4/03/2015

what if: prisons as health care (and, obvi, if health care were good)




A couple of weeks ago as we were walking into the prison, one of the other volunteers was pointing out to me which buildings housed prisoners on death row.

Someone had shown her earlier that week, a guy who runs an art program exclusively for the guys on death row.  She asked him how working with those men differed, if at all, from working with men in the general population, and she told me a story that he told her.  He'd asked the men he was working with what they missed most about life outside.  One of them responded, "Killing."

I'm not naive enough to think that we're in there working with a bunch of Andy Dufresnes.  Come on, now.

But this, "Killing," struck me.  My first thought was, "Holy shit," and my second thought was, "Wow, are we humans diverse."

My third thought was of something in this book I'm grateful I read a long time ago:
Human beings, for example, come in a variety of heights, and many of those considered "normal" are unable to reach high places such as kitchen shelves without the assistance of physical aids -- chairs and step-stools.  In spite of their inability to do this task without special aids, they are not defined as disabled.  Nor are the roughly 100 million people in the United States who cannot see properly without the aid of eyeglasses.  Why?  Because the dominant group -- like all dominant groups -- has the power to define what is considered normal.  In contrast, people who use wheelchairs, for example, to get from one place to another -- to "reach" places they cannot otherwise go -- do not have the social power to define their condition as within the boundaries of normality, that is, as little more than a manifestation of the simple fact that in the normal course of life, people come in a variety of shapes and sizes and physical and mental conditions. (19, the bolding is mine)
What a privilege to be considered "normal." And not just in relation to dis/ability.  I took these photos at Walgreens the other day -- a classic example of normalizing Whiteness (and objectifying Women of Color).




What we do with people considered not behaviorally "normal," Mr. "Killing" being a very good example of one, is put them in prison.  Obviously, I understand that Mr. Killing is likely a danger to those around him and that it would be irresponsible for those of us with more mental/moral? wherewithal to let him just do his thing.

But again, normal is socially constructed when what's actually normal is variance.  We've (in the United States especially) eschewed the latter notion in favor of demonizing/obsessively punishing deviation from dominant norms.

If JoaquĆ­n were here (in my blog, which would be weird), he would argue that Mr. Killing made a choice, and that we all have choices, and that some of us are just bad.  And so when people believe that, that it's possible for a baby to come out bad, then we'll just have to agree to disagree right there.

But if you're with me that all of us are born basically good*, then come with me:

Mr. Killing isn't inherently bad.  He's definitely not "normal" -- My guess is that there's some mental illness going on there, by mainstream standards.  But he's part of the human spectrum.  He is.

So how do we deal with that?

Fourth thought: What if Mr. Killing's mental illness got treated with the loving support and collective persistence with which mine has been treated?  By "normal" standards, obviously, the manifestation of mine -- crying so much all the time -- is a lot less ugly than his -- killing and missing killing.  But what if we suspended our dominant senses of normalcy, took up the reality that variance is what's normal, and took responsibility for this Mr. Killing being a part of our human community?

What if prisons operated under a healing rather than a punitive paradigm?  I'm not talking about "rehabilitation" the way it's traditionally used in conjunction with prisons.  I'm talking about what if prisons were sources of health care**? (And what if the stigma of mental health care were removed to the extent that mental illness might be regarded as urgent and as treatable as, say, cancer?)


I just wonder how that'd be different.

Fifth thought: Architects came up with the principle of "universal design." It's the idea that you build a building so that it's accessible to everyone from the jump; you don't design the building and then add the ramps on.  Educators took up the term to think about designing learning experiences that all kids can access.

I once had a student do a research project on universal design and make this playground.  I wrote about it here.  Note the title of the post.  Hell.

What would a health care system designed under the principles of universal design look like?  Radical given our current state of affairs in the US, sure, but I really don't think I'm asking for too much.

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That train of thought stopped when we got to our classroom and got to work.  But then, at the end of class, one of the incarcerated teachers and I were talking, and he told me that he'd had a really hard week: His best friend of fifteen years had hanged himself.

He'd died of depression.

My friend is sad, but he prefers to use the term "disgusted."  Prison officials knew, he said, that his friend was suicidal, because (1) the friend had attempted suicide before, and (2) my friend had reported his recent behavior to the guards.  Real shitty health care providing, right there.

(I've never wanted to hurt myself, but I have thought that it would be really nice if I could just get some terminal illness so that I could go to bed forever and people would leave me alone.  Or I've thought that I wouldn't really care if the plane I was in crashed.  And when I told my doctor that, she expressed concern and commenced a really thorough treatment plan.)


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Just because I was curious, given how mental illness seems to be all but disregarded as a thing, I looked into how the criminal justice system deals with mental disability.  (And I'm not really certain how the distinction between mental illness and mental disability gets made?) Well it is, by the way, illegal (as of 2002) to execute a prisoner with "mental retardation" -- cruel and unusual punishment, the Supreme Court found.  But different states define "mental retardation" differently, and vary on whether to give the responsibility of deciding whether a person who's been convicted is "mentally retarded" to the judge or the jury.  Oh great.  I'm sure that system is working really well.

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* Over the last couple of years, Ron has helped me to revise this "everyone's born good" thesis of mine, to one more nuanced: He says, "We're all more sacred than we realize, more broken than we realize, and more salvageable than we realize.  In that order."  So that complicated my point here a bit.

** And oh don't I know how shitty mental health care (and diagnosis) is and has always been.  

5 comments:

Anonymous said...

So many interesting points here, Ellen, and I was definitely thinking of you and your work when I read the NYT article when it first came out. I'm interested in how certain (biological?) tendencies get turned on and off through environment and experience. My Christopher, possibly due to his prematurity, was having alarming, angry reactions to well...everything. His "executive functioning" was noticeably less developed than Hayden's. Louis and I worked with a doctor who trained us (not Christopher) in a play therapy protocol. It's helped Chris understand and work with his emotions, and because it is early intervention, it will most likely have lasting effects.

I fear that this kind of access to healthcare is very limited. Chris didn't qualify after the initial screening and we had to persist with our insurance company and then pay more out-of-pocket to continue.

But what if all kids 0-5 had access to pre-school, medical care, and mental health care? So many problems (big and small) develop during these years. I don't know if early intervention could have helped Mr. Killing, but I suspect it could have.

ellen said...

Thank you, Beth. This is such a meaningful example.

Also, I just saw this on FB: http://www.theatlantic.com/health/archive/2015/04/more-than-half-of-prisoners-are-mentally-ill/

ellen said...

Wait, here's the link: http://www.theatlantic.com/health/archive/2015/04/more-than-half-of-prisoners-are-mentally-ill/389682/?utm_source=SFFB

Anonymous said...

Ellen, I came across this pediatrician's work via her TED talk. Her clinic is actually in the Bay area.

http://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime?language=en

ellen said...

Wow, she is really cool. I'm going to see if I can check that clinic out!