The Psychological Effects of Imprisonment
Abstract and Keywords
This article studies the psychological effects of imprisonment. It addresses the argument that the present justice system suffers from legal and structural flaws, both of which cause pain to the imprisoned and eventually increases crime. It notes that adapting to prison means exposure to sexual assault, violence, and overcrowding, which may cause social and personal problems that would prevent successful reintegration.
This chapter reviews the various psychological effects of imprisonment. At an individual level, prison effects can be broadly conceived as the multiple ways in which persons are changed or affected as a result of their incarceration. During the last half of the nineteenth century and most of the twentieth—a period widely regarded as the “age of rehabilitation”—many people believed that prisons could be structured to produce effects that were largely positive or “reformative” in nature. Indeed, imprisonment itself was justified during these years largely because of its supposed ability to reduce recidivism—in essence, to change prisoners in beneficial ways that would decrease their likelihood of committing crimes in the future.
Several developments led to a shift in this particular focus on prison effects. For one, systematic empirical research that addressed whether and how well rehabilitation programs actually reduced recidivism led to increased skepticism about their utility. Although the simplistic characterization that “nothing works” misrepresented the data on prison programming outcomes, the effectiveness of rehabilitation proved more complicated and mixed than many had thought. In addition, increased sociological and psychological sophistication about the effects of “total institutions” such as prisons on the human psyche led to a more critical analysis of the consequences of imprisonment. As a result, at least since the abandonment of rehabilitation as the primary goal of imprisonment in the mid-1970s, most scholarly attention has been focused on the negative or potentially harmful effects of prison confinement, rather than its expected benefits.
As such, prison effects can be conceptualized in two broad, inter-related ways. The first addresses the direct, hurtful, and potentially damaging effects of the pains of imprisonment—the ways in which the deprivations, indignities, and traumas of (p. 585) prison life produce adverse reactions and negative psychological consequences in the prisoners exposed to them. The second kind of prison effect includes the sometimes subtle psychological changes that prisoners undergo in order to adapt to (and survive) the rigors of prison life. This latter kind of prison effect represents a specialized form of socialization—psychological accommodations that occur when people strive to adhere to the formal and informal demands of the social structures and settings in which they live. Called “institutionalization” when it occurs in total institutional settings in general, it has been termed “prisonization” when it takes place in correctional institutions.
Methodological Caveats Concerning Prison Effects
Several issues compromise the systematic, empirical study of prison effects. They are worth acknowledging at some length because they are often overlooked or given short shrift in prison research. The first issue is largely conceptual. Put simply, not all “prisons” are created equal. Notwithstanding the tendency among researchers to talk about prison as if it were some sort of Weberian ideal type, conditions of confinement vary widely along critical dimensions that can render one prison fundamentally different from—and more or less harmful than—another. One of the important lessons of the last several decades of research in social psychology is the extent to which specific aspects of a context or situation can significantly determine its impact or effect on the actors within it. This same insight applies to prisons. Thus, the effects of confinement in, say, a relatively well-run, program-oriented minimum security prison cannot automatically be generalized to those suffered in a dangerously overcrowded or brutally mismanaged maximum security prison. Scholars, researchers, and policy makers who refer to very different kinds of facilities—either to “overcrowded prisons,” or “solitary confinement,” or to “prisons” in general—as though the conditions that they denote are the same, when they are not, may blur critically important distinctions.1 This may result in invalid generalizations about prison effects (or the lack thereof), and also may lead scholars to conclude that different research results or outcomes are somehow “inconsistent” when, in fact, they can be explained by the specific conditions to which they pertain.
The second caveat is that the interpersonal complexities of prison life frequently operate to compromise and limit the measurement of prison effects. For example, many prison researchers have observed that a number of “men in prison have a need to present themselves as ‘super-masculine’ and do not wish to portray themselves as having been vulnerable or potentially remaining so within the prison setting” (Goff et al. 2004, 156). Many prisoners have learned to be wary of persons asking probing, personal questions, are reluctant to share intimate and revealing information about themselves, and rarely have an incentive to publicly admit that (p. 586) they are suffering. Thus, developing rapport and interpersonal trust—especially between prisoners and professional outsiders—is difficult. The resulting lack of candor from prisoners about their personal vulnerabilities and reactions to the pains of imprisonment may lead to an underestimate of prison effects.
Third, the experience of “suffering” is inherently subjective, often psychologically complex, and difficult to precisely measure. Reliance on highly structured, quantitative indices of the pains of imprisonment may fail to capture the phenomenon. Commonly used measures of pain, harm, or impaired functioning that have been standardized in other contexts or with other populations may not be appropriate for prison, or for prisoners whose background and current experiences may be distinctive or unique. Thus:
We still lack research instruments that can quantify the psychological effects of entering a world in which survival may depend on achieving total emotional control, constantly maintaining a high level of suspicion and hypervigilance, and striving for mastery over the intricacies of interpersonal deceit. Similarly, no standardized tests that I know can measure the precise consequences of being surrounded by models of aggressive domination, or calibrate the identity transformations that take place within many prisoners who are treated as categorically untrustworthy, worthless, and unpredictably and inexplicably violent. But that does not mean that these core aspects of the prison experience fail to produce pain or harm or significant psychological consequences that can be accurately described and thoughtfully analyzed. (Haney 2006a, 167)
In a related way, most indices of measurable harm or distress are dependent on self-report. Obviously, prisoners must be consciously pained or in distress over a symptom in order to complain about or report it; the greater their conscious awareness, the higher the likelihood that the frequency and extent of the negative effects will be accurately measured. However, in the course of adjusting and adapting to painful and distressing conditions of confinement, many prisoners necessarily strive to essentially “get used to it,” adapting and accommodating in ways that they hope will make their day-to-day misery seem more manageable—what I will describe below as one aspect of the process of “prisonization.” In any event, a lack of conscious awareness or the inability to verbally express the nature of the potentially harmful changes that are underway should not be mistaken for the absence of a prison effect.
Finally, precisely because many of the most powerful and potentially problematic prison effects include the adaptations that prisoners make to the extraordinary nature of prison itself, the full extent of the changes that they have undergone may not become completely apparent until after their release—that is, when they have left the environment to which they have more or less adjusted and subsequently try to reintegrate back into free society. Psychological changes and accommodations undertaken to reduce suffering or discomfort inside prison may not register as prison effects, especially for prisoners who appear to be otherwise well adjusted to their conditions of confinement. However, these changes may and often do become highly dysfunctional (even disabling) in the world outside prison. They surely represent prison effects, but they are difficult to measure during confinement.
(p. 587) The Direct Effects of the Pains of Imprisonment
The pains of imprisonment—including severe material deprivations, highly restricted movement and liberty, lack of meaningful activity, a nearly total absence of personal privacy, high levels of interpersonal uncertainty, danger, and fear—represent powerful psychological stressors that can adversely impact a prisoner’s emotional well-being. This is especially true if those stressors are experienced in extreme degrees over long periods of time. Indeed, as Hans Toch and Kenneth Adams have acknowledged, the “dictum that prisons are stressful cannot be overestimated,” (Toch and Adams 2002, 230). They and others have written about patterns of “acting out” and other forms of “maladaptive” behavior engaged in by prisoners attempting to cope with the stress to which they are subjected (e.g., Haney, 2006a).
Early studies of the effects of exposure to extreme forms of environmental stress in general concluded that it “may result in permanent psychologic disability” and even that “subjection to prolonged, extreme stress results in the development of ‘neurotic’ symptoms in virtually every person exposed to it …” (Hocking 1970, 23).Although no one would argue that imprisonment is uniformly devastating or inevitably damaging, it is true that “particular vulnerabilities and inabilities to cope and adapt can come to the fore in the prison setting, [and] the behavior patterns and attitudes that emerge can take many forms, from deepening social and emotional withdrawal to extremes of aggression and violence” (Porporino 1990, 36). Indeed, even one review of prison effects that is often cited for the proposition that imprisonment is not necessarily as “cruel and unusual” as many scholars and researchers have contended (Bonta and Gendreau 1990) nonetheless reported a number of negative prison effects. Thus, it cited empirical evidence of many of the measurable adverse consequences of incarceration, including symptoms of psychological distress (such as elevated blood pressure, anxiety, depression, self-mutilation, and suicide), and a range of other problematic reactions (such as increased hostility, introversion, and other interpersonal problems).
In more recent research, Alison Liebling and her colleagues found that the measured levels of distress in the prisons they studied were “extraordinarily high” (Liebling, et al. 2005, 216). In fact, in 11 of the 12 facilities they studied, the mean distress score recorded among prisoners was above the threshold that ordinarily triggers an inquiry into whether a patient is suffering from a treatable emotional or psychological illness. Furthermore, the levels of distress varied in predictable ways, in part as a function of the quality of life in the prison environment (or the prisoners’ experience of it). Thus, prisons whose “moral performance” was poor—ones rated low on social climate and other measures—also produced higher levels of distress among prisoners. Similar findings were reported by Claudia Kesterman (2005), in an analysis of the correlates of depressive symptoms among male prisoners in the correctional systems of several Baltic countries. Kesterman and her colleagues found that poor (p. 588) relations with staff and other prisoners (i.e., perceived rejection), the presence of environmental stress factors, the experience of victimization, the lack of respect by staff, and the absence of home and/or work release at the facility were all significant predictors of whether prisoners manifested depression.
Prison stress affects prisoners in different ways and at different stages of their prison careers. For some prisoners, experience the initial period of incarceration is the most difficult. This first stage of confinement can be so overwhelming that it precipitates acute psychiatric symptoms for the first time, or exacerbates preexisting disorders (e.g., Gibbs 1982). Other prisoners may move through the initial phases of incarceration relatively intact, only to find themselves worn down by the constant psychological assault and stress of confinement. These prisoners suffer a range of psychological problems in later stages of incarceration. Indeed, Taylor wrote that the long-term prisoner “shows a flatness of response which resembles slow, automatic behavior of a very limited kind, and he is humorless and lethargic” (Taylor 1961, 373). Jose-Kampfner has analogized the plight of long-term women prisoners to that of persons who are terminally ill, whose experience of this “existential death is unfeeling, being cut off from the outside … (and who) adopt this attitude because it helps them cope” (Jose-Kampfner 1990, 123; see also Rubenstein 1982).
Certain forms of prison stress can take a more immediate psychological toll. Post-traumatic stress disorder (PTSD) is a diagnosis that is applied to a set of interrelated, trauma-based symptoms, including depression, emotional numbing, anxiety, isolation, and hypervigilance.2 Reviews of the literature on the prevalence of PTSD in prisoner populations suggest that it could occur as much as ten times more often than in the general population (Goff et al. 2004, 155). Another review reported that approximately 21 percent of male prisoners, 48 percent of female prisoners, and between 24–65 percent of male juvenile inmates suffered from the disorder, a much higher prevalence rate than in the population at large (Heckman, Cropsey, and Olds-Davis 2007, 47; see also Gibson et al. 1999 and Zlotnick 1997).
Psychiatrist Judith Herman has proposed an expanded diagnostic category that may more accurately describe the traumatic consequences of certain kinds of prison experiences. Thus, what she termed “complex PTSD” is brought about by “prolonged, repeated trauma or the profound deformations of personality that occur in captivity” (Herman 1992a, 118). Unlike classic PTSD—which arises from relatively circumscribed traumatic events—complex PTSD derives from a more chronic kind of exposure that is more closely analogous to the experience of imprisonment. Complex PTSD can result in protracted depression, apathy, and the development of a profound sense of hopelessness. It represents the long-term psychological cost of adapting to an oppressive situation from which there is no escape and little opportunity to resist: “The humiliated rage of the imprisoned person also adds to the depressive burden … During captivity, the prisoner can not express anger at the perpetrator; to do so would jeopardize survival” (Herman 1992b, 382).
Of course, the unique and potent stresses of imprisonment are likely to interact with and amplify whatever preexisting vulnerabilities prisoners may bring into the prison setting. I made the point at the outset of this chapter that not all (p. 589) prisons are equally painful, or capable of inflicting harm. Prisoners also vary in terms of their backgrounds and vulnerabilities, how they experience or cope with the same environments or events and, as a result, how harmful and disabling the same prison experience may be for them (e.g., Hemmens and Marquart 1999; Gullone et al. 2000). In fact, despite a common stereotype that “hardened” prisoners are especially resilient to stress and impervious to harsh treatment, there is reason to believe that the reverse may be true, at least for a significant percentage of them. Many prisoners come from social and economically marginalized groups and have experienced trauma and other adverse childhood and adolescent experiences that may have made them more rather than less vulnerable to psychological stressors, and less able than others (with less problematic backgrounds) to cope effectively with the chronic strains of prison life (e.g., Gibson et al. 1999; Greene, Haney, and Hurtado 2000; McClellan et al. 1997; Mullings et al. 2004; Zlotnick 1997).
Moreover, some of these pre-prison events—particularly, prior exposure to trauma and to violence—are related to higher rates of victimization inside prison in ways that can compound their effects over time. That is, prison victimization, in turn, can lead to higher levels of distress in prison and symptoms of post-traumatic stress disorder and depression following release. For example, one study of prison distress focused on the degree to which having been victimized in prison—specifically, been subjected to “theft, con games and scams, robbery, destruction of property, assault, and serious threats of bodily injury” (Hochstetler et al. 2004, 444)—led to depression and symptoms of post-traumatic stress. The researchers found that, indeed, “prison victimization contributes to the occurrence of depressive and [post-traumatic stress] symptoms” (448). However, they also found that a history of having been exposed to trauma and violence prior to coming to prison helped to explain the prisoners’ level of prison distress. They concluded that the experience of being victimized in prison added to the pains of the preexisting events to which the prisoner had been exposed and—especially because of the potential for post-traumatic stress symptoms to prove disabling upon release—recommended that “[r]ehabilitative efforts should help inmates recover from trauma occurring inside and outside prison” (452).
In addition, especially over the last several decades, during which prisons have become the default placement for the mentally ill, higher percentages of prisoners appear to suffer from a range of serious, diagnosable psychological disorders, including clinical depression and psychosis as well as PTSD (e.g., Gunn 1978; Harding and Zimmerman 1989; Kupers 1999). The causal origins of these disorders cannot always be determined—some are undoubtedly preexisting conditions, some exacerbated by the pain and stress of incarceration, and others may originate in the psychological deprivation, turmoil, and trauma that the prison experience imposes. In any event, research conducted over the last several decades indicates that somewhere between 12–24 percent of prisoners in the United States now suffer from serious mental disorders (for a summary of these estimates, see Haney 2006a, 250; see also Fazel and Danesh 2002). Although this translates into literally hundreds of thousands of prisoners who should be receiving treatment for their psychological (p. 590) problems, no more than a fraction of that number are. Even fewer prisoners receive the kind of sustained and effective counseling and psychotherapy that they appear to need (e.g., Kupers 1996, 1999).
In extreme cases, some prisoners react to the psychic stresses of imprisonment by taking their own lives. Various studies have documented much higher rates of suicide among prisoners as compared to the general population (e.g., Bland, et al. 1990; Hayes 1989). Elevated rates of prison suicide appear to be the product both of the number of risk factors to which prisoners were exposed before incarceration and also to the harshness of the prison conditions they experience during their confinement (e.g., Liebling, 1995). For example, although Cooper and Berwick (2001) reported that there were individual factors and background characteristics that helped to predict suicide in different groups of incarcerated male prisoners, they also found that institutional factors—the severity of environmental stressors—played a significant role in the levels of anxiety, depression, and suicidality that the prisoners suffered. Most experts believe that psychotherapeutic and other kinds of interventions could have a significant effect in reducing suicide rates. Indeed, one noted that, despite causing the greatest number of prison fatalities, suicide also was “potentially the most preventable cause of death in prisons” (Salive, et al. 1989, 368). Here, too, the available therapeutic resources are not remotely commensurate with the magnitude of the prison-generated need.
Prisonization: Necessary Adaptations with Adverse Consequences
In the classic formulation of “prisonization,” sociologist Donald Clemmer defined it as “the taking on in greater or less degree of the folkways, mores, customs, and general culture of the penitentiary” (Clemmer 1958, 299). In addition to the sub-cultural aspects to which Clemmer referred, there are broad psychological components to the process as well. These changes represent a form of “coping”; they are natural and normal adaptations made by prisoners in response to the unnatural and abnormal conditions of prison life. Of course, they vary somewhat from prisoner to prisoner, in part as a function of their pre-prison life and identity and the nature of the prison experiences to which they are exposed and must confront throughout their prison “careers” (e.g., MacKenzie and Goodstein 1995; Paterline and Petersen 1999; Walters 2003).
Here, too, the stage and duration of imprisonment matter as well. Thus, for example, as prison researcher Edward Zamble noted: “It would appear that the beginning of the term [of imprisonment] induces considerable psychological discomfort …” (Zamble 1992, 420). However, over time, prisoners come to accept the many aspects of prison life that they cannot change. Indeed, as Zamble noted, “the constancy of the prison environment leads to a slow and gradual amelioration” (420). (p. 591) This amelioration may ease some of the pains of imprisonment and, because it appears to lead to a form of “prison adjustment,” it can mask a number of prison effects. Precisely because many of these changes are functional in the prison setting but highly dysfunctional in the world outside, they are problematic and even disabling in the long run.
There are several important psychological dimensions to the process of prisonization. Like virtually all total institutions, prisons typically force people to give up most of the power to make their own choices and decisions. However, this seemingly reasonable practice is often taken to extreme lengths in prison: Prisoners must relinquish control over the most basic and mundane aspects of their daily existence; they generally have no choice over when they get up or turn their lights out; when, what, or where they eat; whether and for how long they shower or make a phone call. These and most of the other countless daily decisions that citizens in the free world make on a day-to-day basis and naturally take for granted are made for them in prison. Prisoners typically feel infantilized by this loss of control. However, over time, by “ameliorating” to the erosion of personal autonomy, the fact that others routinely decide these things begins to seem increasingly “natural.”
As the process of prisonization continues, prisoners come to depend on institutional decision makers to make choices for them, and to rely on the structure and routines of the institution to organize their daily activities. Years spent having others make such decisions, depending on them to organize and direct one’s own behavior, and otherwise submitting to the external control of the course of day-to-day life eventually accustoms prisoners to it. Indeed, the loss of autonomy and the corresponding dependency on prison structure may become so complete that some prisoners are troubled and even traumatized by the unstructured and unpredictable nature of the free world settings to which they return. In extreme cases, they may begin to lose the capacity to initiate activity, to use their own judgment to make effective decisions, or to engage in planful behavior of any kind.
As I indicated in the previous section, the threat of victimization is a persistent fact of prison life. As part of the process of prisonization, prisoners must develop strategies to cope with or adjust to it. Richard McCorkle’s study of a maximum security Tennessee prison attempted to quantify the kinds of behavioral strategies that prisoners used to survive dangerous prison environments. He found that “[f]ear appeared to be shaping the life-styles of many of the men,” that it had led over 40 percent of prisoners to avoid certain high-risk areas of the prison, and about an equal number of inmates reported spending additional time in their cells as a precaution against victimization. At the same time, almost three-quarters of the prisoners reported that they had been forced to “get tough” with another inmate to avoid victimization, and more than a quarter kept a “shank” or other weapon nearby with which to defend themselves. McCorkle found that age was the best predictor of the type of adaptation a prisoner took—younger prisoners were more likely to employ aggressive avoidance strategies than older ones.
Toch and Adams (2002) provided a different perspective, arguing that the threat of exploitation is “tangible” in prison because “fear is equated with ‘weakness,’ and (p. 592) weakness earns contempt and invites aggression” in prison (230). Many prisoners learn to target those who have already shown that they are susceptible to intimidation, a pattern that obviously worsens the plight of weaker prisoners. It follows, then, that prisoners will adapt to these contingencies by attempting to avoid appear ing susceptible to intimidation at all costs. Of course, prisoners struggle to preserve their sense of self and to maintain self-respect in a larger context of pervasive and unavoidable subordination. For some, an exaggerated need to preserve one’s “manhood” results, with prisoners trying to construct it in a prison environment where it is constantly undermined.
Some prisoners cope with the threat of victimization by promoting their own reputation for toughness, responding immediately to even seemingly insignificant insults, minor affronts, or slightest signs of disrespect, and doing so with decisive (sometimes deadly) force. As one prison observer put it, “The cultural rules for recouping manhood arise out of an environment of stress, loss, and deprivation” (Phillips 2001, 23). In these ways, the dangers and degradation of prison life contribute directly to prisoners adopting aggressive survival strategies in which they proactively victimize others.
The issue of sexual assault in prison is a tragic but instructive example of the way that the harsh context of prison helps to elicit extreme, hurtful forms of behavior from persons which, in turn, have severe, traumatic consequences for others. John Coggeshall (1991) described the general process by which this occurs: “In prison, inmates face antagonism from guards, violence from fellow inmates, deprivation from incarceration itself. One method by which inmates retaliate is to humiliate and assault their fellow inmates sexually” (84). Thus, the frustration of sexual deprivation combines with the daily degradations of self to produce a perverse dynamic in which prisoners may acquire some degree of status through the sexual victimization of others (e.g., Rideau and Sinclair 1998). As one researcher put it: “Men who have been deprived of most avenues of self-expression and who have lost status by the act of imprisonment may resort to the use of sexual and physical power to reassert their uncertain male credentials” (King 1992, 68–69).
Prisons also are characterized by elaborate informal rules and norms that are part of the unwritten but essential culture and “code” that prevail inside prison and among prisoners. Like the formal rules of the institution, these too must be abided; there are very real and often severe consequences when violations occur. Some prisoners, eager to defend themselves against what they perceive as the constant dangers and deprivations of the surrounding environment, fully embrace and internalize as many of these informal norms as possible (e.g., South and Wood 2006). The norms of the prisoner culture can be harsh, exploitative, and even predatory. In poorly run maximum security prisons, especially, where the informal prisoner culture may become especially strong, many prisoners—those who cannot manage the elusive task of somehow appearing and remaining aloof and uninvolved—perceive a stark choice between becoming a victim or victimizer (e.g., Haney, 2011).
Prisonization also leads many prisoners to fashion an emotional and behavioral “prison mask” that seems unrevealing and impenetrable. In so doing, however, they risk (p. 593) alienation from themselves and others. That is, they may develop an emotional flatness that becomes chronic and debilitating in social interactions and in their personal relationships. Some will find that they have created a permanent and unbridgeable distance between themselves and other people. Others find that the risks associated with open, genuine communication are too great; their prison experience leads them to withdraw from authentic social interactions altogether (e.g., Jose-Kampfer 1990; and Sapsford 1978). In this way, these prisoners seek safety in social invisibility. They become inconspicuous and unobtrusive by disconnecting from others. Some prisoners retreat deeply into themselves, trust virtually no one, and adjust to prison stress by leading isolated lives of quiet desperation (e.g., McCleary 1961).
The degraded conditions under which prisoners live serve as constant reminders of their compromised and stigmatized social status and role. A diminished sense of self-worth and personal value may result. In extreme cases of prisonization, the symbolic meaning that can be inferred from this externally imposed substandard treatment and these degraded circumstances are internalized. As Gresham Sykes expressed it, the prisoner’s “picture of himself as a person of value”—that is, as a “morally acceptable” person with “some claim to merit … and inner strength” eventually “begins to waiver and grow dim” in a prison setting that refuses to acknowledge these characteristics or potentialities (1958, 79).
Of course, prisoners who truly internalize the broad set of habits, values, and perspectives that prisonization brings about are likely to encounter difficult transitions to free world norms. Indeed, the ability to successfully adapt to certain prison contexts may be inversely related to subsequent adjustment in the community. That is, as one study showed: “[I]nmates who adjusted most successfully to a prison environment actually encountered the most difficulty making the transition from institutional life to freedom” (Goodstein 1979, 265).
It is not difficult to understand why. A tough veneer that precludes seeking help for personal problems, the generalized mistrust that comes from the fear of exploitation, or a tendency to strike out in response to minimal provocations are highly functional in many prison contexts and problematic virtually everywhere else. Especially in interactions with persons who know nothing about the norms and psychological effects of the places from which they come, prisoners may be perceived as unfeeling, distant, or aloof, or cold, needlessly suspicious, or even paranoid, and capable of impulsive, dangerous overreactions. The lingering effects of prisonization function as psychological barriers that can impede post-prison adjustment.
Coping with the Extremes of Prison Confinement
Beyond the “routine” pains of imprisonment, and their attendant psychological effects, there are certain extremes of penal confinement that can produce even more adverse consequences for persons subjected to them. In particular, prison conditions (p. 594) that are on the end points of the continuum of social contact—far too much of it or far too little—have become increasingly common in certain prison systems. Their special and especially problematic prison effects they produce have been studied as well.
Because it touches virtually every aspect of a prisoner’s day-to-day existence, overcrowding greatly amplifies the stressfulness of prison life. Not surprisingly, a large literature on overcrowding has documented a range of adverse effects that occur when prisons have been filled to near capacity and beyond. As a group of prison researchers concluded in the 1980s, as the scope of the problem was just becoming apparent, “crowding in prisons is a major source of administrative problems and adversely affects inmate health, behavior, and morale” (Cox et al. 1984, 1159; see also Gaes 1985 and Paulus et al. 1988) Two other early commentators concluded their review of the literature in much the same way, namely, that “[w]ith few exceptions, the empirical studies indicate that prison overcrowding has a number of serious negative consequences” (Thornberry and Call 1983, 351; see also Ruback and Carr 1984).
Overcrowding may directly affect prisoners’ mental and physical health by increasing the level of uncertainty with which they regularly must cope. One useful psychological model of the negative effects of overcrowding emphasizes the way in which being confined in a space that is occupied by too many people increases the sheer number of social interactions persons have that involve “high levels of uncertainty, goal interference, and cognitive load….” (Cox, et al. 1984, 1159). Indeed, crowded conditions heighten the level of cognitive strain that persons experience by introducing social complexity, turnover, and interpersonal instability into an already dangerous prison world in which interpersonal mistakes or errors in social judgments can be fatal. Of course, overcrowding also raises collective frustration levels inside prisons by generally decreasing the amount of resources that are available to the prisoners confined there. The sheer number of things that prisoners do or accomplish on a day-to-day basis is compromised by the number of people between them and their goals and destinations. Moreover, overcrowding has systemic effects on prison systems that struggle to provide prisoners with basic, necessary services. For example, as several commentators noted in the midst of the rapid increases in prisoner population throughout the United States that occurred during the last several decades, “the prospect of screening inmates for mental disorder and treating those in need of mental health services has become a daunting and nearly impossible task in the present explosion of prison growth” (DiCataldo, Greer and Profit 1995, 574). The United States Supreme Court has found that seriously overcrowded prison systems can become so dysfunctional that they are incapable of providing constitutionally adequate medical or mental health care (Brown v. Plata, 2011).
Despite an occasional study that yields an inconclusive finding (e.g., Bleich 1987),3 it is widely understood that crowding can significantly worsen the quality of institutional life and increase the destructive potential of imprisonment. Among other things, we know from early research that prison overcrowding increases negative affect among prisoners (e.g., Paulus et al. 1975), elevates their blood pressure (e.g., D’Atri 1975), and (p. 595) leads to greater numbers of prisoner illness complaints (e.g., McCain et al. 1976). Exposure to “long-term, intense, inescapable crowding” of the sort that characterizes many prison environments results in high levels of stress that “can lead to physical and psychological impairment” (Paulus et al. 1978, 115; see also Ostfeld et al. 1987).
More recently, British researchers found that high levels of perceived crowding in prison were related to increased arousal and stress and decreased psychological well-being (Lawrence and Andrews 2004). Moreover, the prisoners in this study who experienced prison conditions as “crowded” were more likely to interpret the behavior of other prisoners as aggressive and violent. Other researchers have found that an individual-level factor—the degree of prior street drug use—interacted with the level of prison crowding to explain in-prison drug use. Specifically, “inmates who reported a history of using drugs on the streets prior to incarceration are especially likely to engage in drug abuse inside crowded prisons” (Gillespie 2005, 240). Studies also have shown that “overcrowding is a critical feature of prison environments that dramatically raises the risk of prison suicide” (Huey and McNulty 2005, 507). More specifically, “the reduced risk of suicide found in much prior research to be evident in minimum security facilities”—presumably because of the lower levels of deprivation there—“is in fact voided by the deleterious effects of high overcrowding” (507). Other researchers have found that overcrowding may lead to higher numbers of prison suicides because it decreases the level of “purposeful activity” in which prisoners are able to engage (e.g., Leese, Stuart, and Snow 2006, 359; Wooldredge 1999).
At the other end of the spectrum—and perhaps employed as a way of dealing with some of the dysfunctional systemic problems that overcrowding brings about—a number of prisons have resorted to the previously discredited practice of long-term isolation, implemented as a form of prisoner control and punishment. It, too, has a range of special, problematic psychological effects associated with it. There is an extensive empirical literature that establishes the painfulness of isolation or solitary confinement and its potential to inflict emotional damage. Empirical research on solitary-type confinement has consistently documented the psychological risks of living in these kinds of environments. Despite some methodological limitations that apply to some of the individual studies, the findings are robust. Evidence of these negative psychological effects comes from personal accounts, descriptive studies, and systematic research on solitary-type confinement, conducted over a period of four decades, by researchers from several different continents who had diverse backgrounds and a wide range of professional expertise. Even setting aside the corroborating data that come from studies of psychologically analogous settings—research on the harmful effects of acute sensory deprivation, the psychological distress and other problems that are created by the loss of social contact such as studies of the pains of isolated, restricted living in the free world, or the well-documented psychiatric problems that seclusion poses for mental patients—the psychological risks of solitary confinement are many and varied and empirically confirmed. (See Haney and Lynch 1997 and Haney 2003a for citations to the studies that document the specific symptoms and problematic patterns referred to in the paragraphs below.)
(p. 596) Specifically, in case studies and personal accounts provided by mental health and correctional staff who worked in prison isolation units, a range of similar adverse symptoms have been observed in prisoners, including appetite and sleep disturbances, anxiety, panic, rage, loss of control, paranoia, hallucinations, and self-mutilations. Moreover, direct studies of prison isolation have documented an extremely broad range of harmful psychological reactions. They include heightened levels of the following potentially damaging symptoms and problematic behaviors: negative attitudes and affect, insomnia, anxiety, panic, withdrawal, hypersensitivity, ruminations, cognitive dysfunction, hallucinations, loss of control, irritability, aggression, and rage, paranoia, hopelessness, depression, a sense of impending emotional breakdown, self-mutilation, and suicidal ideation and behavior.
In addition, there are correlational studies of the relationship between housing type and various incident reports that show that self-mutilation and suicide are more prevalent in isolated housing, as are deteriorating mental and physical health (beyond self-injury), other-directed violence, such as stabbings, attacks on staff, property destruction, and collective violence. The use of extreme forms of solitary confinement in so-called “brainwashing” and methods of torture also underscores its painfulness and damaging potential. In fact, many of the negative effects of solitary confinement are analogous to the acute reactions suffered by torture and trauma victims, including post-traumatic stress disorder (PTSD) and the kind of psychiatric sequelae that plague victims of what are called “deprivation and constraint” torture techniques.
Beyond these discrete, more measurable negative effects of isolation, a number of broader changes occur in many prisoners who have been placed in long-term solitary confinement. Although they are more difficult to measure, they may prove equally if not more problematic over the long term. These transformations come about because many prisoners find that surviving the rigors of penal isolation—accommodating to the absence of people and any semblance of normal social life—requires them change their patterns of thinking, acting, and feeling. Like prisonization in general, these changes have the potential to rigidify—to become deeply set ways of being that, in varying degrees for different people, more or less permanently alter who these prisoners are and, once they are released from solitary confinement, who they can become. Because they do not represent clinical syndromes per se, and because they constitute patterns of social behavior that are largely “functional” under conditions of extreme isolation—for the most part becoming increasingly dysfunctional only if they persist upon return to more normal social settings—I have termed them “social pathologies.”
Among the various social pathologies that can develop in prisoners who struggle to adapt to the rigors of severe, long-term isolation are:
1. Adjusting to the unprecedented totality of control that prevails in solitary confinement units by becoming even more highly dependent on the institution to organize all aspects of their daily existence than in general prison settings. Because almost every aspect of the prisoner’s day-to-day life is so carefully controlled in the typical solitary confinement unit, prisoners may lose the ability to set limits for themselves, or to control their own behavior through internal mechanisms.
(p. 597) 2. Conversely, prisoners in highly controlled solitary confinement settings often report losing the ability to initiate behavior of any kind—to organize their own lives around activity and purpose. Living for the most part entirely within the confines of their cells, they have been stripped of any opportunity to do so for prolonged periods of time. Chronic apathy, lethargy, depression, and despair are often reported as a result.
3. Because they are denied regular, normal interpersonal contact within a meaningful social context, prisoners report feeling that they are at risk of losing their grasp on whether and how they are connected to a larger social world, to other people. As their social identities atrophy, some report losing a sense of who, in fact, they are. Some prisoners “act out” literally as a way of getting a reaction from their environment, proving to themselves that they are still alive and capable of eliciting a human response—however hostile—from other human beings.
4. The experience of total social isolation leads some prisoners to engage, paradoxically, in social withdrawal. That is, they move from initially being starved for social contact to eventually being disoriented and even frightened by it. As they become increasingly unfamiliar and uncomfortable with normal forms of social interaction, they are further alienated from others and made anxious in their presence. In extreme cases, another pattern emerges: their present environment is so painful, so bizarre and impossible to make sense of, so disconnected from more familiar social contexts that prisoners create their own reality—they live in a world of fantasy instead.
5. Finally, the deprivations, restrictions, the totality of control, and the prolonged absence of any real opportunity for happiness or joy fill many prisoners with intolerable levels of frustration that, for some, turns to anger, and then even to uncontrollable and sudden outbursts of rage. It leads others to ruminate over their mistreatment and commit themselves to fighting against the system and the people that surround, surveil, provoke, deny, thwart, and oppress them.
Obviously, these social pathologies—adopted in reaction to and in order to survive a pathological set of circumstances—are highly dysfunctional and potentially disabling if they persist in the highly social world to which prisoners are expected to adjust once they are released.
The Post-Prison Consequences of Prison Effects
Prisonization can combine with the high levels of distress and trauma experienced in harsh prison settings to produce lasting problems for ex-convicts (e.g., Haney 2003b). In fact, when Adrian Grounds and Ruth Jamieson (2003) conducted psychiatric assessments of a group on long-term prisoners who had been subsequently (p. 598) released, they found that the most serious psychological problems that many prisoners faced were only manifested after they reentered free society. Indeed, they uncovered a pattern of disabling symptoms and severe psychological problems that paralleled findings from the trauma literature in psychology and psychiatry. Grounds and Jamieson concluded that the “psychological consequences of imprisonment for these men and their families were complex and profound” (358).
Grounds conducted an additional study of persons who had been exonerated and subsequently released. He found that when these ex-prisoners attempted to reintegrate into society they experienced many of the same kinds of psychiatric problems and difficulties as they participants in his earlier study. Indeed, he concluded that the “extent of the suffering was profound” (Grounds 2005, 15). Grounds found “evidence of personality change and adjustment difficulties in this group similar to those described in clinical studies of others who have experienced chronic psychological trauma” (15), which included “marked features of estrangement, loss of capacity for intimacy, moodiness, inability to settle, loss of a sense of purpose and direction,  a pervasive attitude of mistrust toward the world,” being “withdrawn, unable to relate to the world,” manifesting the diagnostic criteria for post-traumatic stress disorder, suffering depressive disorders, and encountering a whole range of serious problems with family contact, social adjustment, and employment (21–41).
The stress of prison confinement has medical as well as psychological consequences that may impair post-prison adjustment (e.g., Massoglia 2008a, b; Schnittker and Andrea 1997). In fact, some of the daunting medical and psychological challenges that ex-convicts face in the transition from prison to free society are reflected in their dramatically elevated mortality rates. For example, one study reported that within two years of their release, former prison inmates suffered mortality rates that were three and a half times that of the general population (Binswanger et al. 2007). Moreover, within the first two weeks immediately following their release, their mortality rates were over twelve times the rate in the population at large. Drug overdose, cardiovascular disease, homicide, and suicide were the leading causes of death.
In addition, the overcrowded conditions and lack of commitment to rehabilitation that characterized American corrections over the last several decades have increased the obstacles that ex-convicts must overcome following incarceration. Sociologist John Irwin (2005) summarized the state of mind of many long-term prisoners preparing to leave the medium-security California prison that he studied. These prisoners had endured many years “deprived of material conditions, living in crowded conditions, without privacy, with reduced options, arbitrary control, disrespect, and economic exploitation” (168). The mounting effects of these “excruciatingly frustrating and aggravating” experiences resulted in “[a]nger, frustration, and a burning sense of injustice” (168), which Irwin concluded was likely to significantly reduce their chances of successfully pursuing a conventional life after release. As Joan Petersilia (2003) has noted, in addition to the lack of rehabilitative services that the typical prisoner now receives, the sheer length of prison sentences in the era of harsh punishment insures that many of them will return home “more disconnected from family and friends, (p. 599) have a higher prevalence of substance abuse and mental illness, and be less educated and less employable than those in prior prison release cohorts” (53).
In addition to impeding successful reintegration generally, the negative psychological effects of imprisonment may also elevate recidivism rates. To be sure, the methodological challenges presented by attempts to determine how much crime a person would have engaged in but for his or her imprisonment are substantial (e.g., Bhati 2006). Not surprisingly, the estimates of the net effect of imprisonment on subsequent criminal trajectories vary somewhat. For example, Paul Gendreau and his colleagues have conducted a comprehensive meta-analytic study of the relationship between incarceration, length of confinement, and recidivism (Smith, Coggin, and Gendreau 2002). They concluded that doing time in prison actually had a “criminogenic”—crime-producing—effect. In fact, imprisonment not only appeared to have increased the chances of reoffending somewhat but also, the more time served, the more likely subsequent offending became. Although the overall effects were modest in size, Gendreau and his colleagues concluded that “the enormous costs accruing from the excessive use of prison may not be defensible” (20). Indeed, they noted that the long-term cost—in terms of increased amounts of crime produced by more people going to prison for longer amounts of time—was particularly problematic “given the high incarceration rates currently in vogue in North America.”
Other research suggests that, in addition to the length of imprisonment, the severity of the conditions of confinement may have an adverse impact on the amount and nature of recidivism. Specifically, Chen and Shapiro (2007) concluded that incarceration under harsh conditions of confinement may increase the likelihood that persons will engage in criminal behavior following their release from prison, and that these effects “appear large enough to outweigh deterrence and drive a net increase in crime should prison conditions worsen” (23). They also concluded that the size of this effect may be stronger “for inmates housed for a longer period” (21).
Whether they reoffend or not, of course, many ex-convicts will reenter free society not only bearing the psychological burdens that years of prison distress and prisonization have created but also thwarted in their goals by a set of structural disadvantages and community-based obstacles that can impede their successful reintegration. As one researcher put it, “incarceration likely acts as a primary stressor, while characteristics of life after release—stigma, decreased earnings and employment prospects, and family problems—are a series of secondary stressors” (Massoglia 2008. 57), ones that many ex-convicts have been ill prepared to confront.
Prisons are powerful social settings that can produce a range of negative psychological effects on persons confined within them. In general, such prison effects include the ways in which prisoners are adversely affected by the severe stressors that characterize (p. 600) prison life (e.g., danger, deprivation, and degradation) and the many accommodations that they must make in order to adjust to and survive the psychological pressures they confront and the behavioral mandates with which they must comply. Prison conditions vary widely, and those variations influence and affect that nature of the changes that prisoners undergo in the course of their incarceration. Prisoners also vary in the degree to which they are affected by their conditions of confinement. However, the risk factors and various forms of trauma that we know predispose persons to a wide range of psychological problems (including substance abuse, criminality, and violence) are, not surprisingly, prevalent in the pre-prison lives of incarcerated men and women; these experiences may make them especially vulnerable to the prison stressors and process of prisonization to which incarceration subjects them. Many of these negative prison effects become fully apparent only after release, when the complete impact of the prison experience and its potentially disabling consequences in free society come to the fore.
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(1) . Most of what I have to say about the effects of imprisonment applies primarily to maximum and medium security prisons, where most prisoners are housed, rather than minimum security facilities, where a much smaller percentage are confined (Stephan and Karberg 2003). These prisons place a heavy emphasis on security and control, and generally house prisoners in cells. The facilities are typically surrounded by high walls or fences, with armed guards at the “security perimeters,” and so on. Obviously, these, too, are gross categorizations, with countless variations in actual conditions of confinement occurring between seemingly similar prisons. My assertions about prison effects are all made with the continuing caveat that as prison conditions vary significantly from facility to facility so, too, do their effects.
(2) . Four criteria must be met in order for the diagnosis of PTSD to be applied. Specifically, a person must: (1) be exposed to a severe stressor resulting in intense fear or helplessness; (2) undergo psychic re-experiencing or re-enacting of the trauma; (3) engage in avoidance behavior or experience psychic numbing; and (4) experience increased arousal, typically in the presence of stimuli related to or reminiscent of the original trauma. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, IV T-R. Washington, DC: American Psychiatric Association (2000). For additional discussions of the disorder, see Wilson and Raphael (1993).
(3) . The potential relationship between crowding and inmate disciplinary infractions and violence has been an especially elusive one, appearing in some studies but not in others (e.g., Steiner and Wooldredge 2009). This apparent inconsistency may be due in part to other facts of prison life that complicate research in this area, including the level of analysis at which crowding is measured and its effects assessed (e.g., “crowding” in an individual housing unit, institution, or system), and the extent to which prison practices actually change (and/or are perceived by prisoners to have changed) in response to crowding, altering things like classification and security procedures, the reporting of infractions and victimization, and so on, inside the prison or prison system. The point is that prisons are complex environments, with many aspects and actors that respond in multiple ways to crowding-related pressures in order to adjust to and function within them. In this instance, we know that inmate violence levels themselves are affected by a complicated set of forces and factors (e.g., Steiner 2009). And we also know that prisoner behavior can be managed in part by a variety of techniques so that violence, even under crowded conditions, can be controlled through exceptional means, such as through an especially high concentration of staff (e.g., Tartino and Levy 2007). These and other complexities likely explain some of the complicated pattern of research results that have been reported on this issue.