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The Relationship Between Trauma and Incarceration

When discussing trauma in the incarcerated population I was struck by the stories of what these people had endured. I wanted to dive a little deeper on the connection between incarceration and trauma to give a more well-rounded image of what incarcerated individuals experience.

To begin it has been found that PTSD occurs at significantly higher rates in incarcerated individuals compared to the general population (Hodges-Pietryka, 2022). There is about a 300% increase between the two populations with PTSD symptoms occurring in 4% of a studies community population and 48% of the studies incarcerated population (Hodges-Pietryka, 2022). Incarcerated individuals are also found to have more likely experienced trauma in childhood that non-incarcerated populations (Hodges-Pietryka, 2022). While in prisons though, assaults and other traumatic interactions are found to be underreported but contribute greatly to the increased percentage of people developing or experiencing PTSD symptoms (Hodges-Pietryka, 2022). This does not end after incarceration though. Many of these individuals struggle with reentry into their communities. While in prison they are likely very bottled up and unable to process or share the thoughts and feelings they are having. This can contribute to more negative outcomes due to unmanaged symptoms which is one of many factors that increases the likelihood of reoffending (Morrison, 2022). The process of reentry is heavily reliant on family/friends, service providers, and community members (Morrison, 2022). Symptoms of untreated trauma such as insomnia, hypervigilance, hyper-reactivity, difficulty with attention and concentration, and paranoia can greatly strain these relationships and hinder the process further (Morrison, 2022).

These issues are a significant factor in why incarceration is often cyclical. We need to shift to a more trauma informed approach to both incarceration and reentry if we want a solid way to tackle the relationship between trauma and incarceration. Many of these prisoners do not have a robust support system so I would suggest improving things on the inside of the system first as many problems arise from the culture within prisons. I strongly believe that there is a “light at the end of the tunnel” but we won’t get there unless work is put in to be more informed on how the system and trauma play a role in the damage being done.

References:

Hodges-Pietryka, M. (2022). Stories of Revictimization During Incarceration: The Returning Citizen's Experience (Order No. 29319933). Available from ProQuest Dissertations & Theses Global. (2707688376). https://ezproxy.bu.edu/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fdissertations-theses%2Fstories-revictimization-during-incarceration%2Fdocview%2F2707688376%2Fse-2%3Faccountid%3D9676

Morrison, M. (2022). Trauma Exposures across the Life Course for Individuals Who Experience

Incarceration (Order No. 29325001). Available from ProQuest Dissertations & Theses Global. (2705437979). https://ezproxy.bu.edu/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fdissertations-theses%2Ftrauma-exposures-across-life-course-individuals%2Fdocview%2F2705437979%2Fse-2%3Faccountid%3D9676

Trauma Informed Care through Art Therapy

Trauma is a unique experience; no two people will experience trauma in the same exact way, thus the impact and responses to trauma are unique as well.  To better understand the various responses to trauma, research has found trauma is stored in the body through our somatic memory, specifically, the nervous system in the brain (Van der Kolk, 1994).  Furthermore, trauma can manifest through somatic flashbacks in the form of physical sensations, including tastes, smells, pain and haptic experiences.  Somatic flashbacks support the notion that memories, particularly trauma experiences, are stored in visual form.  When a traumatic event occurs, the Broca’s area of the brain, responsible for language, shuts down.  Simultaneously, the amygdala, the recognition center for danger in the brain, is put on high alert, resulting in the brain visually recording the traumatic event (Rausch et al., 1996).

To help individuals work through trauma that is held visually and physiologically, imagery and verbal expression can be introduced.  In particular, art expression has been found to effectively assist in grappling with sensory memories and facilitating a narrative to explore memories and flashbacks (Malchiodi, 2003).  When somatic memories are explored through art expression, an individual is able to develop an understanding of why they may be experiencing certain physical sensations to a particular event.  A unique feature of art therapy is that interpretation of the art created is completely up to the artist, allowing them to create their own language of expression.  Moreover, art therapy promotes growth, self-expression, emotional reparation, conflict resolution and transformation (Malchiodi, 1998).

A positive aspect of art therapy is that it provides a medium, art and its subsequent expression, that is not available in many other therapies and forms of expression.  However, caution should also be taken when using art therapy.  Art therapy should be used as art and therapy, with the understanding art is not therapy on it own.  Rubin (1999) stresses “therapy is not enough; art is not enough either”.

There are many forms of trauma-informed art therapy, below are common modalities utilized within carceral settings and how they allow for self-expression.

• Dance: (hip hop, jazz, tap, modern) creates awareness and develops connection with the body; allows for expression of fear anger, hope, happiness
• Music/Poetry/Writing: expands capacity for self-expression
• Theatre: improvisation, play reading, script analysis; creation of scenes to replay responses to an event
• Visual Arts: (painting, sculpting, pottery, collage) allows for expression of visual and emotional feelings; creates a starting point for dialogue and exploration

San Quentin State Prison, California, has a program called ArtReach which “provides a platform for artists on San Quentin’s death row to exhibit their art and creativity”. I invite you to peruse the site.  The art created includes paintings, drawings, poems, and papers.  Many of the poems and drawings capture the trauma of incarceration, being on death row, as well as self-revelations, personal growth, and peace.   https://www.artofsanquentin.com/

Malchiodi, C. A. (1998). The art therapy sourcebook. Los Angeles: Lowell House.

Malchiodi, C. A. (Ed.). (2003). Handbook of art therapy. New York, NY: Guilford

Rausch, S.L., van der Kolk, B. A., Fisler, R.E. & Alpert, N.M. (1996) A symptom provocation study of posttraumatic stress disorder using positron emission tomography and script-driven imagery. Archives of General Psychiatry. 53(5), pp.380-387.

Van der Kolk, B. A. (1994). The body keeps the score: Memory and the evolving psychobiology of posttraumatic stress. Harvard Review of Psychiatry, 1(5), 253–265.

The impact of stress in our lives

Life, our existence is nothing more than a condition where we have the rationality and capacity to function. We go through a number of stages that are supposed to teach us everything that we need to know to learn how to live and how to survive until death reaches us. These stages are infancy, toddlerhood, preschool years, early school years, adolescence, young adulthood, middle adulthood, and late adulthood. Yet, no one quite clearly can explain to you what events are going to transpire in your life that will scar you, what experiences are you going to go through that will activate your stress hormones and put them on a loop, how to handle strong emotions or emotions at all, how to understand your feelings or mental state, or how much life really hurts, disappoints, and feels like it suffocates you one day after the other. Now, all of these events are led by one piece, a masterpiece that feels like it dictates your life, stress.

We are all unique individuals that feel, think, and experience differently. Therefore, all of our individual experiences cannot be compared, and since they’re not alike we cannot fully understand what a person goes through until we live that same experience. Nevertheless, stress is a universal factor that causes an impact in all our lives. It might not be identical situations but it’s the same factor. So, what is stress? The World Health Organizations says that is “a state of worry or mental tension caused by a difficult situation…is a natural human response that prompts us to address challenges and threats on our lives. Everyone experiences stress to some degree.”. So, the continuance of this factor in human beings causes an imbalance that affects the mind, brain, and body.

How does stress affect us? When our body is subjected to an event of experience that causes extreme stress our brain secretes stress chemicals and lights the neural circuitry on fire. It sends alerts to the hypothalamus that sends sensory signals to the amygdala. The amygdala then processes these signals as the image, sounds, smells, taste, and touch of the moment and decides how to interpret that information and what level of danger is perceived. In their connection the autonomic nervous system is activated, alongside with the sympathetic and parasympathetic nervous systems. Both of these in their respective ways tackle the fight, flight or freeze response of the body to the stress. Think of it as a car’s pedals (increase to acceleration and decrease to stop). All of these signals and responses are activated so quickly that the brain doesn’t even have a clue, it can’t be aware of the cascade of events happening so fast. So, the sympathetic nervous system stays on, continuously secreting stress hormones (for example, cortisol), thus impacting and aggravating the individual’s balance and well-being. This overwhelming impact to the individual is focused on their physiological and psychological state. It stands in the way of completing tasks, activities, and duties (studying or working), relationships (partners, family and friends), organ health (heart, stomach, lungs), nervous system function (various levels of body ache and pain), use of substances (illegal drugs like cocaine and opioids, alcohol, and tobacco), anxiety, depression, and much more. Therefore, we need to have certain tools ready at hand to cope, manage, and reduce that unavoidable and always present stress.

Now, how do we reduce those levels of chronic long-term stress? Well, some counter responses towards relieving stress that are available to all of us are due to the different techniques that scientists have come upon throughout time. For example, the relaxation response, a combination of different approaches that evoke a state of relaxation (deep breathing, focusing on calmness and tranquility, connection with God through prayer, yoga, tai chi, and more). Physical activity and movement therapy (stretching, walking, running, swimming, aerobics, dancing, singing, and more) to reduce the body’s levels of stress hormones like adrenaline and cortisol; and produce endorphins to heal. Social support triggers benefits in the well-being of a person. Some say that it helps with the setback of the healing process, improves the self-esteem and self-worth, encourages to keep working on one’s health, shows you other strategies or coping mechanisms, and you feel “loved”.

In addition to the previous mentioned, other ways to manage and assume control over stress is to establish a daily routine, nothing fancy, improve eating habits, prioritize getting enough sleep and rest. Also, limit the time that you spend on the internet (it can make you feel overwhelmed and more stressed), connect with nature, and reach out and seek medical assistance to take it one step further. When dealing with life, stress and stressors will always be present, and it’s completely natural to feel drained, frustrated, on edge, without words, enraged, gloomy, and more. But, do things for you, take care of yourself, modify or change your lifestyle if you have to, control your environment and your level of participation, establish your own time and what are your priorities, to what are you going to focus your energy on. All of this is normal, but what is not normal is not doing something about it, letting it beat, stump, and burry you. Putting yourself as number one as a priority in your life is extremely important, and taking care of your health is not something to be ashamed of. It’s something to be proud and joyous about because not many people can or want to do it. That is what proves great important, that you take care of yourself and are one with yourself.

References:

Boland, B. (April, 2023). All the Ways Stress Can Impact Your Life. BANNER HEALTH. Web page: https://www.bannerhealth.com/healthcareblog/teach-me/stress

Rousseau, D. (2023). Module 3: Neurobiology of Trauma. Retrieved from: MET CJ 720 O2 Trauma and Crisis Intervention Printable Lectures.

Van der Kolk, B. A. (2014). Part Two, Chapter 4: Running for your life: The Anatomy of Survival. The body keeps the score: Brain, mind, and body in the healing of trauma. Viking Penguin.

Van der Kolk, B. A. (2014). Part Two, Chapter 5: Body-Brain Connections. The body keeps the score: Brain, mind, and body in the healing of trauma. Viking Penguin.

Van der Kolk, B. A. (2014). Part Two, Chapter 6: Losing Your Body, Losing Your Self. The body keeps the score: Brain, mind, and body in the healing of trauma. Viking Penguin.

Van der Kolk, B. A. (2014). Part Four, Chapter 11: Uncovering Secrets: The Problem of Traumatic Memory. The body keeps the score: Brain, mind, and body in the healing of trauma. Viking Penguin.

Van der Kolk, B. A. (2014). Part Four, Chapter 12: The Unbearable Heaviness of Remembering. The body keeps the score: Brain, mind, and body in the healing of trauma. Viking Penguin.

Van der Kolk, B. A. (2014). Prologue, Facing Trauma. The body keeps the score: Brain, mind, and body in the healing of trauma. Viking Penguin.

World Health Organization. (February, 2023). Stress. Web page: https://www.who.int/news-room/questions-and-answers/item/stress#:~:text=Stress%20can%20be%20defined%20as,experiences%20stress%20to%20some%20degree.

Art as Therapy

“You gotta resurrect the deep pain within you and give it a place to live that’s not within your body.
Let it live in art. Let it live in writing. Let it live in music.
Let it be devoured by building brighter connections.
Your body is not a coffin for pain to be buried in. Put it somewhere else.”
- Ehime Ora

There are many modalities that can be helpful in the treatment of trauma. This post explores the benefits of creative expression as self-care and treatment using a specific and personal example - my mom. More than prescribed ‘art therapy’, the use of art as a therapeutic form of self-expression has helped my family in many ways. Because it is relevant to this story, I will preface this with a context of culture and history.

My mom suffers from PTSD and many physical ailments. There are many parts of her life she is just now correlating with trauma and others she may not remember yet. I inherited parts of her trauma and quickly assimilated into American culture; I was a child when we emigrated. We came to America at an inflection point of its contentious relationship with Iran, a country on the precipice of Revolution. Being a young mother, she left behind home and family for her safety and that of her child. I remember hearing bombs fly overhead while speaking on the phone from the U.S. with my grandparents in Iran during the Iran-Iraq War. We heard and saw much war and death and many loved ones were lost.

Iran is a tumultuous, beautiful, democratic (at its roots), tyrannical, dangerous, powerful country. We are born from the soil of mixed contradictions, rich with historically significant contributions to mankind. Persians were originally of a monotheistic religion called Zoroastrianism, and hail from one of the oldest empires in history. This beautiful land, like any other, is filled with generational trauma.

In recent times, you may have heard the name ‘Mahsa Amini’, one of countless young people killed by a brutal regime for no reason. That trauma runs deep and wide, we felt it here in America and around the globe; it is directly contributory to pain we feel today (physical and otherwise). We protested the oppression and brutality; we donated, cooked, sang, cried, and rallied. It is difficult to process that much grief for that much death alone, so we feel strength in numbers, and we express that grief in artistic ways. Musicians write anthems, writers pen poems and novels, actors appeal on screens, we cook for and comfort each other. Integral to processing trauma, and to our culture, is art and expression. We are a traditional, communal people so our form of therapy usually revolves around community. It is not uncommon to see a group of Persian friends at a restaurant crying, laughing, eating, and crying some more. We express as much trauma as we hold. This is also common for other cultures around the world.

There are many different, effective ways to use creative expression as a form of self-care and treatment.

Dance Therapy
We learned from Bessel Van der Kolk that (in 2014) there was little known about how artistic forms of therapy “work or about the specific aspects of traumatic stress they address”. Kolk discusses some of the ways that artistic therapies have been measured and produced either disappointing or inconclusive results.

One form of dance therapy paired “nonverbal artistic expression with writing” by social psychologist James Pennebaker and dance/movement therapist, Anne Krantz. The study group that danced then wrote about a traumatic experience showed “better physical health and improved grade-point average. (The study did not evaluate specific PTSD symptoms.)”. Interestingly, when considering just writing therapy that focused on PTSD symptoms, it seems they were less successful when done in “group settings where participants were expected to share stories.” (Kolk, 2014, p.354). Sharing vulnerable thoughts and feelings publicly before readiness can feel more traumatic than healing.

Art & Creativity
Where culture or innate expression may not be a factor for everyone, traditional art therapy is a useful clinical approach:

“Characteristic for art therapy is the methodical use of art means as drawing, painting, collage, and sculpting to shape and express feelings, thoughts, and memories. Art therapy is distinguished from other forms of treatment by active performing and experiencing with art materials, by the visual and concrete character of the process as well as by the result of art making.” (Schouten, et al., 2015).

“Art safely gives voice to and makes a survivor’s experience of emotions, thoughts, and memories visible when words are insufficient.” Art and creativity can tap “into other parts of a person’s experience. It accesses information … or emotions that maybe can’t be accessed through talking alone … Using art therapy to treat PTSD addresses the whole experience of trauma: mind, body, and emotion.” (Fabian, 2019).

Studies have been conducted showing the effectiveness of different forms of art therapy (seen in these examples above) in combination with cognitive therapy for combat veterans with PTSD. “Art therapy may assist with integration of sensory memories and declarative memory and has been shown to reduce symptoms of PTSD in a number of populations.” (Campbell, et al., 2016). They found that “Art therapy in conjunction with CPT was found to improve trauma processing and veterans considered it to be an important part of their treatment as it provided healthy distancing, enhanced trauma recall, and increased access to emotions.” (Campbell, et al., 2016).

Putting it Together
Integrating any type of art or creative expression into trauma therapy is an individual choice. There have been promising studies showing valuable contributions to the treatment of PTSD, enhanced by combining other treatments. Addressing trauma is complex since it can remain hidden in our bodies and minds, so "using a combination of traditional therapy techniques and alternative treatments such as EMDR, yoga, neurofeedback, and theater, patients can regain control of their bodies and rewire their brains." (Kolk, 2014, p.1).

For my mom, art has been helpful and productive as a form of self-care and adjunct to other therapies. Used in conjunction with other treatments, it takes on a calming, meditative quality that stills her mind and body. Joining treatments has helped unlock complex trauma that was hidden from her. This very personal, internal processing does not involve verbal expression, but emotion and thought come through as a physical creation. It is a form of healing during times when she struggles to identify where her trauma resides. Her creations are freehand, and it is in the moment of pure, joyous, creative expression that she does her best work. By her own account, when she is creating, she is 'lost in Zen space' with no concept of time, pain, or physical body. I believe it is in this space that she reconnects with her body and mind in a safe space.

Helpful as PTSD treatment, art “therapies can be helpful in reducing depression and trauma-related symptoms such as alexithymia, dissociation, anxiety, nightmares, and sleep problems… increasing emotional control, improving interpersonal relationships, and improving body image (Johnson & Lahad, 2009).” What is lacking from all articles on the efficacy and full benefits of PTSD treatment, however, appears to consistently be a lack of “robust information on their effectiveness”. It is possible that there have not been any ‘robust’ studies because art can take many forms, is highly subjective and contextual in nature, and is difficult to systematically analyze. From personal experience, I can say that art (in all forms) has been a healing, therapeutic tool for my family. I cannot imagine our lives without it.

References

Campbell, M., Decker, K. P., Kruk, K., & Deaver, S. P. (2016). Art Therapy and Cognitive Processing Therapy for Combat-Related PTSD: A Randomized Controlled Trial. Art therapy : Journal of the American Art Therapy Association, 33(4), 169–177. https://doi.org/10.1080/07421656.2016.1226643

Schouten, K. A., de Niet, G. J., Knipscheer, J. W., Kleber, R. J., & Hutschemaekers, G. J. (2015). The Effectiveness Of Art Therapy In The Treatment Of Traumatized Adults: A Systematic Review On Art Therapy And Trauma. Trauma, violence & abuse, 16(2), 220–228. https://doi-org.ezproxy.bu.edu/10.1177/1524838014555032

Debruge, P., Earl, W., Gleiberman, O., Moreau, J., Murphy, J.K., Saperstein, P., Shafer, E., Shanfeld, E., Seo, R. The 30 Greatest War Films. Variety.
https://variety.com/lists/best-war-movies/

Van der Kolk, B. A. (2014). The Body Keeps The Score: Brain, Mind, And Body In The Healing Of Trauma. Penguin. Amazon Kindle version.

Fabian, R. (2019, Aug 13). Medically reviewed by Legg, T.J., PhD, PsyD. Healing Invisible Wounds: Art Therapy and PTSD. Healthline.

Art & Talk Therapy. Retrieved on 2023, Aug 15 from https://www.aactherapy.com/art-therapy
Also referenced from: Ora, E. (2023, July). Ancestors Said: 365 Introspections for Emotional Healing. 1st ed. Hay House, Inc.

Is Social Media Traumatizing Us?

On a rainy morning, I was getting ready to go on a tour in Dublin, Ireland. The older guide approached us and appeared to be very upset. He asked if we were okay, and if we needed some time before our tour started. Confused, we asked what was wrong. “Did you hear? A mass shooting happened this morning in America.” He was met with a few shrugs and “Yeah, that happens.” Shocked, he replied “If that happened here, we would probably shut down the city for weeks.”

It was in that moment, I began to think about why this group of American’s reacted this way. Besides the lack of action from political leaders, I thought about social media. For years, we have been exposed to violence and tragedy (virtually) right in front of us. In the live classroom this week, it was brought up about social media and having this information right at our fingertips. We have access to more information than ever, and it is quite overwhelming. Even this morning, I woke up to several news notifications involving death and tragedy with pictures attached.

Grace Dowd, a psychotherapist, says “Since we don’t always have enough time to digest one story before another breaks, we can sometimes end up feeling emotionally numb, helpless and immobile. This typically happens when our survival mechanisms are triggered.” Grace then adds, “Our constant access to social media and the news plays into this by continuing to provide access to information to the point where it no longer becomes shocking, and also by taking our attention away with the next crisis.” (Barnes, 2021) Mary Joye, a licensed mental health counselor, says “Repetition of [bad news and images] does damage to us through vicarious trauma.” (Barnes, 2021) Vicarious trauma was also discussed in our live classroom this week. Vicarious trauma is when the trauma does not directly happen to you, but you are affected by it. 

Sites created to share memories and watch funny videos have slowly turned dark over time. On apps such as TikTok, you can watch a cooking tutorial and the next video is a house exploding. How do we protect ourselves?

Limiting time on social media has been a great tool for me. I have seen a major decrease in anxiety. It allows me to process anything I have seen and reflect. As bad as it sounds, I have had to adopt the “ignorance is bliss” stance with trends on social media. Most of these “trends” have turned into a rabbit hole of anxiety inducing videos, such as “top 10 household products that will give you cancer”. I even have friends that set time limits on their phones, or have deleted social media all together. I strongly believe that if we decrease our social media use, society will greatly benefit from it. 

References:

Barnes, S. (2021, Feb 21). "Social Media is Traumatizing Us More Than We Realize" https://www.huffpost.com/entry/social-media-traumatizing_l_602d2c88c5b673b19b654d88.

Am I a psychopath?

The short answer: most likely no. While individuals can exhibit certain traits of psychopathy, there is more to the clinical assessment of this diagnosis. The term "psychopath" has become colloquial in its use. It is thrown around when a friend does something out of the norm, when a character on TV displays particular traits, and when describing actions that are atypical. These instances have made it seem that psychopathy is more common than it actually is. People can certainly fall under the umbrella of "psychopathy" but genuine, diagnosed psychopaths must meet specific criteria in order to be diagnosed as such.

Psychopathy, as noted by Rousseau (2023), can be caused by genetics, neurobiology, and abuse. It is defined by three major characteristics which include callousness, a fearless personality type, and impulse control issues (Marsh, 2022). Approximately 30% of the population demonstrate a degree of these traits, but only about 1.2% are classified as "severe psychopaths," Marsh (2022) adds. In order to test for psychopathy, Robert Hare created the PCL-R

(Psychopathy Checklist-Revised) to measure the "extent to which [an] individual matches [a] prototypical psychopath" (Rousseau, 2023). This checklist consists of 20 items that are scored on a scale from 0-2; 0 means the item is not present and 2 means the item is definitely present. Rating each item a 0, 1, or 2, a score up to 40 can be obtained. Any score greater than 30 indicates severe psychopathy, which can only be "diagnosed" when administered by a professional with an advanced degree (Rousseau, 2023). While you can self-administer this test to get a general idea of where you stand, an accurate "diagnosis" can only come from a professional. "Diagnosis" is in air quotes here because psychopathy is not an official DSM diagnosis. Typically ASPD (Anti-Social Personality Disorder) is diagnosed, and in combination with a high PCL-R score, an individual is labeled to have psychopathic tendencies (Marsh, 2022).

Psychopathy can be viewed as a spectrum. Many individuals show psychopathic tendencies at one point or another and whether you have scored a 0, are in the early 20s, or maybe up in the 30s range, falling anywhere on the scale is not necessarily a bad thing. While yes, those with higher scores have an increased risk for criminal behavior due to the lack of empathy and guilt, psychopaths are not inherently bad individuals. Many are successful professionals who use their traits to their advantage. Being labeled a psychopath does not automatically lead to crime and violence; it all depends on how the traits are utilized in one's life.

Treatments for psychopathy are extremely limited. Successfully curing psychopathy is not possible, but there are methods to manage symptoms and improve one's quality of life. Treatments may include things like behavioral skills therapies, medications, and psychotherapy (Psychopathy Is, 2022).  There tend to be additional challenges in treating psychopaths due to their lack of motivation, poor response to treatments, and resistance to any kind of change. These can stem from a psychopath's lack of ownership of problems and responsibilities as well as their separation from emotions, empathy, and guilt. While psychopathy can be managed, it is more stringent to do so than with other kinds of diagnoses.

So, the question still stands: are you a psychopath? The probability of falling into that 1.2% is very low but never 0. You may exhibit several of the PCL-R items at either level 1 or even level 2, but the best way to get to the bottom of it is to see a licensed professional. This can start you on your path to figuring out why your brain may work differently than others and why you act and respond the way you do in certain situations. Either way, it's all about how you use your personality and traits to your advantage while creating little to no destruction in your path. Change is not impossible and neither is living a successful, rewarding life.

References

Marsh, A. (2022, March). Why psychopathy is more common than you think, with Abigail Marsh, Phd. American Psychological Association. https://www.apa.org/news/podcasts/speaking-of-psychology/psychopathy#:~:text=Although%20severe%20psychopathy%20affects%20just,fall%20under%20this%20broad%20umbrella.

Psychopathy Is. (2022, December 21). Psychopathy Treatment Options. https://psychopathyis.org/treatment/#:~:text=The%20most%20successful%20approaches%20to,They%20may%20also%20incorporate%20medication.

Rousseau, D. (2023). Presentation files: Psychopathy. Boston University.