THE IMPRISONED BODY: WOMEN, HEALTH AND IMPRISONMENT CATRIN SMITH THESIS SUBMITTED FOR THE DEGREE OF DOCTOR OF PHILOSOPHY (SEPTEMBER 1996) DbEFNYDDIO TN er LLYFRGELL, Th U.= TO tE CqNSULTED 11BRARY UNIVERSITY OF WALES, BANGOR SCHOOL OF SOCIOLOGY AND SOCIAL PO I was never allowed to forget that being a prisoner, even my body was not my own (Maybrick, 1905 :112). The idea that law has the power to right wrongs is persuasive. Just as medicine is seen as curative rather than iatrogenic, so law is seen as extending rights rather than creating wrongs (Smart, 1989: 12) Abstract Problems affecting the female prison population have become increasingly acute. In response to a spirit of 'toughness' in penal policy, the number of women prisoners has grown sharply and more women are being sent to prison despite arguments in favour of decarceration and alternative sanctions. In prison, women make greater demands on prison health services and are generally considered to carry a greater load of physical and mental ill-health than their male counterparts. However, a gender-sensitive theory based on an understanding of the relationship between women's health and women's imprisonment has not been formulated. Health is a complex phenomenon of inseparable physical, mental and social processes. Research conducted in three women's prisons in England set out to explore the relationships between these processes. Data were generated from group discussions, in-depth interviews, a questionnaire survey and observation and participation in 'the field'. The findings suggest that women's imprisonment is disadvantageous to 'good' health. Deprivations, isolation, discreditation and the deleterious effects of excessive regulation and control all cause women to suffer as they experience imprisonment. These are not medical problems. Yet, they often become so once they cause, as they inevitably do, stress and anxiety. The woman prisoner who finds herself unable to cope is likely, eventually, to come into contact with the prison medical enterprise where a medicalised view of suffering de-politicises the significance of women's distress. Social and cultural factors in women's pre-prison and prison lives interact to influence their health and their freedom to choose 'correct' health behaviours. While different in degree, the problems facing women prisoners are of the same kind as those they face in their outside lives and the same kinds of 'solutions' are adapted to deal with them. Such solutions often have unforeseen consequences which can intensify the pains of imprisonment and be further prejudicial to health. These findings raise questions about the philosophies underpinning current models of prison health care where the benevolent aims of 'health promotion' may become extremely punitive. Contents List of tables and figures viii Preface ix Acknowledgements xi Introduction 1 1 Women, health and imprisonment : Some 13 theoretical considerations The body, power and self-identity Women, medicalisation and social control Power, legitimacy, adaptation and resistance 2 In 'the system' : Becoming a prisoner 64 The law The police The courts From court to prison 3 The imprisoned body : Regulation, control 96 and self-identity Women's imprisonment : Some facts and figures Regimes for women The experience of imprisonment : deprivations and sources of suffering 4 Reacting and adapting : Women's responses 135 to imprisonment Cutting-off Making good Kicking-off Substance use, the body and the self Self-harm 5 Health, health care and the regulated body 188 'Sick' women? : Patterns of ill-health in women prisoners The Utilisation and organisation of prison health services Power relations and the medical encounter in women's. prisons 6 'Healthy Prisons' : A contradiction in terms? 243 'Healthy Prisons' : The institutional context of health promotion Health promotion : Rhetoric and reality A captive audience : Health promotion in women's prisons A medical solution? : Some concluding thoughts Appendices : 1 Breaking in : Researching women's imprisonment 271 Research question, design and methods Doing prison research : From physical to social access 2 Dramatis personae 300 3 Health Survey : Summary statistics 306 4 Interview guide : Prisoners 320 References 324 Tables and figures TABLES 3.1 Concerns relating to problems outside prison 114 5.1 Non-specific health problems 197 A1.1 Questionnaire survey : Response rate 295 A3.1 Age distribution of respondents 306 A3.2 Marital status of respondents 306 A3.3 Ethnic origin of respondents 307 A3.4 Respondents with children 307 A3.5 Current location of children 307 A3.6 Socio-economic factors 308 A3.7 Normal place of residence 308 A3.8 Usual type of accommodation 308 A3.9 Usual occupation 309 A3.10 Current status 309 A3.11 Sentence length 309 A3.12 Main offence/charge 310 A3.13 Prison status 310 A3.14 Long-term health problems 312 A3.15 Non-specific health problems 312 A3.16 Psycho-social concerns 313 A3.17 Prescribed medications 314 A3.18 Current and previous substance use 314 A3.19 Access to medical officer 315 A3.20 Contact with medical officer 315 A3.21 Preferences for male/female doctor 316 A3.22 Contact health professionals 316 A3.23 Helpfulness of different kinds of services 317 A3.24 Aspects of prison life : prisoners' ratings 318 A3.25 Concerns in prison 319 A3.26 Dealing with a problem 319 A3.27 Staff-prisoner relations 319 FIGURES 5.1 General health rating 196 5.2 Health care rating 239 A3.1 General health rating 311 A3.2 Long-term health problems 311 A3.3 Health care rating 316 Preface HEALTH WARNING: IMPRISONMENT MAY DAMAGE WOMEN'S HEALTH Women prisoners have been receiving a lot of attention of late : mothers shackled at funerals; pregnant prisoners chained in labour wards; hangings at Holloway; Inspection teams beating a hasty retreat; women banged-up for 23 hours a day; 'battery-hen' cells; jail drug abuse shocks, et cetera, et cetera. For journalists, 'this is such stuff as dreams are made on'. Coronation Street, Brookside and Eastenders have all had their fair share of ljail-birds'. The popular imagination, it seems, has been captured. At the centre of the debate rests one fundamental issue : how best to deal with women law-breakers. This debate is by no means new. Feminists have been theorising about women and crime and women's imprisonment for the past couple of decades and it is no longer possible to introduce a study such as this with the assertion that there is virtually no information on the subject. In this thesis I hope to extend and build upon feminist work by analysing women's health and imprisonment. The thesis is about a particular group of women who do not fit a certain stereotype. It is about the ways in which doctors, psychiatrists, police officers, members of the judiciary, probation officers and prison officers seek to control those women who will not or cannot conform to conventional categories of womanhood. It is about women's bodies and the ways in which the social construction of femininity affects women's health. The constraints and contradictions within notions of appropriate femininity make the achievement of healthy womanhood problematic. The thesis tells the stories of women prisoners. However, these are also the stories of women and, in this respect, the thesis is about all women. Women prisoners suffer the same problems as the rest of us. Once you get over the awesome fact of imprisonment itself, the difference may not be so much in nature as in degree. The greatest problems for women - the problems which may or may not lead to them offending - are social and are widespread. However, the tendency in Western societies has been to address social and political issues as problems of individual pathology. As a result, women in general and women prisoners in particular have been increasingly exposed to the gaze of those whose 'expert' knowledge informs our criminal justice, health care and social systems. That gaze, which captures women prisoners in a medico-legal niche, effectively leaves their offending behaviour unexplained. While they are probed, tested, treated, punished, they are rarely understood. What I hope to reveal in this thesis is that what women prisoners need is not 'treatment', 'therapy' or medical intervention in their lives, but rather 'healthy' public and penal policies. Acknowledgements One changes a lot in the course of an academic apprenticeship such as this you develop new patterns of thought, new sources of hope as well as cynicism. I would like to thank all those individuals who directed me, and distracted me, along the way. First of all, I would like to thank all the staff and prisoners who gave of their time, their trust and their histories. Two women prisoners, in particular, gave me hope through their good humour and perseverance : you know who you are. The research was supported by a University of Wales studentship, for which I am particularly grateful. Throughout the time in which I was engaged on this work I received help, advice and much encouragement from a number of people : including, Dr Rosemary Wool, Derek Aram, Yvonne Willmott, Wendy Atkinson, Norah Betts, Pam Shaw, Derek Senior, Joe Sim, Francès Heidensohn, Mary Eaton, Chris Tchaikovslcy, and many, many more. Thank you. I have to thank Chris Powell and John Borland for all their helpful comments over the past four years. And, for his continuing interest, guidance and critical observations, I thank my supervisor, Professor Roy King. Finally, I'd like to thank Meg and Den for their continuing support and encouragement (and for trying to teach me how not to split my infinitives!) and Jen for buying me that beer that day. And, a special thank you has to go to Simon for just being there (in spirit if not in body), when I needed you most ..