The psychiatric survivor consumer movement doesn’t talk enough about prisons and mental health, but we need to. Our natural allies are community harm reduction organizers, restorative justice, and activism against the prison industrial complex.
Mainstream mental health advocates emphasize how lack of treatment ends up getting people in jail. This is partly right – and it’s hard to advocate for an end to abusive hospital care when many people can’t even get a hospital appointment in the first place. We need to push for voluntary community mental health care and an end to the War On Drugs, which drives imprisonment, alongside our challenge to the medical treatment model of drugs and labels. Focusing on force, drugs, and labeling alone is too narrow an agenda. Since prison is such an important issue, when we don’t talk about prison and criminal justice we undermine the reception of our message. We also risk missing the economic and race issues.
The disease model of mental illness gives great leverage in the politics of prison reform. If it’s a brain disease and illness like any other, then compassion and understanding are seen as necessary. Someone with a heart condition, advocates argue, wouldn’t be put under extreme prison conditions without treatment, so someone with a mental illness shouldn’t either.
Is a different strategy possible? Is there a way to talk about prisons, trauma, poverty, and oppression and get the same compassion as the brain disorders argument? Can we challenge the crazy-making abuse that prisons inflict on all prisoners, rather than just focusing on the labeled ones or getting vulnerable prisoners diagnosed and treated? Can we join with social justice activists working for prison reform and social justice?
Not if we’re trapped in a medical model of mental health — or if we’re tied to single-issue, non-profit driven activism. Both aren’t sound strategies. We need to be more honest about these complicated issues, including how interrupting prior medication treatment in prisons is a huge problem (a friend had this happen to him, you don’t want to get arrested then come off of anti-psychotics in prison cold turkey, it is a form of torture). We need to add the right to continue medications, with accurate harm reduction information about risks and alternatives, on our agenda. What we don’t need is to join narrow calls for expanded mental health treatment in prisons, or think that medications are the solution to people driven crazy by imprisonment. Prisons are the problem, not untreated mental illness in prison.
Terry Kupers’ work, including this essay How to Create Madness In Prisons, makes clear the role prison plays in creating traumatized, extreme states and madness. Given that prisoners are disproportionately poor people of color, and that poverty and racism drive people crazy, we need a social view of mental health, rather than a brain-disorder view, to understand the prisons issue.
In the era of mental asylums, when individuals suffering from serious mental illness were confined in large public psychiatric hospitals, institutional dynamics came under the spotlight. Erving Goffman, Thomas Scheff and other “sociologists of deviance” hypothesized that institutional dynamics had a big part in driving patients to regress into impotent and bizarre aggressive behaviours while clinicians were side-tracked into self-fulfilling biases in diagnostics. (1 Goffman E ,1962 Scheff T , 1966)
An example of their theory: A young man is brought to the asylum by family members who consider him “crazy,” he protests loudly that he is not crazy and in fact it is the parents who want him locked up who are actually the crazy ones, the psychiatrist interprets his increasingly loud protests as signs of the very mental illness being ascribed to him, he is involuntarily admitted to the asylum, as he realizes he is being deprived of his freedom his protests become louder and more desperate, the staff take his emotional protests as further evidence confirming the diagnosis of psychosis, he is placed on a locked ward and deprived of most familiar means of expressing himself, he does something irrational such as throwing a chair through a window in order to express his outrage over being deprived of his freedom, the staff are even more convinced of his “madness” and lock him in an isolation room with no clothes and no pens or writing materials, being even more incensed and more desperate to express himself he smears faeces on the wall of the isolation room and begins to write messages with his finger in the smears on the wall. Of course, Goffman and Scheff were very concerned about the self-fulfilling-prophecy aspect of the staff’s diagnostic process, and they warned poignantly that incremental denial of freedom to individuals within “total institutions,” whether they actually suffer from a bona fide mental illness or not, leads them inexorably to increasingly irrational and desperate attempts to maintain their dignity and express themselves….
The recipe for creating madness in our prisons is easy enough to explicate, one merely needs to identify the steps that were taken to reach the current state of affairs. Here is the recipe:
Begin by over-crowding the prisons with unprecedented numbers of drug-users and petty offenders, and make sentences longer across the board.
Dismantle many of the rehabilitation and education programs so prisoners are relatively idle.
Add to the mix a large number of prisoners suffering from serious mental illness.
Obstruct and restrict visiting, thus cutting prisoners off even more from the outside world.
Respond to the enlarging violence and psychosis by segregating a growing proportion of prisoners in isolative settings such as supermaximum security units.
Ignore the many traumas in the pre-incarceration histories of prisoners as well as traumas such as prison rape that take place inside the prisons.
Discount many cases of mental disorder as “malingering.” Label out-of-control prisoners “psychopaths.” Deny the “malingerers” and “psychopaths” mental health treatment and leave them warehoused in cells within supermaximum security units. Watch the recidivism rate rise and proclaim the rise a reflection of a new breed of incorrigible criminals and “superpredators.”
I will briefly discuss these successive steps to madness, starting with the massive prison crowding that began in the 1970’s and continued to swell prison populations exponentially until, just after the new millennium, the prison and jail population in the USA climbed to over 2 million – and it keeps on growing. There was convincing research at the time that prison crowding caused increased rates of violence, psychiatric breakdown and suicide in correctional facilities. (Paulus, McCain and Cox, 1978, Thornbury & Call, 1983) One had only to tour a prison to understand how violence and madness were bred by the crowding.