therapeutic modules

One of the most powerful days at San Quentin yet. I spent the morning with a psychiatrist who provides care to the inmates in East Block. East Block houses Death Row inmates, otherwise known as the condemned. These patients live in small single cells, and are handcuffed at all times when they are not otherwise locked up. During a visit with a psychiatrist, they are placed in a clear cage so that the security guard can leave and offer a semblance of confidentiality. These cages are called "therapeutic modules" by the department of corrections, and are called cages by everyone else who actually uses them. These limitations made East Block distinct for me. I also had my own limitations--this is the only place in San Quentin others felt compelled to have me wear a security vest, which I have never worn before. In the same way that I feel lighter after leaving the prison and turning in my alarm system, I felt relieved to take off this weight after leaving East Block, despite its design for protection.

Many of these inmates have been here for twenty, thirty years. California hasn't executed an inmate in years, and is unlikely to ever do so. So these people are serving life sentences on what is called Death Row, and they have learned to adjust to a unique kind of life that I honestly never gave any thought to until I saw it in front of me.

There doesn't seem to be a set time for each appointment, and the loose wandering time that is locked up in our tiny interview room made me feel, in a small remote way, parallel to the inmate. He spoke incredibly insightfully and thoughtfully about his experience. "There are so many parts of yourself that aren't fulfilled while you're here, and you sit with your thoughts all day long trying to fill yourself." He spoke about experiencing by imagining experiences. "I thought, if I had money I'd go out and buy an expensive kite--the kind that costs a hundred dollars. I'd go out to the park and roll out the string until it flew high, so high you could barely see it...and then I'd pass it off to a kid. See the magical look in his face. Knowing that when I was seven or eight, that would just be magic." And for two minutes, he could feel the joy of this experience. Instead of being angry about not being able to experience it, he could really feel it. Then let it pass.

We talked about mindfulness, stories, and relapses. It's not always so easy to fulfill yourself without light to define shapes and senses. I thought about how I've never a thought quite like that one about the kite, an urge that captured quite that sentiment. I know it is too obvious, but it is too true that imprisonment opens parts of people that maybe everyone has but no one else truly experiences.

Unlike other times I've shadowed providers, these patients spoke to me directly. Asked me questions, explained things to me, looked at me instead of their actual doctor. They seemed to appreciate having another person to share with, to drink in the fact their words were being heard by a new person, newness being a rarity in this environment. One man sat quietly in the cage, and another pressed himself against the glass and stood on tiptoe, getting as close as possible to the small opening of air at the top. I've never spoken to a patient through a glass cage before, and never thought I'd feel such weight and closeness in that environment.

I spent some time in interdisciplinary team treatment meetings, where an inmate in the EOP (enhanced outpatient program for mental health) would sit at the head of the table and discuss his care with a team of psychiatrists, psych techs, and counselors. One felt he no longer needed these services. One wanted more services. Each meeting felt a little tense to me, partly because we were crowded in a room designed to house half the amount of people in it, and partly because each person in the room seemed to be either holding back or removed from the space. It reminded me of working at the Connecticut Mental Health Center in New Haven, where morning rounds which consisted of these strange meetings that I knew were meant to be patient centered but felt kind of like a court trial.

It's hard to write truly about these experiences, partly because I just want to record them before I forget more so than write about them well. But mostly because I don't really understand them enough to write about them, and I don't write well enough to write about things I don't understand. But it's this distance that compels me to stay, move closer, try.

ban the box

Another super interesting day at San Quentin Prison. When we arrived at the gate, the security guard took one look at my co-resident and said, "No blue." He was wearing blue pants, and since the inmates wear blue, this is a no-no color for any visitors into the facilities, the idea being that if we were being monitored from above we may be mistaken for an inmate and this could put us in danger. There was no leeway in this. We looked at each other and saw the other person rack the possibilities: gift shop? an employee with extra pants? sweet talk the guard? pull out the guidelines given to us that read "no blue jeans" and "no blue" but did not explicitly say "no blue pants"? Then someone suggested going to a nearby Target, which we did, where we acquired a new pair of pants, that we later returned after the day was over. Entering the prison that day I paid attention to their clothes, and found that their blue pants really did resemble what my co-resident was wearing, and it was interesting to consider how much that mattered, to distinguish ourselves.

We saw patients in the morning, which I generally enjoy for the exposure to the characteristics of this patient population (a lot of hepatitis C and liver disease, chronic pain, mental health in addition to the bread and butter diabetes and asthma) and for getting to know the individuals better. But the most interesting part was the afternoon.

We were able to attend a session in a class called Community Justice, that was started by a nonprofit called Alliance for Change. It is a 16-week curriculum where a group of inmates attend class four days a week to learn about civic engagement. It is organized by previous members of the course, and run and taught by the inmates to other inmates. Today's course was a debate regarding a real bill hoping to become a law, commonly known as Ban the Box. Simply, it bans employers from making an applicant check a box on their application regarding whether they had been convicted of a felony, until the applicant's full qualifications had been reviewed. If the applicant was then offered an interview, this information could then be attained, but not prior.

There were 22 inmates, and they were split into four groups representing 1) special interest groups against the ban; 2) special interest groups for the ban; 3) citizens against the ban; and 4) citizens for the ban. Each inmate had to go up in front of the large group and speak for two minutes about their position. It's amazing how much personality you can ascertain from two minutes, and I found it endearing when some of them were clearly very nervous about speaking in front of such a big group. Afterwards, the leader asked the group how many had never spoken in front of a group, and half a dozen raised their hands, which blew me away. I wasn't surprised rationally, but it was a concrete reminder of how different our environments have been, and it made me very proud of them for continuing this group and giving each other this opportunity. And some who had been very quiet during the small group discussions became clear and adamant during their moment, which was also touching.

I was also very impressed by how well the inmates argued against the ban. It was clear that the group was strongly for the ban, given their situations and experiences. But they carefully considered others' thoughts into this, and raised many strong points about economics, safety, and rights. They were also funny. One memorable speaker charged with speaking against the ban ended his argument with: "I ask those of you supporting this ban to ask yourself, would you want to work next to a creepy convict?"

Of course the obvious juxtaposition was that the group felt the very opposite of this stereotype. They were warm, engaged, very supportive and respectful of each other. And it seems that this is in large part due to programs and classes like these. I think the issues of what should happen in prisons and how and why are still very complicated, but there doesn't seem to be any question to this being good.

prisons

It took me forever to write this because this topic has become so extremely interesting to me, and there is so much to say about it.

In college I took two classes where I ended up writing an essay about prisons and/or prisoners--one in a moral reasoning (because they have to call everything by a different name; this is basically philosophy) and another in a literature class on misfits where I wrote about Kafka's The Trial. These were some of my favorite things I wrote about, mainly because I was pushed to think more deeply and in more nuanced ways about things I hadn't considered much, or had only considered in concrete ways. In the philosophy class, I wrote an essay about whether risoners had the moral right to revolt violently when certain rights were being withheld from them. This seems like it could be a straightforward argument, but being forced to use definitions and structured logic makes things both more complex and more streamlined. It made me think of a number of things more carefully. How is the prisoner different than the average citizen? How are civil rights different from human rights? The prisoner retains some baseline rights, but by definition is deprived of others, and also has more obligations to the state than the average citizen. But likewise, the state acquires different obligations to people when they become prisoners.

In literature, which in some ways is on the other end of the spectrum from philosophy, we also thought about prisoners, some more literal than others but the obvious one being in Kafka's The Trial, where a man is arrested for a crime that is never shared to the reader or known to the man himself. I didn't see it then but looking back, clearly there is a connection between the two disciplines in this topic--I opened my essay about the book with a line from the quintessential philosopher, Foucault: “He who is subjected to a field of visibility...inscribes in himself the power relation in which he simultaneously plays both roles; he becomes the principle of his own subjection.” This was written about the Panopticon, which is a building designed to allow prisoners to be observed without them knowing when they are being observed. A guard can stand in the center and have view of all the prisoners around them, but they can't see him. So even if the guard isn't looking at you, you feel like it is and it's your own sense of this that limits you. I became really interested in how this sense of individuality--that things are centered on you, that you have this singular relationship with the guard, that you forget about the many other prisoners around you (because you also can't see them)--is a source of imprisonment. In our society, individuality is the means of establishing identity, but in this case it can be detrimental to your sense of self. It also poses an interesting contrast to the other essay, where prisoners are asserting their individual rights.

Anyway, that's all to say that I thought a lot about these theoretical and written arguments when I started my rotation at San Quentin prison a few weeks ago and then a few days after that when we visited DeLancey Street which is a residential program for ex-convicts and would-be prisoners. Obviously these are two very different structures for a similar population of people, so it made think again of the nuances and complexity of this slice of life (which is the totality of life for some).

Our day at San Quentin started with a brief tour and an orientation on the language, rules, and etiquette of the place. But before that, the day really started with getting into the prison, which wasn't the easiest thing to do as a "regular" person. You aren't allowed to wear a million different things (blue jeans, green in any form, yellow raincoats...), and I wasn't allowed to bring in my gray hoodie which I had only meant to help me ward off rain until inside. So I had to walk around in the rain and it was freezing. Then we needed to attain what looked like something I'd call tokens but they called chits, which are round gold coins that look like they were used from the time of Game of Thrones. There are various definitions and uses of the word chit, but I think the one that might apply here is "a signed voucher of a small debt (as for food)." We turn in our chits for our key cards, which let us into the bathroom and not much else. Then we needed our alarm systems--a device we were to clip somewhere on us and strictly instructed to keep it vertical at all times--because if it leaned at all from 180 degrees it would set off a prison-wide alarm that wouldn't go off until a guard found you and was sure it was a false alarm. This is meant to alert the system if you were to fall down as the result of an attack. This seemed a little scary, but then another new medical provider set it off three times that day, twice while leaning over and once while going to the bathroom, so it became a bit less intimidating and more annoying in how self-aware it made us. At another point during the tour, a guard yelled at my co-resident for not having his driver's license on him at all times and proceeded to remind him about a half dozen times that he needed to have his ID at all times. These sorts of things gave a small, strange sense of what it might be like to live there.

Then we sat down for an orientation to the prison. I'm not sure what I expected to be oriented to, but what happened was that we were oriented to a microcosm. We learned about the different units, who was housed there and why, and the lingo for what they were called. We learned about the leader inmates of the prison, called "shot callers" who will direct the behaviors of their fellow inmates, from what type of exercises they will do in the yard to organizing hunger strikes to drug dealing. We learned about which medications aren't prescribed in prison that we routinely use in the community because they have black market value in prison.

And we learned about the bane of the primary care doctor in prison: chronos. A chrono is a request from an inmate for some type of accommodation: a cane, a back pillow, and the most common and most coveted: the lower bunk bed. At first, doctors felt happy about their ability to give, and gave anyone who asked whatever reasonable equipment they wanted--and the lower bunk. So much so that they ran out of lower bunks, since everyone wanted one and the prison is already housing 400% more than its intended capacity. And so this has become a political issue in the prison, with people vying in any way they can to attain a chrono for a lower bed, and the majority of the visit between a doctor and patient can become about attaining this form. They liken this to pain medications in the community (which are very much limited in prison), where the relationship can become very strained over different agendas. So much so that they have devised a "Chrono Clinic," which sounds a lot like "Chronic Pain Clinic." No matter how we try to structure and shape an environment, common inherent tendencies arise from anyone and everyone.

When I left for the day, I found myself relieved to turn in my alarm system. I'd felt consciously limited by it all day, trying to make sure I didn't move in ways that would set it off and have an army of guards running to me. I actually ended up loving my experience much more than I'd anticipated, but I also felt more "other" than I anticipated and it was also nice to shed that when leaving. I had that freedom.