Prejean has become a leading American advocate for the abolition of the death penalty. Her campaign was initiated following her correspondence and visits that she maintained with two convicted murderers. She began this ministry in 1982. The first man was Elmo Patrick Sonnier, who was sentenced to death by electric chair. She visited Sonnier in prison and agreed to be his spiritual adviser in the months leading up to his execution. The second was Robert Lee Willie for whom she also served as spiritual adviser. Prejean gained insight into the minds of the convicted murderers, the process involved in executions, and the effects on the prison guards and other personnel. She became convinced that the state's use of the death penalty was morally wrong and began speaking out against capital punishment. At the same time, she founded Survive, an organization devoted to providing counseling to the families of victims of violence.
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The title of the book comes from a once-traditional phrase in American prisons to designate men who had been sentenced to death. They were held on what was known as death row and were deprived of most social contact and barred from work or participation in prison programs. Prior to the 1960s, when guards would lead a condemned man down the prison hallway, they would call out, "Dead man walking! Dead man walking here!" The origin of the phrase is unknown. It may have been to warn other staff or prisoners to let them know that they should be on their guard since a death row prisoner has nothing to lose and could be violent. It may also have been a kind of honorific declamation, to let other prisoners know that they should move out of the way, death row prisoners being seen as an elite within the prison system. Alternatively, the call may have been a stigma attached to the condemned man, to remind others within earshot not to touch him to avoid catching his bad luck. In any case, its symbolism is clear: the condemned prisoner, in the eyes of the law, was dead already.
The book was adapted as an opera of the same name, composed by Jake Heggie with a libretto by playwright Terrence McNally. It premiered at the San Francisco Opera in October 2000. The international premiere of the opera was in August 2003, in Adelaide. It has been produced in several other cities, including by the Union Avenue Opera in St. Louis, Missouri. In November 2019, Lyric Opera of Chicago will present their premiere of the opera.
