Within the next months, Massachusetts’ legislators are expected to consider an amendment mandating that “Strip searches of inmates, including the videotaping thereof, shall not be conducted by or in the immediate vicinity of a correction officer or other employee of the opposite sex, except under an emergency or otherwise urgent situation.” Massachusetts Bill H.3444, An Act relative to searches of female inmates, comes in the wake of a successful lawsuit filed in 2011 against Sheriff Michael J. Ashe and Assistant Superintendent Patricia Murphy of the Western Massachusetts Regional Correctional Center in Chicopee. This lawsuit was filed on behalf of Debra Baggett and 178 former and current women detainees at the Chicopee Jail. As Jean Troustine explains, the defendants brought evidence showing that over a period of less than two years 273 strip searches had been videotaped, all of women, mostly by men who supposedly did not look.

The proposed law is certainly a step in the right direction. However, allowing the presence of an officer or employee of the opposite sex under an (undefined) “emergency or otherwise urgent situation” leaves the door open for subjective assessments of “emergencies” (for example, the inmate appears upset – a reaction that I’d expect to be fairly common when faced with a strip search) or bureaucratically based “urgencies” (for example, no officers of the matching gender happen to be available.)

Strip searches ostensibly are carried out in order to prevent contraband from entering prisons, yet reports cast serious doubts on the effectiveness of strip searches in that matter. In fact, evidence indicates that the majority of contraband is brought into prisons by prison employees rather than by inmates. Even if a strip search uncovers a bag of heroin or cocaine hidden on the body, that bag is likely to be a drop in the bucket against the background of the larger market of drugs smuggled in by employees. In other words, even if strip searches could be justified in terms of uncovering contraband (which, in fact, strip searches rarely uncover), to the extent that I have been able to see hard data on the matter, the amount of the uncovered contraband cannot justify this practice. In fact, no one really knows how effective strip searches are at keeping contraband out of prisons which is why I urge the Commonwealth of Massachusetts (and the rest of the country, for that matter) to document every strip search: the specific reason for conducting it and what exactly – if anything – the search uncovered.

National studies have found that strip searches often are conducted to establish power more than for real expectations of finding contraband . According to Deborah L. Macgregor, in an article published in the Columbia Journal of Law and Social Problems, women are particularly targeted for these displays of power. It is not uncommon for prison guards to use children as pawns to coerce women to participate in a strip search. For example, women may be threatened with not being permitted to see their children if they fail to cooperate. “Prison and police officers are vested with the power and responsibility to do acts which, if done outside of work hours, would be crimes of sexual assault. If a person does not ‘consent’ to being stripped naked by these officers, force can lawfully be used to do it,” according to Amanda George in the Australian Institute of Criminology.  George cites women’s accounts of strip searches: “We are strip searched after every visit. We are naked, told to bend over, touch our toes, spread our cheeks. If we’ve got our period we have to take the tampon out in front of them. It’s degrading and humiliating. When we do urines it’s even worse, we piss in a bottle in front of them. If we can’t or won’t we lose visits for three weeks.”

Justice Marshall has described a strip search as “one of the most grievous offenses against personal dignity and common decency.” These searches create “feelings of ‘deep degradation and terror'” and instill psychological reactions that “can be likened to those of rape victims.” The punitive nature of strip-searching is particularly egregious in light of the fact that approximately one third of women incarcerated in Massachusetts have not been convicted of a crime. Rather, they are in jail or prison awaiting trial, typically because they are not able to pay relatively small sums of bail money.

The coercive nature of prison exacerbates the humiliation of strip searches. An estimated 70% of women drawn into the correctional system have experienced physical or sexual violence, and in many cases that includes childhood sexual abuse. Prison procedures requiring the removal of clothing and intimate touching of an inmate’s body are especially traumatizing for women who have suffered abuse in the past. Responses to perceived threats can include alienation, withdrawal, fighting back, extreme outbursts, worsening of psychiatric symptoms or physical health problems, self-injury or suicide attempts, and increased substance use. In the prison context, these behaviors can lead to further punishment, including solitary confinement, and can easily be construed as an “emergency” meriting the presence of opposite sex officers at the strip search.

According to testimony provided by Carmen Guhn-Knight (August 7, 2015) based on interviews with sixty women who were videotaped while undergoing strip searches at the Chicopee Jail in western Massachusetts, “Women with histories of sexual abuse told me of their heightened sensitivity to having their naked bodies video-recorded. They said they returned to their communities re-traumatized, and in some cases with PTSD due to being recorded during strip searches.” Guhn-Knight shares some of the reactions she heard from these women: “Do we have to have the videotape? I don’t want to be videotaped naked. I don’t want to be filmed naked… I don’t want the camera on me.” “Is this going to end up on YouTube? … I’m being filmed while everything’s off? I’m naked being filmed.” “I’m not going to get stripped in front of a camera, that’s pornography.” “[You] take someone’s dignity and then do it again with a camera.” According to Guhn-Knight, “Despite their complaints, these women had no choice in the matter; they eventually removed their clothing themselves or were restrained while an officer removed their clothing.”

While the proposed amendment addresses the gender of the person holding the camera, it does not address the broader problem of video-taping strip searches overall. The taping of strip-searches is ostensibly for the protection of the prisoner; that is, having a record may prevent or at least document abuse during the search. However, the preservation of the tapes opens the door for grievous violations of privacy. In a country in which viewing on-line pornography is widespread (and sometimes unavoidable when unrequested porn sites pop up on screens), women inmates have good reason to fear that the tapes of strip searches may be misused for pornographic entertainment. Doubling down on the harm of the practice of videotaping strip searches, research shows that men who watch pornography are more likely to voice attitudes supporting violence against women and to display dominance and aggression (including choking, gagging and insulting name-calling) toward women while engaging in sexual activity.

Based on my reading of the scholarly literature as well as on my own research with formerly incarcerated women, I believe that the proposed amendment does not go far enough to protect women or men from the pain, humiliation and human rights violations associated with strip searches. I suggest that the law be amended to (1) disallow routine strip searches (2) permit strip searches only in situations when there is clearly defined and documented reason to suspect that the inmate is hiding contraband on his or her body (3) clearly inform all prison staff that strip searches may not be used as a form of punishment or discipline, and institute sanctions against staff who order or participate in strip searches in other than situations where there is clearly defined and documented reason for the search (4) disallow all strip searches by opposite sex officers and employees (5) cease video-taping of strip searches (6) immediately discard all existing video-tapes of strip searches.

In a previous post I warned about what I call “fake” education; that is, education that drills students in self-blame and a sense of failure and that disguises the sources of power that perpetuate inequalities. My argument was NOT a call to eliminate access to educational programs until we perfect curricula and pedagogy, but rather a cautionary note based on conversations I’ve had with criminalized women in Boston over the past decade. Let me be clear, as one long-time educator wrote to me, “Without the commitment to access, any reform in the content or delivery of education won’t matter.”

Rev. Vivian Nixon, Executive Director of the College and Community Fellowship and Co-Founder of the Education from the Inside Out Coalition, has kindly allowed me to re-post her insightful thoughts on these issues. You can read the full post here. I’ve re-printed excerpts below. I urge you to read the full article.

Let’s Get Real: Prison Is No Place for Elitism

“It’s incredibly important to pay close attention to quality education on the inside. Having been inside myself — a high school graduate stuck in a prison with no post-secondary options — I argue that any attempt to create broader access to programming would be welcomed by those who currently have no educational alternatives. …”

“It would be wonderful if everyone qualified for Bard Prison Initiative or other intense liberal arts programs, but we know that many will not. Those who do not qualify for a Bard-caliber program could easily do well in a less rigorous community college program. Furthermore, not everyone has an interest in the contemplative life. Some just want to learn how to be a Computer Technician or gain some other marketable skill because they feel it’s their best chance of escaping lifelong poverty.

“That option should be readily available. If one of education’s main concerns is helping students forge a sense of individuality, introspection and self-determination, then the choice to limit educational programs in prison as an attempt to “do what’s best for them” proves antithetical to our ultimate goals. Just as students on the outside participate in educational programs of all levels, incarcerated students should also have a wide range of options — every program should not be exclusive. While quality must not be ignored, we should agree on what we mean by “quality” and not confuse it for elitism. …”

“The practical role of education in helping those incarcerated escape the cycles of marginalization, crime and poverty is as large as its transformative ability to foster critical thought, self-reflection and a stronger sense of self for those in the classroom. When we account for the irrefutable correlation between lack of education and rates of imprisonment, we must take every opportunity we can to provide educational programming for those who need it most. That means a wide range of programs, broader financial aid eligibility and a persistent, long-term commitment to improving educational access for all.”

I’d like to thank the many friends and colleagues who commented on the “Knowledge is Power” post. Stay tuned for additional posts on this very important topic.

Expanding access to higher education has been in the news recently. First, the Obama administration announced a plan making state and federal prisoners eligible for Pell grants, arguing that education can play a role in facilitating post-release employment. Second, Hillary Clinton joined the other Democratic Party candidates in calling for substantial federal spending aimed at making college affordable, declaring that, “To raise wages, there is no better investment we can make than in education.”

According to the American Association for the Advancement of Science,  “Ideally, a liberal education produces persons who are open-minded and free from provincialism, dogma, preconception, and ideology; conscious of their opinions and judgments; reflective of their actions; and aware of their place in the social and natural worlds.” The devil, of course, is not so much as in the details as in the hands of those who have the power to shape institutions and enforce policies. In our far-from-ideal world, the follow-up sentence to the Association’s declaration probably should read something like this (my words): “In reality, most contemporary educational institutions and programs emphasize obedient classroom behavior, rote learning, standardized test-taking that validates only a narrow range of knowledge, self-blame for failure, and a few potentially marketable skills that will prepare future workers to contribute to the profits of private industry.”

The Boston-area criminalized women I have come to know have participated in myriad educational programs as school children and teenagers (where they entered the infamous school-to-prison pipeline) and as adults both inside and outside of prison (hardly an ideal setting for encouraging open-minded, critical thinking). Overwhelmingly, these educational programs share two aims: (1)To encourage the women to admit that they are flawed and diseased; (2)To push the women into the most low-paying job sectors.

Tonya, a Black woman in her mid-thirties recalls her education program in prison: “I felt that I couldn’t pass the GED so fuck it. I’m defective. I took it five times.” This sentiment is one that Tonya has repeated a number of times. For instance, a few years after I first met her she was thrilled to be accepted into a Culinary Arts training program arranged by a local homeless organization. But after a few weeks she complained, “I am not happy. We – the students – are just being used as cheap labor. We’re not learning anything. We spend the day chopping piles of meat and vegetables. They ‘pay’ us $8 an hour. We work 50 hours a week but they only pay us for 46 hours because it’s ‘education.’ The education part? We’re supposed to write a plan for a meal that we would cater. If I could cater a meal it would be soul food but the teacher wants us to make meals that white people like.” A few weeks after that conversation Tonya finished the program only to learn that in order to get a restaurant job she would need to pay $185 to obtain a “safe service” certificate.  She didn’t have the money. “I feel like a loser,” she said.
Tonya’s experience of being used as cheap labor in the guise of a training program is common. Other women I know have been “trained” by being handed a broom and sent off to clean offices or hotel rooms. Paid under minimum wage, they are let go when the “training” is over and replaced by other “trainees.” In many cases, these programs are required by drug court judges or by parole officers as proof of “rehabilitation.” As Tonya has learned the hard way, being sentenced to menial labor that does not pay a living wage is often the prelude or post-script to a prison sentence.

We like to say that “knowledge is power,” but, unfortunately, the thrust of a great deal of contemporary American education has less to do with helping students understand who actually holds the political and economic power in our grossly unequal society, and more to do with drilling students in the notion that they personally are responsible for their own failure to take control of their lives, make the “right” contacts, excel at exams, land jobs, and stay out of jail. That kind of “knowledge” disempowers; it obscures who profits from the status quo; and it keeps individuals focused on their own failures rather than on the structural conditions of poverty, racism and gendered violence that sentence the majority of Americans to be “losers”.

As new educational opportunities may be opening up for criminalized and for low income students, and as teachers and professors (like myself) prepare to go back to school, it’s a good time for educators to give some serious thought to what we actually are teaching our students. Are we merely telling them that ‘knowledge is power’ or are we clarifying that much of the knowledge we are imparting has been accumulated and validated by sources of power with vested interests in maintaining that power? Are we encouraging them to speak truth to power: to discover the truths that shape their lives, to identify who really does (and does not) hold the power in our world, and to speak loudly so that those in power will listen? If we are not doing these things, we are allowing our educational programs to add propellant to school-to-prison pipelines.

The ideas for this post grew out of the Education session at the Free Her conference organized by Families for Justice as Healing.

I’d like to thank expert educator Vivian Troen for helping me think through these issues.

 

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?

Reprinted from the Boston Globe, August 19, 2014

The Aug. 14 editorial “Women get unequal treatment in court-ordered detox” underscored an egregious violation of human rights in the Commonwealth. Due to a lack of treatment beds, drug users who have not been arrested, tried, or sentenced may be sent to MCI-Framingham if a judge deems that they are dangerous to themselves or others.

Women committed to a prison setting do not receive the treatment afforded those who are sent to the Women’s Addiction Treatment Center, which is licensed by the Department of Public Health. Most damning, women of color are three times more likely than white women to be committed to prison rather than to the treatment center.

The way out of this mess, according to Governor Patrick and others, is to fund additional substance-abuse treatment beds in non-prison facilities.

However, many of the women who are civilly committed are not only dealing with addictions but also with poverty, homelessness, serious health problems, and intimate partner violence. One DPH official estimated that 20 percent of civilly committed women do not meet the criteria for commitment; rather, they are committed because no one knows where else to send them.

As a nation, we’ve gone the route of building more prisons in unsuccessful efforts to manage the devastation caused by economic and racial inequalities. Building more “staff-secured” treatment centers will not prove any more successful unless we also address the poverty, gender and racial discrimination, and violence that lead so many residents of the Commonwealth to turn to drugs in the first place.

Susan Sered

Boston

The writer is a sociology professor and a senior researcher at the Center for Women’s Health and Human Rights at Suffolk University.

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

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

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

…..

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

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

…..

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

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

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

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

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

…….

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

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

And that is what I find so difficult to swallow.

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

…….

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

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

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

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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

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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 SystemContinue reading

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