Sunday, July 6, 2014

What Pennsatucky’s #Teeth Tell Us About Class in America | #FreeDentalCareforAll Incl in Expanded & Improved #Medicare4All #VoteGreen!

I know she is supposed to be a cross between a villain and comic relief, but Tiffany “Pennsatucky” Doggett is my favorite character to watch this season on Orange is the New Black. For those (few) who have not watched the series, Tiffany is a caricature of an ignorant/hillbilly/Jesus freak/meth head. In the first season, we saw her provoke and eventually fight Piper, the attractive, articulate protagonist and author of the memoir on which the series is based.
In the midst of a prison culture formally and informally divided by race, Tiffany embodies an equally powerful yet rarely discussed social divide: class. In the first season, we learn that Tiffany wound up in prison after going to a women’s clinic for her fifth abortion and deciding to shoot a nurse she who makes a condescending, classist remark. She’s surprised to find herself embraced by the right-to-life movement as a hero and spends most of season one as a wanna-be religious leader whose  cluelessness is a constant punch line. She isn’t cute or funny or even a font of homespun southern wisdom. Though white, she has nothing in common with most of the other white women: Machiavellian Alex, gender-savvy Nicky, hip Sister Jane, the peacenik Yoga Jones, or even Russian entrepreneur Red, all of whom are presented as smart, literate women who are capable of scheming to improve their lot in life. Tiffany doesn’t even fit in with Morello, a none-too-bright white woman with a working-class accent who lives in a fantasy world of romance and Hollywood magazines. 
The producers of the series provide viewers a clear visual cue of the class divide: The first time Pennsatucky opens her mouth we see a hideous display of broken and missing teeth. More than any other marker in America, teeth indicate class status. Perfectly white and straight teeth—the kind we see on celebrities—belong to the super rich who can afford costly cosmetic dentistry. Nicely aligned and healthy teeth are the sign of professional and upper middle class individuals who can afford regular dental care and basic orthodontia. Crooked teeth with delayed root canal work and a few crowns means the mouth belongs to a middle-or-working- class individual who has access to basic dental care but nothing fancy. And rotted teeth, like those Tiffany and her friends sport, mark the women as poor—a status with both economic and moral meaning. As I’ve been told countless times by Americans who do not earn enough to scrape by, being too poor to have respectable teeth is like wearing an “L” for loser on your face. 
pennsatucky with broken and missing teeth
Pennsatucky cries with joy as she heads in a prison van to get a set of new dentures. 
As a sociologist, I work with women who have experienced poverty and incarceration. And while I don’t know anyone quite like Pennsatucky,  I do know Joy. Raised in a middle-class family, she began to struggle with substance abuse in the wake of ongoing sexual abuse at the hands of a family “friend.” By her early thirties, she had spent over a decade in and out of substance abuse treatment, psychiatric hospitals, the streets, shelters, and jails. I first met her in a rehab program where she looked well groomed and nicely dressed. When I asked her how she’s managed to survive all that she’d been through she told me, “I take care of myself. Even when I don’t have a place to live, I go into the restroom at Burger King and brush my teeth.” A few years later Joy and I chatted about what she is most proud of having accomplished recently: “Going to the [drug treatment] program, attempting to get better, taking care of myself—brushing my teeth even though I don’t have running water in my apartment.” A few months later she called me in tears. She had gone to the dentist and was told that she has seven cavities but that she couldn’t get them filled for another six months because she had maxed out her dental coverage under Medicaid. “By then I’ll have to have my teeth pulled. I used to say bad things about people with no teeth and now I’m going to be one of them,” she said. In short, Joy realized that by losing her teeth she would be losing her class status. 
On Downton Abbey and other BBC period shows, we easily discern the different accents, even dialects, of upper and lower classes. On Orange is the New Black, as in real life in America, access to healthcare remains a class indicator. Rotten teeth are hard to hide. Tooth decay is embarrassing. It signifies that supremely unforgivable character trait: not taking care of oneself—a particularly serious flaw in women, who are expected to look attractive. Several women I know cover their mouths when they speak or chew, and never, ever laugh—they don’t want anyone to see their teeth.
Many of us assume that rotten teeth are volitional—that if someone had just brushed and flossed then they’d have nice teeth. But it’s not that simple. Though teeth are part of our bodies, health care programs treat them as an afterthought. Dental health is not covered by standard health insurance and Medicare has no dental benefits, so about half of Americans don’t have dental insurance. In recent years, the cost of dental care has been increasing faster than the cost of other medical care. There’s also an urban/rural divide on access to dentists: 45 million Americans live in communities where there is a serious lack of dentists. 

 Infographic from the Pew Charitable Trusts
Tooth decay also signifies drug use, especially the “low class” drugs—crack cocaine (Joy’s drug of choice) and crystal meth (Tiffany’s drug). As the national panic shifted from crack to crank (meth), the “faces of meth” became poor white faces with rotted teeth, often attached to stories of women who neglected or endangered their children in their lust for the drug. For women, missing teeth also signifies being a victim of domestic abuse, and while we Americans pity victims, we also blame them for not being brave or strong or smart enough to get away from their abusers. More broadly, on one side of the class divide are those with normatively attractive bodies, respectable educational achievements and decent jobs. On the other side are those whose poor teeth and other “defects” are read as signs that they are incapable of managing their own lives.
pennsatucky with straight, white teeth
 Pennsatucky starts smiling at everyone when she returns with her brand-new teeth.
Like her or hate her, Tiffany scores a victory over the system during the second season when the prison has to pay for a full, beautiful, functioning set of dentures to replace her few remaining rotting teeth. (Sadly, that’s probably not what would really happen: I’ve never heard of anyone getting good dental care in prison. Quite the opposite—women often lose teeth in prison.) When she gets her new teeth, she’s visibly changed. Her lower-class white friends in prison start to think of her as annoying as she shows off her new pearly whites. Two her old friends accuse her of acting as if she is too good for them now. But in an era in which class divisions are increasingly permanent and uncrossable, shiny dentures are not enough to allow her access into the middle-class white clique that includes Piper and Nicky, women whose straight, even teeth are their own.  If we on the left really want to reach across class lines, we should seriously consider making “Free Dental Care for All” our rallying cry.
Susan Sered, author of Uninsured in America: Life and Death in the Land of Opportunity, is Professor of Sociology at Suffolk University. Follow her blog at