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

rapewhistle2

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.

liberia

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.

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.”

Suicide is Painful

The week that Robin Williams’ suicide hit every media outlet in the country, my friend Joy drove into the woods, shot herself up with enough heroin to kill a horse, and sat on a rock waiting to die. Unlike Williams, Joy survived (though the person who found her and called 911 first stole all of the cash from her wallet). And while I’m not surprised or even hurt that Joy’s intentional overdose has not received the media attention of Williams’ hanging, I do feel the need to acknowledge and share the knowledge of what led her to that rock and what happened after she was “rescued”.

The youngest daughter of a white, middle-class couple, Joy recalls that, “Until I was seven everything was normal – white picket fence, father went to work, mother stayed home with the children. Then everything fell apart.” Her parents divorced, her mother received custody and her mother’s boyfriend molested Joy and her older sister. Joy saw therapists and was given psychiatric medication throughout her childhood. Eventually she was removed from the home and placed into the child welfare system where she lived in various foster homes and juvenile programs. “None of these placements worked. I was an early drug abuser.” When I first met her crack cocaine was her drug of choice; a few years ago a boyfriend introduced her to heroin.

As an adult, Joy has never held a job that pays a living wage, never had secure housing, and never had custody of her daughter (her father is raising her daughter.) She suffers from impaired hearing, diabetes, insomnia, Hepatitis C, chronic hip and shoulder pain, lumps in several lymph nodes, and neuropathy in her feet. Joy’s sole legal income is her monthly SSI check of approximately $740, which she supplements through sex work. For the past twenty years she has moved among drug rehabilitation programs, motel rooms, shelters, jail and psychiatric hospitals. During the years I have known her she has been prescribed the following psychiatric medications: Trileptal, Seroquel, Neurontin, Abilify, Remeron, Buspar, Celexa, Wellbutrin, Neurontin, and Effexor.

…..

I’d last seen Joy a few months ago right after she was released from jail. She had been held while awaiting trial on a prostitution charge and then let go on “time served.” After losing track of her for a while, a few days ago I heard that she was in the locked psychiatric ward of a local hospital and I went to visit her. Although brightly painted and staffed by cheerful nurses, the ward gave off a “One Flew Over the Cuckoo’s Nest” vibe. Most of the patients were wearing hospital gowns, and since they are not allowed shoes they shuffled back and forth in the corridors in slippers or socks. Some gave off unpleasant odors; many had the blank “zombie” look of heavy psych medication.

Joy was delighted to see me (and delighted with the chocolate and magazines I brought). I asked her how she ended up on the ward. She explained that she’d been drifting around between stints of jail time and realized (not for the first time) that she needed to make a change in her life if she is going to survive and “be there for my daughter”. She made the decision try methadone and see if she could kick her drug use once and for all. The methadone clinic put her on a dose that was too low for the amount of heroin that she had been using, and she became extremely dope sick. “They moved up my dose but it wasn’t enough so I kept using dope together with methadone. I realized it wasn’t working and I already tried everything else – you know Susan I’ve been in so many programs that I could teach them — so I decided to end it all.” The last thing she remembers is feeling the heroin start to work. When she woke up in a hospital close to where she was found, she was told that she very nearly died and that the medical staff worked on her for a significant amount of time to bring her back.

…..

Two days later the hospital released her. She was told that they had tried to place her into the detox facility with which the hospital works, but that facility only takes people on Suboxone (another drug that is used to treat opiate addiction), not methadone. The nurse handed Joy a piece of paper with some phone numbers for her to call to find a detox program for herself, and told her to leave. Joy said to the nurse, “Are you kidding me? I tried to kill myself less than 48 hours ago.” The staff claimed they didn’t know that, but in that case she could stay in the hospital.

The next day they transferred her to the hospital at which I met her. Joy was assigned a doctor whom she liked, but after one day a “fill-in doctor” took that doctor’s place. The fill-in doctor looked at her chart and cut in half the medication for the neuropathy in her feet and stopped her anti-anxiety medication without talking to her or seeing her. A nurse told Joy that she’d try to speak to the doctor on her behalf, but the doctor made it clear that “I am the doctor and you’ll get the medication I give you.”

Joy was not assigned a therapist but was told to meet with a social worker who tried to find a rehabilitation program for her. Joy told the social worker that she had thrived at a facility she had been in a few years ago, but that program only lasted for five months, after which she was sent back to the streets.

Two days later when I called Joy told me that the doctor felt a large lump in her stomach and was sending her for an ultrasound later that day. Also, a lump on her neck had grown and she was being sent for a scan. I told her I’d drop by but I could only come in the morning. Because visiting hours start at 4:00 the nurse would not let me in (although Joy told her that I was the only person visiting her and that my visits help her want to live.)

Later that day Joy and I talked again on the phone. “It’s good you didn’t come, Susan, because they had me packed up and ready to go to a detox program in [another city]. I was literally going out the door when the program called and said they can’t take someone from a psych ward. So I’m just waiting for them to find a holding place for me where I can wait for a halfway house placement.” I asked her about the results of the ultrasound and scan. These tests had not been done nor had the doctor written up orders for them to be done at her next placement.

…….

The U.S Centers for Disease Control and Prevention (CDC) recently reported substantial increases in suicide rates among middle-aged adults in the United States. Based on National Vital Statistics System mortality data from 1999–2010, CDC researchers found that the suicide rate among American men aged 35–64 had increased 27.3 percent from 1999 to 2010, and among American women aged 35-64 the rate had increased 31.5 percent. A variety of theories have been proposed to explain these increases. Psychologist and author Bruce E. Levine notes that while it is popular to blame chemical imbalances in the brain for suicide, according to the CDC, “Possible contributing factors for the rise in suicide rates among middle-aged adults include the recent economic downturn (historically, suicide rates tend to correlate with business cycles, with higher rates observed during times of economic hardship).

One would assume that our current partiality to theories regarding the biological and chemical bases of mental illness would lead us beyond blaming the individual for his or her pain. But that is not the case – as witnessed by the estimate that nearly two-thirds of people sitting in jails and prisons are mentally ill.

And that is what I find so difficult to swallow.

Within forty-eight hours of Joy’s almost fatal suicide experience she had to fight to stop the hospital from releasing her to the streets where she’d surely be re-arrested for drugs, prostitution or simply loitering. Then she was confined in a locked ward where her visitors were limited and where she was prescribed different medication regimes by two different doctors (one of whom refused to listen to anything she or her nurses had to say). She knows she needs to stay off the streets but she has been told that there is no placement available for someone who is both suicidal and on methadone so the best she can hope for is a temporary “holding” facility until a place can be found in a slightly-less-temporary halfway house from which (as she and I know from her past experiences) she will be kicked-out if she “relapses”. And all of this happened in a very reputable treatment setting, which, Joy told me, is not all that different from jail.

…….

Now, it may be tempting to chalk Joy’s experiences up to bureaucratic run-around or an episode of particularly egregious institutional incompetence. But when the run-arounds and incomeptences are built into the laws, the regulations, the policies and rules and protocols, then they must be understood as manifestations of “the system” rather than as haphazard or idiosyncratic exceptions.

I don’t know if Joy will die from being raped or beaten by a trick, from a bullet one day when she can’t hear the police tell her to stand still, from whatever is causing the mass in her stomach and the lump on her neck, from the chaotic cocktails of prescription medication she receives, or from an unintentional overdose or another try at suicide. I don’t know if she’ll die in prison, a violent and oppressive setting that gives rise to high rates of suicide, or after her next prison release – a time in which suicide rates again rise. I don’t know if she’ll die in a detox facility or a homeless shelter. But each time I say good-bye to her, I have a sick feeling that this may well be for the last time.

You can read more about Joy in Can’t Catch a Break: Gender, Jail, Drugs, and the Limits of Personal Responsibility.

Caste Away: Mass Incarceration and the Hardening of Economic Inequality

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“Caste Away” originally appeared as part of the University of California Press’s blog series coinciding with this month’s American Sociological Association’s annual conference: “Hard Times: The Impact of Economic Inequality on Families and Individuals.”

I first met Elizabeth at a drop-in center for poor and homeless women shortly after she was released from prison. Elizabeth’s father was a firefighter. Her mother worked for years at a stable job in a factory. Her parents owned their home in a working-class white community in a Boston suburb, and raised their children with aspirations of college and a middle-class life. By the time Elizabeth came of age America’s economic landscape had changed. Secure jobs that pay good wages were scarce and even though Elizabeth earned an associate’s degree she wasn’t able to do better than a series of unreliable jobs in food service. When a family tragedy (her sister’s illness and eventual death) made her too sad to smile at restaurant patrons she was fired. Broke and depressed, she lost her apartment, began to drink excessively, suffered several assaults, and was arrested and incarcerated on charges of creating a public disturbance and shoplifting. “Free” now for more than five years, she is stigmatized, unemployable, and sick.

As wealth and income gaps in the United States have dramatically widened over the past decades, the life paths of rich and poor Americans have diverged to the point in which, I believe, we should consider using the language of “caste” to describe American society. Caste arises when social differences become so significant that individual personalities, preferences, talents and weaknesses become subsumed to stereotypical images of the characteristics of a community or group as a whole – what we often call profiling. Groups are identified in terms of physical differences (real or imagined), inter-group interactions become formalized and limited, group characteristics become infused with moral meanings which justify and enforce differential access to valued resources and occupations, and group characteristics come to be seen as inherent and unchangeable.

Elizabeth has helped me understand the workings of caste. She experiences geographic segregation, whether in jail, in homeless shelters or in public housing. She has been arrested for trespassing simply for sitting down and relaxing in neighborhoods not assigned to, in her words, “people like me.” Elizabeth recognizes that there are structural barriers to changing her status, but most days she attributes her position to classic caste-like physical traits: a genetic tendency for alcohol abuse or to PTSD that has “rewired my brain.”

Having been raised in a working-class community, Elizabeth is aware of how differently she is treated now that she has lost some of her teeth and acquired the clothes and mannerisms of the untouchable caste. She once told me that people don’t like to sit next to her on public transportation. “They look at me like I smell bad even though I shower every day.” The only non-poor people she has contact with these days are service providers such as therapists and doctors, or law enforcement agents. Her caseworkers berate her for being involved with men who are, as she puts it, “messed up.” But, Elizabeth explains, “no man who is any good is going to want a woman like me.”

In the twenty-first century health and wealth are tightly correlated. Poor Americans are sick because the housing they can afford is clustered in environmentally unsound neighborhoods; the jobs they can get involve debilitating physical labor, ongoing exposure to toxic chemicals, or harassment by bosses or customers; the food they can afford is nutritionally unsound; and access to consistent health care (especially dental care) is limited. In a cyclical manner, poor health, and especially visually obvious signs such as rotting teeth, limits the ability to get the kinds of jobs that pay living wages.

For Elizabeth, as for many Americans, a prison record sealed her caste membership. She is not alone. By age 23, 49% percent of black men and 16% of black women, 44% of Hispanic men and 18% of Hispanic women, and 38% percent of white men and 20% of white women have been arrested. Poor and low-income Americans are far more likely to be arrested and incarcerated than better off Americans. Over half of the incarcerated population has been diagnosed with a mental health issue and at least 40% suffer from chronic illness. Unhealthy prison conditions partly explain the substandard health profile of Americans involved with the correctional system. But the fact is that people entering prison are already sicker and poorer than other Americans.

Elizabeth often says that before her life fell apart she didn’t even know that there are people who live the way she lives now. But of course, caste is not a new phenomenon. In the United States racial categories traditionally have constituted a caste system and African Americans have long experienced segregation, barriers to occupational advancement, and ascription of morally suspect traits and behaviors such as mental illness, cognitive impairment, infectious diseases, hypersexuality, promiscuity, drug use, defective parenting, and childlike dependence on public assistance. The news, then, is not that America is a caste society. Rather, it’s how easy it has become to join the ranks of the caste of the ill, impoverished and criminalized.

You can read more about Elizabeth in my new book: Can’t Catch a Break: Gender, Jail, Drugs, and the Limits of Personal Responsibility.

Ebola, Secret Serums and Me

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An earlier version of this post entitled “Ebola, Monsanto and Me” contained several factual errors. I thank the dedicated readers for pointing them out. Please be sure to use this version for circulation and re-posting.

During the first months of the growing Ebola outbreak in West Africa, other than on NPR it was hard to find any American thoughtful media coverage of this historic public health tragedy. In mid-July I attributed this apathy to several factors: the “otherness” of Africans; a sense that “it couldn’t happen here;” compassion fatigue, especially regarding Africa and Africans; and our own American disinterest in developing and supporting public health infrastructures.  Still today, this kind of “reporting” goes uncritiqued in the mainstream media: “Apparently, the Ebola virus now enveloping three West African nations wouldn’t have developed into an outbreak if not for the people’s ignorance and belief in witchcraft.” I’m hard-put deciding what appalls me most: The not-so-thinly-veiled racism and xenophobia (“people’s ignorance”), the uninformed dismissal of traditional healing practices (“witchcraft”) that effectively treat many illnesses and that are available before and after foreign aid workers swoop in, or the failure to recognize the role of poverty, malnutrition and deforestation in making a region ripe for the spread of disease.

But that’s old news. Ebola has finally grabbed American headlines with two new developments. First, two Americans working in Africa have become infected and – with the help of super-advanced aviation technology – have been flown back to the United States. Second, these two Americans are being treated with a wonder drug “secret serum” that “likely saved” them.

Now we Americans may not care about water purification or sewage treatment systems, but we sure do love secret serums. Hollywood has made millions from that plot line. Indeed, secret serums are such a shoo-in that I’m thinking of writing a blockbuster script about a secret serum that cures poverty (or at least my own poverty!).

But Ebola is no laughing matter. Except, of course, for the pharmaceutical companies poised to profit when the highly touted secret serum goes on the market.

Let me be clear. I am delighted to see that a medication that may cure Ebola is in the pipelines. And I am thrilled to see that the two Americans who received the serum seem to be recovering. But we’d be putting our heads in the sand to think that an untested drug used on two otherwise healthy and well-nourished people who received the highest quality care at every step of the way means much of anything in regard to the realities on the ground in West Africa. We can’t celebrate the great achievement in developing a potential cure for Ebola without considering the legacy that helped Ebola emerge and spread.

Poverty and environmental degradation — all too often the consequences of global economic policies — set the stage for outbreaks of disease. Deforestation with herbicides such as Agent Orange and RoundUp facilitate the spread of disease. Unlike traditional methods of weed control in which farmers and gardeners selectively remove particular plants in order to allow room for the desired crop to thrive, these herbicides typically are spray bombed from airplanes, indiscriminately wiping out plant growth over large areas and often enter the respiratory systems of the people who live in those areas. While the jury is still out, prominent zoologists and virologists hypothesize that emergent infectious diseases such as Ebola may jump from animal to human populations when eco-systems are disrupted, causing new intensities of human – animal contact. According to Nathan D. Wolfe of the Johns Hopkins School of Hygiene and Public Health, “Human activities that occur in lowland tropical forests, such as ecotourism, logging, and the hunting of wild vertebrates have the potential to increase the frequency of microbial emergence.” Coupled with the densely populated living quarters in urban settings that allow for diseases to spread quickly, and malnourished bodies that are less able to fight off infection, the Ebola outbreak seems almost predictable.

I’m not a big believer in conspiracies. I tend to think that just like us good guys, the bad guys are too busy in-fighting to pull off super-duper clandestine hoaxes. And I believe most people who work for even the greediest large corporations rarely intend to hurt others — but their bosses have certainly benefited from it. We need to recognize that the chemicals that made West Africa fertile for the spread of Ebola were highly profitable for the West, and the new miracle drugs to cure Ebola promise to be equally profitable. In these days of giant multi-national corporations it’s virtually impossible to parse out who manufactures what. But from my outsider sociologist perspective what I see is this: Poison the earth with herbicides and when the soil is ruined for everyone else, there’s even more money to be made patenting and selling GMO seeds that can grow in soil no longer suited to traditional agricultural and horticultural techniques. Convince mothers in poor countries to buy infant formula so that mom can come work at their poverty-wage factory, and then sell antibiotics when baby becomes sick because mom can’t afford clean water to mix the formula. Push cigarettes (especially in poor neighborhoods, as R.J. Reynolds does with its Kool brand cigarettes) and acquire Kentucky Bioprocessing to develop post-exposure Ebola serum.

So, on the unlikely chance that my secret serum blockbuster doesn’t work out, here’s another idea. Maybe I’ll start a company that entices people into buying tons and tons of sugary snacks. I’ll have my day-shift workers produce the snacks at factories I’ll build in states where my friendly congressmen and senators have eliminated worker safety regulations and labor unions. Savvy entrepreneur that I am, I’ll have my night-shift workers produce diabetes medication that all of those eaters of my sugary foods will need to take for their rest of their lives. And, just to cover my bases, I’ll require my workers to switch between twelve-hour day and twelve-hour night shifts. That way I can be sure that during any given twenty-four hour period a bunch of them will need pills to be able to sleep or pills to be able to stay awake. With my profits from those pills I think I’ll build a privately owned prison to house all of those criminals caught using illicit uppers or downers. In the crowded prison, tuberculosis and other infectious diseases will easily spread, expanding the market for the antibiotics produced in the factories I’ll open up in countries that don’t have pesky things like minimum wages. Oh – and just to dot my ‘i’s and cross my ‘t’s, I’ll be sure that the prison canteen sells my sugary snacks at twice the price at which they are sold on the open market.

I love it when a plan comes together!

Dangerous White Dreams, #BreakingBad

Note from Susan: Nancy Heitzeg wrote a brilliant critique of Breaking Bad at Critical Mass Progress, and she graciously gave me permission to repost it here. Her analysis of racism and the glorification of / sympathy for media portrayals of white male drug involvement is right on target. The cultural logic seems to work like this: Black men who use or sell drugs are vicious criminals who should be locked up for a long, long time. Latinos who use or sell drugs are illegal aliens and/ or gang members who work for Central American drug lords. White men who use or sell drugs are brilliant capitalists or somehow sacrificing themselves for their families (for instance by taking meth to stay awake while working two jobs). Black women who use or sell drugs are crack whores who don’t deserve to have children. Latinas who use or sell drugs are naive simpletons manipulated by their macho drug-dealing men. And white women who use or sell drugs are mentally ill, passive victims who need doctors and therapists to save them. I see these themes over and over, not only on Breaking Bad but also on Orange is the New Black. Heitzeg’s piece is reproduced in full below.


Five grueling seasons of the record-breaking Breaking Bad have come to the conclusion fans hoped for and I feared. Yes, the aptly named Walter White – Mitty-esque middle class middle age High School Chemistry Teacher turned sociopathic Meth Overlord aka Heisenberg – is really a Good Guy after all, vindicated as few other “gangsters” before have been. All the loose ends tied up with some truths told, revenge and vindication all around, still the Smartest Guy in the Room.

bb1sDead, yes, as we knew he would be from the onset, but on his own terms. Walter White went out – not as the “monster” many of the cast referred to him as, as many viewers claim they think he is– but as a sort of Hero.

As Steve Almond asks in American Psycho: Why We Root for Walter White: “For those with the good sense to be distressed by this fact, the question remains: where does that leave the rest of us?”

Oh I know there are those who will object to this critique. “Lighten up  — it is just a TV show! And one that was well-written and acted at that.” Others will claim that there is nothing new to see here — that we have always been fascinated by various iconic gangsters and drug lords – most recently and famously Tony Montana, Michael Corleone, and Tony Soprano. “Same as it ever was”, they say.

But it is not. Walter White is, well unambiguously white, no ethnic identity attached – past or present - that once compromised “whiteness”. He “breaks bad” rather than being “born bad” or at least connected from the outset to criminal subcultures. He chooses, and he prevails, unlike the others whose ultimate ends serve as a cautionary tale.

Despite terrorizing both his immediate and extended family, despite subjecting his former student/partner to an array of psychological and physical abuses, despite leaving behind a mountain of mostly brown bodies , despite becoming a ruthless Drug Kingpin in the midst of a Law and Order/War on Drugs era –   Walter White goes out a Winner. Because that is what the viewers wanted.

And this, reveals more than just our penchant for gangster thrillers, it reveals, at rock bottom, our deeply rooted cultural construction and sometimes, celebration, of White Male Criminality.

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