Dying Inside: The HIV/AIDS Ward at Limestone Prison

Chapter 1. Penal Health Care in Contemporary American Society

CHAPTER 1 Penal Health Care in Contemporary American Society Sociologists of punishment have long recognized that inequalities in the broader society are mirrored in and through the prison population , beginning with such classic works as George Rusche and Otto Kirchheimer’s treatise Punishment and Social Structure and Donald Clemmer’s The Prison Community, a Depression-era case study of Illinois ’s maximum security prison at Menard.1 As a staff member of Menard’s Mental Health Of‹ce and a coach of the prison football team, Clemmer had unparalleled access to conduct both an extensive prisoner survey and a detailed ‹eld analysis of the institution. Clemmer ’s major discovery was that the prison’s social hierarchy closely approximated the outside community. Speci‹cally, he discovered that the prison contained three distinct classes: an upper class; a middle class; and a lower, “Hoosier” class. Alternatively, Gresham Sykes’s The Society of Captives, a case study of New Jersey’s maximum security prison (written at the height of the cold war, in the 1950s), focused more on the prison as its own self-contained social system. Ironically, of all sociologists to conduct the earliest investigations of penal institutions in the United States, Sykes most poignantly articulated the similarities between prison and the broader society. 8 In reality, of course, the prison wall is far more permeable than it appears, not in terms of escape . . . but in terms of the relationships between the prison social system and the larger society in which it rests. The prison is not an autonomous system of power; rather, it is an instrument of the state, shaped by its social environment, and we must keep this simple truth in mind if we are to understand the prison.2 Building on the insights of Clemmer and Sykes, one of the most sweeping sociological analyses of a prison is James Jacobs’s study of the Illinois penitentiary at Stateville. Through archival analysis of ‹fty years of Stateville’s institutional life and through rigorous observational analysis, Jacobs’s book Stateville elucidates the rise and fall of various managerial approaches to prison governance that were shaped by and through broader societal developments. Most important for Jacobs was how Stateville had become shaped by the rise of “mass society ”—that is, how the institution had been greatly in›uenced not only by of‹cials but by social movements focused on creating a more socially inclusive, rights-based society. The civil rights movement of the early 1960s served to politicize the prison minority’s population which emerged as a solid majority by the 1960s. The trend toward mass society rede‹ned the status and value of marginal groups in the polity. The demand by prisoners for fuller participation in the core culture was reinforced by the greater sensitivity of the elites to the moral worth of marginal citizens.3 One of the most compelling contributions of Stateville is Jacobs’s discovery that a more activist judiciary was responsible for major changes at the institutional level of penal institutions. Setting forth a whole slew of new mandates designed to ensure minority prisoners’ equal protection under law and to ensure the rights of prisoners to openly practice religion, Stateville underwent important changes, especially greater tolerance on the part of prison of‹cials and the racial diversi‹cation of staff. Most of all, however, Jacobs discovered how the new legal mandates of mass society resulted in greater bureaucratization —in this case, a kind of symbolic deference on the part of Stateville’s elites to new, legally mandated rules and regulations—as Penal Health Care in Contemporary American Society 9 opposed to an idealistic view of prisons as places that put individual rights on par with the institution’s overriding security imperatives. Indeed , Jacobs discovered that, on the whole, legal interventions resulted only in modest reforms into the 1970s. [T]ransformation was incompatible with the tenets of the authoritarian regime. It was also incompatible with the human relations model of management . . . The reforms mandated by the courts can only be implemented by well-run organizations . . . Whether rational administration and responsive grievance mechanisms will be suf‹cient to meet the press of inmate demands is a serious issue to be faced in the future.4 Understanding the authoritarian regime of the penal institution —what sociologist Erving Goffman, in the classic Asylums,5 formulated as the “total institution”6 (individuals living together twentyfour hours a day under a...