Lauren Brinkley-Rubinstein, PhD: Documenting the trauma of incarceration

There isn’t much good associated with incarceration. Lauren Brinkley-Rubinstein, PhD, realized that early in her criminal justice studies, and it set the course for a career focused on understanding how incarceration affects health.

Drawn to sociology as an undergraduate, she majored in the field and minored in criminology, driven by an interest in major societal issues. During her master’s program in criminal justice policy, she even considered working for the FBI — until an interview she describes as “one of the oddest, worst interviews” she ever had made her reconsider. Living and studying in New York City soon exposed her to the deeper inequities of the criminal legal system.

“When I moved to New York and I started to understand the system itself and the history of the system, it became very clear to me the biases in the system and the ways in which the criminal legal system targets certain communities,” she said. “That's the moment that I really decided that there was no way that I was going to be an agent of the system.”

A role at the Vera Institute of Justice helped solidify that shift, sparking her interest in the intersection of incarceration and health. “For the first time I started to think that there are these long-term impacts of being in jail and prison,” she said. “It impacts people over the life course. And maybe if we could do more research that provided evidence that looked at what these long-term impacts were, we could impact policy.”

Examining harms inside prisons

Now an associate professor in the Department of Population Health Sciences at Duke, Brinkley‑Rubinstein focuses on how the trauma of incarceration — whether from flooded cells during climate disasters or the “extreme deprivation” of solitary confinement — shapes people’s health long after release. She spends her time asking questions like: “What are the conditions of confinement that are really bad for people who are experiencing jails and prisons, and to what degree do they carry those experiences as forms of trauma with them?”

Her work has gained national recognition. In 2025, she was the recipient of the Presidential Early Career Award for Scientists and Engineers (PECASE), the highest honor conferred by the U.S. government on early-career scientists and engineers.  

Solitary confinement and mortality

One of her recent papers examines the link between solitary confinement and mortality in North Carolina state prisons. Published in SSM - Population Health, the study found that solitary confinement was both widespread and strongly associated with higher in‑custody mortality. Nearly one in four incarcerated people experienced at least two weeks in solitary confinement between 2021 and 2023. By the end of the study period, more than 6% of the state’s prison population was held in solitary confinement at any given week. Solitary confinement is defined as isolation for 22 to 24 hours per day.

Using weekly housing data from Disability Rights North Carolina, Brinkley‑Rubinstein and her team created a retrospective cohort of 41,525 people who were newly incarcerated in state prisons. During the study period, there were 43 in‑custody deaths. The mortality rate for individuals who had experienced solitary confinement was more than double that of those who had not — 4.23 versus 1.96 deaths per 100,000 person‑weeks. Brinkley‑Rubinstein said these findings highlight solitary confinement as a profoundly harmful condition of confinement.

The United Nation's Standard Minimum Rules for the Treatment of Prisoners, also known as the “Nelson Mandela Rules,” defines punitive use of solitary confinement for longer than 15 days as torture. Despite these rules, Brinkley-Rubinstein said U.S. prisons frequently exceed this.

“The United Nations has defined any solitary confinement as something that we should not be using,” she said. “I almost can't believe that we use it to the extent that we do.”

As for why solitary confinement is linked to increased mortality, she believes the explanation is tied to trauma. “The best explanation I can come up with is that it is an extreme form of trauma. It's extreme deprivation in a way that people often can never get over.”

From research to policy

Her work in this area has helped influence policy debates, including being cited in amicus briefs before the Supreme Court and in state-level reform efforts. “We have seen states try to adopt the Mandela rules,” she said. “No state has gotten rid of solitary confinement, unfortunately. But some of them have decided to impose this limit.”

Brinkley‑Rubinstein hopes to further study states that have restricted solitary confinement to evaluate whether these policy changes reduce mortality or improve other outcomes.

With 11 million people cycling through jails each year and another two million in prison, she says the stakes are enormous. “Everyone knows someone who has been impacted by a jail system,” she said. “It's just so common that it is almost threaded into the very DNA of America. And yet we continue to use it, even though we know it kills people.”

She believes the best intervention is reducing exposure to incarceration altogether and developing alternatives. “Meeting public health issues with public health interventions is the number one way to decrease the trauma and negative impacts of any type of time spent in jail and prison,” she said.

Much of her current work, which includes partnering with non‑armed first responder programs, is aimed at keeping people out of the system in the first place.