University of Pennsylvania ScholarlyCommons Publicly Accessible Penn Dissertations 2016 Wards Of The State: Care And Custody In A Pennsylvania Prison Nicholas Iacobelli University of Pennsylvania, [email protected] Follow this and additional works at: https://repository.upenn.edu/edissertations Part of the Public Health Education and Promotion Commons, and the Social and Cultural Anthropology Commons Recommended Citation Iacobelli, Nicholas, "Wards Of The State: Care And Custody In A Pennsylvania Prison" (2016). Publicly Accessible Penn Dissertations. 2350. https://repository.upenn.edu/edissertations/2350 This paper is posted at ScholarlyCommons. https://repository.upenn.edu/edissertations/2350 For more information, please contact [email protected]. Wards Of The State: Care And Custody In A Pennsylvania Prison Abstract In this dissertation, I examine the challenges and contradictions as well as the expectations and aspirations involved in the provision of healthcare to inmates in a maximum-security prison in Pennsylvania. In 1976, the Supreme Court granted inmates a constitutional right to healthcare based on the notion that a failure to do so would constitute “cruel and unusual punishment.” Drawing on two years of ethnographic fieldwork from 2014-2016 in the prison’s medical unit with inmates, healthcare providers, and correctional staff, I demonstrate how the legal infrastructure built around this right to healthcare operates in practice and the myriad effects it has for those in state custody. Through traversing the scales of legal doctrine, privatized managed care, and collective historical memory, bringing these structural components to life in personal narratives and clinical interactions, I advance the notion that the physical space of the prison’s medical unit is a “ward of the state” – a space of care where the state itself is “made” through interactions among individuals who relay and enact the legal regulations on inmate healthcare. I also argue that incarcerated men themselves are cast as “wards of the state” – the biological and financial property of the state placed in its custody. As such, the state has an obligation to care for inmates as quasi-citizens who are granted a right to healthcare in the setting of rights deprivation as punishment. Even though this right primarily exists as a mandate not to inflict oot much harm, it also creates the conditions for which inmates come to rely on the state for life-saving and life-sustaining services, perpetuating historical forms of racial subjugation through care and containment in the process. Finally, I outline the paths inmates make for themselves to find meaning amidst the multitude of losses they experience and to seek belonging amidst disenfranchisement. While the forms of legal, personal, and political recognition that are available to inmates are few, the structural features of an institutionalized right to healthcare open up spaces for them to envision futures and to make both personal and structural appeals to justice with both tragic and hopeful consequences. Degree Type Dissertation Degree Name Doctor of Philosophy (PhD) Graduate Group Anthropology First Advisor Philippe Bourgois Keywords Healthcare Rights, Medical Anthropology, Prison Ethnography, Public Anthropology Subject Categories Public Health Education and Promotion | Social and Cultural Anthropology This dissertation is available at ScholarlyCommons: https://repository.upenn.edu/edissertations/2350 WARDS OF THE STATE: CARE AND CUSTODY IN A PENNSYLVANIA PRISON Nicholas Iacobelli A DISSERTATION in Anthropology Presented to the Faculties of the University of Pennsylvania in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy 2017 Supervisor of Dissertation: ____________________________ Philippe Bourgois, Ph.D. Professor of Anthropology, University of California, Los Angeles Graduate Group Chairperson: ____________________________ Deborah Thomas, Ph.D. R. Jean Brownlee Term Professor of Anthropology Dissertation Committee: Frances Barg, Ph.D. M.Ed., Associate Professor of Family Medicine and Community Health Adriana Petryna, Ph.D. Edmund J. and Louise W. Kahn Term Professor in Anthropology Deborah Thomas, Ph.D. R. Jean Brownlee Term Professor of Anthropology WARDS OF THE STATE: CARE AND CUSTODY IN A PENNSYLVANIA PRISON © 2017 Nicholas Iacobelli Acknowledgements I first have to express my sincerest gratitude to everyone at State Correctional Institution Graterford for sharing their time, patience, trust, and knowledge with me and graciously sharing their lives and experiences. The healthcare providers were more than accommodating, letting me intrude on their clinical practice and opening themselves up to discussions of difficult topics. The willingness of the administrative staff at Graterford and the officials on the Department of Corrections Research Review Committee to allow my research should serve as a model for other institutions in the service of demonstrating a commitment to openness, academic advancement, and understanding a system that has such a profound impact on the lives of so many Americans. The entire staff at Graterford deserves thanks for allowing me to conduct my research with a considerable degree of freedom – a commodity in short supply there. I especially want to thank Joseph Korszniak and Dr. Nicholas Scharff for being advocates of my work to the PA DOC and superintendents Michael Wenerowicz and Cynthia Link for their administrative support and facilitating access to the prison. Finally, and most importantly, I want to thank those who were (and many who still are) incarcerated there for sharing their thoughts, experiences, and struggles with me. Thank you for investing your time and trust in an awkward and naïve graduate student. I hope I have done justice to your words and participation in my research. This work could not have been completed were it not for the generous assistance from the members of my dissertation committee. Fran Barg served as a source of confidence and continuously pushed me to consider the broader scope of my research and work at the intersection of anthropology and medicine. Deb Thomas pressed me to be more ambitious and rigorous, providing key structural and analytical insights. Adriana Petryna provided a crucial critical eye, boundless faith, and a constant reminder to honor and illuminate peoples’ experiences. Finally, Philippe Bourgois has remained a steadfast supporter of my work and shepherd of my intellectual growth since before starting graduate school. His constant reminders of the joys and importance of conducting difficult, high-stakes fieldwork guided me through the more challenging moments of iii research and writing. I also received wonderful support and feedback from faculty in the Penn School of Arts and Sciences: Nikhil Anand, Kamari Clarke, Mary Frances Berry, Marie Gottschalk, Lisa Mitchell, and Jason Schnittker. Thanks also to John Hollway and David Rudovsky at the University of Pennsylvania School of Law who helped ground my philosophizing on prison healthcare law. I am also extremely grateful for advice and support from the administrative staff in the Medical Scientist Training Program at the Perelman School of Medicine, including especially Maggie Krall and Dr. Lawrence “Skip” Brass. Outside of Penn, I benefitted from conversations about the work and encouragement from Miriam Ticktin, Kathyrn Henne, Clara Han, and Laurence Ralph as well as administrative help and logistical guidance from Madeline deLone at the New York Innocence Project. To my classmate in the MD-PhD program and great friend Utpal Sandesara I owe my eternal gratitude. If not for his continued support, encouragement, deep insight, and unrelenting motivation I may never have developed the courage to write at all. Along the way I also benefitted from the feedback, suggestions, and camaraderie of my other colleagues in the Penn MD-PhD program in Medical Anthropology and the History and Sociology of Science, especially Josh Franklin, Michelle Munyikwa, Sara Rendell, Lee Young, Ben Sieff, Alex Chen, and Luke Messac and comments and edits from fellow students within Anthropology, especially Katherine Culver, Tali Ziv, and Negar Razavi. I also want to thank Kimberly Sue and Caroline Sufrin for being encouraging role models for conducting fieldwork on healthcare in carceral settings, and Puneet Sahota for her mentorship as a physician-anthropologist and her feedback in the development stages of this project. The research for this dissertation was possible with the generous support of the National Science Foundation Doctoral Dissertation Research Improvement Grant, a dissertation fieldwork grant from the Wenner-Gren Foundation, and support from the Penn Medical Scientist Training Program. Dissertation writing was supported with a University of Pennsylvania School of Arts and Sciences Dissertation Completion Fellowship. iv ABSTRACT WARDS OF THE STATE: CARE AND CUSTODY IN A PENNSYLVANIA PRISON Nicholas Iacobelli Philippe Bourgois In this dissertation, I examine the challenges and contradictions as well as the expectations and aspirations involved in the provision of healthcare to inmates in a maximum-security prison in Pennsylvania. In 1976, the Supreme Court granted inmates a constitutional right to healthcare based on the notion that a failure to do so would constitute “cruel and unusual punishment.” Drawing on two years of ethnographic fieldwork from 2014-2016 in the prison’s medical unit with inmates, healthcare providers,