Beyond the obvious scholarship that goes into any UC Press book—research, writing, and editing—are challenges that even sophisticated readers and reviewers may remain happily unaware of. In this multi-part Behind the Scenes series, we throw light on the hurdles UC Press authors face in bringing their work to the public. From field work logistics in foreign countries, to the regulatory snags of evolving public policy, to the unique concerns that scholars of human subjects face, learn about the lengths to which authors go to present their scholarship to the public.

Susan Sered knows comments about Orange is the New Black, Jenji Kohan’s hit Netflix show, are inevitable when readers first learn the subject matter of Can’t Catch A Break. She acknowledges this in a blogpost entitled “What Pennsatucky’s Teeth Tell Us About Class in America,” which links two topics the general public may not analyze overmuch: teeth—as a marker for health and privilege in general (or the lack thereof)—and the vicissitudes of America’s underclass. But this type of analysis is Sered’s métier. As she states early on in the book, rotten teeth signify drug use, poverty, or that great American sin—failing to “take care of yourself”: nearly all the women she studied are “toothless or nearly toothless in the wake of battering and malnutrition.”

From Uninsured in America to the Women of Can’t Catch A Break

Susan Sered
Susan Sered

Sered journeyed from health care to women’s incarceration relatively easily. As she studied some of the nation’s pre-Obamacare 65 million uninsured for Uninsured in America, she found that marginally employed people with health problems were invariably headed for further trouble. Hence her interest in teeth: “People told me that without teeth, or with rotten teeth, it’s very hard to get a job. There’s real discrimination against toothless people.”

Sered became curious about what happened to these people after her ethnographic involvement, as they became even less employable, and entered the “death spiral” of awful jobs, deteriorating health, and potential loss of their homes. “We don’t see dead bodies in the street very often” so where did this underclass end up?

A light went on. “We’re hiding a lot of these people in prison.” Understanding the lives of women who’ve been criminalized—Sered uses that term intentionally because few of the women she researched “stole anything worth a lot of money or were an accessory to a terrible crime”—became her focus for half a decade.

We Knew Prison is Bad For Your Health

“Everyone knows about the mental health issues in prison,” says Sered. But physical health is also a problem. “Very few studies suggested that even at intake people coming into prison were less healthy than the general population. In a horrifying way, being chronically ill is a risk factor for incarceration.” That’s how I became interested in this issue. And women, because in the one or two studies that have looked at the physical health of prisoners, women prisoners are even sicker than men prisoners.”

A Dual-Discipline Approach | Methodology

Anthropologist Sered began a conversation about women who’ve been incarcerated with criminologist Maureen Norton-Hawk, who studied the criminal justice system and women and prostitution. “I wanted to see what is, what happens in their lives. She wanted to know what helped women move on with their lives after prison.” The co-authors invited women from two Boston facilities—a halfway house for women on parole and a drop-in center for poor and homeless women—to share their lives with the researchers.

“Very few studies suggested that even at intake people coming into prison were less healthy than the general population. In a horrifying way, being chronically ill is a risk factor for incarceration.”

A long-term study is difficult to conduct, especially when most of the participants are homeless and suffer from mental health and substance abuse challenges. Of the 47 marginalized and traumatized women (mostly 30-something, working-class white women) who entered the study, 26 remained in touch with Sered and Norton-Hawk for a full 5 years.

Quarterly in-depth interviews with each woman about housing, money, jobs, relationships, families, children (45 of 47 were mothers), and health were punctuated by monthly chats so Sered and Norton-Hawk could try to learn, “how criminalized and marginalized women move through and interpret the world about them.” In addition, the authors accompanied the women on appointments with doctors and parole officers; attended weddings, funerals, christenings, and children’s birthday parties; and spent time in parks, “sober houses,” and crack dens—wherever the women allowed them in. Sered saw her subjects as research partners, “guides in a world I knew nothing about.”

Norton-Hawk arranged donations of MBTA mass transit “T-Passes,” an invaluable monthly lure that explains their very high retention rate: better than any reported in similar studies. “To claim government benefits, you have to go to so many appointments, you have to keep re-certifying for Medicaid, for food stamps. If you don’t have the money to get to those appointments, you lose those benefits.” The mass transit pass made the appointments, and hence the benefits, possible for many of the women.

Also invaluable was the researchers’ office location in downtown Boston, near the two facilities and next to Boston Common (the oldest park in the US) where the homeless congregate. Departmental colleagues helped, as did the building’s security guard, though ostensibly his job, was to keep “the riffraff out.” “If a woman looking confused or high came in and asked for a T-Pass, he’d say, ‘You want Susan or Maureen. Let me call them for you.’ He was fabulous.”

Another detail that may not be top of mind for research in other disciplines? “Our building has really nice restrooms, which sounds trivial, but when you’re homeless, a clean quiet restroom—where no one’s shouting at you to hurry up, where there’s pretty decent-quality toilet paper—is a big draw.”

Protestants versus Catholics

The Protestant half-way house program offered early release from prison and was highly structured: drugs and alcohol were strictly forbidden, there were lots of Twelve-Step meetings, and everyone had written down their life goals. At the Catholic “drop-in” center, women could sit around high because it was a safe space for women to hang out. They were “totally different!” reports Sered, laughing, “but we realized within the first week that almost everyone had been at both facilities at some point.”

Sered “hung around” the drop-in facility (the half-way house discouraged “hanging around”), and soon earned her subjects’ trust. “They weren’t accountable to me for what they did or didn’t do. If a woman said to me, ‘Susan, it’s so cool! I’ve been clean for 2 weeks,’ I didn’t make a big deal, unless I sensed she wanted congratulations. If I ran into a woman nodding in the park, high, I didn’t scold her. I wasn’t her social worker; I didn’t judge her.”

“The Protestants were into changing people and saving them. The Catholics just fed them; as long as they weren’t obnoxiously loud or assaulting other people—they could be stoned, drooling—they could come in and eat.” Sered confesses, “I am Jewish but in this instance I’m on the side of the Catholics: love people unconditionally and let them be. If what the Protestants were doing showed long-term positive outcomes, it would be different, but … women who were working on getting their GED, were really enthusiastic about AA and NA, and constantly talked about staying in recovery? We’d meet them 2 years later, high, at the Boston Common or the drop-in center.”

The Root of the Problem?

In such chapters as “Joey Spit on Me: How Gender Inequality and Sexual Violence Make Women Sick” and “The Little Rock of the North: Race, Gender, Class, and the Consequences of Mass Incarceration,” we meet white sexual abuse survivor Francesca and black high-school dropout Anasia—as well as the perpetually weeping Elizabeth, socially skilled transwoman Ginger, and originally upper-middle-class Isabella. The women’s observations about their own lives stand; the co-authors offer substantial scholarship about ideological infrastructure to buttress the women’s suffering. But no matter the details and distinctions, the gendered violence that begins the book and permeates its pages is a constant:

Criminalized women are twice as likely as other American women to report childhood sexual abuse (45% versus 24%) and more than three times more likely to report family violence while growing up (48% versus 14%). Like Francesca, nearly all criminalized women have experienced poverty, abuse, insecure housing, chronic physical and mental distress, separation from their children, and a host of day-to-day degradations. Nationally, at least 70 percent of incarcerated women report having been raped at some point in their lives, typically more than once and often by multiple abusers …

Girls who try to escape sexual violence by running away find themselves penalized further: they enter the maw of the foster care system or try to survive on the streets, where sex work—seemingly the only option, given their lack of education and resources—inevitably sweeps them into a whirlpool of criminalization and deteriorating health. Though most want to “escape a lifestyle they know will eventually kill them … they remain trapped in the caste of the ill and afflicted.”

That is, in exactly the position Sered suspected as she began to theorize the results of the “death spiral” which led to this research.

Human Subjects Research

Obviously, researching human subjects entails qualitatively different challenges from, say, working with fossils or developing public policy. To protect these subjects, researchers must have their universities’ Institutional Review Board (IRB) vet their protocols against federal standards … even if that entails overruling the preferences of those same subjects. (IRBs arose as a corrective to now-infamous medical experimentation with human subjects in the twentieth century. They try to level inherent structural iniquities between researchers and subjects, for instance, in medical research, where researchers are the expert gatekeepers to treatment—and subjects are not experts, and are sometimes sick.)

“I’m in favor of those very aggressive protections,” says Sered (who herself had previously chaired her university’s IRB), “ but in the social sciences, particularly in anthropology, we’re moving toward a collaborative model. The research I do is not experimental, it’s observational; I’m not changing things in their lives.” Hence her stance that her subjects are research partners.

“Some women were disappointed we didn’t use their real names,” says Sered. “One woman, called “Tonya” in the book, explained ‘I want the world to know I had something to say!’” Sered understood the impulse. “In prison, they’re called “Inmate”—guards hardly ever use names. In the social welfare system, they have numbers. On the street, they’re “whore.” I feel sad we couldn’t use real names.”

If Sered’s population weren’t so at risk, her IRB might have decided to allow people to make their own decisions about pseudonyms, but Sered believes it was a reasonable call. “These women are vulnerable to all kinds of things. What if someone read “Tonya’s” candid remarks and she ended up in jail, or lost custody of her child? Are we being paternalistic? Yes. I’m saying I know better than “Tonya” what’s good for her, that it’s better for her that her real name isn’t used.”

Researcher to Friend to Advocate

Two of the women with whom the authors developed strong relationships were murdered. … “Elizabeth,” had finally moved into her own apartment after 10 years on the streets. She was bludgeoned to death with the leg of her own coffee table by the friend of a man she had dated.

As the study ended formally at the 5-year mark, the co-authors conducted a final interview with each woman. “So many women said—we didn’t ask this—something along the lines of ‘this is the first thing I’ve ever finished in my life.’”

How did the women react to the book? “Women who didn’t have a whole chapter dedicated to them were disappointed,” Sered said. Her policy was to create a blogpost if a woman disagreed with something she’d written. “But I’m not getting a whole lot of criticism: most of the women don’t read well, and they’re not accustomed to challenging authority. Unless there’s a good reason, you don’t bite the hand that … might have a transit pass for you. As much as I try to make it a level playing field, it’s really not.”

Genuine connections seem nonetheless to have been forged. Her co-author has moved on but Sered stays in touch “because I’m an anthropologist and that’s what I do.” The most hard-core addict of all the women in the study was caught in a cycle: locked program, to the streets, to prostitution, to drugs to numb the pain and shame … and back again to a locked program. “Somehow she’s been able to remember my phone number for 7 years,” says Sered incredulously. “Every time she’s in a program, as soon as they let her use a phone, she calls me. I’ve visited her at a dozen different detox and rehabilitation facilities in Massachusetts. Different women at different times wanted different kinds of relationships with me. I stayed open.”

Though fewer women make the effort to stay in touch with Sered (especially once the T-Passes stopped), she is still in regular contact with about 15 women who told her they wanted to keep up the connection. “A few call or stop by my office to say ‘thank you, how are you doing?’ Some call when they’re doing really well, some call when they’re falling apart. Some treasure the lunches I spring for at restaurants like Olive Garden that usually are out of their financial reach. I might not speak to “Kahtia” for months, for instance, but when her child’s birthday approaches she calls to tell me I have to come to keep up the tradition: I was in the hospital with her the day her baby was born, and I’ve been at every birthday party since then—7 years. Women I’m still in touch with see me as a friend.”

These friendships are not always easy on the authors. Over the years they’ve cried with women who lost custody of their children, braced themselves for visits to hospital rooms, and struggled with how much is enough and how much is too much help when a study participant has no money for food and asks for assistance. Two of the women with whom the authors developed strong relationships were murdered. One of them, “Elizabeth,” had finally moved into her own apartment after 10 years on the streets. She was bludgeoned to death with the leg of her own coffee table by the friend of a man she had dated.

Sered would next “like to collaborate with someone who does quantitative research. The combination of the cool stories I collect with the hard numbers that somebody else could collect has more potential to affect policy than just the dry numbers or just the dramatic stories alone.”

She and Norton-Hawk have already acknowledged their move from detached scholars to promulgators of change in their conclusion, A Blueprint for Moving Forward. Given the scope of the issues they describe, offering the book as a tool for “legislative initiatives and advocacy on behalf of all who struggle with poverty, illness, and violence” seems the only stance possible for those unwilling to abrogate their ethics.


Susan Sered is a professor in the Department of Sociology at Suffolk University in Boston. “Over the course of my career my research foci have transitioned from issues of gender and religion to issues of illness and health care. While these two intellectual clusters may sound somewhat far apart at first glance, it seems to me that all of the various phases of my work are tied together by my abiding concern with how individuals and groups interpret their corporeal experiences of suffering and how various powerful institutions endeavor to exert control over those experiences.”