The Management of Elderly Prisoners in France

Introduction

In the past 20 years, France, like many other countries, has experienced a very significant rise in the number of elderly prison inmates (Carcach & Grant, 2000; Crawley & Sparks, 2005; Landreville, 2001; Mara, 2002). On January 1, 2017, there were 78,796 prisoners in France, of whom only 3.5% were women (n = 2,825) (Direction de l’Administration Pénitentiaire, 2017). The incarcerated population over 50 years of age, currently accounting for 11.5% (n = 9,058) of the prison population, has increased considerably in the last 15 years. This increase is generally explained by longer sentences, tougher legislation, and the greater number of criminal acts sentences for people aged 50 and over, notably sexual offenses (Laurens & Pedron, 2007).

In the prison environment, an inmate is considered elderly at 50 years of age (Grant, 1999), a difference of 10 years compared with the general population (Dawes, 2009; Fazel, Hope, T., O’Donnell, I., & Jacoby, 2001). This premature aging can be attributed to their high-risk behaviors (Aday, 2003), high frequency of health problems (Fazel et al., 2001; Hayes, Burns, Turnbull, & Shaw, 2012; Watson, Stimpson, & Hostick, 2004), the lack of pre-prison medical care (Birmingham, 2004), and social isolation (Crawley, 2004; Dawes, 2009).

Few studies have examined the mental health of elderly prisoners. However, the prevalence of mental disorders is known to be particularly high in the prison population, at all ages, compared with the general population. According to international research, 40% to 70% of prisoners suffer from mental disorders (Fazel & Baillargeon, 2011; Piselli et al., 2015; Prieto & Faure, 2004). Dressing, Kief, and Salize (2009) estimate the prevalence of mental disorders in prisons is to be between 27% and 78%. Similarly, studies have found that 20% to 40% of prisoners have cognitive deficits (Stewart, Wilton, & Sapers, 2015; Williams et al., 2009).

In France, recent investigations have found that the prevalence of psychopathological disorders in a sample of elderly inmates aged 50 and over (n = 138) was particularly high, being close to 70%. Furthermore, a very large majority of these incarcerated elderly (89%) showed cognitive deficit, and nearly 20% presented with severe cognitive impairment (Combalbert, Ferrand, Pennequin, Keita, & Geffray, 2017; Combalbert et al., 2016).

The overrepresentation of mental and cognitive disorders among elderly prisoners highlights the extreme emotional vulnerability of this population. It is highly probable that a non-negligible proportion of them had a loss of autonomy. At the ethical level, this raises the question of their specific needs, as well as whether inmates should be kept in detention when they suffer from syndromes of dementia or pre-dementia. In fact, it is possible that the most cognitively impaired prisoners are no longer able to understand criminal sanctions and no longer represent a threat to society. Fazel, Hayes, Bartellas, Clerici, and Trestman (2016) have shown that the mental health needs of older adults in prison are specific and that few high-quality treatment trials have been conducted on prisoner psychiatric disorders.

Likewise, it seems important to evaluate the difficulties created by these mental disorders related to the management of elderly inmates. Given the particular nature of prison structure and organization, it is likely that elderly inmates create a number of problems for prison staff. The first issue concerns the compatibility of their physical and cognitive state under detention. Next, it is possible that prison staff’s ethical and professional guidelines are affected by the presence of these elderly incarcerees who may have a loss of autonomy. While the purpose of the prison sentence is to punish and neutralize an individual seen as an enemy of the social contract and a threat to public safety for transgressing the social order (Beccaria, 1764/1991; Carbasse, 2000; Pirès, 1998; Poncela, 1983 Rousseau, 1762/1993), it is likely that elderly inmates who are physically and/or mentally vulnerable are no longer an enemy or a threat, and thus no longer warrant a prison sentence.

This discrepancy at a political and philosophical level is liable to lead to practical and functional problems. At a structural level, detention set up to neutralize an enemy (Chauvenet, Orlic, Rostaing, & Monceau, 2008) is not designed or organized for aging and vulnerable individuals. We can assume that this obliges the prison staff to find ways of mitigating inadequate and inappropriate structural and organizational systems. At a practical and ethical level, the staff’s points of reference may become distorted because the vulnerability of these individuals weakens the foundations of the legitimacy of practices based on sanctioning a transgression. Furthermore, it is no longer a question of protecting the public from an enemy or the threat that he represents (Foucault, 1994), but of caring for an individual who possibly has already been neutralized by age and its associated losses. At this level, social workers, probation officers (CPIP), and prison officers are all caught between a repressive security organization (Chauvenet, 2010) and an atypical group.

In view of these difficulties and discrepancies, it would be interesting to examine how professional practices and approaches change when traditional reference points are blurred by having to manage a population, which, by its very nature, calls into question the foundations of the prison system and staff work roles. However, to analyze and understand the management of elderly prisoners, the practices need to be identified and examined in context. This involves taking into account the bases of prison staff’s jobs and their interrelationships, notably when these are paradoxical, as well as the underlying principles that govern staff relationships with inmates in general and with elderly inmates in particular. In the light of these observations, our research focused primarily on identifying how prison workers perceive elderly inmates and the difficulties that they encounter in their professional work.

Method

This research was approved by the National Prison Administration (Direction de l’Administration Pénitentiaire—Bureau des études et de la prospective-PMJ5) and supported by the French Ministry of Justice (Law and Justice Research Mission).

Results

The comments of the prison staff indicate that the way elderly inmates are perceived and treated depends on the functions of the sentence and the prison rather than on specificities linked to aging and its associated impairments.

For example,

If you start to look at who occupies the cell, you’ll never cope. As far as I’m concerned, they’re all there for the same reason, there’s no need to know what it is. Whether they’re young or old (. . .), if you start to feel sorry for them, it’s no good. (Warder 13)

Consequently, the staff match the elderly inmate with one of the four traditional images of the prisoner. However, due to the eclecticism of the sentence, these images do not fit logically because they are opposites (enemy vs. citizen; threat vs. user) and also because they differ in form (legal-political / biopolitical). This fundamental paradox obliges the staff to shift from one image to another, and to do so, to reject one to accept the other. Thus, the staff will reject the images of enemy and threat on account of the vulnerabilities of the elderly inmate, but for the same reasons, they will assign him back into the same categories. The probation officers and warders highlighted the incompatibility between the elderly inmate and the image of the enemy. They expressed a real difficulty in matching the repressive nature of the sentence with the vulnerability of the elderly inmate. Moreover, they questioned the purpose of the sentence and even the legitimacy of certain actions. Keeping the person in prison can also appear to be unjustified because the retributive purpose of the sentence can no longer work with a prisoner who has nothing left to give:

A person under legal incapacity who I was in charge of. I wondered how it was possible for a person in that condition to be locked up. I went to see his cell to see what it was like. His wheelchair didn’t really fit in his cell (. . .). He didn’t have a suitable bed. He was constantly falling over. It was bad. (Probation Officer 2)

Similarly, the staff disconnected the elderly inmate from the image of a threat, in that he no longer shows the power to threaten the mental or physical well-being of potential victims. In a detention system organized to neutralize the threat, the staff see him more as a victim of the other inmates. Nevertheless, at the same time as the discrepancy with these images becomes evident, a reverse situation occurs. The staff describe how, on account of his vulnerabilities, the elderly inmate can be used by the others as a “mule,” playing on the compassion that he inspires to smuggle in dangerous and illegal items and substances. Re-applying the image of threat even involves a form of essentialization, whereby all inmates, whatever their age and condition, are potential threats and have an unending power of transgression and subversion: “All the prisoners, whatever their pathology, are dangerous” (Warder 4).

By contrast, a priori, there is no such distortion between elderly inmates and the figures of citizen and user. The staff described them as citizens serving their sentence in exemplary fashion, or as quintessential users, because they are the beneficiaries of services directly aimed at ensuring their safety or health. However, just when the elderly inmate seems to match these categories with no problem, inherent tensions prevent this reassuring match. For example, the perfect fit with citizenship is completely distorted when the staff consider the purpose of the sentence from the perspective of its length. Indeed, the prospect of a return to social life, which is comprised in the purpose of the sentence, is limited for an aging person, and even more for one who is bedridden, to the extent that, from this standpoint, the sentence itself is no longer justified:

After so many years . . . I saw a prisoner with terminal cancer (. . .). He died in hospital. Is it really useful to keep people like that in prison? In my opinion, it isn’t. And even, after so many years . . . is it still useful? (Warder 1)

Moreover, the image of the user as someone using a public service, in other words, who has a right to the service, does not fit easily with the lack or unsuitability of the available means:

In some way, we feel helpless. What can we offer him? There isn’t a magic wand. There’s a box of tools for normal cases, but for the old (. . .) (Probation Officer 1)

It even throws uncomfortable light on staff interventions:

It’s a problem of conscience too, of personal conscience, yes, it’s hard (. . .) because when you see an elderly person fading away day by day, you realize (. . .) what can I say, I just do what I can . . . (Warder 8)

Discussion

The prison workers showed highly ambivalent attitudes to the age-related vulnerabilities of prisoners at both emotional and professional levels. We could expect that their perception of these prisoners would be distorted, in that they do not fit into the traditional categories of enemy and threat. Indeed, we can assume that the elderly inmate has often already been neutralized by the vulnerabilities and fragility related to aging and has none of the characteristics of an enemy or threat. And yet, the prison staff continue to include them in these categories. More precisely, the system itself forces them into these categories. Likewise, we could expect that these elderly prisoners would correspond more to the figures of citizen and user, the latter because they require not only health services but also services to ensure their safety on account of their vulnerability, and the former because, as citizens, they are expected to serve their sentence quietly and be accountable for their acts. However, the prison system excludes them from the categories of citizen and user, although these would actually be more relevant and less problematic.

The presence of elderly, aging, and/or fragile prisoners highlights the problems faced by prison staff caused by the eclecticism of references, ideas, and aims on which their jobs are based and defined. Through elderly inmates’ own vulnerabilities and the vulnerability that they expose in the system, they perfectly reflect the complex and paradoxical system of the figures of the prisoner on one hand and the functions of the staff on the other. The elderly inmate does not fit seamlessly into prison, its structure, and functioning, but, on the contrary, he comes into collision with its limits. Likewise, he does not establish a normal relationship with the staff but reveals the limitations of the practices and management tools used, calling into question the role of the prison workers. Consequently, he highlights the need for adjustments not only at the organizational level but also at the practical and ethical levels. Our results show that the management of these prisoners relies on a form of ground-level inventiveness that bypasses the rules (e.g., not carrying out the regulatory body-search of an elderly prisoner on dialysis) and structure (e.g., reorganizing a wing or floor for vulnerable prisoners), but cannot be based on or conform to the normal, everyday functioning of prison life. The prison workers have difficulty finding satisfactory solutions, because these can only be partial; in other words, they only meet part of the problems posed by advanced age in detention. Moreover, the limitation of the possible solutions that are proposed stems from the dynamics of the figures of the prisoner and the impossibility of having recourse to a single figure. As a citizen and/or user, the prisoner is entitled to treatment in accordance with current public policy; however, the figures of enemy and/or threat are maintained to justify keeping him in detention and his exclusion from the normal care system. The elderly prisoner is thus managed on the same principles and with the same intention as any other younger prisoner. Nevertheless, the paradox at the heart of this principle is further exacerbated by his extreme vulnerability, which undoubtedly adds to the difficulty of the staff to shift from one figure to another. The elderly prisoner, more than other inmates, differs in nature from certain figures, and trying to make him fit into this system undoubtedly requires considerable effort on the part of the staff, making them aware of the inherent contradictions in their professional standards and functions:

These inmates, old or less old, if they’re here, it’s because they’ve done something that brought them here, but then . . . (Officer 5).

Likewise, trying to make the elderly prisoner conform to the traditional figures may lead the prison staff to use emotional defense mechanisms. For example, having to cope with vulnerability, advanced age, and the sick, damaged or dying bodies of these individuals can be particularly hard psychologically:

It’s not my job to see someone vomiting all day (. . .). It’s someone who was naked—I don’t think being in detention respects human dignity. And yet I’m one of those people who are very security conscious, who don’t forgive easily, who want the prisoners to go straight (. . .), but in this case, no, I don’t see the use of detention. (Warder 6)

He’s an old person, we’ve got grandparents (. . .), you have to realize that it’s detention and that he’s just a prisoner. (Warder 4)

When I saw that prisoner, who died, I couldn’t sleep, not because he died, it’s not the first time I saw a prisoner die, but it’s the first time that I did a CPR (cardiopulmonary resuscitation) for real (. . .). I broke one of the prisoner’s ribs. You touch his skin, it’s traumatic, it’s really traumatic. (Warder 8)

Consequently, this confrontation requires greater effort by the staff to bring their reactions and position into line with the affective rules of the prison, which notably involve suppressing their feelings:

I can’t cope with it at all. I didn’t take the prison officer exams to look after old people. (. . .) I don’t have any scruples about it (. . .). We’re not here to look after people who are incontinent and things like that either. In my view, they shouldn’t be here. (Warder 2)

He was old and nasty, he might have been senile, but he knew what he was doing some of the time. (Warder 7)

You don’t ask that sort of question much, apparently if the courts decide to sentence them, if a 75-year-old is given a 15 year sentence because he committed a rape or something. You know that the end of life is near. (Warder 3)

Rationalization is thus a habitual way for the staff to protect themselves and to ensure that certain actions that could pose ethical or moral problems become acceptable. Rationalization is an unconscious defense mechanism through which irrational behavior or feelings are made to appear reasonable. This defense mechanism, by which one justifies attitudes and behavior that would otherwise be unacceptable, is often used to preserve self-respect, reduce guilt feelings, or obtain social approval or acceptance. For example, considering the elderly prisoner as an enemy or a threat justifies imprisonment and using certain security gestures, even if the prisoner is weak and thus more vulnerable than dangerous:

In spite of his age and physical problems, amputated legs, cancer, diabetes, multiple pathologies in short, he can still have phantasms and be a danger to others. (Probation Officer 1)

Society has to protect itself (. . .) even if his health is poor, he still has moments when he’s OK, and then he always commits an offence, I can understand that society doesn’t want to leave him outside . . . (Warder 8)

Conclusion

The prison workers avoid any disorganization of their bearings by applying a strategy that places the elderly prisoner within traditional categories. This strategy, far from arising from the personal disposition of the prison worker, is, in fact, determined by the prison system and its rationale. In a certain way, this rationale neutralizes the specificities of the elderly prisoner, in other words, his disorders and weaknesses. However, the strength of our study is that it shows the inflexibility of this system, in that none of the prison workers can avoid identifying elderly inmates in accordance with the traditional figure of the prisoner. At the same time, they are aware of their fragility, for two underlying reasons: first, on account of their undeniable specific needs, and second, by being treated in the same way, elderly prisoners may become victims of other inmates, or even abused, through lack of appropriate management. At this level, the psychological effects on the prison workers themselves should not be minimized, due to their sense of powerlessness to provide appropriate care for these suffering individuals. The massive defense systems based on rationalization used by prison workers to overcome their feelings or avoid ethical conflicts can also become fixed through constant use in a structure that has difficulty reforming its organization.