The creating of any legal „case‟ and its subsequent career are shaped by decisions made in a dynamic, unfolding process. Cases flow through the various handling
systems employed in legal processes, their courses shifting or terminating at various salient decision points (Hawkins, 1983b:7).
Releasing a prisoner from high security into the community … is not a good idea. Because, he just hasn‟t got any of the skills … you can‟t just sort of open the door
for him and push him out … and expect him to behave normally. He‟s got to go through a journey (PB2, Independent member).
Introduction
Central to this thesis is the argument that prisoners and patients undergo a journey or career while in detention and along these journeys, many key decision-stages exist, including PB and MHRT reviews. At each of these decision-stages, participants are „made up‟ (Hacking, 1986; McCallum, 2001) and „made sense‟ of by report writers and decision-makers.
It is important to consider how patients and prisoners respond to admission to a DSPD unit, because it is a stage at which they are redefined as in need of specialist personality disorder treatment. Those with psychopathy can be presented as „evil‟, „beyond psychiatric help‟ (Mason et al, 2006:337) and as a „species of humans suited to isolation‟ (Rhodes, 2002:458). This is significant because notions of evil can influence the planning of care (Mason et al, 2006; Mercer et al, 2000), while a
diagnosis of personality disorder can help reinforce and justify high security containment as a natural and right response (Rhodes, 2002:458). One problem that arises from this is that it becomes difficult for anyone to take responsibility for a prisoner‟s release to lower security (Rhodes, 2002). In this sense, personality disorder has the potential to be a „disastrous label‟ and one almost guaranteed to extend the length of detention (George, 1998:106).
This demonstrates that „language is significant in determining the individual‟s position and passageway through the mental health network‟ (Parker et al, 1995:72; see also Cohen and Taylor, 1972). Prisoner and patient characteristics, identities, and reactions to imprisonment can have important effects on future institutional careers (Cohen and Taylor, 1972; Ditchfield, 1990; Irwin, 1970), while the apparent effects of the prison experience and staff assessments of change, can, in turn, influence decisions made about transfer and release (Bottomley, 1973a; Crow, 2001; Irwin, 1970; Shalev, 2007).
With this in mind, the first half of the chapter explores how patients and prisoners may adapt and respond to secure institutions; observing that time, signals of progress, uncertainty and trust are important for patient and prisoner journeys. The chapter then considers some of the challenges that are raised by trying to know the unknowable in secure institutions. The second half of the chapter then turns to explore some of the key characteristics of decision-making, observing that decisions are structured by competing choices, objectives, and information. By focusing on the organisation of information, the processes by which participants are „made up‟ (Hacking, 1986; McCallum, 2001) and „made sense‟ of are explored. In this respect the chapter considers how patients and prisoners may respond to their detention, before turning to explore how the criminal justice and the mental health systems may characterise and respond to them. This is important because „the study of particular problem populations
must account for the way in which categories of person are „made up‟ and become known in order to be governed‟ (McCallum, 2001:36).
An interpretive approach to the study of journeys and decision-making
In order to develop a better understanding of the institutional pathways of DSPD patients and prisoners, and how admission to a DSPD unit may impact on PB and MHRT decision-making, my organising theoretical framework derives primarily from Hawkins‟ (1983a, 1983b, 2002) work on decision-making41, although it is also informed
by other interpretive and social constructionist approaches (Berger and Luckman, 1966; Best, 1989; Rein and Schön, 1994; Rose and Miller, 1992, 2008; Spector and Kitsuse, 1987; Stone, 2001). Hawkins (1983b, 2002) identifies the importance of an interpretive or naturalistic approach to the study of decision-making. This reminds us that:
[w]hat is understood as „risky‟ or „dangerous‟ about „DSPD‟ is as much a product of historically, socially and politically contingent „ways of seeing‟ as it is of „objective‟, „quantifiable‟ public health/psychiatric phenomena (Corbett and Westwood, 2005:122, italics in original).
Theoretically the thesis also draws from research that has employed the concept of a journey or career as a framework for making sense of the institutional pathways of patients and prisoners. Several researchers have used the concept of a „career‟ to study offending and long-term imprisonment (Adler and Longhurst, 1994; Cohen and Taylor, 1972; Goffman, 1961; Irwin, 1970; Porporino and Motuik, 1995; Steadman and Cocozza, 1974; Toch, 1995; Toch and Adams, 1989, 2002). Its use dates back as far as Chicago School sociologists including Clifford Shaw (1930, 1931, 1938), and in
41
Hawkins (2002) acknowledges the influence of Peter K Manning (1992) in his work on decision-making. See also Manning (1986) and Manning and Hawkins (1990).
particular, Everett C Hughes (1937, 1958) and his students (see especially Becker, 1963 and Roth, 1963) who developed the concept of a „career‟ as „a lens for peering at larger social processes known as institutions‟ (Barley, 1989:49). Their work demonstrates that a focus on „careers‟ offers a useful mechanism for linking individuals to institutions and for allowing us to move back and forwards between the self and society (Barley, 1989, Goffman, 1961).
Once individuals come to the attention of criminal justice/mental health services, they commence a journey through this system. „Once created, an individual case in the legal system is typically moved from one decision-maker to another until it is resolved, discarded, or otherwise disposed of‟ (Hawkins, 2002:33). This demonstrates that following an offender‟s arrest, their journey through the criminal justice (and mental health) system may take on an „obstacle-course nature‟ (Irwin, 1970):
The creating of any legal „case‟ and its subsequent career are shaped by decisions made in a dynamic, unfolding process. Cases flow through the various handling systems employed in legal processes, their courses shifting or terminating at various salient decision points (Hawkins, 1983b:7).
Decision-making structures a number of interlinked stages of detection, detention, and later decisions about transfer or release (Bottomley, 1972, 1973a; Gofffredson and Gottfredson, 1988; Halleck, 1987; Hawkins, 1983b). This reminds us that decisions are the very „business‟ of criminal justice and mental health systems (Hawkins 1983b) and „critical to … [their] …efficient, effective and humane functioning‟ (Gottfredson and Gottfredson, 1988:2). „Imprisonment is simply one stage of a journey‟ that offenders may have to make (Jewkes, 2007:xxiv), and decision-points should not be considered in isolation because:
to focus on a single decision point, or on a single type of decision, risks excluding the social context in which criminal justice decision-making takes place, the field in which the decision is set and viewed, as well as the interpretive and classificatory processes of individual decision-makers (Hawkins, 2003:187).
All decision-stages are crucial for the institutional pathways of offenders, but Maguire et al. (1984) argue that the decision to release is one of the most important uses of discretion in the criminal justice system. Traditional attention to decision-making at the time of sentencing helps conceal the fact that, while the length of a sentence may be indicated by a Court, in practice, its nature and duration are often determined by a number of other decision-makers including the PB (Bottomley, 1973b; Creighton, 2007; Maguire et al, 1984; Padfield, 2007) and the MHRT. PB and MHRT decisions have particular symbolic significance because they are:
formally organised as the occasion for further legal categorisation of the deviant. It is the point at which a prisoner … may have his identify transformed. Having been the incarcerated deviant … he now has the opportunity to have the label of deviance lifted … and to be re-designated as having paid the price (Hawkins, 1983a:104).
Secure institutions and patient and prisoner responses to detention
A number of researchers have considered how individuals may adapt and respond to detention in a secure institution (see Clemmer, 1940; Cohen and Taylor, 1972; Flanagan, 1995; Goffman, 1961; Irwin, 1970; King and Elliott, 1977; Mathiesen, 1965; Pope, 1979; Sapsford, 1983; Sykes, 1958; Toch and Adams, 2002; Zamble and Poroporino, 1988). Many „pains of imprisonment‟ have been identified by this literature, including loneliness, loss of key relationships with family, friends and communities, the
loss of goods and services, absence of sexual relationships, deprivation of autonomy, and fears about personal security (Sykes, 1958, see also Flannagan, 1980).
Goffman (1961) argues that patients in hospital tend to adapt rather than resist, and suggests four strategies of adaptation: situational withdrawal; intransigence; colonization; and conversion. These strategies indicate that patients seek to manage better the tensions between their inside and outside worlds, and that as residents within a total institution they operate in accordance to a „calculus of risk‟; that is, they learn to work out what behaviour they can get away with and the cost of non- compliance. Goffman also observes that patients rarely adopt one strategy, but instead:
take the tack of what some of them call „playing it cool‟. This involves a somewhat opportunistic combination of secondary adjustments, conversion, colonization and loyalty to the inmate group, so that the inmate will have maximum chance, in the particular circumstances, of eventually getting out physically and psychologically undamaged (Goffman, 1961:64).
Irwin (1970) distinguishes between three adaptive strategies in prison: those who are doing time and continue to have a commitment to life outside; those who are jailing, largely cut-off from their outside worlds, and often lack links to the outside because of their institutionalisation; and those who are gleaning, in that they are trying to effect change in their lives during their imprisonment. While some research has found that prisoners tend to follow a path of least resistance, because it is „easier to serve time, as they were sentenced to do, by passing through it, rather than using it‟ (Zamble and Porporino, 1988:150), other research has indentified that trying to make use of their time is important for long term prisoners (Irwin, 1970; Toch, 1995).
Rather than adapt, others have considered how prisoners may resist. Cohen and Taylor (1972:154-172) suggest five typologies of resistance, based on „the nature of their relationship with authority‟: those who engaged in direct confrontation with the institution and actively resisted adjustment; those who had more symbiotic criminal careers; those whose relationships with authority were characterised by trumping and outflanking authority; those termed private sinners, most often sexual deviants, who avoided confrontation, and tended to live their lives „within their own heads‟; and finally, drawing on the work of Maurice Farber, those they describe as situational criminals, whose institutional careers did not fit into any clear strategy.
Toch and Adams (2002:75) found that inmate attributes led them to be able to distinguish between three main career types: non-disruptive, early starter, and chronic; concluding that non-disruptive and chronic careers involve very different prisoners. Offenders with chronic careers were more likely to be younger, newcomers to crime, have a history of violence, and a record of admission to psychiatric hospitals. Similarly to Cohen and Taylor (1972) they found that an index offence was often revealing in terms of a prisoner‟s institutional career, with those convicted of murder or rape more likely to be non-disruptive, and those convicted of assault or burglary more likely to adopt a chronic career. This reminds us that pre-institutional behaviour is an important factor in understanding behaviour in prison (Cohen and Taylor, 1972; Ditchfield, 1990; Irwin, 1970).
While considerable variation in modes of adaptation to secure institutions have been observed, Mathews (1999:55) argues that sociologists have essentially identified three types: co-operation or colonization, where prisoners „aim to keep out of trouble and do their time with the minimum degree of conflict and stress‟; withdrawal, which can take a number of forms ranging from „physical separation from other inmates, engaging in minimum degrees of communication, depression, or self-mutilation and suicide‟; and
finally, rebellion and resistance, which may involve „engaging in riots or disturbances at one extreme, and forms of non-co-operation at the other‟.
All of these strategies of adaptation are evident in the reports of DSPD patients and prisoners, especially prior to their admission to DSPD services. Prior to admission, very few patients and prisoners are described as co-operative. Most are presented as rebellious and resistant, although many of these are also presented as vulnerable and withdrawn. Following DSPD admission, the majority of prisoners, in contrast to their previous reactions to imprisonment, are depicted as largely co-operative, rather than disruptive. In contrast, many DSPD patients, particularly those transferred to a hospital DSPD unit towards the end of their prison sentence, continue to be recorded as disruptive. This demonstrates that co-operation is dependent on perceptions of fairness and legitimate treatment (Liebling, 2007; Sparks et al 1996) and patients and prisoners may adopt a range of modes of adaptation during their time in institutional settings.
Sapsford (1983) argues that reactions to imprisonment are structured by a prisoner‟s expectations. Indeterminacy can lead to a strong source of anxiety and feelings of powerlessness amongst life sentence prisoners because everything a prisoner does is open to inspection and interpretation. As a result, „most lifers go through a phase of anxiety, depression, withdrawal and/or belligerence as they try to come to terms with their new situation‟ (Sapsford, 1983:82). In response to the depression of self image, Sapsford suggests that lifers may adopt and construct alternative identities to manage their time inside, and as they settle into their sentence may move from an anxious position to one that is marked more by passivity, apathy and dependence.
This indicates that prisoners who are confrontational often come to realise that it is not a strategy that enjoys any long-term success (Cohen and Taylor, 1972:174). Towards the later stages of a sentence, as prisoners begin to anticipate release, they may
become more anxious (Toch and Adams, 2002:91). Some prisoners may choose to opt out of parole because of low expectations and a poor tolerance of uncertainty (Nuttall, 1977). This highlights that patients and prisoners may adopt a number of different roles during their detention (Sykes, 1958) and that the length and stage of a sentence may have a significant impact on styles of adaptation.
This draws attention to the significance of time (Cohen and Taylor, 1972; Sparks et al, 1996; Wahidin and Powell, 2001) and the importance of signals of progress (Roth, 1963, Sapsford, 1983) within institutional settings. Drawing from Roth‟s (1963) research concerning the significance of benchmarks and timetables for patients with tuberculosis in managing their hospital careers, Sapsford (1983) identifies that prisoners „break-up‟ their sentence based on their awareness of a hierarchy of progress before release. Transfers between prisons, job allocations, and changes to security classification are all visible forms of progression, and because prisoners do not know when they will be released, these events act as signals of progress (Sapsford, 1983) and „”messages” about their chances‟ (Maguire et al, 1984:253).
This reminds us that in the total institution, questions of release are built into the rewards system (Goffman, 1961:53) and used as an incentive and a mechanism for maintaining institutional discipline (Appleton and Grover, 2007; Barnard, 1976; Hawkins, 1973; Maguire et al, 1984; Proctor and Pease, 2000). Toch (1995:248) argues that long term prison careers should involve planning to enable „progression from higher- to lower- security settings, with increments of freedom and amenities‟ (Toch, 1995:248). As a result, privileges and decreases in supervision are:
desired not only in themselves, but for their symbolic value. They are signs that the treatment is progressing … [and] … that the patient is getting closer to discharge (Roth, 1963:4).
Signals of progress are worked out tacitly between the prisoner and the institution to provide „at least some semblance of landmarks‟ (Sapsford, 1983:79). Importantly, while Cohen and Taylor (1972:94), found that parole was symbolic as a reward for progress, many prisoners saw their chances of parole as nil, and therefore not a progressive stage. Similarly, Peay (1989:43) observed that patients were aware that MHRTs do not „readily make discharge decisions‟. Despite this lack of knowledge about when they may be released, patients and prisoners may be „continually stimulated to hope for release by review procedures‟ (Sapsford, 1983:22).
Long-term patients and prisoners tend to measure and interpret their progression by comparing their careers with others (Roth, 1963; Sapsford, 1983, see also Barley, 1989). As a result of conversations amongst patients, progress clues become a group product and the patient „never stops watching for clues that may help him guess what stage of the treatment process he has reached‟ (Roth, 1963:xvi). Progress clues are used by both patients and staff to develop a set of norms to anticipate the future and „help them make “reasonable” decisions in a highly uncertain situation‟ (Roth, 1963:xvii). Staff and patient ideas of what constitutes progress may differ (Roth, 1963; see also Duggan, 2007), with the:
official image of the felon, the explanation of his acts, the definition of the programs … quite different than the felon‟s view of these same things (Irwin, 1970:3)
Drawing from Adams‟ (1995) concept of a „risk thermostat‟ that requires the balancing of the likelihood of reward with the likelihood of accidents, Duggan (2007:118-119) reminds us that staff and patients in the DSPD services will approach the balance of rewards and accidents very differently. For the patient, a transfer to lower security is viewed as a „reward‟. The consequences of an accident are „almost inconsequential‟,
because if they are to fail, the worst that will happen is that they are returned to high security (Duggan, 2007). In contrast, the rewards and potential for accidents are viewed very differently by the staff. The reward comes from doing one‟s job and being able to move an individual through the system but this must be balanced with the likelihood of reoffending, for which the staff will be required to take much of the blame (Duggan, 2007). „From the patient‟s perspective, therefore, all of the advantages lie in making the transition whereas, from the professionals‟ perspective, it is the direct opposite‟ (Duggan, 2007:119).
Conceptions may also differ amongst staff because they „do not always see the same problem as the treatment responsibility transfers from one staff member to the next‟ (Toch and Adams, 2002:87). This is important because, „progress‟ does not necessarily imply an increasing knowledge and understanding, but can instead refer to the number of completed treatment courses (Roth, 1963). This is important in the context of PB and MHRT decision-making, because it may be that the number of accredited offending behaviour courses completed is more significant than the actual progress made. These observations indicate that conceptions of progress, and assessments of risk, in DSPD services are likely to be constructed differently by patients and prisoners, prison and hospital staff, and external decision-makers like the PB and MHRT.
As a result, patients may come to define their experience in accordance with professional understanding and definition of illness (Barrett, 1988 in Parker et al, 1995; Crewes, 2006). Programmes enable prisoners to adopt a „vocabulary of adjustment‟ in order to convince unit staff, the PB and other external agencies that they have made