America is a Prison; Cultural Hegemony and the Mental Health Professions - Who are we working for...

CULTURAL HEGEMONY IN MENTAL HEALTH: WHO ARE WE WORKING FOR ANYWAY? 1

America is a Prison; Cultural Hegemony and the Mental Health

Professions - Who are we working for anyway?

Sarvenaz Moshfegh Asiedu

Goddard College

“Prisons are really an extension of our communities. We have

people who are forced at gunpoint to live behind concrete and

steel. Others of us, in what we ordinarily think of as the

community, live at gunpoint again in almost the same conditions.


The penitentiaries, as they call them, and the communities are

plagued with the same thing: dope, disease, police brutality,

murder, and rats running over the places that you dwell in…

America is the prison. All of America is a prison where the

people are being held captive by the real arch criminals. –ZaYd

ShakUr, 1970” (Bernstein, 2010, p.1).

Abstract

In this paper I will be exploring the cultural beliefs implicit

in the field of psychology that support hegemony.

We human beings don’t like feeling responsible: as

individuals for our own actions; as parents for our

children’s hurts; or as a society for our many failings.

(Mate’, 2010, p.218)

“The reason we might continue with a system shown to be fatally

flawed is because awareness of the flaw produces an experience of

such anxiety that rather than face the issue head on and create


an alternate world we find greater ‘security’ in the attempt to

rebuild the one that is broken. (Curtis, 2013, p.1)

Introduction

I walked behind my supervisor, a thin blond white lady in her 50’s in the dim

hallway, heavy steel doors wall to wall on both sides, cement floor. I felt fear, and

despair and powerlessness. Behind each door was a man confined, punished for some

alleged infraction of the jail’s rules, from having an extra candy bar in their cells or

refusing to go back to their cells. I was there as a mental health intern, shadowing my

supervisor as she checked on each man in “the hole” to make sure no one wanted to kill


themselves – or at least to check off that someone had asked them. Some put in notes

to the mental health staff, reaching out for help. We spoke to them through a slit in the

side of the locked heavy door.

“I’m not doing good. I’m real depressed. I miss my kids. I’m losing it.”

My supervisor listens compassionately. What can she offer them? If they

say they want to harm themselves or are out of control, they will be shackled and

brought to the infirmary, stripped naked and put in the “turtle suit” into a cell with a

camera, watched from the infirmary bubble. Inmates that see mental health cannot be

seen by their counselors (graduate interns) while they are in segregation or in crisis.

The only thing she can say is that she will check in on them and to put in a slip if they

feel worse and want to come to the infirmary. No visits in “the hole”. 45 minutes of

time outside the cell per day.

In my time there, I’ve known people to stay in segregation for up to three

weeks, which is supposedly the maximum in the county jail. In state prisons, there is no

maximum time in isolation. Some do years or decades.

My story starts in this dark, smelly place, of men young and virile, men old

and worn out, men that won’t stop fighting, men that have given up. Who are the


players? There’s the inmates, the cops (correctional officers), the case workers, drug

counselors, the medical staff (nurses mostly and doctors) and the mental health staff

(one LSCSW, one psychiatrist, one Doctorate level psychologist and a few interns per

thousand inmates) (Middlesex House of Corrections, 2014, n/p). Who’s the boss? The

cops of course.

There is nothing ethical about incarceration. There is no ethical way to be

complicit in the torture, degradation, and humiliation of animals, let alone human

beings, stripping them naked and handing them like objects, because they have been

convicted of breaking the law, or are suspected of breaking the law. When does a

person become dehumanized? When they challenge power? Or when their existence is

a threat to power?

The primary role of mental health within a correctional institution is not

therapeutic; it is in service to the institution to attend to the vulnerable guard against

claims of neglect. Standards of treatment are not equal to that on the outside. Medical

and mental healthcare is dispensed reluctantly as a “privilege”. Men are constantly

accused of malingering. Why would someone fake a urinary tract infection? “They just

want attention.” One man in the infirmary had to have his testicle amputated due to

negligence. One weak and pale from prostate cancer, is shackled hands and feet to the


chair in the hospital when he receives his chemo. Any words of impatience, discontent,

towards the staff are punished. “Let him wait.”

Mental health professionals are all required to study ethics and to agree

to uphold the “Code of Ethics”. Within any correctional institution, the mental health

staff is expected to follow the rules of the institution, and conform to the culture of the

institution. There is no guarantee of confidentiality. Patients are spoken about between

staff without dignity or discretion. Cries for help and answered by insolation and

punishment. Psychiatric prescription is restricted by institutional policy, often resulting

in underdosing. Survivors of sexual abuse suffering from severe symptoms of post-

traumatic stress are confined for 22 hours a day, strip searched at any moment, forced

to shower with other men. The majority of inmates are chronic drug addicts, locked up

for property crime, their disease arrested for months or years, only to be released onto

the streets.

“They did it to themselves.” “Anti-social personality” “emotionally

disregulated” “no impulse control” “piece of shit junky” “drug-dealing scumbag”

“heartless gangbanger” “thief” “crackhead” “knucklehead” “punk” “manipulator”

“institutionalized” “homeless”


Researching the current role of psychologists within the prison system and the

lack of response to injustice causes me to reflect on the mental health profession as a

whole.

There is no neutrality in the face on oppression. There is only solidarity or

consent. In the words of Judith Herman (1997):

When the traumatic events are of human design, those who bear witness are

caught in the conflict between victim and perpetrator. It is morally impossible to

remain neutral in this conflict. The bystander is forced to take sides.

It is very tempting to take the side of the perpetrator. All the perpetrator asks is

that the bystander do nothing. He appeals to the universal desire to see, hear,

and speak no evil. The victim, on the contrary, asks the bystander to share the

burden of pain. The victim demands action, engagement, and remembering”

(loc 96-7).

America is a Prison; Cultural Hegemony and the Mental Health

Professions - Who are we working for anyway?

The American Psychological Association Code of Ethics (2014)

was written primarily retro-actively, in response to lawsuits and

complaints, focusing its language on research and treatment of


people as individuals. The only mention of the psychologist’s

relationship with society is in the preamble:

Psychologists are committed to increasing scientific and

professional knowledge to improve the condition of

individuals, organizations, and society. Psychologists

respect and protect civil and human rights and the central

importance of freedom of inquiry and expression in research,

teaching, and publication.

(APA, 2014, p.3)

Mainstream psychology and mental health fields avoids

addressing systemic problems, taking an individualistic and non-

political approach in addressing well-being. Unfortunately, by

taking a neutral stance, professional psychologists and

psychology as a field tacitly consent to systems of oppression.

History of Psychology as a Tool of Oppression

“Once we accept that power and interests affect what we do,

we don’t accept the premise that research is neutral, that


interventions are not affected by politics, and that we are just

healers” (Prilleltensky & Nelson, 2002, p.6)

In the education of mental health professionals, there is a

scarcity of critical inquiry of the political basis of

psychological theories and research. Standard textbooks relay

the history of psychology as apolitical, thus ignore the

unflattering practices of the past and present, that helped to

shape and support the prosperity of the few: economic disparity,

the obscuring of national liberation movements, white supremacy,

economic and psychological violence against women and people of

color, internalized oppression, xenophobia, consumerism, the

fragmentation and destruction of Native American communities, the

continued racial oppression of African Americans, and the growth

of the prison industrial complex (Prileltensky,2002; Haney, 1997,

p.500). Only when we endeavor to understand the function of

psychology within a socio-political context, can we begin to

understand its influence in shaping human experience through

culturally implicit internalized beliefs and motives

(Prilleltensky & Nelson, 2002, p.6).


Power

Critical psychologists, Prilleltensky & Nelson (2002) define

power as “the capacity and opportunity to fulfill or obstruct

personal, relational, or collective needs” (Prilleltensky &

Nelson, 2002, p.7). Power can be applied to self, others and

collectives having “varying degrees of awareness” of how their

actions impact others (Prilleltensky & Nelson, 2002, p.7).

Power is variable, intersectional and contextual. Social

class, gender, ability, and race can be factors in power

differentials, as well as valued cultural attributes such as

beauty, intelligence, and assertiveness. Power is dynamic within

a particular setting, relationship and individual (Prilleltensky

& Nelson, 2002, p.7). “The outcome of power is based on the

constant interaction and reciprocal determinism of agency and

contextual dynamics” (Prilleltensky & Nelson, 2002, p.7). Agency

is the individual’s or collective’s ability and volitional

activity and the contextual dynamics are made up of opportunities

based on social and historical circumstances (Prilleltensky &

Nelson, 2002, p.7).


Power in American society is not always expressed through

coercion. The population internalizes “cultural prescriptions”

and self-regulates by restricting their life choices to fit the

status quo (Prilleltensky & Nelson, 2002, p.7). Internalized

oppression and social prescriptions motivate people often outside

of their conscious awareness, which means that actions and

behaviors may not evolve from innate desires but from

“internalized social prescriptions” (Prilleltensky & Nelson,

2002, p.8). Humanistic approaches to treatment are well meaning,

but can cause people to blame themselves for unconscious beliefs

that are motivated by social oppression (Prilleltensky & Nelson,

2002, p.8).

History of the American Prison System

The use of punishment is justified by modern Western

judicial systems based on retribution, deterrence, incapacitation

and rehabilitation (Grillor, 1983; Kerper, 1972 as cited by

Weinberger & Sreenivasan, 1994, p.161): retribution comes from

the Biblical notion of “an eye for an eye”, deterrence is based

on the idea that punishing one sets an example for others,


incapacitation renders the offender unable to re-offend and

rehabilitation is the treatment or “correction” of offenders in

order to re-enter society (Weinberger & Sreenivasan, 1994,p.161).

Rehabilitation during early colonial times was believed to

be accomplished through severe punishment in the form of stocks

and gallows (Weinberger & Sreenivasan, 1994, p.161). Through most

of the 17th century, criminals were viewed as persons who had

“wandered astray” which put an internal limit to their treatment

by the community (Haney, 1997, p.516). In the eighteenth

century, Protestant values influenced the belief that

institutional rehabilitation would be achieved through solitude,

hard labor and contemplation, which evolved into “penitentiaries”

(Weinberger & Sreenivasan, 1994, p.161). The American colonies

at this time were sparsely populated and social control

concentrated on “biblical” offenses such as adultery and

blasphemy rather than property crime (Haney, 1997, p.516). The

“alleged wickedness” of criminals and the causes of crime were

debated in popular discourse in the 19th century which had a

great influence on prison policy and operations (Haney, 1997,


p.516). Psychological theories played a key part in the

transformation of social consensus about crime (Haney, 1997,

p.516).

Psychological individualism was the nineteenth-century

concept that facilitated the creation of a vast prison system and

made confinement the first response of the criminal justice

system (Haney, 1997, p.516). The belief in the “perfectibility

of human nature” created the use of the prison as a place where

change would be coerced in the individual (Haney, 1997, p.516).

Physical control was believed to be needed for successful

rehabilitation“ (Haney, 1997, p.516).

Psychological theories in the science of human behavior

convinced the public that penal policy was a science (“prison

science”) (Haney, 1997, p.517). Metaphors such as “crime-as-

sickness” and “moral disease” were popular along with the genetic

or biological theory of the “born criminal type” (Haney, 1997,

p.517). Penology was perceived as a methodical system “in accord

with the true science of our common human nature” (Haney, 1997,

p.517). Parole, vocational training, early release for good


behavior and individualized treatment were introduced during this

time based on the medical model (Weinberger & Sreenivasan, 1994,

p.161).

Individualistic psychology became more prominent in penology

in the first half of the 20th century (Haney, 1997, p.517).

Indeterminate prison sentences were introduced, which determined

release entirely on demonstrating personal transformation (Haney,

1997, p.517). Juvenile courts shifted the focus from the nature

of the offense to the character of the child and probation

officers were created to intervene in and observe individuals

once they were released from prison (Haney, 1997, p.517).

Psychological experts were relied upon directly to make decisions

concerning all aspects of the penal system and the practice of

classification of prisoners based on their personal

characteristics (Haney, 1997, p.517). Psychiatrists and

psychologists took posts inside prisons for the first time during

this period, though their role was narrow, primarily to

legitimize incarceration and underline the message that crime was

a product of the pathology of criminals (Haney, 1997, p.519;


Weinberger & Sreenivasan, 1994, p.161). Until the 1970s,

psychologists played minor roles setting limits to prisoner

cruelty and in rehabilitation (Haney, 1997, p.519).

Shifts in psychological concepts of social behavior that

emphasized social context during the 1970s could have made an

impact on the penal system had they not been displaced from

positions of any influence during this time (Haney, 1997, p.519).

The 1970s were an era of prison reform; the trial of Angela Davis

brought the conflict to the greater public and prisoners agitated

for unions and political organizations (Bernstein, 2010, p.4).

Prison activists such as George Jackson helped inmates to

understand their confinement from political and historical

perspectives, and hoped to inspire large-scale revolt (Bernstein,

2010, p.2). Reactionary political views influenced public

opinion over any evolution in thinking about crime and punishment

(Haney, 1997, p.521).

There was little commentary or analysis in the field of

psychology concerning the changes in promoted political movements

concerning incarceration (Haney, 1997, p.521). Robert Martinson


published an influential article in the 1970s that stated that

“nothing works” in prison rehabilitation and that attempts at

rehabilitation of criminals was futile (Haney, 1997, p.521). The

programs he evaluated were highly limited based on meager budgets

and did not take into consideration the conditions for inmates

once they were released (Haney, 1997, p.517). This opinion was

accepted and rehabilitation lost favor in public opinion (Haney,

1997, p.523). This evolved into the attitude that since prison

was not a place for rehabilitation, it was simple that punishment

should be graded based on blame and the purpose of prison was to

punish (Haney, 1997, p.523). Indeterminate sentences were

replaced with mandatory minimum and maximum sentences based on

the criminal act itself (Haney, 1997, p.524). It did not matter

who or why the person committed the act (Haney, 1997, p.524).

This shifts the focus from the character of the individual and

individualizes the crime (Haney, 1997, p.524).

The rejection of rehabilitation and the institution of “just

deserts”-based sentencing eliminated any clear mandate for

institutional programming (Haney, 1997, p.525). Less programs,


less incentives to participate as sentences were fixed, and

massive overcrowding caused serious disciplinary problems in some

institutions (Haney, 1997, p.525). Since the goal of prison was

now punishment and no longer reform, public and legal concerns

about psychological destructive practices in prison were

dissipated (Haney, 1997, p.525). The role of the psychologist in

the prison system changed during the 1970s and 1980s,

deemphasizing treatment for security and public safety

(Weinberger & Sreenivasan, 1994, p.161). Psychologists remain in

this role today.

Present Day

The sheriff or warden of institutions has authority over

chief psychologists and other mental health department heads and

has the final word in implementing policy regarding mental health

(Weinberger & Sreenivasan, 1994, p.162). Justification for

placing mental health under correctional administration is that

resources are more available and psychologists would not be seen

as outsiders by the staff (Weinberger & Sreenivasan, 1994,

p.162). There is in fact very little money devoted to mental


health and medical health in the US prison system. Placing

mental health under the jurisdiction of the institution means

that ethical issues brought to the attention of heads of

psychology are not resolved due to their lack of authority

(Weinberger & Sreenivasan, 1994, p.162).

From the perspective of the correctional administration, the

role of mental health professionals in the system is to ensure

compliance and ensure a manageable inmate population (Weinberger

& Sreenivasan, 1994, p.162). Psychologists are expected to act

in “custody-oriented activities” such as inmate discipline

reviews and searches for contraband (Weinberger & Sreenivasan,

1994, p.162). This dual role obviously causes harm to the

therapeutic relationship and integrity of the psychologist in the

eyes of those he is supposedly “treating” (Weinberger &

Sreenivasan, 1994, p.162).

Areas of ethical concern were addressed by “Specialty

Guidelines for Forensic Psychologists” developed by the APA in

1991 (Weinberger & Sreenivasan, 1994, p.162). Areas of concerns

were confidentiality, use of psychological assessment and


treatment interventions (Weinberger & Sreenivasan, 1994, p.162).

Despite the creation of these standards, the same concerns are

present today, almost a quarter of a century later. Despite

research done twenty years ago, highlighting the powerful

influence of social context on prison violence, psychologists and

criminologists continue to focus on individualistic pathological

and biological bases of behavior (Haney, 1997, p.503).

Published 1997 by the APA, the following was published in an

article “Psychology and the Limits to Prison Pain”:

Modern psychological theory thus contains several powerful

lessons for contemporary criminal justice and penal policy,

virtually all of which have been overlooked, ignored, or

disregarded in recent trends toward ever increasing levels

of imprisonment: (a) that exclusively individual-centered

approaches to crime control like imprisonment are self-

limiting and doomed to failure if they do not simultaneously

address criminogenic situational and contextual factors; (b)

that prison environments are themselves potentially damaging

situations whose negative psychological effects must be


taken seriously, carefully evaluated, purposefully regulated

and controlled, and when appropriate, changed or eliminated;

(c) that programs of prisoner change cannot ignore

situations and social conditions that prevail after release if

they have any hope of sustaining whatever positive gains

are achieved during periods of imprisonment; and (d) that

long-term legacies of exposure to powerful and destructive

situations, contexts, and structures can mean that prisons

themselves may act as criminogenic agents – in both their

primary effects on prisoners and secondary effects on the

lives of persons connected to them – serving to increase the

amount of crime that occurs within a society.

(Haney, 1997, p.504)

Seventeen years later, the prison system has grown

exponentially, prisoners are protesting solitary confinement.

Why is the field of psychology silent? Perhaps because it is

focused on creating disorders such as “selfie-addiction” and

conducting yet another study concerning the differences between

men and women, or devising new ways to torture enemy combatants


(Huffington Post, 2014, np). Most likely they are all busy

treating middle-class people with depressive disorders or

children with ADHD. As expressed by Haney (1997) “Because the

White majority is comparatively untouched by the punitive-ness of

prison policy, they are far less likely to press for restraint”

(p.514) Psychologists are primarily White middle class people,

untouched by prison policy.

The current figures for US prison population are “2.4

million people in 1,719 state prisons, 102 federal prisons, 2,259

juvenile correctional facilities, 3,283 local jails, and 79

Indian Country jails as well as in military prisons, immigration

detention facilities, civil commitment centers, and prisons in

the U.S. territories” (Wagner & Sakala, 2014, np). Michelle

Alexander (2011) describes the consequences for being in the

criminal justice system:

Once a person is labeled a felon, he or she is ushered into

a parallel universe in which discrimination, stigma, and

exclusion are perfectly legal, and privileges of citizenship

such as voting and jury service are off-limits. It does not


matter whether you have actually spent time in prison, your

second-class citizenship begins the moment you are branded a

felon. Most people branded felons, in fact, are not

sentenced to prison. As of 2008, there were approximately

2.3 million people in prisons and jails, and a staggering

5.1 million people under “community correctional

supervision”- i.e., on probation or parole. Merely reducing

prison terms does not have a major impact on the majority of

people in the system. It is the badge of inferiority – the

felony record – that relegates people for their entire

lives, to second-class status…..For drug felons, there is

little hope of escape. Barred from public housing by law,

discriminated against by private landlords, ineligible for

food stamps, forced to ‘check the box’ indicating g a felony

conviction on employment applications for nearly every job,

and denied licenses for a wide range of professions, people

whose only crime is drug addiction or possession of a small

amount of drugs for recreational use find themselves locked

out of the mainstream society and economy – permanently”

(p.94).


The International Association for Correctional and Forensic

Psychology (2010) quoted an increase in the past decade for

forensic assessment and expert testimony roles, which may

indicate that there may incentive for many in the field of

psychology to further support the prison system (p.766).

Laughably, the emergence of stress-related disorders such as Post

Traumatic Stress Disorder, is attributed to “current military

actions” and not to solitary confinement or other institutional

trauma (IACFP, 2010, p.766). As a standard , the IACF states

that “Inmates who are seriously mentally ill (psychotic, bipolar,

severely depressed) are assessed minimally every 60 days” (IACFP,

2010, p.777) When “mentally ill” inmates are put in

segregation/isolation, “the stresses associated with

segregation/isolation status can result in further emotional and

cognitive decompensation, resulting in a cycle of even longer

periods in segregation” (IACFP, 2010, p.783) Standards for

dealing with suicidal inmates are taken seriously in the ethical

standards due to the risk of litigation (IACFP, 2010, p.784).


“Inmate suicide remains one of the leading causes of inmate

death… Litigation is a highly stressful process and settlements

can be very costly and can place professional careers in

jeopardy” (IACFP, 2010, p.791). Rather than protest conditions

that cause so many men to take their lives, the IACFP chooses to

protect them selves from the stressful situation of a lawsuit. In

1996 the “Prison Litigation Reform Act” made it more difficult

for prisoners to file lawsuits against correctional facilities,

requiring them to exhaust “administrative remedies”, instituting

a “three strikes provision” that limits the number of times an

individual can file suit, and requiring demonstration of physical

injury alongside with any mental injury (ACLU, 2002, np).

The IACFP (2010) itself notes that more developmentally

disabled individuals than ever in history are being incarcerated

due to deinstitutionalization and changes in criminal

legislation, and more than half of the prison population of 2.5

million suffer from mental illness (p.694, 768, 756). Before the

1960’s, the “mentally ill “were seem as ill first and criminals

second; now the reverse is true (IACFP, 2010, p. 756). Although


the IACFP recognizes the suffering of prisoners, by labeling

individual pathology, they neglect to address the sadistic

culture of the criminal justice system.

“Labels can mask sources of oppression” (Prilleltensky & Nelson,

2002, p.105)

The Use of the DSM in diagnoses emphasizes a diagnostic

label, disregarding the context of individual experience and

masking oppression (Prilleltensky & Nelson, 2002, p.105).

Despite the data, psychologists are still focused on individual,

dyads and families in their interventions rather than

socioeconomic determinants (Prilleltensky & Nelson, 2002, p.9).

Comparisons of the health status of populations in countries of

highly unequal income distribution (such as the United States)

and those with more equitable distribution demonstrates that

economic disparity is linked to poor health status; this

indicates that collective social factors have a great influence

on the well-being of individuals (Keating & Herzman, 1999, as

cited by Prilleltensky & Nelson, 2002, p.11).

Conclusion


Definitions of well-being based in intra-psychic factors

concentrate on cognitive and emotional factors and exclude the

“social, material and political roots and effects of lack of

power” (Prilleltensky & Nelson, 2002, p.11). Conditions that

support well-being require social and political conditions free

of economic exploitation and human rights abuses (Prilleltensky &

Nelson, 2002, p.11).

As future or current professionals in the field of mental

health, I challenge you to answer the question, “Who are you working

for?” I challenge you to ask why cognitive behavior therapy is

continually used to treat highly traumatized populations, such as

addicts and individuals with a history of incarceration. I

challenge you to ask, why in 2014, trauma-informed treatment is

not required for licensing of mental health professionals. I

challenge you to ask why your psychology textbooks leave out the

context and history of theoretical approaches. I challenge you

to ask why many of us humans that are not of the White middle-

class continue to be wary of the field of psychology.


Do you want to serve the machine? Or do you want to serve

humanity? There is no middle ground.

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