Fault LinesSunday 9pm ET/ 6pm PT
Singeli Agnew for Al Jazeera America

Psychiatrist: Damage to youth locked up with adults 'can last for life'

Are we missing an opportunity to rehabilitate young prisoners by sending them to prisons made for adults?

In "Forgotten Youth: Inside America's Prisons," Fault Lines examines what happens to young inmates when they are placed in adult prisons and investigates their claims of physical and sexual abuse. The film airs on Monday, July 20, at 10 pm Eastern time/7 pm Pacific on Al Jazeera America. | Click here to find Al Jazeera in your area.


Beginning in the late 1980s, nearly every state passed laws that made it easier to prosecute juvenile offenders as adults. The legal maneuvers were part of an effort to combat the fear of so-called “superpredators”—crazed minors whose unchecked immaturity might make them indiscriminate killers.

But a growing body of psychological and neuroscientific research has shown that minors are fundamentally different from adults and should be treated with regard for their youthful status by the criminal justice system. Recent U.S. Supreme Court cases have reaffirmed these developmental differences, citing youth’s “capacity for change” and “limited moral culpability.”

Their age should make them more amenable to rehabilitation. But rather than receive services that are age-appropriate, kids in the adult system are often left to fend for themselves—and many are released from prison more psychologically damaged than when they went in.

Psychiatrist Terry Kupers is the author of “Prison Madness: The Mental Health Crisis Behind Bars and What We Must Do About It.” He explains that young prisoners are caught between two codes that are prevalent in lock-up: the prison’s rules and the male code. The rules are administered by the guards, but the prison code is enforced among the population. Inmates shouldn’t show weakness and can’t snitch on one another, even if one is significantly harmed or abused by another.

Fault Lines spoke to Kupers about the mental health impacts suffered by young people who end up incarcerated with adults and what services that they desperately need are being denied to them. An edited transcript of the conversation follows:


Fault Lines: How is an adolescent brain different from an adult brain?

Kupers: We know from a lot of brain imaging studies, like PET scans (photon emission tomography), that certain parts of the brain are acting differently in adolescents than they are in adults. And certain parts are not very developed. For instance, what's called the administrative function of the ego, which is in the prefrontal cortex, if we do a PET scan, we will see that there's less development in that area than there is for instance in the temporal area, which is controlled by passions and anger and such.

What's happening in adolescence is that the administrative functions of the prefrontal cortex are getting stronger and taking control of the more emotion-oriented parts of the brain. So the emotions are still there, but the individual has learnt to control their emotions and act functionally. And that happens in a sped-up fashion during adolescence. It’s happening all through life, but when we enter adulthood the patterns are pretty set.

In adolescence, they're very much in flux. This is the reason why the Supreme Court has ruled that you cannot order the death penalty for adolescents. And the reason is that they’re malleable. Their brain is not entirely formed. They're going through a very chaotic period in development and presumably they will come out the other end and be a different individual as an adult. So we don't want to end their life during that critical phase of their development.

What is the risk of having juveniles in a standard, adult prison environment?

On average, juveniles are less prone to follow rules. They’re more impulsive. They don't think very clearly about the consequences of their behavior. But if you put a number of juveniles in a system that is very rigid with many, many rules and very severe punishments when you violate a rule, it's going to tend to happen that the juveniles are going to run afoul of the rule system and be punished. And so juveniles are going to tend to be in solitary confinement more often than their older peers.

Now besides that, there's the whole dynamic of sexual assault and the prison code. I had one prisoner in another state who was 15 when he came to prison. The first thing that happened to him was that another prisoner grabbed his testicles on the yard. And he hit him very hard. And the reason was that he had been advised by older prisoners that if you don't fight then you're going to become a sexual slave.

So he fought very hard, and the officers come in and they say, “What happened?” And he knew enough not to say anything because if he told them what happened, he would be a snitch, according to the prison code. So they put him in solitary confinement and then he had emotional reactions to being in solitary and became very depressed and suicidal.

How would you explain the longer term, damaging impacts of solitary confinement, particularly for juveniles?

Let me start with a fairly emotionally stable adult. If you put an emotionally stable adult in solitary confinement, they eat their meals in their cell, they get out for less than five hours a week and they do everything in their cell with very few amenities. They may have pencil and paper, they may have a television with very limited channels. But they have no other activities, they have no meaningful activities, they're mostly idle. They're mostly isolated. They don't talk to anybody except for the guard who hands them the food tray and not much conversation happens there.

A youth offender in Michigan is sprayed with a chemical agent by prison guards.
Courtesy of the Law Offices of Deborah Labelle

The average individual will become very anxious, will become very angry, will start pacing or cleaning their cell compulsively, will start having disordered thoughts. They all have trouble concentrating, they might have paranoid delusions and they’re going to have memory problems. They’re going to feel despair, which could be serious depression, it could be suicidal ideas. That’s what's happening to the average mentally healthy adult in solitary.

Now if you add to that mix the adolescent, the adolescent has an incompletely developed brain. If you put an adolescent in solitary confinement, they will have more severe symptoms than the adult. And the reason is because they have less wisdom, they have less maturity, they don't understand the experiences that are happening to them. So for instance, when they become despairing, they might actually kill themselves whereas an adult would think about it a little more. So all of the problems associated with solitary confinement are multiplied when an adolescent is put in solitary.

What are the impacts that you've seen further down the line when those juvenile inmates are subjected to these kinds of punishments and that type of treatment? Is attempted suicide prevalent?

There are two major risk factors for suicide that are at issue: adolescence—the rate of suicide during adolescence is very high compared to adult suicides—and solitary confinement. We have a stunning statistic that 3 to 7 percent of prisoners are in solitary confinement, and 50 percent of the successful suicides occur among them.

So putting someone in in solitary confinement, which is the usual punishment for almost anything in prison, therefore puts them at great risk of suicide. Now that gets multiplied by the fact that adolescents are vulnerable to suicide. So the same causal links that make people despair when they're put in solitary are going to have an exaggerated effect on adolescents, and therefore the risk of suicides will be that much greater.

For inmates, particularly juveniles, who attempt suicide, we've seen videos of what the facility’s response is in those situations. It's extracting them from their cell, it's dealing with them in harsh ways. What concerns do you have about the way the facility responds after a suicide attempt happens?

First of all, there is a tendency among custody staff to think that someone who's making a suicide attempt is malingering, or manipulating. And it's just an approach on the part of staff—probably they've been manipulated by many prisoners and they're just wary of that. It's the wrong approach to use with someone who actually is suicidal.

We think of adolescents as manipulative. In response to the individual's suicidal ideation or even telling the guard, “I'm afraid I'm going to hurt myself,” the guard’s first response is, “You're probably trying to manipulate me.” Then they’re going to miss important clues that there's a suicide in progress here. So that's a very big factor.

We have a stunning statistic that 3 to 7 percent of prisoners are in solitary confinement, and 50 percent of the successful suicides occur among them.

Terry Kupers

psychiatrist and author

The system is not set up really to deal with suicide. There's very minimum mental health contact with the individual who is deemed suicidal. They’re put in a suicide observation cell, their clothes are taken away from them. All of their amenities are taken away. They don't even get recreation while they're in the cell. And then the mental health team comes each day and they ask them, “Are you still suicidal?” Well, before very long even the most seriously suicidal individual will say, “No, I’m not suicidal. Put me back in my cell.”

Now in a disproportionate number of cases, their cell is an isolation cell. And that’s the next mistake that custody staff make. They take them out of observation and put them back in their solitary confinement cell, and that's where people commit suicide. They need frequent visits with the mental health team and they need to be involved in some therapeutic activities so they could work through the despair by talking to people about it. That doesn't happen in prison.  

What has your experience been of guard culture and the type of mentality that exists in these facilities?

There are among guards some very decent people, who try to take care of prisoners and particularly young prisoners. And yes, they do the best they can. They're controlled by very strict orders. So for instance, if they're counseling a youth who's been sexually assaulted, and the youth tells them something, they are required to report that. So there's a limit to their confidentiality. Now among guards, there is basically the same culture as there is among prisoners. It's very misogynistic. That is, guards are very into acting tough, they lift weights, they build their body, they talk a lot in terms of domination and they boss the prisoners around. So they're very tough.

I’ve seen around the country situations where prisoners will mock someone. For instance a young and fair male in a prison, will be considered effeminate and will be called a series of terms like "honey" or "gay" or "woman," and the officers will laugh. And the reason is because the officers share the same culture and the same misogyny, which is to basically derogate anything feminine in a man. So the expression of feelings is more feminine in the tough male culture. And walking in a certain way or showing weakness, all these things are looked upon negatively by the prisoners and by the officers.

Terry Kupers and Fault Lines Correspondent Sebastian Walker watch footage of an incident between a youth offender and prison guards.
Singeli Agnew for Al Jazeera America

A prisoner will say something offensive towards a prisoner like, “You're awfully cute” or “I’d like to take you to my cell and I have things I want to do to you,” and other prisoners will laugh. Well, the officers will laugh. And instead of saying, “Wow, that means this prisoner is in deep trouble.  We need to do something immediately to make sure he doesn't get sexually assaulted”—which would be the correct response—instead they just laugh, and then the assaults happen.

Why isn’t there more public outrage about the types of things that happen in prisons?

People are angry about criminals—that they robbed, that they hurt somebody, that they're violent, whatever they did—and they want their vengeance expressed. They want to punish them harshly and people in general don't think about the repercussions of that punishment.

Now there's two parts to this: One is that what happens in prison is very secret. Prisons are closed-off institutions. Prisons tend to be located in far away places, for instance from the urban centers, and the rules for visiting are very strict, so many visitors are disallowed, or certain prisoners are not allowed much in the way of visiting. Visits are the main way we know what goes on in prison, because the prison authorities don't publicize what's going on. For the abuses to occur, the abuser needs to have an expectation of secrecy. So either the prisoner who sexually assaults a young prisoner or the guard who sexually or otherwise abuses a prisoner has to expect that they'll never come to the public light.

Now in prison there are very obvious dynamics and factors that add to the abuse: One is crowding. We’ve been putting an unprecedented number of people behind bars because of drug laws, because most people who go to prison are going to prison on minor substance abuse-related charges. They don't need to be in prison, they should be in a recovery program. However, we've multiplied the prison population in the United States by 10 times since the early 1970s. Crowding causes an increase in violence and makes the prisons less manageable.

We’ve also been systematically and incrementally dismantling rehabilitation programs in the prisons. When you put them in a crowded facility, there's a lot of violence. They have to be violent to survive, and they don't have much in the way of rehabilitation. The violence multiplies, and then what happens is that most people get out of prison. Ninety-three or 95 percent of prisoners will eventually be released.

The real question the public should be concerned about is not: What crime did the person do and how harsh we can make the punishment? The real question should be: Is what we're doing to them in prison more likely to make them resort to criminal acts and drug abuse when they get out of prison or are they more likely to straighten out and become a productive citizen?

All of these forces add up to make the situation worse. And that's why I say that the public idea that we don't care what happens to them is really foolhardy. We should care! There are close to 2.5 million people behind bars today. That means there's 10 or 20 times that many who had been in jail or prison. If they've been abused in prison and as a result of that abuse when they get out are more likely to resort to illicit substances and crime, then we're making the crime problem in society worse.

Related News

Find Al Jazeera America on your TV

Get email updates from Al Jazeera America

Sign up for our weekly newsletter


Get email updates from Al Jazeera America

Sign up for our weekly newsletter