Writing from inside
===================

* Peter M. Ford

**Letters from prison: felons write about the struggle for life** **and sanity behind bars** Shawn Thompson Toronto: HarperCollins; 2002 266 pp $32 ISBN 0-00-200086-5

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Figure. Photo by: Fred Sebastian

Over a period of several years (the exact dates are not given), Shawn Thompson, starting as a journalist in Kingston, Ont., and ending as an academic in British Columbia, wrote letters to inmates in prisons all over Canada and the United States. This book is a compilation of their replies, interspersed with Thompson's own musings on the incarcerated condition. It seems that he enlarged his network by writing to other prisoners recommended by his correspondents. It is evident from the responses that he asked specific questions in his letters, although it is not always clear to the reader what the exact question was. It is also apparent that the prisoners were aware that he was writing a book; their expectation of ending up in print may explain some patches of rather purple prose.

Living, as we do, on a continent that imprisons a greater proportion of its citizenry than most parts of the world, it is important that we hear from incarcerated people from time to time, if only to remind us of Winston Churchill's dictum that “The mood and temper of the public in regard to the treatment of crime and criminals is one of the most unfailing tests of the civilization of any country.” To judge from the contents of this book and from numerous other sources, it is a test that finds us wanting. 

This book tells us much about life in prison: the constant daytime noise, the smell, the lack of privacy, the heat in summer, the overcrowding and the fear. It also conveys a sense of the profound and persistent boredom that is a feature of life inside. We hear of strategies for dealing with prison life, both in terms of avoiding conflict with other prisoners and of maintaining sanity in the face of prolonged incarceration. There are accounts of the stifling, senseless, often self-defeating and sometimes cruel bureaucracy for which prisons on both sides of the border are justly famous. There is an interesting view from inside of the untoward effects of banning tobacco in the Texas state prison system, a move that has been contemplated for Canadian penitentiaries. A number of respondents had spent time in both US and Canadian prisons, and one who had been in maximum-security prisons in both countries observes that in the US institution he was *surprised* to get out alive, but in Canada he *expected* to.

From US correspondents there are accounts of dangerous racial tensions — but, lest Canadian readers feel smug, there is also an account of what it is like to be an English-speaking prisoner in a Quebec maximum security penitentiary. And I know from French-speaking patients in prison that the converse is no different. Readers of this journal will be interested to hear that when issues of health care arise it is not the quality that is commented on, but rather the difficulties experienced in gaining access to health care.

This book suffers somewhat from presenting an incomplete picture of life on the inside. The respondents are, in the main, articulate, and of course all of them can write. For a fuller spectrum of inmate experience, one would need to tour prisons with a tape recorder to capture the voices of the inarticulate and illiterate. For example, none of the participants in this book tell us about the descent into the abyss of debt, fear and communicable disease that is the lot of the drug addict in prison, particularly in North American institutions, where little is done to treat drug addiction and less is done to prevent transmission of blood-borne pathogens. It has been estimated that 30% of all hepatitis C cases in the US pass through the prison system in one year, and that as many as 25% of all inmates will inject drugs (usually with shared equipment) during their sentence. The correspondents in this book rarely mention drugs and do not talk about injection. The only mentions of hepatitis are in the context of food or airborne spread.

Thompson has a tendency to wander into abstractions that, on the whole, do not add much to the messages from inside. These messages are telling us not only that North American prisons are grim and often dangerous places, but that they are in large part failing in their responsibility to rehabilitate. It is a book that should be widely read if only to make us all a little less inclined to cast human beings into these often dreadful institutions for the sort of crimes that should be dealt with by noncustodial measures.

**Peter M. Ford** Dr. Ford is a professor of medicine at Queen's University at Kingston, Ont. He is director of the Kingston General Hospital Clinical Immunology Outpatient Clinic, and operates HIV clinics in local prisons.