Leaving the Bars Behind

Leaving the Bars Behind
John A. Consiglio

Abstract: For decades now, United States’ correctional policies generally follow a pendulum swing. On one end, our prison and community custody approaches have been primarily focused around confinement and punishment. On the other end of the pendulum swing, our prison and community custody focuses strongly on treatment and rehabilitation to reduce offender recidivism. Over the last few years, evidence-based research has begun to shift DOC policies and practices over to treating and rehabilitating offenders, which in turn, opens the door to many different styles of therapy and training programs for offenders inside prison confinement, and for offenders entering community custody. This academic analysis investigated a number of therapies and education programs in terms of their effectiveness at reducing offender recidivism, primarily focusing on offenders in community custody. The research seems to indicate that Moral Reconation Therapy (MRT) and other cognitive behavior therapies, along with reasoning & rehabilitation programs have been shown to effectively reduce the rates of recidivism for offenders leaving the prison bars behind as they return to their communities.

Introduction and Thesis

            According to national statistics gathered by Washington State’s Department of Corrections, The United States has over 2.3 million people locked up, the highest incarceration rate in the world. One out of 100 American adults is behind bars; while one out of 32 is on probation, parole or is incarcerated (Washington State DOC, November 2011). With such a staggering number of individuals having gone through the criminal justice system, it becomes imperative to investigate the practices and approaches to reducing offender recidivism, and to determine what actions can be taken that show effective recidivism reduction.

            The idea of rehabilitative programs and educations has been a topic of much heated debate through the criminal justice system for decades. From the 50s up until the 70s, rehabilitation and programs had taken a bad wrap from both liberal and conservative pockets of the community. D. A. Andrews and colleagues report in their 1990 article Does Correction Treatment Work?, “rehabilitation came to be seen by liberals as a euphemism for coercing offenders and by conservatives as one for letting hardened criminals off easy…defenders of treatment were branded scientifically and politically naïve apologists for the socially powerful, self-serving human service professionals, or curious relics of a positivistic past” (Andrews et al, 1990; 370). Thus, many jurisdictions in the United States reinforced sentences on offenders that focused primarily on punishment and confinement.

            However, over the last two to three decades rehabilitation and alternative sentencing programs have been on the rise. This is due primarily to the evidence-based research that has been done which showed the effectiveness of certain programs and therapies, as well as the results of strictly punishing and imprisoning offenders. D.A. Andrews and James Bonta write in their book The Psychology of Criminal Conduct, “It soon became apparent to psychologists that if punishment was to be used, it had to be used sparingly and always coupled with the reinforcement of prosocial behavior” (Andrews, 2010; 450). This means that punishment should only be used when it is coordinated with a treatment program. Andrews and Bonta state that reinforcement compared to punishment, has important advantages. For example, only reinforcement can shape and influence new behaviors, whereas punishment can only suppress existing behavior. For offender populations with limited prosocial skills or behaviors, punishment will do nothing to teach them new skills, hindering their chances at rehabilitation (Andrews, 2010; 450).

            For some offenders, their sentences are not completely done within the constructs of a prison environment, but instead can be carried out within their community. This places correction agencies in a difficult position; they have a responsibility to their offenders by providing them appropriate supervision and treatment, while at the same time upholding the responsibility of keeping the community safe. According to the Washington State institute for Public Policy (WSIPP), “only certain evidence-based programs are known to reduce recidivism with adult offenders” (Washington State DOC, December, 2011). Because of this, it is imperative that Parole officers and Community Correction Officers know what treatment programs are effective for reducing offender recidivism.

            The thesis of this report is to examine cognitive behavior therapy, as well as education training, and rehabilitation programs, to examine their effectiveness at reducing recidivism for offenders in community custody. In particular, this report will look at the Risk-Need-Responsivity Model (RNR) in how offenders should be classified for treatment, followed by an overview of the effectiveness of MRT and other cognitive behavior programs, Reasoning and Rehabilitation (R&R) programs, education and work programs, as well as certain programs that exclusively start inside the prison system such as correctional boot camps. To conclude, this report will summarize the findings and discuss some of the public opinions regarding treatment for offenders as well as the political motivations of treatment.

Risk-Need-Responsivity (RNR)

            To begin, it is important for the reader to understand that treatment does very little if it is not used effectively. To do this, one needs to assess which offenders need the most treatment. This is the purpose of the Risk-Need-Responsivity Model or (RNR). According to Bonta and Andrews in the article Risk-Need-Responsivity Model for Offender Assessment and Rehabilitation, they believe that the RNR model is perhaps the most influential model for assessing and treating offenders (Bonta et al, 2007; 1). The basis for RNR can be found in its three core principles: (1) The Risk Principle, which is used to match the level of service to the offender’s risk to re-offend; (2) The Need Principle, used to assess the needs of an offender so they can be targeted in treatment; (3) The Responsivity Principle, used to maximize the offender’s ability to learn from a rehabilitative intervention (can be done by providing cognitive behavioral treatment and tailoring it to the learning style, motivation, abilities and strengths of the offender) (Bonta et al, 2007; 1).

            This model has given researchers much insight and knowledge about offenders and the treatment they require. For example, Bonta and Andrews state, “as risk level increases then the amount of treatment needed to reduce recidivism also increases…However, in everyday practice there is a tremendous pressure to focus resources on lower risk offenders. After all, low risk offenders are more cooperative and motivated to comply with treatment demands than high risk offenders” (Bonta et al, 2007; 9). Thus, we have learned that resources for effective treatment need to be focused on higher-risk offenders to reduce recidivism.

            However, as it was previously stated, many agencies put their resources into treatment for low-risk offenders; offenders who are at the least amount of risk at re-offending in the first place. Furthermore, Bonta and Andrews state “Inappropriate matching of treatment intensity with offender risk level can lead to wasted treatment resources and in some situations actually make matters worse…treatment services provided to high risk offenders show lower recidivism compared to treatment provided to low risk offenders. In fact, in 374 tests of the risk principle, treatment delivered to high risk offenders was associated with an average 10% difference in recidivism” (Bonta et al, 2007; 10). This evidence suggests that higher treatment for high-risk offenders is more effective at reducing recidivism than providing high treatment to low-risk offenders. This is further supported by Bonta and Andrews who found that providing treatment to low-risk offenders only showed about a 3% reduction in recidivism, a very mild effect compared to treatment for high-risk offenders (Bonta et al, 2007; 10).Therefore, the Risk Principle would suggest more treatment to high-risk offenders.

            When we examine the evidence found in regards to the Needs Principle, we find that addressing the criminogenic needs (the offenders social life, competence level, their attitudes and beliefs, etc.) is essential at reducing recidivism, especially when the treatment also infuses the other two principles of risk and responsivity. Bonta and Andrews write, “Based on tests of the need principle, successfully addressing criminogenic needs is associated with an average 19% difference in recidivism. Treatments that focus on non-criminogenic needs are associated with a slight increase in recidivism (about 1%). If we examine only adherence to the general responsivity principle (i.e., use cognitive behavioral methods of intervention) we find on average, a 23% difference in recidivism. Finally, when offender treatment programs put all three principles into action then the effectiveness of correctional treatment can be quite significant” (Bonta et al, 2007; 11).

            We can see the effectiveness of the RNR model in terms of addressing which offenders need treatment and what needs must be addressed during treatment. The data has suggested that it is essential to use more resources treating high-risk offenders; making sure to address their criminogenic needs. However, we must ask whether the RNR model is effective at treating offenders within community custody. Bonta and Andrews write in their report, “If a treatment intervention begins to adhere to one of the principles we start to see reductions in recidivism and when all three principles are evident in a rehabilitation program then we see average recidivism differences between the treated and non-treated offenders of 17% when delivered in residential/custodial settings and 35% when delivered in community settings. Treatment can work in residential and custodial settings but effectiveness is maximized when the treatment is in a community setting” (Bonta et al, 2007; 12). Thus, we find that the Risk-Need-Responsivity model (RNR) is an effective tool for assessing and treating offenders in a community custody setting.

Cognitive Behavioral Therapy: MRT and R&R

            As we learned previously, an effective approach at providing treatment to offenders involves a number of factors. Andrews and his colleagues summarize the following, “Previous reviews regarding studies of treatment would suggest that neither criminal sanctioning without provision of rehabilitative service nor servicing without reference to clinical principles of rehabilitation will succeed in reducing recidivism. What Works, in our view, is the delivery of appropriate correctional service, and appropriate service reflects three psychological principles: (1) delivery of service to higher risk cases, (2) targeting of criminogenic needs, and (3) use of styles and modes of treatment (e.g., cognitive and behavioral)” (D. A. Andrews et al, 1990; 369). Therefore, we must now look at the types of treatment available that can help reduce offender recidivism.

            We begin then, by observing Cognitive Behavioral Therapy. According to Leana Allen and colleagues article The Effectiveness of Cognitive Behavior Treatment for Adult Offenders, they state “Cognitive-behavioral therapies emphasize the connection between cognition and behavior and suggest that dysfunctional behaviors may be altered through changes in dysfunctional attitudes, beliefs, and thought processes” (Allen et al, 2001; 498). Furthermore, Allen and colleagues write, “The cognitive-behavioral approach as applied to criminal behavior suggests that criminals think differently than non-criminals either because of a lower level of moral development or through dysfunctional information processing. Thus, cognitive-behavioral rehabilitation programs focus on changing the problematic thought processes that contribute to criminal behavior. Two of the current models of cognitive-behavioral therapy in a correctional setting are Moral Reconation Therapy (MRT) and Reasoning and Rehabilitation (R&R).The first is designed to change moral reasoning and development; the second is an example of an information processing approach” (Allen et al, 2001; 498-99). Therefore, cognitive behavior therapy is a way to change the thinking and reasoning of an offender, in the hope to eliminate the thoughts and behaviors that contribute and reinforce criminal behavior. As Allen and colleagues suggest, the two most current models of cognitive therapy are Moral Reconation Therapy (MRT) and Reasoning and Rehabilitation (R&R). In order to understand Cognitive Behavioral Therapy, and the success it may have at reducing recidivism, we must look at both MRT and R&R and how offenders respond to these treatments.

Moral Reconation Therapy (MRT)

            Allen and colleagues explain to the reader that MRT stems from Lawrence Kohlberg’s hierarchy of moral development (Allen et al, 2001; 499). “According to this perspective, individuals are assumed to pass through a series of stages of moral development, culminating in the highest levels of moral reasoning, during which individuals make decisions based on their own principles and values. Individuals with higher levels of moral reasoning are suggested to be more capable of choosing behavior that is socially defined as “right” rather than behavior that is considered “wrong.” This implies that criminals, because they have chosen wrong behavior, are at lower levels of moral development” (Allen et al, 2001; 499).

            Allen and colleagues state that MRT is designed to be either a 12 or 16-step program, and the progression through the steps is related to an offender’s increased level of moral reasoning. Offenders may participate in correctional institutions during their incarceration and/or in the community through probation; or through aftercare on release from a correctional facility (Allen et al, 2001; 499). Their study effectively breaks down the main goals of MRT, and state that the treatment can be done within community custody.

            What we must examine next is how MRT does at reducing recidivism among offenders. The subjects Allen and her colleagues viewed in their research of who had gone through MRT were drunk drivers, felony drug offenders, and general felony offenders. In regards to Drunk drivers, Allen and her colleagues’ state, “The evaluations of MRT for drunk drivers in Allen and her colleagues’ research produced two general findings. First, the treatment group, as compared with the control group, consistently demonstrated a lower re-arrest rate for any offense over the course of the studies, and in a recent study, this difference was statistically significant. Second, the treatment group, as compared with the control group, also had a consistently lower re-incarceration rate over time, and this difference was also significant in a recent evaluation” (Allen et al, 2001; 503).

            Furthermore, in regards to felony drug offenders, Allen and her colleagues’ state, “(the) results from these evaluations indicated that felony drug offenders also benefit from participation in MRT. The treatment group, as compared with the control group, consistently demonstrated a lower re-arrest rate for any offense throughout the four follow-up studies. However, these differences were not tested for statistical significance. In addition, the group of felony drug offenders who received MRT had re-incarceration rates that were consistently lower than those of the control group over the series of four studies, and these differences were significant in recent evaluations” (Allen et al, 2001; 503).

            Finally, in regards to overall felony offenders, Allen and her colleagues’ state, “(the) results from these evaluations suggested that general felony offenders who participated in MRT had decreased recidivism. At 5 years, the MRT group had a significantly lower re-arrest rate than the control group. At 7 years, MRT participants had accumulated fewer re-arrests on average than the control group, but this difference was not significant. The MRT group also consistently demonstrated significantly lower re-incarceration rates as compared with the control group” (Allen et al, 2001; 505). Ultimately, Moral Reconation Therapy (MRT) proves to be successful at reducing recidivism among different types of offenders. Furthermore, because MRT can be practiced within a community custody setting, it is this researcher’s opinion that MRT is an acceptable treatment program for offenders in community custody.

Reasoning and Rehabilitation Programs (R&R)

            Reasoning and Rehabilitation (R&R) is an educational, skills-based intervention. It has been described as a “cognitive-behavioral program designed to teach offenders social cognitive skills and values which are essential for pro-social competence. Specifically, the program helps offenders develop self-control, social skills, problem-solving abilities, and the ability to critically assess their thinking” (Allen et al, 2001; 500). Put simply, R&R aims to educate offenders to change their underlying thoughts and attitudes that contribute to their criminal behavior (Allen et al, 2001; 498). This type of program is designed for a small group of high-risk offenders during incarceration or probation (Allen et al, 2001; 500).

            The research done by Allen and her colleagues regarding R&R only looked at general federal offenders in Canada; In their report they state, “Evaluations of the Canadian R&R program have generally found that R&R is beneficial in reducing recidivism…Findings indicated a lower re-incarceration rate for individuals who completed treatment, but this difference was not statistically significant. There was also no difference between the groups in terms of reconviction” (Allen et al, 2001; 507). Furthermore, Allen and colleagues report at least two studies, each of which used rigorous scientific methods, found significant differences in recidivism between the R&R participants and those in the control groups (Allen et al, 2001; 510). To conclude, Allen and her colleagues found that in the majority of the eight studies and in the majority of the measure regarding recidivism, the R&R participants had lower rates of recidivism than their comparison groups (Allen et al, 2011; 510). Therefore, reasoning and rehabilitation programs would be affective at reducing recidivism in offenders, although this report does not have any research that specifically states the advantages of R&R with offenders in community custody.

Vocational Education

            So far we have addressed a number of ways one can assess an offender in terms of the treatment they require, and cognitive behavioral therapies such as MRT and R&R. Correlated with these types of treatment programs are resources offenders can use to further their treatment, and more importantly, to gain knowledge and experience which can hopefully deter the criminogenic behaviors that can lead to offender recidivism.

            In Jeffery Bouffard and colleagues’ article Effectiveness of Vocational Education and Employment Programs for Adult Offenders, they discuss the roles vocational education and employment programs have on reducing offender recidivism. In regards to vocational education, they state, “Vocational education programs are intended to counteract the effects of poor educational achievement and lowered employability commonly found among correctional populations. Such interventions may comprise several different approaches, including classroom-based vocational education, job training, and apprenticeship training, in such areas as electrician or carpentry skills. In addition, programs aimed at improving offenders’ work related skills, such as time management and work ethics are often included. General vocational educational programs involve the provision of classroom opportunities to acquire basic work related knowledge, such as the basic math skills needed for automotive mechanics or construction tasks. This type of educational program is widely offered and is typically a prerequisite for more hands-on types of vocational or job training experiences” (Bouffard et al, 2000; 4).

            However, when Bouffard and his colleagues measured the results of vocational education alone at reducing offender recidivism, their numbers did not paint the programs in a very good light. The research that was done by the team and investigated from previous studies showed mixed results throughout; some demonstrated no significant impact on reducing recidivism; while in some cases the program was associated with increased recidivism (Bouffard et al, 2000; 18). The definition as to whether a program “works” inevitably varies between correctional jurisdictions, and in the end Bouffard and his colleagues determined that vocational education programs “worked” according to the State of Maryland’s criteria (Bouffard et al, 2000; 18-19). Because of this, this researcher cannot give a strong recommendation of vocational education to offenders in community custody until more research is done to effectively gauge their true effectiveness, or only if it is grouped with some sort of cognitive based therapy.

Correctional Industry and Correctional Boot Camps

            While this report is based upon what programs and tools are effective for reducing recidivism for offenders in community custody, it is important for the reader to have an understanding at the way some programs are carried out while offenders are incarcerated. Two such programs are Correctional Industry and Correctional Boot Camps, each of which will be addressed in this section. Starting programs while incarcerated can make working with offenders easier when they enter community custody.

Correctional Industry

            The second program that Bouffard and his colleagues analyzed in their report was employment programs; in regards to offenders and corrections, known as Correctional Industry. Bouffard and his colleagues state, “Correctional industry is a term used to describe a range of offender employment related activities provided during the offender’s period of incarceration. Correctional industries produce a wide range of products and services for both government and private sector consumers, including furniture, health technology, automotive, institutional and jail products, signs, flags, business products and services, textiles and apparel, and food products… Correctional industry programs reduce prison operating costs, produce income for correctional systems through the sale of inmate produced goods, decrease inmate idleness, and provide skills to offenders for later use in the job market…correctional industry work can provide opportunities for inmates to develop time management skills, self-discipline, and work ethics.” (Bouffard et al, 2000; 5).

            However, Correctional Industry also suffers from drawbacks similar to those found in vocational education. For example, Bouffard and colleagues expressed in their findings that the scientific quality of most of their researched studies was fairly low, meaning that there were very few studies to accurately draw scientific conclusions (Bouffard et al, 2000; 22). Only one study was identified that was considered a rigorous scientific study, which found only a small reduction in its treatment group; a difference that was considered not significant (Bouffard et al, 2000; 22). Furthermore, the other studies which showed modestly reliable estimates also produced figures that were not substantially significant. Because of this, this researcher cannot suggest correctional industry as an appropriate tool for offenders who are serving their sentences incarcerated.

Correctional Boot Camps

            The final program that will be analyzed in this report is Correctional Boot Camps, another program that is constructed and implemented primarily during incarceration. Researched and reported by Doris Layton MacKenzie and colleagues in their article Effects of Correctional Boot Camps on Offending, they define Correctional boot camps, also called shock or intensive incarceration as “short-term incarceration programs modeled after basic training in military…Participants are required to follow a rigorous daily schedule of activities including drill and ceremony and physical training. They rise early each morning and are kept busy most of the day. Correctional officers are given military titles, and participants are required to use these titles when addressing staff. Staff and inmates are required to wear uniforms. Punishment for misbehavior is immediate and swift and usually involves some type of physical activity like push-ups...the camps differ in the amount of focus given to the physical training and hard labor aspects of the program versus therapeutic programming such as academic education, drug treatment, or cognitive skills. Some camps emphasize the therapeutic programming, while others focus on discipline and rigorous physical training” (MacKenzie et al, 2001; 127).

            According to MacKenzie and her colleagues, despite their growing popularity, the boot camps remain controversial; advocates believe the atmosphere of the camps conduct positive growth; while critics argue that many of the components are in opposition to the relationships and supportive conditions that are really needed (MacKenzie et al, 2001; 128). However, the results of their research was essentially at an impasse; “an almost equal odds of recidivating between the boot camp and comparison groups, on average. Thus there appears to be no relationship between program participation (boot camp or comparison) and recidivism” (MacKenzie et al, 2001; 130).

             Although, Mackenzie and her colleagues did find that the only characteristic that showed a strong relationship in regards to the effectiveness of boot camp programs was the presence of some after care treatment for adult offenders (MacKenzie et al, 2001; 135). Thus, it appears that Correctional boot camps are not significantly effective at reducing offender recidivism, unless offenders enter treatment when they renter the community, or are transferred into community custody.

Discussion

            As stated earlier in this report, the discussion about treatment versus punishment often sparks heavy debate and concern among individuals in the community, as well as individuals working in corrections, and even those implementing policies in our state capitals. While the research would suggest that certain programs and treatments would be more beneficial for reducing offender recidivism, the views and opinions of individuals often carry a stronger voice than research.

            Despite our growing understanding of effective programs for reducing recidivism, the United States continues to find itself dealing with over-populated prisons and repeat offenders; the struggling economy has also affected the policies correctional jurisdictions implement. In Joan Petersilia’s book When Prisoners Come Home: Parole and Prisoner Reentry, she states “One of the most profound challenges facing American society is the reintegration of more than 600,000 adults—about 1,600 a day—who leave state and federal prisons and return home each year. As of 2002 just 7 percent of all prisoners are serving death or life sentences, and only a fraction on inmates—about 3,000 each year—die in prison. Thus, 93 percent of all prison inmates are eventually released” (Petersilia, 2003; 3).

           

             It is this researcher’s opinion that money is a root cause to how correctional policies are implemented and approached. After all, it takes money to keep prisons up and running. According to Washington State’s Department of Corrections, in 2010 the average cost of incarceration per offender was $34,615 (Washington State Dep. Of Corrections, November 2011). Therefore, the problem that arises is how the resources available to correctional jurisdictions be dealt out. Certain obligations hinder the amount of recourses available; as Petersilia addresses, “Prisoners are the only population group guaranteed free health care in the United States, and as the inmate population has increased in numbers, gotten older and sicker, an increasing share of the prison budget goes to health care…Prison treatment programs, on the other hand, comprise 1-5 percent of state prison budgets, and the percentage is decreasing each year” (Petersilia, 2003; 5). When Petersilia addresses the issue of community supervision in regards to funding, she states, “Ironically, as inmate needs have increased and in-prison programs decreased, parole supervision and services have also decreased for most prisoners” (Petersilia, 2003; 6).

            However, Petersilia states that in fact, proper treatment of offender in the end is a cost-effective approach to reducing recidivism, with the added bonus of saving money:

“Today, there is ample scientific evidence showing that treatment programs can reduce recidivism, if the programs are well designed, well implemented, and targeted appropriately…Effective programs include therapeutic communities for drug addicts and substance abuse programs with aftercare for alcoholics and drug addicts; cognitive behavioral programs for sex offenders; and adult basic education, vocational education, and prison industries for the general prison population. Each of these programs has been shown to reduce the recidivism rate of program participants by 8-15 percent. Even with relatively modest reductions in subsequent recidivism, these programs pay for themselves in terms of reducing future justice expenditures. For example, prisoners who participate in vocational education programs have about a 13 percent lower likelihood of recidivism, and the programs cost about $2,000 per participant, per year. Analysts have estimated that such programs result in an average of $12,000 savings, per participant, down the line in saved criminal justice expenditures…It is thus highly likely that investing in selected rehabilitation programs will generate several dollars’ worth of benefits for every dollar spent” (Petersilia,           2003; 16-17).

            Because of the effectiveness of such programs, public support for rehabilitation is evident within many communities and continues to grow throughout the nation. In Brandon Applegate and colleagues’ article Public Support for Correctional Treatment: the Continuing Appeal of the Rehabilitative Ideal, they found the following, “The most prevalent approach that researchers have taken to evaluate the public’s position on rehabilitation has been to provide respondents with a list of goals and ask which one is the most important. We were able to identify 27 studies that have asked respondents to rate, rank, or choose rehabilitation compared to at least one other correctional goal. Rehabilitation received the highest rating in at least one part of 20 of these studies. For example, 73% of respondents chose rehabilitation as the preferred emphasis of prisons” (Applegate et al, 1997; 238). Furthermore, in regard to the results of their research, Applegate and colleagues state, “The results reported here confirm what a less contemporary or more limited assessments of attitudes toward rehabilitation suggest: Despite perceptions to the contrary, the public supports correctional treatment for offenders. Furthermore, our findings demonstrate that a great deal of consistency exists toward rehabilitation” (Applegate et al, 1997; 251-52).

            However, in concluding this discussion it is important to point out the criticism of certain evidence-based studies. Bonta and Andrews addressed this, summarizing that treatment programs that have been demonstrated to reduced recidivism in tightly controlled experiments, often find their effectiveness diminished when they are adopted by correctional agencies; the true potential effectiveness of treatment in the real world is about half compared to the experimental programs (Bonta et al, 2007; 15).

Conclusion

            The criminal justice system has seen a number of changes in its lifetime. It has struggled with the dichotomy of punishment versus treatment for decades. Over the last three decades, evidence-based research has shown the world that appropriate implantation of treatment and therapy programs can significantly reduce an offender’s likelihood of recidivism. However, this report has shown the reader that only certain treatment programs, when applied to the offender’s needs and risk level, are truly effective at reducing recidivism, particularly with offenders held in community custody. Based on the research that was collected, it is imperative that offenders receive treatment based upon the Risk-Need-Responsivity Model (RNR), to effectively establish how much treatment one would require and which criminogenic needs that should be addressed. If treatment is administered correctly, it seems that Moral Reconation Therapy (MRT) and Reasoning and Rehabilitation programs (R&R) have been shown to effectively reduce recidivism for offenders in a community environment. Furthermore, Vocational Education was not found to effectively reduce recidivism for community offenders (but this researcher believes the education may be beneficial and effective if coupled with either a MRT or R&R program.) Certain programs like Correctional Industry and Correctional Boot Camps were not found to significantly reduce recidivism (Boot camps were shown to be effective when coupled with MRT or R&R programs.) Because of the growing support for rehabilitation programs, and the cost-effectiveness they have as opposed to continued incarceration, it is more important than ever that correctional jurisdictions adapt more treatment programs for offenders in community custody; thus, benefiting their progression and reducing their chances of recidivism. Hopefully this report has shown the importance to adapt more treatment for offenders outside prison walls, in the hope that they can reform their behaviors and attitudes, and leave the prison bars behind.

References

Allen, Leana C., MacKenzie, Doris L., Hickman, Laura J. 2001. “The Effectiveness of      Cognitive Behavioral Treatment for Adult Offenders: A Methodological, Quality Based  Review.” International Journal of Offender Therapy and Comparative Criminology.        Vol. 45 No. 4 Aug, 2001. Pgs. 498-514. Sage Publications.

Andrews, D. A., Bonta, James. 2010. “The Psychology of Criminal Conduct” AP Anderson          Publishing. New Providence, NJ. 2010.

Andrews, D. A., Zinger, Ivan Et Al. 1990. “Does Correctional Treatment Work? A           Clinically Relevant and Psychologically Informed Meta-Analysis.” Criminology. Vol. 28     No. 3 Aug, 1990. Pgs. 369-97.

Applegate, Brandon K., Cullen, Francis T., Fisher, Bonnie S. 1997. “Public Support for     Correctional Treatment: the Continuing Appeal of the Rehabilitative Ideal.” The Prison       Journal. Vol. 77 No. 3 Sep, 1997. Pgs. 237-58. Sage Publications.

Bonta, James. Andrews, D. A. 2007. “Risk-Need-Responsivity Model for Offender          Assessment and Rehabilitation.” Public Safety Canada. Published by Her Majesty    the       Queen in Right of Canada, 2007.

Bouffard, Jeffery A., MacKenzie, Doris Layton., Hickman, Laura J. 2000. “Effectiveness of         Vocational Education and Employment Programs for Adult Offenders: A Methodology          Based Analysis of the Literature.” Journal of Offender Rehabilitation. Vol. 31 No. 1      2000. Pgs. 1-41. Hayworth Press.

           

MacKenzie, Doris Layton, Wilson, David B., Kider, Suzanne B. 2001. “Effects of            Correctional    Boot Camps on Offending.” American Academy of Political and Social Science. Vol.     578 Nov, 2001. Pgs. 126-43. Sage Publications.

Petersilia, Joan. 2003. “When Prisoners Come Home: Parole and Prisoner Reentry.” Oxford           University Press. Oxford, NY. 2003.

Washington State Dep. Of Corrections. 2011. “The Reengineering of Community  Supervision:    DOC Evidence Based Program Implementation.” Dec, 2011. Washington.

Washington State Dep. Of Corrections.2011. “The Changing Face of Corrections: Offender         Trends and Potential Impacts.” Nov, 2011. Washington.

The Cunt Remix (Final Paper)

Introduction

Before reading this, please be advised that the word cunt is used uncensored throughout this blog post. It is not intended to insult or offend anyone, but to serve as a subject for academic analysis and understanding.

Most individuals who have lived in western civilizations have usually heard the saying, “sticks and stones may break my bones, but words can never hurt me.” However, I believe author Manly Hall said it best when he stated, “Words are potent weapons for all causes, good or bad” (about.com). I have stated before that to me, words are simply a combination of letters with meaning attached to them; it is within this meaning that gives words the power to warm and protect or the power to burn and destroy. Generally within most societies are rules (whether written or unwritten) that inform individuals what words one should avoid saying at all costs. Western countries such as the United States for example also have words that individuals are discouraged to say; these words may be discouraged based on racial or prejudice attitudes and a history that the words may come with (i.e. fag, nigger, kike), or they may be words that have been simply deemed “curse” words (bad words) by society (i.e. shit, fuck, damn). In terms of these inappropriate words in Western society, there is one word that many individuals consider to be the most offensive “curse” word in the English language; this word, plainly and simply, is known as cunt.

In this final class-related post, I will be re-analyzing the word cunt, and how it is used in today’s Western culture to insult/demean a target population or group of individuals. In order to provide an accurate understanding of the word cunt and its usage, I will provide for the reader a historical investigation and overview of the word cunt, in order to both determine the word’s previous connotations and to compare them to their modern day connotations. Based upon this analysis, I will be able to predict who is more likely to use the word cunt, and determine the underlying social constructions that fuel the word’s use within society. Furthermore, this analysis I will examine how the words target population feels about the word cunt and if the word truly makes them feel like “victims,” or instead makes them feel liberated from average society.

A History of Cunt

Before we proceed down towards the early origins of the word cunt, it is necessary for the reader to have a basic understanding as to the modern day definition of cunt; that way, one can understand what changes (if any) have been made in terms of cunt’s connotations or meaning. According to the Merriam-Webster Dictionary, cunt is defined as an obscene reference to the female genital organs; it is also loosely defined as a disparaging and obscene term for a woman (Merriam-webster.com). As we can see (and what some of us may have already known), the word cunt seems to clearly have associations with females and their genitals; however, the definition also stated that it is often used as an insult toward woman. Keeping this in mind, we can proceed to examine the early origins of the word cunt and if its reference towards women is evident from the beginnings of its birth.

When looking at any words history, it is imperative to start with the etymology of the word itself. According to Matthew Hunt’s article, Cunt: the History of the C-Word he states, “the origins of 'cunt' can be traced back to the Proto-Indo-European 'cu', one of the oldest word-sounds in recorded language. 'Cu' is an expression quintessentially associated with femininity, and forms the basis of 'cow', 'queen', and 'cunt'. The c-word's second most significant influence is the Latin term 'cuneus', meaning 'wedge'. The Old Dutch 'kunte' provides the plosive final consonant” (matthewhunt.com, 2012). However, according to the Online Etymology Dictionary, the true etymology of the word cunt is a matter of debate.

The word cunt in its modern meaning is attested in the Middle English collection of sayings known as The Proverbs of Alfred, which was published some time before 1325. Within it, it gives the following advice, “Give your cunt wisely and make (your) demands after the wedding” Anderson, 1942). Since the early 13^th century, the word cunt has been used in its anatomical meaning (matthewhunt.com, 2012). However, at this period of time the word cunt was not a word that should not be spoken but was simply a word used as a synonym for female genitals. For example, in Geoffrey Chaucer’s 1390 tale The Canterbury Tales, the word cunt is used several times quite openly, without public outcry (matthewhunt.com, 2012).

However, starting around the year 1230, we start to see the beginnings of cunt’s turn towards stigmatization. According to the first appearance of the word cunt in the Oxford English Dictionary from 1972, cunt was associated with the street name

Gropecunt Lane

, a common street name in English towns and cities during the Middle Ages (matthewhunt.com, 2012). These lanes were generally used as the areas of prostitution, similar to Red Light Districts we know today (matthewhunt.com/2012). Ultimately, over the course of a few centuries the word cunt became something frowned upon.  For example, in Francis Grose’s 1785 book, A Classical Dictionary of The Vulgar Tongue, he defined the word as, “a nasty name for a nasty thing” (matthewhunt.com).

By the late 14^th and early 15^th century, the word cunt had become obscene. However, that did not stop many artists and/or writers from incorporating the ‘nasty name’ into their work. For example, William Shakespeare still used the word cunt in a number of his plays, including Hamlet, Henry V, and Twelfth Night (matthewhunt.com, 2012). However, because of the new nature of the word cunt, many writers’ books or poems were consequently considered controversial by the elites and ruling classes of society; such work includes James Joyce’s Ulysses, D.H. Lawrence’s Lady Chatterley’s Lover, Henry Millar’s Tropic of Cancer, and Ian McEwan’s Atonement (Wikipedia.org). Many of these books were banned in schools and certain shops for a number of years, and some schools continue to ban these books to this day.

Ultimately, it seems that the early origin of the word cunt also shares the same reference to female anatomy (specifically the female genitals) as the current definition of the word does. However, what this overview of cunt’s history has taught us is that cunt was not always considered a ‘curse’ word or a ‘nasty thing.’ Instead, it was considered simply what it was, a reference to a woman’s genitals. Thus, the question that should be addressed is why the essence of femininity suddenly became something so disgusting and taboo to individuals. This question will be addressed later in the discussion and conclusion, along with other aspects regarding the history of the word cunt.

The 21^st Century Cunt

As we have just learned, the word cunt has been used throughout history to identify a woman’s genital organs, and according to Merriam-Webster dictionary can now be used as a disparaging and obscene term for women. However, according to the Oxford English Dictionary the word cunt can also be used as a derogatory term which can refer to anyone. This usage of the word cunt is relatively recent, dating from the late 19^th century and defines an individual as an unpleasant or stupid person (Oxford English Dictionary).Today, the word cunt can be seen or heard through film, premium cable television, books, artwork, radio, comedy, music, theatre, and video games. However, the stigma behind the word remains, meaning that cunt is still considered by many to be an extremely offensive word.

I believe we are at the point where it is necessary to examine what has truly happened to the word cunt, in regards to its usage in today’s society. Essentially what has happened is that the word cunt has become a label. According to Howard S. Becker’s Labeling Theory, “social groups create deviance by making the rules whose infraction constitutes deviance, and by applying those rules to particular people and labeling them as outsiders. From this point of view, deviance is not a quality of the act the person commits, but rather a consequence of the application by others of rules and sanctions to an ‘offender.’ The deviant is one to whom that label has successfully been applied (Becker, 1963). As the definition clearly states, the word cunt is more often than not used as an insult towards women. Thus, we can positively state that women are the target population in regards to cunt’s stigmatization within Western Society. However, do all women find the word cunt offensive? Or do some women think the word cunt is something that should be taken back and liberated?

Cunt: a Word Divided

To borrow from the questions stated above, it is essential to ask, do women have different views on the word cunt? To answer this question as frankly as possible, yes, yes they do. Among women (the target population that is most often stigmatized by the word cunt), one finds that they are often divided into two or three camps. There are women who find the word cunt utterly offensive, there are women who don’t mind the word so much (who may or may not choose to use it), and there are women who fight to liberate the word cunt; to try and take it back, so it can symbolize the power and independence of women. All three of these groups write, report, blog and broadcast their opinions on cunt, and each group will be briefly discussed throughout this section.

According to Hank Johnston’s article Social Movements and Culture, he writes that certain feminists in the 1970s had sought to eliminate disparaging terms for women such as bitch, slut, and cunt (Johnston, 1995). Furthermore, in Dany Lacombe’s article Blue Politics: Pornography and the Law in the Age of Feminism, he states that within the context of pornography, feminist activist and author Catharine MacKinnon argued that use of the word cunt reinforces the dehumanization of women by reducing them to mere body parts; and in 1979 feminist and author Andrea Dworkin described the word cunt as reducing a women to “the one essential, cunt: our essence, our offence” (Lacombe, 1994). In 21^st century America, there are still a number of women that find the word cunt offensive; these articles, Unacceptable, The C-Word, are just a quick example of some of the negative viewpoints regarding the word cunt.

Perhaps it does not come as much of a surprise, but most women are neither overly headstrong about abolishing the word cunt, nor are they headstrong about fighting for its liberation. Instead, many women either find the word offensive or do not. In fact there are many blogs and articles such as, Debates on the C-Word, Why the C-Word is Losing Its Bite, Girl vs. Guy: the C-Word, that show the difference of opinion amongst everyday women within Western civilization.

However, there is a group of women who are fighting to reclaim the word cunt, not just fight to make the word acceptable within society, but honorific, similarly to how the LGBT groups have fought to reclaim and liberate the word queer (Langborgh, 2007). An example of this want for liberation can be seen in Inga Muscio’s book, Cunt: A Declaration of Independence. Throughout the book she examines the word cunt along with the meaning of the word vagina, explaining that cunt is a powerful and liberating word that refers to the whole ‘package of womanhood’; as opposed to the vagina, which is only a specific part of the female genitalia (Muscio, 1998). Other advocates and feminists that have fought to reclaim the word cunt are Germaine Greer and Eve Ensler from The Vagina Monologues (Wikipedia.org). There are a number of women around the globe fighting to reclaim the word cunt; articles such as, Why is the Word "Cunt" Such a Big Deal?, Reclaiming the C-Word, The Feminist Mistake, prove that there is a true debate among women about the word cunt, and whether it should be better off forgotten, or taken back as a word to be proud of.

Discussion and Conclusion

Living in a 21^st century society, one should ask his or herself, what does it mean to be a cunt? Why would someone be called a cunt?  And if an individual is called a cunt, who would be more likely to use the word against another? Going back to the previous definitions presented above for the word cunt, one finds that a cunt is defined as a female’s genitals, an obscene term towards women, and/or someone who irritates or annoys you. Based on these definitions, along with the research, we can reinforce the hypothesis presented earlier that women are indeed the ones generally targeted and stigmatized by the word cunt.

Being that women are more often the target population of the word cunt, one would imagine that the individuals more likely to use the word cunt in a negative or stigmatizing manner would be males. If one takes this hypothesis of males being the more likely offenders to use the word against females, then the question that lingers is what is the underlying reason for labeling women as cunts? Perhaps the reason is based on what feminist Catharine MacKinnon argued about previously in the blog, that the word cunt labels women as nothing more than a set of sexual organs. If one observes women’s place within Western society, one finds evidence to suggest that women are in fact de-valued within society, potentially to the extent where a female would be considered (by men) to be nothing more than a set of sex organs. Over the years, the United States has been far from the best in terms of gender equality. However in 2010, the United States finally took its highest place ever in terms of how it ranks to other countries regarding sexual equality; which place did it take, 19^th (DiBranco, 2010).

Within the first few days of the Social Deviance class, the students filled in what they believed society sees in terms of an ideal woman; some of the personality traits or requirements included being submissive to men and a woman who is seen in a lesser light than her male counterpart (Deviance Discussion, 2012). Furthermore, we see the inequality of males and females in terms of their gender roles regarding sex or sexual exploration. In Jennifer L. Dunn’s article “Everyone Knows Who the Sluts are”: How Young Women Get Around the Stigma, she explains that women who engage in sexual conquests or encounters “too often” are labeled “sluts” by both males and females (Dunn, 2010). However, men who engage in multiple sexual encounters are often commended by other males in society. Ultimately, Western society seems to have a long, rich history of stigmatizing women while rewarding/idling men; which is considered worse, calling someone a cock, or calling someone a cunt?

I won’t lie, I have enjoyed using the word cunt many times throughout the past few years of my life; I often use the term cunt to describe someone I think is a dumb or stupid individual, however I admit that I have used it to describe women I know that I dislike to the very core of my being. For those males who have shared similar experiences to mine, it may be easy for us to look at the history and current debate about the word cunt and say, “It’s not my problem, I never really use it that much, and when I do I don’t use it against females.” In Allan Johnson’s Privilege, Power, Difference, and Us he discusses the danger of individualism, the idea that everything is somebody else’s fault. For example, if you subscribe to the belief that all men are sexist, or that “well I’m not sexist, it’s those other guys,” then the issue regarding the word cunt and its relationship to sexism and inequality will never be addressed or resolved (Johnson).

Finally, in order to understand the importance of certain words and how they fit into ones society, one should ask why words we find incredibly offensive continue to exist in the first place. In Howard Becker’s article, Outsiders: Defining Deviance, he explains that outsiders are those that fail to meet or follow a specified rule created by ones society, or ones who end up breaking a rule when they were previously individuals who enforced it (Becker, 1963). The irony of this is that we punish individuals who use the word cunt, as well as punishing women for continuing to keep the word cunt around at all! Ultimately, this post is not designed to limit ones speech or to tell individuals that you’re a bad person if you use the word cunt. However, this post has hopefully shed some insight to the reader about the ramifications and ripple effects that ones words have in this world. Whether an individual realizes it or not, using the word cunt reinforces the idea that it is somehow shameful to be born with a vagina, or to be born or identify as a woman. If Western society truly wants to stand for the land of freedom and equality that it preaches, then it must release the shackles and stigmas it places on women, and allow them to be seen as the equal individuals that they are.

Remember what author Manly Hall said, “Words are potent weapons for all causes, good or bad”. Today I pledge to take the word cunt, and use it as a weapon for good, for equality, for womanhood. What will you use it for?

Word Count: ~ 2,900 words

http://www.matthewhunt.com/cunt/

http://www.etymonline.com/index.php?term=cunt

http://classiclit.about.com/od/basicsliteratureintro/a/aa_words_2.htm

http://www.merriam-webster.com/dictionary/cunt

http://en.wikipedia.org/wiki/Cunt

http://web.archive.org/web/20070928085802/http://www.academia.org/campus_reports/2000/december_2000_1.html

http://www.ingalagringa.com/cunt/

http://news.change.org/stories/united-states-ranked-19th-in-gender-equality

Johnston, Hank; Bert Klandermans (1995). Social Movements and Culture. Routledge
Obtained through Wikipedia.org

Lacombe, Dany (1994). Blue Politics: Pornography and the Law in the Age of Feminism. Toronto: University of Toronto Press. p. 27 Obtained through Wikipedia.org

Anderson, O.S. The Proverbs of Alfred, 1: A study of the texts. Lund and London, 1942. Obtained through Wikipedia.org/cunt

Becker, Howard. 1963. “Outsiders-Defining Deviance.” Taken from online readings as well as from Readings in Deviant Behavior pg. 39

Dunn, Jennifer L. 2010. “Everyone Knows Who the Sluts are: How Young Women Get Around the Stigma.” Readings in Deviant Behavior. 2010.

Johnson, Allen. “Privilege, Power, Difference, and Us.” Privilege: a Reader. Taken from online readings.

Videos provided by Youtube.com
Photo by John Consiglio

Live Nude Girls Unite! Film Review

Live Nude Girls Unite! Film Review

The main thesis of this film, Live Nude Girls Unite!, is that individuals who work in the sex industry face many problems in their everyday work environment. This is due to the struggles these workers have to go through in order to gain some of the rights that other individuals in society receive automatically. These rights include health insurance and sick days, as well as safety precautions like two way glass and employee/customer interaction. The film follows the female workers at The Lusty Lady Strip Club in San Francisco, California as they unionize to achieve these rights from the owners, who seem to see their employees as money-makers, and not the PEOPLE they are. Overall, the films thesis is also the fact that these sex workers are just individuals like you and me, trying to make ends meet.

The main arguments that were made in support of this thesis came usually from the females who were working for (and later striking) The Lusty Lady. They contested that these rights they were fighting so hard for were generally handed to others in other industries such as health insurance or sick days. Also, they have to protest to stop certain practices that would not stand up in any other work place such as race inequality and discrimination (such as women’s breast size and hair color.)

This film relates to this course in a number of ways including gender issues and class inequality. Most evident however, is how sex workers are treated in society. In Jennifer K. Wesely’s Exotic Dancers: “Where Am I Going To Stop?”, she states that “It is natural, then, for exotic dancers to experience an identity conflict, feeling that their new identity as a deviant is assaulting their long-held identify as a conventional person.” Society tends to stigmatize sex workers as something less than human, therefore, the inequality they face isn’t really our concern. In Margo DeMello’s Humanizing Sex Workers?, she creates ads to help individuals in society recognize that individuals who work in the sex industry are real people, our mothers, daughters, and sisters. The film also touches upon the conflicts regarding capitalism, with the women fighting for rights from their owners.

The arguments/ points I found the most convincing revolved around the capitalistic conflicts that arose. As the women faced discrimination and conflicts at work, their bosses took away more rights and fired people to keep others in line. It reminds me of the 99% struggling and protesting against the 1%. They just want some equality and protection. Also (while not surprising) I was happy to see how well spoken and articulate many of “these” people are. Who would have thought these “strippers” or “sluts” had points on women’s rights, freedoms, and the fight for better rights in the workplace. There was nothing about this film I did not like, overall Live Nude Girls Unite! was my favorite film we watched in class…no not cause of that!!!! I hope every woman or man in the sex industry gets the rights and privilege they are entitled to.

Word Count: 509

Hypochondriasis: the Illness of not having an Illness

Introduction

Picture By Brian Cronin for TIME

Two weeks ago during spring break, I thought for sure I was dying. It started with a simple chest pain, which gradually became worse as the days rolled on. Like many other average Americans, when faced with the threat of illness or disease, I turn to the internet for the “answers.” What I found (and diagnosed myself with) was Costochondritis, an inflammation of the junctions where the upper ribs join with the cartilage that holds them to the breastbone or sternum (emedicinehealth.com). I felt a little better knowing that Costochondritis goes away on its own, and that I had cracked the case on what was affecting me for the last three days.

On day four came the heart palpitations which stayed with me morning until night, and the realization that when I laid on the left side of my body,  my heart felt like it was going to explode out of my chest. Frantic and distressed, I rushed back to my computer see what these new symptoms might mean for me. And sure enough, after researching for twenty minutes on WebMD, I had found the REAL diagnosis to what was wrong with me, I have Coronary Heart Disease!

You might be asking yourself right now if this story has a point. Here it is, four days later all my symptoms had subsided into nothingness and I felt like my average self again. I never went to the doctor once during this event, and my diagnoses (real or not) had been determined based on a few lines of text. In the end, my friends and loved ones decided to diagnose me with Hypochondriasis a.k.a. Hypochondria.   While I know that I am NOT a hypochondriac, I don’t really know much about it. In this blog post, I will provide research and social analysis of Hypochondriasis, including a brief history of the illness, the attitudes and behaviors that label hypochondriacs as deviant (if any), who gains or loses from a diagnosis, both sides of the public perceptions of hypochondria, and finally the social constructions behind it.

History Review of Hypochondriasis

Before Hypochondriasis was camped in with mental illnesses or disorders, its roots could be found within the physical aspects of the body.  Originally, the word hypochondriac or hypochondria comes from the word Hypochondrium, the upper part of the abdomen dorsal to the lowest ribs of the thorax; this word derives from the Greek term hupochondros, meaning abdomen, or literally under cartilage (Avia & Ruiz, 2005). The use of Hypochondriasis to state a feeling of disease without evidence or cause reflects an ancient Greek belief that the internal organs of the hypochondrium was the seat of melancholy and the source of vapors that caused morbid feelings (Avia & Ruiz, 2005).

Research about the history of Hypochondriasis is scarce, but up until the seventeenth century, it was considered a physical condition (Noyes Jr., 2011). Over the next 150 years, the disorder was transformed from an affliction of abdominal organs to a disorder in the nervous system and brain, until it was finally considered a disorder of the mind (Noyes Jr., 2011). Two factors supposedly contributed to this change. One was a shift based on emerging medical knowledge, meaning illnesses that once involved the whole person were now diagnosed and targeted based upon the bodily organs. Because of this, Hypochondriasis became an illness without somatic (bodily) disease (Noyes Jr., 2011).  The other factor was the change in the disorder’s social significance. During the period of Enlightenment (time of reason and science) Hypochondriasis became on one hand, a distinction which conveyed ones class status; someone who was knowledgeable or well learned. On the other hand, Hypochondriasis was of social disapproval, considered something born out of ones own paranoia of disease or illness (Noyes Jr., 2011).

A Diagnosis of Hypochondriasis

Currently, the Diagnostic and Statistical Manuel of Mental Disorders (DSM-IV) states the following for Hypochondriasis:

“In Hypochondriasis patients come to believe, or at least to very strongly suspect, that they are sick with a serious, perhaps life-threatening disease. Minor symptoms or anomalies support and augment their concern. A muscle ache or perhaps an accidental bruise indicates the dreaded diagnosis. Their concerns persist despite the reassurances of their physicians. The preoccupation with illness may become all-consuming; some patients become invalids, bed-bound not by their symptoms, but by their fear of having a disabling illness. Hypochondriasis has a lifetime prevalence somewhere between 1 and 5%, and appears to be equally common in males and females” (Brown.edu).

In terms of ones process of medicalization, hypochondriacs generally visit doctors multiple times complaining of illnesses or ailments. During this time, a doctor may advise an individual that they should seek a mental health professional for a diagnosis of Hypochondriasis or some type of anxiety disorder.  Hypochondriasis may begin anywhere from adolescence to middle ages. The peak age of onset is generally in the twenties and thirties. There are no specific reasons why someone may suffer from Hypochondriasis, although some factors have been shown to have correlation with being diagnosed; witnessing someone else suffer or die of a disease seems at times to trigger Hypochondriasis, and in some cases a serious illness in the patient’s own life may act as a catalyst (Brown.edu). The most common treatment for Hypochondriasis is cognitive behavioral therapy, where patients are trained to focus their attention away from the symptoms (Brown.edu).

Hypochondriasis in Society

While the history and current diagnosis of Hypochondriasis is important, the main area of discussion revolves around the social implications, limitations, and emotions regarding this illness. Within this section I will provide a brief overview of both sides of the argument in regards to the legitimacy and social constructions of Hypochondria.

If you are diagnosed or perceived to suffer from Hypochondriasis, there are a number of things to expect when living and dealing with this condition. For starters, be prepared to be ridiculed, or seen as deviant by society in general. Many individuals living with Hypochondriasis discuss the difficulties of dealing with the illness, along with trying to carry on with their normal lives and be seen as normal. Often, our imaginations take us to the far end of the spectrum, and we find ourselves thinking that hypochondriacs are individuals walking around with surgical masks on, a pair of latex gloves, and are constantly wishing to be sick. This Scrubs clip below (while funny) is an example of how some people may view hypochondria in their minds:

In fact, we as a society generally want to do anything BUT take responsibility and care for these individuals, specifically, because we believe that they do not need to be cared for in the first place. Some health care providers will cover treatment programs for individuals (the exact number or percentage I could not nail down.) Perhaps most surprising, is that many doctors and medical professionals also have a somewhat hostile attitude towards individuals with Hypochondriasis. An article in TIME Magazine titled How to Heal a Hypochondriac stated, “Most physicians tend to think of hypochondriacs as nuisances – patients they are just as happy to lose” (TIME, 2003). The stigma that follows individuals living with Hypochondriasis is similar to the stigmas people have about other mental illnesses such as depression and anxiety disorders. Despite Deeper Understanding Of Mental Illness, Stigma Lingers

As stated previously, many individuals with Hypochondriasis are involved in the conversation. They have created blogs and youtube videos in an attempt to tell their stories, and to help others who have been diagnose to cope and live normal lives. The Happy Hypochondriac, Hypochondriac's Relief Blog, Random Confessions of a Former Self-Proclaimed Hypochondriac

A case has been made, not against Hypochondriasis, but against the individuals who often are diagnosed (or self-diagnosed) as hypochondriacs. Part of this case revolves around the cost that comes with this illness. The same TIME magazine article states, “Hypochondriacs don't harm just themselves; they clog the whole health-care system. Although they account for only about 6% of the patients who visit doctors every year, they tend to burden their physicians with frequent visits that take up inordinate amounts of time. According to one estimate, hypochondria racks up some $20 billion in wasted medical resources in the U.S. alone” (TIME, 2003). The other area people can be unsympathetic is with (stated previously) the over-diagnoses or self diagnosis of Hypochondriasis. The following clip is of comedian Dennis Miller giving a rant about Hypochondria. While viewing it, try and count the number of sympathetic comments Miller makes, against the number of insults or jokes that poke fun at a hypochondriac’s condition:

Discussion and Conclusion

In society, we tend to carry two different attitudes when we think about disease and illness. When it comes to somatic diseases or illnesses, we are often sympathetic towards the individual, and sometimes we put forth an extra effort to include them in all areas of society. On the other hand, individuals who suffer from mental issues such as anxiety disorders, depression, and Hypochondriasis, are not always met with the same love or compassion. In fact, they are often seen as deviant, and often labeled as simply “crazy.”

Yet, the evidence is clear that these are in fact real illness, and many individuals truly do suffer with such illnesses. So what is it about our culture that makes individuals with Hypochondriasis seem deviant? Is there an over-diagnosis of hypochondria? Are more people truly self-diagnosing themselves? And if this is so, is it there fault, or someone else’s?

When we look at the Scrubs clip from above, we see how hypochondriacs are represented in the media. They are seen as people who want to be sick, hope they are sick, and are nothing more than a waste of a doctor’s time and a waste of a hospital bed. Because of these media depictions, when we encounter a hypochondriac in the real world, we can be quick to think that they are crazy and label them as deviant minded individuals. We must remember that if someone is diagnosed with Hypochondriasis, then their illness should be viewed as the same as someone diagnosed with depression or autism.

That being said, do I believe that individuals self-diagnose themselves, you bet I do. Do I think that individuals are being diagnosed with Hypochondriasis at a growing rate, absolutely. Do I think that individuals are specifically the ones to blame for this, no. I believe that this growing number of self-diagnoses and paranoia can be linked to two things, the internet and pharmaceutical companies.

The internet has given people the miracle of knowledge, providing us with an almost limitless amount of information at a rate we have never experienced in history. However, it has also opened up the door for individuals who are worried that their cough is the first sign of the lung cancer growing inside of them. ““They go on the Web,” says Dr. Arthur Barsky, a psychiatrist at Harvard Medical School and Brigham and Women's Hospital in Boston, “and learn about new diseases and new presentations of old diseases that they never even knew about before.” Doctors have taken to calling this phenomenon cyberchondria” (TIME, 2003). This new wave of information has caused an uproar of over-diagnoses and self-diagnosis in a number of mental health illness; The Autism Information Epidemic 

discusses a number of the same issues in its article.

Because media has such a direct affect on our lives, it is no surprise that pharmaceutical companies have taken a very strong interest in it. Every day we are bombarded with commercials, posters, and other advertisements that sell a very simple, very effective message: if you have these symptoms, you NEED this pill. In We're All Mad Here: Pharmaceutical Advertising and Messaging About Mental Illness 

we see how companies will shell out over a billion dollars, to advertise their products to you, and get you to think that there is something wrong with you that needs to be fixed or corrected. It is no surprise that when all is said and done, most doctors recommend cognitive therapy as the best medicine for dealing with Hypochondriasis.

I’m sure throughout the course of our lives we have truly thought we had a bad virus or disease, when really we had a pulled muscle or the flu. To be scared is to be human. But Hypochondriasis is a real illness, it affects people on a daily basis. What is important to remember is that the person who can best answer your medical questions is not WebMD, or the Prozac commercial, or even yourself. The best person who can diagnose you is a doctor or medical professional. If you are overly concerned about your medical condition, schedule an appointment or call a toll free nurses hotline. If you think you suffer from Hypochondriasis, schedule an appointment with a mental health professional, because if you truly think your sick, you can take the steps towards getting better.

Word Count: 2,111

http://www.brown.edu/Courses/BI_278/Other/Clerkship/Didactics/Readings/Hypochondriasis.pdf

http://www.time.com/time/magazine/article/0,9171,490690,00.html

http://shm.oxfordjournals.org/content/24/2/281.abstract

http://en.wikipedia.org/wiki/Hypochondriasis

http://www.emedicinehealth.com/costochondritis/article_em.htm