States are increasingly thought to have a duty to enable convicted persons’ rehabilitation, with some seeing this duty as grounded in convicted persons’ right to rehabilitation. This rights-based argument for rehabilitation emerged alongside the increase in rights litigation for carceral populations within the United States in the 1970s, and the contemporaneous development of the idea of imprisoned persons as “Rechtsburgers” or rights bearers in Europe.

Admittedly, legal recognition of a right to rehabilitation is not universal. Many countries present rehabilitation as a “guiding concept” rather than a right that can be enforced against the state. The United States had also considered it necessary to re-emphasise the importance its criminal justice system attaches to the goals of retribution, deterrence and incapacitation, following their ratification of the International Covenant on Civil and Political Rights (ICCPR) – which highlights the need for rehabilitative treatment within prison settings in Article 10 ICCPR.

Physiatrists are physicians with specialized training in management of disability, rehabilitation, and restoration of function. Physiatrists work with a multidisciplinary team to achieve the best possible functional outcome after a patient has survived a critical illness or injury. Multiple complications of Post-Intensive Care Syndrome (PICS), such as ICU acquired weakness, spasticity, and the development of contracures and chronic pain syndromes, can be managed by a physiatrist. Physiatrists perform procedures to reduce spasticity and injections to manage pain. Physiatrists also perform gait assessmentts, evaluations for assistive devices or wheelchairs, and assessments to facilitate return to work via vocational rehabilitation.

This chapter presents a case study of the post-intensive care syndrome that highlights some of the syndrome’s defining features: the breadth of disability across physical, cognitive, and psychiatric domains; the duration of disability despite appropriate rehabilitative interventions; the varying degrees of disability over time with the potential for recrudescence, particularly with additional episodes of acute illness; and the social ramifications of the syndrome. This case report also demonstrates the holistic approach taken in ICU follow-up clinics and many of the interventions that such a clinic can provide.

Post-Intensive Care Syndrome (PICS) refers to the wide array of physical, cognitive, and psychological symptoms that a patient may experience following an acute illness. Persistent dysphagia is one significant concern that may remain following a patient’s discharge from the hospital. In these instances, the patient will be referred to a speech-language pathologist for outpatient dysphagia therapy services. Swallowing rehabilitation following discharge from the ICU is managed by a team of medical professionals, with the SLP acting as a coordinator for the interdisciplinary team. Referrals may be placed to psychologists, dietitians, and neurologists, amongst other professionals. Outpatient services begin with an initial evaluation that involves several components, including medical chart review, case history, oral mechanism exam, and bedside swallow exam. The patient may also be referred for an instrumental swallowing assessment to allow for direct visualization of the oral and pharyngeal phases of the swallow. Based on the evaluation results, a comprehensive treatment plan will be developed that includes restorative swallowing exercises, compensatory strategies, and diet modifications. Technology may also be incorporated into therapy sessions for maximum benefit.

As discussed in Chapter 1, the primary focus of this book is on the potential of neurotechnology to support the rehabilitation of convicted persons by improving risk assessment and risk management – rather than on its potential for diagnosing and treating mental or brain disorders. Still, in some cases, neurorehabilitation might well become conducive or even crucial to the improvement of mental health in forensic populations. Brain stimulation to attenuate aggressive impulses might serve to reduce the mental distress experienced by some persons subject to these impulses. Furthermore, aggression can be a symptom of a recognised mental illness, such as a psychotic disorder, or may be a core feature of a disorder, as in intermittent explosive disorder. Diminishing aggression using neurotechnology could in such cases be relevant to the person’s mental health, which appears to be an interest protected by human rights law. For example, Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) recognises a “right to the highest attainable standard of physical and mental health”.

After discharge from the intensive care unit (ICU), it is often assumed that a patient’s appetite, weight, and nutritional status will return to premorbid levels with minimal intervention. Malnutrition is common following critical illness, and multiple barriers exist to nutrition rehabilitation following hospital discharge, which are often recognized and understood in this vulnerable patient population. Such barriers include appetite and weight loss, early satiety, gastrointestinal disturbances, altered taste and smell, dysphagia, and the constellation of physical, functional, cognitive, and psychosocial challenges known as the post-intensive care syndrome (PICS). Registered dietitians (RD) can direct the continuity of nutrition care essential to supporting recovery from critical illness, with the goal of helping patients regain muscle mass, strength, and independence. Education and partnership with the patient, family, and medical team are required for the best outcomes in nutrition recovery. Nutrition rehabilitation will be explored after discharge from the hospital by addressing the barriers and strategies to guide the patient toward success.

The goal of this chapter is to introduce racial trauma, radical hope, healing, and Black reparations. It begins with the story of Laverne Cox, a Black transgender woman, actress, and trans civil rights activist who wrote an essay on the impact of White supremacy on multiple generations of her family. The story of Laverne illustrates racial trauma, the emotional responses rooted in structural racism that have an intergenerational impact on health. Informed by a reparatory justice approach, this chapter examines radical healing, hope, and reparations to deal with racial trauma and achieve justice. Radical does not mean violent or extremist but is the notion that complete change is necessary to address political problems. It discusses some features and popular myths about reparations, and examines five principles for reparations: restitution, compensation, rehabilitation, satisfaction, and guarantees of non-repetition. The chapter includes a Food for Thought section on how education may increase support for Black reparations. It ends with a discussion of Laverne Cox and finding hope in our ancestors.

Judging by rates of criminal recidivism, the very trauma that leads to American incarceration only amplifies inside facilities whose purported mission is to rehabilitate. Using psychiatric, literary, and sociological studies alongside three twentieth-century prison memoirs written by American men of color – Jarvis Jay Masters’s That Bird Has My Wings (2009), Shaka Senghor’s Writing My Wrongs: Life, Death, and Redemption in an American Prison (2013), and Ravi Shankar’s Correctional (2022) – this essay examines the use of bibliotherapy as a means of processing traumatic memory, reconnecting with community, redressing harm, and reclaiming control over one’s story to help stimulate and accelerate the process of healing and recovery. Life writing, and memoir specifically, allows for the transfiguration of generational, localized, and institutional trauma while bearing witness to the inner workings of carceral spaces, which are disproportionately populated by men of color and intentionally kept concealed from public view.

The USA as a prison where Black people are confined inside a barbed wire of stereotypes – an idea memorably articulated by Malcolm X in 1963 – is influentially explored in works by Amiri Baraka, Etheridge Knight, and Reginald Dwayne Betts, a three-man mini-tradition within prison writing. Circumstances leading to Baraka’s experience of solitary confinement (memorably chronicled in his 1979 poem “AM/TRACK”) are the subject of the first third of the chapter. Etheridge Knight, who in prison forged his own poetic path out of tools provided partly by Malcolm and Baraka, is the subject of the next third. The Knight-inspired Reginald Dwayne Betts, a lawyer-poet who was incarcerated as a teenager, is the focus of the rest of the chapter (except for a brief examination of Baraka’s son, Ras, a significant political leader). All four men articulate secrets of survival in the coils of carceral culture and model alternative ways of imagining justice.

Despite widespread integration of genetic research by most disciplines, genetics has largely been excised by the field of criminology, a field that continues to be guided almost exclusively by a sociological paradigm. Part of the reason for why genetic research has not been synthesized into the criminological scholarship is due to concerns about the policy implications that might flow directly from it. Specifically, critics of genetic and biosocial research routinely argue that studying the genetic basis to criminality likely would lead to oppressive crime-control policies and perhaps even a new eugenics movement. If criminologists had an accurate understanding of how genetic influences relate to criminal involvement, then these concerns would largely be assuaged. Against this backdrop, the current chapter uses Belsky’s differential susceptibility model as the centerpiece to show that genetic research is not only useful in understanding the etiology of criminal involvement but also that it holds great promise in guiding the development of crime prevention and rehabilitation programs.