At least two million people in the United States are incarcerated in 122 United States prisons. Little is known about the prisoners themselves. Did their background condemn them to bad behavior? Or did they just make grievous mistakes? Do they suffer from a mental illness masquerading as criminal behavior? Can they change their life path? A mental health specialist with 25 years of direct experience providing counseling services to pretrial detainees in Chicago’s notorious Cook County prison system agreed to this interview.

Rosenberg: You have said that law enforcement and military personnel should not be in charge of medical facilities. Can you elaborate?

MM: Yes, they should not oversee a “house of healing.” This might be more apparent in countries run by military juntas like Myanmar, where the rights and freedoms of individuals are not respected, but it is true in the U.S. too. You can’t have commanders telling the medical staff you can’t use this or that — preventing them from doing their job.

A couple of years ago, I was made aware of a situation where the police brought a detained person into the ER suspected of drunk driving. The police officer wanted blood drawn to determine alcohol levels, but the nurse refused for legal reasons. Specifically, a court order signed by a sitting judge must give direct permission to perform such a procedure. This officer had no valid court order. She did contact her supervisor. The nurse got no help from the staffers who were witnessing. The officer upped the ante; he arrested the nurse for not complying with his lack of authorization. This incident is not isolated. Medical facilities and houses of healing should not be directed by law enforcement or the military.

Rosenberg: We often hear that many prisoners are actually “mentally ill,” yet this is confusing. Even if they are mentally ill, isn’t the public still at risk of violence if these offenders are sent to the community?

MM: Many incarcerated people have personality disorders. It is a peculiar way of themselves and the world. Substance use is the immediate behavior we see. Sadly, those detainees who are truly mentally ill will never come to trial; they are just too sick. Unfit for trial (UST) is a rare court ruling. Also, the mental health treatment detainees get when they are incarcerated is purpose-driven. Correctional mental health care often maintains pretrial detainees to get them to stand trial.

Keep in mind that it is very expensive to incarcerate someone and the policy is to save our jails for the most violent criminals. Of course, a corollary to that is many of these people have nowhere else to go because they have become “institutionally dependent” and do re-offend to return to the structure of incarceration.

Rosenberg: You have talked about the prestige and status that can occur among the prison populations.

MM: One example is when prisoners are promoted to wash floors and do important organizational tasks. Even though it pays only a dollar a day, the minimum wage is much higher. These workers have the privileges to walk outside of their housing. With clean clothes, the rest of the inmates have to wash theirs, and they get to wear orange caps and jail jumpsuits. These workers have privileges to walk outside of their assigned housing. The prestige benefits outweigh the burden of competitive employment. Many of these institutionalized detainees, with intergenerational transmission (upbringing), resent the realities of being told what to do by an authority figure. Why should l wait two weeks for a paycheck? I want something now.

Rosenberg: You have talked about the effect of early institutionalization of youthful offenders. Can you elaborate?

MM: Early institutionalization is a pathway to higher levels of the state’s containment. There is no Mommy and Daddy expecting you to be at home at 5:30 with dinner waiting. No one should spend an hour asking what happened at school that day. We call this concept “attachment.” That child feels emotionally bonded to those parents. These [detained] children have staffers on different shifts — morning, afternoon, and overnight. This is not parenting. No set of parents you feel emotionally bonded to. With institutionalized young people, they instead have different shifts-morning, afternoon, and overnight overseers. Though they are not old enough to be in the adult population yet, these juveniles [in these settings] must learn and utilize specific behaviors that preserve their person and body.

Rosenberg: As a mental health specialist, could you make a difference with detainees, especially young ones?

MM: Social distancing [exists] between staff and detainees, and we are limited to how much time we can spend with each person when you have 30 people on the deck. That said, I felt that when a detainee came in with more education, more family support, and powers of insight that could override poor judgment in the past and the ability to learn their “life lesson,” they had a good chance of straightening out their lives.

Each child is different, and we are products of where we come from. I do not feel economic factors like growing up in a neighborhood where there is a dealer on every street need to be “barriers” if parents have ambition and convey to children their life, as they feel their life has a purpose.

Rosenberg: Here in Chicago, there is a lot of acrimony about bail reform and, specifically the abolition of cash bail. The fear is that violent people will walk free.

MM: There is a model of no cash bail in New York. It is marketed as a correctional move toward making amends against the wrong done to African Americans through centuries of slavery perpetuated by the court system and injustice. For such people, some of whom are poor or immigrants who don’t speak English, a bond of $300 might be a million dollars — it is unattainable.

Yet politicians also fan the crime fear flames, as we saw with the notorious “Willie Horton” ads used by George H.W Bush in 1988. Politicians are known to choose subjects that get the public upset or scared, as we can see from Nixon’s “war on crime” to [Illinois governor] big Jim Thompson’s vow to build more prisons.

Rosenberg: Spending 40 hours a week behind bars, including with detainees who you have said insult you in several languages, must be difficult. How did you and your co-workers cope?

MM: Staffers have different ways of navigating their place in a hard job…Some did become more religious or became “Mother Teresa” like to detainees. Some turn to substance abuse. Some became the inmates they worked with. Probably the healthiest response on the part of my co-workers was to “do your job — do your eight and hit the gate” and compartmentalize the stresses — not making it a part of your personal life. Self-care is essential. Like a straight razor, the reader must have a cutting edge.

Martha Rosenberg is a health reporter and the author of Born With a Junk Food Deficiency.