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

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

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 White Women, Opiates and Prison

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 What Pennsatucky’s Teeth Tell Us About Class in America

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?