Research Proposal: Transgender Health Care in Prisons

Questions

- How is the issue of transgender medical care handled in the prison system?

- How must transgender medical care be framed so that it is deemed acceptable and worthy of time and money in the eyes of both the prison system and the public?

- How does the issue of mental health care in prisons enter into this conversation, and how does this impact the efforts of both mental health and transgender activists?

Background

During the Gender and Sexuality Studies Junior Seminar that I mistakenly took the first semester of my freshman year (I had always wondered why there were so many Juniors in that course…), I wrote a paper exploring the case of Michelle Kosilek, a trans woman in prison for murdering her wife, back when she had presented as male. Kosilek—with the help of one of my family friends, an attorney—was requesting that her gender confirmation surgery be covered by the health care she received as an inmate. Of course, this created a great deal of controversy, and as the case went on, verdicts delivered in her favor were overturned multiple times. A vocal group of those opposed to the coverage saw Kosilek as a manifestation of the crime for which she had been imprisoned, something that was horrific and left Kosilek deserving of no compassion. To oppose these arguments, Kosilek’s side of the case rested on the idea (backed up by numerous mental health professionals) that her life was in serious jeopardy if she was not offered this necessary care; essentially, denying her this coverage would constitute punishment so cruel that it might drive Kosilek to suicide attempts.

As a first year student, I focused my paper around Kosilek’s diagnosis of Gender Dysphoria, arguing that despite the improvement between DSMs from the trans-ignorant term “Gender Identity Disorder” to the somewhat less problematic “Gender Dysphoria,” its role as the very foundation of the case was ultimately counter-productive for the struggle for transgender rights, implicating Kosilek’s deviant gender identity into an already complex and stigmatized web of mental illness and criminal activity. But last year, when I wrote a paper on the intersections of transgender and disabled identities, this question was complicated for me. While there is a large portion of the transgender community that seeks distance from “diagnosis”—especially of mental illness—as they feel it delegitimizes their identity, trans and disabled activist Eli Clare claims that this immediate reaction of disgust is marginalizing to others who are mentally ill, as it deems their positions and identities undesirable or false.

I would like to return to ideas brought up in my original paper on the Kosilek case, and examine further the relationship between mental illness and transgender health care, specifically in the case of prisons. When trans health care is not yet offered universally outside of prison, and when it is still not considered by many to be a basic human right, how is the case made for such care to be covered in prisons? To understand this deeply will mean research into many areas: transgender health care in prisons as it is today, transgender health care outside of prisons, transgender life in prisons apart from care itself (as for many prisoners, living in the “appropriate” single sex prison is entirely dependent on where they are in their transition), mental health care in prisons, and the intersections of these forms of care in relation to specific cases brought before the court, such as Kosilek’s.    

Major Sources

Brown, George R., and Everett McDuffie. “Health Care Policies Addressing Transgender Inmates in Prison Systems in the United States.” Journal of Correctional Health Care 15.4 (2009): 280-91. Print

This source should provide me with a basic history of health care policies regarding trans inmates in prison. While it will be somewhat dated (many changes have surely been made since 2009), articles of its kind are rare, so it should offer the most background on my research.

Prout, Curtis, and Robert N. Ross. Care and Punishment: The Dilemmas of Prison Medicine. Pittsburgh: U of Pittsburgh, 1988. Print.

Though this source is not incredibly recent, I am more interested in its exploration of the moral implications of providing health care to prisoners than its factual accuracy today. It may also work alongside a more recent, similar source, so that I could compare the information and see how the system and ideologies have changed over time.

Lamb, H. Richard, and Linda E. Weinberger. “Persons With Severe Mental Illness in Jails and Prisons: A Review.” Psychiatric Services 49.4 (1998): 483-92. Print.

I expect this article to outline the treatment of prisoners with severe mental illness. I should be able to examine how the consideration given to those with official mental illness diagnoses carries over to those who receive a diagnosis of Gender Dysphoria—and thus explore how the emphasis on mental illness in cases like Kosilek’s is particularly effective in the eyes of the justice system.

Penn, Nathaniel. “Should This Inmate Get a State-Financed Sex Change Operation?” New Republic – Sexuality. New Republic, 30 Oct. 2013. Web. 16 Sept. 2015.

This article explores the details of the Kosilek case, and offers information and arguments from both sides.

Schwartzapfel, Beth. “What Care Do Prisons Owe Transgender Inmates?” The Marshall Project. 10 Aug. 2015. Web. 16 Sept. 2015

The Marshall Project is a website dedicated to providing news on the criminal justice system, and therefore may offer a perspective on transgender inmates that is more objective than those found in other areas of the media. The article uses another case of a transgender inmate seeking coverage to discuss the moral and legal implications of providing “proper” trans health care in prisons. 

I will also be looking into different versions of the DSM (particularly the DSM 4 and 5), and will be researching cases similar to Kosilek’s, to better understand how her case was affected by and has affected others.