To understand the hell we call Rikers Island, there’s no one better to ask than Mary Buser. Her stunning, award-winning debut book, Lockdown on Rikers: Shocking Stories of Abuse and Injustice at New York’s Notorious Jail, published in 2015, opened many eyes and strengthened the growing #CloseRikers movement.

A Columbia University-trained Licensed Clinical Social Worker, Buser rose up the ranks to become acting chief of the Mental Health Department at Rikers. One of her duties was to assess the mental health of prisoners in the “bing”—the nickname for the five-story modern dungeon of solitary confinement cells, with 100 human beings per floor.

“The blood is trickling down into his eyes and I realize that we’re well beyond therapeutic dialogue.”

The United Nations equates more than 15 days in solitary confinement with torture. At Rikers that limit is routinely violated, despite recent reforms.

Very few outsiders have seen these torture chambers, and Buser’s bearing witness is vital. “When the knob buzzes, I pull the door open and step into what feels like a furnace,” she recounted in the gut-wrenching prologue to her book.

“I hesitate, dreading the walk through the gauntlet of misery. The smell of vomit and feces hangs in the hot, thick air … I can see the inmates’ faces—dark-skinned, young—pressed up against the windows, eyes wild with panic. ‘Miss! Help! Please, miss!’ They bang and slap the doors, sweaty palms sliding down the windows. ‘We’re dying in here, miss, we’re dying!‘ The officer opens the creaking door and steps back … For a moment Troy Jackson and I stare at one another. ‘Please miss, please,’ he whispers. “Help me…” The blood is trickling down into his eyes and I realize that we’re well beyond therapeutic dialogue.”

Buser worked at Rikers Island in the 1990s, during the reign of “tough on crime” Mayor Rudolph Giuliani and the crack era which drove racist mass incarceration.

As the book illustrates, social workers and healthcare staff in such scenarios face profound ethical dilemmas. They work inside a system that routinely abuses people physically and psychologically, and they document it.

Lockdown on Rikers is an explication of how people with the best of intentions inside correctional institutions try to help the most vulnerable. The jail is full of poor people with mental health and drug problems, homeless people, and survivors of trauma and gang violence. Ultimately, a burned-out and jaded Buser resigned, realizing that she could no longer make a difference.

Instead, Buser became an advocate for prison reform on the outside. She helped found Social Workers Against Solitary Confinement, and speaks and lectures against the carceral state and solitary confinement.

I met with Mary Buser at her studio apartment in downtown Brooklyn, and she was as friendly and warm as her dog, Cha Cha, who sat in on the interview. Our conversation has been lightly edited for length and clarity.

Helen Redmond: How do you square this: If you don’t come to Rikers Island with a psychiatric diagnosis you will probably leave with one?

Mary Buser: That’s a really good question, and it points to the tragedy of having people leave correctional institutions worse than when they arrived. Worse—and that’s all wrong. But that is highly likely.

The biggest case that points that out is Kalief Browder, who came in as a normal 16-year old kid accused of stealing a backpack. Three years later—solitary confinement, beatings, never the same—he committed suicide.

HR: You said in your book, “All roads lead to drugs in some way, whether it’s dealing, doing the drugs or drug mules.” How would you further describe the role drugs play in the lives of women and men in Rikers?

MB: Drugs were everything. I think I also wrote that if they ever legalized drugs—at the time we had 20,000 inmates on Rikers—we’d have eight people left.

I spoke to one man who was in his 70s and was arrested for murder, never been in jail before. He’s the only one that comes to mind who didn’t have a drug problem.

Everyone had a drug addiction. There were mules, women picked up at the airport, often coerced by boyfriends. I saw a lot of men who were in jail for dealing and selling drugs. For the women it was more possession, steering, look-outs. If you’re on a rooftop and the police are coming, a look-out is a charge, you’re a “drug look-out.”

I met a man who was severely developmentally disabled. I asked, what is this poor man doing on Rikers Island? Well, he was used to carry drugs. But this man had no idea what he was doing. He had a very low IQ. When I met him he was counting potato chips to see if there was the right amount in the bag. During a search, he was devastated when his glasses were taken from him. How could we put someone like him on Rikers Island? Everything involved drugs.

HR: One of the things you say throughout the book is that it’s astonishing how much time people get for drug-related crimes.

MB: It’s utterly disproportionate. It’s horrendous for the most part. You did have people arrested for violence related to drugs, with turf wars—so that was another way drugs played out. But for the most part these were nonviolent offenses. And frankly, nonviolent offenses in a community where, I don’t want to say it’s the norm, but this is how a lot of people get by.

I remember speaking to a man, his wife had just had a baby and they needed diapers. And when he got arrested for stealing his wife said, “We should have just let the baby pee on the floor. It wasn’t worth it.”

He said if he didn’t have children who were visiting him in jail and crying, “I would just hang myself.”

But it’s not to buy a Lamborghini, it’s just to get by. The face of the drug dealer we see in the newspaper is someone with horns and a tail. These are ordinary people who’ve made a mistake, who don’t have the options that a middle-class person has to get money. And the punishment is horrendous.

The first person I met in the men’s jail, they were offering him 20 years. He said if he didn’t have children who were visiting him in jail and crying, “I would just hang myself.” It was a first time arrest.

HR: You talk in the book about doing individual and group therapy. But is it really possible to provide therapy if correctional officers are watching and listening?

MB: It’s certainly challenging. For me confidentiality is sacred. With the exception of solitary confinement, in my individual sessions I would never speak if a CO was within earshot. We did have booths, there was plexiglass, and there was an officer on the other side and she was pretty decent. But I would not proceed if I felt that the conversation could be overheard. I felt very privileged for people to share their deepest fears and to expose themselves, and I protected that fiercely.

The Captain of the clinic was reading through the charts like a newspaper.

Now that being said, after you wrote up your charts after the session, charts should be confidential. Lo and behold, I discovered early on the Captain of the clinic was reading through the charts, like reading a newspaper. I went to the unit chief, but it’s tricky. Because you are a guest in their house and they know they are not supposed to be doing that, but there was nothing to stop them.

What I did was, all my chart notes were very vague. I wouldn’t write anything specific, about any charges, or about an altercation they had with a CO. I kept everything very milquetoast. And when my charts were reviewed I was sometimes criticized for not being specific. And I would say: These charts aren’t confidential. I can’t compromise. I just won’t.

That’s changed now. Everything is computerized and you need a password to get into any chart, and there is a footprint of everyone who accesses the chart. That’s huge.

When I worked in solitary confinement, with Legal Aid we would go door-to-door. The CO would open the door so we could talk. Then confidentiality was compromised.

It was a tough situation because Legal Aid, rightly so, said this is a breach of confidentiality. So there was a big push to get them out of the cell, take them down to first floor where we could meet with them privately.

The problem was, you had 500 people, and they would give you one escort who would take half an hour—someone in solitary has to be searched, shackled, belly chains. You are going to wait about half an hour for the escort to get somebody downstairs and then go through it in reverse. And you have to get medications renewed. It was the ultimate clash between security and confidentiality.

From a practical standpoint you were forced to have conversations that weren’t private. You couldn’t do therapy. I remember one man tearful saying, “I’m not going to make it.” And I said, “How much longer do you have?” He said, “I have seven more days.” He had been in solitary for months.

I said, “Hang on, just look at me. Just think, a week from Tuesday you’ll be out and you and I are going to meet in the clinic and sit and talk.” I’d make a little pact with people, try to get them to hold on. Do you have enough to read? They could have reading materials. I’d go back up and make sure they got a magazine. Let them know someone cared about them. That was all you could do.

HR: Can you tell me about STEP, the program for people with drug addictions at Rikers Island?

MB: STEP is an acronym for Self-Taught Empowerment Pride. The Department of Corrections ran it, it wasn’t run by the Mental Health department. It was a program for women in the Rose Singer jail. All the women accepted into the drug rehab program lived in the same dorm, they wore the same garb. It had a militaristic tone to it. The women would march through the halls and you’d hear “One, two, three, four!” It was very disciplined and focused.

He began an affair with her. He was taking her to a trailer behind the jail. She was getting preferential treatment, but at what cost?

Some of the women benefited from it. It helped them with structure. Their days were very structured and they were immersed in groups. Women who were more sensitive found it too much with the screaming and shouting because there was a real drill sergeant feel to it. The program was run by correction officers and the Captains.

But as I mention in my book, the Captain who was running it and a woman I was working with separately in therapy, he began an affair with her. He was taking her to a trailer behind the jail. She was getting preferential treatment, but at what cost?

HR: In the book you talk about jail being a safe place for people. And some of the people I’ve worked with have told me they felt safer in jail than out on the streets or in their homes. Doesn’t this reflect a huge problem?

MB: It’s a sad commentary as to how desperate and chaotic people’s lives can be outside of jail. And there are many women I spoke with who said, “Jail saved my life.” Women who had mental health problems and used drugs. They weren’t in a position to get treatment. Jail forced treatment and it was a time-out from the streets.

I saw this with men, too. One man I discuss in the book got himself arrested because he was HIV-positive and he couldn’t stop using drugs. He thought the only answer was to get himself arrested. That really speaks to what it must be like to be addicted, to be that desperate that this is your strategy for getting well.

The reality was you had to get arrested to get into a drug treatment program.

But it speaks to the larger issue of why aren’t treatment centers readily accessible? Why does someone have to get involved in law enforcement, has to get handcuffed as opposed to going to a program, knocking on the door and saying, “I need help” and being admitted? People in that moment need help.We don’t have that.

I remember years ago when I worked in a drug rehab in the South Bronx for parolees. It was called El Rio. People would knock on the door and say, “Help. I’m not high right now, I will be getting high, I have this window right now—can you help me?” I didn’t say this to them, but the reality was you had to get arrested, take some kind of a plea to get into a drug treatment program. They all had waiting lists 10 miles long.

HR: Has that changed? Do think there is more access to treatment now?

MB: I don’t think there is much for the scale that is needed. Drug addiction is so pervasive and so devastating, and I don’t think we have anything near the scale of what we need to address the problem.

HR: What kind of psychiatric treatment is available for people on Rikers? You said in your book that people are offered a lot of medication.

MB: When I was at Rikers there were 10 jails, and each had a clinic. Most had a mental observation unit, a chief physician and a warden. We would cull out anyone in the general population who appeared to have a mental illness.

This involved going to the receiving room, where buses were coming in with people, and accessing right there whether they should be placed in the mental observation unit. It was typically a 50-bed facility. They would be seen pretty quickly by a doctor, especially if they were psychotic, and started on medication.

When things were running well on Rikers in terms of healthcare, they would be seen several times a week by an individual clinician, weekly by a psychiatrist for medication, and almost daily for group therapy until they could go back to general population. Some people never got stabilized enough to go back to general population.

HR: How did it affect you personally to go into that environment?

MB: We had a waiting list for people to get into solitary confinement. Most people in solitary, 75 percent, were there for nonviolent offenses. People get put in solitary for having too many sheets, too many stamps. Nonsense.

It was very jarring for me psychologically. I never expected to be in a situation like that personally or professionally. I wasn’t cut out for it. I don’t know if any human being is. I was horrified by what I initially witnessed. People banging their heads, the feces smearing, the desperation, the sweat, the heat.

You had to make sure the meds didn’t break down. That is what held the whole place together.

There was a lot of pressure on me to maintain it, to keep people medicated. You had to make sure the meds didn’t break down. That is what held the whole place together: Sleeping pills, anti-psychotics, antidepressants, anti-anxiety drugs. Everything. We had a saying, “If they didn’t have a mental health issue before they entered solitary, they do now.” The relationship between civilians and correction staff was always a little tense, [but] here the deputy warden in charge couldn’t have been more welcoming. He said, “Frankly, it’s your interventions that make this place manageable.”

The meds can only go so far. When they gave out, the head-banging, feces-smearing, makeshift nooses and incoherent babbling create just completely broken human beings.

What initially shocked me didn’t have such a disturbing affect just a couple of weeks later. I think we become desensitized. I kept looking around me and saying, this is the United States, we’re progressive on human rights, we have board-certified doctors, white lab coats, the American flag flying above the jail. Every time I was called to one of the cells for a “situation,” my knees would start to wobble; I had a bodily reaction. It was awful. I started smoking cigarettes, I would have to smoke a cigarette to gird myself before I went up to see what we were going to face. The nicotine relaxed and steadied everything.

HR: How are social work ethics and values challenged when you work in solitary confinement? Should social workers refuse to work in these correctional settings when our Code of Ethics, as I understand it, is so compromised?

MB: They are compromised. On the one hand I’m doing really good work. But by the time I wound up on the “bing” where my profession calls upon me to uphold the dignity of human life and I’m looking at someone who is now babbling incoherently, I’m working on treating him, assessing suicide risk, it’s a real dilemma.

I don’t believe that this practice could continue in its current form without the participation of health workers.

Healthcare workers, social workers who work in there, we are an integral part of this practice. We are not benign bystanders. I don’t believe that this practice could continue in its current form without the participation of health workers. I think we are in very sad shape ethically. I think it’s wrong. I know it’s wrong. It’s going to take a heightened awareness around this. It will take the National Association of Social Workers (NASW), the American Psychological Association (APA) to address this. They need to take a stand. Acknowledge that 15 days is torture.

HR: Where is NASW in terms of a position on solitary confinement?

MB: I’m a member of Social Workers Against Solitary Confinement. The first thing we did was go to NASW to take a stand. They ignored us until our numbers increased and we kept pushing them. Then a man named Frederic Reamer who does work around the Code of Ethics [for NASW] said that when it comes to solitary confinement, NASW doesn’t take a stand. However, it’s their expectation that social workers conduct themselves in accordance with the Code of Ethics.

Well, that’s all well and good until you actually get in there. I know a social worker who spoke up about the way people with mental illness were being treated and she was bullied, mocked. There was no support from her supervisor. She looked to NASW and there was nothing.

As an individual you are powerless. As an employee of the jail or prison you have to pay rent, put food on the table. So how much noise are you going to make? At Rikers we did have some noisemakers. One of them, a physician assistant, wrote up an incident report with an honest appraisal of a person’s injuries that said the man was beaten by guards.

The warden told him, “You should no longer consider yourself safe in this jail.” That’s quite a statement for the warden to make and it means if there is a problem, the COs won’t come to your aid.

HR: Were you a noisemaker? Did you ever report an incident and then feel threatened by correctional staff?

MB: I overheard two officers talking and they wanted time off over the holidays. They were going to provoke a patient who was mentally ill, very fragile and potentially explosive, and create an incident. [Then] they could claim an injury and get time off.

I came in and said, “I can’t believe what I just heard you say. You’re going to deliberately do this to get time off of work for Christmas?” They said they were kidding, but they weren’t.

I saw retribution to people who pointed the finger and it was horrible.

I did make anonymous calls to the Board of Corrections if I was sure I wasn’t putting someone else in danger. If someone came to you with their teeth knocked out, telling you in the sanctity of the counseling session what happened to them, and you say, we have to report this, they [would] say, “No, it will only get worse.” It’s a very dangerous business to point a finger at your captor. I saw retribution to people who pointed the finger and it was horrible. How am I to speak to my own moral outrage and put a person in a position of potentially being killed? I can’t do that.

HR: What are your recommendations for social work students who want to work in correctional settings?

MB: Go for it if this something that calls you. But be aware going in that there are going to be a lot of ethical challenges. Align yourself with like minded people. Try to hold onto your values. Be aware of what’s going on on the outside. Know that there are organizations that are supporting change and try to plug into them.

HR: What ultimately made you resign?

MB: It was a slow process. When I started at Rikers I was a naive social work intern working with women. Like so many, I wanted to make a difference and I felt like I was. I was connecting with women, many around their drug addiction.

I left Rikers for a few years. When I came back I had an awareness that I didn’t have as a student. An awareness of the system, of bail, that people were innocent of the crimes they were charged with. And I learned that people won’t “get their day in court.” Your day in court could be years and years away and you’re expected to survive Rikers, to give up your family, everything.

It’s so easy to say, “I’ll never say I did something that I didn’t do.” It’s so easy to say that from a distance. But when you are in there and people are out to get you, you have to stay alive, survive. And I started to see what these people were up against. And all of my preconceived notions about our legal system started going out the window.

I was angry at what the hell was going on, balanced with the good that I was doing in my groups with women who had HIV and with gang members. Really some beautiful and wonderful people who needed to be heard. There were some beautiful moments but there was this growing anger anD the scales started to tip.

I thought my promotion to assistant chief was going to get me off the frontlines. I was burned out, but not ready to leave. Then I became the acting chief in the solitary confinement unit. That was a horror. It reached the point where I didn’t think I was contributing anything good, that I had simply become a cog in the wheel.

In social settings, my mind would drift to a horror scene in the jail.

I left. But I was determined not to forget, and if it took me the rest of my life, I’m going to tell the story as best as I could. When I started writing the book there was no publicity about Rikers Island. It was during the time that Giuliani was mayor. I was so discouraged. [But] I got an op-ed published in the Washington Post on solitary confinement, and the New York Times did a story on Rikers, on the brutality there, that validated what I was trying to say. It was about a 10-year process to get the book published. It’s everything to me.

I was chain-smoking when I worked at Rikers, and when I left I was able to stop completely. In social settings, my mind would drift to a horror scene in the jail while people were talking. I would think that what they were discussing was so trite. How can they be talking about taking a vacation in Florida when we have this inhumanity of solitary confinement that no one understands the scope of?

Photo of Rikers Island via Wikimedia Commons

Photos of Mary Buser by Helen Redmond