Women
and Psy
The psy-sciences, generally consisting of the disciplines of psychology
and medical psychiatry, emerged during the nineteenth century with
promises of identifying, treating, curing, and managing populations
seen as risky because of their strange or inappropriate
behaviours. Early psy diagnoses focused on naming behaviours
viewed as different, dangerous or immoral to provide a medical basis
for treatment or intervention. In so doing, ‘psy’ surfaced as a
new form of medical and correctional expertise, whose practitioners
quickly sought a great degree of control and governance over
populations diagnosed as mentally ill. ‘Treatment’, however, was
similar to political responses to criminality, in that those diagnosed
with mental illness were confined against their will to mental asylums
(Goffman, 1961;
Rhodes, 1995; 2004). The ability of psy-experts
to
commandeer authority over the lives of individuals under their care is
rooted in claims of objectivity that allow psy knowledges to possess
incontrovertible truths regarding human behaviour and emotion (Penfold
& Walker, 1983; Farber, 1990).
This power to define rational
and irrational or sane and insane behaviour has given the men who have
historically theorised women’s mental illness “the power to prescribe
and proscribe the nature and the role of women in society” (Penfold
& Walker 1983, p28). For generations, these knowledges
remained
unchallenged because women’s knowledges remained subjugated; as a
result, the psy-sciences propose explanations that categorise and
diagnose based on social norms produced within a hierarchical and
patriarchal social structure. The construction of mental illness
among women is thus highly gendered, where women are located on the
derogated side of the gender binary.
Throughout psy’s history and ascendency to power with respect to the
management of mental illness, women have been held to a higher moral
standard than men because of stereotypical expectations of
womanhood. Based on their ‘emotionality’, women are often
syndromised as mad (Ussher, 1991;
Smart,1995; Maracek
,2002); for
example, with respect to the diagnosis of hysteria, Foucault (1979, p146-147) writes:
The notion of hysterization of women,
which involved a thorough
medicalization of their bodies and their sex, was carried out in the
name of the responsibility they owed to the health of their children,
the solidity of the family institution, and the safeguarding of
society.
Syndromising hysteria and more recently personality and mood disorders
fails to take into account the different socio-political contexts
within which women’s emotionality and criminality are born (Smart, 1995; Suyemoto, 2002). Not only are
women more likely than are men to
encounter the psy-disciplines, but as Russell
(1995, p96) writes:
From the perspective of biological
psychiatry, nearly all women are
disordered. Even if we take into account only depression and
premenstrual syndrome, it is difficult to imagine many women falling
outside this net. It is no surprise, then, that criminal women
are viewed as psychiatrically disordered.
Russell demonstrates how the law refutes the production of a female
criminal subject because psy-correctional experts so frequently deem
criminalized women irrational and/or mad. For example, Tammy, a social
worker who has worked with criminalised women for over ten years,
stated:
The institution is quick to dispense
medication. All it really takes is
an appointment with a doctor and you’re prescribed medication. I mean,
when I do programming in there and the nurse comes by dispensing meds,
I don’t think there is ever one woman in the group I’m seeing that
wasn’t getting medication.
The long held belief that the fallibility of women’s psyches
created distress, unmediated by the conditions of their lives, has
formed an almost insuperable obstacle against which women have had to
struggle in attempting to have their perceptions and experiences taken
into account in clinical practice and in the explanatory models that
inform psychiatric practice (Astbury, 1996, p23-34). This dynamic
is
most compelling within the prison setting, where women are encouraged
and arguably coerced to engage with and embrace psy-diagnoses and
psychopharmacological treatment (Penfold
&
Walker,
1983; Ussher,
1991; Russell, 1995;
Smart, 1995; Penfold, 2001; Kilty, 2008).
Prisons: The new asylums
The intersection of psy and criminal justice is a complex one that
functions for a number of reasons. With the advent of the
decarceration movement of the 1970s increasing numbers of people housed
in psychiatric asylums were released with little to no support back
into the community (Rhodes, 2004).
One
of
the
consequences
of this
movement was that over the next two decades many individuals diagnosed
with all manners of mental illness were readmitted into state care, but
into the criminal justice rather than the mental health system (Cohen,1985; Christie,
2000; Rhodes, 2004). The
growing prison industrial
complex reflects the interconnection of capitalist economic motives, a
diverse range of new expertises and thus governing authorities,
political aims, and entrenched ethnocentrism, racism, sexism, and
classism. Paralleling and supporting the prison industrial
complex is an ever-growing concern with technologies of security,
surveillance, and governance, while disregarding treatment in the form
of therapy or counselling. Therefore, while psy gained
significant control within the criminal justice system during the era
of rehabilitation, practitioners redefined their approach in order to
maintain their place of expertise within the correctional domain.
Resulting from the mass incarceration movement, fewer budgetary
allocations to psy-care, and increasing numbers of prisoners with
mental health issues in the criminal justice system, we have witnessed
a disturbing shift in psy discourses. Psy no longer
stresses the importance of therapy in conjunction with
psychopharmacological treatment; instead, it exists within the
correctional system based almost solely on its ability to prescribe
medications to prisoner populations.
With the merging of mental health and criminal justice fields,
practitioners working inside prisons use psy discourses to both assign
and deny women agency. This reflects one of many conundrums
within psy discourse – that of choice versus disease. To clarify,
Jane Ussher (1991, p133) contends
that the dominance of psy discourse is
“based on the belief in a physical aetiology for madness, which serves
political ends. It allows psychiatrists to maintain the
continuity between physical and mental illness and to deny the role of
social, economic or political factors in madness”. In so doing,
the medical model shifts the focus onto some innate deficiency of the
woman rather than addressing the fact that the problem may reside
elsewhere, in differing social domains. With respect to the
construction of madness as irrationality in women, Ussher contends that:
…madness is the absence of reason or
rationality is seen as an explicit
assumption of the positivistic argument, for the model which sees
madness in terms of ‘cause’ and ‘effect’ implies the person is not a
rational agent, he or she having been made to behave in a particular
way. It is implicit within the positivistic discourse that the
mad person has no control (Ussher, 1991,
p146).
If it is the absence of reason that separates madness from badness,
madness is beyond the individual’s control and should be treated
differently from punishable behaviours. Correctional authorities
thus reconstruct prisoners as failing to self-responsibilise, as
attention seeking, and as manipulative ‘bad women’ in order justify
their carceral control (Kilty, 2008). This reconstruction
pushes psy, at least in the prison context, into a precarious
position. While steeped in a medical tradition that seeks to find
a biological explanation for human behaviours and mental illness, in
order to maintain power with respect to carceral governance, psy
experts must now address behaviour as a choice. However, the
correctional use of prescription medications to effectively sedate
rowdy or misbehaving prisoners, actually mollifies that choice.
Subsequently, the problematic behaviour remains an individual issue
within each woman, and experts are able to use her (mis)behaviour to
reinforce the hierarchy of psy within the prison (Farber,1990).
The Impact of Neoliberalism on the
Practice of Psy in Prison
With the ascendance of neoliberalism in the late 20th century came a
modification of the dependency argument, and a common psy goal became
the empowerment of the individual (Cruikshank,
1994). Empowerment
strategies focus on individual agency given that correctional discourse
constructs prisoners as responsible for managing themselves,
particularly their health. Neoliberalism diffuses state power
exemplified in welfarism and demands that citizens become empowered and
self-governing (Cruikshank, 1994;
Garland, 2001;
Hannah-Moffat, 1999;
2001). This shift
marginalises specific populations including the
mentally ill, children, the poor, racialized minorities and prisoners
who do not have the means to become ‘empowered.’ To clarify, the
neoliberal idea that we must all be self-governing social agents stands
at odds with traditional psy explanations that mental illness is beyond
the individual’s control in addition to the common correctional zeal to
control every aspect of a prisoner’s life in the name of the smooth
operation of the prison. Therefore, some correctional discourse
constitutes criminalized persons as no longer in need of care,
treatment, or rehabilitation but rather as ‘beyond repair’ (Melossi,
2000). Despite this fact, correctional professionals claim to
want to empower women prisoners, so they can become responsibilised
agents of their own welfare (Blanchette,
2002; Verbrugge &
Blanchette, 2002), but only through endorsed methods offered by the
prison.
Prisoners are now responsible for their own reformation thereby
eliminating the responsibility of psy and correctional experts to
rehabilitate them (Mathiesen,1990).
If
a
woman
recidivates
it is
because she failed to embrace correctional discourse and knowledge,
which is saturated with psy explanations of behaviour. Moreover,
“one of the preconditions for a new form of governing appears to be the
ability to reconstruct subjectivity – in this case the female criminal
subject” (Hannah-Moffat, 2001,
p166).
The
subjectivity
of
women
prisoners is now at stake (or ironically, at risk). Attempts to
control the mind, soul and ultimately the subjectivity of criminalized
women are now key correctional programming initiatives. This
subjectivity is universalized, essentialist, and denies differences
between women – particularly Aboriginal and non-Aboriginal women (Morin,
1999). In fact, Aboriginal women report feeling treated with
less
respect and dignity than do other prisoners (Morin,
1999).
Feminist criminologists have questioned the capacity of prison
officials to empower women prisoners (Kendall,
2000; Hannah-Moffat,
2001). As previously noted, there are inherent power
imbalances
between these parties and the suggestion that prisoners can be
empowered by a system and people that maintain their oppression and
imprisonment is suspicious at best. For example,
Hannah-Moffat (2001, p170)
writes:
Prisons are organized to limit
individual expressions of autonomy,
control, and choice. They are sites of repression; behind their
walls we find an undeniable imbalance in the relations of power between
the ‘keepers’ and the ‘kept’. Rarely are the ‘keepers’ able or
willing to relinquish their power to facilitate empowerment.
While incarcerated, women prisoners have little influence, collective
or otherwise, over the conditions of their lives. In the end, the
techniques typically associated with empowerment are in the control of
the prevailing organization.
The Correctional Service of Canada claims to have incorporated a
women-centred model of penal governance (Blanchette,
2002; Verbrugge
& Blanchette, 2002). However, using the terminology of
empowerment simply feminises the discourse of correctional practices
(Hannah-Moffat,1999;
2001). The correctional
focus on
empowerment suggests that all women prisoners lack self-esteem and
self-worth, and that they do not know themselves or have incomplete or
inadequate identities. In this context, self-esteem is treated as
essential to reformation and the prison’s raison d’être is to
supply a new subjectivity, a new identity, and one that is empowered,
self-responsibilised and reformed according to psy-correctional
ideals. Rather than empowering women, this system seeks to
reformulate criminalized women according to idealized notions of what
‘good’ women should be. As a result, prison psychiatrists and
doctors frequently prescribe women psychiatric medications to combat
everything from schizophrenia to low self-esteem.
Women who refuse to take the prescribed medication run the risk of
receiving an institutional charge for being ‘difficult to manage’
(Hannah-Moffat & Shaw,
2001). In this repressive context,
women prisoners are disallowed any real way to vent their anger,
sadness, or frustration. In the end, institutional charges for
swearing, yelling, or refusing medication are common occurrences that
can lead to an increase in sentence length or to the denial of
programming (Morin,1999). Given that
programming is the main
method of intervention, withholding access to programs is punitive and
reflects a deliberate attempt by correctional authorities to ensure
that women are complicit in following their correctional plans,
institutional rules, and in taking their prescription medications.
I suggest that coercing women in prison to take prescription
medications is a violation of their rights as psy-citizens to health
care and security (Kilty, 2008).
Citizenship functions as one
component of contemporary attempts at population management through the
allocation and denial of rights, privileges, and even services.
In the community, citizens are encouraged to seek second and even third
opinions regarding their health and mental health diagnoses. We
are also encouraged to research our illnesses and the affiliated
prescription medications in order to ensure a fully informed decision
making process regarding our manner of treatment. Such is the
nature of our psy-citizenship.
Moreover, whereas the biological body has the potential to free itself
from some diagnoses or to become symptom free, psychiatric illnesses
are constructed as chronic and ever-present even when managed.
For example, Islin (2004, p226) points out that “the transformation
from
neurotic subjecthood to citizenship involves responding to calls to
adjust conduct via calculating habits but soothing, appeasing,
tranquillizing, and, above all, managing anxieties and insecurities.”
Citizenship ensures that should we decide to forego treatment, whether
it is chemotherapy for cancer or taking Prozac for depression, we have
the right to do so. Therefore, while correctional discourse
proclaims to be women-centred and empowering, we continue to deny
prisoners the ability to determine their own mental health
destinies. Reminiscent of historic insane, criminal, and lunatic
asylums, the current prison regimes remain repressive institutions that
sacrifice treatment (and prisoner’s rights as psy-citizens) for social
control.
Method
This article is based on 26 in depth interviews; 22 with former
provincially and federally sentenced prisoners in Canada and four with
social workers who work with criminalized women in the community.
Of the 22 former prisoners, eight (36%) had served both federal and
provincial prison time, and 14 (64%) had served only provincial prison
time. Participants were located following initial contact with
social workers at women’s organisations that provide housing, services,
and programming to at risk and criminalized women. The interviews
were semi-structured in nature and aimed at eliciting detailed accounts
of how participants coped with stress associated with but not limited
to their imprisonment.
By focusing on how women coped with stress, one of the main areas of
discussion centred on how participants experienced psy-care while in
prison. More specifically, participants unanimously described the
(over)use of prescription psychiatric medications throughout both
levels of imprisonment. The following analysis reflects this
disturbing finding – women incarcerated in federal and provincial
prisons as well as local detention centres in Canada are currently
subject to violations of their rights to health care and security due
to the psy-care (or lack thereof) they are receiving while
inside. With precious little therapeutic care, women in prison
are frequently subject to varying levels of medicalization in order to
secure their social control.
Moral Regulation: The Medicalization
of Women in Prison
Moral regulation is a process that enables the social control of
certain groups, the goal being regulation by way of changing the
identity and/or behaviour of the targeted population. However,
“to present a project of moral regulation one has to believe that those
subjected to it are capable of reflecting and changing their lives when
properly enlightened by the regulators” (Ruonavaara,
1997, p286-288; Dean,
1994). Whatever the moral project identified as worthy of
reformation via regulation, those championing said moral projects must
possess a coherent and detailed program that outlines the desirable
conduct of the targeted population. Therefore, not only must
those in charge of the regulation project generate a suitable discourse
of ideal conduct, they must also offer suggestions as to how those
working directly with the population can actualize the moral
project. Practically speaking, moral regulators require an
ever-expanding assemblage of individuals working to execute the moral
project – all of whom cater to the party line by expressing the values
and ideals of the overarching goal of change and reformation.
Ruonavaara (1997) distinguishes
between social control and moral
regulation by arguing that moral regulation is a kind of social control
that functions within the social relationship between the regulators
and the regulated via persuasion rather than coercion.
The language and discourses of contemporary moral regulation projects
are much less overt than they have been in the past; what I mean by
this point is that moral wordsmiths couch current moral discourses in
politically acceptable technical language. For example,
Ruonavaara (1997, p292) writes:
In the case of contemporary moral
regulation, the ideologies are the
ones that we ourselves are subjected to. Moreover, they are often
now expressed in technical language devoid of any overt moral
exhortations, such as discourses on health promotion or management
doctrine.
With respect to women in prison, several moral projects are typically
underway at any given time (Gartner
&
Kruttschnitt,
2004; Hayman,
2006; Kilty, 2008). Prison
programming and psy-care serve as the
two primary mechanisms through which, ‘frontline regulators’ present
regulatory discourses to incarcerated women and which constitute the
venues for the constitution of the social relationships between these
two parties. However, for the purposes of this article, I focus
only on psy-care. With this in mind, we must acknowledge the
above-noted discrepancy between psy and moral discourse. While
moral regulation theory suggests that regulators believe that those
subject to regulatory discourses and practices are capable of change,
psy discourses often construct subjects as unable to change, where a
psy-diagnosis reflects a kind of innate and unyielding
abnormality.
Analogous to Ruonavaara’s above statement, experts commonly present
psy-discourses in promotion and/or management language to attempt to
mitigate any moral overtones. The process of psychiatrization
exists in tension – on one hand it seeks to label criminalized women by
identifying their individual barriers to reformation (i.e., whatever
mental illness or diagnosis they are viewed as suffering from), and on
the other, it operates within the neoliberal carceral constraints that
lay all responsibility for change on the hands of prisoners
themselves. Therefore, psychiatrization is a unique moral
project, in that psy-experts secure power within their social
relationship with the regulated (prisoners) through their ability to
prescribe psychiatric medications. Additionally, it is essential
to examine how correctional and psy experts both persuade and in some
cases coerce women in prison to take psychiatric medication.
Medicalization is a process through which we define and treat social
and/or behavioural conditions as medical issues (Conrad & Schneider,
1980; Conrad, 2007). The term refers
to the course of action by
which certain events or characteristics of everyday life become medical
issues, and thus come within the purview of doctors and other health
professionals to engage with, study, and treat. Medicalization
typically involves changes in social attitudes and terminology, and is
commonly accompanied (or driven) by the availability of
treatments. In the realm of corrections, medicalization operates
through the over-prescription of psychiatric medications.
Medicalization in this fashion is most predominant at the local jail or
detention centre level where prisoners are so overcrowded that they are
often double and triple bunked in their cells (Kilty 2008).
Over-prescription effectively subdues this population of women, who are
often characterized as misbehaving or rowdy. Brooke discussed
this role of Seroquel at length, stating:
Everyone was on something, some kind of medication. Lots of
Seroquel. They gave me Seroquel as soon as I got there, my first
night. I was on it the whole time I was inside. It knocks you
out, makes you sleep for like twelve hours – so if you were sad,
depressed, or even angry, the Seroquel just makes you calm – but to the
point where you just can’t react to anything.
Using prescription medications in this way fails to acknowledge the
harmful impact that imprisonment itself has on criminalized
women. For example, Jane, a woman who spent time on and off in a
provincial detention centre, discussed how imprisonment affects one’s
emotional well-being:
Well it makes you crazy in there
[prison]. You’re not well in
your head. Like they send a psychiatrist to see you once you’ve
been there for about two weeks. To see how you’re doing, and some
people just get depressed or they go crazy and those people get sent to
segregation. In seg, they’re just on a whole bunch of medication.
Both Brooke’s and Jane’s narratives illustrate how prescription
medications and the practice of segregation, as technologies of
discipline, are effective tools used to render this population
docile. In her interview, Jane acknowledged that incarceration in
and of itself has a negative impact on the women’s emotional
well-being. The reconstruction of sadness and stress resulting
from one’s imprisonment and criminalization as indicative of some form
of madness or potential dangerousness provides a fertile ideological
ground from which to create illusory images of “crazy” or “rowdy” women
prisoners who must be sedated and segregated. For example, my
interviews consistently demonstrated that women perceived as more
rowdy, resistant, drug addicted, loud, and questioning of authority
were prescribed higher dosages of sedation inducing drugs to ensure
their compliance and docility. Nellie discussed the increasing
dosages of drugs she was given while incarcerated:
Every time I would go in it was usually
in the middle of a drug binge,
you know? And rather than getting me in to a proper doctor or a
treatment centre or something, they just got me lots of dope. The
Seroquel just let me sleep and sleep and sleep so that I didn’t get all
agitated craving my drug. I didn’t react at all, I just laid
there.
Rather than understanding sadness and anxiety as a normal, rational,
and reasonable response to being criminalized and imprisoned,
psy-experts working within the correctional system reconstruct these
‘normal’ responses to their current life situations as abnormal.
Likewise, failing to seek alternative forms of intervention for the
difficulty a prisoner is having coping, medicalising criminalized women
has become the de facto policy for how psy is practiced in the
correctional system as well as in the community, again illustrating the
extension of carceral control strategies beyond prison walls (Cohen,1985).
Carrie, a social worker who works with ‘at risk’ and criminalized women
in the community, articulated this very point:
This woman had good supports on the
outside; good family, a house, had
never been in trouble before. You know all of these good things,
and so when she got to GVI she is obviously upset. She’s bawling
her eyes out for the first few weeks she is there and they keep trying
to push meds on her. ‘Oh here, you need to go on an
anti-depressant’. And she’s like, ‘I’m in jail! That’s why I’m
depressed. I am going to be here for three and a half years! I am
going to be here for three and a half years, like that’s why I’m
crying.’ She had never taken meds in her life, and she didn’t want to
start in prison. She kept saying, that it had to do with where
she was, and that it didn’t have anything to do with some kind of
imbalance or any of those things. You know, ‘I am in jail, that’s
why I’m crying!’.
Within the correctional system there is a reconstruction of any kind of
emotional response that deviates from contentedness as indicative of an
inability to cope or of some kind of greater mental pathology (Chesler,
1972; Ussher, 1991;
Russell, 1995; Suyemoto, 2002). To suggest
that
sadness, anger or anxiety is an inappropriate response to being
imprisoned is to ignore the well-documented impact imprisonment has on
those we incarcerate (Heney, 1990;
Rhodes, 2004, Sim,
2005; Kilty,
2008). Current psy-correctional responses seek to separate
the
prison experience from an individual’s emotional well-being while
inside and subsequently look to innate reasons for any prisoner
responses they view as maladjustment. In so doing, not only do
the philosophies, discourses and practices of correctional institutions
have notions of psy built into them, but also the process of
psychiatrization reflects the larger moral regulation project operating
in prisons.
In contrast to the inconsistent prescription of psychiatric medications
that occurs in the provincial system, several of the women discussed
the ease with which they were able to attain prescription psychiatric
medications in federal prison. For example, Kellie, a former
prisoner of the Grand Valley Institution in Kitchener, Ontario, stated:
The psychiatrist that’s another matter,
she was great. You tell
her what you want, some psych pills and she’ll give them to you, no
questions no nothing. Oh you want this, you want that, no
problem. You know what they do, they medicate people to keep them
calm. They had me on three different antidepressants at the same
time! The only time you talk to the psychiatrist is to get your
medications. You’re in there for ten minutes maybe. Oh, I
need this, I need that, this isn’t working, can we try this.
Write, write, write. It’s ridiculous.
The fact that prescription medications are dispensed so readily
illustrates how the federal correctional approach to psy intervention
is one of medication over therapy or counselling (Heney 1990; Sim
2005). Correctional plans reconstruct the over-prescription of
psy medication as a preventative measure taken against a population
characterised as being difficult to manage or resistant to correctional
regulations and other forms of correctional intervention.
In this light we begin to see how in the correctional arena, psy is
practiced as an extension of the process of medicalization. Joan,
a provincially sentenced woman, likened the impact of this process on
women prisoners to the sedation of mental patients in locked
psychiatric hospitals or institutions:
Joan: There’s drugs and alcohol
problems, okay that’s a primary
problem. That’s the one that’s affecting them now, but there’s
also the underlying mental illnesses. That they have anxiety,
depression, bipolar, manic, there’s lots. There’s so many people
on medications for that in jail, you should see the med-line.
Jen: Do you think they prescribe too much?
Joan: Well, some of them really need it. But then some of them
that really need it aren’t getting the care they need in there, and
then there are the ones that take it just to sleep through their whole
time. Some of them take Seroquel just to sleep through, or we
used to call it bug juice, they used to give them Nozepam and they’d be
like walking zombies; that’s what they give mental people in mental
institutions to keep them sedated. Like they’re drooling out of
the sides of their mouths.
Joan’s narrative reflects a kind of ambivalence regarding the use of
psychotropic medications for women in prison; while she acknowledges
belief in mental illness and in medicalization as the appropriate
method and course of treatment for some, Joan is clearly uneasy about
the impact of such high dosages on the women. Joan does not fully
problematize medicalization, but she notes an important finding – that
not all women prisoners are regulated solely through external
means. Reflective of the power of psy as a key operating moral
regulation project for women in prison, it is interesting to note that
not all women perceive and experience taking prescription medications
as intrusive; in fact, some women engage in self-regulation by
accepting and using psy discourses. Such was the case with some
participants who willingly took Seroquel, an antipsychotic medication
that is currently the prescription drug of choice in prison due to its
common side effect of sedating the individual.
Seroquel: The Current Correctional
Wonder Drug
Seroquel is the market name for the antipsychotic drug Quetiapine,
whose manufacturers claim appropriate for treating schizophrenia and
the manic episodes in bipolar disorder. However, prison doctors
and psychiatrists frequently prescribe Seroquel to prisoners because
its most common side effect is sedation. Of the twenty-two former
prisoners interviewed for this research, all but one was prescribed
Seroquel while in prison. Moreover, the one woman who did not
take Seroquel served time in the now closed Kingston Prison for Women
and was inside before Seroquel was on the market; alternatively, she
took both Valium and Prozac while serving time. Both former
prisoners and community social workers criticized the use of Seroquel
as a sedative, often referring to the drug’s potency, suggesting that
it is overly powerful and an unnecessary sleep aid. For example,
Danielle, a former federal prisoner, stated, “I don’t want to be a
zombie and I don’t want to, like I could sleep all day on that shit.”
Similarly, Carrie, a social worker, spoke about the impact Seroquel had
on one of the women she was working with:
There are a lot of women on
medications. One woman was on 500
milligrams of Seroquel a day. For the first few weeks, she was
comatose. You know, and this was prescribed by a doctor from the
jail. He had said, ‘come back in two weeks and we’ll see how that
goes’. I mean, how can a doctor who doesn’t know the person give
them grandiose doses of medication and then tell them to come back in
two weeks when she hasn’t been assessed by a psychiatrist? Like there
are so many problems.
Carrie’s narrative demonstrates a trend that was evident in many of the
women’s accounts – that there is little correspondence between prison
medical doctors and psychiatrists. In fact, what occurred in more
than one instance were dual prescriptions by doctors and psychiatrists
and/or a battle for power between the two; for women in prison, this
battle commonly resulted in their being placed on medication, then
taken off it shortly thereafter. This point also illustrates how
other professions have absorbed psy expertise in order to actualize
more completely the moral regulation project of ‘empowering women’ to
become appropriately self-governing.
The dosages of Seroquel prescribed to women in prison vary
substantially. This fact alone is not abnormal given that varying
dosages of any medication are common depending on how the individual
reacts to the medication and the claimed seriousness of the
diagnosis. However, some women I interviewed had been prescribed
twenty-five milligrams of Seroquel, while others were taking over five
hundred milligrams of the same medication. Stacey found that with
respect to Seroquel as a prescription medication, the federal prison
system adhered to a ‘more is better’ philosophy:
The one thing with prison is that they
like to heavily medicate people,
and I’m a prime example. Yeah, Seroquel, stuff like that. I
was on a lot of medications. I was a walking zombie. I
could not function. I do not remember half of my time. I
don’t know how I functioned or how I made it from point A to point
B. I can’t even describe to you how many different medications I
was on. When I left prison my parole officer from Guelph was even
asking, ‘How are you walking? How are you doing this?’ I actually went
through withdrawals when I came off this stuff.
Given the fact that so many participants used the exact same phrase to
describe the impact of Seroquel as making them become “walking
zombies”, one must question whether our current system is creating, as
noted by Russell (1995) prescription
drug dependence among women
prisoners. Stacey’s claim to have experienced withdrawal from
prescription drugs is a case in point. Whether they had clinical
diagnoses or not, many women said that they needed their medications to
“get by” and that they “couldn’t sleep” and “couldn’t function” without
them. With few other avenues to help them cope in prison and the
ease with which they are able to obtain them, many women seem to turn
to prescription medications as a way to cope and get through their
sentences. For example, Joan stated, “I need to take these meds,
or else I can’t sleep. The meds just keep me normal so I won’t go
out and get high and act crazy.” As aforementioned, some women
embraced their psy diagnoses and willingly took prescription
medications because doctors told them that these medications were
necessary for them to “get well”.
Contrastingly, despite some of the women’s attempts to explain that
they did not want or need psychiatric medication, but rather that they
needed only time to adjust and cope with their new surroundings, their
self-assertions seem to go unacknowledged by correctional and
psy-experts:
I lost my kids, I was in jail, I was
addicted to drugs – all this shit
and all they did was give me meds to calm me down. They act like
Seroquel is going to make me feel better, but no one talked to me or
offered any real help. The reason I was so depressed was because
I was living in a cell with some other person I didn’t know and had no
idea how my kids were. Meds are not going to change any of that.
Getting criminalized women to take psy medication is thus not merely a
feature in the practice of psy, it is a key component in the exertion
of psy expertise reflected in corrections’ efforts to transform women
‘criminals’ into ‘inmates’ and then into ‘rehabilitated’ women.
In this light, psy expertise becomes an effective instrument for
altering the conduct of criminalized women. However, to assume
that women must be medicated in order to cope with imprisonment does
not help them in the long run; in fact, it may foster a kind of
reliance on psychiatric medications that they may not have otherwise
had.
Ultimately, some psy diagnoses reflect general assumptions about the
nature of women (Chesler, 1972;
Ussher,1991). For example, to be
told by psy-experts that they ‘need’ these medications to cope
reinforces the characterisation of women prisoners as weak, passive,
emotionally unstable, and unsuitable for other common attempts at
coping with stress. As Shannon suggested:
No one would listen to me and that
would get me more and more upset.
They just talk to you like you are a kid who can’t handle it or like
you’re crazy. Every time I would have an encounter with the doctors or
nurses, they just ignored everything I would say and would make me feel
like I was losing it.
By encouraging, and in some instances, coercing women in prison to take
prescription medications, psy-correctional discourse reconstructs women
prisoners as incapable of determining the courses of their own mental
health care. In this light, we can see how psy-experts working
within a neoliberal carceral context attempt to reclaim a certain
degree of control over the emotionality as well as the management and
mental health identities of women prisoners.
Particularly problematic is the fact that women are, in Kellie’s words,
only in to see the psychiatrist “to get your medications” and that they
are there “for ten minutes maybe”. Very little intervention or
discussion between psy-expert and patient occurs, thus minimizing the
potential for any kind of ‘therapeutic’ involvement. Given that
there is only one clinical psychologist on staff at an institution that
may house over one hundred women at any given time, it is obvious that
access to therapy and counselling is limited. Darla stated that
upon arrival at GVI, the women are seen by the psychiatrist for “around
an hour” to “see what your needs are and whether you’re suicidal, or
what your problems are, or if you’re argumentative, you know, your
background.” To expect women upon their initial arrival in prison to be
ready to discuss their clinical history again ignores the traumatic
impact that incarceration has on people. This procedure is a
component of the risk assessment strategy that is so ingrained in
correctional discourse, and confirms my claim that correction’s main
concern is always the security of the institution.
Quickly looking to identify argumentative and therefore potentially
resistant women illustrates a desire to identify those who will be
subject to increased security, medication, and isolation practices
(Hannah-Moffat & Shaw,
2001). This investigatory procedure is
hardly effective as a means of securing the kind of detailed
information that should be required before prescribing psychiatric
medication. Despite this fact, many women in local jails and
detention centres, and provincial and federal prisons are taking
Seroquel for a number of diagnoses other than schizophrenia or bipolar
disorder. In fact, only one participant was prescribed
Seroquel for a corresponding diagnosis of bipolar disorder; the rest of
my participants were given Seroquel for the following reasons:
substance use, substance withdrawal, anxiety, depression, and as
aforementioned, to induce sedation. As aforementioned, out of the
twenty-two former prisoners interviewed for this research, all but one
took Seroquel while incarcerated.
Julie provided insight about the conflicting psy approaches and
strategies that exist at the federal level. For example, she
stated that once you have cascaded your way down to minimum security,
institutional authorities give you a week’s worth of medication and you
are entrusted to take it accordingly:
What they do is they give the girls all
their medication for a
week. Some of them will give them to other people for stuff,
trade them, sell them. Some would use them to get high, or trade
them for things. That’s one thing I didn’t like about it [GVI]
was the medical. You know enough is enough. I’m tired of
people telling me I have to do this, I have to do that, I have to take
this medication. I want that control. Like last week I just
lost it. I went off my meds. I was on something for
depression. See that was another thing in federal, they’d say you
have to take these. And I didn’t want it. You couldn’t
refuse it. Or else I would go to seg. Because I was on
Zoloft before I came to prison and then I needed it because I was
drinking, going through some things, bad relationship, so ok I needed
the medication. But when I went in, I was still on it, and I felt
that I didn’t need this. So when they called the house and said
for me to go to health care, and I went over and the guard that was in
charge asked why I hadn’t taken my medication, I said that I don’t feel
like I need it right now. Then I had to go in to see the shrink,
and the shrink said, ‘well I feel that you need to be on something,’ so
I just said ok because I wanted to get out, you know.
The correctional practice of giving the women housed in minimum
security a week’s worth of their medications at a time may be seen as
an actual attempt by correctional officials to entrust a certain degree
of control over their own mental health to the women themselves.
However, the women are still required to take the medication and if
they refuse to do so, they run the risk of jeopardising their
minimum-security status and even their potential for parole release
(Pollack, 2006; Pollack & Kendall, 2005). Allowing the women
to
manage the taking of their own prescription medications is indicative
of a push by corrections to get the women to self-govern, but to do so
according to corrections’ standards of acceptable psy-care. For
many criminalized women means continuing to take all those medications
that are prescribed for them, whether they want to take them or
not. At times Julie was open to taking prescription medication
when she felt stressed or when she was having difficulty coping, but
wanted the ability to stop taking it. Ultimately, Julie wanted
the control and decision-making power regarding the medications she
took, but knowing that failure to comply would result in a longer stay
in prison she desisted from her attempts to exercise that
control. Similarly, she mentioned being somewhat amenable to the
drug Zoloft because she did not experience side effects from the drug,
unlike the long lasting sedative effects of Seroquel that made her feel
“groggy”, “out of it”, and “unable to concentrate”.
Unfortunately, Julie had to take not only the Zoloft, but also the
Seroquel as it was mandated as a part of her correctional plan.
Resistance may take different forms, and reflects the ability to
struggle against, withstand the effect of, or not to be affected by
something or someone. In this light, Julie’s compliance in taking
her medications is an act of resistance – as she was actively doing
everything in her power to struggle against her imprisonment by
securing her release. Julie’s compliance in taking prescription
medications was a way for her to withstand the punitiveness of the
prison and thus not to be affected by those disciplinary technologies
that exist behind prison walls. While Julie viewed prescription
medications as intrusive, she engaged in a form of self-regulation and
compliance in order to make her time inside less rife with
stress. At the same time, Julie refused to accept the discourse
of her own psychiatrization and of the value of the amount of
prescription medications given to her and other women inside.
Conclusion
The overuse and reliance on prescription psychiatric medications
reflects three broader political trends: first, what Conrad (2007)
identifies as the medicalization of society; second, historic
constructions of women more broadly and women prisoners more
specifically as mad, irrational, or unstable; and third, ongoing
correctional attempts to pacify prisoners with drugs in order to more
easily foster the larger correctional moral regulation project, as well
as to prevent resistance or the questioning of correctional
authority. Seroquel, while being the current prescription drug of
choice, is merely one in a long line of medications that have been
popular in prison.
The main argument of this paper surrounds the rights to services that
may help psy-citizens cope more effectively and in a manner, they see
as most helpful. Institutional mandates deny services and
potential treatment options to criminalized women, which are available
in the community. Ultimately, there are three avenues available
for the betterment of the health of criminalized women in their
capacity as psychiatric citizens. First, we must re-evaluate the power
of psy in the carceral context, with the hope of reducing reliance on
psy-diagnoses and prescriptions. Second, we must improve access
to services and treatments desired by criminalized women so that they
can function independent from corrections (which would require improved
access to information and education regarding each individual’s mental
health so that she can be involved in the decision making process –
which by and large would be a step toward a woman-centred model).
Finally, providing care in and through the community rather than
through corrections would help to separate correctional power over the
mental health care of criminalized persons.
Unfortunately, criminalized women lack the real freedom to make
informed choices regarding their own mental health care, thus denying
them agency with regard to their psy-citizenship; for example,
correctional authorities use a woman’s pending parole release as an
incentive to ensure that she continues to take medication. Worse
yet, these same authorities actually present their strategy as an
attempt to help empower women. Coercion is not empowering; it is
in fact the exact opposite – it is disempowering. Women in prison
have not voluntarily signed themselves into a psychiatric hospital, nor
have they given up their right to determine their own mental health
welfare; they are incarcerated in a prison against their will.
Since psy-care in prison is provided by those who officially work for
and thus report to correctional authorities, as opposed to being a
distinctly separate and outside neutral party, there is no real sense
of confidentiality or trust between ‘patient’ and doctor. As
Kathleen Kendall (1994) asked nearly
fifteen years ago, is it even
possible to have ‘therapy’ behind prison walls?
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