by Ed Lyon

After Kansas City Chiefs linebacker Jovan Belcher murdered his girlfriend and then killed himself in 2012, an autopsy revealed he suffered from Chronic Traumatic Encephalopathy (CTE), a disease caused by blunt head trauma during football blocking. Problems associated with CTE and other types of Traumatic Brain Injury (TBI) include anger, aggression, depression, impaired judgment and poor impulse control, and as previously reported in Prison Legal News, people who have experienced TBI are more likely to commit violent crimes. [See: PLN, June 2017, p.22; Nov. 2013, p.18].

A hard blow to the frontal lobe, which processes emotions and behavior, can cause the same sort of degradation in brain performance as dropping a computer, according to Wayne Gordon, a professor of rehabilitation medicine at Mount Sinai School of Medicine in New York City.

“If something went wrong with the central processing unit, it might be slower – you couldn’t save documents as easily – but it might chug along,” he stated.

For prisoners, who experience TBI at rates many times higher than the rest of the population, the implication is clear. According to Peter Klinkhammer, associate director of services at the Brain Injury Association of Minnesota, “If we don’t help individuals specifically who have significant brain injuries that have impacted their criminal behavior, then we’re missing an opportunity to short-circuit a cycle.”

Yet prisoners are often unaware of any link between past head trauma and their current problems, noted Elisabeth Pickelsimer, an associate professor at the Medical University of South Carolina. And prison officials find it less costly to ignore TBI diagnoses and treatment.

“It’s cheaper for them to just lock them up,” Pickelsimer observed.

Still, as Minnesota Department of Corrections neuropsychologist Adam Piccolino noted, the failure to address TBI-related problems means they are “apt to provide challenges to the offender post-release as they attempt to reintegrate into their respective communities.”

Sustaining a brain injury early in life tends to make people more aggressive when they grow older. A jail prisoner in Denver, Colorado, identified only as “Scott,” suffered TBI at age five at the hands of his foster father. He has since been struck on the head by a baseball bat, a crescent wrench and by gang members who assaulted him while incarcerated. He deals with constant agitation, restlessness, sweats and seizures. 

Scott is enrolled in a new treatment program for prisoners with TBI, in which jail staff take extra time explaining things to him and allowing him to process the information. He attends cognitive training courses, and while there are no drugs approved specifically to treat CTE/TBI, he augments his therapy and cognitive training with psychiatric medication. 

Scott is not alone. Research by the Brain Injury Alliance of Colorado revealed that 54 percent of Denver prisoners and probationers between 2013 and 2018 had a history of TBI. A 2007 study in federal prisons found a high percentage of TBI among female prisoners, with many revealing 10 or more incidents that left them unconscious, usually involving a violent encounter with someone else. Another 2007 study, conducted in Minnesota, found the incidence rate of TBI among prisoners was almost 83 percent. 

Outside the criminal justice system, that rate drops to eight percent among the general U.S. population – about 24.6 million people – according to a 2012 study. 

The Minnesota research identified the most common causes of TBI prior to incarceration as assaults, vehicle crashes and sports injuries. Once incarcerated, prisoners are at risk of TBI resulting from encounters with other prisoners – including a gang-initiation beating called “pumpkinhead,” which purposely attempts to induce brain swelling – as well as self-inflicted head trauma, especially among those placed in solitary confinement.

The University of Denver runs a project that screens jail prisoners to identify those with TBI, partnering with the Colorado Department of Human Services. Prisoners are initially questioned about head injuries sustained in accidents or violent incidents that resulted in loss of consciousness or left them comatose. Those with a history of such injuries are given a thorough neuropsychological screen to assess memory and measure reaction time. 

Since it began in 2013, the University of Denver’s program has found that 96 percent of the jail’s high-risk population has experienced TBI. That finding, in turn, led to a $1 million federal grant to continue the research for four more years. Ten other states have since secured similar grant funding and are coordinating their efforts with Colorado to research TBI/CTE. 

Denver jail case manager Amy Blackman is a former prison guard whose philosophy used to be “Nail ‘em and jail ‘em.” She has since learned that the explosive outbursts of violent behavior associated with TBI are strongly linked to domestic violence and other violent crimes prisoners have experienced. 

The link between TBI and the cognitive, emotional and behavioral problems prisoners suffer was originally established at a National Institutes of Health conference in 1998. These problems also negatively impact prison management and prisoner safety. Other studies, like one conducted in 2005, have extended the link to so-called secondary conditions such as substance abuse, which affects a prisoner’s behavior while incarcerated as well as his or her successful reintegration into society after release.

As recognition of the link between crime and TBI spreads, advocates are working to increase TBI screening for prisoners. Yet a diagnosis can be extremely difficult, with similar traumas resulting in different brain injuries. An effective screening tool is critical, such as the TBI Questionnaire used in the Minnesota study, which revealed that only one of every 83 people with TBI self-reported having such injuries.

“They were told they had their bell rung – they got knocked out,” said Rebecca Desrocher, assistant program director at the U.S. Department of Health and Human Services’ Federal Traumatic Brain Injury Program. But since the injury typically happened long ago, most people do not associate it with latent behavioral problems.

Advocates hope to establish for judges and juries a comprehensive and reliable set of guidelines for TBI-related cases that address culpability as well as punishment and/or treatment for people who commit crimes due to the lasting effects of brain injuries. 

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Sources: denverpost.com, newsweek.com, brainline.org, scientificamerican.com

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