Abstract
We argue that people who are incarcerated and prison health workers are impacted by embodied institutional epistemic injustice. This particular epistemic state results in prison health workers practicing “health harm” instead of health care in prison medical wards. The paper begins by providing background data on incarceration, aging, and health. It then engages the concept of institutional epistemic injustice by framing it as an epistemic component of nonideal theory through the work of Charles Mills and Elizabeth Anderson, and then extending their arguments to understand institutional epistemic injustice as an activity of institutional structures that is imposed on people and embodied. This embodied understanding of institutional epistemic injustice is applied to understanding the health and health care of people who are aging in the U.S. carceral system. It does so by analyzing the effects of this embodied epistemic state on people who are incarcerated and the people who are responsible for caring for their health. We argue that prison health workers take on the harm mentality of the carceral system engaging their patients as prisoners and not as patients. They thus engage in health harm and not health care in their relationship with people who are in their medical care. We end with some key epistemic strategies derived from epistemic injustice and applied to the health and health care of people who are ill, aging, and dying in prison.
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Notes
- 1.
One challenge with data assessing for projects such as this is that, in general, while most institutions use 50 years of age as the mark for an elderly inmate, some use 55. The same institutions will sometimes use data categories of for example, 45–54 and 55–64 in one document and then 40–49 and 50–59 in another. This lack of standardization is curious and unfortunate, but one can still find trends in data related to aging even with some of this muddiness of data.
- 2.
Note that this age range does not include people between the ages of 50–54, who are included in the federal statistics.
- 3.
The last unique data set the Bureau of Justice Statistics published on women was in 2000. It is thus challenging to get specific data on women from the U.S. Department of Justice.
- 4.
Although Blacks and Latinxs are more likely to be arrested than whites, they are less likely to be diagnosed with mental illness than whites prior to and while incarcerated. This doesn’t mean that Blacks and Latinxs are more or less likely to have mental illness, but that they are not being diagnosed or treated for it. See, for example, Prins et al. “Exploring mental racial disparities in the brief jail mental health screening” (2012) for an analysis of racial biases in mental health screening.
- 5.
Stacy Clifford Simplican in The capacity contract (2015) takes up a related challenge to Mills’s work by arguing that Mills’s critique of ideal theory, Rawls in particular, relies upon the construction of “ideal cognitive capacities as the source of inequality,” for which the corrective is the “production of heightened cognitive skills” (88). However, for people with intellectual disabilities this reliance on heightened cognitive skills as the primary source of emancipation and the construction of certain positions as “ignorant” is highly problematic because of the ways “ignorant/cognizant maps on to morally right/wrong” (88). Shelley L. Tremain raises similar concerns about Mills’s terminology and the potential outcomes of this stance in Foucault and feminist philosophy of disability (2017). These arguments lend support for the need to understand that epistemic injustice, as an embodied account, needs further clarification.
- 6.
Nancy Arden McHugh provides an analysis of a range of health and embodied epistemic injustice issues in relationship to mass incarceration through the experiences of women of color, including the unique experiences of incarcerated transwomen and women who are immigrants, in “Epistemic deadspace: Prisons-politics-place” (2021).
- 7.
Structural violence is a term that originated by Johan Gatlung in his 1969 article “Violence, peace and peace research” and is now used widely in health justice to indicate the ways that social inequalities can inflict poor health outcomes on marginalized communities. Gatlung describes structural violence as: “There may not be any person who directly harms another person in the structure. The violence is built into the structure and shows up as unequal power and consequently as unequal life chances” (171).
- 8.
As we develop an embodied view of institutional epistemic injustice we are employing arguments made by Foucault in Discipline and punish (1977) and are building upon arguments made by the LoCI-Wittenberg University Writing Group in “An epistemology of incarceration” (2016), which Nancy Arden McHugh was a member of, as well as José Medina’s Epistemology of resistance (2013) and Lisa Guenther’s Solitary confinement (2013).
- 9.
Sentence length is also affected by time added to sentences while in prison. Black men who are incarcerated are more likely to have time added from disciplinary infraction because they are more likely to be given disciplinary tickets for the same behavior than their white counterparts. They are also more likely to receive solitary confinement and longer time in solitary confinement than their white counterparts. See, for example, “The scourge of racial bias in New York State’s prisons,” (Schwirtz et al. 2016). Although women are sentenced to less time than men, they are more likely (two to three times more likely) to get tickets for nonviolent infractions than men are, for such “infractions” as “reckless eyeballing” and “disrespect.” Furthermore, some women are more likely to receive tickets for minor infractions than others: “women with mental illness, those who are lesbian, bisexual or transgender, African-American women” (Shapiro et al. 2018). In “Epistemic deadspace: Prisons-politics-place,” (2021) Nancy McHugh engages the effects of disciplinary bias on epistemic agency.
- 10.
Although the focus in this chapter is on elderly people who are incarcerated, many people who are incarcerated experience health harm. See Andrea J. Pitts’s “Examining carceral medicine through critical phenomenology” (2018) and Nancy McHugh “Epistemic deadspace: Prisons-politics-place” (2021) for examples of carceral health harm in relationship to gynecological care. Pitts provides a phenomenological account of the experiences of Jennifer Poteet at the hands of her doctor who dismisses her childhood sexual trauma as irrelevant and an “inconvenience” for caring for her gynecological needs (Pitts 2018, 27, quoting Poteet). McHugh examines the role of epistemic violence in Dr. James Heinrich’s forced sterilization of 144 women in California’s women’s prisons.
- 11.
This is not to say that all prison health care providers are under qualified or undertrained nor do we want to say that none of them care about their patients in a carceral setting. As the website, correctionalnurse.net indicates, there are carceral health care workers who do care about their patients who are incarcerated. Our argument is that the carceral system functions on a harm mentality that works to shutdown the caring mission of nursing and other health care providers in a carceral setting, and that a substantial amount of intentionality would be required to resist the harm mentality of incarceration.
- 12.
See, for example, the arguments that Angela Davis makes in Are prisons obsolete? (2003) which challenges her readers to denaturalize the prison system and recognize it as a chosen product of capitalist and patriarchal norms, not an inevitability.
- 13.
This raises the important question of whether prisons as institutions of punishment and harm can ever be sites of care. Thus, essentially pitting the care duties of health care providers directly against the harm goals of incarceration.
- 14.
Although there is a fair amount of evidence that prison health care work is compromised, it is also important to note that there are many excellent and dedicated prison health care workers who intentionally devote their careers and training to this type of work. These workers are the ones that are likely the best positioned to engage in the sort of strategies that we discuss in this section and we don’t want to dismiss their value or work.
- 15.
See Anthony Ryan Hatch (2019) Silent cells: The secret drugging of captive America for a detailed description of the over medicating of people who are incarcerated, making them prisoners that are more docile.
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Acknowledgments
Thank you to James Mathews, José Medina, Andrea J. Pitts, and Gaile Pohlhaus for their critique and insight on drafts of this paper.
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McHugh, N.A., Cleveland, C. (2021). Incarceration, Health Harm, and Institutional Epistemic Injustice. In: Victor, E., Guidry-Grimes, L.K. (eds) Applying Nonideal Theory to Bioethics. Philosophy and Medicine, vol 139. Springer, Cham. https://doi.org/10.1007/978-3-030-72503-7_13
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