jail-cell

I recently read this powerful piece by Jean Trounstine. Jean has graciously agreed to let me repost it here, so that I can share it with my readers. It originally appeared at jeantrounstine.com


 

Every semester my students from Voices Behind Bars, a class I teach at Middlesex Community College in Massachusetts, go to prison. They used to visit state institutions but now that the Massachusetts state prisons do not offer tours (perhaps because it is a hassle to have outsiders trooping through them and criticizing what they see) the students take a tour of Billerica House of Correction, where they experience confinement to some degree and listen for an hour to an incarcerated man talk about his life and what it is like to be behind bars.

Originally, the Middlesex House of Correction was built in 1929 and housed 300 men. Now it has more than 1100, after a $37 million dollar expansion which prison officials say was to accommodate the closing of the Cambridge Jail —not without objections from activists and community members who opposed more prison building (actually costing $43 million per The Lowell Sun.)

I’ve always thought it’s not ideal to have my students learn about prison by going to a place where people are only kept for 2 1/2 years, the county sentence at a house of correction. Certainly a far cry from a life sentence. I told myself students couldn’t really learn as much about the strains of prison without seeing the harsher conditions that exist in state institutions. That is, until this last visit.

Most of the tour went as usual. We went through the older part of the facility where cells can get up to 110 degrees in the summer. We saw the visiting room where men talk to their loved ones through glass. The officer who showed the students around Billerica explained that prisoners must walk on the green stripes in the hallways; there were the usual men cleaning with mops and pushing large barrels down walkways; the smell was of too much cleaning fluid. We passed through the health unit where men were waiting to see practitioners and others were isolated in cells. It was prison as usual.

We no longer are allowed to see the Hole or what prison officials call the Segregation Unit, since men are there disciplined to solitary confinement which my students know Supreme Court Justice Anthony Kennedy recently said can drive men mad. Therefore, the highlight of the tour is always taking them into what is called a “pod.” A pod is the relatively new term in prison construction where prisoners can live in a contained unit. These pods are somewhat stale and robot-like but they allow the COs the ability to see what is going on.

We entered the pod where men do drug treatment and have earned some privileges. It has the reputation of being a better place to reside than the old part of the institution which is pretty grim and can house two men in a cell. To the left is one old institutional unit at Blillerica, looking a little prettier than it really is with whitewashed grey walls, all somehow devoid of color in reality:

On the pod we entered, those incarcerated run some of the addiction groups themselves, we were told. On the tier above the day room where prisoners sit, eat, and play cards at the tables, are rows of cells where men live. The same cells are on the first floor all around the room.  Each cell has a tiny vertical slit—a window—and when we come into their space, the men inevitably stare out the window at us. At times, they’ve pounded on their doors; at other times, they’ve all been at tables eating lunch, trying to ignore the fact that there are outsiders nearby.

This time, when the twenty of us entered, there were only a few men in their brownish beige uniforms sitting at tables. Another two were talking to the guards who policed the room, two perched at a computerized station at one end. The students all took turns entering a cell to see what it is like, a rather disturbing experience on many levels for most of them. One student, we’ll call her Sofia, suddenly turned toward me as Spanish was heard above us. She pointed up at a window where a man smiled widely and pressed his face against the slit.

“That’s my brother,” Sofia said, her eyes filling with tears.

I looked up and he waved at me, his sister’s teacher. Sofia looked away.

I asked the young woman if she had known he would be here, and yes, Sofia said, she knew he was in this  facility but no, she had no idea she might see him. She seemed torn, wanting to look, wanting to hide. She said under her breath as others continued their entrance into cells, as far as she knew, he had no hope of ever not doing drugs. She’d lost touch, she said. She couldn’t imagine he might be doing OK.

But the young man’s face lit with joy when he saw her, and before we left that unit, it was almost as if a light went off for her too. Prison became about loneliness, about being apart, about the kind of pain that happens when families break up. It was no longer just about this space or this room or that hallway. Sofia’s brother, as close as he was, was nowhere near his sister. And would not be for a long time, perhaps never. She understood that and so did I.

When we exited Billerica that day, Sofia told the other students about her brother behind bars. Now, after walking through Billerica, and after being with Sofia, they understood why prison was not just a physical place, but a deep wound.

As awareness is growing of the financial and human costs associated with mass incarceration, we’re hearing talk from politicians on both sides of the aisle (and, believe it or not, even from the Koch Brothers) about the need for “alternatives to incarceration” (ATIs).

The term “alternatives to incarceration” takes for granted that we are talking about ways to handle criminals who otherwise would need to be incarcerated — that incarceration is a reasonable baseline against which to measure “alternatives.” In light of the over-representation of Americans of color and low-income Americans in jails and prisons, however, it’s necessary to be careful about any sort of presumption of correlation between criminality and incarceration. In fact, about a third of people locked up in the US are awaiting trial; that is, they have not been convicted of a crime. Another third are locked up because they violated the terms of probation or parole; that is; the “criminal” act was not sufficiently egregious to require imprisonment but a subsequent action – often simply not showing up for a meeting with a parole or probation officer, or failing to keep up restitution payments or money owed in court fees – was the reason for incarceration. And 97% of federal and state criminal prosecutions are resolved by plea bargain – often accepted by defendants out of fear that if they don’t accept the deal they will be locked up even longer — rather than by trial.

Given these numbers, it’s easier to make a case for abolition than for “alternatives to incarceration.” But that is not the direction in which public discourse seems to be moving. To the contrary, the increasingly popular sentiment goes something like this: A whole lot of people sitting in jails and prisons are mentally ill; they are drug users who need treatment more than they need punishment. Echoing this sentiment, Los Angeles County – the US county with the largest number of incarcerated people – recently approved a $1.9 billion proposal to tear down Men’s Central Jail and construct a 4,885-bed “Consolidated Correctional Treatment Facility”. And while “treatment” certainly sounds beneficial, the content of that treatment has yet to be spelled out.

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Over the past five years I followed a cohort of Massachusetts women who cycle in and out of prison as well as a variety of treatment programs. All of the women, at some point in their lives, have been diagnosed with a psychiatric disorder (most commonly substance abuse, bipolar disorder, PTSD). Overall, these twenty-six women spent far more time in treatment than in correctional settings. Yet, at the end of five years only three women had settled into reasonably secure housing, stable employment and long-term desistance from substance abuse.

Typically, treatment programs include some combination of pharmaceutical, twelve-step and psychotherapeutic components. Most of the women I have come to know are prescribed mind-boggling assortments of psychotropic medication, some of which make them, as Elizabeth (a white woman in her early forties, Elizabeth was homeless for a decade) used to say, into “a space shot” who shuffles around in a daze that puts her at elevated risk for being robbed or assaulted. Whether anti-anxiety, anti-depression or anti-psychotic drugs, these medications are not intended to cure the underlying problems such as sexual assault and homelessness that lead to anxiety, depression and substance abuse. Rather, psychotropic medications are prescribed in order to manage the individual’s response those problems.

While not all treatment programs prescribe psychotropic medication, virtually all incorporate – explicitly or implicitly — twelve step ideology and practices. Treatment facilities tend to be plastered with twelve step slogans such as “Let Go and Let God” and “Cultivate an attitude of gratitude,” and formal AA/NA meetings typically are part of the treatment regime. With emphasis on admitting one’s powerlessness (Step 1) and making moral inventories of one’s faults (Step 4), these programs do not seem to offer the women I have come to know a meaningful script for re-organizing their lives. When I visited Joy, who has been homeless for nearly fifteen years and nearly died as a consequence of a brutal sexual assault, several weeks into her stay in a treatment facility she enthusiastically explained to me that, “I’m learning that my problems are in my head.” Unfortunately, her problems also were in the real world: Less than a year later she was back on the streets where she was sexually accosted by a police officer who then arrested her for solicitation.

Most treatment programs in Massachusetts also include some sort of psychotherapy, and nearly all of the women I know have been treated by multiple therapists over the years, sometimes beginning in adolescence or even childhood. With its focus on the individual psyche, psychotherapy addresses personal flaws such as poor impulse control, allowing oneself to be a victim, and struggles to “get over” past traumas. But as Elizabeth explains, “I don’t need to talk about my problems. I need a place to live so that I won’t be scared all of the time.” This does not mean that therapy is useless; it does mean that “talk is cheap” without the material conditions that permit women like Elizabeth and Joy to build a secure life.

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There is little evidence pointing to long-term success for any particular drug treatment modality. Studies showing positive outcomes typically fail to track program participants for long enough time to establish meaningful rates of success, look only at participants who completed the program, fail to control for confounding variables, or look at very small numbers of participants from the start. The absence of evidence for the success of treatment programs is especially glaring when the treatment is coerced or carried out in a coercive situation. It may be tempting to believe that even if treatment doesn’t help everyone, at least it doesn’t hurt. Yet, as we’ve learned from the past — from efforts to “cure” homosexuality to the tranquilizers (“mother’s little helper“) of the 1960s,  when a patient’s ideas or behaviors challenge social hierarchies of race, gender, sexual orientation or class, treatment that is ostensibly for the patient’s own good may be used to bring the “deviant” individual back into line. As those of us old enough to remember Jack Nicholson’s performance in One Flew Over the Cuckoo’s Nest can attest, therapeutic interventions aimed at “getting inside” the patient’s head can carry heavy costs indeed.

The murky line between punishment and treatment has not been lost on some of the corporations involved in the prison industry. Correctional Healthcare Companies, for example, has expanded beyond providing medical services to prisons and now offers services for the “full spectrum” of “offenders” lives: “pre-custody, in custody, and post-custody,” a timeline that perhaps says more than the company intended about American understandings of criminality.

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

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

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

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

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

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

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

No Magic Bullet – But Some Sensible Recommendations

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

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

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

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

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