To create a healthy nation, we must face the painful past of slavery and connect with those who still suffer its consequences, civil rights lawyer tells attendees at Learn Serve Lead 2019: The AAMC Annual Meeting.
A quarter century ago, 300,000 people were incarcerated in America. Today, 2.2 million people are in jail or prison, with another 6 million on probation or parole. The percentage of women in jail has increased by 646%, and 70% of those are single mothers.
But the statistic that keeps civil rights attorney Bryan Stevenson up at night is this: 1 in 3 black male babies born today will go to jail in his lifetime.
“There's an epidemic of hopelessness in so many of the communities where there's poverty and despair,” Stevenson told more than 4,800 attendees at the opening plenary session of Learn Serve Lead 2019: The AAMC Annual Meeting. “I go into poor communities and I sit down with 12-year-old boys and [they say] ‘I know I’m going to be in jail or prison by the time I’m 21.’” And they see little in their future other than hardship.
But Stevenson — who defends the unfairly imprisoned and together with his team at the Equal Justice Initiative has won reversals or relief for more than 135 wrongfully condemned death row inmates — believes there’s a way forward, a way to “create a healthier community, a healthier society, and a healthier nation.”
First, we must be willing to connect meaningfully with those who are suffering, said the author of the New York Times best-selling book Just Mercy: A Story of Justice and Redemption, which will soon be released nationwide as a major motion picture.
In medicine, he noted, providers recognize that they must engage deeply with patients in order to diagnose their disease. The same is true with social ills. Current solutions “don’t work because they haven’t been shaped by the insights and knowledge that come from proximity” and from the communities involved, Stevenson said. “We need to get close enough to wrap our arms around [those who suffer] and affirm their humanity.”
Next, we must acknowledge the painful history of slavery, persecution, and dehumanization that continue to impact so many lives today, so that we can begin to change the narrative around race and poverty in America.
“I believe the true evil of American slavery was the narrative of racial difference, [the myth] that black people aren’t fully human…. And because of that I don’t think slavery ended in 1865 — it just evolved,” Stevenson told meeting attendees. “Today there is still a presumption of dangerousness and guilt that gets assigned to people of color. It's unhealthy, and it breaks my heart because I can come to a convention like this and see such extraordinary people, people committed to working together. But I still have to say that you can be a talented physician, you can be a talented academic, you can be a dean, you can be a leading researcher in your field, you can be a kind caregiver, you can be an amazing nurse or social worker but if you're black or brown, you will go places where you still have to navigate a presumption of dangerousness and guilt.”
Finally, Stevenson noted, to achieve meaningful change, people must be willing to take uncomfortable steps. It’s human nature to want to stick with what’s safe and familiar, he acknowledged. “It just means you actually have to make a decision … to do what’s uncomfortable.”
But invaluable benefits can come from doing what’s uncomfortable, he remarked, and so can engaging with those in our society who are broken. “It’s the broken who can show us the power of mercy and grace and redemption,” he said.
In an exclusive interview with AAMCNews several weeks ago, Stevenson shared additional thoughts on health inequities, criminal justice, drug addiction, and more.
You work to protect the rights of poor, disenfranchised people, particularly the unfairly accused and death row prisoners. What first motivated you to do this work?
I grew up in a community where racial segregation and poverty constrained people’s aspirations — even though they were incredibly hardworking, decent people. And I started my education in a racially segregated “colored school,” but lawyers came into the community and made them open up the schools. That planted a seed in me. The idea of exercising that power on behalf of marginalized people like the people I grew up with was really intriguing.
Then in law school, I did an internship providing legal services to people on death row. It became clear to me that there was no community of people who were more imperiled than those condemned on death row. Meeting people who were literally dying for legal assistance made me want to respond. So, when I graduated, I started working on those types of cases, and here I am today.
You often speak about the legacy of slavery and racism in this country and our failure to face that legacy. What do you believe are some of the effects of that history today?
There's no question that we have been and are still haunted by our history of racial inequality.
The Europeans came to this continent and killed millions of native people through famine, war, disease, and forced removals. We justified that genocide by characterizing native populations as savages, and then this narrative of racial group differences was used to justify centuries of slavery.
That narrative of white supremacy then turns into decades of lynchings when black people are threatened and burned and hanged and traumatized. Then those experiences create this exodus of refugees from terror, which shapes the demographic geography of this country in places like Cleveland, [Ohio]; Chicago, [Illinois]; Los Angeles, [California]; and Detroit, [Michigan].
Today, there is still a presumption of dangerousness that gets assigned to black and brown people. You can be very accomplished, but if you're black or brown, you will go places where you're going to have to navigate a presumption of dangerousness.
We need an era of truth and justice, of truth and reconciliation. If we don't usher in the kind of conversation that happened in South Africa and Rwanda and Germany, we're not going to achieve any of the progress that so many of us long to see.
How do you see racism affecting the physical and emotional health of many people in this country today?
We know that extended exposure to stress can have very significant effects on health and health outcomes. We have a trauma epidemic in this country where there are thousands of children who live in violent neighborhoods, who are threatened and menaced. By the time they're 4 or 5, they have elevated levels of cortisol and adrenaline coursing through their brains. And when we put a child with a trauma disorder, a child who has trouble focusing or conforming, in an environment like a school where we use the language of threat and punishment to manage them, their problems only get worse.
Then when you aggravate those experiences by policing that targets communities of color, and you aggravate that with the absence of skilled health care workers and you aggravate that with poor housing and poor nutrition and the inability to get basic services, you have a health crisis.
There’s also the accumulated stress of having to navigate a presumption of dangerousness and guilt. I go into the courtroom sometimes and the judge will start screaming at me, ‘Get back out there in the hallway until your lawyer gets here.’ It's exhausting to have to navigate these presumptions, and that exhaustion has consequences for health — and there are people who are less privileged and resourced than I who have to deal with the same exhaustion.
You have bemoaned how our society addresses mental illness and substance use. Can you talk a bit about that?
When we declared our misguided war on drugs, we basically said that people with drug addiction and drug dependency are criminals. We didn't have to say that. We could have said that addiction and dependency are a health care problem.
When you're a child traumatized by constantly being threatened and somebody offers you a drug and you take it and for the first time in your life you have three hours when you feel less threatened, what do you want? You want more of that drug. Then we only exacerbate the problem by putting people in jails and prisons where they don’t get treatment and their conditions get worse.
Nobody says, ‘Oh, that person has a tumor, we should put them in prison.’ But mental health disorders, which tend to affect the poor and people of color, often are not seen as deserving of treatment, and many people who end up in our jails and prisons are seen as not deserving of our compassion.
Shifting from a criminal justice frame to a health frame with regard to addiction and dependency and mental illness would be enormously significant.
What else about our criminal justice system worries you?
We've increased our spending on jails and prisons tremendously, but we haven't had any comparable spending to make sure that the people we send to jails or prisons are guilty or fairly tried or sentenced. So, we wind up with a system that treats you better if you’re rich and guilty than if you’re poor and innocent.
We have so many people in our jails and prisons who are not a threat to public safety, and we are creating collateral damage. We are disrupting families. One in three black male babies born in this country is expected to go to jail or prison. That’s a tragedy. We have to start talking about what it would mean to be fully engaged in crime prevention, to alleviate the conditions that give rise to criminality.
You work very hard to help people in dire circumstances, as do many physicians. How do you manage to avoid burning out?
For me it’s about altering the expectation. I realize I can't live a life that is wholly apart from the lives of people that I care about, including my clients. If you reconcile yourself to the fact that your humanity is implicated when someone else’s humanity is being denied or ignored, then it doesn’t seem as challenging to recognize that you are going to have moments when you feel great anguish or pain or sorrow.
The flip side is that the relationship to the people you serve also creates moments of unparalleled joy, of great purpose and clarity and meaning. A lot of people never get that because they haven’t positioned themselves close enough to something that could be overwhelming. I think that’s the privilege of being a service provider and caregiver. There will be pain but there also will be moments of joy and inexpressible gratitude and love even.
Also, we all need to have our own coping strategies. I grew up in a musical family so music is important to me. And I was pretty active in sports, which offers the ability to alter your brain chemistry just enough to look at a problem differently. That combination of stepping outside myself from time to time combined with deep convictions rooted in the hope of what can be achieved makes it possible to not burn out.
There will be thousands of leaders of medical schools and teaching hospitals at Learn Serve Lead. What do you hope to say to them?
I will urge people to do uncomfortable things because that’s the only way we make progress. Justice has never happened, equality has never been won, breakthroughs in science or in human relations have never been achieved by people who only do things that are comfortable and convenient. We cannot increase the justice quotient or the health quotient if we insist on only doing things that are easy.
Diversity doesn’t happen by itself, inclusion and greater empathy don’t happen by themselves. We have to work at them. We have to commit ourselves even when it’s inconvenient or uncomfortable. We have to be mindful of that as we struggle to move forward on the many challenging issues of equity that face our country.
An earlier version of this AAMCNews article published September 17, 2019, with the title "One man's quest for justice."