With Lewis v. Casey , 116 S.Ct. 2174 (1996) [ PLN Vol. 7, No. 8], the Supreme Court further eviscerated the ability of pro se prisoners to effectively litigate civil rights actions. Consequently, in order for prisoner plaintiffs to prevail in constitutional challenges to conditions of confinement, they must increasingly rely on the expertise of professional legal assistance, resources, and witnesses.
One resource that may help define the consequences to individual prisoners of overcrowding, harsh conditions, and inadequate mental health care is: Trauma and its Sequelae in Male Prisoners: Effects of Confinement, Overcrowding, and Diminished Services , Terry A. Kupers, M.D., American Journal of Orthopsychiatry , 66(2) (April 1996)
Dr. Kupers is a professor in the Graduate School of Psychology at the Wright Institute, Berkeley, CA. He was also a consultant for the HRW team that wrote Cold Storage: Super-Max- imum Security Confinement in Indiana , (1997) [See Review in June 1998 PLN ]. He has toured more than a dozen state prisons over the past 15 years in the capacity of expert witness in litigation concerning the conditions of confinement and the quality of mental health services in prisons.
In "Trauma and its Sequele in Male Prisoners", Kupers links the "deinstitu- tionalization in the mental health system" with a "growing number of individuals with serious mental disorders... in correctional facilities."
He notes that prior to incarceration, many prisoners "suffered severe and repeated traumas as children and young adults" and describes how harsh prison conditions engender "stress response syndromes, decompensation, suicide, and other forms of psychiatric morbidity while incarcerated."
Kupers describes how prisoners, who may have suffered only marginally from mental health problems prior to incarceration, enter a downward spiral upon imprisonment where their inability to effectively deal with stress causes "profound deformations of personality" manifested by behavior that leads to ever more restrictive confinement, which inevitably exacerbates the underlying "stress response syndrome" that initiated the downward spiral.
Among the most traumatic stressors any prisoner can encounter is prison rape. Kupers notes that an estimated 20% of prisoners are raped during the course of their confinement, "yet there has been no more than a cursory mention of rape and no mention of PTSD in the hundreds of medical/psychiatric charts that this author has reviewed in prisons in three states.... It is as if the prison mental health staff figures: `Why diagnose what we do not have the resources to treat?"'
Kupers concludes that there "is a need for further study of stress response syndromes, including but not limited to PTSD, among prisoners with attention to the likelihood that such conditions have been underreported." For the present, however, litigants seeking resource material in the professional psychiatric literature regarding conditions of confinement and their impact on individual prisoners, this paper is an excellent place to begin.
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