Thick metal bars. They sit on the inside and outside of the windows in Shawanna Vaughn’s apartment in the Lincoln Houses public housing unit in Harlem, New York. They are supposed to provide protection, but protection from what? “These bring me right back to those years,” Ms. Vaughn says, wrapping her fingers around the cool metal of the bars. “Everyday I’m reminded of my five years in a cage. Everyday I feel anxiety from the memories rising in my chest. I can hear the screams, feel the pain of the sleepless nights. I have to constantly remind myself that I’m not there anymore, I’m out.” Free, but somehow still confined.
There are currently 2.3 million people behind bars in the United States. While incarcerated individuals remain highly stigmatized and disenfranchised, protest calls for prison abolition and the explosion of COVID-19 cases in prisons and jails, have helped to bring the collateral consequences of incarceration to the mainstream. But even with increased public and government attention questioning the inhumanity of U.S. carceral systems, the psychological damages caused by prolonged incarceration, faced by both currently incarcerated individuals and the 19.8 million formerly incarcerated people, remains unaddressed in policy. This leaves millions of Americans struggling with re-entry, forced to navigate their trauma in silence -- creating a cycle of depression, drug use, re-incarceration, and death.
Ms. Vaughn refers to these carceral induced psychological damages as Post Traumatic Prison Disorder (PTPD). Also known as Post Incarceration Syndrome, PTPD is a subset of Post Traumatic Stress Disorder (PTSD), an anxiety disorder characterized by persistent reexperiencing of trauma, avoidance, hyper arousal and emotional numbing. Through a bill entitled PTPD Shawanna W76337, she is working to bring attention to this condition, speaking not only to the ills of prison, but also the mental-emotional destabilization individuals face before and after incarceration.
“Prison is the place where trauma culminates and time stops; it is the new plantation, present day enslavement,” Ms. Vaughn says. “Many of us were ignored before, but once you go to prison, you are forgotten. I will never be the same, I will never forget, but I will not be forgotten.”
Pre-carceral Trauma and Incarceration
At 17 years old, Ms. Vaughn was sentenced to five years for robbery. But this was not her first time in confinement; Ms. Vaughn was born into confinement. On April 5, 1978, Ms. Vaughn's mother, who was at the time incarcerated at the Corona State Prison for Women in California, was forced to give birth to her daughter while handcuffed to a gurney. To this day, most correctional facilities do not have onsite obstetric care. Additionally, the majority of individuals who give birth while incarcerated are almost immediately separated from their child post delivery. Shackling and Separation: Motherhood in Prison, a report published in the American Medical Association (AMA) Journal of Ethics, explains that such separation can have a devastating effect on the wellbeing of both the mother and infant.
Ms. Vaughn entered her second experience with incarceration already traumatized. “Prisons and jails have become America’s ‘new asylums’: The number of individuals with serious mental illness in prisons and jails now exceeds the number in state psychiatric hospitals tenfold,” states a report by the National Institute of Corrections.
In referring to the unique experience of incarcerated individuals, Post Traumatic Prison Disorder (PTPD) must be defined and treated as a separate entity from PTSD or other mental health disorders. As Dr. Coralanne Griffith-Hunte, a Human, Industrial & Trauma Psychologist, explained:
“We (society) incarcerate a behavior or an act, but being a psychologist I know that behavior is a language, behavior is not the reason that someone commits a crime. So we have to look at what causes it, so we have to look at the ACEs or adverse childhood/community experiences. 67 percent of individuals in our communities experience some form of ACEs and it relates to trauma; whether it’s substance abuse, homelessness, incarceration, emotional and sexual abuse, race discrimination or poverty, we have to look at that.”
Nationally, 45 percent of children have experienced some form of the ACEs; That number jumps to 61 percent among Black children. This results in Black people, who make up 38.3 percent of the incarcerated population (but only 13 percent of the U.S. population), entering the carceral system already suffering from some form of PTSD or similar trauma. Such psychological degradation is only exacerbated during confinement, the devastating conditions, violence, leading to behaviors of internalized subordination, trouble with decision making, sensory disorientation, and social alienation during and post incarceration.
According to a report by the Vera Institute of Justice, approximately 14.5 percent of men and 31 percent of women in jails have a serious mental illness, such as schizophrenia, major depression, or bipolar disorder, compared to 3.2 percent and 4.9 percent, in the general population. 72 percent of incarcerated people with a serious mental illness also have a substance use disorder.
But instead of dealing with such trauma, the carceral system has relied on pharmaceutical “solutions” and stigmatization. When Ms. Vaughn entered state prison, she was given an orange jumpsuit, shown her cell and then told to go to the medicine line.
“I was so confused,” Vaughn recalls. “At that time, I had never taken pills in my life...Yet somehow I was told I would need a pill to go to sleep and a separate one to function throughout the day. I wasn’t given a choice.”
Many individuals are first exposed to and forced onto medication during incarceration and then left to navigate substance abuse following release. This trend dates back to the 1980s, where state and federal cuts to social safety-net programs coincided with massive increases in War on Drugs spending. Such shifts in government priorities resulted in a large mentally ill, houseless populace vulnerable to incarceration and unprecedented numbers of people serving long drug offense sentences, as in the case of Ms. Vaughn’s mother. As prisons began doubling as unintended psychiatric institutions, pharmaceutical companies pinpointed a new consumer base.
A 2019 article in The Atlantic found that big pharmaceutical companies, such as Merck, Gilead, AbbVie, pay physicians to promote their products during criminal justice conferences (even to sheriffs without health certification), give free samples to detention facilities, hold luncheons, etc., touting their products effectiveness in treating carceral mental instability. Such psychiatric drugs are said to “help inmates” making them easier to handle. And because of the Supreme Court rule in Washington V. Harper, that “the Due Process Clause does not require a judicial hearing before the State may treat a mentally ill prisoner with antipsychotic drugs against his will,” there are no protections for incarcerated people against unwanted medicine.
Forcing test medication on disempowered individuals, often without proper diagnosis, further diminishes an individual's agency and control over their own bodies. Nearly 68 percent of people in jail have a diagnosable substance use disorder (compared to 9 percent of the general population), a trend exacerbated by repeated trauma and over prescribing.
“No one is talking about the biggest drug dealer in the world, the whiteness of the dealer, and the harm it causes to the Black community,” Vaughn discussed, alluding to the presence of pharmaceuticals in prison.
Even more so, a 2018 study found that women leaving prison have high rates of mortality from overdose of opioids, antidepressants, and other substances such as cocaine. While the study was unable to determine whether the medications were prescribed or diverted, several studies have linked the exposure to traumatic experiences, occurring in childhood and during incarceration, to substance use disorders (SUDs), including abuse and dependence. SUDs also coincide with Posttraumatic Stress Disorder (PTSD) and other mood-related psychopathology. The presence of pharma in prisons and the lack of prisoner’s rights, combined with a population navigating pre- and during incarceration trauma, are catalysts for individual susceptibility to forced medication and post-release dependence.
Navigating Trauma and Re-Entry
Following her incarceration, Ms.Vaughn felt lost, unsure of where to go, especially as she realized the world had moved forward without her.
Mass incarceration created rapid increases in prison populations that resulted in the abandonment of notions of rehabilitation previously touted as the argument for incarceration. Larger carceral populations along with shortages in staffing and other resources, undermined opportunities for protective norms against cruelty toward prisoners, creating an environment of heightened danger and fear. Many returning citizens experience mental deterioration and apathy, endure personality changes, and become uncertain about their identities. Panic attacks, depression, and paranoia are common following release, with individuals often finding social (re)adjustment and social integration difficult.
As Mika’il DeVeaux explains in The Trauma of the Incarceration Experience, incarceration breeds tangible and easily identifiable forms of punishment, coupled with emotional and psychological punishment; causing individuals to navigate loss of liberty, material impoverishment, personal inadequacy, and loss of autonomy and personal security. This breeds a new form of trauma; added to what was experienced before incarceration, returning citizens now face the trauma of incarceration, and the trauma of inadequate support post release, making it challenging to hold jobs, secure housing, utilize public transportation and navigate the demands of parole.
Ms. Vaughn watched as many other returning citizens ended up back in prison or succumbed to addiction. Navigating her own struggles coupled with what she witnessed from other previously incarcerated people, led Ms. Vaughn to create Silent Cry Inc., an organization which aims to provide resources to those dealing with trauma and loss due to gang violence and police brutality, in addition to aiding women recently released from jail with counseling services. Her goal is to deal with trauma before incarceration, hindering the pipeline of traumatized children and young adults, like herself, into prison.
But Ms. Vaughn kept returning to the notion of Post Traumatic Prison Disorder. “I am constantly battling depression, I am still suffering. I struggle with going to the doctor and taking medication. In a crowd of people I'm nervous and my anxiety becomes all consuming. When I am nervous or worried, I walk the length of a prison cell.”
Ms. Vaughn is part of the 16 percent (4.8 million) of Black people who report having a mental illness; more people than the population of Chicago, Philadelphia and Houston combined. 22.4 percent of this population (1.1 million people) reported having a serious mental illness over the past year. For all Americans ages 18 and older, 26 percent (approx. 1 in 4 adults) suffer from a diagnosable mental disorder each year.
Even with such high rates of mental instability among Black Americans, treatment is rare. In 2018, 58.2 percent of Blacks aged 18-25 and 50.1 percent aged 26-49 with serious mental illness did not receive treatment. Such disparity is in part due to the in-accessibility of mental health service; Ms. Vaughn receives Medicare, unlike the 11.5 percent of Black Americans (and 7.5 percent of white Americans) who are uninsured, but her insurance does not cover therapy.
Stigma and judgment also prevents Black people from seeking treatment. A study by Ward, Wiltshire, Detry, and Brown found that Black Americans hold negative beliefs related to stigma, psychological openness, and help-seeking, which decreases their likelihood of acknowledging psychological struggles (although participants showed an openness to seeking mental health care). An additional study found that Blacks believe that mild depression or anxiety would be considered “crazy” in their social circles and mental health is not an inappropriate discussion topic among family. But with 37 percent of the prison population and 44 percent of the jail population maintaining diagnosed mental health issues, it should come as no surprise that mental health instability is often conflated with criminalization. Society frames incarceration as the fault of the individual. In the U.S, being mentally unstable and Black, is a crime.
Solving Black Mental Health Instability During and After Incarceration
In order to mitigate such mental health disparities, both during incarceration and following release, Ms. Vaughn created PTPD Shawanna W76337. The bill requires the Department of Corrections to create individualized “transitional accountability plans,” that hone in on the mental health needs and rehabilitation of every incarcerated person. These plans include mental health re-entry services, with screening, assessment and the clinical intervention of Post Traumatic Prison Disorder (PTPD). Individuals diagnosed with PTPD will receive specialized health plans, therapeutic services, family counseling, job placement, housing information, and money management assistance.
The legislation speaks to the overlapping and neglected needs of America’s Black population and those navigating the carceral system. As a Black, previously incarcerated woman, Ms. Vaughn is attempting to not only call attention to the needs of previously incarcerated people, in a society where 71 percent of elected officials are men, 90 percent are white, and 65 percent are white men and less than 2 percent of American Psychological Association members are Black, but have legislation created by and for incarcerated people. Ms. Vaughn is currently pushing the bill before members of congress nationally.
Currently, the U.S. Department of Justice reports that more than two thirds (68 percent) of persons released from prison will be rearrested within the first three years of release, and 83 percent will be returned to the criminal justice system within nine years of release. This rate is especially high for those struggling with untreated mental health conditions. Considering that taxpayers already spend approximately $270 billion annually on the criminal justice system, according to the Council of Economic Advisers to the President, the economic toll of recidivism is extremely high. Accounting for total societal costs of incarceration—lost earnings, adverse health effects, and the damage to the families and communities of the incarcerated—the Washington University in St. Louis estimates indirect costs of incarceration, up to three times higher than the direct costs, bringing the total burden of our criminal justice system to $1.2 trillion.
And effectiveness of services similar to what Ms. Vaughn proposes have been documented. Studies show that routine outpatient treatment and consistent access to care, reduce the likelihood of arrest among persons with mental illness. Some states have even begun utilizing Mental Health Courts, which maintain therapeutic goals and attempt to break patterns of incarceration. While little research has been done to thoroughly evaluate their impact and effectiveness, early studies show a positive impact of such intervention methods in reducing incarceration.
Overall, it has been documented globally that mental health interventions are paramount to reducing the involvement of individuals with mental health disorders in the criminal legal system, but also in ensuring individuals’ true rehabilitation. Ms. Vaughn’s bill provides a reconciliation of racialized policies and practices that have led to Black populations’ experiencing cycles of trauma. It provides a way for the U.S. to divest from carceral punishment and invest in community wellbeing (such as education, food programs, employment). It gives governmental officials and society the opportunity to actively reduce harm on incredibly marginalized and vulnerable populations, allowing them services that have historically been denied, and establishing a culture of care and justice over violence and punishment. It provides a path forward that allows so many formerly incarcerated people a chance to live dignified, autonomous lives.
As Ms. Vaughn asserted in a discussion about the bill at a recent community event: “We need holistic, comprehensive mental health services now, to reduce recidivism, to allow me to function as a mother, as a community member; to allow me to be present. I don't want to just be here, I want to be present.”