Woman-showing-pink-ribbon-to-support-breast-cancer-cause-via-Shutterstock-615x345

Pink Ribbon Extravaganza

A newer version of this post (with more great photos) can be read here.

It’s October – the leaves are turning yellow, porch ornaments are coming up pumpkin orange, the first frost is sparkling silver, and everywhere I turn the sight of pink ribbons assaults my eyes and affronts my sensibilities. The annual pink ribbon extravaganza, surely one of the most successful marketing campaigns in history, has millions of Americans walking, running, racing and selling merchandise “for the cure.” Having spent the first half of my career studying religious rituals, I can’t help but think that many of the ribbon bearers see their little scraps of pink as an amulet or a charm, a means of warding off an enemy over whom one feels impotent. If we just wear or sell enough pink ribbons during the month of October, we hope or we bargain with the cancer gods, then maybe we’ll be safe from breast cancer for the coming year.

10well_ribbon-blogSpanMaybe I’m a cynic, or an agnostic, but as a means of averting breast cancer I’d rather put my money on cleaning up toxic chemicals from the environment than on adding a bunch of pink ribbons to our November trash piles or on painting pink ribbons on football fields while the NFL allows known rapists and batterers to play in the league.

Winners and Losers

When my mother became ill with and eventually died of breast cancer in 1971, no one talked about it – not even her close friends were present to offer aid or comfort. Yet, today, as we paint the town pink, I am concerned that we have come to see breast cancer as a relatively normal part of the female life course: puberty, pregnancy and childbirth, followed by menopause and breast cancer. Pushing against this cultural tide, I feel a need to yell: Breast cancer is not normal; nor is it pinkly feminine or cute. The rise in rates of breast cancer over the past century is a palpable sign that something is wrong with our world.

America loves winners, and we have come to regard women who are diagnosed with but do not die from breast cancer as heroic battlers. Those women who die are hidden, lying somewhere outside of the victory circle, “victims” in a culture that at best pities and at worst blames victims for their own misfortunes. It feels absurd to have to say this, but it needs to be said: Breast cancer can’t be cured by the optimism or will power or athleticism or fighting spirits or strength of character of women who are afflicted with the disease. Breast cancer should not be treated as a challenge or as a measure of one’s moral fiber.

And it should never, ever be treated as a commodity.

Big Bucks

Gayle A. Sulik draws attention to some disturbing implications of the ubiquitous pink ribbon. First, pink ribbon marketing, like all “cause marketing,” primarily benefits the company, not the charity or cause. Second, as a result of cause marketing, people actually give less to charities. And third, pink ribbon and other cause marketing can mask conflicts of interest, like when companies promote the idea of cancer research but also manufacture, disseminate, or sell products that contain toxic or carcinogenic ingredients.

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Over the past few years the failure of the pink ribbon movement was brought home to many of us when the Susan G. Komen for the Cure foundation, the most visible promoter of pink racing for the cure, announced that it would no longer fund breast cancer screenings at Planned Parenthood, the health care home for millions of young and low-wage women. This decision, believed to reflect the Komen’s Foundations’ capitulation to anti-choice advocates, was reversed when donations to the organization plummeted in response.

 

Where is the Evidence?

Victory laps in races for the cure, together with the ubiquitous pink ribbons, may lead people to believe that far greater strides have been made in preventing and treating breast cancer than have actually been made. In a 2014 article published in the New England Journal of Medicine, Nikola Biller-Andorno, M.D., Ph.D. and Peter Jüni, M.D. report that data show no evidence that routine mammography screening of women at average risk saves lives. A high-quality study made public by the Swiss Medical Board, “acknowledged that systematic mammography screening might prevent about one death attributed to breast cancer for every 1000 women screened, even though there was no evidence to suggest that overall mortality was affected.”

The NEJM article also cites research showing that many American women overestimate their personal risk of breast cancer and the benefits of mammograms. In a study of U.S. women’s perceptions, “717 of 1003 women (71.5%) said they believed that mammography reduced the risk of breast-cancer deaths by at least half.” Exacerbating the dangers, as a major Canadian study discovered, 21.9% of breast cancers found through mammography screening represented over-diagnoses. In other words, thousands of women each year undergo surgery, radiation and chemotherapy for non-life threatening cancers.

Breast Cancer Action, a national non-profit organization calling for transparency in breast cancer research, treatment and education, has these harsh words to say: “While corporations [such as manufacturers of mammography equipment] have made billions off the disease, progress in breast cancer treatment, prevention, survival, and inequities has not been forthcoming. Three million women in the U.S. are living with breast cancer. Up to one-third of all breast cancers will metastasize, even when found in the early stages. Black women are still 40% more likely to die of breast cancer than white women. And each year, 40,000 women die of breast cancer.”

We Can Do Better

PieChartWhile spending on breast cancer detection and treatment continues to increase, funding for prevention – for learning about the causes of breast cancer – is far less marketable. This year, in my home state, the Massachusetts legislature failed to fund research on potential carcinogenic impacts of chemical exposure despite clear findings that there are specific communities in Massachusetts with particularly high rates of breast cancer. According to reports, “The Massachusetts Senate [2015] budget … did not include a $500,000 request to fund water quality and public health research by Silent Spring Institute.  The Massachusetts Breast Cancer Coalition requested this funding on behalf of its sister organization, Silent Spring Institute to study exposure to toxic chemicals in drinking water and homes in Central Massachusetts and on Cape Cod. Earlier this month, the House of Representatives failed to approve funding for Silent Spring Institute in the FY 2015 House budget. This is the second year in a row that budget requests for important water quality research in both the House and Senate have been excluded.”

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Today, when I walked past the Massachusetts State House on my way to work and saw pink ribbons everywhere, women’s health pioneer Barbara Ehrenreich’s words came to mind. Writing about her own experiences with breast cancer, Ehrenreich wrote, “What sustained me through the ‘treatments’ is a purifying rage, a resolve, framed in the sleepless nights of chemotherapy, to see the last polluter, along with say, the last smug health insurance operator, strangled with the last pink ribbon.”

In honor and memory of my mother, Bernice C. Starr, let me say “Amen.”

 

Updates on the Women of Can’t Catch a Break

The publication of Can’t Catch a Break is not the end of the stories of the women whose life experiences are described in the book. We continue to spend time with some of the women and as we do we learn more about their lives – both the challenges they face and the strategies they use to address those challenges. It is important for us to convey to readers that these women are not “objects of inquiry” but real human beings who, like all of us, change their attitudes and their circumstances over periods of years, months and even days.

This page is a “Reader’s Guide to Updates” on the women whom you have come to know through the book. In some instances we’ve written full-fledged blog entries about issues that their experiences illuminate. In other cases we’ve simply added a few sentences under their names. All names are pseudonyms.

Please check back – we will continue to update this page!

Andrea: Andrea is settled in a studio apartment, but – much to her annoyance — her boyfriend has moved in with her. According to Andrea he is “too proud” to sign up for housing or food stamps.

Ashley: Ashley has a steady job (though she is underpaid and overworked), a nice apartment, and a lovely boyfriend. Unfortunately she was hit by a car about a year ago and is still struggling with severe back pain, as well as with doctors who too liberally prescribe pain meds for her.

Carly: Carly has lost a great deal of weight, remains involved in her church, and still cannot land a job.

Elizabeth: After ten years, Elizabeth finally has her own apartment. She feels safe for the first time in years and is trying to put her life back together. Sadly, her father passed away this year. Her brother, her closest living relative, seems to have inherited her father’s property and he has taken out a restraining order against Elizabeth. Caste Away: Mass Incarceration and the Hardening of Economic Inequality

Francesca: Over the past two years Francesca has moved in with and away from Joey several times. She returns because she needs a place to live. She leaves because Joey is verbally abusive. She remains deeply involved with her sons and her granddaughters, and posts frequent pictures of her granddaughters playing with her and their fathers. Yesterday (October 2014) I met Francesca at her new place: a one bedroom apartment she is sharing with her man [not Joey!], a friend’s daughter and the daughter’s girlfriend, and a another young woman. She is thrilled that her name is on the lease so she is not at the whim of the official tenants, but the place is really, really crowded. But the bigger news (for me!) is that I had the honor of sitting with her while she read the Introduction and Chapter 1 of Can’t Catch a Break. She is the “star” of both of these sections — and she LOVES the book and told me that “you got it.” She laughed at the changes I made to her name and certain identifying characteristics (for the sake of preserving her anonymity in the book) reminded me that we’re planning to write something together on the absurdity of young women straight out of college who work for Children’s Services being able to tell experienced moms like her what they have to do. For Francesca, reading the book was a bit of a walk down memory lane. For me, seeing and hearing her reactions are the most important validation of my work that I could ever hope to get.  White Women, Opiates and Prison

Ginger: Ginger’s beloved mother passed away several months ago. As soon as her outstanding court case is settled (see The New Price of Freedom: $40 (Bail Blog #2) | The Courtroom was a Circus: Bail Blog #3 – $190 and Counting) she will move out of state to live with her brother, his wife and their toddler.

Gloria: Sex, race and prison’s violent double standard: Incarcerating men hurts women, too

Isabella: Isabella is happily married to the man with whom she became involved after she left Reese. They are both on methadone maintenance and out of jail. Neither has a job.

Joy: Joy continues to cycle through jail, detox, psychiatric wards and the streets. She recently told me that she doesn’t expect that she’ll survive much longer. Guilty Until Proven Innocent | Suicide is Painful  | Suicide is Painful, Update

Junie: Junie’s health has severely deteriorated. The last time I saw her she was in respite care. I have not been able to contact her for several months.

Kahtia: On the outside, things look great. She and Enrique are still together, they have their own apartment, and the children are holding their own. On the inside, things are not so good. She has been severely depressed and anxious, and feels that “my life is falling apart.” Over the past year she has had half a dozen health emergencies. Today she told me that the doctor is sending her for a CT scan because “I can’t remember anything, where I put things. I can’t find my medicine. I can’t find my daughter’s shoes in the morning and so she’s late for school. She’s in the best school around here and I’m afraid they won’t let her stay in this school.”

Megan: Megan has been in and out of jail and the hospital. She is no longer able to care for her children.

Melanie: Civil Commitment: If You Build It They Will Come

Tonya: Sex, race and prison’s violent double standard: Incarcerating men hurts women, too

Vanessa: I speak to her on the phone but haven’t seen her for a while. She was living in a rooming house but her room was infested with bugs. She had to throw away all of her clothes and furniture when she moved to another rooming house.

Yes Means Yes: Kudos to California

Ono-Yes

Yoko Ono

Kudos to California

California’s Governor Jerry Brown, on September 28, 2014, signed into law a bill making California the first state in the nation to require universities receiving state funds to use an “affirmative consent standard” for determining whether consent was given by both parties to sexual activity. SB967 represents a paradigm shift from women as victims and potential victims whom we need to encourage to shout “no” a bit louder, to women as agents who have the positive right to engage or refrain from engaging in sexual relations when and with whom and under circumstances of their choosing.

Schools and colleges have been trying to convey the message that “no means no” for at least two decades, yet according to recent data about 20% of women are sexually assaulted in college. In other words, “just say no” hasn’t worked any better in preventing sexual violence than it did in the utterly failed war on drugs. Designed to address high incidences and less-than-stellar responses to rape, sexual harassment and stalking on college campuses, SB967 removes the onus from potential victims to unequivocally convey and prove refusal or resistance (“no”) and places the onus on potential perpetrators to ensure active consent (“yes”).

“Affirmative consent,” according to the bill, “means affirmative, conscious, and voluntary agreement to engage in sexual activity. It is the responsibility of each person involved in the sexual activity to ensure that he or she has the affirmative consent of the other or others to engage in the sexual activity. Lack of protest or resistance does not mean consent, nor does silence mean consent.” The bill further clarifies that “it shall not be a valid excuse that the accused believed that the complainant affirmatively consented to the sexual activity if the accused knew or reasonably should have known that the complainant was unable to consent to the sexual activity.”

The Problem with the Status Quo

“No means no” has been the dominant anti-rape paradigm in the United States for the past several decades. One unfortunate consequence of the “no” paradigm is the responsibility it places on women who have been assaulted to prove that they really did say “no.” But even in the wake of the Violence Against Women Act, the majority of rapists are not arrested; only an estimated 5% of rapists are convicted; and an estimated 3% spend any time in jail.

Rape remains one of the few crimes in which the victim is scrutinized for ulterior motives, false accusations and moral deviance. Despite rape shield laws designed to protect women from verbal assaults by defense lawyers at rape trials, victims can be asked about their social and sexual history when these issues are ruled relevant to determining consent. Victims least likely to see offenders convicted are older, poorer, deemed promiscuous or prostitutes, have a psychiatric or drug abuse history or criminal record, didn’t overtly resist or were acquainted with the offender, or had a history of previous rape or abuse.

Joy, one of the Boston area women whom I have come to know through my work with criminalized women, explained to me that when she went to court to testify against a man who violently and brutally raped her, she assumed that the evidence against the perpetrator was very strong: DNA evidence had led to his arrest originally – his DNA was found on the police computer system; police offers and crime scene officers testified; other witnesses from her apartment building testified; the nurse who examined her in the emergency room testified. However, he was found not guilty. “The last three questions the defense attorney asked me are: Isn’t it true that you were in prison? Isn’t it true that you are an addict? Isn’t it true that you used to work in prostitution?” In other words, her “no” didn’t count.

Joy’s experience represents a broad trend: In this era of DNA testing, consent is the primary defense used in rape cases. Coming at this time, California’s affirmative consent standard is a critical step in diverting attention away from the behavior, clothes, personality, drug use, criminal record or degree of resistance by women who have been raped and placing it where it belongs – on the actions of the perpetrator.

The Need for a New Model

California’s new “yes means yes” law has been critiqued as impossible to implement on the grounds that “consent” is too difficult to assess. I disagree. As the former Chair of the Institutional Review Board (the body that reviews the ethics of research involving human subjects) at Suffolk University, I suggest that the State of California turn to the well-developed, refined and extensively evaluated protocols for informed consent in human subjects research as a model for interpretation and implementation of affirmative consent in sexual activity.

Protocols for protecting human subjects acknowledge the power differentials inherent in the relationship between researchers (in possession of knowledge, institutional backing, monetary resources and access to goods and services such as new medical treatments) and human subjects. The structural imbalance of power in the relationship between researcher and subject demands that researchers are pro-active and clear in facilitating the informed consent or refusal of each human subject. Consent cannot be assumed, silence does not mean “yes,” and it is the responsibility of the researcher to present potential subjects with a real and meaningful choice regarding participation in the research, to refrain from offering inappropriate financial incentives, and to avoid any hint of threatening negative repercussions for refusal to participate. The process of asking for and receiving informed consent includes: (1) disclosing to potential research subjects information needed to make an informed decision; (2) facilitating the understanding of what has been disclosed; and (3) positively promoting the voluntariness of the decision about whether or not to participate in the research.

The language and the technicalities (such as written proof of consent) used in human subjects’ research would need to be revised to meet the needs of ensuring consensual sexual activity, but the model makes a great deal of sense. Like research interactions, gendered interactions are inherently unequal given the greater incomes, financial assets, political power and physical size and strength of men as a group vis-à-vis women as a group, and the far greater likelihood that women (nearly one in five) than men (one in 71) has been raped at some time in their lives. Clearly spelling out the responsibilities of those in positions of dominance will in the long run facilitate positive interactions despite power differentials. And clearly spelling out the rights of those in subordinate positions will, I believe, contribute to more equality in all spheres of life.

You can read more about Joy here: Guilty Until Proven Innocent | Suicide is Painful  | Suicide is Painful, Update

You can read further analyses of rape culture here: Ray Rice and Cultures of Violence /Fighting Rape Culture: Real Tips

Why Can’t US Help Solve Ebola Outbreak without ‘Waging War’ and ‘Sending Troops’?

Published on CommonDreams, Sept. 17, 2014

A fact sheet released on Tuesday by the White House outlines an expanded government commitment in response to the Ebola epidemic in West Africa. “[T]he humanitarian crisis there is a top national security priority for the United States.  In order to contain and combat it, we are partnering with the United Nations and other international partners to help the Governments of Guinea, Liberia, Sierra Leone, Nigeria, and Senegal respond just as we fortify our defenses at home.”  The President’s plan includes the deployment of 3,000 troops to the region. “The United States will leverage the unique capabilities of the U.S. military and broader uniformed services to help bring the epidemic under control. These efforts will entail command and control, logistics expertise, training, and engineering support.”

The President’s plan was quickly lauded with headlines announcing that the US has declared war on Ebola, and that the US plans to send troops to tackle Ebola .

I am, like most everyone else, pleased that the United States has finally, if belatedly, decided to send substantial resources to assist the impoverished communities and nations bearing the brunt of this infectious disease. Yet I can’t help but be put off by the militarization of the response.

The newly declared “war on Ebola” troubles me on several levels. First, I’m not convinced that sending uniformed troops to regions that have suffered excruciating armed conflicts over the past decades is a move designed to inspire trust or hope among the local population. One wonders how these troops will be used: Will they don shields and helmets while forcing residents of poor neighborhoods to stay put or to move to mobile treatment centers?  Will they carry weapons? Will the appearance of foreign soldiers frighten urban residents into fleeing into the countryside?

Turning our attention inward, I am concerned that we come to rely on our military as the only governmental agency capable of responding to any sort of crisis. Do we not have the resources within national health agencies to respond to major health crises?

Military organizations and military culture are not the best way to respond to human suffering. Our America inclination to frame social problems in terms of war underpins our troubled history of crusades to stamp out vices and diseases (the two words often are used interchangeably) ranging from alcoholism to obesity to cancer. Declaring war on disease sends the message that the sufferer is somehow at fault and wars on disease too easily turn into wars on those who embody the disease. Over the past decades, our disastrous national campaign against drugs has been framed as the “war on drugs.” This set of racially charged policies, more aptly described as a “war on drug users,” and has led to local police departments being armed with military equipment (including tanks) and, tragically, to the highest rate of incarceration in the world.

While we might find comfort in the belief that with sufficient technology we can conquer any foe, the world is far more complicated than that. Even if military and medical might could eliminate every single trace of the virus in West Africa, the conditions that made the region vulnerable to the rapid spread of a new infectious disease remain in place. These conditions include deforestation and environmental degradation, rapid movements of populations into overcrowded cities, and yes – wars and other political operations that eat up resources that in other circumstances could go into building a viable and stable public health infrastructure.

Ray Rice and Cultures of Violence

In this piece published today in the Washington Post I argue that since jail teaches people how to be better criminals, it likely also teaches men like Ray Rice how to be better batterers. Click on the link to read the full article.

Be careful about sending domestic abusers to jail. It might make them even more violent

From sports talk radio hosts to feminist bloggers, just about everyone seems to agree: Former Ravens player Ray Rice should be locked up. We should throw away the key.

They’re wrong.

Fighting Rape Culture: Real Tips

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You can read this and other posts by a wide range of women’s health clinicians, advocates and activists on the Our Bodies Ourselves webpage.

The new academic year has started and once again students are attending seminars on staying safe on campus. These orientation workshops typically focus on tips for women like:  “Take control of your online life;” “Make others earn your trust;” “If you see something, say something;” “Be aware & stay alert;” “Make plans & be prepared;” “Party smart;” “Be a good friend;” “Stick together in groups.”

I’m sure all of this is good advice, but it misses what I have come to see as the crux of the matter: Teaching girls and women that if they just try hard enough they can avoid sexual assault places responsibility for rape on the shoulders of targets and potential targets rather than on the shoulders of perpetrators and of political and cultural power-brokers.

As a parent and an educator, I feel obligated to tell my children and students the real truth: Rape is a weapon used to amass, exert and enforce power. It has nothing to do with the behavior or attitude or psychology or sociability or preparedness or intelligence or skirt length or alcohol use of particular girls and women.

Here are the real “tips” that our children and students need to know.

In 2012 there was (brief) international outrage over the brutal gang-rape of a student on a Delhi bus in 2012. This was far from an isolated incident. Women and girls in India are raped on buses, in schools, in bathrooms and at home. They are raped in the context of inter-religious, inter-ethnic and inter-caste violence. They are raped for being educated and they are raped for being uneducated. According to a recent International Men and Gender Equality Survey, nearly one in four Indian men has committed sexual violence at some point in their lives. Rape in India must properly be seen in the context of femicide: The gender ratio in India is at its most unbalanced since 1947, with 1000 boys for every 927 girls. The “missing girls” are eliminated through selective abortion, infanticide, abandonment, preferential feeding of male children and adults, through torturing or killing young married women for their dowries. Tip #1: Politely thank your university or community for rape crisis hotlines and for those shiny whistles they give you so that you can make a scary noise when you are assaulted. And then insist that they invest in educating and socializing men about women’s humanity and that they put significant resources into ending gender violence at its source.

Hundreds of Yazidi women in Iraq have been abducted by ISIS and either sold or handed out to members of the extremist group in Syria.“In the past few weeks, ISIS has “distributed” to its rank and file about 300 female members of the persecuted religious minority, says the Syrian Observatory for Human Rights, a UK-based monitoring group aligned with the opposition in Syria.” The monitors explain, “In ISIS’ eyes, the girls and women are “captives of the spoils of war with the infidels.” Tip #2: If you ever hear anyone saying that a woman who was raped “asked for it,” ask them what the Yazidi women did to entice the ISIS terrorists.

Boko Haram, a militant Islamic group active in Nigeria, has – for several years – been forcing Christian women to convert to Islam and taking them as wives. It has also carried out mass kidnappings and is still holding captive more than 200 girls soldiers abducted in April from a school in Chibok. The group released a video in which the group’s apparent leader called the girls “slaves” and threatened to “sell them in the market” and “marry them out” rather than let them get educations. According to a recent article in the New York Times, “Although about 50 [of the girls] escaped, not a single one of the remaining girls has been found, and despite international offers of help, the Nigerian government has been slow to act. Tip #3: Write for your campus newspaper, tweet, talk, yell, become an expert in social media: Help keep the violence committed against girls and women in the public eye.

In an excellent on-line essay for NOW, Jenna Archer itemizes increases in incidents of gender-based violence in Central America in recent years. “Rates of femicide (the targeted, systematic killing of women and girls), sexual violence, kidnapping, forced disappearance and unjustified detention are on the rise in the region, causing thousands of women to flee Honduras, El Salvador, Guatemala and Mexico due to their well-justified fear of being raped, murdered or tortured.” Calling out the “pandemic of gender-based violence,” Archer notes that, “Rates of gender-based violence in Honduras rose sharply after the 2009 coup d’état and during the subsequent regime of Porfirio Lobo. Between 2002 and 2010, the rate of femicide increased 257 percent and, today, the second most prevalent cause of death of women is gender-based violence.” And, “Girls may be kidnapped and forced into sex and drug trafficking. In some regions, it has gotten to the point that parents no longer allow girls to go to school because they fear for their safety.” Tip #4: Get together with friends and teachers to learn and and talk about the “pandemic of gender-based violence.”

Thousands of Central Americans travel through Mexico every year attempting to reach the United States. But because they make the trip illegally, they are vulnerable to kidnappings, extortion and robbery – with organized criminal groups such as Los Zetas often acting in cahoots with law enforcement authorities. Women face the additional reality of widespread sexual violence. According to Rev. Prisciliano Pedraza, a priest and director of a shelter for migrants in the town of Altar, near the Arizona border, “The women passing through here know that they’re going to be raped. … Migrants are a vulnerable group, and the most vulnerable among them are women.” While there is no systematic tracking of rates of violence, Father Pedraza puts the figure at 90 percent of all female migrants. Tip #5: Support candidates who support true immigration reform.

Across the United States an estimated 70% of incarcerated women have been victims of physical and sexual violence. With only a few exceptions, all of the Boston-area criminalized women with whom I work have suffered sexual abuse. About half of the women were sexually abused as children. To escape, many of them ran away from home (and so were exposed to additional violence on the streets) and turned to drugs to “self-medicate.” As drug users they became vulnerable to sexual violence at the hands of dealers, johns, prison guards and – as one woman puts it – “shady police who make you do things for them.” And, even in this era of the Violence Against Women Act, the vast majority of rapists are not arrested. According to estimates only 5% of rapists are convicted and 3% spend any time in jail. Tip #6: Don’t count on the police or the courts to save you from sexual assault.

My new book describing my work with criminalized women is now available through Amazon and other bookstores. You can read more here.

 

Snapshots from Ferguson and Liberia: Something’s Happening HERE

The two images reprinted below have appeared widely in media outlets over the past weeks. Eerily similar? Both show armed police or soldiers carrying shields facing off against unarmed people of color. Without careful perusal, it’s hard to tell which caption belongs with which photo.

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ferguson

“Liberian Soldiers Seal Slum to Halt Ebola” Associated Press, Aug. 20, 2014

“Photo Essay: Police and Protesters in Ferguson” St. Louis Post-Dispatch  Aug. 14, 2014

The Stories Behind the Photos

In Liberia’s capital city last week, residents of a densely populated, poor neighborhood protested when security forces sealed off their community as a quarantine measure in response to the Ebola outbreak. According to reports, residents asserted that not only had they been cut off from their homes but also that they were being disproportionately exposed to the virus because sick people from outside their community were being brought into an Ebola screening center set up in their neighborhood by the government.

In Ferguson, Missouri, when residents took to the streets to protest the shooting by a police officer of Michael Brown – an unarmed African-American youth, thousands of law enforcement officers as well as National Guard were deployed to contain the demonstrators. As of this writing, several hundred protesters have been arrested.

Poverty, Inequality and The Burden of Disease

Liberia is among the poorer nations of the world. In 2012 the gross national income per capita was $580; 75 babies out of 1000 could be expected to die before the age of five; and the total annual expenditure on healthcare was a meager $102 per capita. The top causes of mortality in Liberia include malaria, diarrhea, respiratory infections, AIDS and malnutrition.  Neither money nor the burden of disease is distributed evenly in Liberia. As calculated by the GINI index, Liberia is one of the least economically egalitarian countries in the world.

Fifteen years ago, Ferguson was a predominantly white middle class suburb of St. Louis. By 2010, the population was two-thirds black . Elizabeth Kneebone, a fellow at the Brookings Institution, notes that in 2014 every Ferguson neighborhood but one has a poverty rate over 20%, “the point at which typical social ills associated with poverty like poor health outcomes, high crime rates and failing schools start to appear.”

In the state of Missouri, the rate of poverty among Black men is twice that of white men (22.5% vs. 11.6%). Among Missouri women, 24.3% of Black women vs. 14.5% of white women are living in poverty. In St. Louis County (where Ferguson is located), the rate of emergency room visits due to asthma among children under 15 years is 52% higher than the overall rate for the state. (High rates of childhood asthma are associated with environmental pollution and substandard living conditions.) The rate of infant mortality is 9% higher than the state’s rate and 21% higher than the U.S. national rate. The rate of babies born with a low birth weight (an excellent indicator of women’s overall health status and of the child’s future health status) is 8% higher than the state’s rate, and 20% higher than the national rate.

The Legacy of Injustice: War on the Poor and the Ill

Liberians are struggling with the aftermath of two recent civil wars. “Liberian scholars offer a range of explanations for the years of conflict including ethnic divisions, predatory elites who abused power, a corrupt political system, and economic disparities. The Truth and Reconciliation Commission found that underlying those proximate causes, the seeds of conflict were sown by the historical decision to establish Liberia as a state divided between natives and settlers, and the use of force to sustain the settlers’ hegemony.” While many Liberians are incarcerated for the “crime” of being poor or disliked by the police, perpetrators of crimes against humanity during the civil war have not been punished. Following the civil wars, according to Amnesty International, “Senators, Deputy Ministers, police officials, Special Security Service agents and Liberia National Police officers were allegedly engaged in or ordered beatings, looting, arbitrary arrests, abductions, shootings, ritualistic killings and other abuses. In most cases, no investigations were carried out and no action was taken against alleged perpetrators. … Law enforcement forces were reported to have unlawfully arrested and detained people and to have used torture and other ill-treatment, including during attempts to extort money on the streets. … Conditions in police lock-ups were appalling, with juveniles and adults routinely held together. Detainees were often subject to abuse by police and other detainees. … The formal justice system often failed to deliver fair trials and due process. Lengthy pre-trial detention beyond that allowed by law was the norm, with roughly 90 per cent of prisoners being pre-trial detainees. As well as corruption and inefficiency, the system suffered from lack of transport, court facilities, lawyers and qualified judges.”

Residents of Ferguson are struggling with the historical legacy of legally sanctioned racial discrimination, nearly four decades of ‘trickle-down’ economics that have eliminated middle and working-class jobs in the mid-west and throughout the country, and housing policies that price low-income Americans out of the housing market and segregate people of color in densely populated neighborhoods with lousy schools and housing and crumbling infrastructures.

Ferguson residents are also struggling with what Michelle Alexander aptly calls the “New Jim Crow” – decades-long ‘tough on crime’ policies that primarily targeted men of color and have led to the United States claiming the highest incarceration rate of any nation in the world. In 2012, one out of every 200 Missouri residents was in prison or jail serving a sentence of one year or longer. And, unlike in much of the rest of the country, Missouri’s prison population actually rose 1.3% in 2012. Incarceration rates for white men in Missouri in 2012 were 650.6 per 100,000. Among black men in it was nearly six times that: 3,640 per 100,000. Law enforcement personnel, like members of all three branches of government in Missouri, are overwhelmingly white.

Last year, Ferguson used municipal court fines to fund 20.2 percent of the city’s $12.75 million budget. (Just two years earlier, municipal court fines had accounted for only 12.3 percent of the city’s revenues.) Incarceration rates specifically for Ferguson are not available. But, statistics posted on the Ferguson municipal website hint at the facts on the ground. In 2012 (the last year for which data are posted) Ferguson exhibited a striking gender imbalance in its population.

Male population 9,279  (43.9%)
Female population 11,856  (56.1%)

Women do live longer than men in most of the world, but the gender disparity in Ferguson is more in line with war zones – with countries like Liberia that have experienced lengthy civil wars — than with American “suburbs.” If I had to make an educated guess as to the whereabouts of the missing men I’d guess dead or in jail. The face-off in the photo above certainly makes that guess plausible.

For What It’s Worth

We Americans like to believe that “this kind of thing” could never happen “here.” We’re shocked by the egregious killing of a young man in Ferguson, by the outraged community response and by the overtly militarized law-enforcement response. We’re less shocked by the circumstances surrounding the outbreak of Ebola in places like Liberia. But – as we’ve seen over the past few weeks – the systemic inequalities that give rise to poverty  and disease “over there” also drive anger, distrust and mass incarceration right here in America.

With a nod to the Buffalo Springfield’s 1966 masterpiece: “There’s something happening here / What it is ‘IS’ exactly clear / There’s a man with a gun over there / Telling me I got to beware / I think it’s time we stop, children, what’s that sound / Everybody look what’s going down.”

Please check out my new book Can’t Catch a Break: Gender, Jail, Drugs, and the Limits of Personal Responsibility

And for more on the social context of responses to the Ebola outbreak check out: Ebola and US and Ebola, Secret Serums and Me

Aswirl in a sad spiral, women in detox face human rights violation

Reprinted from the Boston Globe, August 19, 2014

The Aug. 14 editorial “Women get unequal treatment in court-ordered detox” underscored an egregious violation of human rights in the Commonwealth. Due to a lack of treatment beds, drug users who have not been arrested, tried, or sentenced may be sent to MCI-Framingham if a judge deems that they are dangerous to themselves or others.

Women committed to a prison setting do not receive the treatment afforded those who are sent to the Women’s Addiction Treatment Center, which is licensed by the Department of Public Health. Most damning, women of color are three times more likely than white women to be committed to prison rather than to the treatment center.

The way out of this mess, according to Governor Patrick and others, is to fund additional substance-abuse treatment beds in non-prison facilities.

However, many of the women who are civilly committed are not only dealing with addictions but also with poverty, homelessness, serious health problems, and intimate partner violence. One DPH official estimated that 20 percent of civilly committed women do not meet the criteria for commitment; rather, they are committed because no one knows where else to send them.

As a nation, we’ve gone the route of building more prisons in unsuccessful efforts to manage the devastation caused by economic and racial inequalities. Building more “staff-secured” treatment centers will not prove any more successful unless we also address the poverty, gender and racial discrimination, and violence that lead so many residents of the Commonwealth to turn to drugs in the first place.

Susan Sered

Boston

The writer is a sociology professor and a senior researcher at the Center for Women’s Health and Human Rights at Suffolk University.

Suicide is Painful, Update

Last week I wrote about my friend Joy, a woman who has dealt with sexual violence, homelessness, substance abuse, humiliation and criminalization since she was in her early teens. A few days earlier she had tried to end her life. Precipitating the suicide was her realization that if she kept using heroin she would not survive. She made the tough decision to go onto methadone, and enrolled in a methadone clinic. Though she told the clinic  about the extent of her heroin use, she was given too low a dose to stave off painful withdrawal symptoms. (Clinics sometimes give doses that are too low to be effective out of fear that patients are trying to trick the staff into giving them more methadone than they really need.) To supplement the methadone she went back to the streets and sex work for the money to buy heroin. The day she tried to kill herself she felt, as she told me later, “What’s the point? I try to do the right thing, go on methadone, and that doesn’t work. There’s nothing left for me.”

Today Joy called me again. She sounded great. She’d had two weeks of a safe bed to sleep in and nutritious meals to eat in the psych ward of a hospital near my house, and the doctors there had gradually raised her methadone dose to a point at which she was no longer dope sick.

“How did you get them to keep you for so long?” I asked, reminding her that last week the hospital had told her that she couldn’t stay there for more than a few days. “They tried to find a place to send me,” Joy explained, “but the social workers couldn’t find anyplace willing to take someone who is on methadone and coming from a psych ward. So they tried to send me to a homeless shelter but I told them that if I went into a shelter I’d be back on the streets and I’d jump off the roof, so they had to keep me because I said I was suicidal. I actually wouldn’t jump off the roof, but sometimes,” Joy added, “you’ve got to finagle a bagel.”

“What now?” I asked. “Well they just gave me my phone back and I’m waiting for the detox [facility] to pick me up.” “What are you detoxing from?” I asked. “You haven’t used drugs. You’ve been in the hospital for the past two weeks.” “Methadone,” she replied. “They decided to send me to detox to get me off methadone because that is the only way I can get a placement in a halfway house or rehab.”

Sounds crazy? Yes, it is. But those are the rules.

Joy has been around this block before, and she doesn’t expect the system to make sense. I, far more naïve than she, repeatedly find myself hoping that this time the doctors, the social workers, the nurses and the caseworkers who advocate for Joy will be able to arrange an appropriate, permanent placement. But even the best medical and social service personnel (and she has been assisted by many wonderful professionals) cannot create a rational plan out of the current hodgepodge of short-term public and private programs.

No Magic Bullet – But Some Sensible Recommendations

There is no magic bullet that will cure Joy. The social conditions — and especially the gender inequality and sexual violence that cause her misery continue to be our reality. But there are steps we can take both at the policy and the programmatic levels that can increase Joy’s odds of survival.

One, we must bring the jumble of programs for people who are struggling with substance abuse into a coherent system in which a given individual can know that she has a therapeutic “home” that she can turn to, a home that knows her history and in which there is at least a fighting chance of developing some level of mutual trust. Joy cannot even remember all of the programs she has been sent to over the years, but when we tried to brainstorm we came up with a list of more than three dozen different facilities and programs — each with its own intake and assessments, each with its own medical protocols, each with its own rules. Right now, I am still fuming over the idiocy of putting Joy on too low a dose of methadone in an outpatient clinic, increasing her dose in an inpatient psych ward, and then sending her to a detox facility to withdraw from methadone so that she can get into a “holding” program while waiting for placement in a rehab program.

Two, we need to change the criteria for participation in mental health programs and in substance abuse programs in order to serve the needs of people like Joy with “dual diagnoses” (mental illness and addiction). The fact is that the majority of people who overuse psychoactive substances are, in one way or another, self-medicating their misery. The ersatz distinction between mental illness and addiction reflects out-dated ideas about what constitutes criminal behavior. It is neither realistic nor helpful.

Three, we need to know when to say “enough” to drug treatment programs. Joy has been through so many programs that, as she once told me, “I could teach the classes myself.” Rather than send Joy to detox and still another program, it would be far more sensible to provide her with secure housing where she will have access to on-going healthcare and emotional support, where she won’t be kicked out for breaking the rules or for “relapsing” (which, I acknowledge, she likely will), and where she will have at least a fair shot at putting down the roots and building the social networks that, in the long run, may be more salutary than methadone.

Over the next few weeks I will post additional recommendations for addressing the suffering experienced by Joy and other women I have come to know in Massachusetts over the past decade.You can read more about my work in Can’t Catch a Break: Gender, Jail, Drugs, and the Limits of Personal Responsibility.

Can’t Catch a Break

9780520282780_SeredOur new book Can’t Catch a Break: Gender, Jail, Drugs and the Limits of Personal Responsibility is now available through University of California Press, Amazon and other bookstores.

The book presents the work Maureen Norton-Hawk and I have been doing for the past six years following the experiences of a group of women post-incarceration in Massachusetts. Through interviews and ethnographic fieldwork we accompanied the women as they navigated a variety of programs, services and life events.Most of the book is made up of the women’s stories and how their stories evolved over time.

Each chapter focuses on a particular woman as she moves among  home, the streets, rehabilitation programs, correctional institutions, hospitals, clinics and shelters; among happy, sad, abusive and deeply caring relationships with friends, family and romantic partners; and among churches, Twelve Step groups, therapists and therapeutic treatment of various sorts.

We remain in touch with some of the women. You can read about their recent experiences here.

Here is an excerpt from the Introduction:

“The majority of the forty-seven of the women we first met in 2008 began their lives in working class families. Most were sexually abused as children. Nearly all witnessed their mothers’ being beat on or yelled at by husbands or boyfriends. Several women became addicts through prescribed pain or anxiety medication in the wake of an illness, injury or a botched medical procedure. In their twenties most scraped by in the unstable occupational sectors of the working poor: food service and nursing homes, and raised their young children with sporadic financial contributions of male partners and public assistance. Poor health eventually made it impossible for nearly all of the women to hold down jobs, leading to homelessness and vulnerability to violence and exploitation. Several remember pleasant childhoods with strong and positive family relations, but found their lives spiraling downward as adults when in a period of a few years their parents died and they could not afford to keep up the rent or mortgage payments. Almost all of the project participants have used drugs, in their words, “to numb myself” – particularly in the context of engaging in sex work in order to feed themselves and their children.

“All of the project women have been incarcerated, typically for a few months at a time and typically for prostitution, shoplifting (often of small cosmetic items), possession of small amounts of drugs, accessory in a crime committed by a boyfriend or husband, in several cases public drunkenness, and – most frequently – violation of the terms of probation or parole associated with a minor charge. (Only one of the forty-seven women in the project was incarcerated for a crime against another person.) Incarceration leads to loss of custody of, and often loss of contact with, their children. Coming out of prison with no money, no home, their children gone, and a criminal record that makes them unemployable, the women became dependent upon men, public services and the underground economy.”

“Over the past five years we have seen the same women sober and high, homeless and housed, employed and unemployed, in a supportive relationship and abused by a boyfriend, enthusiastically attending church and stigmatized by church members, involved on a daily basis with their children and out of the children’s lives, sick and healthy, happy and despondent. Sometimes they tell us how well things are going: perhaps they finally got housing, a kind boyfriend, sobriety, charges dropped, health care, surgery, better medication, food stamps, visits with children, a part-time job, a wonderful new caseworker, or reconciliation with estranged family members. We have learned over the years that how well things are going one month or one year is unlikely to predict how things will go later down the line. An individual sometimes will look and sound and act like a poster child for the category “working poor” as it was used during the Clinton administration: A worthy, productive, hardworking soul who with a bit of help will climb the rungs of America’s economic ladder. The same woman a year earlier or a year later will look and sound and act strung out, down and out, “shit out of luck” – the unworthy, unproductive “welfare queen” or “crack whore” who cares more about dope than about jobs or her children. That these transitions are so commonplace suggests to us that the line between scraping by and not scraping by has become exceedingly fragile in contemporary America.”

Here is an excerpt from Chapter 1:

When Francesca came bursting onto the scene at the drop-in center for poor and homeless women she brought a quick spark of energy into the circle of worn-out faces and worn-down bodies slumped in armchairs, nodding off while watching the Jerry Springer show and waiting for the shelters to re-open at 4:00. Outspoken, energetic and full of plans, she declared how terrible it is that Boston’s “Mayor Menino stands by while so many people have to live on the street.” With a few tosses of her long, shiny hair, Francesca announced her dream of opening and running a facility that “welcomes everyone.” Five minutes later she swept out the door into the August heat with a promise to “buy Pepsi for everybody,” and Ginger resumed her desultory search through a pile of donated toiletries, Elizabeth carried on weeping into a handful of tissues and Vanessa went back to scratching her arm and poking around in the trash in hopes of finding a cigarette stub long enough to take outside and light up.

A week later Francesca returned to the women’s center. Flashing her brand-new bright turquoise acrylic nail extensions, she pulled a sequined mini-dress and a pair of 1960s style “go-go” boots out of a bag. With the recession of 2007 shutting down employment opportunities for undereducated and unskilled workers, she had taken one of the few jobs she could get — waitressing and dancing at a local strip club. Thrilled with the clothes and even more thrilled with the admiration from the male patrons, she was nevertheless firm that she would not have sex with the customers — she wouldn’t even let them kiss her on the cheek. But by late fall her situation became tense. At the club, she said, “the owners expect the girls to have sex for money.” As time went on, she began going out on “dates” and drinking more heavily as a way to put up with the pressures of the men at the club. “It is starting to get out of control.”

Just a few months later Francesca injured a ligament in her leg. Unable to go on dancing, she was fired on the spot. Initiating what would become our routine over the next five years, Francesca called us. We picked her up a block away from the club and drove her to the apartment of an old boyfriend who was willing to let her stay with him at night but would not give her a key or allow her to stay in the apartment by herself during the day. Now a regular at the women’s drop-in center, she maintained her outward tough “I don’t take crap from anyone” style but began to confide to us that she felt afraid and vulnerable. “All I do is walk around all day – I have no place to go.” Her arthritis had become increasingly painful (the joints in her fingers looked miserably swollen) and “I have a pain in my throat that my doctor thinks might be throat cancer. My father died of cancer.” Often on the verge of tears, she even considered suicide. “I just can’t catch a break anywhere.”

Here is the Table of Contents:

1. “Joey Spit on Me”: How Gender Inequality and Sexual Violence Make Women Sick
2. “Nowhere to Go”: Poverty, Homelessness, and the Limits of Personal Responsibility
3. “The Little Rock of the North”: Race, Gender, Class, and the Consequences of Mass Incarceration
4. Suffer the Women: Pain and Perfection in a Medicalized World
5. “It’s All in My Head”: Suffering, PTSD, and the Triumph of the Therapeutic
6. Higher Powers: The Unholy Alliance of Religion, Self-Help Ideology, and the State
7. “Suffer the Children”: Fostering the Caste of the Ill and Afflicted
8. Gender, Drugs, and Jail: “A System Designed for Us to Fail”
Conclusion: The Real Questions and a Blueprint for Moving Forward

Here is a review from Publisher’s Weekly:

In this passionate, deeply researched study, Suffolk University sociologists Sered and Norton-Hawk argue that prisons have “become the way that America deals with human suffering,” especially the suffering of women, who are being incarcerated at ever higher numbers. The authors, who closely studied 47 formerly incarcerated women in the Boston area for 5 years, examine both how women land in prison and how fragile their lives are after release. They discuss the inarguable connections between being abused and getting arrested. Reaganomics and welfare reform, Sered and Norton-Hawk argue, have had disastrous consequences for these women, both before and after incarceration. In particular, lack of stable housing makes women who have been imprisoned more dependent on men. In the study’s most original chapter, the authors argue that the therapeutic and mental health services available to the incarcerated and formerly incarcerated, rather than directing attention to how society has stacked the deck against marginal women and suggesting political solutions, teach that people’s problems are the result of their own unhealed trauma. This compelling and important book deserves to be widely read.

Here is a short article about the gorgeous painting on the cover of the book:

Judging a Book by Its Cover: Color Drenched Acts of Resistance

by Caitlin O’Hara

Can’t Catch a Break, published this month, is a brilliant book that teases out the nuanced relationship between gender, drugs, and jail in many women’s lives.

We asked coauthor Susan Starr Sered the story behind the cover image, which features an abstract image of bold colored stripes, dripping paint, and few hints as to how to contextualize what we’re seeing.

In an email, Susan describes her search in vain for appropriate images dealing with women and prison. The results depicted literal prison imagery that didn’t capture the range of experiences of the women her book profiles, or “disgustingly voyeuristic male-fantasy pornography.”

And then she came upon “this gorgeous image.” The piece is part of an installation by artist Markus Linnenbrink, at the JVA/Prison in Düsseldorf, in a 132 ft long underground tunnel that connects its security check to the visitors’ area. The artist explains that the JVA prison is considered “a model institution and has been designed to deal with security and humanity as best as possible, thus the desire for a unique approach [to its visitor entrance].” You can find more images and information about the project at this Colossal profile.

“It’s hard for me to describe why this image struck me so forcefully,” Sered writes. “Perhaps the vertical lines look like bars made out of women’s make-up and nail polish. The color dripping down from the horizontal stripes looks as if it’s weeping. The ambitious horizontal stripes decaying down into drips on the wall evoke, for me, the mess that’s come of the good intentions behind trying to cut down on crime, drug use and so on. And finally, people in prison spend so much time with nothing to do but stare at blank walls, so I love imagining those walls as color drenched acts of resistance.”

And with that, Sered cuts to the heart with precision, as she does so often throughout the book. Beyond interpretations of line, color, drip, and context, what captivates is the image’s undefinable power: inviting yet defiant; strong despite, and owing to, its imperfections. Just like the women this book profiles.

And follow this link to the “Page 99 test” discussion of Can’t Catch a Break. “Open the book to page ninety-nine and read, and the quality of the whole will be revealed to you.”