Abstract
Although the research for this book occurred prior to the global pandemic, Armando Lara-Milan's fascinating Redistributing the Poor arrives at a most opportune time. Examining both the world's largest jail and a large urban public emergency room in Los Angeles, California, this book puts into rich empirical perspective the enormous challenges the USA confronts at a time when an already austere carceral state has plunged deeper into crisis. For scholars of punishment and social control, this book makes several important contributions.
First, by employing a comparative ethnographic perspective—what the author refers to as historical ethnography as explicated in minute detail in one of the book's appendices—Redistributing the Poor shows the virtues of comparative analysis generally and comparing traditional institutions of punishment and social control to ones not typically associated with the carceral state. Specifically, this methodology allows Lara-Milan to reveal at the capillary level of institutional power how mass incarceration extends into health care delivery for the poor. The analysis is careful in its focus on both ethnographic observations and archival documents appropriate to in-depth organizational-level analysis.
Lara-Milan's historical ethnography, moreover, shows important limitations of a major theory of mass incarceration. By focusing only on neoliberal governance to the exclusion of careful attention to economic shocks and ever-present legal regulation, this book shows how legal processes operate to shape consequential organizational processes. While the methodological approach is atypical to studies on the endogeneity of law, Redistributing the Poor provides a granular perspective of how “legal rules function less as absolute mandates than as rhetorical claims that acquire meaning through dialog across organizational, professional, and legal fields” (Edelman et al., 1999: 446).
Lara-Milan's research focuses broadly on the interface of urban governance and the micro-politics of big city jail and public hospital regimes. Through a combination of archival and ethnographic field observations, Redistributing the Poor never overstates its findings nor conclusions. Much like other careful studies of organizational deviance, Lara-Milan's study convincingly shows complex systems of managing the health of the poor in the broader context of institutions struggling to stay operational. That is to say, rather than focusing on a series of discrete or static events, Lara-Milan makes empirically grounded observations of crises as part of an ongoing process of “administratively disappearing” the poor and health aggrieved populations under study: Ultimately, administrative disappearing pushes us to think about state activity as the conscious resolution of crisis—crisis that moves from one institutional space to the next, while state institutions continue to carry on (when they otherwise might have failed) and the poor continue to suffer.
(p. 24)
Part I of the book is framed by the author's critique of deindustrialization and attendant mass imprisonment of the poor as sufficient for understanding the expansion of medicine in large urban jails. By leveraging both ethnographic analysis of critical events involving incarcerated individuals and accompanying policy documents, Lara-Milan provides a richly contextual analysis of medical crises as they unfold inside the world's largest jail. Specifically, the jail's classification process leads to more medicalization, not because of the need to treat an illness, but for the purposes of social control. Obviously, this is not the traditional model of medicalization that is suggestive of rehabilitative and therapeutic imperatives. Rather, at intake, medical personnel preemptively administer mentally ill incarcerated individuals (as well as other “high risk” categories of incarcerated individuals) powerful psychotropic drugs. This adaptation serves, in effect, to foster compliance through sedation. Lara-Milan shows, moreover, how medicinal control serves critical institutional ends. In the LA County Jail, psychotropic control is a chief modality for managing populations with histories of violent crime and at once provides legitimacy to teams of officers that respond to crises. By moving incarcerated populations into designated “medicalized spaces” legal mandates are met in the absence of attending to actual medical needs.
Far beyond highlighting new forms of penal discipline, Lara-Milan argues that jail administrators deploy these strategies to manage both austerity measures that limit medical care, appease legal monitors, and diffuse threat of lawsuits: “It is the continuous circulation of inmates into and out of medicalized spaces—the mere act of processing inmates—that becomes the policy solution to the legal problem” (p. 87, emphasis in original).
In Part II of the book, Lara-Milan presents an archival history of a large urban hospital emergency room's response to impoverished patients. In Chapter 3, “Opioids, observation, and restricting access in the public emergency room” we learn how the tension between increased patients' rights and fiscal austerity is set against a backdrop of economic and institutional crises. To be sure, there are continuities between jail intake and hospital staff's liberal use of opioid painkillers. This contact point sets in motion a quasi-functional institutional logic for governing impoverished ER patients. First, it enables staff to manage large populations of poor patients without sacrificing already limited bed space. Beyond managing overcrowding, Lara-Milan shows how medicalization is used as a means to label patients as criminal drug abusers. At the same time, this practice serves to justify greater law enforcement presence in the hospital waiting room. In tracing the institutional history of the urban hospital, Lara-Milan points to the importance of attending to urban poverty governance as a form of institutionally mediated action.
Lara-Milan's study makes a compelling case for how criminologists might present alternative theories of the state in future studies of punishment and social control. Attending to how marginalized populations are redistributed into institutions entangled in crises from within and without, Redistributing the Poor elucidates the complexity of crisis management, legal mandates, and ever-present fiscal challenges confronting carceral institutions in the contemporary USA. Extending Garland's (2012) conception of Foucault's “history of the present” to one of “problematizing the present”, Lara-Milan provides subtle but important insight into the operations of state power. Redistributing the Poor invites interesting possibilities for future research that focuses more explicitly on how “[i]ntractable problems are key moments in which states must mobilize administrative disappearing to ensure that not much change actually occurs” (p. 166).