The smiling queen

This week’s reflection is a tribute to the late Queen Elizabeth II…

Sombre silence

It was right and proper that the United Kingdom (UK) marked the funeral of Queen Elizabeth II with a bank holiday. We Brits needed a dedicated day to mourn our beloved monarch who reigned over us for an incredible 70 years.

Sadly for me, key workers don’t always get bank holidays off. So I worked a normal Monday in a local prison and then drafted this tribute on the train on the way home. It was unusually quiet in jail that day. Yes there was the usual clanking of iron doors. But there was far less people noise - no calling out ‘Doc doc!’ as I passed by closed cell doors. No, the loudest voices were those of the television broadcasters commentating on the funeral service. Prisoners joined the rest of Britain in watching our Queen make her final journey.

Formative memory

Now that I think about it, Queen Elizabeth II is the focus of one of my earliest and fondest childhood memories. I remember it like it was yesterday. I guess it was her Silver Jubilee tour. My mother had dressed us in our 1970’s finest. My grandmother had packed a flask of orange cordial and a whole box of cheese crackers. My ‘grandpy’ had donned his military medals. And we had camped out on a grass verge, waiting for the royal motorcade to pass by as it headed into my home town of Kingston-upon-Hull, which back then was somewhat down-at-heel in places.

Cheerfully bright

The crackers ran out - so I guess we waited quite a while - but finally we got to see her! It was just a few seconds, but I remember her outfit being so pretty and colourful, and - thanks to her brightly coloured lipstick - her smile being equally sparkly. My childish take on the whole occasion was one of feeling really chuffed that the Queen had bothered to get dressed up and drive all the way up to see us in Hull!

Although I never got to see her again, I think that - likely subconsciously - I somehow incorporated that early memory into my attitude towards professional attire. Whether I'm in scrubs in an overseas jail, in smart casuals for a day in a British jail, or zipped into a skirt suit in some snazzy lecture theatre, I like to add a splash of colour to my outfit and my lips, and I try to remember to keep on smiling. A cheerful face does wonders for sick prisoners!

Social justice

It’s more than 40 years later and I no longer live in Hull. No I live in London, work in English prisons, and run Integritas Healthcare, an offender healthcare NGO centred on the principle of social justice. And over the intervening years I've evolved a working belief that social justice and hereditary privilege are mutually incompatible. As monarchy is the ultimate hereditary privilege, I guess I’m a republican - in theory. Yet I've always been a fan of the Queen. Her dying has brought all this to mind and so I’ve decided to re-evaluate my seemingly opposing beliefs.

On the one hand it seems perverse that the British Royal Family gets to live in a whacking great palace in the centre of London whilst countless roofless souls squat under its many surrounding bridges. That said, I have no doubt that the fact of homelessness saddened Queen Elizabeth. She was a devout Christian who loved and served both her Lord and her people in exemplary fashion. I’m sure she tried to promote justness in the manner of Proverbs 8:15: 'Because of me, kings [and queens] reign, and rulers make just decrees'. Yet it is true that she also reigned over the twilight years of the British Empire, an organism that was responsible for many unjust acts. And back in ancient times God Himself warned the nation of Israel of the injustices that would occur in response to their desire to create a monarchy to replace their established system of prophets.

On the other hand, many members of the modern-day British British Royal Family spend huge amounts of time on patronage of various socially just charities, and no doubt some of them are similarly generous with their personal wealth. Our new king, Charles III, has done enormous good for socially disadvantaged youngsters through his brainchild, The Prince's Trust. Moreover, in other countries the loss or long-term absence of a monarchy does not go hand-in-glove with progression towards more socially just societies. I've lived in and worked behind bars in many a monarch-less state and so know full well that things are often decidedly grim when a president rather than a monarch sits in the palace!

Give thanks

So is monarchy really incompatible with social justice? Or is the issue a whole lot more complicated than that? Whatever you and I come to decide, I give thanks to God for Queen Elizabeth II and I pray for Britain's new King Charles III. May he be an early adopter of his mother's lifelong habit of greeting everyone in his kingdom with a cheery smile. And may we all remember to smile more - because, no matter our individual problems, there is always something to be thankful for. And a happier heart is a healthier heart.

A happy heart makes the face cheerful...

Proverbs 15:13

Dr Rachael Pickering is our voluntary Chief Medical Officer. Her personal opinions are not necessarily the same as those of Integritas Healthcare. We are always grateful for support.

The Ms Maxwell Series: Is sleep deprivation torture?

We return to our series pegged around the topic of torture, which made British news headlines in early Spring 2021 when Ghislaine Maxwell’s brother, Ian, spoke out against what he felt were torturous conditions in her New York jail. She is apparently being continually observed in a 6x9ft (1.8x2.7m) cell with no natural light and terrible food & water rations.

Previously: What’s diet got to do with it?

After exploring the questions of ‘What is torture?’ and ‘How small is too small?’ for a jail cell, we discussed ‘What’s diet got to with it?’. The UN’s Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules) stipulate food must be nutritious and a detainee must have ready access to drinking water. However, whether or not allegedly inedible food could be considered ill-treatment amounting to torture as defined by the UN’s Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT) is doubtful. Either way though, it’s neither necessary nor proportionate punishment for detainees to be without access to nutritious food and reasonable quality water.

Now: sleep deprivation

More recent news reports have shone light on new bruising around Ghislaine’s eyes, suggesting she is now suffering from sleep deprivation as a result of being woken by torchlight repeatedly throughout the night as part of her suicide watch.

The suicide prevention in jails and prisons guidance written by the World Health Organisation (WHO) recognises that adequate monitoring of suicidal prisoners is important to prevent deaths, especially during the night:-

Adequate monitoring of suicidal inmates is crucial, particularly during the night shift (when staffing is low) and in facilities where staff may not be permanently assigned to an area (such as police lockups).

The guidance also understands that the ‘level of monitoring should match the level of risk’. If Ghislaine’s New York jailors have conducted risk assessments that clearly identify her being high risk of suicide, then constant surveillance may be necessary for her own safety. However, if Ian Maxwell’s claims are true and her jailors are acting purely out of an excessive fear for their own reputation, then her level of monitoring is truly excessive and could even be counter-productive. And, as the Judge presiding over Ms Maxwell’s case has already suggested, she could have an eye covering to help her sleep despite frequent nightly checks. So why didn’t someone think of it before?

The Nelson Mandela Rules, which are designed to maintain a prisoner’s human rights and dignity, include guidance on sleeping arrangements:-

All accommodation provided for the use of prisoners and in particular all sleeping accommodation shall meet all requirements of health, due regard being paid to climatic conditions and particularly to cubic content of air, minimum floor space, lighting, heating and ventilation.

Darkness is essential for good quality sleep. As levels of light decrease at the end of the day our body produces the hormone melatonin, which causes muscle relaxation and the feeling of tiredness, which in turn initiates sleep. Light exposure during the night may impede this natural rhythm, provoking periods of wakefulness. Therefore, appropriate lighting, or lack of it, at night time is an important right for prisoners.

Sleep deprivation and interrogation

Historically, the technique of depriving a prisoner of sleep has been used for the for purpose of obtaining a confession or other information. Sleep deprivation was one of five techniques employed by the British Military as an interrogation method during the 1970s. In the European Court of Human Right’s trial Ireland v. the United Kingdom, it was concluded:-

... Although the five techniques, as applied in combination, undoubtedly amounted to inhuman and degrading treatment, although their object was the extraction of confessions, the naming of others and/or information and although they were used systematically, they did not occasion suffering of the particular intensity and cruelty implied by the word torture as so understood. ...

The Court concludes that recourse to the five techniques amounted to a practice of inhuman and degrading treatment, which practice was in breach of [the European Convention on Human Rights] Article 3.

Whether sleep deprivation is inflicted for the purposes of interrogation or it is a result of other biopsychosocial factors, what might be the health consequences?

The importance of sleep

It is common knowledge that a lack of sleep can impact health and wellbeing. In the short term, it reduces concentration and increases irritability. Ongoing sleep deprivation decrease the immune system’s defence against infectious diseases - not a welcome thought during a worldwide pandemic! It also increases the risk of heart disease and diabetes with serious consequences for life quality and expectancy.

How can prisoners achieve better sleep?

Achieving good sleep in prison is a challenge. The stress and chaos of prison life, sometimes compounded by drug and alcohol use, or a mental health problem, often lead to sleepless nights.

Many of the environmental factors in prison cannot be changed, but it is both easy and important to empower prisoners to choose small things that can have a positive impact on their quality of sleep. This is called ‘sleep hygiene’. Making these small changes also increases their sense of control, which is a rare and precious sensation for most of the world’s detainees.

PILs

Our picture-heavy, word-light Insomnia Patient Information Leaflet (PIL) has been designed especially to help prisoners with sleep hygiene. We are in the early stages of an ongoing project to translate our detainee-friendly PILs into multiple languages and make them freely available on our website. This will make them readily accessible to individuals and organisations involved in supporting many of the world’s 11 million detainees. If you have a heart for helping detainees improve their own health and wellbeing, you could donate to our work or (if you’re suitably skilled) join us as a translator.

So Is Ghislaine Maxwell being tortured?

Next time we will reflect on this series’ findings and decide…

If Ian Maxwell’s allegations are true, is Ghislaine being ill-treated in a manner that could be said to amount to torture?

Until then…