“Concussion protocols” is a phrase we hear nearly every week during football season. The effects of head trauma on a person’s behavior and personality are not new science, though research on the topic is far more advanced now than it was when Phineas Gage had a railroad spike shot through his head nearly two centuries ago. Despite this research, what is not discussed enough is the correlation between head trauma and incarceration. 

My name is David Annarelli. In 2011, I was ejected from a moving car at about 45 miles an hour. I suffered a bilateral subdural hematoma, intracranial bleeding, axon retraction, and possible axon disruption—the literal tearing of brain tissue. It took me months just to regain my balance after I woke from my coma. I lost about six months of my life between December 2011 and June 2012. My moods overwhelmed me, swinging between depression to mania. Over the next several years, my behavior became more erratic, until things came to a head one night in 2016 as police untrained in deescalation arrested me in my home while I was in the midst of a mental health crisis. I woke up in jail and was sentenced to a Virginia Department of Corrections (VADOC) prison. 

Now, after years of fighting, the VADOC still refuses to properly acknowledge my preexisting head trauma, as well as nine other concussive blows I suffered while in Virginia custody.  

From the very beginning, I was denied medical care, even though I reported six walnut-sized lumps across the back of my head along with common concussion symptoms such as nausea and blurry vision. The institution was also informed of my past traumatic brain injury (TBI), though they chose to ignore this. In the past decade, dozens of medical, neurological, and psychological reports, often across disciplines, have called attention to the unquestioned correlations between TBI and criminalized behaviors. Yet, to date, there has been no attempt to provide follow-up medical care, including new scans for other concussive blows that I’ve sustained. This is telling and speaks of willful ignorance because scientific research can inform how we understand culpability in our criminal legal system and the basic minimal care that must be afforded to those who are, and will be, imprisoned.

This seems like it would be a “no-brainer”—these institutions declare themselves departments of “corrections,” yet there is no attention paid to research on the very organ that directly determines behavior. Why does Virginia, with its DOC budget of $1.5 billion per year, continue to ignore such an integral piece of behavioral science? This information is crucial for staff who may not recognize unacceptable behaviors as symptoms or results of brain trauma and incarcerated people overwhelmed by the daily sensory overload of prison.

In a piece published by Prism about incarceration and brain trauma, reporter Tamar Sarai reported, “An overwhelming percentage of the country’s incarcerated population and survivors of abuse (who may also be incarcerated) live with brain injuries, many of which are undiagnosed. The carceral system erroneously argues there’s a clear line between ‘victim’ and ‘offender,’ yet brain injuries are still incredibly high for people on either side. Research estimates that over half of the nation’s incarcerated population has sustained at least one brain injury in their lifetime, creating challenges that both amplify the horrors of life inside prison and could help explain past behavior that led to their incarceration. For survivors of domestic abuse, brain injury prevalence is notably high as well, making the quest to restabilize their lives more difficult while also heightening their vulnerability to criminalization.”

It’s clear that David’s experience is not unique. About 46% of incarcerated people have experienced traumatic brain injuries. 

“Now [46%] is a really soft number because what does that mean? If you’ve had a TBI with loss of consciousness, does it mean you’ve been in a coma? Does it mean you’ve had a concussion? I still think when you compare that number to the estimates for the general population living with a disability due to a TBI—which are closer to 2%—that the population of people who are incarcerated have experienced brain injury at much higher rates,” said Dr. Mark Harniss, an associate professor at the University of Washington in rehabilitation medicine and disability studies. 

Harniss also worked as the principal investigator on a grant focused on translating evidence about TBIs to practice within the Washington state DOC. 

Research on this subject is difficult: neurological history can be complicated, and factors like TBI can also overlap with an individual’s psychiatric history and substance abuse. Nevertheless, Harniss feels this research can have a direct impact—especially when there are so few resources for incarcerated people with TBIs. 

“In terms of the chronic side of TBI, I think in general, most states don’t have programs that address that,” said Harniss. Even screening probationers for TBI symptoms is a strategy that was only recently introduced in Colorado—one of the few states that have any protocols in place for incarcerated people with a TBI.

Another main issue stems from an interpersonal level: corrections staff are not usually trained to work with individuals who have had TBIs. 

“Mental health is much more in a rehabilitation model. Correctional officers are much more in a command-and-control kind of model,” said Harniss. As part of his grant, Harniss set up screening protocols and statewide deescalation training for corrections officers. According to Harniss, deescalation is especially important because individuals who have experienced a TBI are likely to be punished for presenting in what is interpreted as a noncompliant manner.

Harniss also identified where he thinks intervention could be most effective: when an incarcerated person leaves prison. Supportive housing, for example, could go a long way toward helping people navigate the stresses of reintegration and would help to reduce one of the most painful threats that face people with TBIs: the risk of recidivism and a return to prison. 

“I just feel like the space where there’s the most potential is at reentry,” said Harniss “And so to me, that’s where a lot of attention should be given. That’s a space where there’s a lot of points of failure.”