THE SOCIAL AND CULTURAL CONTEXT OF MENTAL ILLNESS IN PRISON By JOSEPH D GALANEK MA, MPH Submitted in partial fulfillment of the requirements For the degree of Doctor of Philosophy Dissertation Adviser: Atwood Gaines Department of Anthropology CASE WESTERN RESERVE UNIVERISTY January 2012 CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the dissertation of Joseph D. Galanek Candidate for the Doctor of Philosophy degree*. Atwood D. Gaines, Committee Chair Eileen Anderson-Fye Lee Hoffer Amy Blank Wilson September 23, 2011 *We also certify that written approval has been obtained for any proprietary material contained therein. Copyright © 2011 by Joseph D. Galanek All rights reserved Table of Contents List of Tables 2 List of Figures 3 Acknowledgements 4 Glossary of Prison Terms 6 Abstract 9 Chapter 1: Introduction 11 Chapter 2: Background, Literature Review, and Research Questions 14 Chapter 3: The Research Site: Oregon State Penitentiary 34 Chapter 4: Methods 50 Chapter 5: Mentally Ill Inmates’ Relationships with Correctional Officers 94 Chapter 6: Mentally Ill Inmates’ Relationships with Mental Health Staff 132 Chapter 7: Relations Between Staff: Security, Medical, and Mental Health 165 Staff Chapter 8: Mentally Ill Inmates and Their Relationships with Inmates 188 Chapter 9: The Cultural Construction of Mental Illness in Prison 219 Chapter 10: Conclusion and Discussion 261 Appendix A: Interview Questions 288 Appendix B: Codebook 294 References 297 1 List of Tables Table 4.1 Recruitment Statistics 53 Table 4.2 OSP Inmate Sample Characteristics 54 Table 4.3 Days Housed in Disciplinary Segregation 55 Table 4.4 OSP Point Prevalence: Psychiatric Disorders 62 Table 4.5 Staff Sample Characteristics 81 Table 4.6 Inmate Interview Statistics 83 Table 4.7 Staff Interview Statistics 86 Table 4.8 Direct Observation Statistics: March 2009 – November 2009 90 Table 4.9 Interviews: Analysis Methods 92 2 List of Figures Figure 3.1 Map of OSP 36 Figure 8.1 OSP Hierarchy: An Old School Convict’s Emic Perspective 193 3 Acknowledgements This dissertation focuses on how social relationships help people in the most difficult of circumstances. This central idea has permeated my life as this work was completed, and without the support I received from family and friends, this research could not have been completed. First, I would like to thank Michelle Martello, who has supported me through all stages of this work and who has always been there for me, no matter what the cost. Michelle’s patience and love have seen me through some of the most challenging points in my life, and I am forever in gratitude for her presence in my life. I would also like to acknowledge my parents, Joseph and Barbara Galanek who have always encouraged me in my educational pursuits. Without their strong belief in the value of education and hard work, I would not be where I am today. Finally, these friends have supported me through the highs and the lows of graduate study and recognizing their friendship is important: Dr. Mark Votruba, Dr. Christian Hays, Gary Pfenning, Brad Casucci, Stephanie McClure, and Nadia El-Shaarawi. I would also like to acknowledge the support and guidance of my dissertation committee, Professors Atwood Gaines, Eileen Anderson-Fye, Lee Hoffer, and Amy Blank Wilson. Their support of this project, their suggestions, comments, and encouragements have allowed me to complete this work, and I thank them for the time and energy they have offered me during this process. Additionally, this research could not have been completed without the generous support of the National Science Foundation. This research could not have been conducted without the Doctoral Dissertation Improvement Grant I received from 4 the NSF, and I acknowledge here the contributions they have made to ensuring this project came to fruition. Finally, I would like to acknowledge the staff at Oregon State Penitentiary. Working in one of the toughest institutions in the state, they still afforded me the courtesy of their time and a willingness to participate in this research. Their service to the state of Oregon, as well as to this research should be acknowledged. Without the cooperation of the Oregon Department of Corrections, this dissertation would not exist. Finally, I acknowledge the men who are incarcerated at Oregon State Penitentiary who offered me insight, trust, respect, and their cooperation. I am grateful and humbled that they agreed to speak to me about their lives behind the wall. It is hoped that a better understanding of these men’s lives will provide the reader with insight into their challenges and offer some hope that recovery from their illness is a possibility. 5 Glossary of Prison Terms BHS – Behavioral Health Services; the mental health treatment services within the Oregon Department of Corrections. Usage: Call BHS, this guy needs to be seen; I need to see my BHS worker Blocks – Cell blocks, primarily D and E Usage: I was housed in one of the big blocks CTS – Counseling and Treatment Services; previous name for mental health services in ODOC. Used interchangeably with BHS or in conjunction depending on inmate or staff. Cellie – Cell-mate in two man cells Usage: My cellie’s real cool, we play cards all the time. Correctional Officers – Professional term used for officers in penitentiary. Usage: We’re not guards, we’re correctional officers. Cops – Correctional Officers Usage: The cops don’t bother me around here. Ding – Negative term to refer to an inmate with mental illness Usage: I got celled in with a real ding! 6 Dirty UA – receiving a positive result for drug use from a urinalysis. Usage: He got a dirty UA and got sent to the hole DSU – Disciplinary Segregation Unit; “The Hole”, “Seg” – the jail within the prison that houses inmates who have committed rule infractions. Usage: I got 30 days in Seg this time. Ed Floor – Education floor where inmates attend education classes House – A cell Usage: I don’t want the cops to come shake down my house. IMF Floor – Inmate Management Floor; offices for mental health providers, correctional counselors. Inmates are seen on this floor for scheduled appointments. IMU – Intensive Management Unit; OSP’s supermax unit – a disciplinary segregation unit in which inmates are locked down 24.5 hours/day. The prison inside of the prison. Meds – Generally refers to psychiatric medications. Usage: I need to get my meds adjusted. MHI – Mental Health Infirmary; current name for inpatient psychiatric unit. ODOC – Oregon Department of Corrections 7 OSP – Oregon State Penitentiary Pill Line – Area of control room floor where medications are distributed to inmates. Spinnin’ Out – term used to describe an inmate with psychotic symptoms or extreme emotional responses to prison stressors. Usage: This guy is spinnin’ out, call BHS. Security: General term for uniformed corrections officers Usage: Don’t do anything stupid to get security to come over here. SMU – Special Management Unit, former name for the inpatient psychiatric unit for Oregon State Penitentiary. (Pronounced “Smoo”) Usage: We gotta get this guy upstairs to SMU. 8 The Social and Cultural Context of Mental Illness in Prison Abstract by JOSEPH D. GALANEK MA MPH This dissertation investigates how social and cultural processes in a maximum security state penitentiary may mediate the course and outcome of severe psychiatric disorder for inmates. It identifies those processes which may contribute to recovery from severe psychiatric illness in prison. Participants included 20 inmates diagnosed with a severe mental illness and having high mental health treatment needs. Participants also included 23 prison staff. Through ethnographic interviews and direct observation of the prison environment, this research identifies how social processes such as relationships with staff and inmates, as well as cultural constructions of mental illness, may mediate positive outcomes for inmates with severe mental illness. In terms of social processes, inmates and staff identified that relationships with penitentiary staff were crucial for inmates’ functioning and well-being within the institution. These relationships were structured along institutional cultural ideals of respect and trust. Rather than the prison being a site of “total control”, correctional officers in particular were able to exercise a high degree of flexibility in their interactions with mentally ill inmates to ensure that these inmates received appropriate treatment. Additionally, inmates’ relationships with treatment staff were also identified as crucial to inmates’ positive functioning 9 within the penitentiary. Participants also identified that positive relations with both mentally ill and non-mentally ill inmates contributed to psychiatric stability by offering social support and opportunities to engage in pro-social activities within the institution. Cultural constructions of mental illness in the penitentiary also mediated course and outcome of psychiatric disorder. These constructions created an institutional space for these inmates that warranted a more flexible interactional style from staff. Staff reports of inmates’ complex clinical histories confounded discrete constructions of personality disorder, substance abuse disorders, and major mental illness. Further, staff and inmates identified contextual factors such as employment, appropriate housing, and coping skills as critical as pharmacological interventions for psychiatric stability within the prison. This dissertation contributes to anthropological theories