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Old 08-04-2009, 10:50 AM
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Default Post Incaceration Syndrome (PICS) - The Facts

Hello all,

I have found the below information on PICS. I have read several threads that describe, in part, this disorder but this is the most complete document I have seen thus far. It appears to most adversely effect those that had prior addictions before their incarceration and also those who have spent long periods of time in segregation. The more knowledge we all have the better - at the least this might provide some resource to identify risk.

The Post Incarceration Syndrome (PICS) is a serious problem that contributes to relapse in addicted and mentally ill offenders who are released from correctional institutions. Currently 60% of prisoners have been in prison before and there is growing evidence that the Post Incarceration Syndrome (PICS) is a contributing factor to this high rate of recidivism.
The concept of a post incarceration syndrome (PICS) has emerged from clinical consultation work with criminal justice system rehabilitation programs working with currently incarcerated prisoners and with addiction treatment programs and community mental health centers working with recently released prisoners.
This article will provide an operational definition of the Post Incarceration Syndrome (PICS), describe the common symptoms, recommend approaches to diagnosis and treatment, explore the implications of this serious new syndrome for community safety, and discuss the need for political action to reduce the number of prisoners and assure more humane treatment within our prisons, jails, and correctional institutions as a means of prevention. It is my hope that this initial formulation of a PICS Syndrome will encourage researchers to develop objective testing tools and formal studies to add to our understanding of the problems encountered by released inmates that influence recovery and relapse.

Post Incarceration Syndrome (PICS) - Operational Definition

The Post Incarceration Syndrome (PICS) is a set of symptoms that are present in many currently incarcerated and recently released prisoners that are caused by being subjected to prolonged incarceration in environments of punishment with few opportunities for education, job training, or rehabilitation. The symptoms are most severe in prisoners subjected to prolonged solitary confinement and severe institutional abuse.
The severity of symptoms is related to the level of coping skills prior to incarceration, the length of incarceration, the restrictiveness of the incarceration environment, the number and severity of institutional episodes of abuse, the number and duration of episodes of solitary confinement, and the degree of involvement in educational, vocational, and rehabilitation programs.
The Post Incarceration Syndrome (PICS) is a mixed mental disorders with four clusters of symptoms:
(1) Institutionalized Personality Traits resulting from the common deprivations of incarceration, a chronic state of learned helplessness in the face of prison authorities, and antisocial defenses in dealing with a predatory inmate milieu,
(2) Post Traumatic Stress Disorder (PTSD) from both pre-incarceration trauma and trauma experienced within the institution,
(3) Antisocial Personality Traits (ASPT) developed as a coping response to institutional abuse and a predatory prisoner milieu, and
(4) Social-Sensory Deprivation Syndrome caused by prolonged exposure to solitary confinement that radically restricts social contact and sensory stimulation.
(5) Substance Use Disorders caused by the use of alcohol and other drugs to manage or escape the PICS symptoms.
PICS often coexists with substance use disorders and a variety of affective and personality disorders.

Symptoms of the Post Incarceration Syndrome (PICS)

Below is a more detailed description of four clusters of symptoms of Post Incarceration Syndrome (PICS):

1. Institutionalized Personality Traits

Institutionalized Personality Traits are caused by living in an oppressive environment that demands: passive compliance to the demands of authority figures, passive acceptance of severely restricted acts of daily living, the repression of personal lifestyle preferences, the elimination of critical thinking and individual decision making, and internalized acceptance of severe restrictions on the honest self-expression thoughts and feelings.

2. Post Traumatic Stress Disorder (PTSD)

Post Traumatic Stress Disorder (PTSD) is caused by both traumatic experiences before incarceration and institutional abuse during incarceration that includes the six clusters of symptoms: (1) intrusive memories and flashbacks to episodes of severe institutional abuse; (2) intense psychological distress and physiological reactivity when exposed to cues triggering memories of the institutional abuse; (3) episodes of dissociation, emotional numbing, and restricted affect; (4) chronic problems with mental functioning that include irritability, outbursts of anger, difficulty concentrating, sleep disturbances, and an exaggerated startle response. (5) persistent avoidance of anything that would trigger memories of the traumatic events; (6) hypervigilance, generalized paranoia, and reduced capacity to trust caused by constant fear of abuse from both correctional staff and other inmates that can be generalized to others after release.,

3. Antisocial Personality Traits

Antisocial Personality Traits are developed both from preexisting symptoms and symptoms developed during incarceration as an institutional coping skill and psychological defense mechanism. The primary antisocial personality traits involve the tendency to challenge authority, break rules, and victimize others. In patients with PICS these tendencies are veiled by the passive aggressive style that is part of the institutionalized personality. Patients with PICS tend to be duplicitous, acting in a compliant and passive aggressive manner with therapists and other perceived authority figures while being capable of direct threatening and aggressive behavior when alone with peers outside of the perceived control of those in authority. This is a direct result of the internalized coping behavior required to survive in a harshly punitive correctional institution that has two set of survival rules: passive aggression with the guards, and actively aggressive with predatory inmates.

4. Social-Sensory Deprivation Syndrome:

The Social-Sensory Deprivation Syndrome is caused by the effects of prolonged solitary confinement that imposes both social isolation and sensory deprivation. These symptoms include severe chronic headaches, developmental regression, impaired impulse control, dissociation, inability to concentrate, repressed rage, inability to control primitive drives and instincts, inability to plan beyond the moment, inability to anticipate logical consequences of behavior, out of control obsessive thinking, and borderline personality traits.

5. Reactive Substance Use Disorders

Many inmates who experience PICS suffer from the symptoms of substance use disorders. Many of these inmates were addicted prior to incarceration, did not receive treatment during their imprisonment, and continued their addiction by securing drugs on the prison black market. Others developed their addiction in prison in an effort to cope with the PICS symptoms and the conditions causing them. Others relapse to substance abuse or develop substance use disorders as a result of using alcohol or other drugs in an effort to cope with PICS symptoms upon release from prison.

PICS Symptoms Severity

The syndrome is most severe in prisoners incarcerated for longer than one year in a punishment oriented environment, who have experienced multiple episodes of institutional abuse, who have had little or no access to education, vocational training, or rehabilitation, who have been subjected to 30 days or longer in solitary confinement, and who have experienced frequent and severe episodes of trauma as a result of institutional abuse.
The syndrome is least severe in prisoners incarcerated for shorter periods of time in rehabilitation oriented programs, who have reasonable access to educational and vocational training, and who have not been subjected to solitary confinement, and who have not experienced frequent or severe episodes of institutional abuse.

Reasons To Be Concerned About PICS

There is good reason to be concerned because about 40% of the total incarcerated population (currently 700,000 prisoners and growing) are released each year. The number of prisoners being deprived of rehabilitation services, experiencing severely restrictive daily routines, being held in solitary confinement for prolonged periods of time, or being abused by other inmates or correctional staff is increasing.
The effect of releasing this number of prisoners with psychiatric damage from prolonged incarceration can have a number of devastating impacts upon American society including the further devastation of inner city communities and the destabilization of blue-collar and middle class districts unable to reabsorb returning prisoners who are less likely to get jobs, more likely to commit crimes, more likely to disrupt families. This could turn many currently struggling lower middle class areas into slums.
As more prisoners are returned to the community, behavioral health providers can expect to see increases in patients admitted with the Post Incarceration Syndrome and related substance use, mental, and personality disorders. The national network of Community Mental health and Addiction treatment Programs need to begin now to prepare their staff to identify and provide appropriate treatment for this new type of client.
The nation's treatment providers, especially addiction treatment programs and community mental health centers, are already experiencing a growing number of clients experiencing the Post Incarceration Syndrome (PICS). This increase is due to a number of factors including: the increasing size of the prisoner population, the increasing use of restrictive and punishing institutional practices, the reduction of access to education, vocational training, and rehabilitation programs; the increasing use of solitary confinement and the growing number of maximum security and super-max type prison and jails.
Both the number of clients suffering from PICS and the average severity of symptoms is expected to increase over the next decade. In 1995 there were 463,284 prisoners released back to the community. Based upon conservative projections in the growth of the prisoner population it is projected that in the year 2000 there will be 660,000 prisoners returned to the community, in the year 2005 there will 887,000 prisoners returned to the community, and in the year 2010 1.2 million prisoners will be released. The prediction of greater symptom severity is based upon the growing trend toward longer periods of incarceration, more restrictive and punitive conditions in correctional institutions, decreasing access to education, vocational training, and rehabilitation, and the increasing use solitary confinement as a tool for reducing the cost of prisoner management.
Clients with PICS are at a high risk for developing substance dependence, relapsing to substance use if they were previously addicted, relapsing to active mental illness if they were previously mentally ill, and returning to a life of aggression, violence, and crime. They are also at high risk of chronic unemployment and homelessness.

Post Release Symptom Progression

This is because released prisoners experiencing PICS tend to experience a six stage post release symptom progression leading to recidivism and often are not qualified for social benefits needed to secure addiction, mental health, and occupation training services.

· Stage 1 of this Post Release Syndrome is marked by Helplessness and hopelessness due to inability to develop a plan for community reentry, often complicated by the inability to secure funding for treatment or job training;
· Stage 2 is marked by an intense immobilizing fear;
· Stage 3 is marked by the emergence of intense free-floating anger and rage and the emergence of flashbacks and other symptoms of PTSD;
· Stage 4 is marked by a tendency toward impulse violence upon minimal provocation;
· Stage 5 is marked by an effort to avoid violence by severe isolation to avoid the triggers of violence;
· Stage 6 is marked by the intensification of flashbacks, nightmares, sleep impairments, and impulse control problems caused by self-imposed isolation. This leads to acting out behaviors, aggression, violence, and crime, which in turn sets the stages for arrest and incarceration.
Currently 60% of prisoners have been in prison before and there is growing evidence that the Post Incarceration Syndrome (PICS) is a contributing factor to this high rate of recidivism.

Reducing The Incidence Of PICS

Since PICS is created by criminal justice system policy and programming in our well intentioned but misguided attempt to stop crime, the epidemic can be prevented and public safety protected by changing the public policies that call for incarcerating more people, for longer periods of time, for less severe offenses, in more punitive environments that emphasize the use of solitary confinement, that eliminate or severely restrict prisoner access to educational, vocational, and rehabilitation programs while incarcerated.

The political antidote for PICS is to implement public policies that:

(1) Fund the training and expansion of community based addiction and mental health programs staffed by professionals trained to meet the needs of criminal justice system clients diverted into treatment by court programs and released back to the community after incarceration;
(2) Expand the role of drug and mental health courts that promote treatment alternatives to incarceration;
(3) Convert 80% of our federal, state, and county correctional facilities into rehabilitation programs with daily involvement in educational, vocational, and rehabilitation programs;
(4) Eliminate required long mandated minimum sentences;
(5) Institute universal prerelease programs for all offenders with the goal of preparing them to transition into community based addiction and mental health programs;
(6) Assuring that all released prisoners have access to publicly funded programs for addiction and mental health treatment upon release.
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Old 08-04-2009, 07:58 PM
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Thank you for posting that information. Its something that has been on my mind quite a bit lately.
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Old 08-07-2009, 11:59 AM
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I appreciate you posting this. A very informative read.
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Old 08-19-2009, 06:19 PM
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This was very informative. I appreciate you taking the time to put this here for all of us. I worry too when mine gets out how things will be i.e. job, a "normal" exisitence...
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Old 01-08-2011, 06:44 PM
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Wonderful information. So sad, and so true. I hope my children live to see the day that REAL rehabilitation is the NORM. Sadly, I doubt it. At least not in Texas...
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Old 03-29-2011, 03:00 AM
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Very good article. Sending to my old cellmate, who sadly is back in his 2nd time since I got out. Worried he is doing a life sentence on the installment plan. His anxiety is terrible both in and out of prison, and I am sure his heroin problem doesn't help either..
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Old 03-31-2011, 03:40 PM
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Wow.. this just described the man I have been involved with for the past 3.5 years. I knew when we meet he had been in for 12.8 years and once we began dating his behaviors were a bit strange but now I realize the extent of the damage that has been done to him.

My next question would be if he does not acknowledge he has issues and needs professional help.. how do I help him, can I help him?

I truly love this man but he has such strong markings from each category above.

Thanks.. barb
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Old 04-05-2011, 01:19 PM
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Wow!
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Old 04-27-2011, 01:39 AM
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I am in the last days before he comes home or at least gets released and this is so on my mind, ten years in virtual isolation has left him very vulnerable. I fear for the older inmates, those who had education or good incomes coming out to a system of social security in which life will be vastly different than when they went in.

The truth of the matter is it is bleak, he is planning for the time whens he's free of Texas but Texas isn't the problem. I am truly at a loss about what to do except be supportive and to protect myself, I have children and grandbabies to think about.



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Old 06-29-2011, 02:46 AM
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so so true and so so sad
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Old 10-11-2011, 12:44 PM
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I wish there was more about pics.... This is one of my main research focuses for my degree.....the fact that it is not even acknowledged and treated like PTSD baffles me. Many people get out and are suffering, from something that could have been prevented or treated with education
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Old 10-11-2011, 04:46 PM
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try looking up SHU sindrum may be of some help it to deals with inprisonment and even after it to odd thing is if you ascked me all three of those things can end up with with out prsion seclueshon will do it to you just as good as solitary then agan i dont think the only way to call it solitary is if it is in a prison lol but i do think that this sindrum may fall in line with parts of what your looking for
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Old 10-27-2011, 12:00 AM
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Quote:
Originally Posted by PhDboundfelon
I wish there was more about pics.... This is one of my main research focuses for my degree.....the fact that it is not even acknowledged and treated like PTSD baffles me. Many people get out and are suffering, from something that could have been prevented or treated with education
What type of pics are you looking for? As a ex-offender, I am curious to know if I can help you with your research.... Let me know
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Old 10-29-2011, 09:03 AM
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Quote:
Originally Posted by FreeBird0311 View Post
What type of pics are you looking for? As a ex-offender, I am curious to know if I can help you with your research.... Let me know
I think she was looking for information on Post Incarceration Syndrome (pics),not pictures.Not sure if your offer was to help with information of photographs
I would like to see more therapsits focus on the treatment of ex-inmates.
It probably does not get much attention due to lack of funds or people who care that have money.Sad but true that money and power talk!
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Old 12-08-2011, 02:39 PM
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yeah thats my question. . . where do we go from here ...what is the treatment and what can we as loved one do to help
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Old 12-09-2011, 04:00 AM
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I will have a loved one leaving prison straight from a six year shu incarceration (in four years +).
He was suffering the above effects after previous terms already and I really have no idea how to help him when he is released.
How can they be expeced to get a job or go to school when they can barely go to the next room?
He has the belief that bad things happen but you just man up,push on and don't talk about things.
Not very conducive to trusting a therapist at all and would probaly only trust one that had "done time" and could relate (if he would even go).
I really fear for him since as a validated gang member and going on a third strike,he is probably looking at life in shu if he can't make it this time.
I am trying to support him while he does his time in shu but can only do so much.It is just eating away at me knowing that they are in effect causing him to be even more affected in a negative way and then will expect him to just go be "normal" or get a violation of his three year parole after he maxes out (that is California for you).
I am glad you are making this the focus of your education!
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Old 03-11-2012, 08:03 AM
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Quote:
Originally Posted by __*RaiLynn*__ View Post
yeah thats my question. . . where do we go from here ...what is the treatment and what can we as loved one do to help
That's exactly what I thought after reading this. It is GREAT information about what it is and how it works, but all it says is to implement laws blahdy blahdy blah. What can WE do to help them through this? Do they EVER get over it? My husband still has 8 months left but before I read this, he straight up told me he's worried about flipping out on other people for things that we as "normal" people consider little but are in fact huge to him - which is only one of the things that he said that matches up with one of the facts about PICS. Now I'm worried and don't know what to do when he comes home or how to act or help him or anything. Please help!!
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Old 04-10-2012, 05:24 AM
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My husband of less than a year lays sleeping beside me. We married in June shortly after his release in January of 2011. He has spent the majority of his adult life in prison, and at the ripe old age of 27 he is a registered sex offender doomed to the registry for at least the next ten years if not twenty five depending on how that new SORNA act works. He has been diagnosis-ed with PTSD and anti-social whatnot, and now I have run across this information on PIC. It seems that this also inflicts my husband, so now the questions is, "What do I do with this?" He has already violated once in his excruciating long probation sentence(3years/1year served so far) and we are now facing another violation that may send him back for 18 months. He says that prison is easier than living out here and it really doesn't bother him to do 18 months. This is obviously PICs, and I just want to shake him awake, because I furiously want him on this side of the fence with me, not on New Castle Grounds where I have to be stripped searched just to step inside and give my husband a kiss. He fails to see my frustration.

Where do I find my strength during this waiting game with probation and "Is it a violation or not...?" and how do I find medical help for my husband instead of just more prison time if they do violate him? He always seems to take one step forward and then two steps back, as he has just found a councilor that he is finally getting in touch with and is able to tell his story to. Now it looks like he may wind up back in prison and will lose out on this great resource....I feel as if this is just running on, so here I will sign off, if there are suggestions as to help, I look forward to hearing them.....
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Old 04-10-2012, 06:45 AM
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Sorry but he likes prision
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Old 04-20-2012, 08:01 AM
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I didn't even know that such a disorder had been described. Seems I got many of these symptoms. Need more research and resources to help inmates and ex cons deal with this terrible problem.
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Old 05-06-2012, 08:59 AM
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Last time my husband was home, he always woke at the same time. Went for a walk at the same time. Ate at the same times every day and could not no matter what leave dishes after the evening meal.
He hated the supermarket ..even getting milk...too much choice. Choice was s big stress..along with crowds. He kept all of his toiletries lined up in the bathroom until they were moved by the kids a few times and then they were lined up on a shelf in his cupboard. He tired easily from every day tasks but he thrived in a factory environment and I swear it was due to the routine.
I don't know if he had PIC but he us back in and I will definitely seek help before he comes home...not just for him but for us.
It's scary stuff, Jenni
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Old 05-07-2012, 06:15 PM
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Thanks for this very interesting and informative article!
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Old 05-09-2012, 02:16 AM
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Yes, thanks for sharing!
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Old 05-11-2012, 09:11 AM
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[/quote] I just want to shake him awake, because I furiously want him on this side of the fence with me, not on New Castle Grounds where I have to be stripped
searched just to step inside and give my husband a kiss. He fails to see my frustration...[/quote]

I'll be damned if I would be stripped searched to see any one, regardless of our relationship or his crime. I'm just saying...
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Old 06-04-2012, 11:25 AM
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Well I am a mother and my daugher who is 26 will be coming home next week. I don't know what to expect and am scared. Please help me. This is the first time in prison (not jail though) and she got six months. She calls and is crying, her baby was 3 months old (first and only child) so she has missed her "baby life" mostly. What can a mother do? I am so worried about her. God please helps us.
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