Ebola and US

I wrote a piece on the Ebola outbreak for Salon.com.

For more, follow this link.

Here is an excerpt:

The United States, according to the CDC, has sent a seven-person team to help in Guinea, and provided protective clothing and equipment for healthcare workers in all three countries. In the grand scheme of things, that is a minimal amount of aid – echoed by the minimal coverage the outbreak has garnered in U.S. media. (Far more attention was afforded GOP Congressman Phil Gingrey’s outlandish and factually implausible comments about refugee children crossing the border bringing Ebola into the United States from Central America.)

There is more than one way to interpret America’s disinterest. One is racism — the sense that the people dying of Ebola are so different from “us” that we really can’t identify with them. Another is compassion fatigue. Isn’t there always some horrible disease afflicting Africa and Africans?

Indeed, many of the English-language articles that have been written about the Ebola outbreak focus on “ignorant” and “superstitious” Africans who give more credence to witchcraft than to modern medicine.

 

For another post of interest, follow this link:  The Medicalization of the Death and Other Penalties

The Courtroom was a Circus: Bail Blog #3 – $190 and Counting

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$190 and Counting: Bail Blog #3

Click here for the story of Ginger’s arrest and my experience bailing her out: The New Price of Freedom: $40 (Bail Blog #2)

A quick refresher

In May 2014 Ginger called the police when a man (we’ll call him Pete) in the housing facility for formerly homeless men where she’d been living for the past year threatened to bash in her head and the head of her “nigger boyfriend.” The police came and arrested Ginger for spitting at the man. A transgender woman, she was terrified at being locked up in the men’s jail. She called me in tears and I came to the jail and bailed her out for $40. Three days later we went to court for her arraignment. She met her court-appointed public defender for the first time when he stood up as she was called to approach the bench.

Over the past few months Ginger has called me at least three times a week to make sure that I had not forgotten that I promised to drive her to court in July. Without access to a car, she worried that she wouldn’t be able to arrive for the 9:00 a.m. court session, and that even if she did arrive on time she would look disheveled. But mostly she wanted to be sure I’d be there to support her.

Ginger’s morning in court

Yesterday the big day finally arrived. Ginger had dressed carefully in jeans and a nice shirt that did not scream out either ‘male’ nor ‘female’; in other words, an outfit designed not to ruffle any feathers at the courthouse.

Our first stop was the clerk’s office. Ginger handed over the form showing the $40 bail which we assumed would be refunded when she came to court. After all, that is the purpose of bail. The clerk, however, explained that Ginger had been released on personal recognizance and the $40 was a non-refundable fee paid to the bail commissioner.$40 down.

Ginger then was told to pay the clerk $150 for the lawyer’s fee. Since her total monthly income is $700 (Social Security) out of which she pays rent, telephone, transportation, toiletries and other necessary expenses, the $150 cleaned her out for the month. (We later heard the judge tell a young white man that he either could pay the $150 or do fifteen hours of community service. Ginger was not given that choice – we do not know why.)

In the courtroom nothing seemed to be happening. A number of lawyers were chatting, several court employees were catching up on their weekend activities, and a handful of people like Ginger were sitting nervously waiting for the judge to arrive. The bailiff told us that Ginger’s lawyer would be late and so we sat down to wait some more. The judge finally entered the courtroom, everyone rose, and the first half dozen cases were called. Each took under three minutes; each was continued to a later date.

At 11:00 the judge called for a ten minute recess. Half an hour later the session had not yet resumed but Ginger’s lawyer finally arrived and came over to chat with us in the courtroom within earshot of at least a dozen people. He asked her if the man involved was in court. Ginger explained that Pete did not come and that he had met with her and the director of the transitional housing program at which time he told them that he did not want to press charges. The lawyer asked Ginger if Pete had written this down. Ginger said he had not and added, “Pete is not going to do something like that.” I silently observed that it’s unlikely that Pete is sufficiently literate to write a memo of this sort, and that even if he could he would not want to produce an official document for the courts out of fear that it could be used against him in the future. Ginger’s lawyer told us that when the judge called them they would set the next court date and that he has every hope that the charges will be dropped at that time. We asked whether he could request today that the charges be dropped but, the lawyer said, that’s not possible because Pete had not informed him that he didn’t want to press charges.

Since the lawyer had not been in touch with Ginger over the months between the arraignment and yesterday’s court date we were a bit miffed, an emotion I was ready to show but that Ginger – far savvier than I – refrained from expressing. A minute before the judge re-entered the courtroom the lawyer gave Ginger his business card and told her to tell Pete to call him. Ginger explained that “there’s no way Pete will call.” “That’s not a problem,” the lawyer replied. “You can call me and tell me that Pete doesn’t want to press charges.”

The judge called Ginger’s name. The lawyer agreed to a court date in September and a minute later the next case was called. Ginger is out $190 dollars and her case is still considered “open”.

Return to debtor’s prison

A 2014 report by the American Civil Liberties Union, Modern-Day Debtors’ Prisons: The Way Court-Imposed Debts Punish People for Being Poor, documents the resurgence of what look a lot like debtors prisons. “State and local courts have increasingly attempted to supplement their funding by charging fees to people convicted of crimes, including fees for public defenders, prosecutors, court administration, jail operation, and probation supervision. And in the face of mounting budget deficits at the state and local level, courts across the country have used aggressive tactics to collect these unpaid fines and fees, including for traffic offenses and other low-level offenses. These courts have ordered the arrest and jailing of people who fall behind on their payments, without affording any hearings to determine an individual’s ability to pay or offering alternatives to payment such as community service.”

Elizabeth, a homeless woman I met in Massachusetts at about the same time I initially met Ginger, decided one night to sleep on a bench at a train station. She had come to feel that it was too dangerous to sleep in more open places like parks where, as she explained, “people are murdered all the time.” At the station she was arrested for trespassing by a police officer who “doesn’t like homeless people.” In court she was ordered to pay a $300 fine. She did not have the money. Exasperated, she noted, “This is a waste of the court’s time…they should be going after real criminals.”

Living on Social Security, Elizabeth could not pay the $300 at one go. So, when a month or so later she called the police for assistance (a motel clerk tried to steal money from her), the officers who came looked at her ID, saw that she owed the $300 fine, and arrested and handcuffed her. “I spent three days in jail waiting for a judge because it was a three-day-weekend.” The lesson Elizabeth learned from this experience: If you have outstanding warrants – even for court fees – do not call the police even if you are being threatened or attacked.

Cases like Elizabeth’s are shocking enough. But if I hadn’t been able to help Ginger not only would she have sat in jail for three days waiting to be arraigned, but she also would have become one of the many women I know who have accumulated fees WITHOUT being convicted of a crime. As a consequence, she would be liable to be locked up for any minor infraction of the law: jay-walking, littering, or simply failing to pay the court fees on a case that was dropped or in which she was acquitted.

Something even conservatives can get behind

Not only are these practices likely unconstitutional under the Fourteenth Amendment’s Due Process and Equal Protection clauses, they are also fiscally nonsensical. We pay to keep people in jail awaiting arraignment or trial for the price of $200 or so per day because they cannot afford to pay bail as minimal as $100 [Guilty Until Proven Innocent]. And I saw in court with Ginger yesterday, we finance droves of prosecutors, public defenders and court staff who split their time between hanging around waiting for cases to be called and processing people like Elizabeth for “trespassing”.

Ginger would be the first to agree that violent criminals should go to prison. Indeed, she has been the target of violence far too often for too many years. But – I believe – she’d also be the first to agree that yesterday’s farce does nothing to keep her or anyone else safe. Quite the contrary, it sends the message that justice has a price – in Ginger’s case (so far) — $190.

Follow this link for another post on a related theme: Guilty Until Proven Innocent

Civil Commitment: If You Build It They Will Come

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Massachusetts General Laws Chapter 123, Section 35 permits the court to involuntarily commit to an inpatient substance abuse treatment someone whose alcohol or drug use puts themselves or others at risk. Last week the Massachusetts ACLU, together with Prisoners’ Legal Services and the Center for Public Representation, filed a class action suit in US District Court in Boston challenging the constitutionality of sending women committed under Section 35 to state prison.

Melanie

Melanie grew up in a close-knit, working-class Boston family. When she had her first child, “The hospital messed up my C-section and left staples inside.” She developed a painful infection, and was prescribed Fentanyl, Percocet and Klonopin. Her second child also was delivered by C-section, and again there were complications. Six surgeries and many pain clinic sessions later, Melanie muses, “Maybe I was hooked on meds, but nothing touched the pain.” At about that time an acquaintance suggested heroin, which successfully quelled the agony while opening up whole new sets of challenges. A year or so later she moved out of the house she shared with her children and husband and moved in with her parents because she didn’t want her kids to see her high on drugs. Maintaining a close relationship with them, she shuttled back and forth between the two households nearly every day for a year or so.

Melanie’s parents desperately wanted to help but were out of their depth. Finally one day, after she called them from the police station in a neighboring town to tell them that she had been picked up for shoplifting at a local pharmacy, they discussed with the police and the judge the best course of action. Her parents and the judge decided that given the absence of a criminal record and the presence of a supportive family (and, I surmise, the fact that she and her family are white) the judge did not charge her with shoplifting. Rather, he civilly committed her under Section 35.

For the purposes of Section 35, a substance abuser or alcoholic is defined broadly and rather vaguely as a person who “chronically or habitually” uses controlled substances or alcohol to the extent that “such use substantially injures his health or substantially interferes with his social or economic functioning . . . or . . . he has lost the power of self-control over the use of [controlled substances or alcohol].” Petitions for civil commitments can be made by a relative, guardian, police officer, physician or court official, or one can petition for commitment on one’s own behalf. While the law requires that the court call for a psychological assessment, it is unclear what that assessment means. In any case, there is no trial, no due process, and no possibility for appeal.

What Melanie’s parents didn’t know is that under Massachusetts law, a person can be committed under Section 35 to prison if there is no space available at a licensed substance abuse treatment facility. Melanie’s parents thought they were doing the right thing. They thought Melanie would receive treatment for her addiction and maybe even for her chronic pain. They were shocked to see her handcuffed and led out of the courtroom. Sick and vomiting, she sat in a holding cell at the courthouse for a full day. And then she was shackled and put on the bus to MCI-Framingham, the medium security women’s prison where she spent the next month.

According to ACLU staff attorney Jessie Rossman, upon arrival at MCI-Framingham, women committed under Section 35 are strip-searched, deprived of their personal possessions, and issued a prison uniform and number. Then they “are sent to the medical unit for detox – what [the Department of Corrections] calls detox, which essentially is just you being given a bucket. They are given over-the-counter drugs like Tylenol and Tums,” but no medication such as methadone, Suboxone or Vivitrol which are frequently used to facilitate detox. After detoxification in the medical unit, civilly committed women are sent to “The Mod”, a large room with bunk beds where women being held pre-trial are imprisoned. Unlike other prisoners they cannot visit the library, pray at the chapel, or participate in prison programs. Civilly committed women at MCI-Framingham cannot even access the addiction treatment programs available to sentenced prisoners. Ironically, the original reason for this policy seems to have been to discourage MCI to be used as a treatment facility.

“If you build it they will come”

By every measure, the MCI-Framingham “solution” to drug addiction is a disaster. The average length of stay for women sectioned to MCI-Framingham is longer than for women sectioned to the Women’s Addiction Treatment Center (a “staff-secured, but not locked” facility) licensed by the Massachusetts Department of Public Health to treat women who have been civilly committed. According to data compiled by the Massachusetts Women’s Justice Network, women sectioned to prison are less likely to be released to an outpatient facility and more likely to return to court (11% compared with 3%). Most damning, women of color are more likely than white women to be sectioned to prison rather than to the Women’s Addiction Treatment Center (31% compared to 9%).

The way out of this mess suggested by nearly everyone – judges, prison officials, public health officials, legislators, Governor Deval Patrick and most advocacy groups — is to fund and allocate more substance abuse treatment “beds” (that’s the term that is used) in non-prison facilities.

On the face of it this argument makes sense, but a bit of digging through the record indicates otherwise.

Massachusetts opened the Women’s Addiction Treatment Center in 2007 in order to provide an appropriate treatment setting for women committed under Section 35. In a classic instance of “if you build it they will come,” the Massachusetts Department of Public Health reported in a February 12, 2014 hearing held at the Massachusetts State House that the number of women committed through Section 35 dramatically increased over the following years, growing from 347 in FY 2006 to 1591 in FY 2012. At the same hearing, Department of Correction Commissioner Luis S. Spencer reported that the number of women committed to MCI-Framingham also continued to increase, going up from 221 women in 2007 to 310 women in 2012.

Spencer explained that many of the people committed under Section 35 are not only dealing with addictions but also with other mental health challenges as well as physical health problems including diabetes, heart disease, COPD, liver diseases, infectious diseases, Hepatitis C and dementia. Many have long histories of sexual victimization, self-injurious behavior, and psychiatric treatment. Brian Sylvester of the Massachusetts Department of Public Health estimates that 20% of those committed through Section 35 do not meet the criteria for commitment; rather, they are committed because no one knows where else to send them. People self-commit and are committed by others because there are insufficient spaces in detoxification facilities, because their insurance will not pay for detoxification or rehabilitation or even because they cannot afford housing. According to Sylvester, “Section 35 has become the catch-all for gaps in the system: substance abuse, mental health, criminal justice and medical.”

It is a travesty that drug users who have not been arrested, arraigned, tried or sentenced are sent to prison. And it is a travesty that needs to be seen in the broader context of local and national policies. The National Institute on Drug Abuse states in its Principles of Drug Addiction Treatment, “To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems.” But how (and the Institute does not ask this) can an individual’s vocational problems can be addressed when so many Americans work at jobs that do not pay a living wage, and when individuals with criminal records often cannot land a job at all? How can an individual’s social problems be addressed when poverty locks millions of people into communities with high rates of violence, when a quarter of American women experience sexual or intimate partner violence at some point in their lives? And how can an individual’s legal problems be addressed when the United States has the highest incarceration rate in the world?

As a nation we’ve gone the route of building more and more prisons in unsuccessful efforts to manage the devastation caused by economic and racial inequalities. I’m far from convinced that building more and more “staff-secured” treatment centers will prove any more successful.

You can read more on the confluence of punishment and treatment in Incarceration by Any Other Name: A Return to the Cuckoo’s Nest?

Morality Hijacked by Religion

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“One of the greatest tragedies in mankind’s entire history may be that morality was hijacked by religion.” ― Arthur C. Clarke

A Sociologist’s Thoughts on the “Hobby Lobby” Supreme Court Decision

Introductory college courses on religion typically begin with a unit called “what is religion?” We tell our students right off the bat that there is no natural, universal or inherently true definition of religion. We discuss how some people consider Buddhism to be a religion because Buddhist rituals and symbols “look religious,” but others might say Buddhism is not a religion because there is no formalized notion of god. Some people consider Judaism to be a religion because of the presence of a sacred text and a tradition of attributing rules of behavior to God, but others might say that Judaism is an ethnicity. (Of course, anyone who watches the Daily Show realizes that Jon Stewart is Jewish in the sense that his parents were Jewish and he uses Yiddish slang in his sketches, but he makes it perfectly clear that he does not “believe” in the Bible or observe the laws.)

In contemporary American English we generally use the word “religion” to describe institutions characterized by an organized body of people who posit some sort of God, attribute to that God some sort of moral potency, and conduct rituals that are perceived as having the gravitas of tradition. In other words, we use “religion” in terms that more or less resemble western Christianity.

From the earliest days of European settlement in the Americas there have been heated and often bloody disputes over what counts as religion. European missionaries did not recognize Native American beliefs and practices as “religious.” Rather, they considered them “heathen” which justified forcible conversion and even murder. The beliefs and practices of many 19th and 20th century immigrants were labeled “superstition” which justified national campaigns to re-educate those primitives who insisted on holding onto their old wives’ tales. And in 1993, when the Branch Davidians “cult” in Waco Texas was stormed by the Bureau of Alcohol, Tobacco and Firearms, the death toll included twenty-five children.

np9705191These verbal gymnastics cut both ways. Over the past few decades there have been a number of court cases challenging government support of Alcoholics Anonymous. To sociologists, AA looks and acts like what we in America generally consider to be a religion. It grew out of a Christian movement in the beginning of the twentieth century; it has prayers (the Serenity Prayer), scripture (The Big Book), rituals, and a belief system that posits a Higher Power. Interestingly, the rulings – while complex and not totally consistent – have leaned towards declaring that AA is not “religion” but rather “spirituality,” a category even less definable than religion. Is a long walk in the woods spiritual? Many Americans would say yes. But what if you’re walking in the woods because your car broke down? Is that still “spirituality”? What if you pray to the tree god in the woods? Is that now “religion” or “heathenism”? Would it be protected by the First Amendment? And what if the tree god answers you – is that spirituality or schizophrenia? There is no right answer, of course. But how you answer these questions likely reflects your cultural milieu.

That Pesky Establishment Clause

Given that there is no “true” definition of religion, we tell our students, the questions for sociologists are: Who determines what gets to ‘count’ as religion? And, whose determinations carry weight for other people? The answers to these questions, we tell our students, have more to do with political power than with theological purity. In the United States today the IRS has authority to classify organizations as “religious” for the purpose of tax exempt status and psychiatrists have license to determine if an individual is “religious” or mentally ill for purposes of standing trial. But ultimately, in the United States that power rests in the hands of the courts.

“I have as much authority as the Pope. I just don’t have as many people who believe it.” — George Carlin

Justice Alito, of course, is smart enough to realize that under the Establishment Clause of the Constitution the Court cannot favor one “religion” over another. A way around that pesky clause, at least in the Hobby Lobby ruling, is to cherry pick the beliefs and practices that one considers to be “religion.” So, in the majority opinion, objections to contraception are “religion” while objections to blood transfusions or vaccinations are not. Though not spelled out by Justice Alito, the implication is there: Mainstream Christians object to contraception (we’ve been bombarded with pictures of the very attractive, white “All American”-looking Green family) while objections to blood transfusions or vaccinations are associated with fringe groups or cults.

“Sincerity – if you can fake that, you’ve got it made.” George Burns

The Hobby Lobby ruling invoked a second category that is just as confusing – and as culturally determined — as “religion.” According to Justice Alito religious beliefs meriting protection have to be “sincere.”The Court did not, however, specify what sincerity is or how it is measured. If you recant Judaism because the Inquisition threatens to burn you if you do not embrace Christianity, then are your Jewish beliefs less sincere than those of someone who “chose” the flames? If you have spent most of your life as a devout Christian but for a period of time experience a crisis of faith, a long night of the soul, are your beliefs during that time “insincere” and so not protected by the law? And who gets to decide what or who is sincere? Just because someone says something in a sincere voice doesn’t mean that they are not lying (if that were true Bernie Madoff wouldn’t be in prison), and just because someone cannot articulate their beliefs in a manner that others find credible does not mean that they are insincere.

What beliefs were so compelling as to lead these justices to make a ruling that at best is nonsensical and at worst is discriminatory and unconstitutional? In part, their ruling reflects a broad American consensus that religion overall is good for society and healthy for individuals, and so should receive public support. We have a government Office of Faith Based Initiatives, we love studies showing that church goers are healthier than non church goers and that meditation improves cardio-vascular function, and as a country we entrust churches with children’s moral education.

One might have thought that the assumption that religion (and especially “sincere” religion) is inherently good – or at least benign — would have been undermined by the many religion-driven wars, genocides, suicide bombers and terrorist attacks of the past century. We Americans tend to have short memories, but surely 9/11 is still in our communal consciousness! There must, then, be other considerations that were sufficiently persuasive to have blinded Justice Alito and his colleagues to the potentially dangerous consequences of sincere religious beliefs.

The Court answered this question in their statement that the Hobby Lobby ruling is narrow – that it applies only to contraception and not to blood transfusions or vaccinations. On the face of it both blood transfusions and vaccinations should be even more problematic as a requirement for employers to include in health insurance policies. We need only think about the many Biblical verses declaring that the blood is the soul and the life. And in the case of vaccinations we are talking about children before the age of consent. Contraception is special, I believe, because it speaks to women’s autonomy in a way that few other matters do. Indeed, women’s bodies are often the central battleground in contemporary culture wars not only in the majority Christian United States but in Israel and in the Muslim world as well.

“Religion. It’s given people hope in a world torn apart by religion.” ― Jon Stewart

In any war there are few motivations that are as compelling as religion. Invoking the will of God has extraordinary power to inspire people to action: Where human laws are seen as flawed and transient, God’s laws are believed to be perfect and eternal, even transcending death of the mortal body. Religion has the extraordinary power to lead people to martyrdom and to genocide, to endangering their own lives to save children in the slums of Calcutta and to sacrificing children to blood-thirsty gods, to giving away their worldly goods and to appropriating the worldly goods of others. And it has the power to erase from the minds of at least five Supreme Court Justices the thousands of years of human history in which millions of women died in childbirth because they did not have the means to prevent pregnancies that were too closely spaced.

The framers of the Constitution clearly understood the power of religion, and tried to contain it. In the Hobby Lobby decision, SCOTUS unleashed it.

 

You can read more about recent SCOTUS decisions affecting women’s reproductive rights here: Pregnant Bodies as Public Property

 

An Open Letter to Robert McDonald

In response to reports of long-waiting lists, cover-ups and a toxic culture at the Veterans Administration, President Obama nominated Robert McDonald to head the VA. In his public address yesterday, the president praised Mr. McDonald’s long career in corporate America as CEO of Procter and Gamble. In what should be a red flag not only to progressives but to all of the 99%,  House Speaker John Boehner shares the president’s high opinion of McDonald: “Bob McDonald is a good man, a veteran, and a strong leader with decades of experience in the private sector. With those traits, he’s the kind of person who is capable of implementing the kind of dramatic systemic change that is badly needed and long overdue at the VA.” Given that Boehner is on record in favor of privatizing the VA, I can’t help but wonder what sorts of changes McDonald will implement. I also can’t help but wonder why President Obama seems to be falling for the same-old same-old idea that the private sector is better than the public center at just about everything.

McDonald’s nomination is not getting a lot of press. In progressive-leaning news sites it’s been shadowed by the Supreme Court’s Hobby Lobby decision allowing companies the “religious freedom” not to include contraception in insurance plans. But I see these two events as tightly linked — both are part of a growing movement to privilege corporations over people.

The cat’s out of the bag and I assume that McDonald will be a shoe-in to head the VA. But until that is made official we do have a window of opportunity to educate McDonald — who has no experience in health care or social services — about the issues he will face in his new job. To help in that endeavor, I have written an open letter to Robert McDonald. I truly hope he reads it!

 

Dear Robert McDonald,

There’s been a lot of noise lately about the mess at the VA (the mess you are being tapped to clean up), and I’m sure you’ve heard some big name politicians and pundits — including your friend John Boehner — calling for privatization or at least outsourcing of VA healthcare. You are going to hear from lots of people that government can’t do anything right, that the private sector is more efficient and more cost-effective, and that the best thing you can do for veterans is to give them the same choices about their healthcare that other Americans have.

I’m not going to waste your time telling you that the government actually can do a whole lot right. After all, you were a paratrooper so you know that government airplanes and parachutes generally work. I’m sure you have personal experience with well functioning traffic lights, the interstate highway system, safe drinking water and public libraries. And though you have no experience in the healthcare field, you likely know that in the US — where healthcare is structured around corporate models of private ownership, we spend more on health care and have substantially poorer health outcomes than countries with a national health service.

In order to do a good job for veterans you will need to understand why a market approach doesn’t work for healthcare. At Procter and Gamble your mission as CEO was to sell products to consumers who can make informed choices in the free market. But, as I’m sure you learned being a former military man and all, people don’t choose their injuries or illnesses. That makes it silly at best and cruel at worst to tell people to “choose” the health insurance plan that best “meets their needs.” Actuaries can calculate the odds of certain illnesses for population groups, but we mortal humans can’t foresee our own particular future health. Of course, “choice” is marketable in America and even is touted as a selling point for President Obama’s Affordable Care Act. But happily for you and your fellow service and former servicemen and women colleagues, neither the Department of Defense nor the Veterans Administration has ever bought into that idea.

But what about vouchers, you may ask. Even if we agree that all veterans should have the same comprehensive health care coverage, shouldn’t we give veterans the right to choose where they get their care?

Let’s think about that a bit. At Procter and Gamble you could ethically market Charmin’s squeezability over Cottonnelle’s extra-absorbent ripples because you understood that most consumers are capable of evaluating how well their toilet paper does its job. You also understood that in the long run it doesn’t make much of a difference which brand of laundry detergent a consumer uses; Tide may be a bit better or worse than Whisk, but choosing the inferior brand is not going to kill any consumers.

That model doesn’t work in health care. Most people cannot evaluate whether one type of medication, surgical procedure or therapeutic approach works better than another. Nor can most of us assess whether one hospital or healthcare provider has a better track record in dealing with particular health problems or types of individuals. Unlike in the choice of toilet paper or laundry detergent, these differences can be matters of life and death. Let’s take head injuries as an example. Now, someone who doesn’t know much about brains might choose a hospital that looks nice and new and shiny, that has friendly registration clerks, that advertises compassionate patient care. But, trust me, veterans with head injuries would do a lot better at an overcrowded and bedraggled VA hospital where the doctors are specialists in the kinds of injuries suffered in battle and where the cutting-edge research in the world on traumatic brain injuries is being carried out.

At Procter and Gamble you were charged with reducing costs so that you could increase profits for stockholders. And I understand you were good at that! Now, I’m not saying that you shouldn’t streamline VA services so that they will be more efficient. But I am asking you to remember to keep your eye on the only bottom line that really matters in your new job, and that is the health and well-being of our veterans.

I know this job will present many challenges for you, so in closing I’d like to suggest that you bring along with you to the VA one of the mottoes of commerce: The customer is always right. Please, Mr. McDonald, listen to veterans – to men and women, try to understand their concerns, and put their interests above those of politics.

I wish you great success. And please feel free to call on me for advice.

Susan Sered

More on the VA here: The VA Scandal: How About a Reality Check?

SCOTUS Ruling: Pregnant Bodies as Public Property

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Susan’s note: You can read my analysis of the “Hobby Lobby” ruling here

Yesterday’s SCOTUS ruling striking down 35 foot buffer zone around women’s health clinics in Massachusetts on the grounds that it is “extreme” baffles me. I just paced out 35 feet from my front door. It’s not a lot. I find it hard to believe that anyone who can use a ruler would see 35 feet as an over-zealous restriction on freedom of speech, especially given the bloody history of attacks on abortion clinics and providers.

When a group of educated and intelligent people (at least in the case of most of the justices) make a declaration that so clearly flies in the face of commonsense I have to ask if there is some other agenda driving them. It’s the same question I ask regarding those who deny climate change: Do they really understand the evidence or are they driven by broader anti-science or anti-government regulation of industry sentiments?

“Agenda” sounds like a harsh word, implying greed, personal aggrandizement or some other scurrilous motive. But the reality is that all laws and legal decisions are agenda-driven in the sense that they arise and are adjudicated within social contexts.

So when news of the ruling broke the first thing that popped into my mind was not a point of constitutional law but rather a conversation I had a few days ago with a pregnant woman who complained that everyone – relatives, co-workers and total strangers – feel that it’s okay for them to touch her belly. People who would never dream of invading anyone else’s bodily space in that way seem to believe that a pregnant woman’s body is somehow public property. She’s even had people make nasty comments to her when she asks them to refrain, and she told me that she’s thinking of putting a sign on her belly saying “Hands Off .”

I’m a medical sociologist. My job is to think about the social forces surrounding bodily experiences. And one thing I’ve learned over the years is that we seem to have a consensus in the United States that women’s reproductive experiences are a matter in which the collective legitimately has a deciding role.

What do these phenomena have in common? Outlawing lay midwives or homebirths. Incarcerating women for refusing a caesarian section? Disallowing welfare benefits for a child born less than two years after a previous ‘welfare baby’. Taking away children from women who use drugs, even when there is no evidence that the mother neglected or abused the children. In my work I’ve seen criminalized women pressured into having an abortion with the threat of the State taking away their other children if they go ahead with this “irresponsible” pregnancy. And I’ve also seen criminalized women coerced into looking at pictures of ultrasounds when, upon incarceration, they were found to be pregnant.

The SCOTUS ruling was based on freedom of speech arguments. So while I am tempted to see the ruling as part of a broader attack on women’s right to choose, it’s worth noting that the judges actively offered suggestions as to how Massachusetts can protect women entering clinics by changing traffic laws or vigorously enforcing the laws against blocking entrance to or egress from the building. But basically, the ruling came down to the Court privileging the rights of others (of anyone?) to weigh in on women’s reproduction, even people who have demonstrated associations with groups who have used violent and deadly tactics in the past, over the rights of women to bodily integrity.

I do think the state has a rightful role in protecting the health of women, children, men and even animals. But I am concerned that this role seems to expand out of all proportion regarding women’s reproduction. Today’s ruling was narrow in focus – it related only to women’s health centers. So I can’t help but wonder what the ruling would be if the case involved anti-vaccine activists standing outside children’s health centers and yell at parents who choose to vaccinate their children. Or Scientologists standing outside mental health centers yelling at people who see psychiatrists? Or celibacy advocates standing outside urologist offices and yelling at men seeking treatment for erectile dysfunction?

I find it interesting that the lead plaintiff, Eleanor McCullen, is described in the press as a “grandmotherly” woman whose claim is that “I should be able to walk and talk gently, lovingly, anywhere with anybody.” My pregnant friend, I’m guessing, would see her as one of the “belly patters” whose motives may have been kind, voyeuristic or anything in between, but whose actions constituted an assault on her private bodily space.

White Women, Opiates and Prison

Popping_pills_by_the_moon_unit

Author’s note: Race is hard to write about; so is class; so is gender. I struggle with articulating — especially in a short essay –  two truths. Broad social forces and inequalities impact life experiences. And, each individual has her own unique life experiences framed by the particular ways in which class, race, gender, sexual orientation, ethnicity, nationality, citizenship status and other social categories intersect for her. I thank Robin Yang and Lois Ahrens for helping me try to get it right here. I accept sole responsibility for bits where I’ve missed the mark.

Black men have been the face of incarceration in America for decades, and black men continue to be locked up at rates far exceeding those of other gender and racial demographic groups. But, over the past few years, just as the pace of incarceration finally began to decline for men and for black women, incarceration rates have risen by 47.1% for white women. Opiate use seems to be driving much of that increase.

CDC Director Tom Frieden, in a 2013 briefing, announced that rates of opiate use, abuse, overdose and death are rapidly increasing among women. Aside from age (those in the 45-54 year age group have the highest rate of opiate related death), Frieden did not offer demographic details beyond the rather meaningless “mothers, wives, sisters, and daughters.”

Research published last week by the Boston Globe found that the number of babies born in Massachusetts with opiates in their system is more than triple the national rate, and that the numbers in Maine and Vermont are even worse. This research did not track race, but we do know that Maine and Vermont are two of the whitest states in the county – 95% white, Massachusetts is 84% white, and that many of the opiate hot spots in these states are poor, white communities. In Fall River, for instance, approximately 72% of residents have received a prescription for opiates, a rate well above the state average of 40 percent.

While the media seems shocked to “discover” that white women make illicit use of drugs, we really should not be surprised. Indeed, over the same years in which black men were the face of incarceration, white women were the face of medicine. White women take more prescription and over-the-counter medication, are prescribed more pain medication, undergo more cosmetic surgery, and make more doctor visits than any other major demographic group. White women are the greatest users of commercial holistic healing (alternative and complementary medicine). And white women are over-represented on pharmaceutical commercials and in high profile “war on illness” campaigns such as the pink ribbon breast cancer extravaganzas.

Just as higher incarceration rates do not necessarily mean that black men are especially wicked, higher medication rates do not necessarily mean that white women are especially sick. They do mean that white women tend to be portrayed as particularly in need of — and deserving of — expert medical care, and that the health challenges of white women are treated with more attention than the health challenges of other groups. Think, for instance, of how the natural aging process becomes seen as a medical problem (medicalized) when millions of prescriptions are written for hormone replacement therapy (HRT) for women who do not have any disease other than not being young. And think of the racial implications of these findings from a large government study released in the 1990s: HRT use among white women was 89% higher than among black women and white women were 54% more likely than black women to receive HRT counseling from their doctors.

Women – and especially white women – are prescribed more psychiatric medication (especially for depression and anxiety) than men. Jonathan Metzl, in Prozac on the Couch: Prescribing Gender in the Era of Wonder Drugs, traced advertisements for psychiatric medication in the American Journal of Psychiatry over a period of decades. He found that marketing to doctors disproportionately addressed women’s problems. Advertisements for Milltown and then Valium featured women’s unhappiness with their husbands, family responsibilities and sex, and offered medication as a way to make them more compliant with expected gender roles. Overwhelmingly, the pictures in these advertisements were of white women benefiting from treatment provided by white male doctors.

…..

What does all of this mean for white women’s experiences of opiates today? Continue reading

Orange is the New Black: What Pennsatucky’s Teeth Tell Us About Class in America

Author’s note: Friends and colleagues who know that I’ve spent most of the past decade working closely with criminalized women have asked me what I think of “Orange is the New Black”. While I could do without the dubious emphasis on sex among the women, and I doubt that women prisoners ever have the kind of power attributed to Red or Gloria, overall I think the series does a good job portraying women prisoners as real, complex human beings and of showing the miseries of life inside and outside of prison for most incarcerated women.

(A version of this post with fabulous photos: http://bitchmagazine.org/post/what-pennsatucky%E2%80%99s-teeth-tell-us-about-class-in-america)

I know she is supposed to be a cross between a villain and comic relief, but Tiffany “Pennsatucky” Doggett is my favorite character to watch this season on Orange is the New Black. For those (few) who have not watched the series, Tiffany is a caricature of an ignorant / hillbilly / Jesus freak / meth head. In the first season we saw her provoke and eventually fight Piper, the attractive, articulate protagonist and author of the book on which the series is based. At the start of season two, when Tiffany returns from a three week stint in solitary, even her former friends – the other poorly educated, young white women – turn on her.

Tiffany isn’t cute or funny or even a font of homespun southern wisdom. But in the midst of a prison culture formally and informally divided by race, Tiffany embodies an equally powerful yet rarely articulated social divide: class. Though white, she has nothing in common with the other white women: Machiavellian Alex (Piper’s lover and nemesis), gender savvy Nicky, hip Sister Jane or even Russian entrepreneur Red, all of whom are presented as smart, literate, able to plan and scheme, and holding some understanding of the outside world. Tiffany doesn’t even fit in with Morello, a none-too-bright white woman with a working-class accent who lives in a fantasy world of romance and Hollywood magazines.

The producers of the series provide viewers a clear visual cue to the class divide. The first time Pennsatucky opens her mouth we see a hideous display of broken and missing teeth. More than any other marker, teeth indicate class status. Perfectly white and straight teeth – the kind we see on celebrities — belong to the super rich who can afford costly cosmetic dentistry. Nicely aligned and healthy teeth are the sign of professional and upper middle class individuals who can afford regular dental care and basic orthodontia. Crooked teeth with delayed root canal work and a few crowns means the mouth belongs to a young or middle-aged middle or working class individual (someone with access to basic dental care but no more); a complete set of dentures indicate an older working class individual. And rotted teeth, like those sported by Tiffany, marks one as poor, a status with both economic and moral meaning. As I’ve been told countless times by Americans who do not earn enough to scrape by, being too poor to have respectable teeth is like wearing an “L” for loser on your face.

Teeth: The Orphan of the Healthcare System Continue reading

Medicalization of the Death and Other Penalties

Executions of three men in Oklahoma and Ohio have been postponed recently in the wake of controversy regarding the botched administration of lethal injections.

Lethal injection table. (Photo: <a href=" https://www.flickr.com/photos/kenpiorkowski/11501354666/in/photolist-iwks3o-7T8bhE-nvjDfh-BFeFH-atNfvj-j1SMiz-dfe8c-57C3i3-5YEDVk-dCh1ad-8ViGsY-8ViGgs-4jjfVB-bwwHQ7-5YJSFo-ediZUT-LtcQL-nuZBTq-nQS5KZ-nvjDjA-nvjDjf-9Q5HY1-apoiVi-nvjDiU-5961SS-cp4c1Q-8VmRzW-drAGpU-ofdXe-4CMpR2-ectFEr-8ViHjY-8ViHdm-8ViHgG-8ViHaq-bo99Lg-8ViGQL-8ViGWJ-7wY18P-8VfCgk-8VfCdH-5nuZnD-7pkB92-4HYrVk-4FNumb-nuq6pB-8PssQT-bM7Gs6-gwXrCE-a2gjpo" target="_blank">Ken Piorkowski / Flickr</a>)Lethal injection table. (Photo: Ken Piorkowski / Flickr)

Capital punishment is by nature controversial. Can the state ever be 100 percent sure that the person sentenced to execution really committed the crime? Is there no possibility that evidence was overlooked or misinterpreted, that confessions were coerced or that there were mitigating circumstances? Looking at the photos of the three Oklahoma and Ohio men raises additional questions: Is it truly coincidental that all three are African-American? Can anyone truly believe that racism did not contribute to their death sentences when we know that African-Americans are incarcerated at nearly six times the rate of white Americans; that African-Americans are 14.2 percent of the total US population, but 34 percent of defendants executed since 1976; that the victims of nearly all lynchings throughout US history have been African-American? And ultimately, from a human rights angle, is it ever morally justified to sentence a person to death?

But the recent controversy is not about these ideological, ethical or sociological issues. The current controversy focuses on a single question: Is death by lethal injection “too painful” and therefore inconsistent with the Eighth Amendment, which prohibits cruel and unusual punishment? That question is, at heart, a medical question.

In our society, doctors function as the primary and often sole legitimate judges of pain. Doctors decide what constitutes “real” pain, who “really” is in pain and how pain should be treated. The monopoly of doctors over the treatment of pain is made clear by the anti-drug laws that have filled our courts and prisons with the many people incarcerated for “illicit” use of the very same medicines that doctors routinely prescribe. With the power to determine who is a drug seeker and who is a “legitimate” pain patient, physicians function as arbiters of the moral order. Of course, a great deal of the hands-on work of treating pain is delegated to nurses, paramedics and pharmacists. But only doctors hold the authority to make formal decisions regarding pain.

This has not always been the case. At other times in history and in other cultures, pain has been the province of shamans and priests, mothers and grandmothers. In other words, pain has been addressed as a moral, spiritual, relational or domestic challenge rather than (or in addition to) a medical one.

The medical monopoly over pain treatment is part of a much broader social process of characterizing problems or conditions in medical terms and adopting medical approaches to address those problems or conditions. This process, known as medicalization, is a hallmark of contemporary Western societies. Over the past century, more and more, phenomena, sensations and experiences have been drawn into the medical sphere. Pregnancy, childbirth, infant feeding, menopause, weight (too much or too little), sex drive (too much or too little), gender identity (think of gender reassignment surgery), anxiety, anger, depression, alcohol and drug dependence – and all sorts of physical “imperfections” from nose to breast size – are handled medically.

In medicalized cultures, physicians are employed to supervise, control and – when possible – correct those who are deemed “deviant.” Invoking an aura of scientific impartiality that other social institutions cannot easily claim, physicians determine eligibility for disability insurance (SSI and SSDI), justify – or not – insanity defenses, and write the prescriptions for the psychiatric medications so heavily used within the penal and welfare systems. While public acceptance of physicians as gatekeepers to social services, pain treatment and other desired goods is premised on the objectivity of science, there are, in fact, significant differences among physicians in how they rule regarding SSI and SSDI, what pain medications they prescribe, and how likely they are to support insanity defenses. Indeed, while we tend to assume that doctors’ first and only loyalty is to their patients, in the current health care reality, doctors generally are paid and employed by insurance companies, hospitals and government agencies (including prisons).

The transformation of capital punishment into a medical event is part of this broad cultural landscape. While the American Medical Association has ruled that physicians should not administer lethal injections, the fact remains that physicians helped design the lethal injection protocol. Lethal injections utilize standard medical materials such as intravenous lines, EKG machines and drugs obtained from pharmacies (barbiturates, pancuronium bromide and potassium chloride). Seventeen death penalty states require physician involvement and all practicing jurisdictions employ medical personnel, though not always doctors. Physicians monitor vital signs, declare death and sign death certificates. And doctors declare incarcerated people sufficiently “competent” for execution.

I want to be clear that only a tiny number of physicians actively participate in administering lethal injections. I also want to be clear that many doctors dedicate their lives to caring for those who are poor, afflicted and underserved. In the current climate of growing alliances between medical and penal institutions, my concerns are structural rather than personal. That does not, however, detract from what I see as a problematic cultural trend of defining and treating “deviance” in medical terms. Los Angeles County – the county with the largest number of incarcerated people in the country – has approved a plan to replace a jail with a correctional center designed to provide care for prisoners suffering from mental illnesses and substance abuse. In New Hampshire, the Department of Corrections is planning a new “gender sensitive” 224-bed prison designed for the particular needs of incarcerated women, most of whom have been identified as suffering from post-traumatic stress disorder as a result of sexual violence. The new prison intends to meet needs for “personal healing”: there is no discussion of the need for freedom or autonomy.

“Treatment” certainly sounds more benevolent than “punishment.” And it certainly is the case that the overwhelming majority of people serving time in US jails and prisons suffer from physical and mental health challenges. Yet the receipt of a psychiatric evaluation reduces a defendant’s chances of having his or her charges dropped. It also increases the likelihood of a conviction, a prison sentence, and a lengthier sentence at that. Given the gross overrepresentation of people of color in US jails and prisons, I worry that the medicalization of the penal system risks adding “insane” to the long list of incurable flaws assigned to black and brown Americans by white America. I worry that rebranding from “offender” to “sick” – instead of seeking new models that get at why people really are caught up in the system – encourages the proliferation of psychiatric medication to be used as chemical restraints (less visible but no less repressive than physical restraints.)

And I worry that utilizing standard medical equipment, procedures, materials and terminology to carry out executions sends the message that capital punishment is, if not therapeutic, at least okay.

Copyright, Truthout.org. Reprinted with permission

http://www.truth-out.org/opinion/item/24251-medicalization-of-the-death-and-other-penalties

The New Price of Freedom: $40 (Bail Blog #2)

freeimage-4692086-webYou can read more on the problems of the bail system here: Guilty Until Proven Innocent

Last Saturday evening I woman I’ve come to know – I’ll call her Ginger — called me up in tears. She was at the police station in my suburban home town and she needed $40 (cash only) for bail. Homeless and disabled since her teenage years, she didn’t know anyone who had money or a car to drive to the suburban station. Feeling desperate, she called me, explaining that because of the long Memorial Day weekend she would be held in jail until Tuesday if she couldn’t come up with bail.

At the station a cordial police offer asked to see the cash and then told me to sit and relax on chairs in the station vestibule while waiting for the clerk to come. After about an hour the clerk arrived and, still in the vestibule, I handed over the $40 in a transaction that seemed weirdly informal. (I’ve never bailed anyone out before, but this is not what expected from years of watching Law and Order.) Half an hour later the police officer beckoned me to come inside and said, “There’s a problem.” It turns out that my friend didn’t have any identification on her so there was no way of knowing if Ginger was indeed Ginger. He asked if I could vouch for Ginger. I said yes. He asked how I know Ginger. I said I’m a Suffolk University professor and that for the past six years Ginger has been in a study I’ve been conducting among homeless and criminalized women. He jotted a few words down on a piece of scrap paper and then asked if there are other ways I can verify Ginger’s identity. Puzzled that my university credentials and a six year relationship were not sufficient, I managed to come up with that I was introduced to Ginger by a caseworker at a Boston shelter.

That seemed to do the trick and ten minutes later Ginger emerged from jail. She was shaking. My first thought was that it was a bit chilly out so I gave her my jacket, but she continued trembling so hard that she was unable to walk or talk. For a few minutes I couldn’t figure out why she was so upset. Ginger had been arrested before, she knew the drill, and all in all this suburban police station was relatively pleasant. Then, I looked at the paperwork she had in her hand and realized (part of) what was going on: The form telling her to come to Court on Tuesday morning listed her name as George. Though I knew that what she calls her “government name” is George, I’d forgotten how frightening it is for her to be “George” inside of a jail.

How It All Started

Born into one of the working-class Irish neighborhoods in the 1970s, Ginger knew, in her words, that “I was not a regular boy” since age five or six. Like many children who are different from their peers, George was the target of abuse. In neighborhoods like hers people who broke the gender code were beaten up. Ginger recalls that her mother’s house was repeatedly spray painted with the word “faggot,” rocks were thrown through the window, and her family was threatened with violence and ostracism. When she was thirteen, her stepfather, who also beat her mother, molested her. After a few stints in psychiatric hospitals where she was treated for PTSD, her psychiatrists signed the documentation for her to be classified as meeting Social Security’s criteria for disability (SSI) when she was fifteen. After a few particularly horrific attacks she left home in order to protect her family from further violence. She had heard that New York is the place to be “for girls like me,” and so that is where she headed. Young and petite, Ginger quickly found a job in a drag show, was introduced to crack, and started working the streets.

Like Ginger, many transgender women are forced to leave school in the wake of abuse and find it difficult to obtain employment in a society that often is not comfortable with gender diversity. Close to two thirds of transgender women having a history of incarceration, and transgender women are so frequently perceived to be sex workers by the police that the term ‘walking while trans’ was coined. Open and even chatty about almost all parts of her life, Ginger never talks about her experiences in men’s prisons. However, according to national studies over half of LGBT prisoners report having been sexually assaulted in prison – a rate 15 times higher than the general population. In the hypermasculine cauldrons that are men’s prisons, transgender women are particularly likely to be targets of rape. The night I picked Ginger up at the police station her trembling body gave proof to the terror and pain she had experienced in the past.

As Ginger and I sat in my car with the heater blasting she smoked a few cigarettes, the focus came back into her eyes, her slim body quieted down, and eventually she was able to tell me what happened.

After years of homelessness she had been placed by her caseworker into a room in a long-term shelter for men where she shares the bathrooms, kitchen and living room with approximately twenty men, some of whom have lived there for over a decade. Her caseworker told her that if she stays in the shelter, pays her rent on time and doesn’t make any trouble she’ll likely be eligible for a low-income apartment in two years or so.

On the night before the visit to the police station Ginger had made popcorn in the microwave in the communal kitchen. It burned and set off a fire alarm. On Saturday evening a shelter resident who had been harassing her since she moved in (for example, he often stands outside the bathroom and takes pictures of her coming out of the shower) burst into the living room and started screaming at her for waking him up the previous night. “He said he’s going to smash my head, ‘yours and your nigger boyfriend.’” (Ginger is white, her boyfriend is African American. He does not live at the shelter.) As the tirade went on Ginger did two things: She spit at him and she called the police because of the threats he had made.

Listening to Ginger’s account of the evening, I struggled with understanding why she called the police. Quite a few of the homeless and criminalized women I know have been locked up in the wake of turning to the police for help. In this era of mass criminalization, it is not uncommon for women (and men) to have outstanding warrants for a variety of technical reasons. Elizabeth, a rather weepy middle-aged woman whom both Ginger and I know, called the police because a motel she stayed at for a few nights wouldn’t return her room deposit ($50) in a timely manner. When the police came they looked at her ID, saw she owed court fees, and put her in jail for three days over a long weekend.

Aware that both of us know how often this sort of thing occurs – especially to homeless and to transgender people, as well as to sex workers and people of color – I asked her why she called the police. She was truly afraid for herself and for her boyfriend, she said, and she assumed that threatening to smash someone’s head is illegal. However, as it turns out, she explained, when the police came they told her that threatening is not against the law but spitting is.

The police took Ginger to the station in her slippers, t shirt, and draw string pajama bottoms; they cut the string off her pajamas at the jail. That is what she was wearing when I came to pick her up.

The estimated cost to the taxpayers for holding Ginger in jail for three days while waiting for a judge to come to court: $375.

The price of freedom: $40, which seems to be the current going rate for this kind of thing.

It’s time to reform the system.

You can read Part II of my adventures with Ginger here: The Courtroom Was a Circus

More of Ginger’s story appears in my forthcoming book Can’t Catch a Break: Gender, Jail, Drugs, and the Limits of Personal Responsibility.