by Eyal Press
“A COLLECTIVE PUBLIC YAWN”
On May 17, 2014, Julie Brown, a reporter at the Miami Herald, published an article in the paper about the abuse of mentally ill prisoners in the TCU at Dade. Below the headline was a photograph of Darren Rainey, clad in prison blues. Brown’s main source was Harold Hempstead, who had turned over copies of the complaints that Harriet had encouraged him to write. The article indicated that after being interviewed, Hempstead had been threatened with solitary confinement and other forms of punishment by three corrections officers.
After the Herald article appeared, Jerry Cummings, the warden at Dade, was placed on administrative leave, and some prisoner rights advocates questioned whether the Department of Corrections had tried to cover up a murder. Few questioned why the burden of exposing it had fallen to a prisoner rather than to one of the prison’s mental health or medical professionals. The duty to protect patients from harm is a core principle of medical ethics. According to the National Commission on Correctional Health Care, an offshoot of the American Medical Association that issues standards of care for prisons, any mental health professional who is aware of abuse is obligated “to report this activity to the appropriate authorities.”
But counselors are not likely to fulfill this duty if they have reason to fear that doing so will put them in danger, a feeling that is pervasive. In a 2015 survey by the Bureau of Correctional Health Services in New York City, more than one-third of mental health personnel working in prisons admitted to feeling “that their ethics were regularly compromised in their work setting,” in particular because “security staff might retaliate if health staff reported patient abuse.” A year before the survey was completed, the U.S. Justice Department published a report about the brutalities routinely visited on incarcerated people in New York’s main prison, Rikers Island, where “a deep-seated culture of violence” had taken root among the guards. The violence flourished, in part, because of “inadequate reporting by staff … including false reporting,” the Justice Department concluded. One counselor who did try to report it was Randi Cawley. In 2012, Cawley was sitting at her desk in the mental health assessment unit at Rikers when a group of guards entered with a young man who was handcuffed to a gurney. After dragging him into an examination room with no cameras in it, the guards took turns slugging him in the face with closed fists, a cascade of blows that went on for five minutes. Then the guards got to work on another prisoner, who suffered multiple contusions. In the morning, the walls of the unit were streaked with blood. Yet the official incident report made no mention of abuse. One guard told an administrator the victims had “hit their heads on the cabinets themselves.” Cawley decided to report what really happened, naming the specific guards and officers involved. Afterward, she began to field threats: dead flowers were placed on her computer; ominous messages were left on her phone. Eventually, she felt so unsafe inside Rikers that she quit.
The abuse at Rikers was brazen and extreme. But how exceptional was a culture of violence in the mental health wards of America’s prisons? Not very, the evidence suggested. In 2015, a report by Human Rights Watch found that excessive force was routinely administered to the 360,000 prisoners in America with mental illnesses. Chemical sprays, stun guns, extended solitary confinement: all of these tools were used with disturbing regularity to incapacitate and punish mentally ill prisoners. In the view of Jamie Fellner, then a senior adviser at Human Rights Watch and the report’s author, one reason for this was that mental health professionals rarely intervened to suggest alternatives. “Mental health staff in prisons all too often acquiesce,” said Fellner. “There is this culture of ‘It’s none of our business,’ which means that nobody ends up advocating for the patient.”
In Fellner’s view, the mental health attendants who made these accommodations were not victims. They were enablers, shirking the “duty to protect” and deferring to security in ways that could have fatal consequences. In one case described in the Human Rights Watch report, a mentally ill prisoner in Dallas died after officers kicked him, choked him, and doused him with pepper spray, even after he had been placed in restraints and had stopped resisting.
Kenneth Appelbaum, a psychiatrist who spent nearly a decade as the mental health director of the Massachusetts Department of Correction, agreed that excessive deference to guards was a problem. But Appelbaum also faulted professional organizations such as the American Psychiatric Association for paying little attention to the ethical challenges facing clinicians who worked in prisons. At the APA’s annual meetings, Appelbaum said, “barely 1 percent of the sessions have anything to do with care and treatment in a correctional setting. Prisons are where so many of the sickest people with the most serious psychiatric disorders in our society end up, and as a profession we constantly lament this. Yet our professional organizations are not very engaged in asking how we should care for patients in those settings.”
The lack of engagement was all the more striking in light of the scale of the need. In 2014, the Treatment Advocacy Center, a nonprofit organization dedicated to eliminating barriers to care for mental illness, and the National Sheriffs’ Association copublished the first national survey of treatment practices in correctional facilities. In forty-four of the fifty states it surveyed, the institution holding the most people with severe mental illnesses was not a hospital. It was a jail or prison. The pattern prevailed in liberal states like California, where the largest mental health institution was the Los Angeles County Jail, and in conservative ones like Indiana, where several state prisons held more mentally ill people than the largest remaining psychiatric hospital. Overall, “the number of mentally ill persons in prisons or jails was 10 times the number remaining in state hospitals,” the report found. Among the consequences were overcrowding, physical attacks on corrections officers, an overreliance on solitary confinement, and the deterioration of people in custody who were subjected to neglect and abuse.
“When things go wrong, as they inevitably do, the prison and jail officials are blamed,” the Treatment Advocacy Center noted. The real problem rested with a society that failed to fund and maintain “a functioning public mental health treatment system,” the report suggested, and that had forgotten its own history. In colonial America, “lunatics” and “mad persons” had often been confined in jails and prisons. But by the middle of the nineteenth century, this practice came to be seen as barbaric and cruel, thanks to reformers like Dorothea Dix, who drew attention to the deplorable conditions that the mentally ill were forced to endure in the jails of Massachusetts and other states. In a report submitted to the Massachusetts legislature in 1843, Dix relayed seeing indigent wards with severe mental health problems “chained, naked, beaten with rods, and lashed into obedience.” At the urging of Dix and other reformers, a network of asylums and public psychiatric hospitals soon emerged to provide more suitable treatment. By 1880, the federal census found that “insane persons” accounted for less than 1 percent of America’s jail and prison population.
A century later, when a new generation of reformers pushed for state psychiatric hospitals to close, few imagined the horrors that Dorothea Dix had witnessed would recur. One person who did anticipate this was Marc Abramson, a psychiatrist who visited the county jail in San Mateo, California, in the early 1970s, as the deinstitutionalization movement was gaining traction, and noticed the large number of mentally ill people in custody. “There may be a limit to society’s tolerance of mentally disordered behavior,” warned Abramson in an article published in 1972. “If the entry of persons exhibiting mentally disordered behavior into the mental health system of social control is impeded, community pressure will force them into the criminal justice system of social control.” A year after Abramson’s article appeared, the California state legislature held hearings to discuss the concerns he had raised. But as the years passed and the number of mentally ill people behind bars continued to grow, the level of public attention faded, suggesting that many communities were happy enough to have jai
ls and prisons take care of a problem that might otherwise have been left to them, just as Abramson had feared. “Perhaps the most alarming aspect of the present situation is that such numbers no longer elicit much professional or public reaction,” observed the Treatment Advocacy Center report. “Half a century ago, such reports would have elicited spirited public discussion and proposals for reform; now they elicit a collective public yawn.”
In Appelbaum’s view, the lack of engagement from professional organizations reflected the fact that the vast majority of elite psychologists had no experience working in jails and prisons and regarded such work as beneath them. “Correctional health care has been seen as the place that clinicians who were not really competent to practice out in the community would end up,” he said. “It has had this stigma. If you are working in a correctional setting, there must be something about you that you’re not up to snuff.”
One reason for the stigma was money: the pay in most prisons was paltry, which diminished the prestige and attractiveness of working in them. Another was a body of critical literature produced in the 1960s, when scholars such as Michel Foucault and Erving Goffman published influential studies depicting institutional psychiatry as an instrument of social control. In his 1961 book, Asylums, which drew on a year of field research at a psychiatric hospital in Washington, D.C., Goffman wrote scathingly about staff members who “have been reported forcing a patient who wanted a cigarette to say ‘pretty please’ or jump up for it.” Such abuse flourished in what Goffman called “total institutions,” regimented places cut off from the outside world where individual autonomy was crushed and where the people in confinement were humiliated and besmirched. The staff who wielded power in such institutions besmirched themselves no less, Goffman’s account suggested, a perception reinforced in novels such as Ken Kesey’s One Flew over the Cuckoo’s Nest, in which the villain, Nurse Ratched, exacts revenge on an insubordinate patient, Randle Patrick McMurphy, by arranging for him to be lobotomized (the lobotomy proceeds even though McMurphy is not mentally ill). Such works cast a powerful spell on the popular imagination and made many psychiatrists understandably loath ever to set foot in a “total institution” again. In this context, correctional psychiatry came to be seen not as a laudable form of social work but as dreary and debasing—as dirty work.
“HUMAN MATERIALS”
By the time the Herald article on Darren Rainey appeared, Harriet Krzykowski was no longer working at Dade. She wasn’t even in Florida anymore. She had gone back to Missouri, where she and Steven had moved so that they could be closer to his ailing mother. When I visited Harriet, she told me that after she left Dade, she tried to erase the experience from her memory. Then she saw the Herald story about Rainey’s death and the memories came flooding back, a wave of flashbacks that brought on a familiar set of physical symptoms. She couldn’t eat. She fell into a depression. She started losing her hair again.
When we met, Harriet was wearing faded jeans, a short-sleeved blouse, and a black wig. A trace of melancholy glimmered in her eyes. Enough time had passed that she was finally ready to discuss her experience, but revisiting the past also made her think about why she hadn’t spoken out earlier. “There was one particular night I couldn’t sleep because I was crying too hard, thinking, oh my God, all this time has gone by and I didn’t say anything, even when I was out of the situation,” she said. “I let it continue. These guys are still suffering. They’re still there—it’s still happening, it’s happening all over. Why didn’t I do more?”
Harriet was not the only former Dade employee who was haunted by such thoughts. A few weeks after we met, I had lunch in Miami with a behavioral health technician named Lovita Richardson. Originally from Daytona Beach, Richardson told me she was initially excited to work at Dade, convinced that she could make a positive difference in the lives of her patients, whom she saw as victims of societal neglect. “This is an invisible population; people assume you’re scum of the earth,” she said of the men in the TCU. Richardson knew how easily derogatory assumptions could render people invisible in America. She was raised by her paternal grandparents, who, like many African Americans of their generation, experienced the indignities of the Jim Crow South directly when they worked as domestic servants for a wealthy white family in Miami Beach, where Black people were not allowed after sundown. Growing up, Richardson was the only Black student at the Catholic girls’ school she attended. At first, Richardson relished the opportunity to treat the prisoners at Dade with the compassion that she felt they deserved. “I couldn’t wait to get to work,” she said. One morning, at around 10:30, she walked out of the nurses’ station in the TCU, toward the exit, and then stopped. She turned around, circled back, and glanced again at what she thought she’d seen out of the corner of her eye. Across the glassed-in hallway, a group of guards were bludgeoning a prisoner who was shackled to a chair inside his cell, punching and beating him while one of them stood watch. The victim absorbing the onslaught was a tiny man, “maybe 110 pounds soaking wet,” Richardson recalled. Richardson watched in stunned silence for several minutes as the battering continued, long enough for the guard on lookout duty to spot her.
Afterward, Richardson wanted to report what she’d seen, but she hesitated when a coworker with more experience warned her that she would merely be endangering herself. In the days that followed, the guards dropped by to tell her that she wouldn’t be needed in that unit because they had already taken care of everything. Their tone was polite, but the message was clear. “They let you know, we’re running this place—this is our house, you’re just visiting,” she said. Soon thereafter, she started having nightmares and questioning what kind of person she was. When I asked her if she still had these thoughts, tears welled in her eyes. “It makes you feel like you’re letting this person down,” she said. “They are at risk for their very life, and you know it, but you’re not helping them out.”
The coworker who advised Richardson also spoke to me, though she did not want to be identified. She understood exactly how Richardson felt, because she had been in the same situation herself. She was the mental health counselor who had called George Mallinckrodt after seeing guards stomp on a prisoner in handcuffs. Afterward, she told me, “I wanted to cry. I wanted to scream.” Yet on the form indicating what she had witnessed, “I wrote I didn’t see anything.” A Latina woman who grew up in East Harlem before relocating to Florida, she, too, felt a responsibility to treat incarcerated people humanely, both because it was her job and because she knew what it was like to experience fear and helplessness in the presence of security officers. (Growing up in Harlem, she said, “I knew that racism was alive and well and that the police, if they got the opportunity, would step on me.”) After witnessing the stomping incident, she told me she thought of quitting but, like Harriet, was in no position to leave her job. “If I had not needed my paycheck, I would have walked out,” she said, her eyes falling. “There were no other jobs.”
The only mental health counselor I met who told me he did not fear for his safety while working at Dade was George Mallinckrodt, who is six feet three, with a broad wingspan and a lanky, athletic build. But Mallinckrodt said the job nearly caused him to have a nervous breakdown. When he was fired, he felt a wave of relief wash over him. The relief eventually gave way to unsettling memories, among them an exchange he’d had with a prisoner who kept flinging his food tray at the window of his cell, as though it were a Frisbee. After failing to persuade him to stop, Mallinckrodt concluded that the man was in the throes of a psychotic episode. He also noted, with surprise, that there were no food stains on the window. Only later, when he heard about prisoners receiving empty meal trays as a form of punishment, did he realize that the man was outraged because the guards were starving him. “I was seeing abuse, but I was labeling it as ‘Oh, he’s psychologically compromised; he’s mentally ill,’” Mallinckrodt said. After leaving Dade, Mallinckrodt published a memoir, Getting Away with Murder, that described the cruelty he witnes
sed. In one passage, a prisoner tells Mallinckrodt about a patient in the TCU who, after receiving an empty food tray, stuck his arm through the flap on his cell door, demanding something to eat. A guard grabbed his arm; then another officer came over and kicked the door flap, smashing the arm again and again. Mallinckrodt talks to the victim, who shows him his bruises, and reports the incident. Nothing is done.
* * *
Like George Mallinckrodt, Harriet Krzykowski felt a compulsion to write down her experiences. Halfway through our first conversation, she reached into her purse and handed me a fifty-two-page single-spaced manuscript. She wrote it in feverish outbursts, she said, jotting down details on her arm when she didn’t have paper or a laptop nearby. The manuscript wasn’t finished and had no title, but she called it her “trauma narrative,” a label that matched the diagnosis she’d been given by a therapist she had started seeing, who told her she had post-traumatic stress disorder. In one passage, Harriet recalled seeing a guard repeatedly taunting a prisoner by calling him Tampon, until the man flew into a rage. When Harriet asked the guard about the insult, he said, “He got his ass raped, and now he needs a tampon to stop the bleeding.” Harriet later spoke with a nurse, who confirmed that the prisoner had been sexually assaulted.
