**Understanding and Responding to People in the Criminal Justice System
Who Live with Self-Inflicted Violence**

**By Ruta Mazelis**

**Introduction**

Every day, every hour, inmates in jails, prisons, and juvenile detention
centers are bleeding, burning, and bruising themselves. These actions,
known as Self-Inflicted Violence (SIV), are often considered to be the
behaviors of the highly disturbed or pathologically manipulative, yet
they are actually the most effective coping mechanisms many people have
to manage their lives in the moment. When understood, the cuts, bruises,
and blisters of SIV can guide us to better understand incarcerated
individuals. They also provide us with ideas to stimulate healing and
change not only for those individuals, but for our criminal justice
system as well.

SIV is the intentional injuring of one's body as a means of coping with
severe emotional and/or psychic stressors. It is used most commonly to
manage the aftereffects of earlier trauma, especially experiences of
childhood physical, sexual, and emotional abuse or severe neglect.
Because the majority of persons who are incarcerated in correctional or
psychiatric facilities have histories of trauma, staff in these
facilities---both clinical staff and line staff---will work with people
who self-injure and should have a clear understanding of:

-   what self-injury is,

-   who does it,

-   why people do it, and

-   what staff can/should do about it.

**What is self-inflicted violence?**

Clinically, SIV has been referred to by many terms, including
"self-mutilation," "delicate skin cutting," and "parasuicidality." While
commonly used, all of these labels misrepresent the behavior and
meanings of SIV. Mutilation is not a goal of someone who self-injures,
and some forms of SIV leave no scars. While cutting is one of the most
prevalent methods of SIV, other common forms of self-inflicted violence
used are punching, hitting, burning, bruising, head-banging, picking, or
scalding the body. Each of these serves its own purpose and these
different methods are not often interchangeable.

Many myths abound regarding SIV. One of the most prevalent is that the
behavior is a failed, minimal suicide attempt, known as
"parasuicidality." In fact, the opposite is actually true. SIV is often
used to manage the strong emotions that lead one to consider dying, and
it often serves to avert suicide attempts. Practices that seek to
eliminate SIV (including physical and chemical restraints, seclusion,
constant observation, and intervention) actually increase the risk of
successful suicide by removing an effective coping strategy that acts as
an alternative to ending one's life.

**Who self-injures?**

Currently, attention to SIV by the media and the mental health field has
focused on youth, particularly adolescent girls. While use of SIV often
begins in childhood or adolescence, it is not uncommon among men and
women of all ages. Therefore, while SIV is an important issue in the
juvenile justice system, it is equally important that it be understood
in the adult system as well. Other assumptions regarding people who live
with SIV are that they are white and of middle or higher socioeconomic
class. This is inaccurate. SIV is utilized by men and women of all
classes, races, and cultures. The common denominator amongst people who
live with SIV is a history of some form of trauma. Research shows that
the vast majority of incarcerated people have known histories of
childhood trauma, especially childhood abuse. For example, a recent
study of men incarcerated in a county jail reported that 59% of them
acknowledged some form of sexual abuse occurring before the age of
13.[^1] A history of abuse, as well as other forms of trauma, is
especially likely for people in the criminal justice system who struggle
with mental health and/or substance abuse problems. Rates of prior
trauma are as high or higher for individuals in the criminal justice
system as for individuals in the mental health system.[^2]

Childhood trauma often has profound repercussions in later life and can
greatly impact a person's physical, emotional, and spiritual being. As
reported by NYCASA, a 1999 study of female inmates at Bedford Hills
Correctional Facility in New York found that over 80% had a history of
childhood physical and sexual abuse, and more than 90% had experienced
battering or sexual assault during their lifetime.[^3] In a study of
inmates on death row, 100% had histories of family violence and more
than 87% were victims of severe physical and/or sexual abuse and met
criteria for Post Traumatic Stress Disorder.[^4]

A history of abuse does not excuse criminal behavior, but it may help
explain it. For example, the use of alcohol and other substances is an
effective method of "self-medicating," commonly used by traumatized
people to "numb-out" or escape from intrusive thoughts and emotional
pain. The use of illegal substances, and the behaviors necessary to
access such drugs, often results in criminal behavior and incarceration.
Similarly, most of the people (male and female) who work in the sex
trade are victims of childhood sexual abuse. People who learn as
children that sex is the most effective currency for maintaining
relationships and feeling valued (not to mention making money) find as
adults that sex work still meets these needs. The vast majority of
incarcerated women have been arrested on charges of solicitation, drug
offenses, or both.

Childhood trauma can take many forms, including experiences of:

-   early loss and separation, especially of a parent /caregiver or
    sibling due to

    -   illness

    -   death

    -   divorce/separation

    -   drug and/or alcohol abuse

    -   incarceration

    -   neglect

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-   poverty and deprivation

-   severe illness, hospitalization, surgery

-   war

-   racism

-   childhood abuses, including

    -   sexual assault, including incest

    -   physical assault

    -   emotional abuse

    -   witnessing domestic violence, and

    -   neglect.(emotional and/or physical)

These same traumatic events or conditions during childhood are the
antecedents of SIV.

> *. . . the age at which their abuse and/or neglect had occurred played
> an important role in both the severity of their self-destructive
> behavior and the form it took: The earlier the abuse, the more
> self-directed the aggression. Abuse during early childhood and latency
> was strongly correlated with suicide attempts, self-mutilation, and
> other self-injurious behaviors. . . .Histories of sexual abuse, in
> particular, predicted continued suicide attempts, self-mutilation, and
> other self-destructive acts. Severity of neglect scores predicted
> continued suicide attempts, self-mutilation, and other
> self-destructive behaviors. During this period, the subjects with the
> most severe separation and neglect histories were the most
> self-destructive.*
>
> ---Bessel A. van der Kolk, M.D.[^5]

Acts of SIV often lead to psychiatric interventions. By far, the most
common psychiatric label given to those who self-injure, especially
women, is Borderline Personality Disorder. This diagnosis, while now
acknowledged to be strongly correlated with childhood trauma, often
elicits intensely judgmental and punitive treatment from clinical staff,
both in psychiatric hospitals and in corrections facilities. While the
most common accurate diagnoses given to childhood trauma survivors are
Post Traumatic Stress Disorder and any of the Dissociative Disorders
(and the recognition that anxiety, depression, extreme mood swings and
hearing voices are not uncommon amongst trauma survivors), these are not
usually applied to people who live with self-injury. Also, recent
research has identified that people with psychiatric diagnoses not
previously considered to be related to childhood trauma, such as
schizophrenia and obsessive-compulsive disorder, do have a very high
prevalence of childhood trauma and that the trauma might be related to
the development of those disorders.[^6]

> All too often, the result of psychiatric diagnosis is to stigmatize
> certain people as dishonest, unlikable, and, worst of all, hopeless.
> Nowhere are these iatrogenic (harm caused by treatment) effects of
> diagnosis more pernicious than in the criminal justice system, and no
> diagnosis hurts more than that of a personality disorder. . . people
> who are so described are treated as if their disruptive and
> self-destructive acts are simply evidence of moral weakness, dishonor,
> and perhaps evil.
>
> ---Joel Dvoskin, Ph.D., A.B.P.P.[^7]

**Why do people deliberately cut, punch, or burn themselves?**

Just as the substance use and sex work (described above) serve a purpose
and solve a problem for survivors of childhood trauma, so too does SIV
(and most other trauma-related behaviors) serve a functional purpose for
those who do it. Typically, SIV is driven by the underlying need for
self-regulation and serves as a means of grounding, a way of managing
highly dissociative states that impinge and impair functioning. It helps
the person manage intense, seemingly overwhelming feelings, memories,
and experiences. It is best understood as an act of self-defense,
defending oneself from being consumed by the overwhelming distress of
despair, numbness, or the re-experiencing of abuse. When asked how SIV
helps, those who live with it say it helps them to:

-   feel real, get a sense of their physical boundaries

-   diminish intense emotions such as despair, terror, grief, self-hate,
    rage, shame, or helplessness

-   facilitate dissociation, to disconnect from their sense of self when
    overwhelmed

-   diminish dissociation, when the sense of disconnection is unwanted;
    SIV serves as "grounding"

-   symbolize internal pain through an external expression

-   remember without consciously knowing; re-enacting of previous abuse
    as an attempt to gain mastery

-   communicate what cannot be said verbally

-   express anger at someone else by directing it at their own body;
    i.e. punching themselves to avoid violence towards another

-   stop or diminish flashbacks of abuse

-   communicate between personalities in those with Dissociative
    Identity Disorder (formerly known as Multiple Personality Disorder)

-   symbolize spiritual beliefs

Many people who self-injure feel no physical pain at the time of the
acts of SIV. While some clinicians believe that this is a result of
certain naturally produced brain chemicals (endogenous opioids known as
endorphins), this theory is flawed. The wounds of SIV are often minimal.
Many require little or no medical attention. They are no different from
many minor wounds that are the results of accidents, and these do not
cause any sort of chemically induced relief. The absence of pain from
self-injury is much more likely related to the depth of the
psychological disconnection (or dissociation) the self-injuring person
is experiencing at the time. Also, as SIV is often used as a release for
profound emotional pain, persons who self-injure report that the
emotional pain is so overwhelming it makes the less intense physical
pain from the self-injury irrelevant. Many people who cut themselves do
so as an act of expression and release of deep and very difficult
emotions. As a poet once wrote: "I hurt so much, I bleed."[^8] People
who have survived traumatic childhoods often struggle with dissociation,
which is the sense of having one's thoughts, feelings, and identity
separate from one's body. Dissociation is often described as a sense of
"extreme spaciness." While an effective form of self-preservation,
dissociation leads to feelings of disconnection and/or unreality and
thus interferes with learning new ways of being in, and interacting
with, the world. For some people it may be a preferable state of being
when overwhelmed; at other times dissociation is unwanted or
frightening. SIV is often used as a tool to manage dissociation, either
to increase it or to decrease it. As a result, SIV serves as an
"all-purpose tool" for many institutionalized or incarcerated people.

Persons with histories of severe abuse who experience emotional numbness
often turn to SIV to "feel something." This is particularly poignant for
those who are kept in isolation most of the time. Inmates in highly
restrictive environments who have no hope for change in their situations
not only tend to self-injure, but often do so with escalating severity
as their helplessness and hopelessness increase. For these people the
SIV serves as a way of feeling "something" in the midst of continued
intolerable emotional and experiential numbness.

> Many of the most violent men in prisons mutilate themselves at least
> as viciously as they mutilate their victims (that is to say, very
> viciously. . . . The things these men do to themselves are the most
> common, "everyday" events in the world of maximum-security prisons. .
> . . At the least violent of the self-mutilative spectrum, these men
> cut their wrists or forearms or other areas of their bodies. . . . On
> the other hand, I have also known prison inmates who have cut off
> their own penis and testicles, others who have torn out their own
> toenails, and others who have blinded themselves. When these various
> forms of self-mutilation no longer bring feeling, many of these men
> come to realize that the only way to kill the pain in their souls is
> to kill the whole body. For these men, their living death is an
> intolerable, zombie-like existence.
>
> ---James Gilligan, M.D.[^9]

Abuse survivors, especially those who disconnect from themselves and
others through dissociation, often struggle with a fluid sense of
personal boundaries. Because their personal physical and emotional
integrity have been repeatedly violated they may literally not know
where they end and "other" begins. Sometimes the sight of a cut and the
presence of one's own blood help a person literally understand his/her
own physical boundary. It is a way of experiencing that "what is
bleeding is me, it is where I begin."

Abuse survivors' struggle with identifying and exercising personal
boundaries is especially difficult when they are housed in facilities
that are unsafe or overcrowded, or when they are kept in isolation
(isolation of someone who self-injures is a very common institutional
reaction to SIV). The need to manage strong feelings (or absence of
feeling anything) in these settings contributes to the use of SIV. This
is especially true in the face of ongoing sexual and physical violence
and intimidation while incarcerated, when the inmates' options are so
very limited.

Violence in correctional facilities, especially sexual assault, is
remarkably common. Research in seven Midwestern prison facilities showed
that over 20% of male inmates experienced pressured, coerced, or forced
sexual contact, both by other inmates and by staff.[^10] Women in
correctional facilities also face threats and acts of violence and
sexual abuse. For many the experience of sexual abuse and
objectification is a continuation of their childhood and adolescent
lives. "Women prisoners report experiencing routine sexual harassment
once incarcerated. In addition, many women in prisons and jails across
the U.S. report they are victims of sexual abuse by staff. Reported
incidents include male guards touching women's breasts and genitals when
conducting searches, watching prisoners while they shower and dress, and
raping prisoners."[^11]

**What can staff do to stop people from injuring themselves?**

Typically, interventions for self-injury focus on the immediate
prevention or stopping of acts of SIV. While this seems logical, it
generally results in an escalation of SIV rather than diminishing it.
The reason for this is simple: coercion, even if intended to "prevent
harm to self" is inherently retraumatizing. It reenacts or mimics
previous trauma, with its resultant loss of control, helplessness, fear,
outrage, and overwhelmed coping.

> *I have been in prison for the last five years. Three years ago I
> tried to kill myself. I cut my throat. It was serious. They put me in
> solitary confinement for 14 months. I didn't talk to anyone. I had a
> really hard time in there. I got extremely depressed.*
>
> *I just cut myself an hour ago. Now I do it in the shower. I don't
> tell the prison shrink that I do this. It's too risky. I cut my
> thighs, stomach, or breasts so I can hide it. I bandage myself with
> toilet paper and scotch tape. I will be released in two months. Until
> then I pray I don't get strip-searched for anything.*
>
> *I don't want anyone to "help me" ever again.*
>
> ---d.t.[^12]

"Doing nothing" actually leads to better outcomes than coercive
measures, especially those that involve restraint, seclusion/isolation,
and/or forced medication (chemical restraint). Unfortunately many
psychiatric and criminal justice practices and policies promote
revictimization. However, as awareness of the impact of trauma on mental
(and physical) health increases, more clinicians, judges, and wardens
are reconsidering the use of interventions that ultimately cause more
harm than good. While interventions that directly address trauma and its
impacts are very useful, what might be even more significant for healing
is the creation of a trauma-informed environment. Such an environment
promotes collaboration between staff and inmate to identify what is both
helpful and hurtful when struggling with the urge to self-injure. People
who have survived trauma have experienced frightening helplessness and
need as much control over their lives as possible. This includes making
decisions about SIV. All staff can be taught skills to promote
collaboration, insight, and communication even while focused on the
maintenance of security and safety.

> Many who self-harm have limited ability to modulate or tolerate
> emotional responses to the world, and often do not have a very
> concrete sense of self. I have often found that although it may be the
> anxiety that surfaces first and can trigger the self-harm, that as
> individuals learn to sit with that anxiety for longer and longer
> periods of time (delaying the self-harm) these people often discover
> another emotion that is below the anxiety, be it sadness, fear, anger,
> abandonment, etc. I have also seen where memories are beginning to
> surface and the self-harm can push that back down. What I have seen as
> very powerful is beginning to see their self-harm as a language, as
> saying "I am overwhelmed" or "I am scared" or "this feels too
> familiar," in combination with learning that they can at first delay
> the act for a few moments (which then allows them to try a few more
> moments, and so on and so on), and the behaviors slowly begin to
> lessen. As they begin to experience some intense emotions and then see
> that these emotions can lessen by experiencing them, they begin to
> lessen the behaviors. My work the last 7--9 years with incarcerated
> females has really opened my eyes to these behaviors. We see some of
> the most extreme: massive cutting with objects inserted into cuts,
> both eyes blackened, head banging to the point of a laceration. These
> women have some of the most severe abuse histories and are some of the
> most unattached. Many have histories of torture by families with many
> generations of extremely sick individuals.
>
> ---Dr. Maggie Zinman, Ph.D.[^13]

*Systemic Change*

To reduce SIV and to promote recovery from other sequelae of trauma,
violence between inmates or between staff and inmates must ultimately be
addressed. Healing can rarely occur when physical and/or emotional
safety is threatened. Correctional facilities in which this is a problem
must strive to create, implement, and enforce policies to end the
ongoing violence, rape, molestation, or intimidation within the
institutional setting. This pertains to actions between inmates as well
as between corrections staff and inmates. As this current violence
decreases, so will the need for SIV to cope with the repercussions of
unsafe environments. The most successful approach to decreasing
violence, intimidation, and misunderstanding is to provide staff and
inmates with information about the prevalence and repercussions of
severe childhood trauma, to facilitate the creation of trauma-informed
environments00000000000000, and to promote the development of
trauma-informed practices and policies. For example, when corrections
officers receive trauma training they often learn to perceive inmate
behavior from a different, less personal and inciting perspective. This
attitudinal shift often results in decreased reactivity towards the
inmates, which then influences inmate responses to staff as well. The
establishment of trauma-informed criminal justice facilities requires a
philosophical shift in the culture of the facility.

> *. . . I've just spent almost three weeks locked in a filthy little
> box for cutting myself. Twelve of those days were spent naked while
> being viewed, by anyone who entered the office, via closed circuit TV.
> It was awful. I wished for death many times. . . .*
>
> *The guards violated my rights to confidentiality by ripping the pages
> out of my journal and art therapy book, passed them around amongst
> themselves, then punished m by sentencing me to solitary
> confinement---because they didn't like what I had said. . . . I'm not
> ashamed to say that I'm afraid to go to confinement--- because of the
> hostility displayed towards me by various guards. Confinement has
> always been a notorious place to be beaten up and otherwise abused,
> without any witnesses anywhere. I was severely brutalized down there
> seven years ago and I wear a brace on my leg as a result, and will for
> the rest of my life.*
>
> *I am fighting the desire to slash my entire body open.*
>
> CeCe[^14]

*Individual Action*

To successfully help a person to stop using SIV, it is necessary to
consider several questions:

-   Is the inmate educated about trauma and, specifically, about the
    relationship between trauma and SIV?

-   Does the inmate have a desire to address SIV?

-   How does SIV help the inmate?

-   What problems is SIV meant to solve?

-   What does the inmate believe might be helpful to her/him to promote
    healing?

The answers can be determined by discussing the meaning and usefulness
of the behavior with the inmate. Working together with the person, that
knowledge can be used to develop alternative coping strategies that are
effective solutions for managing the triggers that lead to SIV. Not only
will this exchange serve to develop a customized approach to minimize
the use of SIV, but it will build trust and model a way of solving
problems without using self-directed or other-directed violence. An
attitude of respect promotes integrity.

> Although the choices of alternatives to SIV may be more limited in
> correctional systems than outside, self-abusive inmates can address
> the emotional and situational triggers of self-injury by:

-   Exercising (whether by doing pushups in one's cell or walking in the
    yard), to provide physical release for intense emotions or psychic
    stress

-   Speaking with someone who is able to listen compassionately and not
    overreact to the idea of SIV; this may be a mental health
    professional or a peer

-   Meditating or using progressive muscle relaxation and grounding
    techniques to facilitate calm and manage dissociation

-   Writing, drawing, or using music and other creative pursuits, which
    are often helpful in facilitating expression of feelings that cannot
    be verbalized, and

-   Learning about the impacts of trauma and healing, as such
    information can contextualize SIV for that person. Many trauma
    survivors, especially those who experienced abuse in early
    childhood, are unaware of the profound and ongoing impact that the
    trauma has on their adult lives.

People living with SIV can benefit from the following health, mental
health, and support programs that can be conducted effectively in
corrections settings. In addition to specific skills, these programs
provide a sense of connection and meaningful activities. What is most
important is providing a space, place, and opportunity for the learning
of self-respect, boundaries, communication, and emotional expression.

-   Education regarding

    -   self-injury, especially as it relates to a history of trauma

    -   harm-reduction principles

    -   strategies to create alternative behaviors

-   Group therapy and support groups to

    -   identify and address the sequelae of trauma

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    -   explore the meanings of SIV

    -   develop and practice alternative choices for managing the
        triggers that lead to SIV

    -   practice mutually supportive, healthy relationships amongst
        peers. Inmates with trauma histories report that peer support is
        the greatest single factor in changing self-perceptions and the
        need to self-harm.

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-   Purposeful, community betterment, self-improvement, and support
    programs such as

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-   mentoring

-   gardening

-   animal training

-   job training

-   parenting

> I am a 40 year-old woman recovering from SIV. Since coming here (to
> prison) with a life sentence in 1997 I've grown beyond the need to
> self-injure, though the impulse still arises in highly stressful or
> painful circumstances. The healing I've found was self-motivated, not
> due to being treated for the disorder while property of the Department
> of Corrections. Their method of dealing with inmates who self-harm is
> not much different than some outside ones. Inmates who hurt themselves
> are punished for it by being stripped and confined for up to 3 weeks
> in a small bare cell. Of course this is done under the guise of
> protecting that inmate from themselves. . . . I found strength by
> forming my own support group consisting of people who were doing
> positive things for themselves. Some of those had self-harmed in the
> past and found other ways to deal with life. As I grew I began
> reaching out to people who were actively harming themselves, passing
> on what I had learned. I also took steps to begin healing from my past
> trauma, sexual abuse issues. I believe my healing there, the
> self-forgiveness I found, were the biggest achievements in no longer
> having the need to harm myself.
>
> Darlene D.[^15]

Helping an inmate look at the strengths that he or she has within is
more productive than focusing on what are often considered to be
pathological or manipulative acts. Acts of SIV often trigger intense
feelings (such as disgust or anger) in those who work with people who
self-harm. It may be easier to not "take it personally" if staff can
reframe their thinking about "manipulative" behavior in terms of an
inmate's attempt to *indirectly* communicate his/her story. For the
person living with SIV, the self-injury is an act of self-preservation
and self-help. It is not useful to punish a person who is attempting to
manage the pain of profound emotional and spiritual wounding.
Remembering the following may make it easier to be patient with a
self-injuring inmate:

-   Acts of SIV are helpful as well as harmful; people with histories of
    trauma, often severe, turn to SIV as a way of managing what feels
    unmanageable any other way.

-   The wounds of self-injury are seldom life-threatening; SIV is often
    used to avert suicide in people who are considering suicide.
    Mandating the elimination of SIV increases the likelihood of
    suicide.

-   Behavior change takes time.

**Trauma-Informed Correctional Systems**

Education about the consequences of childhood trauma is crucial for
staff and inmates alike. Training provides staff with the most effective
approaches for intervening with persons who self-injure, as well as for
all inmates who live with other sequelae of trauma, while increasing the
safety of everyone concerned. These trauma-informed interventions equip
officers and other staff to "provide a respectful human encounter, to
facilitate medical treatment if it is needed, to help begin or advance
the process of understanding self-injury as an adaptation or
reaction."[^16] As a criminal justice facility becomes trauma-informed,
incidents of violence towards self, staff, and other inmates will
decrease. This provides a safer environment for staff and inmates alike,
and reduces recidivism in the long run. For people who have lived lives
in which violence is the norm, it is crucial to provide opportunities
for understanding of their history and instilling hope for personal
change. With such support, even inmates with life sentences, and those
on death row, have transformed themselves.

> *I use my cutting as a way to hide my anguish, sadness, and guilt. If
> I use violence against myself I can typically hide all the negative
> feelings, appearing quite happy and content to those who don't know
> me. This decreases the questions and the prying. . . .The most help I
> have received has been provided by those with no psychological
> training, the other people who are housed here with me. The ones I
> have allowed close enough to get to know the real me. . . .When people
> aren't afraid of me or the fact that I may cut this helps me to feel
> "normal," which helps the desire decrease. Being in prison is in no
> way helpful to the sickness that thrives on hatred, loneliness and
> guilt. . . .What it all comes down to is yes, I am a felon, a
> murderer, a cutter. . . . But I am a sister, an aunt, a daughter, a
> granddaughter, friend, and lover. I am . . . a young woman who has
> survived herself.*
>
> ---Stephanie Sara Timothy[^17]

Change needs to occur on multiple levels, from policy development to
individual interventions. Stopping retraumatization is crucial. As of
2002, fourteen states had no law prohibiting sexual relations between
inmates and correctional staff.[^18] Education of corrections staff
regarding the prevalence of trauma histories in the people they work
with is also critical. Staff can learn how these histories impact the
lives of the inmates that they work with and can facilitate environments
that permit greater personal dignity and respect. As wardens
increasingly become aware of the benefits of trauma-informed facilities,
specific staff educational programs are being developed. Mental health
care providers who are experienced in the dynamics of abuse and the
process of recovery are developing trauma care strategies that address
inmate needs. Peer-driven activities that promote harm reduction and
healing from SIV and trauma are inarguably meaningful. Progress in these
areas is not only possible but has already begun. Judges, wardens,
corrections staff, mental health professionals, and former inmates are
leading the shift toward a trauma-informed criminal justice system.
Guides now exist to facilitate the launch of peer support groups for
trauma survivors. The greatest hope for profound change will come in the
collaboration between all stakeholders in the criminal justice system,
including former prisoners and providers who have lived with SIV.

**RESOURCES**

## Alderman, T. 1997. *The Scarred Soul: Understanding and Ending Self-Inflicted Violence.* Oakland, CA: New Harbinger Publications. (Also available from the Sidran Institute, 1-888-825-8249; www.sidran.org.)

Casarjian, R. 1996. *Houses of Healing: A Prisoner's Guide to Inner
Power and Healing.* Boston: Lionheart Foundation. (P.O. Box 194 Back
Bay, Boston, MA 02117; 781-444-6667; www.lionheart.org).

## Connors, R. E. 2000. *Self-Injury: Psychotherapy with People Who Engage in Self-Inflicted Violence*. Northvale, NJ: Jason Aronson. (Also available from the Sidran Institute, 1-888-825-8249; www.sidran.org.)

Deiter, P., Nicholls, S., and Pearlman, L. A. 2000. **"**Self-Injury and
Self Capacities: Assisting an Individual in Crisis." *Journal of
Clinical Psychology* 56 (9): 1173--91.

Harris, M. and Fallot, R.D., eds. 2001. *Using Trauma Theory to Design
Service Systems*. New Directions for Mental Health Services Series. San
Francisco: Jossey-Bass.

## Herman, J. L. 1992. *Trauma and Recovery: The Aftermath of Violence---from Domestic Abuse to Political Terror.* New York: Basic Books. 

Mazelis, Ruta, ed. *The Cutting Edge: A Newsletter for People Living
with Self-Inflicted Violence.* 1990-present.(Quarterly newsletter
published by and available from the Sidran Institute, 200 East Joppa
Rd., Suite 207, Baltimore. MD 21286-3107; written submissions via
e-mail: [**cuttingedge@sidran.org**](mailto:cuttingedge@sidran.org);
subscription orders: www.sidran.org, 1-888-825-8249.)

Mazelis, R. 2003. "Understanding and Responding to Women Living with
Self-Inflicted Violence." A publication of the Women, Co-Occurring
Disorders and Violence Study funded by the Substance Abuse and Mental
Health Services Administration. (Available free for download at
http://www.healingselfinjury.org/SelfInjury%20Fact%20Sheet%20Final.pdf.)

Moses, D.J., Reed, B.G., Mazelis, R., and D'Ambrosio, B. 2003 "Creating
Trauma Services for Women with Co-Occurring Disorders: Experiences from
the SAMHSA Women with Alcohol, Drug Abuse and Mental Health Disorders
Who Have Histories of Violence Study."

Prison Ashram Project. Human Kindness Foundation. P.O. Box 61619,
Durham, NC 27715; 919-304-2220; www.humankindness.org.

Saakvitne, K., Gamble, S., Pearlman, L.A., and Lev, B.T. 2000. *Risking
Connection: A Training Curriculum for Working with Survivors of
Childhood Abuse.* Baltimore: Sidran Institute Press.

## Trautmann, K., and Connors, R. 1994. *Understanding Self-Injury: A Workbook for Adults.*

Pittsburgh Action Against Rape. (Also available from Sidran Institute,
1-888-825-8249; www.sidran.org.)

Wilkerson, J.L., 2002. *The Essence of Being Real: Relational Peer
Support for Men and Women who have Experienced Trauma.* Baltimore:
Sidran Institute Press. (Also available for free download from
www.sidran.org.)

*Websites*

Healing Self-Inflicted Violence: www.healingselfinjury.org

The Sidran Institute: www.sidran.org

The National Center for Trauma-Informed Care:
http://mentalhealth.samhsa.gov/nctic/

[^1]: Johnson, R.J., Ross, M.W., Taylor, W.C., Williams, M.L., Carvajal,
    R.J., Peters, R.J. 2006. Prevalence of childhood sexual abuse among
    incarcerated males in county jail. *Journal of Child Abuse and
    Neglect* 30(1): 75--86.

[^2]: Jennings, A. 2005. "The damaging consequences of violence and
    trauma: Facts, discussion points, and recommendations for the
    behavioral health system. "Alexandria, VA. National Association of
    State Mental Health Program Directors and the National Technical
    Assistance Center for State Mental Health Planning. www.nasmhpd.org.

[^3]: Fact Sheet. New York State Coalition Against Sexual Assault
    NYSCASA, 63 Colvin Ave., Albany, NY, 12206; 518-482-4222;
    www.nyscasa.org.

[^4]: Freedman, D., 2000. Precursors of lethal violence: a death row
    sample. *Social Science and Medicine*, 50(12): 1757--1770.

[^5]: Van der Kolk, B. A. 1996. "The Complexity of Adaptation to Trauma:
    Self-Regulation, Stimulus Discrimination, and Characterological
    Development." In *Traumatic Stress: The Effects of Overwhelming
    Experience on Mind, Body, and Society,* ed.. B. A. van der Kolk, A.
    C. McFarlane, and L. Weisaeth. New York: Guilford Press.

[^6]: Read, J. 2003. "The Contribution of Early Traumatic Events to
    Schizophrenia in Some Patients: A Traumagenic Neurodevelopmental
    Model." *Journal of Psychiatry* 64 (4): 319--45.

[^7]: Dvoskin, J. "Sticks and Stones: The Abuse of Psychiatric Diagnosis
    in Prisons" *The Journal of the California Alliance for the Mentally
    Ill* 8(1): 20--21. **(**also available at The Zero---The Official
    Website of Andrew Vachss, www.vachss.com).

[^8]: Robin et al. 2005. *The Cutting Edge*, 15(59).

[^9]: Gilligan, J. 1996. *Violence: Reflections on a National Epidemic*.
    New York: Vintage Books, p. 40.

[^10]: Struckman-Johnson, C., and Struckman-Johnson, D. 2000. "Sexual
    Coercion Rates in Seven Midwestern Prison Facilities for Men." *The
    Prison Journal* 80: 379--90.

[^11]: Amnesty International. 1999. "Not Part of My Sentence: Violations
    of the Human Rights of Women in Custody." Washington, DC: Amnesty
    International.

[^12]: d.t. 2000. *The Cutting Edge* 11(64).

[^13]: Zinman, M., Ph.D. 2007. Personal communication.

[^14]: CeCe. 2002. *The Cutting Edge* 12 (48).

[^15]: Darlene D. 2006. *The Cutting Edge* 16 (64).

[^16]: Deiter, P., Nicholls, S., and Pearlman, L. A. 2000. "Self-Injury
    and Self-Capacities: Assisting an Individual in Crisis. *Journal of
    Clinical Psychology* 56 (9): 1173--91.

[^17]: Timothy, S.S. 2007. *The Cutting Edge* 17(67).

[^18]: Amnesty International USA.2004.