Wednesday, May 11, 2011

A New Medical Model

While there is a great deal of work to be done in extricating American states from mass incarceration and in clearing the social and individual wreckage it has created, in another sense it is over. Lou Reed would say, "stick a fork in it and turn it over, its done." In California Governor Schwarzenegger acknowledged as much when he called the parole system broken and agreed to allow the courts to take over running the prison medical service. Governor Brown, through his proposed realignment plan (shifting resources and choices from the state to the counties) and is parole policies has also signaled that he wants to steer the state away from mass incarceration. Plata/Coleman, the giant prison health care case now before the Supreme Court has exposed inhumanity of mass incarceration and its rigid inability to actually protect public safety (for example by mismanaging preventive mental health care).

But penal history suggests that regime change requires a new vision of how to bring order to prisons while affirming the values of larger society. Mass incarceration had a moral account of its own, one that stressed the imperative of keeping Californians safe by physically isolating troubled individuals in their communities with a propensity toward crime and graduated levels of custodial security inside. In a sense, mass incarceration was a crude public health strategy, prisons prevent crime by quarantining those who would spread it. While this account is increasingly in tatters, it is not clear what replaces it. A return to the rhetoric of rehabilitation and penal welfarism, while predicted in some quarters, is quite unlikely (and probably not desirable). Neither prisoners or the community is likely to embrace a narrative of prison as a hospital to cure individual diseases of the will.

I believe the humanitarian medical crisis that California's prisons are now experiencing holds some promising clues to a path back toward legitimacy in prisons. Humanitarian medicine is political/therapeutic project that emerged more than one hundred and fifty ago with the Red Cross in Europe. The Red Cross sought to relieve the suffering of the dying and wounded abandoned to their fates on battle fields. Since World War II it has expanded its jurisdiction to natural disasters and pandemics, and from a focus on rescue the suffering to telling their story. While prison health care poses different dilemmas than the battle field or the site of catastrophic disasters, it shares some important features, especially the isolation of prisoners from the normal structures of knowledge and action that link individuals in post-industrial societies and the burden of stigma and fear associated with their crimes.

In Europe a version of this humanitarian medical model for prisons has emerged through the work of the European Community organs like the European Committee for the Prevention of Torture and the Committee of Ministers of the Council of Europe, as well as the European Court of Human Rights. Since the early 1990s, these organs have begun to highlight health care as the crucial framework for preserving dignity in prison. Through a series of reports, guidelines, and through the European Prison Rules, these agencies have made improving prison health care both an upward wedge toward improved prison conditions and regimes overall, and a stopper against regression through overcrowding or violence.

The US constitutional system does not have such innovative human rights organs as the Committee for the Prevention of Torture. But federal courts have enormous power when they encounter unconstitutional conditions. In California the courts have confronted a massive unconstitutional complex that is also a humanitarian medical crisis. Whatever happens in the Supreme Court, California is likely to be grappling with resolving that crisis for years to come. In the short term, the humanitarian medical model itself can provide a crucial tool kit for restoring the legitimate order to our prisons.

I'll be speaking on this topic tonight at the Scottish Centre for Crime and Justice Research annual lecture in Edinburgh. When I get back I'll try to elaborate a bit more in this or future posts.


Ree said...

I agree that a humanitarian medical model is a promising framework to construct a more functional prison system, but I think significant differences between the Red Cross in Europe and the prisons of the U.S. must be accurately identified and stressed from the get-go. Some very initial thoughts:

Unlike the humanitarian Red Cross/Rescue model in Europe, which worked to faithfully bring competent healthcare to inhumane environments, prison healthcare here more often than not has been for many years, a perversely punitive exercise and not a healing endeavor. This is despite official statements to the contrary and successful lawsuits on the matter. In practice, healthcare continues to be an integral part of the coercive apparatus of our prisons, and that needs to be seen clearly and addressed as such. As a former California State prisoner, I witnessed alarming behavior on the part of healthcare providers, who regularly and unjustifiably denied the most minimal preventative treatment to women prisoners while taking the time to subject them to a barrage of verbal abuse and sexist insults. This was more common than not. Further, women were often subjected to invasive and ultimately harmful treatments that had seemingly nothing to do with their reason for seeking medical care, and years later, those procedures remain medically unfounded. In prison, women often returned from medical appointments unhealed, hurting more, and in such distress that many sought never to seek prison medical care again, no matter what the consequences. It was a difficult and daunting task to avoid illness in a grossly over-crowded prison environment, but I knew many women who avoided medical clinic to the extent of harming themselves permanently. A far bigger overhaul is still critically needed- theoretically and in practice - to deal with our prisons’ harmful healthcare legacy, both for prisoners and staff.

So while I think the European humanitarian medical model is a very promising one, I think the particularly harmful legacy of prison healthcare here in California must be taken into account. The Red Cross did not have to deal with this, but any new prison regime change here - will.

Also, as the result of what has happened inside our prisons, we have large communities on the outside of traumatized former prisoners who carry that baggage with them. Any future humanitarian health model will have to deal with the legacy of the past, not only for prisoners, but for the families and communities who are dealing with the aftermath.

Shafinaaz Kamrul said...

In the State of California, where there are so many people who are incarcerated for long periods of time, health and well-being of prisoners are very significant concerns. I was watching a documentary the other night about the use of isolation cells in prisons and the long term effects that such punishment has on the prisoners. Some of the prisoners mentioned that it made them feel even more “inhuman” and I don’t think this is the best method for restitution or rehabilitation. My understanding is that sometimes prisoners are isolated so that they recognize the severity of their actions, and appreciate the privilege of being in a social setting with other human beings. The documentary pointed out that the people who are repeatedly put into isolation cells are the ones who have the hardest time integrating themselves back into society once they finish their sentence and are released. A lot of them even become repeat offenders because prison seems to suit them better than the world outside. In this way, they are punished beyond the 5,8 or 10 years they are in prison because of the long-term effects on their mental health. I understand it is a much more complex issue that what I made it out to be. I have no answer to the question of how to keep other prisoners and the society safe without isolating the people who just cannot fit in without being a threat to others. It would be very interesting to see the development and integration of the humanitarian medical model that you speak of in the California prisons. Such a system would only be fair because no one deserves to be punished beyond what was determined by the court as appropriate “compensation” to society for the crime they committed.