Abstract
Today, one in five adults incarcerated in U.S. prisons—21% of the country’s total prison population—are at least 50 years old (Carson, 2020). By contrast, only 5% of incarcerated older adults were age 50 or older in 1993 (Carson & Sabol, 2016). In Aging behind Prison Walls: Studies in Trauma and Resilience, Tina Maschi and Keith Morgen point out that while the United States has seen recent declines in the overall prison population, the percentage of older adults has been rising. This is concerning for many reasons, including the fact that prisons were never designed to serve as nursing homes, chronic care centers, or end-of-life care facilities. The prioritization of punishment above care in prisons sets a troublesome backdrop against the growing number of older adults housed in these institutions, who oftentimes present with substantial and complex health needs. Ultimately, these circumstances have led to a crisis in criminal justice policy that consists of a lack of services for a sizable—though frequently overlooked—portion of the prison population. This slippage in care and services prompts the reader to consider the microlevel and macrolevel costs of the current punishment imperative against older adults, considerations that are particularly timely given calls for criminal justice reform in the era of the COVID-19 pandemic (Nowotny et al., 2020).
Aging behind Prison Walls is organized into two sections. The first seven chapters provide important context about the growing number of older incarcerated adults, the unique experiences of older incarcerated adults, and common barriers that arise among this population. While the first section of the book provides an effective overview of the consequences of mass incarceration for older adults, the second section of the book shifts to discussions of policy. Specifically, chapters 8 to 10 urge for policy reform grounded in compassion and a reckoning of the suffering that has been inflicted upon older adults—suffering that the authors emphasize trickles into society at large.
The greatest contribution of this book lies in the authors’ abilities to convey the complex, cumulative trauma experienced by older adults across three specific timepoints: before incarceration, during incarceration, and postrelease. Maschi and Morgen accomplish this by presenting unique, multimethod data from several original data collection efforts. First, the authors review findings from their larger “Hartford Prison Study.” This project (2010) included a sample of 677 older incarcerated adults from one Northeastern prison. Maschi and Morgen also present data from their “Co-Constructing Community Project” (2013–14), which includes (a) survey data from community service providers and (b) in-depth interviews with 31 formerly incarcerated adults. Finally, the authors present data from their “Coming Out of Prison Study” (2013–14), which includes focus group and qualitative interview data with a sample of 10 formerly incarcerated older LGBTQ+ adults in New York state.
Using these data, Maschi and Morgen demonstrate that older adults in the samples faced a range of traumatic experiences prior to their incarceration periods. Preincarceration examples collectively include childhood physical and sexual abuse, deaths of family members at young ages, parental neglect, and PTSD symptoms following military service. Notably, Mashchi and Morgen highlight the prison environment as a second source of trauma among older adults. Here, compelling accounts are offered of medical neglect, staff misconduct, victimization and violence exposure, poor nutrition, and social isolation. The descriptions provide a graphic glimpse into conditions of confinement from the viewpoint of older adults. One glaring example includes a participant’s account of a man’s stabbing (homicide) and subsequent response by staff to simply drape a sheet over his collapsed body (pp. 3–4). Another participant made reference to the “death rooms” used for terminally ill patients (p. 29), something he bore witness to working as a porter in the prison. Another individual reported witnessing correctional officers “stomping inmates into comas” (p. 93), and a fourth participant stated plainly, “I am 72 years old, and I am afraid of getting raped again” (p. 93). Respondents’ accounts of their in-prison experiences are powerful and underscore the dehumanized statuses felt among this population (e.g., “If you’re in khaki, you are considered non-human,” p. 101) in a setting that is meant to “reform.” Finally, Maschi and Morgan highlight a third source of trauma: re-entry. As stated by the authors, “release from prison can initiate a new trauma for older adults” (p. 142). Examples are provided of elder abuse, age discrimination related to joblessness, neglect, limited access to health care, homelessness, social isolation and family rejection, and lack of access to vital documents and social services.
The experiences of trauma presented in the book demonstrate a clear need for progressive policies at the intersection of criminal justice and health. At a minimum, comprehensive and wraparound services are needed to assist the growing number of older adults in the U.S. carceral system. These services include health care, trauma recovery programming, violence prevention, social support assistance, re-entry planning, and housing. Several examples are highlighted across the world toward the end of the book that demonstrate such programming is indeed possible to implement, including RECOOP in the United Kingdom (p. 224), the Kevin Waller Unit in Australia (p. 219), and the Gold Coat Program Dementia Unit in the United States (p. 219). In addition to humanizing older incarcerated adults as a population and emphasizing the need for more responsive services, a major theme of the book is to “issue in a caring justice consciousness that will guide criminal justice reform” (p. 3). The authors use the term “caring justice” to motivate social responsibility and care toward others across society, including older adults with criminal justice system contact. Thoughtful prompts are placed throughout the book to challenge readers to consider their own feelings and action points regarding this goal.
One aspect of the book that left room for desire was in the authors’ descriptions of the research methods used. Despite incorporating findings based on data across three studies, Maschi and Morgen provide little description about how they gathered their data for each project. In fact, methodological descriptions were largely reserved for a few short pages in the appendix. Providing a rich overview of the research methods used (ideally in a standalone chapter) is something that would have elevated the book, particularly given the rarity of the data and the difficulties associated with original data collection in correctional settings. Doing so would have also increased transparency, offering readers important information for further contextualizing the strengths and limitations of the findings presented. Despite this limitation, however, those interested in the nexus of health and crime, as well as individuals engaged with scholarship and/or policy in social work, sociology, criminology, gerontology, and public health, will gain from reading this important contribution to the literature. The book would make a particularly useful supplemental text for graduate seminars on punishment and policy, incarceration and health, aging and society, or adult and family trauma. The book could also be adopted for advanced special topics undergraduate courses on mass incarceration or social gerontology.