Psychiatric  Incarceration

Mental Health in


Prison is maddening. Being forced to live in a cage is deleterious to the body and mind. That this simple truism is not everywhere accepted is a sign of how successful this country's brutal notion of justice has been. According to this notion, it is only a travesty that so many "mentally ill" people happen to be locked up in prison. How much better it would be if they were in the proper type of enclosure is the implied alternative. This positivist position treats madness as something physical, really there regardless of circumstance, like a cut or a burn. This prevents them from seeing the obvious: being stuck in a cage, being exposed daily to violence and assault, being punished instead of heard, being deprived of intimacy and tenderness and sex all this can destroy one's sense of contentment, one's ability to cope with stress and think straight. Surely many pull through and persist through torturous conditions, but they shouldn't have to, and who can blame those who do not? It does not take an expert social scientist or criminologist to figure out why are there so many mad people in prison. In fact, there are good reasons the experts cannot see it. It is at all times easier to imagine that the crisis of "mental illness in prisons" is a case of misplacement, for it means that the United States will not have to reckon with the fact that it is an organized trauma-machine that systematically tortures and confines those most affected by its violence.

Psychiatric techniques are highly amendable to the prison environment. In fact, it seems unlikely that prisons could function as well as they do today without the widespread use of antipsychotics as a tool of tranquilization. This accords with how they were originally used in the asylum system as well. Today, COs are receiving training in trauma-centric care; some training manuals even concede that the majority of prisoners have experienced trauma or deprivation and that they would be unlikely to have ended up in prison without these factors. Remarkably, the belief that prisoners acted out of compulsion or in response to factors outside of their control does not convince prison wardens or politicians that continuing to lock them up is an unconscionable act of brutality, but rather that trauma-centric therapeutics could serve as a more reliable means of crowd management. Psychiatric knowledge and techniques do not threaten the prison-industrial complex; they have become crucial components of its structure. Anne E. Parsons has noted that, during efforts to close prisons, officials have even claimed that it would be cruel to decarcerate, because they offer needed psychiatric treatments. Psychiatrists, therapists, social workers, and clinical psychologists have long been embedded in the system and have yet to meaningfully contribute to alternatives to incarceration. At most, some have expressed professional frustration over jurisdictional control: we want the disturbed and depressives, you keep the violent thugs. But for the most part, professionals in these fields have been comfortable contributing their expertise to make the prisons function better. Perhaps this contribution arises out of the desire to ameliorate some suffering, but the experts have yet to commit themselves to changing the conditions that produce it. 

The focus on the mentally ill in prisons has the added effect of averting our gaze from the diverse sites of incarceration the psychiatrized formerly and currently find themselves in. Though we tend to talk about the rise of mass incarceration as a twentieth century phenomenon, the United States has depended on carceral solutions as the primary response to complex social problems at least since the mid 19th century. As Brandon Harcourt has demonstrated, if we use the number of people incarcerated in both prisons and asylums (not even including other enclosures) compared to the total population for an aggregate rate of incarceration, the US' story appears to be less one of the rise of imprisonment than of the continuity of incarceration as a strategy. The rate in the mid 1950s, when far more people were locked in asylums than in prisons, is not so far below the rate at the peak of mass incarceration. And many of the formerly incarcerated psychiatric patients did not experience freedom, but found themselves in new forms of captivity. The introduction of Social Security incentivized local authorities to shift the burden of the cost of treatment/confinement from the states to the federal government. This was supposed to support the creation and usage of innovative "community treatment centers," but this largely did not happen. Instead, many states treated nursing homes and group homes as mini-institutions. Other patients found themselves in and out of the old hospitals or of psychiatric wards of general hospitals, a process which also potentially inflated discharge rates, without making it clear that at least some individuals were being shuffled between different enclosures rather than truly living outside of institutions. 

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