Why swallow razor blades? An ethnographic study on violence, agency, and negotiated health in the United States prison setting

Background: Inmates and ex-inmates might represent a ‘biologically damaged’ population, having a disproportionately high burden of disease when compared to the general community. Moreover, people living with HIV might be considered a ‘special population’ within the carceral setting, having increased access to medical, social, and fiscal resources when compared to the general inmate population. This research investigates the role of medical, welfare, and penal systems as they frame the ‘lived experience’ of HIV-positive inmates. More generally, this research explores the social relationships between inmates and various security and medical personnel as they negotiate for individual health and agency. Methods: Ethnographic research explored the ‘lived experience’ of 34 HIV-positive male and female inmates as they moved through a state jail / prison system and back to the public community. For about 12 months during 2011- 2012, 77 semi-structured interviews and participant observations were conducted across seven penal facilities and community-based organizations in New England, United States. Participants (N=72): short- and long-term inmates in jail / prison (n=26); prison healthcare providers (n=14); correctional officers and administrators (n=17); ex-inmates and family of inmates (n=9), and physicians and social workers (n=6). Analysis and interpretation of data involved interview transcription and thematic content analysis through coding with Nvivo 9 software. Results: Inmates’ social relationships with staff were often centred on the coproduction of a particular form of ‘violence’, which I conceptualise as ‘degradation.’ Inmate recidivism and engagement in self-inflicted degradation (e.g. swallowing razor blades, urinating in one’s cell, faking medical symptoms) may be considered a behavioural and social tactic used to gain agency within prison, as well as access to community-based welfare and medical institutions upon re-entry into the public community. In prison, practices of degradation might be most visible through a common social interaction of ‘prison games.’ I interpret prison games to involve inmates’ deployment of ‘abjectionable’ and anti-social behaviour for social and capital gains while prison staff attempt to manage this behaviour. Collectively, the practice of degradation might provide insight into a ‘degraded citizenship’ experienced by millions of people who pass through a U.S. jail or prison each year.