© Radical Philosophy Review Volume 18, number 2 (2015): 267–285DOI: 10.5840/radphilrev201412827 Online First: December 12, 2014

White Supremacy, Mass Incarceration, and Clinical

Medicine: A Critical Analysis of U.S. Correctional Healthcare

Andrea J. Pitts

Abstract: Through a study of Fanon’s writings on colonial medicine, this paper focuses on the intersection of clinical medicine and mass incarceration. I argue that correctional medicine operates as an extension of colonial medicine via structural white supremacy. To clarify this position, I first draw from the recent literature on mass incarceration to highlight the relationship between carceral punishment in the U.S. and structural white supremacy. In the second section of the paper, I combine my analysis of structural white supremacy and mass incarceration with an analysis of colonial medicine. Here, I focus on Fanon’s writings on medicine and health under conditions of structural oppression to clarify a pattern of violence inflicted upon communities of color and poor communities in the United States, i.e., the communities most affected by mass incarceration.

The function of a social structure is to set up institutions to serve man’s needs. A society that drives its members to desperate solu-tions is a non-viable society, a society to be replaced.

Frantz Fanon1

1. I would like to thank the REACH Coalition in Nashville, Tennessee, for their important work and for their critical analysis of earlier iterations of this project. I would also like to thank the anonymous reviewers of this manuscript for their comments and suggestions, which made a tremendous impact on the paper overall. Finally, I would like to thank Elisabeth Paquette and Geoffrey Adelsberg for their continued support and critical engagement with my research.

Frantz Fanon, “Letter to Resident Minister,” Toward the African Revolution, trans. Haakon Chevalier (New York: Grove Press, 1967), 53.

268 Andrea J. Pitts

Health is politics by other means.Alondra Nelson2

Over the last several decades researchers, activists, and educators have provided arguments outlining the relationship between struc-tural white supremacy and the rise of mass incarceration in the

United States.3 Among these distinct theoretical positions, authors have pointed to the continued exploitation of Black Americans within U.S. history via the political economy of chattel slavery, the convict-lease system, Jim Crow laws, the FBI suppression of Black political organizing in the 1960s and 1970s, and most recently, via the prison industrial complex. Also, with respect to mass incarceration and white supremacy, theorists have turned to the writings of Frantz Fanon for critical support of their respective argu-ments against the structural racism of the contemporary carceral system in the U.S. For example, Joy James harkens to the legacy of anticolonial resis-tance offered through Fanon’s work to situate her edited collection of writ-ings by political prisoners in the U.S., many of whom cite The Wretched of the Earth among the sources for their critical views.4 Also Lisa Guenther’s recent work has drawn heavily from Fanon’s Black Skin, White Masks to con-struct a phenomenological approach to the harm caused by solitary confine-ment as a method of punishment in the U.S.5

2. Alondra Nelson, Body and Soul: The Black Panther Party and the Fight against Medical Discrimination (Minneapolis: University of Minnesota Press, 2011), ix.

3. Cf. Michelle Alexander, The New Jim Crow: Mass Incarceration in the Age of Colorblindness (New York: The New Press, 2010); Loïc Wacquant, Prisons of Poverty (Minneapolis: Regents of the University of Minnesota, 2009); Ruth Wilson Gilmore, Golden Gulag: Prisons, Surplus, Crisis and Opposition in Globalizing California (Berkeley: University of California Press, 2007); Angela Y. Davis, Abolition Democracy: Beyond Empire, Prisons, and Torture (New York: Seven Stories Press, 2005); Joy James, The New Abolitionists: (Neo)slave Narratives and Contemporary Prison Writings (Albany: State University of New York Press, 2005); Angela Y. Davis, Are Prisons Obsolete? (Toronto: Open Media, 2003); Joy James, States of Confinement: Policing, Detention, and Prisons (New York: Palgrave Macmillan, 2000).

4. Joy James, Imprisoned Intellectuals: America’s Political Prisoners Write on Life, Liberation, and Rebellion (Lanham, MD: Rowman and Littlefield, 2004), 21. James’s anthology contains works by Angela Y. Davis and Black Panther activists George Jackson and Huey Newton, all of whom cite the influence of The Wretched of the Earth in their respective political educations.

5. Lisa Guenther, Solitary Confinement: Social Death and its Afterlives (Minneapolis: University of Minnesota Press, 2013), 54–61.

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In a related but distinct body of literature also focusing on structural white supremacy, scholars of Fanon’s work have examined the importance of the author’s practice as a clinical psychiatrist in France, Algeria, and Tu-nisia. A number of films and biographies have taken up this central aspect of his life and have provided intimate portraits of everything from his bedside manner as a physician to his role as an innovative reformist and therapist within the institutional settings in which he worked.6 Some scholars have also begun to note the theoretical importance of his writings on medicine, psychiatry, and health. For example, Sylvia Wynter has offered Fanon’s no-tion of sociogeny as a reply to problems of consciousness posed by philoso-phers of mind such as David Chalmers and Thomas Nagel.7 Another view in this discourse is that of Françoise Vergès, who has argued that through his clinical work, Fanon attempts to “decolonize psychiatry.” Vergès claims that Fanon’s innovative practices in the hospitals in which he served shed impor-tant light on the history of colonial medicine.8

These parallel literatures on Fanon’s work highlight a fruitful inter-section between the study of the structural operations of white supremacy and the practice of clinical medicine. Along these lines, through a study of Fanon’s writings on colonial medicine, this paper focuses on the intersec-tion of medicine and mass incarceration as a structural operation of white supremacy. While the mid-1990s gave rise to an interest in the discipline of correctional healthcare and the appearance of several academic jour-nals dedicated to the topic (e.g., CorrectCare and the Journal of Correctional Health Care), the majority of this literature—primarily provided by medical and public health researchers, criminologists, and legal scholars—has yet to engage with perspectives from the diverse fields of critical race theory, post-colonial and decolonial theory, Black and Latina/o radical thought, woman-ism, mujerista theology, or feminist thought. Given this dearth in the cur-rent literature available on correctional health care, and coupled with the frequently cited abuses via medical mistreatment and neglect of people who

6. Cf. Peter Geismer, Fanon (New York: Dial, 1971); Jock McCulloch, Black Soul, White Artifact: Fanon’s Clinical Psychology and Social Theory (New York: Cambridge Univ. Press, 1983); Patrick Ehlen, Frantz Fanon: A Spiritual Biography (New York: Crossroad, 2000); David Macey, Frantz Fanon: A Biography (New York: Picador, 2001); Abdenour Zahzah and Bachir Ridouh, Frantz Fanon: Mémoires d asile (Algeria: Anwar Cinéma, 2002).

7. Sylvia Wynter, “Towards the Sociogenic Principle: Fanon, Identity, and the Puzzle of Conscious Experience, and What It Is Like to be ‘Black,’” in National Identities and Socio-Political Changes in Latin America, ed. Mercedes F. Durán-Cogan and Antonio Gomez-Moriana, 30–66 (New York: Routledge, 2001).

8. Françoise Vergès, “To Cure and to Free: The Fanonian Project of ‘Decolonized Psychiatry,’” in Fanon: A Critical Reader, ed. Lewis R. Gordon, T. Denean Sharpley-Whiting, and Renée T. White, 85–99 (Oxford: Blackwell, 1996).

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are incarcerated (e.g., in court cases such as Balla v. Idaho State Board of Cor-rections, Plata v. Davis/Schwarzenegger, Budd v. Cambra, Coleman v. Wilson, and numerous others), in this paper, I argue that correctional medicine op-erates as an extension of colonial medicine via structural white supremacy. To clarify this position, I first draw from the recent literature on mass in-carceration to highlight the relationship between carceral punishment in the U.S. and structural white supremacy. In the second section of the paper, I combine my analysis of structural white supremacy and mass incarcera-tion with an analysis of colonial medicine. Here, I focus on Fanon’s writings on medicine and health under conditions of structural oppression to clarify a pattern of violence inflicted upon communities of color and poor com-munities in the United States, i.e., the communities most affected by mass incarceration.9

I. Mass Incarceration and Structural White SupremacyTo arrive at the intersection of mass incarceration, structural white suprem-acy, and clinical medicine, first it is important to outline the relationship between U.S. policies that support carceral punishment and structural fea-tures of white supremacy. By referring to structural white supremacy, I am claiming that racism is not an individualistic set of biases or beliefs about people of differing racial groups. The claim I am rejecting is the belief that racism is the result of individual prejudices and discrimination. Against this view I maintain that what makes white supremacy structural in nature are the material differences in terms of rewards and harms sanctioned via insti-tutional social practices. Or put another way, following Eduardo Bonilla-Sil-va, we can consider the structural feature of white supremacy the develop-ment of racialized social systems that afford material benefits to whites as a social group against a background of racial hierarchy. Bonilla-Silva states: “racialized social systems are those societies that allocate differential eco-nomic, political, social, and even psychological rewards to groups along ra-cial lines, lines that are socially constructed.”10 In this sense, I claim (along with many of the theorists cited in the introduction to this paper) that the vast increases in rates of incarceration since the 1970s in the United States is due to material benefits and harms distributed via hierarchized racial so-cial systems.

9. To clarify, I am not intending to conflate the context of structural racial oppression in the U.S. with forms of racial oppression in other neocolonial contexts. My analysis of Fanon is meant to mark some structural features of white supremacy that may coincide with non-U.S. neocolonial contexts, but is not intended to offer a full analysis of the racial dynamics of such contexts.

10. Eduardo Bonilla-Silva, White Supremacy and Racism in the Post–Civil Rights Era (Boulder: Lynne Rienner Publishers, 2001), 44.

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One example of such a structural feature of white supremacy is ex-plained through the notion of the prison industrial complex. Popularized by Eric Schlosser in the 1990s but later developed by other theorists, this term refers to the capitalist expansion of correctional facilities and related for-profit corporations that serve correctional facilities.11 Angela Y. Davis writes of a comparison between the expansion of prison industries and military industries:

Both systems generate huge profits from processes of social destruction. Precisely that which is advantageous to those corporations, elected offi-cials, and government agents who have stakes in the expansion of these systems begets grief and devastation for poor and racially dominated com-munities in the United States and throughout the world.12

The broad claim here is that the expansion of prisons in the United States primarily harms non-white racial groups For example, in 2012 the U.S. De-partment of Justice Bureau of Justice Statistics cited that Black men were six times more likely to be incarcerated than white men, and Latinos were 2.5 times more likely to be incarcerated than white men.13 Among women, Black women, ages 18–19, were three times more likely to be incarcerated than white women, and Latinas were nearly twice as likely to be incarcerated as white women of the same age group.14 Also, with respect to the benefactors of such corporate expansion, consider the Corrections Corporation of Amer-ica and the GEO Group, the two largest private prison conglomerates in the world. Both companies each earned over $3 billion dollars in revenue in 2010, and their respective CEOs each received annual compensation pack-ages of over $3.2 million.15

Connecting these structural harms and benefits to Fanon’s critique of colonialism requires that we further analyze the history of processes of ra-cialization in the United States. To draw this link—between colonialism and white supremacy in the U.S.—we can turn to conceptions of neo- or internal colonialism. Emerging in the 1960s through the work of African, Latin Amer-ican, African American, and Chicano social theorists working to understand the link between class oppression and structural racism, authors as diverse as Kwame Nkrumah (Neo-colonialism: The Last Stage of Imperialism 1965),

11. Eric Schlosser, “The Prison Industrial Complex,” The Atlantic Monthly (December 1998).

12. Davis, Are Prisons Obsolete?, 88. 13. E. Ann Carson and Daniela Golinelli, Prisoners in 2012: Trends in Admissions

and Releases, 1991–2012 (Washington, DC: US Dept. of Justice Bureau of Justice Statistics, 2013), 25.

14. Ibid. 15. America Civil Liberties Union, Banking on Bondage: Private Prisons and Mass

Incarceration (New York: American Civil Liberties Union, 2011), 9, 13.

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Pablo González-Casanova (“Sociedad plural, colonialismo interno y desar-rollo” [Plural Society, Internal Colonialism, and Development”] 1963), Har-old Cruse (“Revolutionary Nationalism and the Afro-American” 1968), and Luis Valdez and Roberto Rubalcava (“Venceremos! Mexican-American State-ment on Travel to Cuba” written in 1964) all offered analyses that explained domestic structures of imperialism subjugating people of color without the imposition of external colonial political rule. As Ramón A. Gutiérrez states: “Internal colonialism offered minorities an explanation for their territorial concentration, spatial segregation, external administration, the disparity between their legal citizenship and de facto second-class standing, and their brutalization by the police and the toxic effects of racism in their lives.”16 This idea was also succinctly developed by Black radicals in the 1960s. For example, Stokely Carmichael, Charles V. Hamilton, and Malcolm X each ar-gued that a global liberation movement would be necessary to overturn the expanding capitalist political economy that degraded and exploited Black Americans.17

In a 2005 piece on the continued relevance of the concept of internal colonialism, Robert L. Allen discusses the link between direct colonial rule and internal neocolonial rule. He writes that the rise in Black Power mili-tancy in the 1960s created a crisis for white American economic and politi-cal interests, i.e., white Americans effectively were faced with the threat of losing control of Black communities across the nation. He states:

As a result, the white power structure sought to maintain hegemony by replacing direct white control of the internal black colony with indirect neo-colonial control through black intermediary groups, much as the era of national independence struggles classic colonialism gave way to neo-colonialism in the Third World. Whereas direct white control was the policy of the conservative, segregationist, Southern Ruling class, indirect neo-colonial control was the policy of the liberal white power structure of the North.18

Allen points to three aspects of internal neocolonialism, harkening back to his 1969 analysis in Black Awakening. The first feature of internal neo-colonial involves the small growing Black professional middle-class that emerged from the civil rights movement, whose marginal successes for Black Americans have aided in overshadowing the increasingly high rates of unemployment and poverty for many Black communities in the U.S. Sec-ondly, what Allen describes as “Black Capitalism” is the increased number of

16. Ramón A. Gutiérrez, “Internal Colonialism; An American Theory of Race,” Du Bois Review 1.2 (2004): 282.

17. Ibid., 287; Robert L. Allen, “Reassessing the Internal (Neo) Colonialism Theory,” The Black Scholar 35.1 (2005): 7–8.

18. Allen, “Reassessing the Internal (Neo) Colonialism Theory,” 4.

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Black-owned business in the U.S. since the civil rights era. Yet, again, he states that media portrayals of the successes of Black-owned businesses “promote the illusion of general black economic progress while corporations seek to deploy the class to effectively penetrate the market in black communities and other markets nationally and globally.”19 Finally, the increased numbers of Black elected officials across the U.S. also provides support for an image of Black political mobility in the country. However, as Allen correctly points out, many Black mayors were elected in cities that were suffering from eco-nomic, public health, and educational crises. This forced many elected offi-cials to find resources to manage these crises. He writes: “Inner cities were like rebellious colonies and urban battlegrounds, and the job of pacification was shifted to the new black mayors.”20 To attempt pathways out of these so-cial problems, he claims, many officials had to cater to social interest groups with the financial resources to address the city’s needs and to struggle with the local electorate and with city councils to bring about structural changes. “This,” he states, “is one face of neo-colonialism.”21

The second major strand of Allen’s critique is the relationship between the FBI suppression of Black radical organizing through COINTELPRO (“Counter Intelligence Program”) of the 1960s and 1970s and the mass in-carceration of Black women and men since the late 1970s. With increased minimum punishment laws for nonviolent offenses and increasingly harsh sentences for drug convictions, Black Americans are systematically removed from communities across the U.S. Also, following incarceration, convicted felons are stripped of voting rights and legally denied educational, housing, and employment opportunities.

In agreement with Allen, I claim that the structural disenfranchisement, removal, and exploitation of people of color mirror the economic and politi-cal forms of imperial domination that existed within many colonial settings. While the material and ideological conditions of internal neocolonialism will differ depending on the specific geopolitical context in question, it is impor-tant to mark the ways in which racialized groups that historically faced ex-ternal political rule and domination continue to confront structural features that marginalize and disadvantage such racialized groups even in post-inde-pendence and post-civil rights contexts. In the U.S., the convict lease system that followed the abolition of slavery continued to exploit the labor of Black Americans through the attribution of criminality as a racialized character of Black Americans. For example, under the convict lease system many newly “freed” Black Americans found themselves charged with petty crimes of theft, vagrancy, trespassing, and loitering on the very plantations on which

19. Ibid., 6. 20. Ibid.21. Ibid.

274 Andrea J. Pitts

they were enslaved. Most often, such crimes were economic crimes of re-moving food or of remaining in their former plantation homesteads while deciding how to adjust their lives and livelihoods after abolition.22

Finally to further strengthen the link between internal colonialism and mass incarceration, we can support Allen’s interpretation of internal colo-nialism via Andrea Smith’s analysis of the “three pillars of white supremacy.” Smith argues that making sense of the power relations that different groups of people of color experience under white supremacy (e.g., Native peoples, Latinas/os, Arab and Muslim Americans, Asian Americans, African Ameri-cans, etc.) requires that we interpret the notion of white supremacy as oper-ating via three distinct but related logics.23 These three logics or “pillars” are slavery/capitalism, genocide/colonialism, and Orientalism/war.24 The first pillar is the commodification of people of color, and in particular the com-modification of Black peoples through the brutality of the Middle Passage, the violence and exploitation of African and African-descended peoples in slave economies in the colonial Americas and the Caribbean, the unjust conditions of the convict lease system, the regulation and control of Black Americans via Jim Crow law, and the perpetual criminalization of Black Americans within the current era of mass incarceration. The second pillar, Smith argues, operates via the elimination of indigenous peoples, either through violence or through assimilation. In particular, Smith underscores the “present-absence” of Native peoples in the U.S. and the “temporal para-dox” wherein “living Indians [are] induced to ‘play dead,’ as it were, in order to perform a narrative of manifest destiny in which their role, ultimately, was to disappear.” 25 The third pillar of white supremacy, “Orientalism,” drawing here from the work of Edward Said, names specific peoples or na-tions as “inferior and as posing a constant threat to well-being of empire.”26 Orientalism thus provides global justifications for military violence. Smith cites here the U.S. “War on Terror,” which justifies harassment and violence against Arab and Muslim Americans, and which justifies military aggression against predominantly Muslim and Arab nations.

These three pillars of white supremacy then serve to reinforce one an-other and effectively attempt to separate communities of color all affected

22. Michael Hallett, “Commerce with Criminals: The New Colonialism in Criminal Justice,” Review of Policy Research 21.1 (2004): 56.

23. Andrea Smith, “Heteropatriarchy and the Three Pillars of White Supremacy,” in Color of Violence: The INCITE! Anthology, INCITE! Women of Color Against Violence (Cambridge, MA: South End Press, 2006).

24. Ibid., 67–69. 25. Ibid., 68. Smith is citing Ella Shohat and Robert Stam, “The Imperial Imaginary,”

in Unthinking Eurocentrism: Multiculturalism and the Media (London: Routledge, 1994).

26. Ibid.

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by the differing logics of white supremacy. Smith outlines three scenarios in political organizing work that places differing non-white racialized groups at odds with one another. She argues that resistance to only one logic of white supremacy makes us complicit with the structural domination of oth-ers. Thus, following Smith, resistance to mass incarceration via critiques of anti-Black racism requires attention to other logics of white supremacy in order for these efforts to be effective. For example, Angela Y. Davis, Rafeef Ziadah, and Gina Dent have recently been proposing a campaign against the multinational security company Group 4 Securicor (G4S), whose provisions of surveillance and carceral services and materials are used in Palestine, South Africa, the United States, and in 122 other nations. Davis, for example, argues that the U.S. support and involvement in South African apartheid and the industrial benefits afforded to U.S. companies via apartheid must be remembered as a precursor to the U.S.’s support of the Israel occupation in Palestine. G4S, she states, represents “what is called ‘security’ under the neoliberal state.”27 These conceptions of security support the privatization of security, imprisonment, warfare, healthcare, and education.28 Thus, the British conglomerate G4S operates through multiple axes of white suprem-acy, from the anti-Black racism of South African apartheid and mass incar-ceration in the U.S. to the anti-Latino racism of U.S. customs and immigra-tion operations at the Mexico-U.S. border, to the anti-Arab and anti-Muslim racism under the occupation and incarceration of Palestinians under U.S.-supported Israeli force.

Turning back now to the prison industrial complex, in particular, we can more clearly connect colonial domination—wherein the exploitation and control of one racial group within an independent nation-state benefits a distinct and hierarchically dominant racial group—and mass incarceration. Moreover, by combining Allen and Smith’s respective analyses, we can also begin to see how colonial medical practices foreshadow and link anti-Black and anti-Latina/o racism to correctional healthcare within the U.S. carceral system. 29 That is, an understanding of internal neocolonialism structurally

27. Angela Y. Davis, “Angela Davis on Palestine, G4S and the Prison Industrial Complex,” http://youtu.be/W9KxslVHRs8, posted by War on Want, December 20, 2013.

28. Ibid.29. Cf. Roxanne Lynn Doty, “The Criminalization of Immigrants as a Racial Project,”

Journal of Contemporary Criminal Justice 27.3 (2011), and Tomás Almaguer, Racial Fault Lines: The Historical Origins of White Supremacy in California (Berkeley: University of California Press, 2009). The increased criminalization of undocumented immigrants and the militarization of immigration law enforcement are also facets of the operational power of white supremacy in the U.S. However, given the length of this paper, I cannot sufficiently address the topic here.

276 Andrea J. Pitts

interprets mass incarceration as a part of the operational powers of white supremacy. Given this link, we can turn directly to Fanon’s writings on co-lonialism, medicine, and health to locate correctional health care within the broader structure of white supremacy.

II. Colonial Silencing and Clinical MedicineAcross the span of differing Black political traditions, many authors and ac-tivists have cited a relationship between the provision of healthcare and the structural harms wrought on Black and colonized peoples. Alondra Nelson’s Body and Soul: The Black Panther Party and the Fight against Medical Dis-crimination carefully outlines Black healthcare activism in the United States, focusing on the Black Panther Party’s healthcare organizing beginning in the 1970s. Before this, she cites Martin Luther King’s call for healthcare jus-tice and the NAACP’s campaign for “medical civil rights” in the 1960s.30 Nel-son identifies three tactics taken up by Black health activists that sought to address systematic healthcare inequalities in the nation: institution build-ing, healthcare integrationism, and “the politics of knowledge.” These first two tacks focus on changing access to healthcare for African Americans and establishing clinics and treatment programs that are developed for and by African Americans. The third approach, the politics of knowledge, seeks to critique the epistemic discourses about Black bodies created by the bio-medical sciences. This approach also focuses on developing interrelated analyses of “the biological, social, and political spheres of life in response to the scientific determinism of some biomedical theories.”31 Within this third approach, Nelson notes two emphases: criticisms of knowledge produc-tion within the biomedical sciences that perpetuated racist hierarchizations based on assumed natural racial differences. The second emphasis within this approach is on extra-scientific factors that lead to health disparities be-tween Black and white Americans, and that perpetuate the discrimination and abuse of Black patients within clinical health settings. Nelson cites the work of Kelly Miller and W.E.B. Du Bois in the late nineteenth century as examples of this latter emphasis. Both authors, in their respective writings, focused on structural factors and patterns of discrimination that led to high rates of disease and death among Black populations in the U.S.32

It is within Nelson’s third approach, the politics of knowledge, that we can situate Fanon’s writings on colonial medicine and health.33 Fanon’s own clinical experiences as a practicing psychiatrist in France, Algeria, and

30. Nelson, Body and Soul, 5, 23. 31. Ibid., 26. 32. Ibid., 44–47. 33. Nelson is charting the work of African American health activism, however, I am

here applying her work to other Black traditions of health activism.

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Tunisia all shaped his writings on colonial domination. Notably, several bi-ographers and theorists of his work have discussed the changes that he ef-fected during his time at Blida Psychiatric Hospital in Algeria. For example, Vergès describes his approach as an attempt to develop “social therapies” for patients that “aimed to open the hospital, to humanize it, to make the pa-tient a man among other men, and to facilitate his resocialization.”34 Also, in Nigel Gibson’s account of Fanon’s essay “Medicine and Colonialism,” the au-thor points to Fanon’s articulation of the Manicheanism portrayed through the patient-doctor dynamic within a colonial situation. Gibson writes:

In the colonial set-up, the idea of what is true is constructed through a Manichean interpretation. For the native, saying ‘no’ to the French ‘yes’ can be the only truth. . . . In the colonial situation, where the subjugation of the colonized body is particularly marked, medicine takes on an additional import. The native reacts in a ‘undifferentiated, categorical way,’ because swallowing a pill constitutes a feeling of infection by the colonial power.35

Gibson’s main purpose for emphasizing the Manicheanism of colonial medi-cine in Fanon’s writings is to illustrate what he considers a dialectical move-ment toward revolutionary struggle. For my purposes here, I would like to refer to Nelson’s work on the politics of knowledge in medicine to eventu-ally return us to the relationship between structural white supremacy and correctional health care.

In his 1959 l’an cinq de la révolution algérienne, translated into English as A Dying Colonialism, Fanon presents a phenomenological description of the levels of trust and distrust among European doctors and Algerian pa-tients in French-occupied colonial Algeria. Alongside the “racialism and humiliation” that accompany colonialism, Fanon claims that Western medi-cal science becomes “part of the oppressive system” in contexts of colonial domination.36 The provider-patient relationship in a colonial situation, he states, is one marked by distrust and diffidence— e.g., “I find myself liter-ally insulted and told I am savage.”37 The patient may justly worry that she/he will be mocked, humiliated, or abused by the doctor. The physician may worry that patients are not genuinely seeking to improve their health and instead harboring ulterior motives that remain under the guise of medi-cal attention. Due to such high levels of distrust, then, Fanon writes that in the clinical encounter: “The doctor rather quickly gave up the hope of ob-taining information from the colonized patient and fell back on the clinical

34. Vergès, “To Cure and to Free,” 86. 35. Nigel Gibson, “Beyond Manicheanism: Dialectics in the Thought of Frantz

Fanon,” Journal of Political Ideologies 4.3 (1999): 344–45. 36. Frantz Fanon, A Dying Colonialism (New York: Grove Press, 1965), 121.37. Ibid., 125.

278 Andrea J. Pitts

examination, thinking that the body would be more eloquent.”38 The doctor, then, according to Fanon, effectively silences the patient by expecting that the physical manifestations of illness and injury will speak the truth that the patient will not or cannot express about her/his own medical condition.

Published after Black Skin, White Masks, A Dying Colonialism devel-ops a theoretical critique of the Algerian context of colonialism, which, by this time, he had witnessed first-hand. Already in Black Skin, White Masks Fanon sharply critiques what Nelson refers to as an approach to medicine that focuses on claims made internal to scientific knowledge practices. For example, his criticisms of Octave Mannoni and other leading contemporary psychoanalysts of the period point to his aim of challenging the findings of these theorists and, in Nelson’s words, “to demonstrate [that] racism, not rationality, was at the root of scientific claims about the alleged inferior-ity of [colonized peoples].”39 However, by A Dying Colonialism and the essay “The ‘North-African Syndrome,’” Fanon’s focus on medicine shifts and he emphasizes the clinical aspects —i.e., the practice of caring for patients—of biomedicine within a colonial context.40

Consider too that, although Fanon initially attempted to submit Black Skin, White Masks as his medical thesis (which was rejected by his commit-tee, leading him to submit a more “traditional” analysis), his writings pub-lished after that text mark a shift in his thinking about the “formal medical racism” that he encountered while working as a clinician in Lyon and Blida.41

Through Fanon’s experiences in these clinical settings, he began to note, as he describes in “The ‘North African Syndrome’” the colonial impact on the epistemic and hermeneutic dimensions of the relationships between colonial medical staff and colonized patients.42 In this essay, Fanon proposes

38. Ibid. 126.39. Nelson, Body and Soul, 25.40. Fanon also expands his critique of clinical medicine in The Wretched of the

Earth. However, I do not have sufficient space here to note the connections between this later work and his 1950s publications.

41. Richard C. Keller, “Clinician and Revolutionary: Frantz Fanon, Biography, and the History of Colonial Medicine,” Bulletin of the History of Medicine 81.4 (2007): 827.

42. By “hermeneutics,” I follow Tsenay Serequeberhan’s criticism of European philosophical hermeneutics (i.e., the work of Martin Heidegger and Hans-Georg Gadamer). Serequeberhan’s “indigenization” of European philosophical hermeneutics refers to “interpretive and reflexive presuppositional reflections grounded in and on the actuality of our post-colonial present” (2). Thus, drawing from his analysis of African philosophical traditions, my use of the term ‘hermeneutics’ refers to the practice of articulating “the interpretive character of human existence” given one’s cultural and historical horizon (1) I understand Fanon’s work to be engaging in this type of philosophical practice.

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three theses about the diagnoses that his colleagues in Lyon are making about the prevalence of North African patients who express symptoms of pain and illness, but who have no identifying lesions to explain their symp-toms.43 His colleagues claim, he writes: “When you come down to it, the North African is a simulator, a liar, a malingerer, a sluggard, a thief.”44 Rather than accept this diagnosis, Fanon offers these three theses:

1) “That the behavior of the North African often causes a medical staff to have misgivings as to the reality of his illness;”

2) “That the attitude of medical personnel is very often an a priori at-titude. The North African does not come with a substratum common to his race, but on a foundation built by the European. In other words, the North African, spontaneously, by the very fact of appearing on the scene, enters into a pre-existing framework;”

3) “That the greatest willingness, the purest intentions require enlight-enment. Concerning the necessity of making a situational diagnosis.”45

Fanon poignantly asserts here that Western medicine teaches medical staff to look only for lesions in the body to explain harm. Thus, because a North African patient expresses symptoms that cannot be located in any specific site of the body, the clinicians become frustrated with the patient. The cli-nician then, according to the contemporary medical standards, assumes “The North African’s pain, for which we can find no lesional basis, is judged to have no consistency, no reality. Now the North African is a-man-who-doesn’t-like-work.”46 This diagnosis, as a malingerer and as untrustworthy, however, Fanon claims is based in a structural a priori determination made by French doctors who view North African patients as inherently deceptive and lazy.

Interestingly, Fanon’s second thesis can be supported by current em-pirical research that suggests that health care providers routinely offer dif-ferent treatment regimens to patients exhibiting identical symptomatolo-gies but whose visible identities differ only by race and gender. For example, one study found that “male physicians prescribed twice the level of [pain-killers] for white ‘patients’ than for black ‘patients.’”47 Other studies indi-cate that physicians rate black patients lower than white patients on factors

Tsenay Serequeberhan, The Hermeneutics of African Philosophy (New York: Routledge, 1994).

43. The standard operative assumption for clinicians was that pain or illness could only result from physiological lesions within the body.

44. Frantz Fanon, “The ‘North African Syndrome,’” in Toward the African Revolution: Political Essays, trans. Haakon Chevalier, 7 (New York: Grove Press, 1967), 7.

45. Ibid., 4–13. 46. Ibid., 6. 47. B. D. Smedley, A. Y. Stith, and A. R. Nelson, Unequal Treatment: Confronting Racial

280 Andrea J. Pitts

like intelligence, educational level, level of compliance, likelihood to abuse drugs and alcohol, and likelihood of follow-up with occupational and reha-bilitational therapy. Such findings turned up in studies even when physi-cians were primed with information about their patients’ income levels and educational backgrounds.48 This research also claims that implicit biases and stereotypes of “well-meaning whites who are not overtly biased and who do not believe that they are prejudiced demonstrate unconscious im-plicit negative racial attitudes and stereotypes.”49 Accordingly, this supports Fanon’s third thesis, that even “the greatest willingness [and] the purest in-tentions require enlightenment.”50 His recommendation that medical pro-viders look to the “situation” of the patient reveals that he attributes illness, pain, and the morbidity of North African patients as, in Keller’s words, “a somatic manifestation of psychological pressures placed on a marginalized population suffering in a contemptuous host society.”51 Fanon describes the conditions of North Africans living in France as a “daily death” wrought with conflict, hatred, and patterns of abuse ‘in the tram, the doctor’s office, with the prostitutes, on the job site, at the movies, in the newspapers, in the fear of all decent folk of going out after midnight.’52 All aspects of French soci-ety implicate the harm and suffering of North Africans. Fanon thus provides here a structural interpretation of the detrimental medical conditions for racialized patients in France.

Secondly, in A Dying Colonialism, Fanon’s analysis of medical practic-es during the Algerian Revolution focuses specifically on the hermeneutic and epistemic dynamics of medical practitioners and patients. Importantly, Fanon links the personal and intimate encounters between medical provid-ers and patients within the broader structural framework of colonialism, and illustrates the ways in which the practice of medicine becomes an in-strument for both domination and resistance to colonial violence.

Fanon claims that Western medical science is continuous with systems of colonial violence and domination. Despite the institution’s prima facie “concern [with] man’s health [and that] its very principle . . . is to ease pain,” within contexts of colonialism, Western medical science is taken as yet an-other mechanism for the subjugation and degradation of colonial subjects.53 He describes hermeneutic and epistemic dynamics whereby medical knowl-edge and practice become subsumed under structural frameworks of mean-

and Ethnic Disparities in Health Care (Washington, DC: National Academy Press, 2002), 11.

48. Ibid. 49. Ibid., 10.50. Fanon, “The ‘North African Syndrome,’” 10.51. Keller 2007, 827. 52. Fanon, “The ‘North African Syndrome,’” 13. 53. Fanon, A Dying Colonialism, 121.

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ing that translate the significance of illness, not toward the ends of health and wellbeing, but rather as tools for colonial domination. For example, he writes: “The statistics on sanitary improvements are not interpreted by the native as progress in the fight against illness, in general, but as fresh proof of the extension of the occupier’s hold on the country.”54 This is not merely a reactionary dismissal of Western medical practices, but rather, the spread of Western clinical medicine becomes understood as an indication of the omnipresence of colonial power and its control over the lives and deaths of those who are subject to colonial force. Here, we can think back to Gibson’s analysis of Fanon’s articulation of Manicheanism under colonial conditions: illness is used as a justification for French colonial medicine.

Such hermeneutical contexts not only affect those who are subject to the brutality of colonial conquest, but also those who benefit from it. That is, Fanon describes several of the interpretive responses of European doc-tors in Algeria and the manners through which the voices of those who are colonized become distorted. He states: “When the native, after a ma-jor effort in the direction of truth, because he assumes his defenses have been surmounted, says, ‘That is good. I tell you so because I think so,’ the colonizer perverts his meaning and translates, ‘Don’t leave, for what would we do without you?’”55 Thus, here Fanon points to forms of willful and col-lective patterns of ignorance on the part of the colonizers in their interac-tions with colonized patients. Charles Mills, in his essay “White Ignorance” describes such structural forms of ignorance as insulating mechanisms for white supremacy.56 He argues that collective memory must also account for collective amnesia, that is, shared hermeneutical gaps and mistaken beliefs that support structures of racism and white supremacy. These patterns of distortion and self-delusion, existing among whites and non-whites alike, point toward the provider-patient communicative dynamics that Fanon de-scribes. Mills ‘stretches’ Marxism (in the Fanonian sense), to address epis-temic patterns of ignorance within white supremacy.57 He states:

(class) domination and exploitation were the foundation of the social or-der, and as such they produced not merely material differentials of wealth in the economic sphere, but deleterious cognitive consequences in the ideational sphere. . . . [However,] one can detach from a class framework a Marxist “materialist” claim about the interaction between exploitation,

54. Ibid., 121–22. 55. Ibid., 122. 56. Charles Mills, “White Ignorance,” in Race and Epistemologies of Ignorance, ed.

Shannon Sullivan and Nancy Tuana (Albany: SUNY Press, 2007). 57. Frantz Fanon, The Wretched of the Earth, trans. Richard Philcox (New York:

Grove Press, 2004), 5.

282 Andrea J. Pitts

group interest, and social cognition and apply it with far more plausibility within a race framework.58

Mills’s claim about the epistemic domain of structural white supremacy links the internal neocolonial character of white supremacy to the degrada-tion and harm done to persons of color within other racialized social sys-tems, like the U.S. Such forms of epistemic harm, and the subsequent physi-cal violence and suffering inflicted on people of color begins to shed light on the intersections between structural white supremacy, mass incarceration, and medical care.

Also worthy of note in Fanon’s description of the epistemic and her-meneutical aspects of colonial medicine is what he calls the physician’s un-derstanding of “the eloquence” of the colonized patient’s body. This phrase refers to the directed examination undertaken by the doctor when all trust has been lost between patient and provider. That is, the doctor refuses to listen or rely on the expressed symptomatology of the patient and, instead, as Fanon states, the doctor “[falls] back on the clinical examination, think-ing that the body [will] be more eloquent.”59 In such a situation, the expe-rience of illness—the pains, discomforts, longings, and sensations—of the patient are eclipsed. The colonized patient’s own lived experience of her/his body becomes irrelevant to the process of forming a medical diagnosis. Instead, the body is assumed to “speak for itself” and to speak in a manner that cannot be affected by the distorting effects of colonialism. However, as Fanon notes, the doctor’s confidence that the patient’s body will facilitate better treatment soon dissipates, because rather than finding a docile or compliant body, “the body proved to be equally as rigid.”60 He continues: “The muscles were contracted. There was no relaxing. Here was the entire man, here was the colonized, facing both a technician and a colonizer.”61 The patient’s “body” too does not lend itself to the treatment regimens and therapy offered by the clinician. I do not interpret Fanon pointing solely to physiological differences here. Rather, I understand him to be describing a Manichean position available to the patient, wherein the patient too lacks confidence and trust in the colonizing doctor and thus either refuses (con-sciously or non-consciously) to compliantly follow the prescriptions of the doctor or refuses (consciously or non-consciously) to blithely give her/his body over to the clinical examination. This embodied resistance can occur in a number of ways. Non-conscious forms of such a refusal might be similar to what studies of clinical medicine call the “nocebo effect” wherein patients exhibit negative physical responses to medically inactive substances. Other

58. Mills, “White Ignorance,” 34. 59. Fanon, A Dying Colonialism, 126. 60. Ibid. 61. Ibid., 126–27.

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more conscious forms of resistance might include a refusal to enter into a clinical setting despite the need for care, or through the refusal to undergo treatment in a manner outlined by a physician. With respect to this latter action—what contemporary medical practitioners would label “noncompli-ance”—Fanon situates the trust or mistrust in Western medical treatment within a colonial encounter wherein the lives and epistemic authority of col-onized patients are already deemed expendable. He writes: “Accepting the medicine, even once, is admitting, to a limited extent perhaps but nonethe-less ambiguously, the validity of the Western technique. It is demonstrating one’s confidence in the foreigner’s medicine. Swallowing the whole dose in one gulp is literally getting even with it.”62 “Noncompliance” in this context, refers not to an individual’s refusal to adhere to the treatment regimen of a physician, as it so often gets cast in contemporary discussions in biomedical ethics. Rather, the terms of acceptance for a colonized patient are steeped in a broader structural context of white supremacy which refers outward to the histories of manipulation, deception, and destruction meted out by European colonizers. Again, as Fanon reminds us, “The fact is that . . . coloni-zation, having been built on military conquest and the police system, sought a justification for its existence and the legitimization of its persistence in its works,” its works in this case, being Western medical science and practice.63

Turning now to the U.S. prison system, or what poet activist raulrsali-nas has called “a backyard form of colonialism,”64 we can now directly link Fanon’s interpretation of colonial medical science to correctional health care. Fanon’s description of the neglect and subsequent appraisal of the col-onized patient’s body opens a hermeneutical space for understanding the clinical encounter faced by millions of incarcerated poor people and people of color in the United States. Namely, as a mechanism of internal neocolo-nialism, correctional health care operates within a white supremacist sys-tem of punishment that requires an inherent distrust in the testimonies of persons who are incarcerated. In addition, for-profit correctional healthcare companies earn billions of dollars in annual revenue for the very healthcare services that are offered in correctional facilities across the nation.65

62. Ibid. 131. 63. Ibid., 122. 64. Alan Gómez Eladio, “‘Troubadour of Justice’: An Interview with raúrsalinas,”

Behind Bars: Latino/as and Prison in the United States, ed. Suzanne Oboler, 214 (New York: Palgrave Macmillan, 2009).

65. Recent arguments suggesting that Black male prisoners are healthier and safer than non-incarcerated Black males do not consider the economic benefits of maintaining bare-minimum levels of health for prisoners for the purpose of exploiting prison laborers, and for financial gain via the subsidiary companies serving correctional facilities. Cf. Evelyn J. Patterson, “Incarcerating Death:

284 Andrea J. Pitts

Although by law, medical care must be provided within U.S. correctional facilities per the 1976 Supreme Court ruling in Estelle v. Gamble, evidence of the continued neglect and abuse of prisoners at the hands of prison adminis-tration, staff, and health care providers can be found through the numerous federal audits, lawsuits, and forms of public resistance by U.S. persons who are incarcerated. Consider, for example, recent legislation that speaks to the unjust conditions within correctional health care. In the 2000s, the state of California stands out as particularly relevant for assessing the abuse of prisoners via medical treatment. In 2005, through a court-mandated receiv-ership, California Prison Health Care Services was seized by the federal gov-ernment due to the state’s ongoing inability to comply with federal health and safety standards.66 Two class-action lawsuits, Plata v. Davis (2001) and Plata v. Schwarzenegger (2005), led a federal appellate court to effectively take over the health care system in California prisons, citing that upon sev-eral inspections over the span of roughly five years, the state’s prison health care system was unable to provide constitutionally adequate medical care. Audits of the correctional health care system in California were issued as the result of several earlier class-action lawsuits that raised concerns about the inadequacy of the medical care in prisons across the state.67 In a 2005 report, for example, a court-appointed receiver stated that “on average, an inmate in one of California’s prisons needlessly dies every six to seven days due to constitutional deficiencies in the CDRC’s [California Department of Corrections and Rehabilitation’s] medical delivery system.”68

To draw connections with Fanon, first, we can note that Fanon’s chap-ter on colonial medicine in A Dying Colonialsm directly references medical care in prisons. He writes regarding cases of prisoners of war in World War II: “It is obvious that certain circumstances can appreciably change the doc-tor-patient relationship. The German prisoner who was to be operated on by a French surgeon would very often, just before being given anesthetic, beseech the surgeon not to kill him.”69 Thus, we find that the colonial silenc-ing described by Fanon implicates contexts other than those of European colonial violence. Moreover, as I have outlined above, if we consider mass incarceration a structural facet of internal colonialism (Allen) and white

Morality in the U.S. State Correctional Facilities, 1985–1998,” Demography 47.2 (2010): 587–607.

66. Catherine Megan Bradley, “Old Remedies Are New Again: Deliberate Indifference and the Receivership in Plata v. Schwarzenegger,” N.Y.U. Annual Survey of American Law 62.4 (2007): 703.

67. See, for example, Coleman v. Brown 2:90-cv-00520-LKK-JFM (E.D. Cal. 1990); Shumate v. Wilson, 95-619 (E.D. Cal. 1995); Plata v. Brown, 3:01-cv-01351-TEH (N.D. Cal. 2001).

68. Plata v. Schwarzenegger, No. C01-135 (N.D. Cal. Oct. 3, 2005). 69. Fanon, A Dying Colonialism, 123.

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supremacy (Smith), Fanon’s analysis is quite apt for further analyses of cor-rectional health care. As in the context of colonialism, in the context of mass incarceration in the U.S., patients are often treated as untrustworthy with respect to their health needs. As the recent copayment policies and empiri-cal data on racial disparities in health care suggest, the provider-patient relationship can be fraught with unjust credibility assessments about the likelihood of certain groups of patients to be undisciplined and dishonest when it comes to their own health needs. For example, the National Com-mission on Correctional Health Care cites among the reasons in support of a copayment medical program is that “inmates who can spend money on a candy bar or a bottle of shampoo should be able to pay for medical care with the same funds—it is a matter of priorities.”70 Thus, if a patient chooses to refuse treatment after seeking medical services, medical providers, para-phrasing Fanon, ‘determine a priori’ that the patient is simply irresponsible or malingering due to some set of ulterior motives.

Also, as in the case of Fanon’s critique of the North African Syndrome, medical personnel or other prison officials may deem themselves superior knowers with respect to a patient’s ability to reliably articulate or under-stand her/his own health needs. Accordingly, prison staff and health care providers may expect the inmate’s body to “speak for itself” whether or not there is the presence of some malady or injury that requires medical atten-tion. Similar to what we saw in Fanon’s work, in correctional health care, hermeneutical gaps may emerge that lead to abuse, misdiagnosis, mistreat-ment, and neglect. In other words, without a situational diagnosis of the structural conditions of white supremacy, medical providers cannot serve as providers of healthcare for incarcerated patients. Or to use Fanon’s phrase, correctional healthcare operates within a “non-viable” white supremacist society that structurally fails to serve the needs of people of color.71

For these reasons, I offer here Fanon’s work on colonial medicine as a set of theoretical resources useful for interpreting the discipline of cor-rectional healthcare as a facet of structural white supremacy. Much more research can be done to address philosophical, political, and ethical aspects of correctional healthcare. I offer this analysis here as a starting point for further critique with the hope that more work will be done to challenge the health care conditions faced by millions of people in the U.S. today.72 — • —

70. “Position Statements: Charging Inmates a Fee for Health Care Services,” National Commission on Correctional Health Care 1996, http://www.ncchc .org/resources/statements/healthfees.html. Accessed December 5, 2012.

71. Fanon, “Letter to Resident Minister,” 53. 72. It is important to note that contexts of medical care differ widely across various

geopolitical contexts, and this analysis is not meant to account for non-U.S. correctional settings. Such an analysis is certainly a worthy project, but would require much more space and context-specific research than I can offer here.