Book Review: Aging behind prison walls: Studies in trauma and resilience

Understanding the Problem: Mass Aging in Prison

The authors first begin as any good researchers conducting scientific inquiry should, with a detailed background of the problem, complete with statistical support to bolster their argument. The data are indeed staggering. We learn that by the end of the next decade, prisoners over the age of 55 will make up one third of the U.S. prison population, a snowball that continues to grow ever larger within a system focused on “punishment, deterrence, and incapacitation” as its main pillars rather than rehabilitation (p. 11). The authors attribute the rise in an aging prison population to both a general increase in the aging population and the fallout from 1970s and 1980s era mandatory minimum sentencing policies, some of which have resulted in longer prison terms for people with “multiple strikes” (p. 5). Because avenues such as geriatric or compassionate release tend not to be pursued for this population, we learn that many people not only grow older, but frailer, and often end up dying in prison. In 2013 alone, the authors note that about 31% of state prisoners serving life sentences are 65 and older. The main takeaway here, Maschi and Morgen emphasize, is this: Prisons are not designed to be nursing homes, psychiatric hospitals, or hospice facilities, yet the aging populations they house will likely need one or all of those services at some point in their (more likely to be shorter) lives. We are asked to not only think about a more compassionate way to address the issues of incarcerated older adults, but we are also presented with the underlying reasons why these issues have arisen in the first place.

Issues of Social Responsibility

Of course, prisons themselves are static buildings, and we are reminded that people create, regulate, implement, and experience the practices of such institutions. From the beginning, the authors put the narratives of incarcerated older adults at the forefront, starting with “James O,” with whom they conduct a life history narrative (as part of their larger Hartford Prison Study) that reveals a winding path of loss, poverty, addiction, and divorce leading to James’s eventual incarceration. In getting the reader to think about levels of prevention and intervention, Maschi and Morgen ask us: “what if?” What if individuals and communities had intervened earlier, done better at strengthening support and weakening the pipeline of events that often leads people to incarceration? Policy and related systemic issues, the authors note, are a part of the fabric of social responsibility in the story of incarcerated older adults. In the case of James O. and for the larger inmate population, the authors suggest the use of a compassionate care framework, one that includes a modified sentencing structure that takes into account a person’s underlying issues and history of offenses, and an environment that emphasizes safety and rehabilitation. As social workers, we are encouraged to think about how we can advocate for more compassionate care of the incarcerated within our workplaces and communities.

Giving a Voice to Incarcerated Older Adults

As Maschi and Morgen continue to give shape to the identities of older incarcerated adults, they introduce special subpopulations and the stories of trauma, resilience, and coping that make them unique. In particular, the authors present data from their Coming Out of Prison Study in which they explore the experiences of LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning, with the + indicating other sexual identities) incarcerated older adults and their reentry into society. We learn that prison time for this group is fraught with more sexual violence than the general prison population and that few community resources exist for older adults who identify as LGBTQ+ upon reentry into the community. As one older LGBTQ+ adult notes, “…they are going to push you into the LGBTQ+ youth center. But for anybody over the age, there’s nothing” (p. 165). The authors allow space for their participants to speak, and what LGBTQ+ incarcerated and formerly incarcerated older adults in the authors’ study call for is a better integration of aging, criminal justice, and LGBTQ+ services to assist them in transitioning back into home, work, and community.

Central to understanding the plight of incarcerated older adults is the information detailed in the authors’ third chapter, “Trauma and Diversity Among Older Adults in Prison,” which includes a discussion of the role of trauma and violence older adults experience both prior to incarceration and while incarcerated. Utilizing data from their Hartford Prison Study (n = 677), the authors note that seven of 10 incarcerated older adults reported a previous history of trauma, including an average of three traumatic experiences spanning one or more stages over the life course. Indeed, the cumulative effects of chronic stress and early childhood trauma are often layered onto the trauma of incarceration. In addition, once incarcerated, older adults reported high levels of interpersonal trauma often involving physical or sexual violence. Further, through the use of rich qualitative description, the authors give us an up close look into the strategies older incarcerated adults have developed to foster resilience as a means of coping with their incarcerated status. This includes asking participants how they feel their previous life experiences have impacted their current circumstances. This is a key for students to learn and for seasoned clinicians to remember—if we are overly prescriptive, we miss the detail inherent in the client’s conceptualization of the problem.

For social work students who are just starting to understand, in a more purposeful way, the experiences of the clients they meet, Maschi and Morgen end this chapter with a life course systems power analysis of their participants, identifying the number of traumatic experiences over the life course, the various systems the incarcerated older adult interacted with over time, and the channels of power and oppression that existed to create barriers to rehabilitation. Far from just presenting data without its application, the authors end this chapter with recommendations at the institutional level that include engaging prominent stakeholders including both administrators and service recipients.

Collective Consciousness and a Call to Action

Finally, the authors introduce a path to co-constructing community as well as an eclectic theoretical framework that draws from multiple disciplines to help readers understand a better way of viewing and addressing the problems of incarcerated older adults—problems that we as social workers and fellow members of society have been encouraged throughout the text to take ownership of. This new paradigm, the caring justice partnership paradigm, is described by the authors as “…a daily philosophy and way of life that promotes personal and relational evolution” (p. 171). Although at times the authors’ theoretical grounding seems to take readers into the weeds as they detail their theory development, which covers everything from Jungian psychology to the teachings of the Iroquois Nation, it is not without purpose—the authors truly believe that in order to effect meaningful change within the population they are studying, the collective must be held accountable, changing the way we view ourselves and our place in society. This can only be achieved, Maschi and Morgen note, by interweaving nurturance, empathy, and compassion, with the individual and social responsibility to uphold the elements of a just system for all.

Although the chapter on co-constructing community precedes the theory chapter, it might do well to come closer to the end, as it drives home the idea of a path which communities can follow toward changing the future for incarcerated older adults. This helps to leave impassioned social work readers with an answer to an important question—what can we do about this and how can we do it? How do we prepare the community for the return of this population—what is needed, in the words of the incarcerated, to make this transition smoother? We come to understand, through more rich description from the authors’ qualitative work, that upon their release, incarcerated older adults want various kinds of support, spanning from the foundational supports of food, clothing, and shelter to health and mental health supports to address chronic conditions and trauma. The incarcerated older adults studied also named social and family support, and guidance both in community reintegration and in transforming the justice system for the incarcerated, as areas that need to be addressed if a rehabilitative path from prisoner to productive citizen is to be forged.

Overall, this text is an informative and useful addition to any clinical or macro special topics social work course. It is well organized, with up-front summaries of what the chapter will discuss and a final summary of the information discussed at the end of each chapter to help ground the reader. Each piece of empirical or theoretical backing that is presented also comes with suggestions for policy and practice, a strength that speaks to the authors’ collective years of experience in the field, and an important element in setting an example for students who are engaging in both clinical and macro social work practice. Most importantly, Maschi and Morgen don’t present a laundry list of static case studies but rather truly humanize the people they are studying, an essential skill in evidence-based social work research and practice.