Vulnerable Women and Victimization: Tackle the Trauma and Curb the Offending

Healthful Vitality | 06/16/2021 | By Ramya Challappa | Vulnerable Women and Victimization

BACKGROUND: The current corrections model does nothing effective to curb reoffending by women. If offending and reoffending by the female population is increasing at such a significant rate, one must ask why? It appears that the ever-increasing rate of female incarceration is attributable to one underlying factor – trauma. Gaining knowledge on female incarceration issues is fundamental to all stakeholders to fix the problem. Understanding trauma and its impact on female offenders provides insight into the problem of and the solution to female criminal behavior. A corrections model that helps women cope with pre-incarceration and incarceration-specific trauma will likely lead to a decline in female offending and recidivism. This article is about the right to healthcare in respect of vulnerable women and victimization.

Vulnerable Women and Victimization: The Cycle of Trauma and Offending for Female Inmates

The Right to Healthcare for U.S. Prisoners:

Before one can discuss the need for a gender-responsive, trauma-focused corrections model, it must be established that female prisoners have the right to trauma treatment. In Estelle v. Gamble, the U.S. Supreme Court held that the Eighth Amendment requires the federal government and state government(s) to provide adequate physical and mental healthcare to prisoners [1] Medical care is considered adequate if it is “real” – i.e., if medical personnel could objectively and impartially perceive the treatment as healthcare as it is understood by the medical community [2] Examples of inadequate healthcare include: 1) inadequate mental health screening during intake; 2) failure to follow up with prisoners with known or suspected mental health disorders; 3) failure to provide adequate numbers of qualified mental health staff; 4) the improper use of restraints or shackles; and 5) the excessive use of force against mentally ill prisoners [3].

Women in prison have the constitutional right to adequate healthcare, but rarely are afforded that right. Physical and sexual abuse in prison by staff and other inmates, the shackling of pregnant inmates, and the lack of effective counseling for trauma are only some of the potentially unlawful healthcare practices that frequently occur in U.S. prisons [4]. Because of the social stigma surrounding inmates, little has been done by the medical, legal, or judicial communities to provide increased healthcare protections to inmates [5]. Legislation meant to protect female inmates rarely pass because of pushback from conservatives who believe that an inmate should not be given healthcare “luxuries” in prison that the everyday “blue collar” taxpayer cannot afford.[6]

The Intersection between Trauma and Incarceration for Women

Women are the fastest growing criminal justice population in the United States (“U.S.”). [7] Between 1980 and 2014, the number of incarcerated women increased by over 700%, rising from approximately 26,000 in 1980 to approximately 215,000 in 2014.[8] Since 1980, the incarceration of women has outpaced the incarceration of men by over 50 percent [9] This is the result of more expansive law enforcement efforts in low-income neighborhoods, stiffer drug sentencing laws, increased rates of sexual and physical assault in correctional facilities, decreased funding for prison healthcare, and post-conviction barriers to reentry that uniquely affect women. [10]

Today, over 220,000 women are incarcerated in U.S. prisons. [11] Incarceration hasn’t deterred or rehabilitating women enough to lower recidivism rates. According to the Bureau of Justice Statistics (“BJS”), about one-quarter of women released from prison reoffend within six months of release, one-third reoffend within a year of release, and two-thirds will reoffend within five years of release. [12] While the rates of incarceration and recidivism for women have increased dramatically, the criminal justice system has done nothing to modify the system to account for women’s gender-specific needs.

What is Trauma and Why Does it Matter for Rehabilitation of Women in Prisons?

The criminal justice community often forgets that trauma is primarily a mental health concern. Trauma is defined as “interpersonal or domestic physical, sexual or emotional abuse or neglect which is sufficiently detrimental to cause prolonged physical, psychological or social distress to an individual.[13]” A traumatic experience can be a single event, events, and/or a chronic condition.[14] Complex trauma, the type most prevalent in female offenders and inmates, is characterized by severe victimization that leads to a feeling of powerlessness.[15] Complex trauma results from a consistent history of physical and sexual abuse occurring in early childhood, before the age of ten, when a child’s identity is developing.[16] Complex trauma has lasting effects on brain development, such that it alters brain chemistry and damages the brain.[17]

Vulnerable women and victimization: Incarcerated women and re-traumatization

Incarcerated women are at an increased risk for re-traumatization. Re-traumatization occurs when an individual experiences an event or sensation that makes her feel as though she is the victim of a new traumatic event or is reexperiencing a prior traumatic event.

Re-traumatization can be caused by: 1) failing to screen for pre-incarceration trauma history or prior mental health treatment by prison psychiatrists; 2) discounting reports of abuse or other traumatic events; 3) using isolation or physical restraints; 4) using experiential exercises that humiliate the individual; 5) endorsing a confrontational approach in therapy; 6) labeling behavior/feelings as pathological; 7) minimizing, discrediting, or ignoring client or patient responses; 8) disrupting counselor–client relationships by changing counselors’ schedules and assignments; 9) obtaining urine specimens and having individual undress in a non-private setting; and 10) imposing agency policies without exception or an opportunity for trauma victims to question them – all pervasive problems for incarcerated women housed in prison(s).[18]

A) Impact of trauma on the brain of females likely to offend

Traumatic experiences adversely affect the human brain and can have lasting effects on cognitive development.[19] Studies have shown that traumatic stress affects the functioning of three key brain regions – the prefrontal cortex (the decision-making center), the amygdala (the emotional processing center), and the hippocampus (the memory and spatial navigation center).[20] Traumatic stress can permanently alter these parts of the brain.[21] Traumatic stress plays a significant role in perpetuating and exacerbating mental illness and often precedes the development of mental disorders such as post-traumatic stress disorder (“PTSD”).[22] There is a bidirectional relationship between trauma and mental illness: mental illness increases the risk of experiencing trauma, and trauma increases the risk of developing mental disorders.[23]

Prefrontal cortex

The prefrontal cortex is the part of the brain that allows humans to focus attention where they consciously choose, not where fear or desire instinctively demands.[24] Once fully developed at 25, the prefrontal cortex allows humans to think rationally and consider options, not just react from reflex and habit.[25] Victims of severe trauma, usually those diagnosed with PTSD, show a marked decrease in the volume and functional ability of the “ventromedial prefrontal cortex” – a region of the prefrontal cortex responsible for regulating emotional responses triggered by the amygdala.[26] This explains why victims of severe trauma make reactive, emotionally-driven decisions long after the traumatic event has occurred.[27] Victims of severe trauma also exhibit hyperactivity of the amygdala in response to stimuli in anyway connected to the traumatic event.[28] This hyperactivity leads to emotionally-driven responses to adverse, threatening stimuli.[29]

Neural mechanisms trigger extreme stress responses

Victims also show considerable reduction in the volume and size of the hippocampus.[30] They cannot retrieve memories, discriminate between past and present events, or interpret environmental context(s) correctly.[31] Their “neural mechanisms” trigger extreme stress responses when confronted with situations that only remotely resemble a traumatic event from their past.[32] This leads victims of trauma to become paranoid and fearful of situations that resemble the traumatic event.[33] Severe trauma disrupts the neurobiology of the brain, resulting in chemical imbalances including abnormally high levels of cortisol (the stress hormone) and norepinephrine.[34]

Vulnerable women and victimization: Impact of trauma resulting from sexual and physical abuse of women

Trauma, especially resulting from sexual and physical abuse, impacts women’s brains in distinct ways. Approximately one in two women in prison suffer from PTSD. [35] Individuals with PTSD show diminished levels of hippocampal and prefrontal cortical activity (i.e., impaired long-term memory and cognitive reasoning functions).[36] Female inmates who have committed violent offenses show abnormal cortisol production that is a long-term consequence of severe trauma associated with PTSD.[37]

To cope with victimization, a woman’s brain alters relevant neural networks (networks that govern the processing and understanding of life experiences), leaving them underdeveloped.[38] For example, a woman who is raped is likely to have underdeveloped neural connections in areas of the brain damaged because of the rape such as those that regulate feelings of safety, responses to adverse stimuli, feelings of self-awareness, and appropriate responses to anger.[39] These “under-developed” brain connections increase the likelihood that a victim of trauma will engage in criminal activity in response to victimization.[40]

B) Long-Term & Short-Term Reactions to Trauma

Victims of abuse experience both long and short-term reactions to trauma. The immediate response to trauma is an unconscious “fight, flight, or freeze.”[41] Initial reactions to trauma include confusion, sadness, anxiety, numbness, dissociation, withdrawal, apathy, short-term abuse of drugs and alcohol, greater startle responses to shocking stimuli, a lack of control over emotions, and insomnia.[42] These responses are affected by an individual’s background, coping skills, age, prior victimization, and mental health.[43] These responses are normal because they affect most survivors and are, in the short-term, psychologically cathartic.[44]

The overwhelming majority of trauma victims exhibit initial reactions to victimization that resolve without severe long-term consequences.[45] This is because most trauma survivors are highly resilient, able to develop socially appropriate coping strategies, have strong support networks, can take off work or school to heal, and have access to some form of psychiatric or psychologic care.[46] This is one explanation why the majority of women who experience trauma do not offend.

The women most likely to offend are the minority of women who – because of past trauma, the lack of support networks, and the lack of consistent mental health services – develop severe social, behavior, and cognitive impairments.[47]

Vulnerable women and victimization: Indicators of more severe responses to trauma

Indicators of more severe responses to trauma include continuous distress without periods of relative calm, acute dissociation, abrupt and inconsistent outbursts of violence or rage, and feelings of mistrust and danger inconsistent with a situation or environment.[48]

Delayed reactions common in those who experience the long-term effects of trauma include chronic fatigue, sleep disorders, emotional detachment, magical thinking (the belief that certain behaviors, including adverse behaviors, are appropriate to protect against future trauma), nightmares, fear of trauma recurrence, anxiety, flashbacks, depression, the avoidance of emotions or activities associated with the traumatic event, relationship disturbances, isolation, self-blame, a belief that memories and feelings are dangerous, involvement in high-risk activities, and increased use of alcohol and drugs.[49]

A Thought Experiment: Using “the Medical Practice” to Promote Rehabilitation and Reduce Recidivism

Profound studies on vulnerable women and victimization are necessary because of the growing number of women victims in this field. If we are going to continue to incarcerate and thus traumatized women, such incarceration should be done in the most humane way possible. If offending, incarceration, and recidivism of female inmates are to be curbed and the conservative call for incarceration remains, then the underlying trauma that leads to offending must be managed. To manage trauma for female offenders and reduce criminal behavior, a corrections model that accounts for the unique experiences of vulnerable women must be created.

Gender-responsive and trauma-focused model

It appears that a gender-responsive and trauma-focused model would create a corrections system that appropriately accounts for female offenders’ needs without being overly expensive or idealistic.

A gender-responsive system focuses on preparing a woman for life after prison by helping her overcome trauma from sexual assault, addiction, domestic violence, and separation from family.[50] Gender-responsiveness aims to meet women’s unique needs through individual counseling, staff training, and the implementation of group therapy and social development programs.[51] This type of system acknowledges differences between male and female inmates, the differing societal barriers female inmates face in the civilian world, and how those differences relate to rehabilitation.[52]

Gender-responsive systems focus on the intersection of substance abuse, physical and sexual exploitation, prior and ongoing trauma, mental illness and/or disability, tumultuous social relationships, and poverty in vulnerable women’s lives.[53] Only by confronting and understanding these conditions can a woman overcome or learn to cope with the resulting trauma.[54]

Gender-responsive treatment system and inequality

A gender-responsive treatment system also acknowledges the social and political structures that support inequality, which leads to low self-esteem, lower pay, and higher rates of violence against women.[55] This model also focuses on creating an environment that combats prior abuse and promotes healthy socially appropriate relationships for women since negative relationships and the lack of counseling to cope with them results in offending behavior.[56] Most women in prison have never received counseling for either prior sexual abuse and domestic violence or healthy relationship building with parents, significant others, and children.[57]

A prison psychologist/psychiatrist studied in women’s trauma should endeavor to address all or most of these issues if a gender-responsive system can be effective.[58] Prison presents a unique opportunity for psychologists and/or psychiatrists to reach this vulnerable group through a trauma-focused gender-responsive corrections model.

Indeed, rehabilitation has several benefits, including reducing diseases (acute or chronic), illnesses, or injuries. The rehabilitation would support starting a healthy lifestyle to educate on all things related to maintaining good health.

Also Read: Ending Learning Poverty: All Stakeholders Are Invited

References

1. 429 U.S. 97, 103 (1976).

2. See ACLU National Prison Project, Know Your Rights: Medical, Dental, and Mental Health Care (last updated, 2005), available at https://www.aclu.org/sites/default/files/images/asset_upload _file690_25743 .pdf (discusses how adequate medical care requires the action of prison medical staff to be supported by legitimate medical judgment).

3. See id. (Lists the aforementioned as examples of actionable harm for inadequate mental healthcare under the Eighth Amendment).

4. See generally The Sentencing Project, Women in the Criminal Justice System: Briefing Sheets (2007), available at https://www.sentencingproject.org/publications/women-in-the-criminal-justice-system-briefing-sheets/ (explaining the abuses female prisoners face while incarcerated) [ [hereinafter Women in the Justice System]. 

5. Kelly Moore et. al., J. Jail Inmates’ Perceived and Anticipated Stigma: Implications for Post-Release Functioning. Self and Identity, The Journal of the International Society for Self and Identity (2013), available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103667/.

6. Id.

7. The Sentencing Project, Fact Sheet: The Incarceration of Women & Girls, 1 (2015), [hereinafter The Sentencing Project] https://www.sentencingproject.org/publications/incarcerated-women-and-girls/

Related Article: Tips for an Effective Leadership in Healthcare

8. E. Ann Carson., Prisoners in 2014, Bureau of Justice Statistics, NCJ 248955 (2015), available at https://www.bjs.gov/content/pub/pdf /p14.pdf [hereinafter Prisoners in 2014].

9. National Resource Center on Justice Involved Women, Fact Sheet on Justice Involved Women in 2016 (2016), available at http://cjinvolvedwomen.org/wp-content /uploads/2016/06/Fact-Sheet.pdf [hereinafter National Resource Center on Justice Involved Women].

10. The Sentencing Project, supra note 7.

11. Id.

12. Id.

13. Substance Abuse and Mental Health Services Administration, Trauma Informed Care: A Sociocultural Perspective, in Trauma-Informed Care in Behavioral Health Services 1, 7 (2012), available at https://www.ncbi.nlm.nih.gov/books/NBK207195/#part1_ch1.s5 [hereinafter Trauma Fact Book].

14. Id at 20.

15. Id at 106.

Also Read: Is Intermittent Fasting Safe for Women?

16. Id at 96.

17. J. Douglas Bremner, Traumatic Stress: Effects on the Brain, 8 Dialogues in Clinical Neuroscience 445, 447 (2006), available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181836 [hereinafter Traumatic Stress: Effects on the Brain].

18. Trauma Fact Book, supra note 39 at 114.

19. Id at 80

20. Bruce S. McEwen et al., Central Role of the Brain in Stress and Adaptation: Links to Socioeconomic Status, Health, and Disease, 1186 Annals of the New York Academy of Sciences 190, 190 (2010), available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2864527.

21. Id.

22. Trauma Fact Book, supra note 39 at 59.

23. Id. at 67.

24. See Amy Arnsten et al., The Effects of Stress Exposure on Prefrontal Cortex: Translating Basic Research into Successful Treatments for Post-Traumatic Stress Disorder, Neurobiology of Stress 89, 89 (2015), available at http://www.sciencedirect.com/science/article/pii/ S2352289 514000101 (defines the prefrontal cortex as the part of the brain that provides top-down regulation of behavior, thought and emotion, generating the mental representations needed for flexible, goal-directed behavior, including the ability to inhibit inappropriate impulses, regulation of attention, reality testing, and insight about one’s own and others’ actions) [hereinafter The Effects of Stress Exposure on Prefrontal Cortex]

Related Article: Immediately End Corruption to End Poverty

25. Human Rights Watch and American Civil Liberties Union, Growing Up Locked Down: Youth in Solitary Confinement in Jails and Prisons Across the United States 1, 20 (2012), available at https://www.aclu.org/report/ growing-locked-down-youth-solitary-confinement-jails-and-prisons-across-united-states [hereinafter Growing up Locked Down]

26. The Effects of Stress Exposure on Prefrontal Cortex, supra note 50 at 91.

27. Trauma Fact Book, supra note 39 at 61.

28. Id.

29. Id.

Also Read: Is Intermittent Fasting Bad for Women’s Hormones?

30. The hippocampus helps an individual to record new memories and retrieve them later in response to specific environmental stimuli; Godehard Weniger et al., Reduced Amygdala and Hippocampus Size in Trauma-Exposed Women with Borderline Personality Disorder and Without Posttraumatic Stress Disorder, 34 Journal of Psychiatry & Neuroscience 383, 397 (2009), available at https://www.ncbi.nlm.nih.gov/pmc /articles /PMC2732745/pdf/0340383.pdf.

31. Id. at 398.

32. Id.

33. Trauma Fact Book, supra note 39 at 66.

34. See Trauma Fact Book, supra note 39 at 75 (explaining that trauma and maltreatment involves the disruption of chemicals that function as neurotransmitters (e.g., cortisol, norepinephrine, dopamine, causing escalation of the stress response).

35. National Resource Center on Justice Involved Women, supra note 10

36. Kathleen Brewer-Smyth et al., Physical and sexual abuse, salivary cortisol, and neurological correlates of violent criminal behavior in female prison inmates, 55 Biologic Psychiatry 21, 21 (2004), available at https://www.ncbi.nlm.nih.gov/pubmed/14706421.

37. Id.

38. Maia Szalavitz, Sexual and Emotional Abuse Scar the Brain in Specific Ways, Time Magazine (June 05, 2013), https://healthland.time.com/2013/06/05/sexual-and-emotional-abuse-scar-the-brain-in-specific-ways/

39. Id.

40. Id.

41. Trauma Fact Book, supra note 39 at 62.

42. Id.

43. Id at 61.

44. Id.

45. Id.

46. Id at 61-63.

47. See generally id. at 61-63 (explaining that women who lack the aforementioned services are at greater risk of experiencing the delayed reactions that lead to offending).

48. Id at 61

49. Id at 62

Also Read: Worsening Pandemic Performance Reveals Declining Governance

50. Linda Sydney, Supervision of Women Defendants and Offenders in the Community, U.S. Dept. of Jus., Nat. Inst. Corr. (2005), available at http://static.nicic.gov/Library/020419.pdf.

51. Id.

52. Id.

53. Id.

54. Id.

55. Id.

56. Examining Gender-Specific Treatment Programs in Women’s Prisons, supra note 37 at 16.

57. Id at 24.

58. Id at 28