When David Delvalle hears the jingle of car keys or the blare of a car siren, it triggers painful memories of his years locked up in a Massachusetts prison. He's on such high alert in public that his 11-year-old daughter often asks him why he’s looking around so much.

“I don’t want my family looking at me like I'm a broken, flawed human being because I'm still overcoming the 10-and-a-half-year sentence the DOC [Department of Corrections] gave me that left me more broken than when I came in,” said Delvalle.

He was paroled almost a year ago after serving seven-and-a-half years for attempted murder after a man broke into his house and tried to rob him. That feeling he described of brokenness has been a struggle ever since his release.

For years, advocates have recognized incarceration can lead to mental health trauma in inmates that continues after their release. In 2001, addiction specialist Terence Gorski coined the term “ post-incarceration syndrome” (PICS) for this trauma, describing it as a combination of post-traumatic stress disorder, institutionalization, antisocial personality traits, social sensory deprivation and substance use.

Although the term PICS is widely used among inmates and justice reform organizations, it is not recognized by the American Psychiatric Association. Approximately 1,700 people with criminal convictions were released from Massachusetts prisons in 2022, yet no figures exist for the percentage of those suffering from symptoms of PICS; the question is never asked.

That may soon change.

In May, U.S. Reps. Ayanna Pressley of Massachusetts and Grace Napolitano of California asked the National Institute of Mental Health to research PICS to help prevent and treat the disorder. In a letter, they wrote: “investing in the mental health of the formerly incarcerated population decreases the risk of recidivism and bolsters community safety.”

And that's not the only effort underway.

The New York Senate is considering legislation that would mandate mental health treatment for “post-traumatic prison disorder” for people returning from prison. The NAACP also passed a resolution in 2019 supporting the provision of trauma-informed services to incarcerated and formerly incarcerated people to address “post traumatic prison condition.”

In a statement, Massachusetts prison officials said they offer programs and connections to services to help returning citizens prepare for successful reentry. None specifically address post-incarceration syndrome.

About 33% of people formerly incarcerated in Massachusetts re-offend and return to jail or prison within three years of their release, according to the latest figures available.

Delvalle believes people return to prison because they fear failure.

“I feel like that’s the most extreme post-incarceration syndrome, where you want to revert back; that’s how scared you are that the world is going to hurt or traumatize you further,” said Delvalle.

Prison is trauma

About 40% of incarcerated people have a history of mental health issues, almost double the prevalence in the general population. Although a high percentage of inmates enter prison with adverse childhood experiences, incarceration also causes trauma or worsens existing symptoms.

Larry “Ibrahim” Myers spent his childhood in abusive foster care situations after his parents, who abused drugs, could no longer care for him. As a teen, he was adopted by his older godparents. Without parental guidance, Myers said he made poor decisions and landed in juvenile detention. Over the years, he cycled in and out of Massachusetts prisons, with his most recent stint lasting seven and a half years for armed home invasion.

A man with a pensive and sad expression sits on bleachers at a park.
Larry “Ibrahim” Myers said he often feels like he doesn’t fit in in the outside world.
Dominique Farrell GBH News

“You look at how bad the staff would treat you, regardless of what you were in there for, and you had to eat their s---,” said Myers. “You deal with it from the COs [correctional officers]. You got to deal with it from the convicts, the people that think they own the jail, people that think they can tell you what to do, people that try to take something from you.”

Wanda Bertram, communications strategist at Prison Policy Initiative, said the violence in prison is intentional.

“They [prison officials] resist outfitting their facilities with amenities that could make everyone feel safer,” said Bertram. “In fact, they take steps that actively curtail safety and create tension within the prison environment.”

Myers vows never to return to prison, but he often feels like he doesn’t fit in in the outside world. He’s uncomfortable in crowds and being in public. Even large family gatherings prove daunting.

“I go through all kind of like anxiety for weeks and months before something,” said Myers. “And I just want to be able to go out and enjoy myself like I like I used to.”

Myers was released from prison eight years ago, but continues to struggle with PICS. That’s why he works with several social organizations helping other returning citizens deal with their trauma.

Inmates count the days until they are released from prison and can reunite with friends and family. But once they're out, rebuilding their life after years behind bars can often feel alien and intimidating.

Dr. Craig Haney, a professor of psychology at University of California, Santa Cruz, who specializes in the psychological effects of incarceration, said returning citizens find it more difficult to reenter society than they anticipated.

The social rules they learned to survive behind bars — who you can and can’t talk to, showing respect and not trusting anyone — are counterproductive in society.

“Often, they [returning citizens] don't know how to act around people. They don't know when they're acting inappropriately,” Haney said. “You really feel like there's something wrong with you, because nobody tells you you're going to encounter these problems when you get out.”

“You really feel like there's something wrong with you, because nobody tells you you're going to encounter these problems when you get out.”
Dr. Craig Haney

The fear of returning to prison

James Watson is never alone. The 6-foot-5-inch affable Watson fears being sent back to prison and wants an ironclad alibi this time. In 1984, the then 20-year-old was wrongfully convicted of murdering a Boston taxi driver. The crime occurred in the middle of the night when Watson said he was home asleep. He spent decades behind bars until his conviction was overturned in November 2020. He worries the police could again arrest him again for a crime he did not commit.

After Watson was released, he stayed with his sister. He recalls jumping from bed in the middle of the night thinking it was “count time,” the several times a day when officials count prisoners.

“When it’s count time, you gotta be standing up in your room,” said Watson. “Sitting on your bed is a penalty. You get a ticket. You go into isolation for any infraction whatsoever.”

A black man with short cropped grey hair and mustache poses for a portrait sitting on a street-side bench on a sunny day.
James Watson, who struggled with anxiety and phobias after his release from prison, launched the nonprofit Confronting Injustice to help returning citizens deal with the trauma of their incarceration.
Dominique Farrell GBH News

Watson first heard about PICS from other returning citizens and recognized the anxiety and paranoia in himself.

He dislikes crowds and people standing too close to him, so he avoids traveling by bus or subway. And he’ll never take a taxi. After having every aspect of his life supervised in prison, Watson struggles with being told what to do.

In prison, the only time Watson could express his true emotions was when he was alone in his cell. He is still trying to shake that tough guy persona.

Watson and his wife, Linda Solomon, along with another returning citizen, launched the nonprofit Confronting Injustice to help returning citizens deal with the trauma of their incarceration. Once a month, speakers lead online workshops focusing on PICS.

“It’s an opportunity for people to come together in the community to talk about what's happening with them and things that they can do when they get triggered and what family members and friends can do when they see someone acting in a way that may not make sense to them,” said Solomon.

Connecting with those who understand

With few mental health providers equipped to deal with the specific needs of returning citizens, many have turned to each other for support.

On a muggy summer evening, dozens of returning citizens and advocates crowded into the basement of Haley House in Roxbury for a kind of networking group.

Haley House began as a soup kitchen in 1966 and has since expanded to offer community programs like affordable housing, urban agriculture, and a cooking and nutrition program. In May 2022, Haley House launched Life Foundations Training to assist those released from prison integrate into society.

Just as important, the program allows people with PICS to come together as a community.

“We're leaning on each other because your family doesn't understand what it's like to be incarcerated. Your friends don’t understand what it’s like to be incarcerated,” said Delvalle.

“We're leaning on each other because your family doesn't understand what it's like to be incarcerated. Your friends don’t understand what it’s like to be incarcerated.”
David Delvalle

A person out on parole generally can’t commiserate with others in the same situation because Massachusetts parole system generally prohibits them from interacting with each other — except through a recognized program like Life Foundations Training.

Formerly incarcerated people also face barriers to employment and housing, which exacerbate their mental health issues. Haney said the most frequent mental health problem returning citizens face is depression.

“The public needs to understand that people who go to prison are not fundamentally different from the rest of us, and it’s in our interest to reintegrate them into society,” Haney said. “Programs should include counseling … along with concrete assistance in finding employment and housing.”

Delvalle received an associate degree behind bars and is now attending Tufts University full time to pursue a bachelor’s degree. He works as a program manager at Haley House. Even with his education, the support of his family, Tufts and his community, Delvalle continues to struggle with PICS.

“The narrative has already been painted that we're bad people. So, to unpaint that narrative, it's hard, it's nearly impossible,” said Delvalle. “You literally wake up every day and you be the closest thing to Jesus that you can. I am emotionally drained once I get home.”