All posts by Susan Sered

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.

 

 

The VA Scandal: How About a Reality Check?

The VA Scandal: How About a Reality Check?

Recent reports from VA medical centers about their long waiting lists and subsequent efforts to hide those lists reminded me of a course I used to teach, misleadingly titled, “Introduction to the US Healthcare System.” No, I was not luring in students with the promise of an introductory course and then requiring them to become proficient in advanced statistical methods. The bait and switch was far more subtle: there is no US healthcare system. “System” denotes an overarching set of principles, practices, procedures and organizational structures. I later changed the name of the course to “Introduction to the US Healthcare Landscape” (still a bit deceptive in that one might assume that a landscape is attractively cultivated). A better title would be “Introduction to the US Healthcare Mess.”

Our so-called healthcare system is made up of an incoherent multitude of financing and delivery mechanisms with identities that are far from transparent. We have for-profit and not-for-profit hospitals both of which rely heavily on government funding. We have hospitals owned by religious organizations and hospitals that used to be owned by religious organizations that are now owned by for-profit chains, although they keep their religious names, like St. Elizabeth or St. Jude. We have physician practices that are situated in hospitals and look like they are hospital clinics but are actually just renting space from the hospital. We have insurance companies and hospitals competing for “good” (that is, well-paying and relatively healthy) patients and customers. We have ambulance services that are run by municipalities or counties; private ambulance services run by for-profit companies; volunteer ambulance companies – call an ambulance and you have no idea what kind of bill you’ll be paying or to whom. We have copious amounts of medical records that are rarely transferred from one institution to another, and we have medical errors accounting for an alarming percentage of American deaths. We believe that emergency rooms serve as a safety net, but by federal law emergency rooms are only required to assess and stabilize patients (and are allowed to charge a whole lot to do so), not to cure them. And I haven’t even touched on the anarchy of services for the elderly or the rapidly growing prison healthcare industry.

“System” is not the only misleading word in my old course title. “US” is nearly as deceptive. Health care services, regulations and financing vary enormously from state to state. Each state sets its own threshold for eligibility for Medicaid; in the stingiest states any income at all precludes Medicaid eligibility – essentially forcing individuals to choose between healthcare and food. In other states (such as my home state of Massachusetts) one can earn a fair amount above the federal poverty level and qualify for government-subsidized health care.

The consequences are frightening. Just this morning I spoke with Junie, a fifty-five year old woman whom I’ve known for the past six years. Abused as a child, Junie ran away from home and lived on the streets for many years. In her forties she found out that she was HIV positive. In Massachusetts she received excellent medical attention – the supervised use of retroviral medication kept her numbers well under control and she remained healthy. However, housing in Massachusetts is expensive (the wait list for low income housing can be as long as ten years), and Junie knew she had to get out of the shelters and into a stable apartment in order to stay off drugs and out of trouble. She moved to another state where living costs are lower, and a family friend helped her get into low income housing. However, in that state she was not eligible for medical care. Within a year or so the HIV turned into full blown AIDS with an array of awful symptoms. Her kidneys failing she came back to Massachusetts where she now is sick enough to be eligible for temporary respite housing.

We might be tempted to see Junie as a poor unfortunate who fell through the cracks of a healthcare finance system mostly made up of employment-based health insurance augmented by a safety net for that minority of Americans who are not covered through their employers. That view is simply not correct. In the state of Arizona (the epicenter of the current VA scandal) for instance, the numbers break down like this: 45% of the population is covered by employer insurance (either a the primary insured or as a dependent), 4% have other private insurance, 18% are covered by Medicaid, 13% are covered by Medicare, 2% have other public insurance, and 18% are uninsured. Arizona is among the ten worst states in regard to percent of uninsured residents. The worst states are Texas and Nevada (27% uninsured) and Florida (25% uninsured).

While the full list of VA centers under investigation for fraudulent waiting lists has not been released, the five states that so far are reported to be involved (Texas, Arizona, Colorado, Florida and Mississippi) are all states with bad track records of healthcare coverage overall: tightfisted Medicaid eligibility thresholds and large numbers of uninsured residents.

The VA as the National Safety Net

In much of the country – and especially in the states with high rates of uninsured residents – the VA functions as the de facto safety-net. Approximately one quarter of the nation’s population, about 70 million people, are potentially eligible for VA benefits and services. In any given year approximately 75 percent of all disabled and low-income veterans use the VA system for some service.

I will never forget Yolanda, a school teacher I met in southern Texas a number of years ago. Here is a letter she wrote to me:

In 1998, one of my younger brothers at age 39 took ill. Seizures that he had were mistaken for a heart attack. A CAT scan showed he had a shaded area in his head. “Possibly a blood clot.” said his doctor. It turned out to be a malignant brain tumor rated #5. The worst a person can get. Further testing needed to be done to determine the proper treatment. All of these were very costly and his medical bills had already started to pile. Even then, the doctor said that with the proper treatment and starting immediately with chemotherapy, my brother could live at least 4 more years. We acted quickly to get him on disability and Medicaid. Without Medicaid, my brother could not afford any testing or treatment. None of us siblings were in the position to help out financially. We couldn’t understand the denial of Medicaid since my brother would no longer be able to work. How would he or his wife pay for all his medical needs? The doctor wrote letters for them to present to the Texas Department of Human Resources but they didn’t help in making the decision to approve it. …

Emergency visits to the hospital provided him with supplemental vitamins and potassium, which gave him temporary strength. But his medical bills were rising and the hospital never admitted him for longer time than needed to give him the vitamins and potassium. Usually about 4 to 6 hours. Again my sister in law applied for Medicaid. No luck and my brother still had not received the proper treatment. We started doing fund raising activities to help him with utility bills and other family needs. His wife still angered kept on applying to Medicaid for him.

A friend reminded my brother that he was a veteran of the military service and should check out the VA clinic. My brother and we thought that the VA only helped war veterans and my brother never went to war during his 4 years of service. Mistaken we were. However, to receive medical services, we had to take him to San Antonio where VA Hospitals and more clinics are located. This is a 5-hour drive from our hometown. We took turns driving him to and from every weekend. It was hard for us but harder for him going to and from so many times in his weak state. Eventually he had surgery and was started on radiation. It didn’t help any and a second surgery was done. The second surgery left him paralyzed on the right side. I went from working full time to part time so I could help out more with his physical needs. Months passed and he kept getting worse. My sister in law again went to apply for Medicaid so he could get care locally. It was getting harder and harder to move him on the 5 hour drive to San Antonio. There was no success in getting Medicaid and months passed. The whole situation became hardship for his wife, children and all family members. My brother eventually stopped responding to anything and we were basically just waiting for his time to end. Two weeks before he died at age 41, my sister in law received a phone call to say that finally the Medicaid had been approved. She told them exactly what to do with it. From the day my brother was told he had a brain tumor, he only lived for 1 year and 10 months.”

Yolanda’s brother certainly would have been saved a great deal of suffering if the VA were to have allowed him to receive treatment closer to home. But let’s be clear about this: Yolanda’s brother did not die because of the VA. He did, however, die with more suffering and less dignity because we do not have a healthcare system in the United States.

The Call for Privatization

As soon as the Arizona VA scandal broke, House Speaker John Boehner and others could hardly contain their excitement. This was a golden opportunity for pushing the same old proposal for privatizing the Department of Veterans Affairs. Privatization is not a new idea. But it is a bad one. Who would take over the care of veterans? Halliburton? Corrections Corporation of America? United Health? Aetna? None of these companies have track records that suggest trustworthiness.

There is no doubt that the VA is riddled with problems including half-hearted recognition of the needs of women veterans and a long history of denying that lethal wartime practices such as the use of the defoliating Agent Orange made veterans sick. All of this is inexcusable and the VA must be held accountable. The VA also must be held accountable for hiding the lengths of waiting lists for care instead of screaming from every DC rooftop for adequate funding.

But framing the current unconscionable delays for care at the VA as an issue of government inefficiency is disingenuous. The VA is not responsible for the fiscal conservatism that drives politicians to vote against adequate budgets. (To paraphrase one of my favorite bumper stickers from the 1960s: Things would look a lot different if the VA were to get all the money it needs and the Air Force had to hold a bake sale to buy bombers.) The VA cannot make up for the lack of a national system of healthcare coverage for all Americans, especially when those who serve in the military disproportionately come from and return to communities with few economic resources and little political power.

In the short term (until the VA can hire sufficient numbers of providers) it certainly makes sense to allow veterans on waiting lists to receive treatment at non-VA facilities. In the long term, that is not a good solution. The VA as a national enterprise acknowledges the collective responsibility for our society to care for veterans, recognizes that veterans have unique health needs that are best met by providers with expertise in those needs and provides a level playing field in which all veterans have the right to receive equal treatment regardless of their personal finances or the willingness of private companies to take them on as customers. Permanently outsourcing veterans on the waiting list to non-VA facilities undermines these principles. In addition, the annual Independent Budget published by the nation’s leading veteran organizations reported that the VA is “the most efficient and cost-effective health-care system in the nation.” A 2005 survey from the RAND Corporation [link] similarly found that “VA patients were more likely to receive recommended care” and “received consistently better care across the board, including screening, diagnosis, treatment and follow up.” I recall a conversation with a physician who, splitting his time between the VA and one of the large, prestigious Harvard teaching hospitals, told me that, “At the [Harvard] hospital I need to get referrals and approvals for everything and the patient has to run all over the place to be treated. In the VA it’s more of an old-time G.P. practice – As the doctor I can get the care for my patients that they need all in one place.”

Good News: Embracing Health Care as a Right

Something fabulously exciting has emerged from the public mea culpa of the past two weeks. It turns out that Americans are not afraid to use the word “rights.” Again and again, I’ve heard liberal and conservative pundits say that our veterans have the “right” to healthcare. While national debates over Obamacare have backed away from declaring that access to adequate health care is a basic human right (instead, discussions have been framed in terms of cost and choice), the VA scandal has opened the door for us to think deeply about healthcare as a human right not just for military veterans but for all who serve as teachers, parents, growers of food, cleaners of streets, producers of the clothing we put on our backs, builders of the houses in which we live – that is, for all human beings in that we all, by virtue of being human, are depended upon and depend upon others for our very survival. To my mind, the real lesson we need to learn from the current scandal is quite the opposite of privatization which would further chop up and distribute responsibilities (and profits) for healthcare among more and more corporations. What we need to learn from this scandal is that the VA should become part of an integrated, rational, coherent national healthcare system.

For more on the VA follow these links: On Memorial Day: “Remember the Ladies” and An Open Letter to Robert McDonald

Guilty Until Proven Innocent

You can read more about the problems of bail here.

A few days ago I ran into a friend of mine – I’ll call her Joy – whom I hadn’t seen for a while. In fact, she’d pretty much disappeared; she hadn’t picked up her phone or returned calls and I hadn’t received the Christmas or Mother’s Day cards she’d been sending me for the past six years. “Susan, I’ve been locked up,” she told me. “Why didn’t you call me from jail,” I asked her. “You know I would have come to visit.” “They took my phone so I didn’t have your number,” Joy explained. “You could have written – I would have come,” I continued. “Well, she said, I thought I was just going to be there for a few days so by the time you got the letter I’d be out.”

Here is what happened: “I caught a prostitution charge. I was in what they [police] call a bad neighborhood and a cop – he was from the gang unit — stopped me and ID’d me [asked to see her I.D.]. Then he arrested me for prostitution.” “Were you working the streets?” I asked (in the past she has worked in prostitution.) “No! I wasn’t. I’m not looking to go to jail. I told him [the cop] that, and I told him that there’s no way he could have seen me soliciting anyone – I hadn’t even talked to anyone. He said, ‘I’m a policeman and you’re a criminal. Who do you think the judge is going to believe?’”

“He brought me to the station and they told me I needed to pay $40 to bail myself out. I didn’t have $40. So they kept me in jail. Then, a few days later I saw the judge and he set $250 bail. I didn’t have that. So they sent me to MCI [state prison]. I was there for a month. Susan, I had to get out of there, so I told my lawyer to plead [guilty]. They let me plead for time served, so I got out.”

Wrong Place, Wrong Time

Like most incarcerated women, Joy is no violent, hardened criminal. Rather, she has, in her words, “the bad luck to be in the wrong place at the wrong time.” She was first locked up when she ran away from a juvenile treatment center to which she had been sent when she “acted out” after having been molested by a friend of the family. By the time she was twenty she was deemed disabled and qualified for SSI (Supplemental Security Income for disabled, poor Americans). Her medical challenges and diagnoses include impaired hearing, bi-polar disorder, PTSD, diabetes, insomnia, Hepatitis C, addiction, chronic hip and shoulder pain, lumps in several lymph nodes, and neuropathy in her feet. During the time I have known her the monthly SSI check has been approximately $740. That is her only source of income. Often homeless, Joy is vulnerable both to violent men and to overly zealous police and court officers.

Joy has been locked up at least a dozen times over the past fifteen years. However, to the best of her memory there was only one time that she was incarcerated as a direct outcome of a trial and sentencing. All of the other times she was locked up while awaiting trial or because she had violated the terms of her probation. In fact, among the criminalized women I have come to know the single most common reason for being locked up is for violating the conditions of probation. Typically these violations consisted of failing to attend AA meetings, missing an appointment with a PO, or being stopped by the police on a petty charge such as loitering. In other words, the initial offense was deemed by a judge to be too minor to require incarceration but the woman ended up serving time anyway.

Locked-up Awaiting Trial

Joy is one of thousands of women who spend time during any given year in the Awaiting Trial Unit at MCI-Framingham – the only state prison for women in Massachusetts. In fact, on a typical day forty-three percent of the women held at MCI-Framingham are in the Awaiting Trial Unit.  To be clear, that means that they have not been convicted of a crime. They are awaiting trial in prison because they could not afford to pay bail. Women often are held for substantial periods of time: The average length of pre-trial detention at MCI-Framingham is about 77 days.

Though far more men than women are incarcerated around the country, pre-trial incarceration has a disproportionately negative impact on women. In Massachusetts, while women comprise only 7% of state prisoners they comprise 33% of pretrial detainees held by the MA Department of Corrections. This disparity reflects the lower rates of major and violent crimes committed by women (fewer women are convicted and sentenced to long prison terms) and substantially higher rates of poverty among women. Women incarcerated in pre-trial status typically have been arrested for non-violent crimes and are too poor to pay even minimal bail fees. As Francesca, another woman who has been held pre-trial explains, “There are lots of women who are $10 short on bail. They can pay most of it but not all so they are kept in jail which costs the State a lot more.”

Francesca is right. According to the Massachusetts Bail Fund it costs the state around $125 per day to hold individuals awaiting trial. For a fraction of the cost to taxpayers to incarcerate people like Joy awaiting trial, money could be invested in community-based, community-run services that would help keep people out of jail. The costs to the accused individuals are even steeper: While sitting in jail waiting to be tried they stand to lose their jobs, their housing, their health care and the ability to care for their children.

According to the Justice Policy Institute, people who await trial in jail rather than out on bail are disproportionately poor and Black or Brown. And, people who are held during the pretrial period are more likely to be convicted and receive harsher sentences than those who are released on bail. This makes sense. If you can go home, fix your hair, clean yourself up and come back to court dressed in your best skirt and blouse you’re going to make a better impression on the judge than if you are brought to the courtroom in a prison bus, frightened and exhausted from nights in jail.

Bail Out

A variety of alternatives to monetary bail are being discussed and tried out around the country. And while I am in favor of most moves that keep women like Joy out of jail while awaiting trial, I think we need to be cautious about replacing monetary bail with other onerous or punitive policies. A few weeks ago Joy was picked up on a charge of distributing drugs. The “drugs” in question were a legitimate prescription that she had picked up at a local pharmacy for her own use. She needed this prescription and had no intention of selling it. A policeman arrested her as she left the pharmacy with an acquaintance she happened to run into. The pharmacy’s security camera recorded her purchase and subsequent interactions: No packages or money exchanged hands; she and her acquaintance had simply chatted. Because of the security camera’s tape Joy knows she will not be convicted. Bail was set at a couple of hundred dollars and Joy managed to bail herself out. However, as a condition of her bail she has been required to go to a “holding facility”  to wait for a bed in a rehabilitation program. This facility is located at a considerable distance from her family and friends, and it offers no programming or opportunities for women to earn money. She was told that she would be held for an indefinite amount of time and that it could be months before a bed would become available in a rehabilitation program. All in all, Joy says, it’s not really different from prison. She made the decision not to go. As a consequence, she assumes, she will be sent back to jail the next time she is stopped by a cop or sets foot in a courthouse.

Better Alternatives

Like most Americans, I had taken for granted that bail is the sensible way to make sure that criminals show up in court and do not flee before they can stand trial and pay their dues to society. But when I began to think about Joy and other women I know, I realized two things:

One: These women are not fleeing anywhere. They have children, they have families. They are not violent criminals. They are facing fairly short sentences. Bail serves no purpose in terms of ensuring that they show up in court.

Two: Several women I know (Joy is one of them) have been assaulted by men who were arrested for a violent crime but had the money to afford bail. In other words, bail did not prevent them from beating up women.

This simply does not make sense.

Nationally there is a recent surge of interest in developing rational tools for assessing whether or not an individual accused of breaking the law is violent and / or a flight risk. In states where these tools have been adopted, the rate of pre-trial incarceration declined and there has been no increase in criminal activity carried out by individuals awaiting trial at home rather than in a jail or prison. So yes, there are good economic and criminological arguments for overhauling or even abolishing the monetary bail system. And I’ll repeat those arguments to anyone who will listen. But that is not the whole story.

When a third of people who are locked up have not been convicted in a court of law, the story is about how we’ve flipped the core principle of American justice – innocent until proven guilty – on its head. The story is about a system in which people who can pay can get out of jail – even if they have been accused of violent crimes, while those who can’t pay are locked up – even if all they’ve done is steal some food.

The story is about freedom as a commodity that can be bought and sold.

For more on this issue check out The Pretrial Working Group. and the Massachusetts Women’s Justice Network.

You can read more about Joy in my new book Can’t Catch a Break: Gender, Jail, Drugs and the Limits of Personal Responsibility – available through University of California Press, Amazon and other bookstores.

 

On Memorial Day: “Remember the Ladies”

2016 Update: According to Senator Barbara Mikulski (D-MD), “Currently, medical prosthetics for female amputees are provided as one-size-fits-all and are based on male anatomy. This means female veterans often receive prosthetics that are burdensome, uncomfortable and may not be fully functional.”  An appropriations bill currently making its way through Congress would fund research and acquisition of prosthetic devices that fit women’s bodies. The bill also would allow the VA to cover the costs of reproductive services for veterans who suffered service-related injuries that prevent them from starting families. According to NPR Veterans Correspondent Quil Lawrence, “A law passed in 1992 made it illegal for the VA to pay for IVF, which some people oppose because embryos are often destroyed in the process.”

 

I understand that if women are to have the privileges of citizenship then we should have the responsibilities as well. However, given the needlessness and horror of nearly all wars, I am not at all sure that it is a good thing to expand the number of people who can be called upon to fight.

I understand that if women are excluded from military service then the power of the military  remains in the hands of men. But in light of the near absence of women in the high ranks of the armed services – the ranks where the important decisions are made – I’m not convinced that military service for women achieves a more gender equitable sharing of power.

I understand that for many women the military is a pathway to education and a career. However, – and this is what I’d like to write about this Memorial Day – military service has turned into a path of misery, ill health and homelessness for large numbers of women.

In the second decade of the new millennium, American women have come to make up approximately 15 percent of the U.S. armed forces. While women are not technically in combat roles, in their duties and service environments women face the same dangers and fears as men: exploding ordnance, bullets, vehicular accidents. According to studies the military poses additional threats for women: about one in three women in the armed forces has been sexually assaulted, twice the civilian rate.

Women who have been sexually assaulted are more likely than other women to suffer from chronic pelvic pain, fertility problems, high rates of pregnancy complications and perinatal death, gastrointestinal disorders, arthritis, invasive cervical cancer, hypertension, urinary tract infections, anxiety and sexually transmitted infections. A history of having been abused is correlated with a lifetime of earning less money, missing more days of work and a greater likelihood of becoming homeless.

Servicewomen suffer from higher rates of depression, anxiety, and post-traumatic stress disorder (PTSD) than do their male counterparts. According to the National Center for PTSD, women in the military run double the risk of developing PTSD of male service members. The Veterans Administration (VA) has found that women are four times more likely than men to experience long-lasting PTSD. This is not surprising: While male veterans who return home no longer face the active dangers of war, women veterans who return home continue to face the active dangers of sexual violence in a society in which one nearly 1 in 5 women has been raped at some time in her life; 1 in 4 women has been a victim of severe physical violence by an intimate partner in her lifetime; 1 in 6 women has experienced stalking victimization during her lifetime. One cannot “get over” trauma if one continues to live with trauma-inducing conditions on a daily basis.

Marriages of female troops fail at almost three times the rate of marriages of male service members. And while veterans have long been more likely than non-veterans to become homeless, women veterans seem up to four times more likely than non-veteran women to be homeless. The number of women veterans who have been in touch with the VA or Department of Housing and Urban Development (HUD) for assistance with housing more than doubled between 2006 and 2010. Two-thirds of these women were between 40 and 59 years old, one-third have disabilities, and many have minor children.

According to the Government Accountability Office (GAO), a quarter of the VA’s homeless support programs do not meet the needs of women. For example, the VA does not have the statutory authority to reimburse grant and per-diem housing providers for costs of housing veterans’ children. Thus, mothers must face the dismal choice of going to the streets with their children or of handing their children off to relatives or social service agencies. The GAO also found that women reported experiencing sexual harassment and assault both on the part of male residents and on the part of staff members in the temporary housing paid for by the VA.

Women who have been drawn into the United States correctional system describe similar cycles of poor health, homelessness and ongoing exposure to gender violence (both in and out of prison). In research that I conducted together with a colleague in Boston from 2008-2013, only 15% of women who had served sentences in the state prison became steadily employed during the five years following their release. Only 35% became securely housed. Seven-seven percent were hospitalized overnight at least once. Eighty-five percent continued to receive prescriptions for psychiatric medication.

For most of these women the cycle of illness, poverty and abuse seems unlikely to be broken anytime soon. But I believe that there are steps that can be taken now to reduce the chances that women veterans will join the ranks of women who circulate among homeless shelters, battered women’s shelters, jails, prisons, rehab programs, and the streets.

Here are two concrete ways in which we can and should remember the ladies this Memorial Day:

  1. Put into place clear and effective programs to reduce sexual abuse and harassment of women in the military. Senator Kirsten Gillibrand’s bill requiring the armed forces to remove handling of sexual assault cases from male commanding officer should be brought up again in the House and Senate, and it should be passed and enforced.
  2. Provide adequate funding for the VA so that all veterans — men and women — can receive proper health care and secure housing immediately upon finishing service.

Maybe, hopefully someday soon we will declare a national ‘Peace Day’ in which we remember and honor all of those who dedicated their lives to ending violent conflict. But for now, let’s at least make sure that women who serve in the armed forces do not face as much danger from their comrades-in-arms as they face from shrapnel and bullets.

 

Incarceration by Any Other Name: A Return to the Cuckoo’s Nest?

The big news coming out of Los Angeles County – the county with the largest number of incarcerated people in the country – is the approval of a plan to replace an overcrowded, decaying jail with a correctional center that provides care for  incarcerated men suffering from mental illnesses and substance abuse. The plan includes a $1.9 billion proposal to tear down Men’s Central Jail and construct a 4,885-bed “Consolidated Correctional Treatment Facility”. The proposal also calls for “upgrading” the Mira Loma Detention Center in Lancaster into a 1,040-bed facility for women. Altogether, these proposals would add about 1,000 beds to the county’s jail system, bringing the total to just over 21,000.

No doubt about it – the jail that many consider to be one of the worst in the country – needs to come down. No one has anything good to say about the Los Angeles County Men’s Central Jail – a facility known for its abhorrent conditions and rampant violence. However, replacing a “jail” with a “correctional treatment facility” is, at best, a cosmetic change. At worst, it sets the stage for rebranding individuals who have been drawn into the correctional system from “offenders” (that is, people who did bad things) to “sick” (that is, people who are a bad thing.)

“Treatment” certainly sounds more benevolent than “punishment.” And it certainly is the case that the overwhelming majority of people serving time in U.S. jails and prisons suffer from physical and mental health challenges. Around the country incarcerated men and women have higher rates of hypertension, anxiety, myocardial infarction, psychotic episodes, asthma, arthritis, major depression, cervical cancer, urinary tract infections, chronic headaches, tuberculosis and hepatitis, than Americans in the general population.

I acknowledge that we are holistic beings whose physical, emotional, mental and spiritual lives are, on a deep level, one and the same. But, just for now, let’s bracket that deep epistemological insight and ask: Why the newfound public attention to mental illness – a vague, subjective and stigmatized category, rather than physical illness – far more concrete, less stigmatized, and usually more treatable. Why the sudden surge of interest in mental health treatment for criminalized Americans?

Over past year or so we have reached a tipping point regarding mass incarceration. In the current mid-term elections, every single candidate I have heard has spoken about the need for “prison reform” (a vague idea that typically centers on getting “treatment” for the many mentally ill prisoners.) That we’ve reached this point reflects the hard work of anti-incarceration and human rights activists, the inability of states and counties to afford the economic cost of incarceration, the cumulative numbers of people impacted by decades of mass incarceration making it harder for “average” Americans to see so-called criminals as “Other” (my guess is that by now most Americans personally know someone who has been locked up on a minor charge because of “tough on crime” policies), and perhaps simply the usual waxing and waning of the popularity of public policies.

But I think that there is another factor at work here. Redefining criminalized Americans as mentally ill resonates with deeply rooted ideas regarding sin: That deviant behaviors and identities are manifestations of core personal flaws. The fluidity of “criminal,” “sinful,” and “mentally ill” classifications in the United States are clearly seen in the rebranding of homosexual desire from sin to criminal to mental illness over the course of a single century. That is far from the only example of this sort of fluidity. Psychoactive drug use has been labeled a Christian sin (most clearly in the case of Native American religion), a crime (and indeed the largest driver of mass incarceration today), and an illness (according to the American Psychiatric Association, American Psychological Association and virtually all psychotherapeutic authorities.)

How particular identities or practices are branded drives how those who are associated with those identities or practices are treated. And, on the face of it, we’d assume that those who are categorized as “ill” will be treated better than those who are categorized as “sinful” or “criminal.”

So here is where I want to push back a bit. It seems to me that sinners – in normative American Christian understandings — can be “reborn” and their sins can be washed away. Criminals (in theory) can “serve their time,” “pay their dues to society,” and be “rehabilitated.” Those who are classified as mentally ill, however, are diagnosed with a chronic – that is, incurable – condition. Medication can help control the symptoms, but if the individual ceases to be compliant with doctor’s orders, that person will relapse – the mental illness that was suppressed by treatment will reemerge. Rhetoric about not blaming the mentally ill for their mental illness (after all, it’s biological, chemical or genetic) is a two edged sword. As the women’s movement has long argued, excusing groups of people from the responsibilities of civic life because of inherent weakness ultimately serves to disempower. You cannot control what you cannot control. Continue reading Incarceration by Any Other Name: A Return to the Cuckoo’s Nest?

Marissa Alexander and the Shot Not Heard Around the World

I’ve been thinking a lot today about Marissa Alexander, the woman who could be incarcerated for as long as sixty years for firing a single warning shot in the direction of her abusive husband. Today she is back in court, again, requesting immunity under “stand your ground” in light of new evidence of her husband’s abuse. The shot most certainly not heard around world injured no one and may well have saved her from further abuse at the hands of a violent man. It has not, however, saved her from abuse at the hands of the courts. In 2012 she was convicted of aggravated assault and sentenced to 20 years in prison. Marissa Alexander had given birth a week before the incident, her husband had beaten her up during her pregnancy, and she had a court injunction that was supposed to keep him away from her. She also had a license to carry a concealed weapon, was trained in using the weapon – and, it bears repeating – no one was hurt.

At the time of her trial and verdict the Court denied her right to use a gun in self-defense under the “stand your ground” law in Florida. The contrast to the ruling in the case of the death of Trayvon Martin at the hands of George Zimmerman seemed a clear demonstration of how racism, even in our era of “colorblindness” (see Michelle Alexander’s The New Jim Crow) permeates the law enforcement, judicial and penal systems.

But today when I read her message to her three children who are growing up without their mother, I’ve been thinking more about Marissa Alexander’s gender.

For the past six years I’ve spent a great deal of time with women in the Boston area who had been incarcerated in Massachusetts. Studies consistently show that the about 70% of women drawn into the correctional system have been targets of physical and sexual violence (Meda Chesney-Lind has written powerfully about this issue.) In my own observations this estimate may actually be on the low side. Furthermore, having been in prison sets women up for further abuse and assault. As “ex-offenders” they lose their eligibility for government-subsidized housing and as a consequence are likely to become homeless. In fact, a 23 city report by the United States Conference of Mayors confirms that domestic violence is the primary cause of homelessness for women (www.usmayors.org). Women who are homeless or insecurely housed are vulnerable to assault on the streets, and, with few alternatives available, may move in with a man who is – as several women I know put it – “sketchy” which puts them at even greater risk of intimate partner violence.

Why – despite efforts our society has put into helping victims of violence – do Marissa Alexander and so many other women continue to suffer intimate partner assaults, abuse, sexual exploitation, and rape? The Violence against Women Act, signed into law by President Bill Clinton on September 13, 1994, increased penalties for repeat sex offenders, trained law enforcement officers and established the National Domestic Violence Hot Line. We have police, social workers, psychologists, battered women’s shelters, rape crisis hot lines, mandatory reporting requirements – surely these should have, or at the very least, could have solved the problem of violence against women. We have public proclamations that raise awareness of childhood sexual abuse, date rape and domestic battering. But the culture of violence that endangers women, children, and many men has not changed; rates of gender violence have not declined; and men who rape or abuse women are unlikely to be charged with a crime, if charged they are unlikely to be convicted, and if convicted are unlikely to serve significant prison time (more on this in the National Violence Against Women Survey).

Continue reading Marissa Alexander and the Shot Not Heard Around the World

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

This piece originally appeared in Salon in April, 2014

When I first met Gloria, over five years ago, she was in what she and others sometimes call “the homeless life.” That is, she circulated through a variety of homeless shelters, relatives’ couches, and apartments of men with whom she informally exchanged sex and domestic chores for a place to stay. Like other women in similar circumstances whom I met as part of a long-term project involving marginalized Boston-area women, Gloria (a pseudonym) was always concerned about lack of housing. Knowing that she would not survive on the homeless circuit much longer, she turned to a social service agency that placed her into a subsidized room in a “single room occupancy” (SRO), what used to be called a boarding house.

As is typical in SROs, she was not permitted to have overnight guests in her room. However, when her boyfriend was released from jail, he had nowhere else to go. For a while she snuck him into the building, a situation that humiliated both of them when she stood guard outside the communal bathroom door to make sure that no one saw him enter or leave.

Within less than two months he locked her in her room, destroyed her telephone, raped her and beat her up. Gloria was afraid to call in the police. She had learned through past experiences that women who report sexual violence may become vulnerable to negative repercussions from a variety of state agencies. In fact, a survey conducted by the National Law Center on Homelessness and Poverty found that at least 11 percent of evictions from public housing and Section VIII (subsidized) residences targeted women because they experienced domestic violence. In some cases, women were evicted for defending themselves. In other cases they were evicted simply because the violence created a “public disturbance.”

* * *

Gloria’s dilemma will soon be faced by many, many more American women.

Despite the well-publicized fact that the United States has the highest incarceration rate in the world, there is good news: America’s race to incarcerate may be slowing down. California, the state with the largest number of people behind bars, has been ordered by a panel of federal judges to reduce the state’s prison population by approximately 10,000 to deal with prison overcrowding. (After several appeals, the court extended the deadline for compliance to February 2016.) Nationally, incarceration rates are going down for Black men and women and for White men (not for White women). Declining incarceration rates can be attributed to a variety of factors, including changing social attitudes regarding drugs (particularly marijuana); large numbers of inmates finishing the lengthy mandatory sentences they were ordered to serve at the height of the war on drugs in the 1980s and 1990s; budgetary constraints including rising cost of prison healthcare as prisoners age; and the ongoing advocacy work of community and prisoners’ rights organizations.

American men remain incarcerated at 20 times the rate of women. And as Gloria knows well, the legacy of their imprisonment continues to play out in the lives of their families and communities long after their release. In a large-scale Oregon study, Margaret Braun found that at least 25 percent of male ex-prisoners engaged in acts of violence against wives and girlfriends within the first several years post-release.  The impetus for this violence simmers during confinement. In focus groups conducted by researchers from the Vera Institute of Justice and the Institute on Domestic Violence in the African-American Community, currently and recently incarcerated men stressed their demands that wives and girlfriends demonstrate loyalty to them while in prison, running errands for them, putting money into their prison account, and – above all – avoiding even a suspicion of new romantic interests.

Loyalty often was framed in terms of control. As one man explained, “One view of women is they just there to do what I want them to do. Slaves … somebody to be there at your every beck and call.” And in the words of another man, “I’ve seen over and over since I’ve been here [in prison], guys will get on the phone and they’ll accuse their wives or girlfriends of cheating with someone else. I mean, it’s never just a regular conversation.”

More broadly, prison culture amplifies the sexist attitudes and gender violence of so-called free society. Young men thrown into overcrowded jails often learn that in order to survive they have to become tough, numb to the pain of others; they learn to be the aggressor in order not to be the victim. This dynamic is deeply gendered. Criminologist Donald Sabo and his coauthors write, “Rape-based relationships between [same-sex male]  prisoners are often described as relationships between ‘men’ and ‘girls’ who are, in effect, thought of as ‘master’ and ‘slave,’ victor and vanquished.”

These attitudes do not suddenly evaporate upon release. Over the past decades, both the incidence and intensity of violence against women has risen in communities with high rates of incarceration. Indeed, Beth Richie, author of “Arrested Justice: Black Women, Violence, and America’s Prison Nation,” links the rising rates of brutal sexual violence carried out against black women to the disproportionately high rates of incarceration of black men during the regime of what law professor Michelle Alexander calls the “New Jim Crow.”

Tonya, an African-American woman in her 30s who has had abundant experience with men in prison (her child’s father was incarcerated shortly before he was born; she spent a great deal of time, energy and effort visiting her man while he was in prison; and now that he has been released he has moved into her house), helped me understand the links among mass incarceration, prison culture and violence against women. “I believe that there is a level of violence and anger in any person, that anger can be increased … depending on … how much time was given for the crime, and the level of violence that the individual has to deal with in the correctional facility. Do I believe that violence can trickle out into the community? Yes and no. Some men have the ability to take traumatizing experiences and utilize it to teach others about the violence, homosexuality and verbal abuse from state officials and correctional officers they have to deal with on an everyday basis … [But] this type is atypical … In my opinion men who are typical … have displayed behaviors of cheating, lying, stealing, manipulation of women and people who don’t know any better … Males only have so much patience before snapping and reliving what they view as an attack on them.”

Tonya explains that for men, “It can easily go both ways depending on what kind of support you do have when you get out of jail, what resources are available to you, and what is not available. See, it’s a cycle,  ‘I don’t have an education, so I can’t get the job I want, I can’t pay child support because no job and no education, my girlfriend or wife is stressing because I got a record which is stopping me from working and paying child support, which if you don’t  pay child support they take your licenses and you go back to jail, so I have to go back to robbing someone or selling drugs, because there’s no food in the house for the kids, which is making me feel less of a man, so I become angry which leads to violence on my women, my kids, and anyone else that is coming at me in what I view is negative.”

* * *

Structural barriers created by misguided policies add fuel to the fire. Many men exit prison to find themselves barred from ever obtaining employment in the legal economy, unable to afford stable housing, and unable to support their families. When men leave jail they compete with women for the limited number of (typically low-paying) jobs available in low-income communities that already experience high unemployment rates. Barriers to employment for former prisoners are driven by social stigma and lack of work experience, and by laws permitting or even mandating criminal background checks, a practice that puts men (who are more likely than women to have a criminal record) at a disadvantage.

Throughout the country, low-income Americans are especially likely to be incarcerated. As a consequence, prisons and welfare offices often “serve” demographically similar populations – except in regard to gender. Welfare eligibility tends to be limited to poor women with children; and nearly all Section VIII subsidized housing vouchers (housing subsidies for low-income households) go to female-headed households. Because laws exclude individuals holding criminal records from eligibility for public and subsidized housing, people released from prison (again, more likely men than women given the demographics of incarceration) often find that they are dependent upon women for a roof over their heads.

However, the same housing laws allow (and sometimes require) law-abiding citizens to be evicted if a former prisoner or someone who commits a crime is caught staying in their house. In fact, women like Gloria risk losing not only their housing but also their welfare and food stamps or even custody of their children when a man – even the child’s father in some cases– is “caught” living in “her” apartment. Yet a low-income man who has to pay his own rent may not be able to pay child support. And failure to pay child support, in turn, can be used by the courts as a reason to send a parent to jail.

* * *

As I have come to know Gloria and other women in similar situations I have become aware of ways in which gender-based violence is reinforced by economic policies and welfare laws that pit women and men against one another. These policies set up poor and marginalized women to become the targets for the fury, confusion and exaggerated machismo that are nurtured in prison. And while these policies may seem irrational, there is, in fact, a deep logic behind them. The promotion of  competition and conflict along gender lines shifts attention away from harmful public policies to the wrongs committed by individual members of the “opposite sex.” Taking a step back, we see that throughout history ruling elites have fostered animosity between ethnic groups, between the very poor and the working class, the young and the old, immigrants and non-immigrants – between groups whose solidarity could threaten the wealth, status and power of the privileged few. Gloria’s conflict with her boyfriend is just the latest chapter in that history.

Large-scale prison release is imperative if we wish to rebuild a democratic society. But while we are opening prison doors we need to institute policies that prevent the violence of prison culture from spilling over into communities. These policies must include eliminating structural barriers to housing and employment for formerly incarcerated people, investing in jobs and housing, expanding eligibility for welfare and other social services, facilitating reunification of families and households destroyed by decades of mass incarceration, and developing programs of restorative justice that provide men with the resources to develop more positive ways of responding to the women and other men in their lives.

Follow this link for more on gender and incarceration: Marissa Alexander and the Shot Not Heard Around the World

Our Prisons are Drugging Women

This piece originally appeared in Salon in August, 2013

A report issued earlier this month by the Center for Investigative Reporting revealed that doctors have sterilized as many as 148 women inmates in California prisons during the five-year period from 2006 to 2010. As a feminist and a mother, my initial response to the report was fury at the prison system for its blatant disregard of women’s rights and sadness for the women who will never again be able to carry, birth, nurse and raise their children. As a sociologist who works with criminalized women in Massachusetts, my second response (I am ashamed to say) was relief: Here in Massachusetts, with our top universities and progressive politics, such a thing would never happen.

Once I finished seething, crying and telling myself how lucky I am to live in Massachusetts, a slightly different picture began to form in my mind. Forced sterilization is an outrageous human rights violation, and prison rights advocates correctly argue that any sterilization performed on incarcerated women is by definition coercive. But this is only part of the story of how women in prison are controlled. In Massachusetts we may not sterilize incarcerated women, but we sure do drug them.

Having followed a group of 20 women post-incarceration for the past five years, I have become increasingly concerned with the use of medical procedures and treatments to “manage” the problems caused by social and economic policies and by overuse of incarceration.

I first met Elizabeth, a white woman in her early 40s, as a participant in a study I was conducting among women who have been incarcerated in Massachusetts. A decade or so earlier she had the misfortune of losing the sister with whom she had been especially close throughout her life. Devastated by the death of her sister, she struggled to keep up the smiling expression demanded in her job as a waitress. Told by her boss that her teary demeanor made the customers uncomfortable, she was let go. Without a job she was unable to keep up with her rent, and at the age of 32 she became homeless. Without a secure place to live, Elizabeth became a target for repeated robberies and sexual assaults.



Like many other homeless people, she was arrested for loitering, drinking in a public park and resisting arrest when a policeman she had called to protect her from assault decided to arrest her instead. In prison she was put on Thorazine and Lithium, medications that typically are used for psychosis (she has never been diagnosed as psychotic). Elizabeth explained, “This [the drugs they gave me] made me gain weight and made me into a [space cadet]. It’s not the right medicine. I’m not crazy, that’s for crazy people. I have PTSD and depression from being raped.” In a fog from the medication, Elizabeth lost privileges such as use of the prison canteen and was repeatedly confined to her cell for failing to cooperate with the orders of correctional officers. She was lucky; her cell mate spent two weeks in solitary confinement.

America’s astronomical rates of incarceration (the highest in the world) and America’s equally astronomical rates of psychotropic drug use (also the highest in the world) are two sides of the same coin. Both medicalization (the tendency to characterize social problems or conditions in medical terms and adopting a medical approach to address those problems) and criminalization construe social problems as the moral failings of individuals. This formulation draws attention away from the social miseries that lead to pain, disability, illness and the need to do whatever it takes to survive. When Elizabeth needed job security and affordable housing, what she received was a prison sentence and a cocktail of psychotropic medication.

Such medication certainly can be beneficial for people whose emotional distress or mental confusion interfere with their ability to stay safe, make sound decisions or experience pleasure or satisfaction in life. But the medications Elizabeth was prescribed actually diminished her capacity to make sound decisions and stay out of harm’s way. The issue for Elizabeth is that prisoners have very little – if any — power over what medication they receive, or are denied. Talk therapy is also much less accessible in prison than outside. And any treatment inmates get tends to emphasize individual pathology rather than acknowledging the social injustices that brought many women to prison in the first place.

While men are more likely than women to be caught up in the net of incarceration, women are more likely than men to be controlled through seemingly more benign medical practices. In Massachusetts in 2012, 56 percent of women inmates were treated with psychotropic medication while in prison. (In comparison, only 17 percent of male inmates were treated with psychotropic medication.) In prisons and jails across America, psychotropic drugs are used to subdue inmates. Ostensibly prescribed in order to treat inmates’ pathologies, these drugs often function to restrict autonomy in much the same way as shackles and solitary confinement; they can cause serious side effects including lethargy, seizures and menstrual irregularities; and they are liable to interfere with prisoners’ ability to participate in the preparation of their own defense cases.

I have reached out to various people in the Massachusetts penal system about these issues. Though none have been willing to speak on the record, most people who work in positions of power in the system in Massachusetts are well-intentioned and clearly understand that women inmates struggle with a variety of problems and barriers including histories of sexual abuse. They genuinely want to help women inmates improve their life situations. And they believe that psychotropic medications are a crucial part of that mission. Thus, in response to my questions about overuse of medications, I typically am told that they feel the problem is the underuse of medications.

Medical and penal interventions are often used in tandem to modify, reform, punish and control people – especially poor people and people of color – who are seen as lying outside of, or as threatening, social norms and power hierarchies. The vast majority of female inmates have experienced sexual abuse or assault (estimates vary from 70 percent to 90 percent). Whether through medical or penal practices, women are held responsible for dealing with the consequences of rape. While few people nowadays openly blame women for being raped, the fact is that a history of sexual abuse substantially increases a woman’s chances both of ending up in prison and of being treated with psychotropic medication while there. As Elizabeth learned the hard way, our national solution to “rape culture” is to “fix” women who have been assaulted rather than to change the social attitudes and policies that set women up for abuse.

In this wider context, forced sterilization inside of prisons is one – albeit particularly horrifying — instance of the use of medical procedures and treatments to “manage” marginalized women. In “Killing the Black Body: Race, Reproduction, and the Meaning of Liberty,” Dorothy Roberts documents how the forced sterilizations of the eugenics campaign of the early 20th century (a campaign meant to improve the human gene pool by preventing the “unfit” from procreating) functioned to keep women – and particularly black women – in check. More recently, coerced sterilization has raised its ugly head in public debates regarding the family cap for recipients of welfare (the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 allows states to deny mothers further financial assistance after the birth of another child) and in blatantly racist proposals to require contraceptive implants for mothers accused of using crack.

Women like Elizabeth face double jeopardy, first in their difficult life circumstances and then in the way they are treated once they enter into the criminal justice system. I do not claim that psychiatric medication (or sterilization, for that matter) is never appropriate. But when two of the most powerful social institutions — medicine and prisons – join forces, the threat of coercion is all too real. We rightfully express outrage when women in prison are sterilized, but our silence in the face of inappropriate medicalization could justly be called criminal.

For more on this theme: Incarceration by Any Other Name: A Return to the Cuckoo’s Nest?