Between 40 and 60 percent of prisoners have brain injuries or serious illnesses that affect their behavior. Scientists disagree on the extent to which such injuries cause antisocial behavior, but there is concern that these individuals may reoffend once released. Some doctors in the West are urging not to wait and to invest resources in their rehabilitation while they are still behind bars.
Among the criminals with brain diseases is 19-year-old Ilnaz Galyaviev, who opened fire at a school in Kazan last week. His exact diagnosis is unknown, but according to “Kommersant” it is about brain atrophy, which is the gradual death of its cells. This disease leads to memory loss and impairment of cognitive functions – a person loses the ability to think clearly, confusion of consciousness arises. Over time, personality disintegration begins, and the process can be accompanied by numerous mental pathologies.
There are many reasons why brain atrophy can develop. One of the most common is chronic stress, which increases blood levels of the hormone cortisol. The problem can be hereditary or acquired – for example, as a result of head trauma. Scientists in many countries see a direct link between brain damage – both from physical injury and disease – and crime. A study conducted at the University of Oxford shows that people with traumatic brain injuries, especially those sustained at a young age, are more likely to commit violent crimes than those who have not suffered similar injuries. Scientists hypothesize that damage to the prefrontal cortex of the brain, which is responsible for decision-making and social interaction, may occur at the time of injury.
The Russian text translates as Kazan shooter Ilnaz Galyaviev has been diagnosed with a brain disease. In the coming months, doctors will determine whether Galyaviev is sane. A healthy prefrontal cortex makes connections between a person’s actions and their potential consequences, predicts outcomes, and suppresses thoughts that might lead to socially unacceptable actions. If there are disturbances in the prefrontal cortex, a person may exhibit excessive aggression and impulsivity.
Swansea Prison is a Victorian building with modern additions on the coast of Bristol Bay in Wales. It is a men’s prison: in some cells those already convicted serve their sentences, in others they await sentencing. The regime is not the harshest in Britain – rarely do they hold people whose sentences exceed a year and a half. But Kris Allen will spend several years in Swansea. The guards call him “difficult”. He himself admits: “Sometimes I thought I was going crazy. I didn’t understand what was happening to me. I was extremely aggressive”. In Swansea, they say, they see a second mission as equally important as their main one – to reduce the risk of reoffending.
In 2015, the British non-profit organization Disabilities Trust, which specializes in the rehabilitation of people with brain injuries, sent its report to the government: with the help of colleagues from other countries, experts estimated that up to 60% of prisoners had head injuries that could affect their behavior and lead to repeat offenses. The organization offered to help. The Department of Justice liked the idea, but they had some conditions: “It should be a program that can be run by anyone. We are not going to hire psychologists, neurologists, and psychiatrists. These should be things that supervisors can do themselves. It should take very little time. And it should cost us nothing.
Ivan Pitman spent several months trying to make contact with the prisoners through a small window in the door of their cell. The Disabilities Trust agreed. So a team of volunteers from the Trust arrived in Swansea and met Chris Allen for the first time. Allen comes from a poor family. He grew up with a gang of friends in a crime-ridden neighborhood. In his youth, he began “entertaining” himself with petty theft, which often landed him in the dock.
Five years ago, Allen was in a car accident, suffered a severe head injury, and fell into a coma. He was saved by a neurosurgeon. But after the accident, everything changed – Allen became more aggressive and his crimes more brutal. Meanwhile, he increasingly forgot the details of his life. “When they told me what I had done, I just couldn’t believe it. I couldn’t remember most of what had happened.” So, with little understanding of what was happening to him, Allen ended up in Swansea. As his sentence was over 18 months, he was due to be transferred to another prison, but volunteers from the Disabilities Trust intervened.
Neuropsychologist Ivan Pitman has spent his life working with people with brain disorders. In recent years, he has been helping prisoners in the hope that one day they will be released and able to return to normal life. “The most difficult part of my job is determining what constitutes an injury. If you look at my patients, you will never understand that they have deviations. They look just like us,” Pitman says. When Pitman first began working with prisoners, he spent several months talking to his patients through a small window in the cell door. The men in the cell were not open to conversation at first, and trust had to be earned each day.
Experts believe it is possible to prevent recidivism by providing a person with tools to help them manage their emotions while still in prison. After long weeks, the door to the cell opened. Pitman stood on the threshold. Two guards stood on either side of him. More weeks passed. After some time, Pitman was able to identify a group of 15 people who were more willing to make contact than others and confirmed that they had suffered head injuries. The prison set aside a small, separate room for them: now only a table separated Pitman from the prisoners, but the patients no longer showed aggression. “At this stage, I already know that their ability to remember and process information is impaired. That’s why, over time, we start doing simple things: we meet at the same time every day, then we talk for 15 minutes, then we drink tea for five minutes, then we go outside and play ball for 20 minutes. My job is to make them feel safe, not to show aggression, and to always know what’s going on. Because when do we feel fear? When we’re not in control of the situation. In such a situation, Pitman says, a person’s heart rate increases, sweating occurs, and adrenaline begins to be produced. A healthy person usually finds a way to calm down. But not Pitman’s patients. “When they get nervous, they will go to the limit. And most likely, they will hit you.”
To what extent is the head injury responsible for this behavior? It does not affect whether a person feels aggression or not. It does, however, contribute to the manifestation of that aggression. “Brain injuries will never make you a different person. But they can certainly break your brakes,” says Pitman.
Paul Warren was recently discharged from the neurosurgery unit at Liverpool Hospital. He feels physically well, but he cannot live the same life as before. Every day, Paul goes to the convenience store around the corner, where he is greeted by an Asian cashier. Paul has known her for several years, but after an injury, he began using racial slurs every time they met.
According to experts, the main task in working with such people is to create a very predictable environment for them: “It’s like going to work and all the lights are green.” “He had never allowed himself to do that before. But that doesn’t mean he’s never thought it. It is only now that he is thinking it that he is saying it. That’s the difference between a person’s behavior before the injury and after,” Pittman says. According to the expert, the main task in working with such people is to create a highly predictable environment for them. It’s like you’re driving to work and all the traffic lights are green. The red one just doesn’t light up on your way. You don’t stop. You don’t get nervous or angry.
In the United Kingdom, the vast majority of people seek psychiatric treatment voluntarily. However, the Mental Health Act allows for compulsory treatment of certain patients in some cases. The first document in the country establishing this practice was adopted in 1800 after an assassination attempt on King George III. The criminal turned out to be James Hetfield, a former military man. On a May evening, during the performance of the national anthem in the theater, Hetfield tried to shoot the king, but missed. At the trial, two surgeons confirmed that Headfield had sustained several head injuries while participating in military actions. The defense insisted that he was insane at the time of the assassination attempt. At the time, criminals found to be insane were exempt from punishment. To prevent the same thing from happening to Headfield, Parliament hastily passed a law allowing compulsory treatment.
In many countries, people who have committed a crime and have been declared legally insane are ordered to receive treatment. Madelene Lillegren says that not only head injuries can affect a person’s behavior. She conducted her own study and found that crimes are often committed by people with frontotemporal dementia – a specific form of degenerative dementia characterized by atrophy of the frontal and temporal lobes of the brain. “These brain areas play a crucial role in building relationships with other people, in impulse control. Can we really say that these people made the decision to commit a crime? Or did the crime result from their illness? I think the truth is somewhere in the middle. It is reasonable to assume that changes in the human brain that occur in frontotemporal dementia can be the cause of criminal behavior,” says Lillegren. “At the same time, a person with psychopathy, who lacks the ability to empathize with others, is more likely to commit a crime, but they may reject this idea because these individuals are often on medication for long periods of time.”
Doctors are aware of many risk factors that can lead to antisocial behavior. When specialists talk about head injuries, they are not just talking about confirmed concussions – sometimes a minor blow is enough. Often, people who have not lost consciousness after an injury do not seek medical attention because they are too busy with everyday activities and simply take painkillers. Other known risk factors are mental illnesses that affect decision-making: schizophrenia, bipolar disorder (a condition characterized by alternating periods of depression and mania), and even depression alone. “Studies conducted by scientists indicate that such health problems may increase the likelihood of antisocial behavior in about 10% of cases. That is a very small percentage of people. For most others, a head injury alone is not enough – it is a combination of factors,” warns Dr. Sina Fayzel, a psychiatrist at the University of Oxford. “For example, if you grew up in a family where your father was violent in some way, was cruel and ended up in prison, the risk also increases.”
Numerous studies confirm that the vast majority of people with mental health problems are no more prone to violence than others. And most violent acts are committed by people who do not have a diagnosed mental disorder. Dr. Faizel admits that he never claims that certain health problems could be the cause of a crime committed.
Judges and juries find it much easier to understand the defendant’s problem when it is visible in medical images. “In some cases we can say that. For example, one of my patients attacked a person because he thought that person was spying on him. In his mind, he was only defending himself. In other cases, the diagnoses slightly reduce the degree of responsibility, but do not eliminate it. When it comes to settlement, it is much easier for a judge or jury to understand the situation if it is a significant problem, such as a brain tumor or severe head injury. The defense can often present an MRI scan and visually show the difference in function between a healthy brain and a damaged one, relying on technology. In many cases, however, the scans are inconclusive. Even in schizophrenia and Alzheimer’s disease, significant changes are often not visible. “We have to rely on doctors’ conclusions, which are based on conversations with patients, medical history, and how other people judge this person’s behavior,” says Sina Fayzel.
Hugh Williams, a British professor of clinical neuropsychology, has stricter criteria: he is confident that only one or two out of a hundred people with brain damage will suffer irreversible consequences. And he fully shares his colleagues’ views on the interplay of factors – both social and health – that drive a person to commit a crime. “If you are a child under the age of five and you are in the poorest 5% of the population, you are simply more likely to suffer a serious head injury due to your circumstances,” says the professor. Williams compares what happens to the people he observes to a never-ending hangover syndrome.
This is how Chris Allen, who is currently in prison in Swansea, describes his condition.
He is now being helped in his rehabilitation by volunteers who are teaching him the basics: how to cope with stress, how to calm down, how to follow a routine so that events are always predictable, and how to see the green light on the street more often.
Volunteers hope that these simple techniques will help Allen get out of prison once and for all and stay out.
“I learned a lot from them,” says Allen. “The coolest thing is to avoid confrontation with other people and to know how to calm down. I am very grateful to them.”