How being incarcerated affects your mental health, according to a psychologist and neurologist

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Emily SwaimApr 5, 2023, 23:42 IST
How being incarcerated affects your mental health, according to a psychologist and neurologist

Incarceration comes with a host of issues, from physical violence to emotional abuse, which can significantly affect mental and psychological health.Getty Images

  • Rates of PTSD among incarcerated people are five times higher than the general US adult population.
  • Depression has been shown to worsen while incarcerated, but frequent visits from family may help.
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Poor eating, sleeping, social, and working conditions in correctional departments can drastically affect mental health.

Poor eating, sleeping, social, and working conditions in correctional departments can drastically affect mental health.
Prisons can often neglect basic needs like heating and cooling.Anadolu Agency / Contributor / Getty Images

The United States has nearly 2 million people incarcerated in its jails, prisons, juvenile correction centers, state psychiatric hospitals, and immigration detention facilities.

It's no secret that many of these institutions offer poor living conditions, including extreme heat or cold, frequent violence, unsafe working environments, and punishments like solitary confinement.

Such a stressful environment can profoundly impact not just your mental health, but your brain itself.

Developing PTSD: The rate of PTSD is five times higher among incarcerated people compared to the general US population, making it a common mental illness in prison.

Developing PTSD: The rate of PTSD is five times higher among incarcerated people compared to the general US population, making it a common mental illness in prison.
PTSD is a major concern among incarcerated people.Steven Puetzer / Getty Images

Trauma exposure is common in detention facilities. One study found up to 97% of incarcerated juveniles experienced some form of abuse that increased their risk of PTSD.

This may help explain why multiple studies have found that nearly half of incarcerated people (48%) have PTSD, which is over five times the general rate in the US (9%).

PTSD manifests in many ways. A study on older jail residents, aged 55 and up, found the most commonly reported PTSD symptoms were avoiding reminders of the trauma, nightmares, feeling constantly on guard, and emotional numbness.

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Losing self-control: Prisons remove the freedom of making decisions like what to wear and when to sleep, which has been shown to affect the ability to practice self-control.

Losing self-control: Prisons remove the freedom of making decisions like what to wear and when to sleep, which has been shown to affect the ability to practice self-control.
Many choices are made for you while incarcerated.Stephan Gladieu / Contributor / Getty Images

During incarceration, most decisions are made for you: when to wake up, what to wear, and how to spend your day.

Your brain can become used to this rigid routine and lose the flexibility needed to make your own choices, said Marieke Liem, a psychologist working at the Violence Research Initiative and associate professor at the Institute of Security and Global Affairs.

According to one study based in a Dutch remand prison, three months of this understimulation damaged individuals' abilities to make plans and exercise self-control.

Liem said people who were incarcerated for a long time, or incarcerated since a young age, may permanently lose some of their ability to self-regulate.

Developing or worsening mental health issues: Lack of proper mental healthcare and social isolation from friends and family raises the risk of conditions like depression.

Developing or worsening mental health issues: Lack of proper mental healthcare and social isolation from friends and family raises the risk of conditions like depression.
Visits from friends or family can make a huge different in a person's mental health while incarcerated.South_agency / Getty Images

Incarceration, by definition, separates you from the outside world, especially your social network.

The resulting isolation can raise your risk of mental health issues, which is a major concern considering that two in five incarcerated people already have a history of mental health issues like depression — twice the rate of the general adult population. And studies show that those issues can worsen in both juveniles and adults after a few months of incarceration.

There are many reasons for this, one being the lack of proper mental health care and adequate medication. But a big determinant may also be a lack of socializing with friends and family.

A study on Ecuadorian prisons found people who were not visited during incarceration were likely to have depression or psychosis.

On the flip side, research shows people who have contact with family during incarceration are less likely to have depressive symptoms and tend to have better relationships with their children.

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Becoming emotionally numb, which could increase the risk of violence toward others or self-inflicted injury.

Becoming emotionally numb, which could increase the risk of violence toward others or self-inflicted injury.
Some incarcerated people develop what's called a "prison mask" to avoid feeling hurt or disappointed.Anadolu Agency / Contributor / Getty Images

Liem said some people create a "prison mask" to protect themselves from getting hurt or disappointed, meaning they suppress vulnerable emotions like sadness and fear under a wall of stoicism to look tough and avoid getting taken advantage of.

However, this type of emotional numbing can be unhealthy long-term. It's been shown to trigger anger and violence toward others or self-harm and suicidal thoughts about oneself.

Being severely sleep deprived: As many as 88% of incarcerated people have poor sleep quality, and up to 73% may have insomnia.

Being severely sleep deprived: As many as 88% of incarcerated people have poor sleep quality, and up to 73% may have insomnia.
Sleep deprivation is a major problem among incarcerated people.Anadolu Agency / Contributor / Getty Images

With noisy cellmates, excessive lighting, and rock-hard mattresses, sleeplessness is a frequent complaint among incarcerated people. While facility conditions vary, a 2022 review found as many as 88% of incarcerated people have poor sleep quality, and up to 73% may have insomnia.

There is little research on how sleep deprivation affects cognitive functioning among incarcerated people specifically. What is well understood is how sleep deprivation generally affects the human mind, like making it hard to focus, recall details, or learn new information.

"Sleep deprivation, even in someone with normal intellectual functioning and living in a more comfortable housing situation than prison, may result in cognitive deficits similar to being drunk," said Audrey Nath, neurologist at Neuromonitoring Associates, who works with Medical Justice Alliance to advocate for appropriate neurological care among incarcerated people.

One study found sleep-deprived people were 4.5 times more likely to sign a false confession than adequately rested participants.

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Losing control of your emotions: Sleep deprivation and malnutrition among incarcerated people have been shown to trigger aggression and fights.

Losing control of your emotions: Sleep deprivation and malnutrition among incarcerated people have been shown to trigger aggression and fights.
Many prisons don't provide enough nutrition in the form of fruits and vegetables.Portland Press Herald / Contributor / Getty Images

Sleep deprivation also makes it harder to control your emotions. That helps explain why research has linked sleep disruption to an increase in aggression among incarcerated people.

Another cause of aggressive behavior is undernutrition. Many prisons provide meals high in sodium and calories, but fail to offer sufficient servings of fruits, vegetables, or fiber.

Furthermore, research into county jails has shown deficiencies in key nutrients, like magnesium, vitamin D, and omega 3 fatty acids, which are important for brain health, particularly how your brain responds to stress.

Studies show when incarcerated people receive vitamin supplementation, they got into fewer fights.

Developing a cognitive disability: Frequent violence can sometimes include a blow to the head that could result in a traumatic brain injury.

Developing a cognitive disability: Frequent violence can sometimes include a blow to the head that could result in a traumatic brain injury.
Prison violence may include blows to the head that can cause traumatic brain injury.iStock

A 2022 review found 19% of people in prisons experience physical victimization, such as blows to the head, during their sentence.

A blow to the head can cause what's called a traumatic brain injury, which, in general, can trigger memory loss, impulsivity, or even a full-blown personality shift. However, the review didn't specify how many of these attacks led to TBIs, and accurate data for this is hard to come by, anyways.

"The number of cases of TBI's from physical assaults within jails and prisons is likely underreported, as many of these people are not sent to outside medical facilities for care," Nath said.

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Worsening mental and physical health: Medical treatment for mental and physical health issues is often unsubstantial or nonexistent once a person is incarcerated.

Worsening mental and physical health: Medical treatment for mental and physical health issues is often unsubstantial or nonexistent once a person is incarcerated.
Medical neglect among incarcerated people can worsen an already pre-existing mental or physical health issue.1054391550 / Getty mages

"In my experience, sadly, medical neglect appears to be a major cause of neurological deterioration in incarcerated people," Nath said. She reports seeing "many startling cases of abject medical neglect" during her advocacy work at detention facilities.

"In one case, the patient's seizure medication was stopped," she added. "He then had a generalized seizure, and head injury as a result."

In another case, Nath described a detention facility that had years of opportunities to diagnose one individual's inflammatory disorder that can cause vision loss. She said they failed to give a thorough health examination that would have caught the disorder and enabled timely treatment. This individual is now completely blind.

Medical neglect is also a major concern for those entering incarceration with a mental health issue. Over three in five incarcerated people with a history of mental health issues do not receive appropriate treatment. And over half of those who were taking medication before incarceration are forced to discontinue their treatment regimen.

After incarceration, many people develop what is called Post-Incarceration Syndrome.

After incarceration, many people develop what is called Post-Incarceration Syndrome.
Even after leaving incarceration, many people report long-lasting mental health issues.Gallo Images / Contributor / Getty Images

Some psychological and neurological effects of incarceration can last years after your release. For example, people who have been incarcerated for many years or who have endured solitary confinement may develop Post-Incarceration Syndrome.

PICS can resemble PTSD or anxiety disorders, with symptoms like hypervigilance and emotional detachment. After release, you may have difficulty falling asleep or forming intimate relationships.

Other PICS symptoms are unique to this condition. For example, after years of walking the same facility halls, your sense of direction may atrophy, and you may find it very difficult to find your way in the outside world.

This is why, when seeking psychiatric or neurological care after release, it's important to find a professional who understands the unique aspects of the incarceration experience.

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