We Keep Us Safe: Mutual Aid Across the Walls

By Olivia Pandolfi

From PHN Issue 42, Spring 2020

In the midst of the COVID-19 pandemic, people around the world are mobilizing to demand the release of incarcerated people. The prison system poses a legitimate public health threat because it is difficult to practice social distancing while incarcerated. As a result, the virus spreads quickly, usually after being introduced by a guard or other workers.

People with loved ones in prison and who want to abolish prisons have mounted phone zapping, letter-writing, tweet storming, and other campaigns to pressure officials to decrease the population of prisons and jails. These demands to release people often center aging, immune-compromised, and other vulnerable populations, but can extend to everyone. In many cities, car caravans or “drive-ins” have been organized to disrupt traffic and show support for decarceration measures while keeping participants safely distanced from one another in their cars. In these protests, people deck out their cars with signs and slogans such as FreeThemAll4PublicHealth and #FreeOurPeople, naming local officials to demand action.

Another kind of action is the movement of money and resources. The Inside/Outside Soap Brigade and Survived and Punished NY are helping organizations around the country send soap and other essential supplies to incarcerated people, and other mutual aid networks are mobilizing in similar ways. Hundreds of bail funds in the National Bail Fund Network have posted bail for people to get out of jail, with New York City’s Emergency Release Fund focusing specifically on transgender, gender nonconforming, or intersex folks.

An online map of COVID-19 cases behind bars created by activist journalists tracks confirmed cases as well as potential cases reported by people inside. The map is on the internet at COVID19BehindBars.com. The creators of this map are also planning to print and mail a newsletter for people in prison, with information on where COVID-19 outbreaks are happening in prisons, tips on protecting yourself from COVID-19, and hotlines to call if someone is sick in your facility. To request the newsletter, or to report possible cases of COVID-19 at your facility, write to Corcione Media LLC, P.O. Box 40062, Philadelphia, PA 19106.

People are taking important action from inside of prisons and immigrant detention centers, too. By mid-April, incarcerated people in at least eight states had begun hunger strikes to demand urgent action from the facilities where they’re held for cleaner conditions, better health care, and release. An estimated 3,000 incarcerated people across the country have participated in more than 75 protests, according to Perilous Chronicle, a digital media project. The majority of the hunger strikes have been in immigration detention centers, but inmates in Cook County Jail have also been refusing meals. Incarcerated people have also participated in protests, vigils, and actions held outside facilities’ doors by holding up signs to windows, making noise in concert with honking horns and shouting protesters outside, and recording phone messages about their experiences and stories that are played over speakers at mass actions.

Due to this pressure, people have been released from prisons, jails, and detention centers all over the country. As of mid-April, in at least 16 states, county jails have reduced their populations, some by as much as 30%.

Promoting Mental Wellness in the Time of Coronavirus

By Rosa Friedman

From PHN Issue 42, Spring 2020

Being locked up is difficult enough under normal circumstances, and right now circumstances are far from normal. You may be experiencing a wide range of emotions, like loneliness due to lack of contact with peers and visits from loved ones, helplessness and anger at not being able to protect yourself, or numbness at the unrelenting nature of this crisis. You might shift dramatically between moods with little
warning, or have more thoughts about or symptoms related to other traumatic experiences. Whatever you’re feeling, remember there’s no wrong way to react to what’s happening. It’s normal to feel ungrounded, helpless, or just “off” in such an unusual situation, one where there’s so much uncertainty and powerlessness. It’s also normal to feel extra calm, especially if you’ve been through a lot of crises before. What’s important is to focus on what’s within your control and to do what you can to
care for yourself, mentally as well as physically. Here are some ways to practice selfcare during this difficult time:

  • Follow a routine. Try to go to bed and wake up at the same time each day. Make a schedule for yourself and stick to it. It will help you stay grounded and not feel too overwhelmed.
  • Exercise. Movement stimulates chemicals that relieve stress and lift your mood, as well as keeping you physically healthy and enabling you to sleep better. Try the following exercises, with a 30-second break in between to catch your breath:
    • Squats (multiples of 5)
    • Push-ups (multiples of 5)
    • Jumping jacks (20+)
    • Plank (1+ minutes)
    • Lunges (10+ each side)
    • Crunches/Sit-ups (multiples of 5)
    • Burpees (multiple of 5)
  • Meditate. One practice called a body scan can be helpful for dealing with anxiety and other intense feelings. Sit with your eyes closed and make your inhales and exhales last the same amount of time. Starting at the top of your head, check in with each part of your body. Notice what feels comfortable and uncomfortable, whether there’s tightness, heat, or other sensations. You’re not trying to change anything, just notice it. If you get distracted, gently bring your focus back to where you left off without chastising yourself. Go through each part of your body, all the way to your toes.
  • Write. This could mean journaling or writing letters to people on the outside. Writing about what you’re feeling and experiencing can be a great release and a positive way to work through it. If you’re feeling helpless, it might help to write to local news organizations about how the jail or prison where you’re being held is
    dealing with coronavirus.

Don’t beat yourself up if you struggle to follow this advice. It can be hard to find focus and motivation when you’re dealing with such challenging circumstances. The most important self-care practice you can do is be kind and patient with yourself, so give yourself credit for whatever you try, no matter how small and insignificant it feels!

If You’re Having Symptoms of COVID-19

By Suzy Subways

From PHN Issue 42, Spring 2020

Most people with COVID-19 have no symptoms, or their symptoms are mild. But some have:

  • Cough
  • Fever
  • Tiredness
  • Shortness of breath
  • Difficulty breathing, in severe cases

In an article for Prison Legal News, Michael D. Cohen, M.D., explains that people in prison who are over 50 may be at higher risk for severe symptoms. There is currently no vaccine or cure for COVID-19. Scientists have started testing some possible medicines, but they don’t know if these will work yet. It’s important to ignore rumors and just get health information from reliable sources like the Centers for Disease Control and Prevention (CDC) and World Health Organization.

What to Do If You Get Sick

Dr. Cohen writes that people who are mildly ill should stay in their cells as much as possible during their illness and wear a mask if possible. If you feel short of breath, pain or pressure in your chest, confusion or excessive sleepiness, or your lips, face, or fingertips look blue, you need prompt medical care. You may need to go to the hospital and receive oxygen.

“Please keep an eye on the people in your unit who are sick in their cells,” Dr. Cohen urges. “If they develop shortness of breath or worsen in any way, they need access to the clinic for further medical evaluation.”

Some Tips for Mild Symptoms

  • Mild symptoms can include fever, cough, and sore throat.
  • Take tylenol (also called acetaminophen) for fever or body aches.
  • Gargle warm salt water (about a quarter spoonful or generous pinch of salt in a regular cup) when you wake up and before you go to bed for sore throat. Use cough drops or drink tea or other warm beverages for cough.
  • Stay hydrated by drinking water.
  • Vapor rub from commissary can help cough and congestion.
  • If you are congested, breathe deeply and cough forcefully to get the mucus out of your lungs at least a few times every hour while you’re awake.
  • Make sure you get up and move around a little bit every few hours during the day, even if you are fatigued and just want to sleep.
  • Try to eat balanced meals at mealtimes, even if you do not feel hungry.
  • Get at least 7 hours of uninterrupted sleep every night.

Exercises to Make Your Lungs Stronger

An exercise described by Dr. Sarfaraz Munshi and nurse Sue Elliott from Queen’s Hospital in London may help get air into the bases of your lungs, in order to prevent pneumonia. You can do it several times a day, as soon as symptoms start.

  • Lie on your back and take 5 deep breaths.
  • Hold each breath for 5 seconds and release it.
  • At the end of the 6th breath, give a big cough (covering your mouth).
  • Repeat the steps above so you have done everything twice.
  • Lie on your stomach and take slightly deeper than normal breaths for 10 minutes.
  • Most of the lung is in the back, and lying on your stomach allows you to more fully inflate your lungs, so try not to spend all of your time lying on your back.

Respiratory Steam

Philadelphia herbal medicine practitioner Kelly McCarthy recommends doing a respiratory steam. You can do this with just hot water. This can help to clear out mucus or a dry cough, or if you have a lower respiratory condition in your lungs.

How to do this: Place just-boiled water in a bowl, put your face over the bowl, put a towel over your head to create a mini sauna around your face, and breathe in deeply. Take care not to burn yourself with the steam.

Ideally, McCarthy recommends using herbs like rosemary, thyme, sage, oregano, lavender, chamomile, mint, or eucalyptus, if you can get any of these. If you do, place 2 tablespoons of dried or fresh herbs in a large bowl, add just boiled water, and follow the instructions above.

Call the COVID-19 Hotline

The COVID-19 Prison Hotline is 410-449-7140, for incarcerated or detained people to call when they have coronavirus symptoms, when there’s an outbreak in their unit, or when they are being denied adequate medical care for coronavirus. The Incarcerated Workers Organizing Committee and Fight Toxic Prisons, the groups that set up the hotline, announced: “We want to know where and when there is an outbreak, so that we can help mobilize support networks and media to lift up the demands of people on the inside.”

Ask for Help from Loved Ones Outside

If you have a loved one on the outside who can support your health, make sure to sign the form giving them access to your health information. If you get sick or are denied treatment, keep notes and paperwork on everything. Give your loved one the name of a friend in your facility, and ask that person to call your loved one on the outside if your symptoms become worse or if you are taken to the infirmary and can’t call. Your loved one can also call medical staff, the warden, and deputy warden to politely ask what is being done to care for you, and call back to make sure they do it.

Ways to Boost Your Immune System

McCarthy and other herbalists suggest trying these—some foods and spices may be available at commissary or from package companies, depending on your state and facility:

  • Fruits and vegetables, including leafy greens and citrus fruits
  • Canned sardines, mackerel, and oysters
  • Fermented vegetables, such as sauerkraut or kimchi
  • Ginger powder, cayenne powder, cinnamon powder, coconut oil, garlic powder, honey, lemon juice, oats, black pepper, and Italian seasoning, especially thyme
  • Walking, which can help your immune system
  • Not smoking
  • Herbal tea, especially chamomile tea, to help with stress and insomnia
  • Sleeping 9 to 12 hours a night—sleep helps clear out stress hormones and is the time the immune system is most active

Dr. Cohen recommends keeping a three-week supply of food in case you miss a commissary day due to lockdown. And, as our nurse friends remind us, laughter is still the best medicine.

How to Protect Yourself and Others from COVID-19

By Lorin Jackson and Frankie Snow

From PHN Issue 42, Spring 2020

Handwashing

Handwashing can help prevent the spread of COVID-19. Here are some tips for handwashing:

  • Wash your hands with soap and water for at least 20 seconds.
  • Make sure you rub all hand surfaces with soap, including thumbs, fingertips, and backs of hands.
  • Dry with a paper towel if possible, and use that to turn the water off.
  • Always wash your hands before and after eating, and after coughing, sneezing, blowing your nose, or being in a crowded area.
  • If soap and water are not available, use hand sanitizer that contains 70% alcohol or more.
  • It is believed that the virus enters the body through the eyes, nose, or mouth. Avoid touching your eyes, nose, and mouth with unwashed hands.

Coughing and Sneezing

  • Any time you cough or sneeze, try to cover your nose and mouth with a paper towel and immediately dispose of it, then wash your hands.
  • If you don’t have a napkin or paper towel, cover your mouth and nose with the crook of your elbow and sneeze.
  • If you are wearing a mask, try your best to pull the mask down and sneeze into a paper towel, then put your mask back on and wash your hands.

Protective Gear

Tips for wearing a mask:

  • Wearing a cloth mask can help prevent the spread of COVID-19. The current recommendation is that everyone wear a mask at all times when around other people. This stops people from unknowingly giving the virus to others and helps protect people from exposing themselves to it.
  • A mask should be removed if someone is experiencing difficulty breathing or is unconscious. Additionally, someone should not wear a mask if they cannot remove it on their own.
  • For a mask to be effective, it should fully cover the nose and mouth and fit closely to the face.
  • It’s important to wash your hands after touching your mask or removing it.
  • Masks should be washed after each use and dried completely before wearing again. If this is not possible, take your mask off as soon as you enter your cell, leave it near the entrance, and wash or sanitize your hands after removing.
  • Wearing masks for hours every day can irritate your skin and cause sores. This usually happens where the straps are pressing against the skin. If this happens around your ears, place some gauze or a little bit of fabric from a T-shirt under the straps to protect your skin.

The following may be at high risk for severe illness from COVID-19:

  • People 65 and older—but people in prison may be at higher risk starting at age 50, since it’s hard to live healthy inside
  • People with chronic lung disease, diabetes, chronic kidney or liver disease, obesity, or moderate to severe asthma
  • People who have serious heart conditions such as atrial fibrillation or uncontrolled high blood pressure
  • People who have compromised immune systems, such as those with poorly controlled HIV or prolonged use of corticosteroids or other immune-weakening medications

If you are at higher risk of getting very sick from COVID-19, you should:

  • Stock up on supplies you may need if you get sick and need to stay in your cell.
  • Wash your hands often.
  • Limit close contact, especially with people who are sick.
  • Try to practice social distancing if you are able and avoid crowds.
  • If you develop shortness of breath, it is an emergency and you need to be seen by a doctor.

Sanitizing Surfaces

Research has shown that COVID-19 can remain on surfaces for hours to days. The following recommendations have been made by the CDC in order to keep your living environment as clean and safe as possible:

  • Disinfectants (including: diluted bleach, alcohol solutions with at least 70% alcohol, hydrogen peroxide, Clorox, Lysol) should be used daily to clean high-touch surfaces, such as tables, doorknobs, light switches, toilets, faucets, and sinks.
  • If possible, it is best to wear gloves while cleaning and wash one’s hands immediately after cleaning or removing gloves.
  • For hard (non-porous) surfaces: Diluted bleach can be used to prevent the spread of the virus. It must have a contact time of 1 minute. To prepare a bleach solution, mix 5 tablespoons (1/3rd cup) bleach per gallon of water, or 4 teaspoons bleach per quart of water.
  • Follow the directions of the specific product to determine if it should be diluted and the best application method. Shared bathrooms should be cleaned and disinfected as frequently as possible, especially in circumstances where a person who shares the bathroom is showing signs of illness.
  • While it is unknown how long air inside a room occupied by a sick person is potentially infectious, it is best to improve ventilation as much as possible to decrease the time that respiratory droplets remain in the air.
  • For clothing:
    • Clothing of someone who is sick can be washed with other people’s items.
    • Wear gloves when laundering items for someone who is sick and throw away
      gloves after they’ve been used.
    • Don’t shake dirty laundry—try to minimize the spread of the virus in the air.
    • Launder items in the warmest possible temperature and dry it completely.
    • Always wash hands after wearing gloves or after cleaning with bare hands.

What’s Up with COVID-19?: Here’s the Scoop

By Lorin Jackson and Frankie Snow

From PHN Issue 42, Spring 2020

As of April 30:

  • There are more than 3.25 million cases confirmed worldwide, with roughly a million incidents of recovery from the disease, and almost a quarter million have died.
  • In the United States, there are about a million cases, with almost 130,000 recovered and more than 60,000 deaths.
  • The United States has more recorded deaths than any other country. One possible reason is that there is not a coordinated national or regional effort to test people and track cases to contain outbreaks.
  • Congregate settings, such as nursing homes, detention centers, prisons/jails, and homeless shelters are extremely vulnerable to massive outbreaks of COVID-19 and account for some of the spikes in cases. This is because it is difficult to properly quarantine and maintain physical distancing in these settings.
  • As of mid-April 2020 in New York City, the NYC Department of Correction said that 369 inmates tested positive out of more than 3,900 in custody at Rikers Island and smaller facilities.
  • As of April 29, more than 70% of people incarcerated in federal prisons who have been tested for COVID-19 had the virus.
  • Chicago’s Cook County Jail is one of the largest and most impacted jails. More than 800 people had tested positive by April 28, and it had one of the highest infection rates in the country. In April, activists held a two-day emergency bailout where more than 130 people were able to leave the jail.

Lifestyle Changes

  • The COVID-19 pandemic continues to halt economic and social activity on the outside. A pandemic is an outbreak of a disease that spreads across multiple countries or continents.
  • Most states have shelter-in-place ordinances happening, as well as curfews that mandate people stay at home unless absolutely necessary (like grocery shopping or picking up meds).
  • If folks do leave the house, they are to wear masks covering their nose and mouth—surgical face masks, bandanas, or scarves, for example. Many people are sewing or crafting their own face masks because companies that supply masks are out of stock and cannot create masks fast enough to supply the demand.
  • K-12 schools and colleges are closed for the rest of the school year in many states. Some schools anticipate that next fall or even into next winter, they will be holding classes online.
  • To reduce the risk of getting sick by going out in public places, lots of people are ordering essential items online. Delivery services (groceries, packages, etc.) are overwhelmed and often struggling to meet demand. Only essential businesses are allowed to be open and operate right now. These include grocery stores, some restaurants that deliver food, pharmacies, gas stations, laundromats, medical facilities, the post office, and hardware stores. If you do go out, the expectation is that you will wear a mask, practice good hygiene, and practice social distancing. Social distancing is the practice of leaving at least 6 feet between yourself and every person around you. Most stores and businesses are enforcing social distancing by limiting the number of people who can go in at a time.
  • Shelter-in-place orders and recommendations to stay at home are in an effort to “Flatten the Curve.” The goal of this public health strategy is to slow the spread of COVID-19 and prevent a rapid spike in cases that will exceed the healthcare system’s capacity to care for patients. There have been more cases in New York City than any other city in the United States. The situation in New York City is grim; hospital systems have limited resources to care for everyone who is sick.
  • COVID-19 disproportionately affects Black and Latinx communities, in both infection and death rates. The disparity is attributed to income inequality, inequities in healthcare access and disease prevention, and higher rates of infection in cities.
  • In one month, 22 million people filed for unemployment because of layoffs and business failures. The unemployment rate in late April was estimated to be between 13% and 20%, though many underemployed people may not be captured in the data. The last time unemployment rates were this high was during the Great Depression.
  • Over 31% of people in the U.S. could not pay rent in April, and rent strikes are being organized across the country.

What is COVID-19?

By Monet Davis and Lorin Jackson

From PHN Issue 42, Spring 2020

All information adapted from the Centers for Disease Control and Prevention at CDC.gov and the World Health Organization at who.int.

Defining COVID-19

The coronavirus disease 2019 is a disease caused by a virus that was discovered in the Wuhan province of China in February 2019. It is abbreviated as COVID-19 and often referred to as the “coronavirus,” “corona,” or “the ‘rona.” In COVID-19, the ‘CO’ stands for ‘corona,’ ‘VI’ for ‘virus,’ and ‘D’ for disease. The 19 is for the year 2019.

Cause

The cause of the virus is called SARS-CoV-2. SARS-CoV-2 belongs to a family of viruses called coronaviruses, which are common in people and different animal species. The virus that causes COVID-19 is thought to spread mainly between people, when an infected person coughs or sneezes and an uninfected person breathes in the droplets that remain in the air. People can also be infected by touching surfaces, such as door knobs and handles, that have been exposed to the virus and then touching their eyes, mouth, or nose. Risk of spread increases when people are physically close to each other (within 6 feet). Many state and local governments have issued stay-at-home orders and encouraged everyone to practice physical distancing, or reducing physical contact with others and maintaining a distance of at least 6 feet. Health organizations are encouraging people to regularly wash their hands and disinfect surfaces.

Symptoms and Treatment

Information about COVID-19 is constantly changing as we learn more. The most common symptom of COVID-19 is fever. People with COVID-19 have reported symptoms of mild to severe trouble breathing, cough, sore throat, shortness of breath, and unexplained loss of taste or smell. Some patients also experience gastrointestinal symptoms such as diarrhea and nausea. There is currently no vaccine to prevent COVID-19. Avoiding exposure is the best way to prevent catching the virus. Some people with COVID-19 do not show any symptoms, and can still spread the virus to other people. Those who catch COVID-19 can usually recover from the virus by properly treating symptoms with cold/flu medications, fluids, and rest. If your symptoms include a cough, fever, and/or difficulty breathing, seek medical advice. The earlier the virus is treated, the better.

Mythbusting COVID-19

5G mobile networks did not create COVID-19, and these networks cannot spread the virus. People of all ages can be infected by the coronavirus. Older people and those with pre-existing medical conditions are more vulnerable than others. People of any ethnic background can contract the virus, and the virus should not be referred to as the “Chinese” virus; this is a global pandemic.

Transgender Housing in Prison

By Fatima Malika Shabazz

From PHN Issue 41, Winter 2020

Hello everyone: Since it’s been so long since I’ve written an article for Prison Health News, it makes sense that I introduce myself. My name is Fatima Malika Shabazz. I am a formerly incarcerated Afican American Transwoman. The last time I wrote anything for Prison Health News, it was due to a civil action I filed against the California Department of Corrections. Since that time, I have been released on parole; I have also been heavily involved in advocacy and activism surrounding either reforming or eliminating bad department of corrections policies related to the trans population.

Currently I am a part of a cohort here in California working on changing the policies regarding housing transgender inmates. Under the current policies, individuals housed in any of the 35 California prisons are done so based on their gender assigned at birth. This has proven problematic for many transgender inmates who identify either as trans-male or female regardless of their physical presentation, as well as those who present as non-binary. As a result, there have (over the years) been many incidents of violence against trans inmates, including murders by homophobic and transphobic cell mates, incidents that we believe could have been avoided had the department had policies such as California Senate Bill 132 in place.

If activists are successful in getting our vision of the bill passed, Senate Bill 132 would allow trans people to choose the type of facility (male or female) they want to be housed in based on their gender identity, as opposed to gender identified at birth. This bill (should it pass), comes at a timely moment, as there has been an increase in violence against incarcerated trans women. The violence has escalated especially since former Department of Corrections Secretary Scott Kernan negotiated away the safety of LGBTQ inmates by eliminating Sensitive Needs Yards. These were housing units in California prisons that traditionally held people who were in danger of facing violence in general population. Examples included informants (“snitches”), LGBT people, and people who were at risk of sexual assault.

The vision for this (at least from my perspective) is that trans people would be able to live in safer, more inclusive spaces that correlate more accurately to their personal gender identities. It must be noted, however, that this is not intended to be a hard and fast written in stone type policy—it is, in fact, meant to provide an option. Point of fact is that some trans women might rather be housed in men’s facilities, due to their personal dating preferences. It should also be noted that as a matter of policy, romantic relationships between inmates and/or staff are illegal, as is sex, consensual or otherwise. However, if trans women want to continue to be housed in men’s prisons as a matter of preference, they would continue to have that option, as would trans men.

The long-term goal is to ensure that trans people would know that the option exists for them to utilize at any point while serving their sentences, and secondly that a safer option is at their disposal, because it is an actionable policy. It is the desire of those working on the language of the bill that having this policy in place and ensuring that it is actionable would reduce the possibility of violence being committed against them, including the high possibility of being housed against their will with someone with a history of homophobic or transphobic violence. The bill would reduce the possibility of transgender people being murdered in prison simply for being trans.

As a trans woman, I am acutely aware of these elements of violence. I personally, however, cannot attest to what situation exists for trans men who may desire utilizing this option in the same way. It may very well be plausible that trans men would feel safer remaining in women’s facilities, which would be their prerogative. It is the concern of the cohort that no incarcerated trans person be placed in a situation that would make them feel less safe. With these concerns in mind, we are working very carefully to make sure the language of this bill reflects the concerns of all parties impacted by this bill.

Please be aware that this is still a monumental work in progress, but as we progress, I will duly keep everyone informed. And if you are considering doing something like this in your state, I’m of the opinion that you should. All trans people are entitled to live with respect and dignity, and if this will provide a modicum of that, why not pursue making it happen?

Complex PTSD

By Lucy Gleysteen and Brittany Mitchell

From PHN Issue 41, Winter 2020

What is complex trauma, or complex PTSD?

Complex trauma is a trauma that is repetitive, occurs over a period of time, and is frequently interpersonal in nature. Complex PTSD most often develops in childhood and can include experiences of abandonment at an early age, physical abuse or neglect, sexual abuse, emotional abuse, living in a neighborhood that has high levels of violence, being impacted by war, repetitive and invasive medical procedures, or other experiences of being in a traumatic environment for a prolonged period of time. Not everyone who has had traumatic experiences develops complex PTSD. However, those who do might experience certain difficulties that can be painful to live with.

What is the difference between complex trauma and regular PTSD?

When people hear the term PTSD (post-traumatic stress disorder), the first thing that often comes to mind is the experience of having suffered a traumatic event such as being in combat, exposure to gun violence, or experiencing a natural disaster. This type of trauma is called single incident trauma. Such experiences can contribute to having nightmares, flashbacks, anxiety, fear, depression, anxiety, emotional withdrawal, numbness, hypervigilance (having your senses on high alert), avoidance of reminders of the traumatic event, irritability, guilt, and shame. This article will focus on complex PTSD. There is a lot of overlap between single incident and complex PTSD. While the two types of trauma have a lot in common, complex trauma often involves the set of symptoms below that were classified by Judith Herman in her book Trauma and Recovery: The Aftermath of Violence–from Domestic Abuse to Political Terror.

Relational Impact

Complex trauma can deeply impact one’s sense of self and how they relate to others. If, as a child, a person learns that it is unsafe to have closeness with others, that will impact relationships in the long term. This can create a strong sense of loneliness, isolation, and feelings of disconnection.

Emotional Impact

Complex trauma can create challenges in emotional regulation. This could mean that it might be difficult to control and process feelings of anger, sadness, disappointment, or other forms of emotional distress. Those who have CPTSD might have a difficult time with self-soothing. Sometimes a person’s tolerance for handling difficult emotions can be very low. People with complex trauma are more likely to use substances like drugs or alcohol or engage in other self-harm.

Impact on Consciousness

Individuals who’ve experienced complex trauma might experience difficulty with memory and attention. Sometimes when a traumatic event occurs, our body’s capacity to cope might be overwhelmed, resulting in an emotional and social “shutting down” process called dissociation. Dissociation is a mental process that involves disconnection from emotions, memories, body, or sense of self. Dissociation exists on a wide spectrum, and it is possible to dissociate a little bit (i.e., daydreaming or walking somewhere and suddenly arriving at your destination without fully remembering the process of getting there), or it can
be more severe and involve forgetting one’s own identity. Everyone at some point in their lives has experienced dissociation, but it is more frequent and severe for those who experience complex trauma. This is one of the brain’s ways of coping with feelings of fear, anxiety, and shame—or achieving emotional safety. However, it can be problematic when dissociation occurs so frequently that a person is unable to feel positive emotions or process their more difficult feelings.

Impact on Self-perception

Self-perception is how a person feels about themself. Complex PTSD can cause a constant feeling of guilt, shame, and responsibility for the trauma that occured. Over time, this can create a self-image in which a person views themselves as incapable, inherently bad, unworthy, or unlovable.

Impact on Worldview

Complex trauma can affect a person’s understanding of the world as a safe place. This can cause someone to be on high alert at all times, looking for danger, even when they are in a situation where danger might not be present. This might look like a belief that people are essentially bad, or the world is essentially unsafe. Beliefs stemming from this could include, “Nothing good will ever happen to me,” “No one is safe outside at night,” etc.

Impact on the Body

CPTSD and PTSD in general are associated with significant negative health effects including chronic pain, digestive issues, weight gain or loss, hypertension, and cardiovascular issues. We say about trauma that it “lives in the body,” meaning that our body holds reminders of our emotional states. For instance, a person who experiences a lot of hyperarousal (easily startled, always on guard, quick to fight or run, heart racing, sweatiness, difficulty paying attention) might hold that in the body in the form of muscle tension. This is a very simplistic description of trauma’s relationship with the body, but a whole field of study called Somatics is dedicated to better understanding the relationship between our mental health and its bodily effects and experiences.

What are strategies for managing the impact of PTSD?

  • If possible, engaging in individual therapy, group therapy, or both.
  • Spending time figuring out what activities help you feel soothed, calm, and in control. These are called “grounding techniques” and can look like mindful coloring, writing in a journal, praying, running, stretching, breathing rhythmically, humming, dancing, tapping, holding something soft or weighted, or playing with a fidget toy.
  • Developing safe relationships and seeking support. Think or journal about: Who am I with when I feel like my best self? Who am I with when I feel calm, soothed, joyful, engaged? What qualities about these relationships give me these emotional freedoms?
  • Identify triggers (situations that lead to painful reliving of memories or emotions).
  • Be gentle with yourself and speak reassuringly to yourself.
  • Owning your right to have boundaries AND developing the communication skills to clearly and healthily set a boundary with someone and keep it.

Update on Descovy for PrEP and Treatment

By Seth Lamming

From PHN Issue 41, Winter 2020

In October 2019, the Food and Drug Administration approved a new medicine, Descovy, for pre-exposure prophylaxis (PrEP) to prevent HIV. PrEP is a drug regimen that people can take daily or on a particular schedule to prevent getting HIV from sex. PrEP has not been proven to be effective in preventing HIV transmission through needle sharing. Descovy (made up of emtricitabine and tenofovir alafenamide) and Truvada (made up of emtricitabine and tenofovir disoproxil fumarate) are the only two medications that can be used for PrEP. They are both frequently prescribed as treatment options for people who have HIV. Descovy and Truvada are both nucleotide reverse transcriptase inhibitors, which means they stop HIV
DNA from being copied from its RNA blueprints. This stops HIV from replicating. Most people in prisons and jails are not prescribed these meds for PrEP. The “logic” is that people in prisons and jails do not need PrEP because they are not allowed to engage in sexual activities while incarcerated.

Descovy is not actually a new medication, even though it just got approved for use as PrEP. It was first released in 2016 for HIV treatment, and it contains an updated antiviral ingredient called tenofovir alafenamide, a newer version of tenofovir than the version in Truvada. Truvada has been around since 2004 and was approved as a medicine for PrEP in 2012. Descovy and Truvada are both made and sold by a drug company called Gilead Sciences. While the release of a new drug that can both treat and prevent HIV is a positive move towards ending HIV, advocates have some issues with the drug company’s actions.

First, Descovy has not not been approved for use by cisgender women or transgender men. Whenever a new drug is approved for public use, it has to go through clinical trials before the medicine is available to the public. Clinical trials are a series of tests that prove a medication is safe and effective and show possible side effects. Clinical trials for Descovy only tested the effectiveness of the medication in cisgender men and transgender women. In other words, Descovy has not been proven to stop HIV from replicating in vaginal tissue. Gilead’s decision to not include cisgender women and transgender men in clinical trials has caused outrage among HIV/AIDS activists across the country. Critics have stated that Gilead did not want to spend money on clinical trials for women because men who have sex with men form the bulk of the market for PrEP, in the United States anyways…

Second, Gilead is claiming in its advertising that Descovy is safer and more effective than Truvada. All medications have the ability to cause side effects. A medical provider’s decision to prescribe medication takes the risks and benefits into account. If the health benefits of taking a medication are greater than the risk of side effects, then it is worthwhile to take amedication. Clinical trials showed that Descovy is less likely to cause kidney damage and bone weakening than Truvada. However, Descovy has a higher risk for causing weight gain and cardiovascular disease than Truvada. What does not sit right for many people is that Truvada will lose its patent in 2020. Advocacy groups have criticized Gilead’s messages about Descovy being safer and more effective than Truvada as an attempt to get consumers to switch over to the newer medicine, which will be more expensive ($1,758/month). When Truvada’s patent runs out soon, other drug companies will be able to make generic, off-brand versions of the same medicine and sell them for a lower price.

There is currently a class action lawsuit directed at Gilead in the midst of accusations that Gilead delayed development of Descovy in the early 2000s despite the fact that they knew Truvada had long-term side effects that could damage bone and kidney health. Advocates believe that Gilead did this in order to continue making money off of Truvada while its patent was still in effect. The class action lawsuit mainly deals with people who are taking Truvada for HIV treatment—not for HIV prevention. However, ads on television and social media have created some panic about the safety of Truvada for PrEP. This might discourage some people who are at high risk for HIV from taking PrEP.

Although PrEP is not an indication for most people to take Truvada or Descovy on the inside, many may be taking these medications for treatment. At your next medical visit, you can ask the medical provider when the last time your kidney function, liver function, and comprehensive metabolic panel labs were done. These are the most basic tests that should be performed routinely when you are taking lifelong medications.

Eating Healthy with Diabetes in Prison

By Donna Ballard

From PHN Issue 41, Winter 2020

With me being diabetic and in prison, it’s hard to eat healthy. To eat healthy in prison, you really have to go hungry. They serve us a lot of bread, corn, tortillas, and potatoes. We eat a lot of starches and white food that turns to sugar. We have to learn to eat only half of what they serve. If you eat your
veggies, it’s a start. Some meats.

You get a lot of sodium from commissary food, and starches and fatty foods. There are ways to eat better, but it’s always small portions. Now, if you go to the store, you can get stuff for yourself that will help you. At the store, you get peanuts, energizer mix and M&M’s, mix it together to make a snack mix. You can snack on it all week. Jalapeño peppers, meats—some things are good. Check the labels for contents. I hope my sharing has helped.