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A Death in the Box

A Death in the Box

October 31, 2004
By MARY BETH PFEIFFER
A Death in the Box

October 31, 2004
By MARY BETH PFEIFFER

By the time Jessica Lee Roger was discovered on the floor
of her prison cell on Aug. 17, 2002, it was too late. In
the 24 minutes since guards had last checked her, she had
tied a bed sheet around her neck and, after many attempts
over three years in prison, finally strangled herself. When
word of Roger's suicide spread through the cellblocks of
the Bedford Hills Correctional Facility that sultry
weekend, two correction officers cried. Fellow inmates were
angry. The superintendent, who was away for a few days, was
devastated. A mentally ill young woman had died, and she
had died in the most stressful and isolating place in the
New York state prison system. Jessica Roger, 21, killed
herself in the ''box,'' and many thought she didn't belong
there.

For more than a third of Roger's 1,200 days at the prison
in Westchester County, she was, as she said in a letter to
her mother, ''locked up and locked in'' as punishment for
her fits of rage and resistance. For 250 days, she was
confined to her cell, unable to participate in programs or
communal meals. She spent another 160 days in the ''special
housing unit,'' what inmates call the box. The box is the
most severe punishment in prison: the final threat, the
ultimate time out. It is a small barren chamber set apart
from the general population with a concrete floor, a steel
door and no clock to mark the time. The essential quality
of the box is isolation -- a gloved hand passes food
through a slot in the door; a caseworker's muffled voice
filters through the holes in a small Plexiglas window.
Inmates are allowed few personal possessions. Lights are
never fully extinguished. It is four walls for 23 hours a
day -- a psychologically punishing experience by design.
For people like Jessica Roger, it can also be an incubator
of psychosis.

Forty years ago, America's seriously mentally ill were
housed in psychiatric hospitals that kept them too long and
often without good cause. As those hospitals closed, a
promise to provide care in communities went unfulfilled. At
the same time, America's prison capacity grew; it has
quadrupled since 1980. People with untreated mental illness
are often poor and homeless. Many commit petty crimes,
creating arrest records that often lead to harsh sentences.
Today some 250,000 Americans with mental illness live in
prisons, the nation's primary supplier of mental-health
services.

Mentally ill inmates do not do well in the tense and
rulebound world of prison. They create scenes, lash out
unpredictably and cannot or will not obey orders. Special
housing units are intended for the most violent inmates,
but they also tend to collect those who are troublesome and
mentally ill. More than 800 of the 4,300 inmates in New
York's special housing units suffer from mental illnesses
like schizophrenia, major depression or personality or
trauma disorders. They may talk to voices only they can
hear. They may see conspiracies in simple routines. They
may have little emotional control or be obsessed by
inexplicable fears. For these people, prolonged confinement
to a cubicle-size room is a grueling psychological test
that many fail. About 6 percent of inmates in New York have
been housed in the box since 1998. Yet 34 percent of
suicides, 26 in all, have occurred there.

This isn't news to prison officials, who have been sued
over special housing units in at least 10 states. In
California, a federal judge said that placing the seriously
mentally ill in such confinement was ''the mental
equivalent of putting an asthmatic in a place with little
air to breathe.'' Over the years, advocates in New York
have challenged conditions in the box at four state
prisons. Those lawsuits resulted in incremental but largely
isolated changes -- increasing the mental-health staff at
one prison, providing inmate counseling at another. But the
underlying problem remains: when people with mental illness
end up in prison, the need to treat them collides with the
need to keep prison order, and everything about the system
favors the latter.

Consider Attica, the infamous New York prison, where in
1998, after 18 years of fighting in court, officials
settled a lawsuit on behalf of mentally ill inmates in its
special housing unit. The prison promised to monitor
inmates closely, provide better mental-health care and do a
better job of training staff members. Nineteen months
later, a court expert found that little had changed: the
symptoms of ill and psychotic inmates were routinely
written off as ''malingering.'' Men who broke down were
hospitalized and inexplicably returned to the box
afterward, only to break down again. Since the settlement,
there have been seven suicides at Attica, among New York's
highest. Frustration with this slow pace of change led
advocates for mentally ill inmates to file a suit against
the entire state prison system in 2002. The suit, for which
witnesses are now being deposed, asserts that mentally ill
inmates are punished for exhibiting symptoms of illness
that the system has failed to treat. Relegated to the box,
they become sicker from the ''near total lack of human
contact.''

Roger had attempted suicide in the box at least four times
before she succeeded. Once, she tied a sheet around her
neck during a 100-day sentence, which was meted out after
she refused orders and overturned furniture. She left a
note with the outline of her hand spattered with blood:
''This is how I feel.'' She was sent to a prison
psychiatric hospital for a month, where she was counseled,
medicated and treated. Then, although she received a
diagnosis of bipolar disorder, borderline personality
disorder and other mental illnesses, Jessica was returned
to complete her punishment in the small airless cell that
had broken her. Within days, she again attempted suicide.
Jessica Roger was a large young woman with hazel eyes and a
ponytail of dark blond hair. She was needy, bright and
emotionally so much a child that in the visiting room she
would cling to her mother, head on her shoulder, arms
wrapped around her. Born and raised in Poughkeepsie, N.Y.,
Roger had been in and out of mental hospitals 17 times
since she was 11; she had gotten only as far as the fifth
grade.

When she was 16 years and 4 days old, just past the
threshold at which children become adults under New York
criminal law, Roger was arrested for the relatively minor
offense of biting her sister's arm in a fight. But while in
custody, the explosive teenager kicked a jail guard who was
trying to refasten the handcuffs that had slipped from her
wrists. She was convicted of second-degree assault of a
correction officer.

Dutchess County Court Judge George Marlow tried hard to
avoid sentencing Roger to prison. He approved a plea deal
to send her to an intensive program for emotionally
troubled juveniles, one of few suited to her. But while she
waited in the hospital for a bed to become available, she
set fire to a mattress. The deal collapsed. ''When someone
has a documented history of mental illness, as this
defendant does,'' the judge said at her 1999 sentencing,
''there ought to be a place where there could be both
isolation and treatment. That is the only humane
response.'' Lacking that place, Marlow made what he called
one of the most painful decisions in a 32-year career:
sentencing Jessica Roger to 3 1/2 to 7 years in prison. It
was her first foray into the criminal-justice system.

New York is one of more than 30 states that operate 23-hour
confinement units and prisons, sometimes called
''supermax'' facilities. Many of these were built in the
1990's in a frenzy of construction; there are now more than
20,000 inmates nationwide in these units. The resurgence of
isolated confinement is often dated to the 1984 lock-down
at the federal penitentiary at Marion, Ill., after rising
violence led to the murder of two guards. But it was also
fed by America's incarceration binge: prisons crowded with
gang members, the drug-addicted and the mentally ill
presented a daunting management challenge. And in an era
when the rehabilitative ideal had long been waning,
punitive forces took another step forward. ''The
supermax,'' said Gov. Tommy Thompson of Wisconsin in 1996,
''will be a criminal's worst nightmare.'' In New York and
elsewhere, there was little public debate about the effect
that the units would have on the people confined there.

Between 1998 and 2000, New York built special housing units
for 3,000 inmates, almost doubling capacity in the belief
that completely shutting off troublemakers would make
prisons safer. Under the state's disciplinary system,
rule-breaking inmates face escalating sanctions. Smoking or
failing to carry an ID card, for example, could mean a loss
of phone, recreation or commissary privileges. Harassing
staff members or refusing an order could mean cell
confinement, called ''keeplock.'' A sentence to the box was
meant for the worst offenses, which is how Glenn S. Goord,
commissioner of the New York State Department of
Correctional Services, has defended the units. (Goord
declined to be interviewed for this article, citing the
pending litigation.) In a November 2000 report on prison
safety, he described some of the offenses by those in the
box: Anthony Burton punched and stabbed an officer with a
pen; Carlos Rodriguez stabbed another inmate to death;
Claudio Cuadrado cut an officer with a razor. ''The inmates
confined in disciplinary housing,'' he said in a press
release last fall, ''are 'the worst of the worst.'''

But attorneys, psychiatrists and legislators who have
visited New York's special housing units describe the
occupants in different terms. While some are violent
criminals befitting the system's most extreme form of
punishment, many others are mentally disturbed people
consigned to the box for lesser offenses -- creating
disturbances, using drugs or failing to follow orders. In
fact, in 1986 assault counted for half of sentences to the
box; in 2000 just 15 percent of special-housing-unit
sentences were for assault.

Prison is an inherently dangerous place, and it is easy to
understand why correction officers view the box as an
irresistible tool for controlling violence. Donald E. Premo
Jr. has served as a correction officer and supervisor in
New York prisons for 19 years. When inmates refuse orders
or start fights, whether they are mentally ill is
irrelevant, he said: they are a security threat, and his
job is to contain them. ''It's not so much the harm to
them,'' Premo said of mentally ill inmates who are sent to
the box. ''But what is the harm to the facility if they are
not controlled?'' The statistics in New York do show a
significant drop in staff and inmate assault, but staff
attacks had been dropping before the units were built. A
study of facilities in three other states found little
evidence of improved safety. Still, Premo and other
officers say they have no doubt that the special housing
units have made prisons safer.

Among Roger's personal papers were dozens of yellow
disciplinary citations, mementos from her time at Bedford
Hills: she repeatedly refused to tuck in her shirt; she
tossed toilet water; she smoked cigarettes in her cell and
shouted obscenities at staff members; she bit an inmate.
She was 280 pounds of attitude and illness who, in one
profanity-laced outburst, told an officer: ''That's what
I'm in here for, hitting one of you. . . . '' Roger's
second sentence of 60 days in the box was for an
''unhygienic act'' -- spitting on an officer. She made it
through 56 days before attempting suicide.


"There's not a room she's not in,'' says Joan Roger, 46.
Jessica's mother is sitting at the green Formica-top table
of her three-room apartment in a downcast neighborhood of
Poughkeepsie, a Hudson River city about 80 miles north of
Manhattan. The white walls of the apartment are crowded
with photographs. There's Jessica at 11 months clutching a
teddy bear, and at 4, beaming and bright-eyed in matching
short sets with her older sister, Cora. There's Jessica at
13 with her mother and grandmother. And in her mother's
bedroom, a picture of Jessica in her casket, wearing a
lavender Tasmanian Devil T-shirt and jeans, framed by a
heart-shaped wreath of faded silk flowers. There's a
visible bruise on her forehead that adds to her mother's
questions.

Wisps of hair fall from a tight knot and across Joan
Roger's ruddy face. Her sweatshirt is stained and worn. She
accepts blame, maybe too much, for what happened to her
Jet, as she called her daughter. Driven by ''mood swings,''
Joan was verbally abusive to her daughters, she said --
''fine one minute, the next minute I was off and running.''
Her ex-husband, Kevin Roger, 46, recalls Joan yelling awful
things at the girls and once grabbing a knife from her hand
that, she acknowledges, ''had his name on it.'' Joan left
the girls with Kevin around the time Jessica turned 11.
Jessica was shattered.

Kevin Roger's alcohol abuse is a refrain in Jessica's
letters and records. But unlike Joan, Kevin, who is suing
the state prison system, does not apologize. ''I drank,''
he says. ''I still drink. It's legal.''

''To me,'' Jessica Roger told a psychiatrist when she was
17, ''my life has been nothing but hell.'' She spent much
of her adolescence in institutions for troubled and sick
children. She broke more than a dozen windows during her
fits and tantrums. She first attempted suicide by
overdosing on pills when she was 13. She was a regular at
the local psychiatric emergency room. She might have gone
on this way except that there came a point at which her
behavior -- a fight with her sister -- ceased to be
regarded as the acting out of a troubled adolescent and
instead became a crime. This time police insisted that
charges be filed, and Roger's fate was sealed.


"Mommy these people are stressing me out again. They took
my sheets, my blankets and my mattress out of my cell
because I keep hiding under the bed and covering myself so
they can't see me. . . . Mommy I really feel like hurting
myself but I am afraid to tell these people because I don't
want them to put me in a cold . . . cell with nothing but a
thin mat and a gown. . . . Mommy the feeling of hurting
myself is getting stronger. Why won't these feelings just
stay out of my head forever? I can't deal with them
anymore. My thoughts about hurting myself are racing now
they are going faster than before.''

When Roger wrote to her mother in June 2001, she was
serving 60 days in keeplock -- locked in her cell for all
but an hour of exercise a day -- for setting fire to a
book, yelling during the inmate count and other offenses.
These forays into solitude were intended, a hearing officer
told her, as ''an understood deterrence to future similar
behavior.'' But like many ill inmates, Roger seemed inured
to punishment. In a county jail, she was so uncontrollable
that a stun device was used on her more than once. Another
time, jail officers stripped her of her jumpsuit and bra,
after she refused to do it herself, and put her in a
suicide-proof gown. ''Do whatever you want to me,'' she
impassively told a jail officer in 1998.

Inmates like Roger are at the heart of a societal debate --
played out mostly in courts, academic publications and the
reports of reform organizations -- over whether seriously
mentally ill people belong in isolated confinement. But
it's a question that is debated in prisons too, with lines
sometimes drawn in unexpected ways. The Department of
Correctional Services runs New York's prisons, but clinical
care of the mentally ill is left to the Office of Mental
Health. Bedford Hills Superintendent Elaine Lord, who
retired in March, was known as an advocate for mentally ill
inmates for whom harsh punishment in the box could be
destructive and lead to a spiral of misbehavior. Lord, who
declined to be interviewed for this article, sometimes
clashed with mental-health clinicians, who advocated
punishment to curb what they saw as inmate ''malingering''
or ''manipulating'' -- feigning or using illness, usually
to get out of disciplinary sanctions.

It is a classic tug of war in an overburdened system in
which the corrections side is supposed to take the ''bad''
inmates and the mental-health side is supposed to take the
''mad'' -- and where both sides have limited resources,
arguments ensue as to who belongs where. In a deposition
taken for the lawsuit against the state, the superintendent
summed up a school of thought with which she agreed. ''We
need to stop arguing about whether people are mad or bad,''
testified Lord, who cried at the inquiry into Roger's
death, ''and design some effective interventions.''

Roger's borderline personality disorder marked her as
willful, manipulative and, incorrectly, all but
untreatable. In her time at Bedford Hills, she was
sentenced to 16 terms in disciplinary confinement, mostly
in keeplock, on 46 separate charges. She had two sentences
to the box totaling about five months. She was luckier than
others in New York. Inmates who are mentally ill spend on
average about three years in special housing units,
according to a Correctional Association of New York survey.
They get caught in a vortex of worsening illness and
behavior that leads to ever more punishment.

The debate over the effects of isolation on even a normal
human psyche is longstanding. In 1821, the New York
Legislature directed its prison at Auburn to conduct an
experiment: put 80 of its worst offenders into what a group
promoting the idea described as ''complete solitary
confinement, free from all employment, all amusement, all
pleasant objects of external contemplation.'' The inmates
soon became suicidal and psychotic. One leapt from a
gallery when his door opened; another beat his head against
the walls of his cell. The experiment was abandoned within
two years. ''A degree of mental anguish and distress may be
necessary to humble and reform the offender,'' the warden,
Gershom Powers, wrote, ''but, carry it too far, and he will
become either a savage in his temper and feelings, or he
will sink in despair.''

Modern research on prisoners of war; immobilized
spinal-injury patients; solo, long-flight pilots; Antarctic
dwellers and prison inmates has shown the human mind
vulnerable to unraveling during periods of isolation and
sensory deprivation. In 1979, Stuart Grassian, a Harvard
Medical School psychiatrist, was asked to assess 14 inmates
who were housed in the small, windowless cells of a
solitary confinement unit at a maximum-security prison in
Walpole, Mass. One inmate could not recall the days before
he slashed his wrists. Another described feelings of panic
and fear of suffocation. Many heard voices, were
hypersensitive to sounds or obsessed over thoughts of
torture and revenge on guards. Since then, Grassian has
evaluated scores of inmates in New York and other states,
and has no doubts about what he calls the ''toxic'' effect
of isolation.

Grassian's findings are part of a body of research that is
consistent and ample but also, in the words of a recent
article in The Prison Journal, ''weak methodologically.''
For one, his research was conducted in the context of a
lawsuit -- often the only way to get access to the
cloistered world of prisons. And it is based on observing
and interviewing inmates rather than tracking them over
time or comparing them with control groups. A research team
in Canada tried to settle the debate in the late 1990's by
comparing the mental health of 23 inmates segregated for 60
days with those who were kept with the general population.
It found no harm to the isolated inmates, who were less
mentally healthy than the control group. However, the
study's subjects -- many of them volunteers -- had access
to personal possessions, televisions and computers. In an
article in the Canadian Journal of Criminology, the
researchers cautioned that their findings are ''somewhat
irrelevant'' to conditions in the United States, ''where
prisoners can sometimes be segregated for years for
disciplinary infractions with virtually no distractions,
human contacts, services or programs.''

Researchers and advocates generally do not object to short
periods of confinement for ill and unruly inmates; they
recognize that truly violent prisoners must be contained.
But since the 1980's, the number of New York inmates
serving special-housing-unit sentences of longer than six
months has increased at six times the rate of the
population. Inmates can, and do, spend years in the box. In
2002, New York had among the nation's highest proportion of
inmates -- nearly 8 percent -- in isolated confinement,
which includes the box and keeplock. ''The scale of
punishment in New York State is particularly onerous,''
said Hans Toch, a prison researcher who is a professor of
criminal justice at the State University at Albany. ''They
think nothing of putting someone into a segregation setting
for a year and a half for what is a serious but not
horrendous offense.''

Carlos Diaz, 46, had been in a special housing unit in New
York for five years when he hanged himself with a shoelace
in 2000. He had accumulated so many infractions that he had
10 years left in the box. Such deaths are investigated by
an oversight board called the New York State Commission of
Correction, which found that Diaz had been virtually
abandoned. Although he was at one point ''extremely
delusional,'' no one was monitoring his condition or
providing mental-health care. ''It is a well-established
fact,'' the commission noted pointedly, ''that inmates
serving long-term sentences in S.H.U.'s are likely to
decompensate due to extended periods of isolation and
sensory deprivation.''

In 2001, the commission investigated two deaths six months
apart that painfully illustrate lapses in mental-health
care that lead ill inmates to act out and be disciplined.
In each case, severely mentally ill inmates at separate
prisons died from ''decreased intake of food and water'' --
they starved, in other words -- one after announcing a
hunger strike and the other while on a suicide watch. The
Commission of Correction was searing in its criticism: ''In
both cases, the inmates had been identified as having
significant mental-health and/or medical problems and were
not afforded the care and treatment that these services are
required to provide.'' Significantly, the commission's
findings are nonbinding; they are often rejected or
ignored.

Cases like these are symptoms of a system under strain. The
number of mentally ill inmates grew by 78 percent since
1991, while mental-health staffing has grown by 57 percent.
Complicating matters, jobs often go unfilled. Pedro Molina
appealed for help in 2001 at a prison with chronic
recruiting problems. His note in Spanish was found weeks
later on a stack of 40 requests; no one had translated or
triaged the request, and Molina, 27, hanged himself in the
box.

When another inmate, Ralph Tortorici, 31, killed himself in
1999, Goord himself expressed frustration, appealing to the
Office of Mental Health for more psychiatric hospital beds.
''I am seriously concerned about the potential for
unfortunate occurrences similar to the premature demise of
Mr. Tortorici,'' Goord wrote. Tortorici suffered from
schizophrenia and believed the government had implanted
computer chips in his body; he was so ill that he had been
hospitalized four times for periods of up to a year. The
prison system's lone 189-bed hospital has not been expanded
since opening in 1980. Since then, New York has built 38
prisons.


Each morning at Bedford Hills, Jessica Roger would visit
Andy DeMers, a correction officer she had made friends
with. She would put her head, puppy-dog-like, on the high
counter he manned. It was a ritual they shared: He would
''tune'' her nose, making a noise as he tweaked it. One
day, she called to him as she was led to a van bound for
the prison psychiatric hospital. ''Who's going to tune my
nose?'' she asked. DeMers recalled that ''there was a
sweetness inside her,'' a quality he said few officers saw.
Officers aren't trained to connect with inmates but rather
to control them, many experts told me, leading to many
confrontations and failures of opportunity. ''She was
reachable,'' said DeMers, who has since retired.

Betty Guzzardi, a petite woman in her 50's, lived on
Roger's cellblock in the months before her suicide. She was
one of a handful of mother hens who would try to lift
Roger's spirits. ''We used to tell her, 'You're a young
girl; you'll be getting out,''' said Guzzardi, who has a
daughter Roger's age. The women would play cards and
Yahtzee with her, and Roger would laugh and enjoy the
company. Guzzardi once watched Roger pull an electrical
outlet cover off a wall and gouge her wrists with the
broken pieces; she had often seen her cry. When told that
Roger had been put into the box two days before her suicide
-- in an incident that apparently began with Jessica
smoking and ended with her throwing a chair -- Guzzardi was
incredulous. ''Are you crazy?'' she told an officer.
''She's too depressed.

''The whole facility was like 'How could they do this
knowing how she was?' It was very upsetting to us that a
young girl like that took her life, and more than that, the
facility helped her take her life.''

State prisons bear the brunt of what is often called the
''criminalization'' of mental illness. In New York, the
tally of mentally ill inmates has swelled to 7,500, or 11
percent of the population. Unprepared for the task, the
system has tried to respond, if inadequately. Units have
been built for mentally ill prisoners who cannot live with
the general population. Therapy programs have even been
started at a few special housing units. In the face of the
systemwide lawsuit, the state is proposing to expand these
services, along with measures to reduce time in the box for
good behavior and for offenses that stem from mental
illness. But advocates say that more in-patient hospital
beds and dedicated units are needed for mentally ill
inmates, along with training to help correction officers
recognize the manifestations of illness. Just as important,
better oversight is needed of a system with little
accountability.

Thanks to a previous lawsuit against Bedford and the 1987
settlement that was reached, the prison has among the
highest levels of mental-health staff in the state and the
mental-health care that Roger received was most likely far
superior to that in the rest of the system. Women in the
special housing unit are monitored regularly and given
monthly therapy. But while the lawsuit improved care, it
did not achieve what Jessica Roger needed most. It did not
keep her out of the box. Facilities in at least four states
preclude the seriously ill from 23-hour confinement; a
proposal to do that in New York has languished in the State
Legislature. Had it been law, Roger might still be alive.

In her final tortured hours, Jessica Roger was moved from
the box to a suicide observation cell and back again. She
exhibited ''self-injurious behaviors'' on the way back to
special housing, the Commission of Correction's report
states, questioning why she wasn't returned to observation.
But mental-health staff members had considered a prior
gesture to be ''manipulative,'' the report asserts; Roger,
they thought, was trying to get out of the box. ''The
ultimate tragedy,'' writes Terry Kupers, a prison expert
and psychiatrist, in an article in The Correctional Mental
Health Report, ''is when overconcern about malingering
leads mental-health staff to miss what would otherwise be
clear signs of an impending suicide.''

On Aug. 20, 2002, Roger's counselor closed out her file,
recalling recent encounters with Jessica. ''This writer
would ask inmate if she had decided if she wanted to get a
new ticket yet (misbehavior report) and inmate would laugh
and say she wasn't going to get locked.'' Before long,
however, the inevitable happened.

''Inmate acted out after hours and was sent to S.H.U.,''
the counselor wrote. ''Writer was informed of her death
yesterday morning on 8/19/02. She will be missed.''




Mary Beth Pfeiffer, who is on leave as the projects editor
at The Poughkeepsie Journal, is a 2004 Soros Justice Media
Fellow.

 http://www.nytimes.com/2004/10/31/magazine/31PRISONER.html?ex=1100426477&ei=1&en=69c679fa353585af