40 Years of Solitude

Over the years, I had heard only bits and pieces about the Angola 3; Robert King, Herman Wallace and Albert Woodfox; three Louisiana men who were serving time for a robbery when they were convicted of murdering a prison guard in April of 1972.  It wasn't until just recently that the case came back to my attention, when Mr. Woodfox was released last week after serving the longest sentence in solitary confinement in US history.  

Solitary confinement is a pretty self-explanatory term; "serious, predatory" offenders, are confined to a cell alone, for 22-24 hours per day, usually in an effort to protect the safety of themselves and others.  Prisoners who are considered to be at risk for violence (e.g. pedophiles, witnesses, children, etc) are also kept in isolation as well as prisoners, like the A3, who were "suspected of organizing illegal activities" inside prison walls.  The punishment was initially intended to allow prisoners to "reflect on their misdeeds and draw closer to God" through isolation and seclusion from others.

After their conviction in 1972, this was the fate of the Angola 3, who were kept in seclusion for fear that they would organize an uprising in the prison and spread "Black Pantherism" among the other inmates.  All three men were sent to solitary in 1972, King for 29 years before he was released, Wallace for 40 years until his release in 2013 and Woodfox, serving 43 of his 45 year sentence in isolation until his release on February 19.  

I won't even discuss the fact that Mr. Woodfox's case was overturned three times, how the prosecution's witnesses were discredited, how evidence was lost and racial discrimination was rampant throughout the trial.  I was more intrigued by the impact that spending that much time alone can have on a person's psyche and how Mr. Woodfox and the others seem to have emerged with their faculties intact. Its interesting that I didn't really think of keeping someone alone as a form of torture until I learned about the effect it has on people over the course of time.  

Prisoners who have spent time in solitary describe it as "spirit-killing," "mind-altering," saying that "people come in with a few minor problems and leave as sociopaths."  Many prisoners report that it only takes a few days for some to begin having hallucinations, talking to themselves and displaying early signs of psychosis such as paranoia, disorganized speech and bizarre behavior.  Mr. Woodfox says he was able to survive only through reading and trying to stay connected to the outside world, but still suffered severe panic attacks, hallucinations and insomnia for much of his time there.

Research shows that prolonged periods of seclusion can lead to a condition called "isolation panic"- with symptoms such as severe anxiety, insomnia, aggression, depression, delusions and self-harm. The psychological effects of forced seclusion are often irreversible and can present themselves in as little as 15 days.  This punishment is especially harmful to those already dealing with mental illness, as being placed in isolation exacerbates their conditions and limits access to medical and mental health care.

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I've read that the goal of isolation is to keep prisoners and guards safe from the most aggressive inmates, but it seems that prolonged isolation from others actually contributes to the high rates of recidivism among those who spend time there.  Many of those held in "super max" prisons need to be "re-socialized" before they can be released into society, and rates of recidivism among this group are as high as 20% in some states.

We don't have to debate the fact that people who commit crimes deserve to be punished.  I get it.  But, where are the limits?  Since we know human beings are social creatures what is the real goal here?  Are we trying to break people's minds?  Are we punishing them for their crimes by slowly driving them insane using methods we know for sure will work?  It just doesn't seem right.


So after 45 years, Mr. Woodfox is finally free.  Finally out of the 6x9 box he has spent the last half-century of his life in. As I said, I'm not here to debate his guilt or innocence, I'm just amazed that he survived this long in a room by himself and a little shocked that our system of justice relies on a form of psychological torture as punishment.
How do you feel about it?  Find out more about it here and let me know what you think.

I Don't Want to be a Case Study

I had a patient tell me that last week and at first, I thought he was joking. Then I thought about how many people in his position probably feel the same way and I realized it wasn't a joke at all.

The patient is what we call "Priority" here at my clinic, which means that he is HIV positive.  He moved back here from Chicago, came to my clinic to have a form filled out and casually mentioned that he has been positive since 2011.

That's where I come in.

As soon as I sat down with him, he hung his head low, taking long deep breaths, readying himself for what he thought was to come.  The first thing he said was:

"I'll come in for care, I just don't want to be a case study, you know?  

That's why I stopped going to the doctor in the first place.

They do that...study people.  Measuring the incidence of this and the occurrence of that.  

Every time I went to an appointment, there was a new person asking me questions.  

People that I never met before.  I hate feeling like I'm being studied. I'll stay home before I feel like that again."  

As he explained, I thought about it and the truth is he's kinda right.  When patients come in for appointments, they don't just see the doctor, there are at least 5 other people waiting to see them each and every time; each new person asking the same basic questions, checking the answers off on forms, paying them to take surveys and give up personal information.  I can totally see how he feels.

Most patients are thrilled to answer questions and a $50 gift card definitely sweetens the deal.  And then there are others, who couldn't care less about a gift card to Target and resent our intrusions into their personal lives.

So, to us, the surveys and questions make sense - we need the information.  We do need to know the incidence and occurrence of things because its our job to have that information and it helps us help our patients.  But, there has to be a way to make people feel better about things. I'd rather patients get and stay healthy than refuse to come in simply because of the questions on a form.  They are much more than that.

Flint Crisis A Byproduct of Poverty

"If there was even a whiff of lead in Grosse Pointe, better believe they'd be pumping in Perrier by the end of the day." ~Ron Fournier on NPR 


I caught a piece on NPR about the Flint issue, where the guest speaker mentioned how strongly poverty impacts the problem, stating plainly that this would not have happened if poverty weren't a factor.  It sounds obvious but when you sit and really think about it, its quite disgusting how the whole thing unfolded.  (See timeline of events here)

LeeAnne Walters: One of the first Flint residents to speak out 

As social workers, we are all too aware of the role being poor plays in a person's quality of life. Everything is impacted from birth to death and every moment in between.  Poor people are less healthy, less happy and they die younger from preventable causes.  This wouldn't have been an issue in the suburbs of Anytown, USA as its residents would have marched down to City Hall as soon as they noticed even the slightest twinge of a problem and the government would have responded posthaste providing remedies and follow up to make sure that everything was peachy-keen.

This could only happen in a place like Flint, where 40% of its residents live in poverty.  Poverty leads to lack of options, lack of options creates dependence and dependence can lead to a fear of standing up for oneself and a realization that nothing will change even if you do.

In some cases, there is that one resident who cries out and rallies the community behind their shared cause; but in many communities no one stands up because they are so used to being beaten down they feel there is no point.  When poor people speak out they are told to "stop complaining;" they are berated for having the audacity to expect that they deserve the same treatment as others.  Many of the children of Flint were continuously affected since birth, when their mothers made their bottles with lead-laced drinking water.  When they started to notice their water was turning brown, they were lied to, rather blatantly for over a year while politicians slept soundly at night, their children safe from the poison being funneled into homes a few towns over.

One of our basic tenets as social workers is to challenge social injustice "on behalf of vulnerable and oppressed individuals and groups of people."  We must advocate for those who can't advocate for themselves.  We must mobilize citizens and let them know how powerful their voices can be when everyone is on the same page.

Basic Areas of Concern for Teen Girls

Working with teens can be difficult.  You know this if you work in a school, group home, detention center or other agency that serves adolescents.  Young people are dealing with so much these days, so many choices, decisions and pressures that shape their feelings about themselves and the world around them.


Teenage girls can be an especially challenging group to reach, as girls are faced with a different set of pressures that affect almost all of the choices they make.

In practice, I've found some success in reaching young women and I've noticed a few key areas that seem to have the biggest impacts on their lives.  When working with them its been helpful for me to have basic knowledge of the following:

1. Parents & Siblings: What is the current status (and history) of relationships with parents and siblings, in the home or outside? 
2. Stability: Have living arrangements and important relationships been stable over time?   
3. Connection with Mother: Is the relationship with mom tense or supportive? Close-knit or estranged?  Is Mom even around at all?
4. Sexual History: Is the client sexually active now or in the past?  Is she in a serious relationship?
5. View of Self: How does she feel about herself in terms of self-esteem, self-efficacy, self-confidence and level of self-awareness? 
6. Present/Past or Future Orientation:  Are past issues dominating her present feelings? Is she able to see herself in the future?  Does she feel positive about her place in the world?

All of these pieces affect and are affected by each other to form the whole person.  Deficiencies in these areas tend to show themselves in internalizing behaviors such as depression, anxiety and somatic complaints and externalizing behaviors such as fighting/aggressiveness, sexual promiscuity and vulnerability to unhealthy relationships.  Being aware of these major areas of concern will assist with diagnosis and addressing the presenting problems.

Successful interactions with teenage girls will require more than knowledge of the above, the most important piece of the puzzle is YOU! Are you the type of adult that a young girl feels she can confide in?  What makes you different than her parents and other adults that she doesn't trust?  How can she be sure that you have her best interests at heart?  Here are a few ways to become the adult that the kids on your caseload need: 

• Remember your own time as a teenager: Fully remember the thoughts, feelings and pressures you were facing.  
• Realize they are not adults: Understand that they do not process things the way you do.
• Resist the urge to parent: They are not your kids so don't treat them as such.
• Recognize their need for autonomy: A teen's sense of control over their own life has a strong impact on the decisions they make.  
• Reinforce their strengths: Help them see how special they are regardless of their history or current circumstances.

These are just some of the things that have worked for me.  What works for you?

Case in Point: Meet Moussa

Not Moussa

Moussa is a 19 year old from Ivory Coast, who recently came here after his mother worked for years in a braid shop until she could bring her children here one by one.  He arrived here last month and speaks only French and Dioula, the dialect spoken in his town.

Living in West Philadelphia, he will be required to attend one of the neighborhood high schools and let me tell you, they both leave a lot to be desired.

In Ivory Coast, he went as far as the 11th grade, but will be required to begin in the 9th grade here, the grade where everyone else will be 14, while he is basically a grown man, walking the same hallways as children.

I spoke to one of my colleagues about the situation, a woman who immigrated from Haiti decades ago.  I told her I was concerned about how Moussa will fare in high school and especially concerned about how the other kids will treat him, considering he can't speak the language and he looks and acts different than everyone else.  She told me that its very hard for children coming here from other countries and that most of the kids end up fighting in response to the merciless bullying they experience. Many children also report discrimination from their teachers who assume they are less intelligent than other students, making many of the children feel "invisible" in school.

The experience of immigration in and of itself has been shown to have negative impacts on children.  When that experience is coupled with discrimination and bullying, the child can experience negative outcomes that last into adulthood.

What can we do?

For now, I'll do my best to help Moussa and his family with the process of applying to school and ensuring that he is placed where his needs will be met AND that his school officials are aware of what he might be facing there.  I'll also refer the family to a welcoming group for people from his country, where he can interact with people his age who have adjusted to being in the US.  I'll do my part to the best of my ability, but I'm concerned that its just not enough.      

On The Way to Slaughter

I work in a medical office, what used to be called the "Free Clinic," a facility in a system of city-run health centers that provide medical care to city residents, regardless of insurance or ability to pay. My office is outside of the lab, the place where patients come to have their blood drawn; a terrifying concept for some, especially the children who scream, kick and cry, often having to be held down in order to get the samples.

The waiting area for the lab is directly outside of it and over the years I've wondered how the experience of seeing and hearing other children having their blood drawn affects the children waiting in line for their turn.    

Dr. Grandin and her Bovine buddies.  

It made me think about Dr. Temple Grandin and her famous research into a more humane process for animal slaughtering. As an "Animal Welfare" expert, Dr. Grandin led the charge for new designs in slaughterhouses that prevent cows from hearing and seeing what happens to the cow in front of the line.  She found that when cows can see and hear what's waiting for them, they became panicked and stressed, thrashing around in an attempt to get away, often injuring themselves and setting off a domino effect of fear among the other cows.

Its the exact same thing with the kids.  While they wait for their turn, the sounds coming from the lab are clear; something bad happens to children in there.  I see kids waiting for their turn, their eyes wide with fear and wonder. When their number is called, I can only imagine what they think will happen to them. Sometimes, they run away and have to be caught and strapped down; and for those who have been in there before, the visit is even more terrifying, because they remember the ordeal from the last time.  All of it leads to a horrible experience for children and an anxiety-inducing trip to the clinic for the parents.  And all of it happens in clear view of the waiting area, leaving children terrified before they even walk through the door.

What can we do?  

Because of Dr. Grandin's research, slaughterhouses are now outfitted with curved loading chutes which control how much a cow sees and hears, and other mechanisms that provide a more comforting experience in the animal's last hours.

I'm not sure how we could fix this for the children.  Revamping the placement of the waiting area would require a re-design of the entire building, which will probably not happen. There has to be something we can do.  Having blood drawn is something that most of us will have to do many times over the course of our lives. It will probably never be fun, but it doesn't have to be traumatic either.

Any ideas?