Volume 13, Number 2, 2005
“I was just a little girl when my father said he was going to shoot me and my mother. … We didn’t have any choice, so we went and stood where he told us to, facing the other direction with our backs toward him. When my mother heard the gunfire, she pushed me to the ground as hard as she could. After I heard the gunshot, I couldn’t understand why my mother was still standing. Then I heard my father laughing. He shot the gun in the air just to scare us.… He had beaten me so many times when he was drunk that I couldn’t go to school in that condition.… Alcohol and drugs became my escape. I dropped out of school.”
—A prison inmate, in an interview with Kathleen Brewer-Smyth
When Kathleen Brewer-Smyth, assistant professor of nursing, was earning her doctorate at the University of Pennsylvania and researching her dissertation on how traumatic brain injuries relate to violent behavior, she turned to the prison system to find women who had both committed violent crimes and been victims of abuse.
She says she was looking for a physiological relationship between trauma and acts of violence. “Was it because they were exposed to violence, or is there an actual change in the brain due to abuse that could trigger violent acts?” she asks.
Before Brewer-Smyth joined the College of Health and Nursing Sciences faculty last year, most of her nursing career was in neurology, neurosurgery, neurorehabilitation and trauma. From that experience, she says, “I realized any insult to the central nervous system can affect behavior,” but she wanted to learn more “in order to teach others how to work effectively with neurologically impaired populations and trauma victims.”
Brewer-Smyth studied the literature and conducted private interviews and neurological examinations on more than 120 women in minimum- and maximum-security prisons. She was investigating incidents of physical and sexual abuse predating their crimes that could have resulted in the neurobiological damage and related factors that might have contributed to criminal behavior. She says she has found strong evidence that the neurobiological outcomes of abuse and violence could contribute to the victims eventually exhibiting violent, abusive and self-destructive behaviors.
She describes her findings in “Women Behind Bars: Could Neurobiological Correlates of Past Physical and Sexual Abuse Contribute to Criminal Behavior?” in the journal Health Care for Women International. In it, she writes, “Taken together, these studies could differentiate females who become incarcerated for violent and other criminal behaviors from other females, based on the severity of past abuse perpetrated against them.”
She also has concluded that additional large-scale studies are needed “to confirm this premise and to test interventions for abuse and violence prevention and rehabilitation of victims of abuse.” She notes that 32 percent of female inmates have been convicted of violent crimes, but little is known about the neurobiological factors that could be affecting their behavior and their health.
When Brewer-Smyth conducts her research, she questions inmates about histories of physical and sexual abuse, and she tests their basal salivary cortisol levels in the morning and evening. Cortisol, a steroid hormone produced by the hypothalamic-pituitary-adrenal axis, is released in the body from signals in the brain during stressed or agitated states.
Along with other regions of the brain, this axis affects behavior, responses to stress and inhibitions.
It’s already known that excesses or deficiencies of cortisol lead to physical symptoms and disease states, Brewer-Smyth says, but she has suspected that it also could lead to acts of violent behavior, predisposing these female victims to becoming criminals.
In working with some of the inmates, she says, she first had to convince them that she couldn’t get them out of prison sooner or change their sentences, and so there was nothing to be gained by lying to her. At times, she also had to overcome what she calls a “Who do you think you are?” attitude.
She says she won the inmates’ trust by demonstrating an interest in hearing their stories and caring about them based on knowledge and understanding from years of working with neurologically impaired populations and trauma victims. Eventually, she says, “The majority of them really opened up.”
Brewer-Smyth says she was shocked at the degree of trauma many of the women had experienced. One told her, “I committed murder, but I never wanted to kill anybody. I only wanted him to stop hitting me.”
More than 90 percent of the 123 inmates she interviewed had neurological histories predating their crimes. Brewer-Smyth found abnormal levels of cortisol in women who had experienced severe and repeated trauma. But, those levels were significantly more abnormal in abused women who had committed violent crimes, she says.
In an article in Biological Psychiatry, she writes, “A greater number of traumatic brain injuries with loss of consciousness and suicide attempts, more recent abuse and low morning basal salivary cortisol levels could be associated with dangerous violent criminal behavior, including murder, in female prison inmates.”
“We’re locking up victims of abuse,” she says. “They need to be treated as victims as much as criminals.”
—Barbara Garrison