suggests that differential responses could be due to a combination of physical, genetic, contextual and social factors, such as skull thickness, the magnitude of g-forces involved in the impact or past history of more minor, sub-concussive injuries.
Due in part to these variables, not all TBIs result in a medical paper trail. Doctors treating people with serious wounds might miss diagnosing a brain injury, and hospitals do not always code for every presenting condition. Also, many people who suffer a head injury, especially a milder one, such as a concussion, might not seek medical attention at all.
Researchers have started using detailed interviews with prisoners to get a better sense of how many have suffered from a brain injury. In a recent South Carolina survey of 636 prisoners, some 65 percent of males and 73 percent of females reported having sustained TBIs at some point in their lives. Injury counts are likely underestimated. Many people, for example, are unaware of injuries that they might have sustained when they were babies or young children. And even adulthood injuries were not entirely clear to prisoners. "They were told they had their bell rung—they got knocked out," says Rebecca Desrocher, assistant program director at the U.S. Department of Health and Human Services's Federal Traumatic Brain Injury Program.
The very nature of brain injuries can also make tracking them—and figuring out how many an individual might have suffered—especially difficult. As Pickelsimer points out, "after you've had some, you don't remember them as clearly." These injuries are additive, with each assault to the brain compounding damage from the previous ones. The average reported number of TBIs for an individual prisoner was about four, Pickelsimer says. And some reported up to a dozen.
Through these interviews, Pickelsimer says, another thing became clear: prisoners were often not aware that a single event—or a series of them—could be making it harder for them to earn a ticket out of jail, or avoid being sent back in the future.
Bad behavior
As much as TBI seems to increase the likelihood that a person will wind up in prison, it also seems to make the corrections environment that much more difficult to navigate. In prison, "there's so much that goes on a day-to-day basis: 'Line up over here; do this; do that,'" says David Maltman, a policy analyst at the Washington State Developmental Disabilities Council. When a prisoner with TBI is misremembering rules or is slow in responding to instruction, many prison staff are likely to see a prisoner as noncompliant or intentionally defiant, provoking situations that can lead to further injury—or at least poorer chances at an early release.
Brian injury also increases the likelihood that people will have other mental health troubles, including substance abuse, and can also make it more difficult to overcome additional conditions. In a survey of adults enrolled in a New York State substance abuse program, about half had a record of TBI, Gordon says. The screening that Pickelsimer and her colleagues have done in South Carolina found that for both men and women, alcohol and crack cocaine were among the most common substances to which TBI prisoners were addicted. And these habits can cloud a person's memory of brain injuries they might have suffered in accidents, altercations or other incidents, which makes accurate diagnosis even more challenging. For those getting substance abuse treatment, a TBI can also make traditional rehab programs less effective. With the "reduced processing speed and their memory challenges," Gordon says, lessons might need to be altered or even repeated for enrolled prisoners with a history of TBI.
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14 Comments
Add CommentCognitive retraining?? What a friggin joke. Tell that to a mother when repeat offender rapes her daughter. Tell that to the parents of children being introduced to crack by a repeat offender. Recognizatinga criminals's history of 'brain trauma' does not protect the children.
Reply | Report Abuse | Link to thisThis article claims that those with brain injury are more likely to exhibit anti-social and violent behavior than those without.
This is another reason to keep those incarcerated where they are to serve out their full sentence. Out 'on the street' they are a threat to even more potential victims.
If there is a reason to keep violent criminals in jail...KEEP THEM THERE!
I think prisoners have to find their own way to fire their damaged neurons on their brain matter.
Reply | Report Abuse | Link to thisMeditation and attending preachings(may be from interpreters of bible)can help to regroup thoughts.
Quote: "It's not as cut-and-dry as a lot of people think,"
Reply | Report Abuse | Link to thisAnswer: Actually it seems it is.
"The Prison Service has said it will not fund further research into prison food even though a recent study found that changing inmates' diets cut violent behaviour by 35%."
Dear Sirs, It is a sad observation that the comments submitted lack any compassion and miss the point entirely. The vast prison population is mostly non-violent "offenders". The criminal justice system is so skewed towards fundamental injustice, that "the confined population" should reveal a deep connection between incarcaration and brain injury. From personal experience, I can remember being beaten by policemen at ages 14,15,16,etc. They hit with batons usually when they can't deal with an alcoholic adolescent because they are more brutal than "the percieved threat". I also saw a prisoner on Rikers Island,(1959) get his head collapsed by guards for "resisting". Ten guards and a captain with clubs, blackjacks, etc. I witnessed this. Several months later I saw the adolescent immate in the hospital line still with huge bandages covering his entire head. Yes, head trauma, I know it well. John Billera,Key West Fl. age 70.
Reply | Report Abuse | Link to thisTo continue, the incidence of brain injury cannot be seperated from the histories of alcohol and drug abuse.Sadly, the profile coming from South American poverty populations include glue sniffing, but these "exotic" forms of drug use have a silent presence in our prison populations. Esp. PCP,MDMA,and really anything young people can ingest when neglected. This is your current adult prison population. The kids have grown up, and head injuries are just "The tip of the iceberg".
Reply | Report Abuse | Link to this"Cognitive retraining?? What a friggin joke. Tell that to a mother when repeat offender rapes her daughter. Tell that to the parents of children being introduced to crack by a repeat offender. Recognizatinga criminals's history of 'brain trauma' does not protect the children."
Reply | Report Abuse | Link to thisI think you are missing the point of the article. It does not claim that recognizing TBI makes children safer. It claims that treating it in prison may be effective at helping prisoners recognize and manage the times when their brains are not functioning well. THAT is what keeps children safe, after the prisoners are released. It does not say that prisoners should be released earlier just because they have TBI or have had cognitive treatment.
"This article claims that those with brain injury are more likely to exhibit anti-social and violent behavior than those without."
"This is another reason to keep those incarcerated where they are to serve out their full sentence. Out 'on the street' they are a threat to even more potential victims."
You can't keep someone in jail longer just because they have TBI, no matter how angry you are at them, and you can't deprive a prisoner of time off for good behavior just because they have TBI. They are released according to the rules regardless of whether they have had cognitive therapy or not. Therefore it is better for society, and safer for those children you are yanking our heartstrings with, to give the prisoners treatment that helps them fit back into society peacefully. Incarcerating a prisoner with TBI as punishment, with no attempt at rehabilitation, doesn't work so well, because their injuries prevent them from learning from punishment. The roots of their crimes, whether violent or non-violent, are in their brain injury, not in just choosing to perform the crimes.
"If there is a reason to keep violent criminals in jail...KEEP THEM THERE!"
I can see how angry you are about this, but again, you can't keep someone in jail beyond their sentence just because you have a reason to keep them there. The law requires their release. This article does not have anything to do with that. It has to do with helping criminals avoid bad behavior both in prison and after their release, something I expect you probably agree with.
The point I take from the article as a mental health professional is that childhood and early adult screening for TBI are critical to help reduce criminal activity, mental illness, and substance abuse. Teachers, social workers, and medical professionals should all be on the look out for TBI whenever they encounter a student/patient that is having behavioral difficulty.
Reply | Report Abuse | Link to this100 years from now, society may look back in sadness at how we didn't know any better than to imprison our mentally ill and brain injured citizens.
Neuroferritinopathy would be a 'human model of TBI' , an increase of iron in the brain.
Reply | Report Abuse | Link to this"This mutation results in abnormal iron accumulation in the brain"
When one has a brain injury , bruise in the brain , or an active bleed , blood spills.
The iron in the blood spills and ferritin is produced to 'mop up' / store the iron / iron accumulation.
"Depression, anxiety, obsessive-compulsive disorder (OCD), personality disorders, addiction, and panic attacks"
Those are the symptoms of Myoclonus-dystonia , linked to neuroferritinopathy.
"Neuroferritinopathy is regarded as an adult onset movement disorder, however patients actually begin to deposit iron within their basal ganglia from early childhood. This disorder should be regarded as a cause of iron deposition in infants"
http://jnnp.bmj.com/content/83/3/e1.181.short?rss=1
"Patient's bipolar symptoms completely subsided after phlebotomic reduction of iron overload.".
Reply | Report Abuse | Link to thisWhat a shock - treating people violently can cause them to be violent! Due to socialized learning, and due to TBI. I am skeptical that talk therapy can be an effective treatment in the long run, though I would be interested in seeing the results of further studies. I imagine that behavioral therapy, oft repeated, might help establish new neural pathways to take over for the pathways damaged by TBI.
Reply | Report Abuse | Link to this"I am skeptical that talk therapy can be an effective treatment in the long run"
Reply | Report Abuse | Link to thisIn my experience the best predictor of change and growth of "new neural pathways" is simply the determination and commitment of the patient. Witness Representative Gifords amazing progress after being shot in the head. If a patient can relearn to walk and talk, then they should be able to relearn impulse control. However, treatment is a long tedious grueling slog.
Talk therapy is only a start. A blend of Mindfulness based therapies are most effective in my opinion (aka metacognitive awareness training). Also, good old behavioral therapy is probably effective, but I can't site any studies off hand.
I'm a big believer that change is possible. It requires dedication and commitment and the old adage "expectation predicts outcome" applies.
The key is "making sure that when people step out into the community they're not falling into an abyss," he says. And "in doing that, we're also helping society at large stay safer."
Reply | Report Abuse | Link to thisAs a speech-language pathologist who works in the area of cognitive rehabilitation--and as the sister of a prisoner (whom I love dearly)--and as a woman who experienced childhood sexual abuse... therefore, as a human being with some understanding of these issues, I must say that we are NOT protecting our children by ignoring the great need of these individuals. Anger is an understandable response, but we should be careful how it is directed. Only when we advocate for change and see the fruition of this care for all people will we, as a society, be safe and whole.
When I worked in a prison, I was amazed at the number of prisoners with untreated seizures. It was not just one or two but a large number of them. They were not on seizure medicine. I asked one of them why he was not on seizure medicine. He told me "It doesn't work." (I went to a foreign country to build homes for poor people. All their seizure medicine is slow release. They will not allow any mission team from the US to bring seizure medicine. If Banana Republics can force generic medicine manufacturers to make slow release forms of seizure medicines, why can't the US import those?)
Reply | Report Abuse | Link to thisAnother surprise was the large number of inmates who blamed their crime on antipsychotic medicine. The most common medicine leading to crime however was crack.
My training in a state hospital let me recognize a number of mental illnesses.
A number of sociopaths had high IQs. They would attempt a scam from inside prison. The scams would be brilliant. However, they usually fall in a pattern. Unless Inmate Brilliant has a degree in criminology, he comes up with an idea that has been used previously. The officials recognize the pattern and are ready for him.
An aside: Other causes for prison exist besides mental illness. Some of the men had never been taught basic socialization skills. In part of Africa they killed off all the old male elephants. All the young males went wild. They killed a number of other animals. They had no idea how to act. The government introduced some old males and their behavior changed.
The same thing happens with humans. Some of the prisoners said to me, "Grown men behave different from the way we thought. You are the first grown man we have ever known. When we get out, we are going to act like you do and not come back to this place."
No one is excusing the behavior of criminals; understanding how TBI affects the brain will make the prisons safer for both inmates and guards. One glaring problem in the prison system is substance abuse, which TBI victims often use to cope with anguish associated with physical and mental trauma. The main goal of the prison system besides punishment is rehabilitation into society, and cutting down on recidivism. Addressing how TBI and substance abuse affects individuals in the prison system is an important step to reaching these goals.
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