The behavioral and other cognitive changes that TBI can bring, "if left unaddressed, are apt to provide challenges to the offender post-release as they attempt to reintegrate into their respective communities," notes Adam Piccolino, a neuropsychologist for the Minnesota Department of Corrections.
Bridge to the outside
Treating TBI in the broad adult population is not a perfect science. The goal is to "supply them with skills they need to better regulate their behavior and process information," Gordon explains. It often involves cognitive retraining and rehabilitation—and has imperfect results. And as he points out, these therapies have yet to be thoroughly tested on incarcerated populations.
Others argue that tools that seem to work in the broader population should be used in prisons as well. Cognitive rehabilitation therapy is one such tool that seems to be gaining traction in the TBI field. It aims to help those TBI sufferers make better-informed choices and to improve memory. And with such minimal knowledge about TBI and its symptoms, simply educating inmates about their—and others'—condition might go a long way in helping them cope with related challenges, Desrocher says.
Even with proper education and therapy, though, people with TBI will often experience behavioral issues. So many groups have put an emphasis on training staff—and even arresting officers—to handle these sorts of prisoners better in hopes that they "can recognize a behavior for what it is—and not defiance of an infraction of the rules," Maltman says. Resulting altercations can put law and corrections staff—and fellow prisoners—at risk for injury.
But knowing which prisoners might benefit from alternative approaches requires thorough screening processes that are either highly variable across institutions or entirely absent. "Additionally," Piccolino notes, "once an offender is identified with having incurred a TBI, the process of knowing whether they also experience ongoing complications related to their TBI is challenging."
Some organizations, such as the Brain Injury Association of Minnesota, have gone a step further and are also working with prisoners' family members, probation officers and outside support services to ready ex-convicts for release. Klinkhammer notes that for prisoners with TBI, returning to the outside world can be an extremely difficult transition. Once predictable prison routines disappear, he explains, it's almost like Dorothy going from her black-and-white reality in Kansas to the colorized world in Oz. Although that shift might sound like a blessing, for those with a brain injury who have difficulty managing their reactions or processing a lot of incoming information quickly, the new environment can be too much. "It can be very overwhelming, and it could result in one or more reason for a person to 'recidivize'"— do something that will land them back in jail, even if they had no intention of breaking the law— Klinkhammer says.
Much of his group's efforts come down to education and helping family and other community members learn how to support a prisoner with TBI returning to the outside world. And oftentimes just explaining to them that an old injury might be contributing to unpredictable behavior is a big help. "People know that their loved one's been knocked out" or were in a car accident years before, Klinkhammer says. "But the thought that the outcome of that may result in disinhibition or that it could be an aggravating factor to a person's criminal behavior gets lost."
The group does not yet have formal data on the success of the program, but from his observations, Klinkhammer says, "individuals are doing better when they are able to dovetail back into society in a way that they're supported." 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."
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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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