When I leave my cell, I leave with a plan. I am headed to the trash, the ice machine, the phone, and back to my cell with my head down, my pace fast. I set my course, half hoping my folks won't answer my call and I can get back to my cell quicker, and half terrified that they won't, confirming my desolation. I count my steps.

Somewhere between the trash and the ice, around step #73, a member of my community stops to say hello and ask me a friendly question. I am flooded with irritation. I snap and answer curtly, get back on my track, and start over at step #1. I have to get the ice in my cup and back to my room as efficiently as possible, as quickly, with as little interruption as I can. I keep my head down, a conditioned response from years of worrying my face might be cut, never knowing what's around the corner. 

I panic when I see a guard. I panic when I see the violent groups that coalesce in the absence of guards. I panic in the morning and at night. I am always alert. Last night, a woman was stabbed in the head. A woman I know. A woman with a 30-year sentence. She passed out in front of our dorm, handcuffed, in a pool of blood. I stayed in bed because there was nothing I could do. 

This morning the dorm officer and the rec officer got into a fight. They were the only officers in the unit and they stood face to face, shoved and swore, while 400 women watched, unattended. Neither officer raised their fist, but there was a moment when if one of them had flinched it would have come to blows. 

Ice chuckles into my cup, and I hurry back to my cell. Safe.

Being held in a dangerous environment for 18 years is a different kind of trauma than experiencing a one-time traumatic event. Before I was locked in solitary confinement for a year in the county jail, before I had ever been shackled, showered, or screamed at, I was already deeply affected by trauma. My mother and father were heroin addicts in the 1980s and weren't able to care for me. They left me in the care of my father's parents, a little dirty and hungry, while they suffered addiction, incarceration, and separation. When I was reunited with my mother at the age of 12, I was exposed to drugs, neglect, and sexual violence. A few years later, my first intimate partner burned me with cigarettes and set my belongings on fire. When I was 22, police arrested me, accusing me of minimal involvement in a violent crime. 

My life has always been hard, but these particular events I was able to navigate and survive. 

It was time that caved me in, and now, I've crumbled to pieces.

Trauma is usually divided into big-T trauma (a major event such as rape, natural disasters, and major car accidents), little-T traumas (an event with usually mild to moderate impact like the death of a pet, divorce, or an incident of bullying), and C—cumulative trauma, which is when trauma is extended over time and possibly generations. Cumulative trauma results from long periods of repeated exposure to stressors without any hope of solution. These stressors can be instances of oppression, deprivation, or continual threat to one's safety or humanity, such as systemic racism, slavery, or, in my case, incarceration. 

Every minute of the day feels as if there is a giant snake contracting around my chest. Sometimes I lay in my bunk in the corpse pose and try to relax my body, one small section at a time. I can make a little progress with my feet, a little more with my knees, but my chest is caught in a trap. If I can relax it for one second it seizes right back up. Invasive nightmares, dissociative events, crippling anxiety, and substance abuse—my symptoms could earn me a heavy diagnosis that could include personality disorders, obsessive-compulsive disorder, depressive disorders, bipolar disorder, anxiety disorders, dissociative disorders, and so on—any of which would result in many psychotropic medications and big psychiatric bills. However, my treatment would fail to address the specific ways the carceral system has left me, my family, and society worse than before. 

That's because while the Diagnostic and Statistical Manual of Mental Disorders, better known by its acronym as the DSM, includes trauma from captivity as a prisoner of war or a victim of torture as criteria for Post Traumatic Stress Disorder (PTSD), it only includes interactions with the criminal justice system (along with racism and discrimination) as a V code. This means that whatever adverse psychological consequences come from it are not classified as a disease or diagnosis, and cannot be covered by an insurance policy.

As the official list of mental diseases recognized by the American Psychiatric Association (APA), the DSM has gradually become an instrument with enormous power. Insurance companies require a DSM diagnosis for reimbursement, and the list shapes research funding. 

This research and its findings too often reflect the invested interests of its board members. Many of those board members are stockholders in big pharmaceutical companies that represent political ideology outside of health and wellness. Even as far back as 2006, 56 percent of the 170 panelists selected to review DSM-4 had at least one tie to the pharmaceutical industry, according to researchers from the University of Massachusetts-Boston.  

In 2020, 58 percent of those in state prisons and 63 percent of those in jails met the criteria for drug dependence or abuse. There is currently no substance abuse or mental health counseling available to us.

Post Traumatic Stress Disorder was first acknowledged as a psychological disorder in the third edition of the manual, and codified into the most recent, DSM-5, as a specific category for stress disorders which result from "exposure to actual or threatened death, serious injury, or sexual violence." Since that time, many researchers and organizations have pressured the APA and subsequent volumes of the DSM to include subcategories of PTSD: Disorders of Extreme Stress Not Otherwise Specified (DESNOS) or complex PTSD, and more recently Post-Incarceration Syndrome (PICS). These additional diagnoses would encompass larger life experiences and recognize the consequences of chronic trauma scenarios. PICS has been classified by a specific cluster of mental health symptoms in addition to chronic PTSD: institutionalized personality traits, social-sensory disorientations, and social and temporal alienation. 

A psychiatric diagnosis has serious consequences, as the correct diagnosis is critical for the correct treatment, but attempts to include stressor-specific subsets of PTSD in the last two editions have been shut down. As a result, many circumstances of trauma such as domestic violence, coercion, child abuse, and their subsequent symptoms, are not fully accounted for within the PTSD category. The longer an individual is exposed to these traumatic experiences, the more likely it is that they will be adversely affected, and that it will take longer to recover.

See also: 'A modernized, streamlined incarceration experience.' New prison technology surveils life on both sides of the wall.

Living in prison is one of those traumatic experiences. As a growing number of studies have found, it causes irreparable psychological harm and, as a result, people who endure it are left with debilitating mental health symptoms. To the average citizen, it goes against their sensibilities to consider the prisoner a victim and their incarceration a trauma. Since the 1950s, researchers have studied what Gresham Sykes called "the pains of imprisonment." Yet popular beliefs around deviations from social norms and punishment for those deviations prevent adequate conversation about the harms inherent in prison life, dismissing the social responsibility to take into account the rights and needs of incarcerated individuals. This leads to an "anything goes" mentality when it comes to our treatment, which greenlights the violence, neglect, and other torture enacted across the U.S. prison system. 

There needs to be accountability for the psychological damage caused by incarceration as more and more members of society experience it, for longer periods of time.  If society upholds the pretense that jails and prisons act as a rehabilitative service, we must consider what condition these people will be in when they re-enter society.

I was sentenced to life in the Georgia penal system and, like every other Lifer I know, believed that my behavior, my ability to stay in a straight line and be quiet, would somehow prove that I was worthy of a second chance. I have been in the penal system since 2004. I have been changed, but not for the better.

Despite my history of substance abuse, I have not received one minute of counseling, nor been offered a single rehabilitative course. In the last five years, the institution has become flooded with narcotics. The facts of my reality are backed by a U.S. Department of Justice special report, updated in 2020, which showed 58 percent of those in state prisons and 63 percent of those in jails met the criteria for drug dependence or abuse—compared to only 5 percent of the total adult population. There is currently no substance abuse or mental health counseling available to us, unless you happen to be serving a probated sentence. I have not had the opportunity to improve my social skills, gain any emotional intelligence, or increase my chances for a successful re-entry. 

In fact, my preexisting mental health concerns have been exacerbated from living under extreme stress and fear. What was normal on the outside has become unheard of here. No one sits down to a nice meal together, meets with friends, or enjoys a sunset. What is normal here will be viewed as startling or strange to people who have not been in my shoes. Here I stay to myself. I can eat a meal in 90 seconds. 

From the beginning, even the incarcerated individual expects the micro-managed order associated with a total institution. In reality, residents within the institution immediately encounter an inconsistent world of arbitration with unpredictable consequences.

There was pressure to do the impossible, which suspended us in fear. The torture of it was that there wasn't trouble every time you were caught without a button.

When I first entered prison in Georgia, the institutions were overstaffed and there was an officer at every turn. Their surveillance alone was maddening.  I was afraid that doing anything wrong would inevitably extend my stay. I couldn't grasp that I would be here for 20, maybe 30 years regardless, so day after day I walked on this impossible line. After some time of never knowing when someone was coming to observe me reading, sleeping, or eating a smuggled apple, I was always watching myself to make sure I looked like I was doing the right thing; a double consciousness. Never knowing when a guard would come rifle through my socks, taking my extra pair, I wore two at a time, afraid I would get caught. We were made to walk in straight lines in silence, with an officer enforcing order every 50 feet. 

Once, I let myself slip and commented on a bird, a rare sparrow, flying low, to no one in particular; a normal thing, to hear the sound of my own voice. I was caught and made to step out of line, ordered to talk to a brick wall, humiliated and left behind. I became a new target for the guard's attention: more pat searches, denied passage, walls to talk to. I bit down on myself like my whole being was a tongue; to comply, to adjust, to taste blood.

All of the rules were petty, conflicting, and difficult to adhere to. Each year after it got real cold, I was issued a coat. The coat had to be buttoned, and I had to wear my ID card clipped to the outside left collar. I was allowed to wear a hat, but only if I had on my coat, and never indoors. My hair had to be up, my shirt tucked in, and my shoes approved—boots back then, unless I had a medical reason to be excused from combat. A few years ago, the boots were collected and we were each issued a pair of bright orange generic Crocs. We knew then that the budget had been cut and the paradigm changed. The boots meant hard labor, pseudo-military bullshit. The Crocs ushered in the discharge of pretenses about rehabilitation and confirmed that we were simply bodies being stored and neglected. People slipped and fell in the rain and snow, ankles were broken. Now, since the Crocs have torn to pieces and never been replaced, we just wear our tennis shoes, purchased by our family or passed down from our friends gone home. 

None of these rules are being enforced right now, and shoes aren't anyone's concern. If you have shoes you are considered rich and fortunate—if your peers haven't stolen them from you. When the rules were in place, when our shirts were tucked in and our hair was up tight, the shoes had to be lined up under our bed, straight as arrows; shower shoes, house shoes, tennis shoes, boots. A specific order. Back then a missing button, a loose hair, or the wrong shoe could result in reprimand, loss of privilege, or isolation. Each of these held a significant weight in our scant environment, but from the perspective of someone with no release date, the consequence could be the denial of one-day freedom. Even to this day, I line up my shoes. I spend an extra minute getting them just straight. 

The rules were sometimes racist, always dehumanizing and impossible.

The thing about a missing button, like a fallen strand of hair, was that it was mostly out of our control. The buttons cracked in the laundry, or fell off over time, and there was never access to extras. It was against the rules to possess a needle or thread, but also against the rules to be missing a button. There was pressure to do the impossible, which suspended us in fear. The torture of it was that it wasn't like there was trouble every time you were caught without a button. I could wear a missing button (or be guilty of any other petty infraction) for weeks and no one would say a word, but one day when someone was having a bad day or had something to prove, there would be hell to pay. The problem was, I never knew. 

In 1970, a researcher at the University of Rochester proved that stress which arises as a consequence of unpredictable circumstances and occurs in the absence of an outlet for frustration has devastating health consequences. More recent investigations into correlations between socioeconomic status and health outcomes show that folks living in poverty suffer from more stress, which over time destroys people's bodies. This corresponds perfectly with my life behind bars. 

In prison, the only method of safety was to not be seen; to move quickly, in big groups, and hope to not be noticed. We focused on being invisible. For years, we would think invisible thoughts, pray to gods to go unseen, or intentionally look as oppressed as possible to blend in. Yet, there was no way to measure up, to adhere to all the arbitration. By the very nature of our incarceration we were always guilty, always wrong, and always waiting for the other shoe to drop. 

The rules were sometimes racist, always dehumanizing and impossible. If you were white you couldn't have braids, if you were Black you couldn't have an afro. If hair grew on your face you had to shave it, but our armpit hair grew on forever and we were rarely issued razors. We could be written up for looking a staff member in the eye or for not doing so; both could be deemed insubordination. I started speed walking everywhere I went. Anytime I stepped out of the safety of my cell I would run and hurry back. I still run and hurry back, for the same and for different reasons. The old ways are almost completely gone, but those of us who endured them still feel the heavy pressure to be just right. Some of us have turned the system on its head, and now the strong among us make the rules.

In the last five years, since the time of the Crocs, there has been a steady decline in the number of staff members in every facility in the state. There are no longer officers at every turn, in fact sometimes there isn't an officer in sight. No noticed buttons, ID cards, braids, or buns. Gang violence and a sense of lawlessness has replaced the old turnkeys and their micro-aggravations. 

In many ways, the confusion has stopped. Before, we never knew who was being targeted, why, or what the consequences would be. The officers have been replaced, and either you are enacting a new social order or you are still walking fast to safety, still trying to be invisible.

There's a rumor that this facility is closing and we will be transferred farther South. The bright side is that the water may be cleaner, but the real problems aren't structural and we know that they'll follow us wherever we go. 

I have been transferred from one facility to another six times in the last 20 years. Most of the time it was random and unexpected, as most transfers are. General population distribution means that in the middle of the night I could be told to pack up my belongings, which will be sifted through and downsized, and be put on a van to go to an unknown destination. I will be made to leave without telling anyone I know goodbye, without the opportunity to complete my goals, wrap up my affairs, or solidify my plans for the future. For years I have slept with one ear open, expecting to be hauled away from the people I know or to discover that the people I know have disappeared. 

That is the thing we must do: always listen. There was a time, when there were officers, they would announce that we needed to be by our doors, or lock our doors, or line up at the door.

Lately, since a few people have died and one woman tried to escape, it's becoming a more regular thing to be counted and inspected like we used to be. But it's hard to hear what's going on over 96 women, three televisions, and, in the summer, the fans. There is a roar of noise, and anytime it swells I have to look to see what is going on. It could be an instruction I don't want to miss, like the old days, or it could be some kind of danger: a fight, an emergency. For example, a few weeks ago my dorm caught on fire. The fire alarm did not go off and after it was extinguished, the maintenance man found duct tape holding the electrical outlet together. Most of the time the noise is nothing, a funny commercial or a message from one person to another, but I never know, so I look out of my cell window 20 times a day. In the absence of a reliable alert, I stay vigilant throughout each day and I sleep on edge at night. My hair is literally falling out.

There is a part of me who thinks one day I will be reunited with the trees and the grass and the part of me that was free. But I know I will never be that person, not after all of this damage and disorder.

I have a hard time seeing myself beyond here. In fact, I feel strongly that I'll always have this looming sense of fear in my life; this uneasy sense of scarcity, danger, and unpredictability. It may seem trivial to be afraid of shoes and buttons for 20 years, but it is the arbitrary nature of the offense, with the uncertain outcomes, that has ground me down; the standards I can never achieve, even if my life and my livelihood depends on it. The threats have evolved, but my response to them, and the responses of those around me, are still the same; intensified, more and less irrational, over time.

The stress and anxiety that results from the long exposure to trauma in prison has changed me forever. If I imagine myself released from here, somewhere where the threats have subsided and my chronic fears resolved, I can only see myself weeping. At first maybe from relief, but then on and on from deep, deep scars of stress and sorrow.

At night, I dream that I have done something that will keep me here forever. I dream that something has happened, beyond my knowledge or control; a reflection of the circumstances of my arrest and every day of life since. In my dreams, I am hiding dead bodies and scrubbing blood out of carpets, things I have never done. I often dream I am not in prison, but that I have to sneak back in before my absence is discovered. In most of my dreams, I am gathering the basic supplies we lack: good food, medicine, and adequate clothing (and sometimes lip gloss and perfume!). I dream I am bringing these things back in so that me and my neighbors can survive.

I was talking to an old friend the other day who was very excited to tell me that she had bought a pair of bongo drums. I was surprised to hear that she plays, and then she told me, "I only know the few things you taught me." I was surprised to hear that I had played a drum, that I had taught someone to play. Me, who avoids people, who never makes eye contact, even with people I know and trust. Me, who wears my shoulders around my ears, sweats and shakes. When I tried to remember that person she knew, I could see myself: barefoot, cheerful, creative. I did play the drums, the keyboard, and the flute. I was able to build a fire, recite a poem, and tell a joke.

There is a part of me who thinks one day I will be reunited with the trees and the grass and the part of me that was free. But I know I will never be that person, not after all of this damage and disorder.

I fill another cup with ice water. When I hold it up to the light, it sparkles like glitter from the metals, the sediments from the old pipes, like Star Trek. There are rats the size of cats circling the dry storage. They live off the rice and bread and beans, like we do. 

Without taking the harmful consequences of incarceration seriously, and without recognizing the psychological damages it produces, the conditions that cause incarceration-induced traumatic stress disorders continue to flourish while we continue to languish. 

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Carla J. Simmons has been incarcerated in the state of Georgia since 2004. She holds an associate degree in Positive Human Development and Social Change from Life University and is a member of the Justice Arts Coalition. She has contributed to Scalawag as an author and artist, as well as Rattling the Bars on the Real News Network and the 2024 edition of the Other Almanac. She takes seriously the work of social justice and has become passionate about trauma in the carceral system. Exploring this topic has helped her raise awareness as well as process her own horrific experience. She is a survivor of state and domestic violence, a member of a very small, very supportive family, and someone who believes in the huge significance of now, while hoping for better, for us all.