Wicked Bad Habits

461 Pages·2014·19.18 MB·English

by  Kim Sue

Wicked Bad Habits: Governing Women in the Carceral-Therapeutic
State in Massachusetts

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Sue, Kimberly Lauren. 2014. Wicked Bad Habits: Governing
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Women in the Carceral-Therapeutic State in Massachusetts.
Doctoral dissertation, Harvard University.
Accessed April 17, 2018 5:03:50 PM EDT
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Wicked Bad Habits:
Governing Women on Heroin in the Carceral-Therapeutic State in Massachusetts

A dissertation presented

by

Kimberly Lauren Sue

to

The Department of Anthropology

in partial fulfillment of the requirements
for the degree of
Doctor of Philosophy
in the subject of
Anthropology

Harvard University
Cambridge, Massachusetts

March 2014
© 2014- Kimberly Lauren Sue
All rights reserved.
Dissertation Advisor: Professor Arthur Kleinman Author: Kimberly Lauren Sue

ABSTRACT

Wicked Bad Habits:
Governing Women on Heroin in the Carceral-Therapeutic State in Massachusetts

In this dissertation, I focus on the social response of criminalization and incarceration to
the problem of heroin use among women in Massachusetts in the ongoing era of the United
States’ “War on Drugs.” Based on fieldwork conducted between 2010-2014, I argue that the
convergence of therapeutic ideals with the prison system creates a means of governing and
regulating these women’s lives via what I call the “carceral therapeutic state.” I examine various
facets of treatment programs in the state women’s prison, MCI-Framingham, and a local Boston
jail, Suffolk County House of Corrections, including drug treatment, trauma treatment and work
readiness programs. I consider how and why these programs in prisons and jails have become
means to centralize and solidify the criminal justice system as the predominant site of addiction
and mental health treatment for poor women on drugs.
Over the past eighteen months, I have followed women with opiate addictions recruited
from the prison, the jail, and a local community suboxone clinic over time as they traverse many
spaces: their homes, the streets, hospitals, shelters and back into prisons and jails. These women
struggle mightily with the task of recovering from drug addiction as well as incarceration itself. I
explore the dilemmas they face during and after incarceration as they struggle for well-being and
for moral lives amidst many sources of everyday violence and harm, including themselves. I
also consider how political and moral valuations of women who use drugs are based on a
particularly American notion of selfhood, volition and health.
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Table of Contents

1 Introduction 1
2 The Politics of Addiction Treatment and Incarceration 45
3 Historical Treatment of Deviance and Addiction at the State Women’s Prison 86
4 “Programming” Addiction Away 132
5 Pain, Addiction and the Pharmaceutical-Prison Nexus 186
6 Discipline, Punish and Treat Trauma 239
7 Embodied Deviance and the Carceral Production of Social Death 284
8 “Recovery Is My Job Now” 336
9 Conclusion 383

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List of Images, Maps and Figures

Map 1.1: Boston neighborhood segregation 12
Map 1.2: Poverty levels by neighborhood 13
Figure 1.1: Substance abuse treatment admissions, 2010 17
Table 1.1: Top-ranked primary drug admissions by city 18
Figure 1.2: Drug crime by neighborhood, 1971 20
Figure 1.3: Offense breakdowns by gender, 2006 26
Table 2.1: Habit self versus the inner self 74
Figure 5.1: Sales of opioids and use of opioid prescriptions 198
Figure 5.2: Tweets from the RxPATROL’s Twitter feed 203
Figure 5.3: Brain chemistry diagram 213
Figure 5.4: Department of Corrections’ pamphlet on drug dogs 226
Figure 5.5: Example of Facebook post on drug smuggling suboxone 227
Figure 5.6: Facebook post on smuggling neurontin 227
Figure 5.7: Facebook post #contraband 228
Figure 5.8: Facebook post #drugsmuggling 228
Figure 5.9: CDC diagram illustrating drug diversion 236
Image 7.1: Lydia in the hospital 289
Image 7.2: Lydia’s healing wound 324
Figure 8.1: Page from Mary’s skills workbook, re-entry class 354
Figure 8.2: Mary’s handwritten response to being a felon 355
Figure 8.3: “Speed Bump” worksheet from Mary’s re-entry class 355
Figure 8.4: DOC budget, FY2011 381

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Acknowledgments

Conducting fieldwork in prisons and jails on addiction has truly tested my mettle and
spirit. Given the substantial institutional, bureaucratic and systemic challenges that I have faced
over the years, I realize that it is the contributions of many individuals other than myself that
have helped make the completion of this work possible. But it would not be possible without the
women themselves who have generously opened up their lives and hearts to me. Incarceration,
trauma and drug use are sensitive topics to share with anyone but I found a true generosity of
spirit and commitment to the goals of this work among women who have and continue to use
heroin. They have given me the encouragement to finish this work as I witness the truly difficult
circumstances that they navigate skillfully every day. I particularly want to thank the woman I
call Tina for being such a kind and compassionate informant and friend. She took it upon herself
to teach me about the complexity of addiction and incarceration in her life. Her ongoing work
and commitment to serve others in similar situations is truly inspiring and gives me great hope.
From its inception, I knew that working in prisons and jails in the United States would be
difficult given the high level of concern given to prison research. Many people experienced with
the prisons and jails in Massachusetts helped me with the necessary and critical logistics,
including Dr. Warren Ferguson, Dr. Stephen Martin, Dr. Joseph Cohen, Jennifer Johnson, and
Rheana Kohl at the Department of Corrections Research office. I also am indebted to Dr. Ken
Freedman, Donna White and the staff of the suboxone clinic. To Chris Jepson, who was the
director of the suboxone clinic and is an experienced addiction clinician, I thank for many
insightful conversations about how to best take care of women on heroin. He encouraged me to
produce a work that speaks to real life clinical quandaries and is grounded in patient experiences.
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I also wish to thank prison and jail administrators who made space and time for me at the
prison and jail, including Christina Ruccio and Rachelle Steinberg at the Suffolk County House
of Corrections, as well Lynn Bisonnette, the Superintendent of MCI-Framingham as well as the
Directors of Treatment, Lyn Muise and Lynn Lizzotte at the South Middlesex Correctional
Center and MCI-Framingham, respectively. I thank the numerous caseworkers and program
directors who allowed me to sit in on their programs.
This work benefitted from innumerable conversations and ‘jam sessions’ I had with
colleagues and friends, including intellectuals who never stepped foot in classrooms past high
school. I thank interlocutors in addiction and prison studies, including Nancy Campbell, Helena
Hansen, Eoin Cannon, Eugene Raikhel, and Samuel Roberts. I thank clinicians including Norm
Neiberg, PhD, and Edward Khantian, an addiction psychiatrist, for opening up about the old days
of treatment. I thank Harry Leno for helping me think outside of the box in how we can better
treat one another.
At Harvard, there are innumerable people who made this possible. My dissertation
committee has been so kind and generous with their time and their intellectual proddings. Arthur
Kleinman has challenged me at all levels to make this work both critical and accessible. When I
have despaired, he has offered me near instant support based on his years of experience and
knowledge as a mentor and a scholar. Byron and Mary-Jo Good have been generous and
inspiring mentors and friends, drawing on their vast and substantial fieldwork both in and outside
of the United States. And Philippe Bourgois opened up his fieldsite and his home to me, offering
me many ways to think insightfully and critically at a grounded level about drugs and
incarceration. Doing fieldwork and learning from him, Laurie, Fernando and George was a great
joy and is a continual reminder that this work can be fun, stimulating and exciting. I have also
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benefited particularly from years of conversations and support from Allan Brandt, who is a true
epitome of a thorough and kind scholar. From the moment I received a welcome email from him
into the MD-PhD program in the social sciences at Harvard, he has been a great friend and
champion of my work. He and I have had many important and inspiring conversations about
studying and writing about addiction. Others in the program, including Susan Greenhalgh and
Duana Fullwiley, have prodded me towards critical medical anthropology scholarship and
writing. Of course Paul Farmer, Salmaan Keshavjee, Anne Becker, and David Jones have been
staunch supporters for many years and it has been my pleasure to teach and learn from. I hope
my work contributes to the body of global health knowledge and ideas that you all have
pioneered. To Laurence Ralph, Laurie Hart, Jeremy Greene, Joao Biehl and Adriana Petryna,
Jean Jackson, Erica James, I thank you all for conversations, encouragement and cheerleading.
Graduate school is also a process of learning how to support oneself and one’s
colleagues, and my graduate school classmates have offered support quickly and often when I
have been dispirited, discouraged or stuck at a dead-end. Marty Alexander has read and edited
countless talks and papers and we have had innumerable Skype conversations, the content of
which is embedded in this entire dissertation. Amy Saltzman Porter has been my steady friend
and companion in the MD-PhD process along with my other excellent colleagues in this small
program, including Darja Djorevic, John Heintz, George Karandinos, Sae Takada, Alison
Hwong, David Kim, Zirui Song and Tisa Sherry. Emily Harrison has been my on-site historian
and public health scholar and has walked with me alongside the research and writing. And I have
benefited from the mentorship and friendship of so many in the program, including Felicity
Aulino, Kate Mason, Seth Hannah, April Opoliner, Sa’ed Atshan, Husan Ying, Andy McDowell,
Maria Stalford, Janis Calleja and Marilyn Goodrich. I am inspired by joint-degree colleagues
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whose work shows both attention to academic scholarship and clinical medicine: Scott
Stonington, Seth Holmes, Carolyn Sufrin who have all charted truly inspiring career and life
paths. Amy Cohen at the MD-PhD program has been an excellent cheerleader and source of
support.
My friends and mentors at Harvard Medical School have helped me through seven years
of training with humor, compassion and advice. I look up to these clinician-educators who
constantly inspire: David Hirsh, Bill Taylor, Orah Platt, Bela Bashar at Dimock, and at MGH-
Chelsea, Marya Cohen, Jess Zeidman and Carina Fernandez-Golarz. And many friends, now
residents and fellows, are equally supportive: Katrina Ciraldo, Anuja Singh, Lekshmi Santosh,
Michael Podolsky, Simeon Kimmel, Lindsay Ryan, Amy Pasternack, David Tian, Kirsten
Austad, Jessica O’Brien, Chuan Mei Lee, Aarti Surti and Rachel Rosenberg.
My family has watched and supported me through thick and thin over these past seven
years. My grandparents, while not always understanding the joint MD-PhD path, have inspired
me to work hard and quickly. My mom, dad and brother have fielded calls of anxiety and
frustration alike and have helped me gain equanimity. And my partner James Cowling has
provided me unconditional support and advice as he looks out for my overall well-being. His
support and love have contributed to all parts of this project.
Finally, I gained strength to write and continue this dissertation from the ongoing
advocacy efforts I witnessed while in the field. These include friends in the struggle like Andrea
James at Families for Justice and Healing, Erika Kates and Louellyn Lambros of the
Massachusetts Women’s Justice Network, ACT-UP Boston, Black and Pink and Critical
Resistance. I hope this dissertation is able to better support you in a continual and ongoing
struggle for social justice.
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