The next is an excerpt from “Prisons and Health in the Age of Mass Incarceration” by Jason Schnittker, Michael Massoglia, and Christopher Uggen (©2022 Oxford College Press).
On the coronary heart of the connection between prisons and well being is a paradox. Prisons are charged with being punitive and therapeutic, with denying freedom and offering care. Widespread correctional ideas are replete with ironies. Protecting custody, as an example, is a sort of confinement the place the intent is to protect these in jail from hurt, particularly from different individuals in jail.
However the concept is a contradiction if custody itself is dangerous. And, certainly, incarceration is commonly dangerous. The language of protecting custody, as an example, is commonly used synonymously with solitary confinement, which is particularly detrimental to well-being.
The paradoxes are obvious in different methods, too. Within the spring and summer time of 2020, greater than 900 imprisoned Individuals died of COVID-19, and 1000’s extra will die of different causes. Prisons are implicated within the unfold of different infectious ailments as nicely, together with, a minimum of traditionally, HIV and tuberculosis. Bodily and sexual abuse are usually not unusual in jail environments, resulting in emotional and bodily hurt.
On the similar time, although, many individuals in jail obtain urgently wanted well being care, and so they obtain care they possible wouldn’t have obtained previous to incarceration. For a lot of, incarceration will increase their entry to medical therapy, resulting in significant enhancements of their well being and danger profile, from extra correct diagnoses of long-standing issues to raised blood sugar management and lowered blood stress. For younger Black males, mortality in jail is decrease than mortality exterior of jail.
The paradox on the coronary heart of jail well being care has, if something, grown sharper over time.
Whereas drugs has expanded the vary of therapeutic applied sciences, and ideas of acceptable punishment have advanced, the authorized system has failed to supply steering for what prisons are obligated to supply with respect to well being care, making the stress on the coronary heart of the system much more fraught. The stress is heightened additional by the seemingly sharp however truly porous boundaries of the jail system’s remit. No matter care prisons are capable of present to these of their custody ends abruptly at their launch, even because the well being of these beforehand in jail grows worse and higher entry to care would support their rehabilitation.
Understanding the connection between prisons and well being requires us to carry each of those concepts on the similar time: prisons can undermine well being and supply significant well being care companies, and so they function in an surroundings that insists on each. Understanding the connection additionally requires us to grasp the jail system as a fancy establishment, working beneath a different set of authorized, cultural, and political mandates.
As an establishment, the jail system ostensibly serves the pursuits of felony justice. As with many different establishments, nevertheless, prisons are more and more certain up with quite a lot of coexisting and sometimes incompatible objectives. Prisons are required concurrently to oversee, punish, right, and preserve the well being of these of their care. The identical personnel usually serve all these features directly.
Given these mandates, there are essential distinctions between what prisons are obligated to do, are allowed to do, and truly do. As well as, prisons intersect with different establishments charged with the care of comparable populations, albeit with totally different duties and working ideas. At current, as an example, the U.S. jail system supplies a great deal of care for individuals who, in an earlier period, might need been handled in a psychiatric hospital. By some accounts, jails can now be considered America’s largest system of psychiatric hospitals.
However the authorized mandate that undergirds well being care in prisons units prisons aside from different care-providing establishments. At root, prisons are inimical to well being. The legislation stipulates that U.S. prisons should present well being care, consistent with the Eighth Modification’s prohibition in opposition to merciless and weird punishment. However the constitutional mandate that helps jail well being care is way totally different from the ethic of care that governs regular well being care encounters.
Not like hospitals or clinics, prisons are largely outlined by punishment. This, in fact, is apparent. Punishment is what most individuals affiliate with prisons. Prisons contain cells, restraints, supervision, and serving time. And prisons typically are concerned in state-sanctioned killing, as within the case of capital punishment.
Well being is the antithesis of punishment. To punish is to hurt and wound, whereas to care is to heal and remedy. To self-discipline is to strip away, whereas to deal with is to construct up. Guards impose passivity, whereas physicians intervene to permit exercise. It’s tough to think about respecting an oath to first do no hurt when the institutional prerogative is to penalize.
When judges sentence individuals to jail, they accomplish that beneath the belief that the expertise will probably be painful. Some judges go a step additional: they consider a jail sentence needs to be not solely painful in itself—as if the forceful separation from family members and extreme restrictions on freedom are inadequate—but additionally moreover painful, such that the fabric and social circumstances of jail life shouldn’t be in any respect conducive to well-being. Some jail and jail officers even boast in regards to the pains they inflict, as after they don’t have any air con in the summertime warmth, no pay for labor, and meals prices of pennies per day.
To make sure, the philosophy behind incarceration has shifted over time. Strict punishment was not all the time the guiding philosophy. It’s attainable, as an example, to treat a jail sentence as a chance to rehabilitate individuals, as we did a lot earlier in our nation’s historical past. Additionally it is attainable to treat prisons as a spot to supply individuals with the abilities essential for re-entry, as we did till comparatively late within the twentieth century.
But the current period has been outlined primarily when it comes to a get-tough strategy, in addition to a reluctance to increase to individuals in jail something that is likely to be thought-about an amenity. Tellingly, even the shared idea of “rehabilitation” is essentially totally different in prisons and hospitals. In corrections, rehabilitation denotes the elimination of offending, whereas in drugs it denotes enhancing and restoring capacities. In hospitals, rehabilitation is expansive, whereas in prisons it’s restrictive. Rehabilitation turns into lowering recidivism or, much more reductively, lowering the fee to society as soon as somebody is launched.
But the very fact stays: The correctional system is plainly within the enterprise of offering care.
Jason Schnittker is a professor within the Department of Sociology within the School of Arts & Sciences on the University of Pennsylvania. His co-authors are Michael Massoglia of the University of Wisconsin-Madison and Christopher Uggen of the University of Minnesota.
The textual content above is an excerpt from “Prisons and Health in the Age of Mass Incarceration” (©2022 Oxford College Press). Used with permission from the writer.
