Sunday, March 7, 2010

Locking Women Away.

At DailyKos, a review of my friend Lynne Haney's new book:

Offending Women: Power, Punishment, and the Regulation of Desire
By Lynne A. Haney
University of California Press: Berkeley
Softcover, 304 pages, $24.95
Feburary 2010

Money quote:

The policies of mass imprisonment, which systematically remove so many women from their communities, seem to signify a shift in how state regulation is conceptualized and practiced. While poor women have always had their lives regulated by the state indirectly, through social policies, laws, and encounters with caseworkers, more of them are living and raising children quite literally within the state--often for long stretches of time. Moreover, through parole, probation, and "community-based" corrections, the penal system remains in these women's lives for years after release. The state's methods of control also seem to rely more heavily on direct modes of intervention characteristic of total institutions. And these modes of intervention appear to be based on restrictive models of citizenship and forms of claims-making.

Author: A professor of sociology at New York University, author of Inventing the Needy: Gender and the Politics of Welfare in Hungary.

Basic premise: The author looks at two programs set up in California as "community-based prisons" for mothers to be housed with their children in alternative, less institutionalized settings. One program, Alliance, was researched in the early 1990s, when the focus of social programs was moving toward insistence on self-reliance instead of the "welfare state." With this cultural imperative in the background, the program focused on emphasizing job and life skills acquisition in a boot camp-like setting (punctuality, chores, classes were all emphasized). In the second program examined a decade later, Visions, the author notes the shifting of cultural priorities--instead of prepping individuals for the basics of taking responsibility for themselvespractically in society, now young mothers are coached in a brand of therapeutic self-governance, heavily reliant on 12-step methods and confessional mode. In both cases, society-wide injustices are swept under the rug; solutions are located in the individual alone, in the case of Alliance as a lack of job/life skills, in Visions as a pathologized internal child. The author examines the daily routines of both programs, their effects on the women and the growing hybrid of public/private institutions that make regulation and benchmarking difficult.

Readability/quality: Relatively free of jargon, engaging when exploring the daily routines of these young mothers in each setting, thoughtful about the implications for wider society, the book is a relatively smooth read from an assured expert who clearly has spent a career looking at the issues tackled.

Who should read it: Same as for Interrupted Life (in fact, one of the essays in the previous book is by this author, short and focused on only one aspect of one of these programs)--those interested in women and society, incarceration, alternative programs, children's issues.

Bonus quote:

It matters that the women in Visions confronted a discourse of desire as opposed to a discourse of need. First and foremost, it matters because of the institutional practices that accompanied this discourse; the women at Visions received counseling not education, group therapy not job training, and treatment for personal addiction not preparation for social integration. While not all women accepted these practices, few could disrupt them in a consistent or collective way. Unlike the young women at Alliance, who used the prevailing needs talk as they challenged it, the women at Visions turned on themselves and one another. Although some Visions inmates tried, few were able to move the emphasis from personal to societal failings. At Visions, the discourse of desire seemed like a channel through which claims to social justice and fairness were silenced; the women subjected to this discourse seemed one step closer to a state of disentitlement.

Both Alliance (skills-based) and Visions (therapeutics on steroids) sound like a nightmare. Alliance, presented first in the book, has an understandable rigidity given that these women were convicted of something (mostly drug crimes), but Haney points to the inherent contradiction in the program--even as counselors and staff are harping non-stop on self-reliance to these women, they are confiscating their AFDC aid and pooling it for survival. The women, once they get a few skills under their belts, recognize this and being reporting conditions to public agencies, spurring investigations. From a sociological point of view, Haney was in the right place at the right time to document the formation of blocs of resistance, but alas, they come to naught for various (predictable) reasons. As bad as Alliance comes across, Visions is much worse--the constant pressure to confess confess confess and to have more horror traumatic abuse stories than your fellow prisoners is appalling; women turn on each other viciously, using information gleaned in group self-help sessions, and the whole program comes across as a Jerry Springer-like emotional "Lord of the Flies."

Ironically, both programs were conceived with the best of intentions: to allow women to serve time with their children, in a softer setting than normal, in a place of emotional safety and practical learning. Both programs were supported by staunch women's advocates. And both ended up mired in truly appalling dynamics. The bottom-line problem with both is the diminishment of the role of connection and empowerment; problems are always and forever seen as individual crosses to bear and hurdles to overcome. Haney's book is also a warning about the blurred area of unaccountability created by these public/private entities.

Not the subject of the book, but one that would be a welcome follow-up by some author: the effect on the children of growing up in these programs.

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Debunking Mr. Smith on the Washington Numbers.

A recent column from Wesley J. Smith comments on the new report out of Washington on how Death with Dignity is working there. I comment on his posts so often because he's so good at perpetuating lies about Death with Dignity and assisted suicide - on all end of life care. Here are some things he again gets wrong:

The first dehumanizing assisted suicide “statistics” from Washington are in, with 36 people reportedly overdosing themselves via lethally prescribed drugs in the first year. Washington voters were “sold” on assisted suicide, as is always the case, with the fear of being in pain that cannot be alleviated. But, as in Oregon, assisted suicide in practice is mostly about existential fears. These are serious issues to be sure, but they are not demises of writhing agony used by assisted suicide advocates to sell hemlock as if it were honey.

I'm afraid that Smith is out of line with the majority of voters in Oregon who have long had public-square, in-depth discussions about end of life care. I don't think democracy or laws always work to protect individual rights but I have to say that Washington has proven that all the doomsday scenarios painted by opponents of the laws have not come to bear.

What's at contest is how Smith defines death and human life. From his continued involvement with the Schindler family, the Catholic church, and from his writings, it's obvious that he's determined that death - defined until the 60s and 70s as the rather simultaneous end of breathing, heart beat, and brain function - now must be redefined because of technology that can perpetuate the first two artificially.

The latter, brain function, according to Smith and his fellow "pro-life" advocates, is unimportant. (Except when a big news story like the recent finding of brain activity in some PVS patients (though not any patients who suffered anoxia as Terri Schiavo had) comes along as a possible hook that they can hang their insensitive claims of murder on.) But brain function is not unimportant to elders. For many, it defines who they are. In many ways so does physical competence, mobility, living. These values in no way slight the lives of those with less mobility but simply reflect human ideas of what it means to be alive.

Yet, Smith's attempts at redefining death are incongruent with the majority of society and the laws that are constantly evolving to address new technology. Autonomy was cited in the report as the top reason for patients to request aid in dying. That's a statistic, not an opinion. And it signifies that loss of autonomy means something to a lot of people, whether Smith wishes to call it "existential" or not. What's at issue is that his definition of dying - all aggressive care all the time, regardless of the wishes of the patient or their family - is not the definition that society wishes to work from.

I'll let his juvenile attempts to discredit the report - a long-time tactic of end of life care opponents, science-deniers, ideologues, and conservative religious groups bent on dictating how we should live - and his portrait of proponents of aid in dying as killers slide. No one is out to cut down terminal patients but to treat them as they wish to be treated at the end of life, not as someone else thinks they should be treated. Hemlock as honey? "Sold" on assisted suicide? Fear of end of life "quality of life" is real and great. We are inhumane fools to ignore them. But Smith has an agenda. And the fact that the report doesn't show his predictions of old ladies being coerced into ingesting lethal drugs for their money, minorities and the disabled being preyed on, the "culture of death" devouring the most vulnerable in society, makes him more surly than usual. He's got a "slippery slope" argument to prove and unfortunately, the statistics don't work in his favor. So what does he do? He goes after hospice.

From the story:

Doctors said loss of autonomy was an end-of-life concern for all 47 patients. Ninety-one percent were also concerned about losing the ability to participate in activities that made life enjoyable, and 82 percent were worried about “loss of dignity,” their doctors said. The report also said that more than 40 percent were worried about losing control of bodily functions, 23 percent about being a burden on family, friends or caregivers, and 25 percent were concerned about inadequate pain control. Only one person was concerned about the financial implications of treatment, according to the doctors’ reports.

The report also states that 72% of people who committed assisted suicide were in hospice. This marks the continues assault by assisted suicide consciousness on hospice medicine. Suicide prevention is one of the important services hospice is supposed to provide, along with other interventions, to help a suicidal terminally ill patient get past the darkness to live the rest of his or her life.

Uh, what's 72% of 36? That hospice is being taken over by AS advocates is silly. The common practice in hospice is to treat a terminal patient's paint - indeed that's why it was founded. The issue here is that treating pain often means sedation, often until death. That's not an option that some like. Conflating suicide with with assisted suicide is a disingenuous trope. As Death with Dignity works in Oregon and Washington, the patient is dying from a terminal disease. That disease is the killer, not terminal illness.

It works, too. Several years ago, St. Christopher’s Hospice, founded by the great medical humanitarian Dame Cecily Saunders, released a report showing that of 1700 AIDS patients, only two had requested assisted suicide and none had killed themselves, a remarkable figure since this was when the epidemic was at its worst. The point of the report was to show that quality of their care could overcome the worst situations. But with legalized assisted suicide, this essential service is often (or always, who knows?) denied to patients, particularly since the ideologues of Compassion and Choices are usually involved in facilitating these deaths.

Saunders founded her hospice at a time when technology was just starting to change the definition of death. And she's been quoted as saying, as a staunch Catholic and following of C.S. Lewis, that she founded hospice in part to combat euthanasia. Modern assisted suicide is divorced from early definitions of euthanasia, both Socrates-type and the Nazi-type. Hospice is a brilliant and humane approach to end of life care; by proclaiming it as a service that reduces patients' options, as subject to "the culture of death" is absurd. But it's a common method of scaring the dying into spending their last days, weeks, months in hospitals, exactly where 80% of them say they don't want to be. We know that Oregon, since the legalization of Death with Dignity, has the highest percentage of in-home deaths of any state in the country. For all his claims at knowledge of this subject, he is woefully uninformed or dishonest about hospice use in states where DwD is legal. I won't even touch Saunder's AIDS report. The AIDS movement is responsible for reviving the assisted suicide movement. Yes, ending suffering at the end of life is sufficient to give some terminal patients the peace they want. Others see no difference between sedation to unconsciousness and ending their suffering.

So, Washington looks like Oregon, redux. And that’s too bad. Terminally ill patients deserve better than to have their worst fears verified by doctors issuing lethal prescriptions instead of vowing to stay with the patient to the end caring for their pain, validating their dignity, and supporting the importance of their lives.

Dignity, pain, suffering, autonomy, "quality of life" are not the same for all terminal patients. That the Washington report confirms Oregon's results is fantastic news! These bills have encouraged the elderly and ill to discuss how they die; have perpetuated humane treatment of the dying; have moved more patients into hospice; have allowed patients to die where they want, at home with their family; have established successful "do not resuscitate" laws and practices; have encouraged families to work together to ensure that patients have the treatments they want at the end of life. Think what you want about assisted suicide. These bills have proven that accepting death and working to give patient's their choices in treatment are imperative, life-affirming, humane, and encouraging signs.

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