Going Upstream: Prisons and the Social Determinants of Health

A couple of weeks ago, I joined with hundreds of other students and scholars at Johns Hopkins for a conference on prisons and the social determinants of health. The star of the conference was this story:

One day three men were fishing in the river when they noticed a baby floating towards them. Two of the men jumped out of their boat to save the child, and the third brought the baby and the boat to shore to care for it. As they stood around comforting it, one of the men spotted a second baby floating downstream! As he ran back towards the river, he was shocked to see his friend turn and run upstream. “What are you doing?!?” he cried. “There’s a baby in the water!” His friend shouted back over his shoulder: “I’m going to find the asshole throwing kids into the river!”

It was repeated and referenced throughout the day; it is a story about root causes and priorities, and it’s quite appropriate in a public health context where there’s always a tension between treating the symptoms or identifying the etiology. “Going upstream” means looking for the systematic and institutional causes of the illnesses and deaths public health workers encounter every day. We have to save the babies in the water, but we can’t ignore how they got there.

What we heard time and time again at this conference was a curious mix of ideas and arguments: on the one hand, many of Baltimore’s and America’s worst public health problems could be laid at the feet of the mass incarceration of its least advantaged residents. The nexus of poverty and educational failures were closely correlated with racism and prisons, and these were closely correlated with premature mortality, disease, and lost capacities. Put simply: prisons are one of the primary mediating terms for the creation of disparate health outcomes for whites and blacks.

And yet: we heard from a number of scholars who tried to give us a window onto criminality and delinquency through the neurobiology of adolescent impulsivity or the experience of substance abuse and dependency. These scholars didn’t even mention these racial disparities, and so they seemed to offer us little hope of a connection between the putative objectivity of brain and addiction science and the clear biases in arrests, prosecutions, convictions, and incarcerations. We even heard from one scholar who spent a long time touting his credentials and then accused African-American men of “compensatory narcissism.” (What was *he* compensating for?)

by Flickr user John Watson

Each panel was punctuated by a student poet from Dew More Baltimore, and these sizzling lyrics gradually seemed to impress the speakers that they could not ignore race any more. As the day went on, we heard from Elijah Cummings and Eddie Conway. We heard from a group of formerly incarcerated men who ran non-profits working on reentry and job placement. And we started to hear more talk of solutions: ways to reduce the number of people in jail, divert juveniles from the school-to-prison pipeline, and deal with substance abuse issues. David Kennedy‘s work with SafeStreets is designed to reduce the number of crime victims, and as a side effect reduce the number of people incarcerated: this is certainly laudable work worthy of all the celebration it has received, but it’s not really about abolishing prisons so much as it is about better-managing policing to increase efficacy,  reduce costs, and mitigate harms. In that sense, it’s meliorist rather than abolitionist. It goes upstream, but does it go upstream enough? Or does it tarry there in the water because there are lives to be saved right now?

What I never heard was a response to Vesla Weaver‘s challenge from the beginning of the day: African-Americans who encounter the criminal justice system are increasingly socialized with a dual logic: they are held responsible for the outcomes in their lives, while being actively disenfranchised in the decisions that will affect the conditions that produce those outcomes. The language of personal responsibility is rampant, even in public health; yet we know that demographic and institutional factors will play a major role in shaping outcomes. Disenfranchisement is the ultimate “up stream” moment; building social capital and public health seems to require re-enfranchisement.

Of course, Weaver herself didn’t tell us how to accomplish that. And so I return to Elinor Ostrom: you have to create an alignment between responsibility and the power to act. Ostrom showed that institutions can “crowd-in” responsibility: those who will experience the consequences of an action have to be the ones who control it. Civic capacities are hampered by medical and social incapacities, but at the same time civic capabilities can produce better outcomes in medicine and the economy.

Right now, we seem committed to more expert management of disenfranchised populations, and so we continue to create the mismatched logic of powerless responsibility and unaccountable power. The alternative is to let the Dew More poets take center stage and ask the scholars to wait for the intermission.

The Conservative War on Prisons, etc.

by Seany2000
by Seany2000
Via Metafilter’s kliuless (who definitely has a kliu):
  • The Conservative War on Prisons: “Right-wing operatives have decided that prisons are a lot like schools: hugely expensive, inefficient, and in need of root-and-branch reform. Is this how progress will happen in a hyper-polarized world?”
  • Raise The Crime Rate: “Statistics are notoriously slippery, but the figures that suggest that violence has been disappearing in the United States contain a blind spot so large that to cite them uncritically, as the major papers do, is to collude in an epic con. Uncounted in the official tallies are the hundreds of thousands of crimes that take place in the country’s prison system, a vast and growing residential network whose forsaken tenants increasingly bear the brunt of America’s propensity for anger and violence.”
  • The Caging of America: Why do we lock up so many people? “Six million people are under correctional supervision in the U.S.—more than were in Stalin’s gulags.”

Status Emotions and Punishment

I haven’t written much about status emotions, recently, but I came across one of my favorite Facebook memes and remembered again how central it seems. I don’t endorse the misogyny here, but it perfectly describes the way that fundamental attribution bias transforms resentment into contempt, and thus leads, in my view, to both epistemic and moral error:

Funny Confession Ecard: Once you hate someone, everything they do is offensive. 'Look at this bitch eating those crackers like she owns the place.'

I’ve also been thinking a bit about the role of status emotions in our treatment of criminals in the US. It’s important to recognize when your differing judgments are leading you away from the common sense moral community, and punishment is one place that this seems to be occurring for me. Put simply, I just don’t see any good reason to disdain or show contempt for convicted criminals. This follows quite self-evidently from my claim that status emotions are immoral and unreliable. But this puts me outside of the mainstream society’s judgments about criminals, and I wonder if I’ve missed something, am wired differently, or am simply altering my intuitions in order to bite the bullet on my idiosyncratic account of the moral emotions.

Recall that Michelle Mason just assumes that some people are better than others in her account of contempt as a reactive attitude. But the genius of Strawson’s account of the reactive attitudes was that it allowed us to sidestep tricky metaphysical questions about agency and determinism. Mason does the same thing, sidestepping tricky metaphysical questions about personal identity and the persistence of character traits over time and context. Yet she doesn’t thematize the question of persistence or identity in the same way that Strawson thematized determinism and blame.

Blame and punishing seem appropriate, but what I notice is that the prisoners I teach are thoughtful human beings who are interested in the texts we’re reading. They are polite, respectful, and in my judgment genuine. Almost every day that I come to class, someone thanks me for the lesson. At the same time, they have criminal histories. Some were simply caught up in the war on drugs, but some of them allude to having done truly bad things; this is not just a matter of a self-selected group of victim-less criminals. And yet, that doesn’t seem like it matters to me. It doesn’t seem like it should matter: to my mind, they are due the same esteem as anyone else.

Criminals could be the perfect test for status emotions, if you set aside all your concerns about the US’s problems with mass incarceration, innocence and plea bargaining, the racialization of justice, and the war on drugs. Of course, we shouldn’t set those things aside when we’re talking about policy, but at a certain point you have to admit that some people really are guilty. If the claim is simply that they wouldn’t be guilty in a radically different society, we’re back to begging the question in Strawson’s original use of the reactive attitudes: in that case, determinism actually does matter, and these crimes were [over]determined and thus deserving of neither blame nor contempt.

I think we can preserve blame while jettisoning contempt: we resent the criminal for the harm they do, and don’t worry about determinism. We can’t disdain the criminal without assuming something like: “You are the sort of person who would have done that in a different context. I am the sort of person who would not have done that in any of the proximate possible worlds.” I doubt such assumptions are warranted. Perhaps I am wrong. But the policy debate that takes all those political-economic-racial questions seriously would otherwise shift to seeking better means of distinguishing the truly innocent, those whose moral and social status has been wrongly undermined, from the truly guilt, those whose moral and social status is rightly low. My claim is that there is no fact of the matter about trans-modal character, and that this is morally relevant to status.

Contempt depends on the fiction of the doer behind the deed; it disdains the sinner in addition to hating the sin. If someone admits to having committed a bank robbery or a murder, they’re still: (a) human beings, (b) autonomous agents, (c) members of my moral community, (d) capable knowers, and (e) subject to the same moral luck as all contingent creatures. Thus, they are my moral equal and ought to be my social equal as well: an intuition that reports otherwise is simply in error, no matter how many people share the intuition.

Here’s where it’s helpful to be a contrite fallibilist, though: does anyone who has the status hierarchy intuition also have a reflective defense of it? Macalester Bell doesn’t. Mason doesn’t. But maybe somebody does.

What is “Public Philosophy”?

My department invited Sharon Meagher to do a seminar last Friday on how to redirect our energies towards “public philosophy.” Meagher has a great textbook for introducing philosophy through an exploration of urban issues that offers a situated approach to philosophical inquiry, and she’s done a lot of work trying to organize and advocate for publicly engaged philosophers.

What got us hung up was how much of what we were already doing was “public philosophy.” The term “public philosophy” can encompass things as diverse as doing any sort of philosophy in public (like anything in The Stone or The Partially Examined Life), doing any sort of political philosophy, or engaging the public in doing any sort of philosophy (Socrates Cafe, my own Free Philosophy Courses page, etc.)

In a banal sense, any time a philosopher publishes a paper, they’re doing doing philosophy in public just by making the paper openly accessible. Anyone with a philosophy blog or podcast is doing “public philosophy” by that definition. Even a classroom is public, after all, but teaching in one doesn’t seem to be enough to qualify.

Shy as we were to name the thing we didn’t want to be for fear of offence, we sometimes seemed to be using the term as a kind of corporate marketing speak, “re-envisioneering” ourselves into a new justification for the status quo. Rebranding is a great new use for the fallacy of the heap. Philosophers well know the kinds of problems that emerge from definition and typology, yet we easily fall into the same kinds of traps as non-philosophers when we’re not consciously practicing our metacognitive techniques. And so on Friday we struggled over whether we wanted to define public philosophy as “engaged” or “activist” philosophy, whether it would include politicized (African-American, feminist, queer, Africanist) engagement with the traditional philosophical canon, and whether the work done under this title could include difficult and often jargonistic analytic and textual scholarship.

Is “public philosophy” just “philosophy”?

The abstract, esoteric, and metaphysical disputes that are often defined *out* of public philosophy are just as often the ones that actually plague the public discourse. For instance, the political philosophy of John Rawls and Robert Nozick are often excluded from definitions of public philosophy for being abstract and irrelevant. Yet while some of the most politically contentious scholarship in philosophy has had little impact on public life, quite a lot of our public discourse still seems to be trapped by crude versions of Rawls and Nozick on just deserts and distributive justice. The same thing could be said for ontotheological debates about what it means to be human; the relationship between metaphysical, psychological, and political freedom; or the difficult epistemological questions about what counts as knowledge, whose testimony matters, and what should be taught as science.

To my mind, what makes us philosophers is the shared conviction that these detours into difficulty are the only way to resolve our disputes.

The major proponents of public philosophy, who have sought to create networks of solidarity and mutual aid with other public philosophers, would go even further: it seems that this new concentration on the public will entail either the creation of new forums outside of the university for the public to engage in philosophy (because engaging in philosophy is a public good) or philosophers aiding public advocacy by helping make arguments and articulate the philosophical foundations for social movements (because philosophy can be liberatory.) 

This specifically public approach to philosophy tends to involve a slightly more demanding sense of usefulness to the public: clarifying concepts relevant to public matters, helping social scientists navigate the tricky metaphysical and normative implications of their value-laden descriptions of the world, or doing philosophy in unconventionally politicized spaces (senior centers, prisons, high schools, elementary schools, or anarchist collectives.)

It also seems relevant to ask, here, why we need philosophers to do these things. Why not create new forums to do psychology or physics outside the university? Why can’t social scientists navigate their own metaphysical and normative implications? Why not let social movements articulate their own principles and foundations? Why not teach classics or economics in unconventionally politicized spaces?

Speaking of which: if you’re (a) in the DC/Baltimore area, and (b) interested in teaching a college-level course at a local prison, please get in touch with me! Non-philosophers welcome! The pay is $0, but it’s totally rewarding.

Dom and I drop some more “science” on crime

Sentiments of Rationality is at it again. Dom seems to have convinced himself that conservatives are actually right about criminal justice, since they care about victims and safety more than liberals, and trust their authority figures. He goes on to suggest electric shocks in order to speed punishment and reduce incarceration time. Here’s the gist:

If we want to deter crime, then, we can do so effectively by viewing it as an educational problem that requires cultivation of the proper habits, ones which are pro-social and lead to fuller self-development of individual, i.e., more freedom in a positive sense.

I’m glad Dom continues to push this line of argument vis-à-vis  conservatism and criminal justice, because it’s clearly fruitful. I’ve gotten two posts out of it, myself! However, anyone who’s really fascinated by modern crime and punishment should read Foucault’s Discipline and Punish. Though I often suspect Foucault of just the critically-edged nostalgia that troubles some of Dom’s interlocutors, it’s still the first book to differentiate the modern situation from the same old conversations that philosophers have been having since Socrates demanded a full pardon and a daily coolness stipend. Then, if you want to keep at it, take a look around the internet at prison statistics and the sorts of things that generally trouble “corrections officers” and prison reformers. I recommend the Prison Policy Intiative, this neat blog, or what the man himself says on the subject.

With nearly 80,000 inmates in the NY State system, (which is the only system I’ve encountered professionally) much of the concern surrounds costs and efficiency, as well as the injustices that efficiencies create. As with any discourse, getting your head around general moral principles won’t help you much when you’re faced with a rusty, decrepit system with out-of-control costs. It’s more fun to talk about in the abstract, though….

So: in Arendtian fashion, I take issue with the paternalization of the state. Unlike schools, prisons generally deal with fully-formed adults. Much of what Dom says might apply to juvenile detention, except that we generally assume that more leniency is required for minors. (Maybe that’s the root of the problem: if we could only draw and quarter a few teenage rapists, perhaps the rest would fall into line… but I’m just kidding, really.) Dom actually uses an elementary school example to make his point:

Some children have a nervous tendency to repeatedly tap their pen or pencil on their desk, making it difficult for others to concentrate. The most effective approach to dealing with this behavior would probably be a (literal) slap on the wrist, but even if we avoid corporal punishment entirely, it still seems the most reasonable response would be to punish the children in some other way (maybe even just telling them to stop, which puts a social pressure on them).

However, what some teachers have begun doing is giving the students drinking straws to tap instead. The problem is taken as some inflexible given, a natural disorder which requires educators to accommodate students rather than vice-versa. But this is bad for everyone involved. The child is reinforced in a bad behavior that, outside of the protective school environment, could lead to other bad consequences. Meanwhile, we have to take extra time and effort to see to the children’s “special needs”.

This pencil-tapping analogy threw me for a loop. I guess it’s meant to be an exemplar of our impotent, libertine educators, but I think that it’s a fatally bad example in this conversation. To go from that to “regularly administering electric shocks to prisoners over the duration of their sentence” seems like a major jump. (They are used, and inevitably cruelly and for the inappropriate enjoyment of the corrections officers) It suggests to me that he might be letting the examples do some of his reasoning for him.

Yes, I agree we should spank our children. But should we spank our adults? It seems to be poorly argued to say that the one follows from the other. We spank children in order to make them into responsible subjects; having become responsible subjects (who refuse to respond to authority), adults require different treatment. Just think about your own habits, and how much more difficult they are to change than they once were. Many claim that criminals put themselves in this diminutive position vis-à-vis the state by committing crimes. Yet they cannot argue this, through syllogistic and valid reasoning, so instead they talk around the problem, through the analogies Dom describes. They attempt to enforce a paradigm of criminal juvenality by constantly asserting the primacy of examples drawn from parenting and education. Meanwhile, the state gains tremendous powers to discipline and control the lives of its citizens, and becomes increasingly paternalistic.

I meant what I said in my last post: the truly criminal are lost to us. Lock them up, torture them, kill them, it doesn’t matter, because they won’t ever become good. But let’s not for a second pretend that the state is so trustworthy that it won’t find a way to extend its oversight of criminals to increasingly banal parts of our everyday lives. Drug use, sexual deviance, political dissent, whatever strikes the political fancy: the capacity of the legislature to criminalize activites is unlimited. We’d best be sure that the pseudo-criminals that bad governments produce aren’t tortured along with the bad people we’d like to see punished.