In the movie “Joker,” Joaquin Phoenix’s character frequently bursts into unnerving laughter at socially inappropriate moments. His actions were partially based on a real neurological condition called Pseudobulbar affect. I know this because I suffer from it too. The movie doesn’t show an exact cause, but for me and many others, it starts with a brain injury.
In 2018, I was with a man who beat me over the course of 10 weeks, strangling me, punching me in the head, and dragging me off the bed so that my head slammed into the ground. He went to prison, and my life was changed forever. In addition to the uncontrollable laughter, I often found myself emotionally overwhelmed, bursting into tears and physically collapsing in public. I’d always had a very active brain, with thoughts constantly flying around, but now I’d wake up in the morning and feel like I had no thoughts at all.
More than a year passed before I learned this all stemmed from a brain injury. If I’d known this sooner, I would have had a far easier time navigating the criminal justice system. I’ve come to realize that my experience isn’t rare — among victims or perpetrators of crime. Studies show that incarcerated people are far more likely to have brain injuries than the general population.
After my abuser was sentenced, I met other victims, and I started showing up at the Colorado legislature to advocate for our interests. I learned that lawmakers were considering a measure to provide brain injury screenings to people in prison. At first, I was angry. Why should they get these screenings, I thought, when victims of violence also need this help?
But I also knew the line between those categories isn’t always clean. Before my brain injury, I had been coping with my partner’s emotional abuse by drinking, and one night I drove under the influence. Around the time that the abuse became physical and he injured my brain, I was sentenced to probation. Every day I had to call to see if I needed to do a random drug test. A brain injury can mess with your short-term memory. I would set alarms to remind me to make the call, but then I’d forget if I’d made it, and I’d panic.
If I did have to go in, the probation office was stressful for a surprising reason: the doorbell. At one point, I found myself having a meltdown, screaming at everyone, “How can you stand this doorbell!?” As a result, I had a breathalyzer machine in my car and would have to blow into it while driving.
All this pressure overwhelmed me, and on several occasions I attempted suicide.
Before my injury, I worked as a project manager for a medical company, a job that involves convincing specialists to explain stuff to you. I started making calls and soon met Kim Gorgens, a University of Denver professor of psychology who has been telling the public about how common brain injuries are inside prisons: Studies suggest that between 40% to 80% of people inside suffered an injury, compared with just 5% to 9% of the general population.
Gorgens in turn introduced me to Marchell Taylor, who served more than 20 years in prison, and was pushing the legislation to get neuropsychological exams for people inside. He has described how, for most of his life, he’d felt impulsive and easily agitated. He learned this was due to a brain injury early in his life. After getting out of prison, he committed another crime. He believes this stemmed from his inability to manage his emotions, in part because he hadn’t been educated about his brain injury.
I said I wanted to pursue a bill that would require brain injury screenings for crime victims. We’re still writing it. Taylor was excited, because whatever process we come up with can be adapted to work for people in jail who are facing trial. District attorneys’ staff members can help victims fill out questionnaires — “Have you ever been hit in the head?” “Did you lose consciousness?” — while public defenders can help their clients do the same thing. The goal is to increase awareness among everyone who works in the system so that it’s more likely that someone, at some point, says, “Hey, have you considered seeing a neurologist?”
Because when you leave these brain injuries untreated, you make it more difficult for us to build a healthy and productive life.
One day, while I was on probation, I was late for a doctor’s appointment and my stress increased as he used jargon I didn’t understand. Then I drove to a pharmacy, where the bright lights, colors, noise and people were overwhelming — a brain injury can also trigger agoraphobia. Now I see how all those stresses fed on one another and attacked my frontal lobe. But at the time, I didn’t understand what was happening.
Outside the pharmacy, a child fell off her bike. I drove too close to her and her mother started screaming at me, “You almost hit my kid!” I put my car in park and fully intended to get out and punch her. Instead, I just screamed, “Shut up! Shut up!” And then the uncontrollable laughter set in, and I laughed as I drove home.
Who am I becoming?, I thought. This isn’t me.
I believe that if we get help for victims, we are going to prevent a lot of them from becoming offenders themselves. Whenever I see news of a football player assaulting his girlfriend or wife, I first feel angry. As a victim of such violence myself, I want them to be held accountable. But I also find myself thinking of all those brain injuries they suffered while playing. They also need help so that they don't hurt anyone else. And if these NFL players aren’t getting the proper support, what hope do the rest of us have?
Melissa Bickford is a former project manager for a well-known medical company from Colorado. She now works on legislative issues with Colorado Victims for Justice.
If you experienced a traumatic brain injury and involvement in the criminal justice system, we’d like to hear from you. Please email Maurice Chammah at firstname.lastname@example.org.