Why prisons are not “The New Asylums”
| Published date | 01 July 2017 |
| DOI | 10.1177/1462474517704852 |
| Date | 01 July 2017 |
| Subject Matter | Articles |
Article
Punishment & Society
2017, Vol. 19(3) 272–289
! The Author(s) 2017
Why prisons are not
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‘‘The New Asylums’’
DOI: 10.1177/1462474517704852
journals.sagepub.com/home/pun
Liat Ben-Moshe
University of Toledo, USA
Abstract
This paper will offer an antidote to the axiom that jails and prisons are becoming
‘‘the new asylums’’ in the U.S. Without disregarding the reality of having dispropor-
tioned numbers of people with disabilities (psychiatric, cognitive, learning disabilities in
particular) in jails and prisons, I will caution against declarations that prisons are
becoming ‘‘the new asylums’’ in the U.S. and offer a more nuanced explanation that
incorporates perspectives from those critiquing incarceration, institutionalization and
psychiatry to shed new light on the connections between incarceration and deinstitu-
tionalization at present and in the past. The claims that post-deinstitutionalization
people with psychiatric disabilities were ‘‘abandoned to their fate’’ and re-incarcerated
in jails and prisons via being homeless will be critically examined. While doing so, I will
also discuss the processes of disablement inherent in prisons and in being housing
insecure.
Keywords
deinstitutionalization, disability, homeless, mental illness, prison
In a recent editorial of the Journal of the American Medical Association
(Sisti, Segal and Emanuel, 2015), three renowned bioethicists called for ‘‘a return
to the asylum’’ following what has become familiar logic: citing statistics of the
number of mentally ill in prison; claiming that jails and prisons are becoming the
new asylums; that they are largest mental health facilities in the U.S. in the absence
of psychiatric hospitals; stating that deinstitutionalization failed and led to people
being homeless and funneled into the criminal justice system, and therefore the only
way to correct it is to reinstate psychiatric hospitals. The first author of the article
(Sisti) then re-appears in a New York Times forum in 2016 about ‘‘the mentally ill
Corresponding author:
Liat Ben-Moshe, University of Toledo, 2801 Bancroft st. (MS 920), Toledo, OH 43606, USA.
Email: liat.benmoshe@utoledo.edu
Ben-Moshe
273
in prison’’, reinstating these same claims (Sisti, 2016). I will refer to these set of
claims as ‘‘the new asylums’’ thesis.
Why are we still discussing deinstitutionalization of psychiatric hospitals in
2016, decades after its heyday? Why is it taken for granted that deinstitution-
alization is relevant to an analysis of the current phenomenon of mass incar-
ceration? And why are there so many people with mental health differences
behind bars currently, if not for deinstitutionalization? I will set to answer
these questions by returning to the era in which ‘‘the new asylum’’ thesis first
arose, the end of the 1970s and into the 1980s. My aim is to interrogate and
destabilize the seemingly neat connections that are being drawn between deinsti-
tutionalization, homelessness and imprisonment. The second analytical aim is to
reveal why these counter-hegemonic readings, which I offer here, did not gain
traction – because of the erasure of the socio-political benefits of maintaining
the ‘‘new asylum’’ thesis.
I will offer a three-part analysis of the hegemonic narrative equation ‘‘deinsti-
tutionalization ! homelessness ! imprisonment,’’ which I shorthand as the ‘‘new
asylums’’ thesis. The construction of the ‘‘homeless mentally ill’’ in social science
literature and the medicalization of the phenomenon of homelessness will provide
the core of interrogating the ‘‘deinstitutionalization ! homelessness’’ nexus. I will
then briefly discuss the criminalization of housing insecurity to further explain the
nexus of ‘‘homelessness ! imprisonment.’’ Lastly, I will provide alternative
explanations to the phenomenon of the ‘‘mentally ill’’ in prison, which will address
the deinstitutionalization ! imprisonment trajectory. Here, I will offer a counter
hegemonic argument showcasing the disabling effects of imprisonment as well as
the lack of mental health treatment while incarcerated. I will end the paper with a
discussion of why this analysis matters in our current moment.
‘‘The New Asylums’’
To untie the Gordian knot between imprisonment, deinstitutionalization of psy-
chiatric hospitals and homelessness, I will bookend this paper with scenes from the
2005 PBS Frontline documentary appropriately titled ‘‘The New Asylums,’’ pro-
duced and directed by Miri Navasky and Karen O’Connor. The documentary
showcases life behind bars for those with severe mental health difference in a
supermax prison in Ohio. I will begin with a discussion of the first scenes in the
film and end the paper with a discussion the disabling effects of incarceration and
mental health treatment behind bars as exemplified in the film.
The film opens with a collage of forthcoming vignettes with a grim voice-over
inquiring: ‘‘Why have American prisons become the new asylums?’’ Posing the
question already makes the case in the first few minutes of the film that indeed
prisons are the ‘‘new asylums’’ and the only question is how it came to be this
way. The first scene in the documentary introduces us to an African American
man in an ambulance being questioned by paramedics and police. Then the
274
Punishment & Society 19(3)
narrator informs us: ‘‘Scenes like this have become all too familiar throughout
America. As the nation’s psychiatric hospitals shut down, police departments
everywhere were left to handle the growing number of mentally ill on the
streets.’’ How did it come to this? Fred Cohen, prison mental health consultant
says:
Once you had hundreds of thousands of people leaving the mental hospitals, they
suddenly, obviously, didn’t become mentally healthy. They went to the streets, they
became homeless, and then they eventually began to cycle into the system that cannot
say no.
If you are watching this documentary online or reading the transcript, at this point
you are prompted to click on [What happened to mental hospitals?]. This link1
takes you to the aptly named page ‘‘Deinstitutionalization: A psychiatric ‘‘titanic.’’
It is an excerpt from Out of the Shadows: Confronting America’s Mental Illness
Crisis by psychiatrist E. Fuller Torrey. Torrey is the founder of the Treatment
Advocacy Center.2 The center supports the psychiatrization of those with mental
health differences and their hospitalization.
One does not even have to read the excerpt to understand the implications
embedded in the title of the piece (‘‘Deinstitutionalization: A psychiatric ‘‘titanic’’)
offered by PBS to its viewers as an answer to the question ‘‘What happened to
mental hospitals?’’ The juxtaposition of deinstitutionalization (as a disaster-like
event) and the scene of taking a person experiencing mental distress to jail solidify
for the viewer the main thesis – that the irresponsible closure of psychiatric hos-
pitals nationally led to massive homelessness and to a revolving door leading those
same populations to now be scooped up by criminal justice apparatuses. Precisely
because this narrative seems so common sense, it requires further scholarly exam-
ination as to how ‘‘the new asylums’’ became the prevailing discourse around
deinstitutionalization and imprisonment.
Throughout this paper, I complicate the answer many people give in relation to
the question of how did prisons become spaces of confinement for the so called
‘‘mentally ill.3’’ I suggest that deinstitutionalization could be characterized not only
as a process or an exodus of oppressed people outside the walls of institutions but
as a radical anti-segregationist philosophy (Ben-Moshe, 2011; 2013). It is not some-
thing that ‘‘happened’’ but an ideological shift in the way we react to difference
among us. The resistance to institutionalization and psychiatric hospitalization
arose from a broader social critique of medicalization and medical authority
(Conrad, 1992; Scheff, 1970; Smith, 1978), institutionalization (Goffman, 1968)
and
the
anti-psychiatry
and
consumer/survivor/ex-patients
movements
(Chamberlin, 1978; Chesler, 1972; Morrison, 2013; Szasz, 1961). Although these
ideological shifts did not solely bring about deinstitutionalization and the closure
of psychiatric hospitals, any significant decrease in institutionalized populations
would have been impossible without them.
Ben-Moshe
275
Untangling housing insecurity from deinstitutionalization
Although there are variations to this idea, the hegemonic story is that deinstitution-
alization led to ‘‘dumping people in the streets,’’ or to ‘‘mentally ill’’ people living in
the streets or in jail via being homeless. Deinstitutionalization of people who were
labeled as mentally ill began in 1950s onwards and resulted in massive closures
of psychiatric hospitals across the U.S. In 1955, the state mental health population
was 559,000, nearly as large on a per capita basis as the prison population today.
By 2000, it had fallen to below 100,000 (Gottschalk, 2010; Harcourt, 2011).
Although the heyday of deinstitutionalization is far behind us, I will focus in the
next few sections on the hegemonic discourse regarding the failure of deinstitution-
alization, which gained prominence in the early 1980s. I will therefore attend to
literature and studies that are written in or focus on this era. There were several
influential scholarly books decrying the failure of deinstitutionalization written at
that time or chronicling these times such as Dear and...
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