The big news coming out of Los Angeles County – the county with the largest number of incarcerated people in the country – is the approval of a plan to replace an overcrowded, decaying jail with a correctional center that provides care for  incarcerated men suffering from mental illnesses and substance abuse. The plan includes a $1.9 billion proposal to tear down Men’s Central Jail and construct a 4,885-bed “Consolidated Correctional Treatment Facility”. The proposal also calls for “upgrading” the Mira Loma Detention Center in Lancaster into a 1,040-bed facility for women. Altogether, these proposals would add about 1,000 beds to the county’s jail system, bringing the total to just over 21,000.

No doubt about it – the jail that many consider to be one of the worst in the country – needs to come down. No one has anything good to say about the Los Angeles County Men’s Central Jail – a facility known for its abhorrent conditions and rampant violence. However, replacing a “jail” with a “correctional treatment facility” is, at best, a cosmetic change. At worst, it sets the stage for rebranding individuals who have been drawn into the correctional system from “offenders” (that is, people who did bad things) to “sick” (that is, people who are a bad thing.)

“Treatment” certainly sounds more benevolent than “punishment.” And it certainly is the case that the overwhelming majority of people serving time in U.S. jails and prisons suffer from physical and mental health challenges. Around the country incarcerated men and women have higher rates of hypertension, anxiety, myocardial infarction, psychotic episodes, asthma, arthritis, major depression, cervical cancer, urinary tract infections, chronic headaches, tuberculosis and hepatitis, than Americans in the general population.

I acknowledge that we are holistic beings whose physical, emotional, mental and spiritual lives are, on a deep level, one and the same. But, just for now, let’s bracket that deep epistemological insight and ask: Why the newfound public attention to mental illness – a vague, subjective and stigmatized category, rather than physical illness – far more concrete, less stigmatized, and usually more treatable. Why the sudden surge of interest in mental health treatment for criminalized Americans?

Over past year or so we have reached a tipping point regarding mass incarceration. In the current mid-term elections, every single candidate I have heard has spoken about the need for “prison reform” (a vague idea that typically centers on getting “treatment” for the many mentally ill prisoners.) That we’ve reached this point reflects the hard work of anti-incarceration and human rights activists, the inability of states and counties to afford the economic cost of incarceration, the cumulative numbers of people impacted by decades of mass incarceration making it harder for “average” Americans to see so-called criminals as “Other” (my guess is that by now most Americans personally know someone who has been locked up on a minor charge because of “tough on crime” policies), and perhaps simply the usual waxing and waning of the popularity of public policies.

But I think that there is another factor at work here. Redefining criminalized Americans as mentally ill resonates with deeply rooted ideas regarding sin: That deviant behaviors and identities are manifestations of core personal flaws. The fluidity of “criminal,” “sinful,” and “mentally ill” classifications in the United States are clearly seen in the rebranding of homosexual desire from sin to criminal to mental illness over the course of a single century. That is far from the only example of this sort of fluidity. Psychoactive drug use has been labeled a Christian sin (most clearly in the case of Native American religion), a crime (and indeed the largest driver of mass incarceration today), and an illness (according to the American Psychiatric Association, American Psychological Association and virtually all psychotherapeutic authorities.)

How particular identities or practices are branded drives how those who are associated with those identities or practices are treated. And, on the face of it, we’d assume that those who are categorized as “ill” will be treated better than those who are categorized as “sinful” or “criminal.”

So here is where I want to push back a bit. It seems to me that sinners – in normative American Christian understandings — can be “reborn” and their sins can be washed away. Criminals (in theory) can “serve their time,” “pay their dues to society,” and be “rehabilitated.” Those who are classified as mentally ill, however, are diagnosed with a chronic – that is, incurable – condition. Medication can help control the symptoms, but if the individual ceases to be compliant with doctor’s orders, that person will relapse – the mental illness that was suppressed by treatment will reemerge. Rhetoric about not blaming the mentally ill for their mental illness (after all, it’s biological, chemical or genetic) is a two edged sword. As the women’s movement has long argued, excusing groups of people from the responsibilities of civic life because of inherent weakness ultimately serves to disempower. You cannot control what you cannot control.
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The 1962 book / 1975 film One Flew Over the Cuckoo’s Nest dramatized the growing awareness that locking hundreds of thousands of people up – often permanently – in state mental and prison hospitals was a bad thing to do. The deinstitutionalization movement (correctly) contended that mentally ill Americans deserve the same rights as all Americans. In its view that an individual should not be defined and limited solely by one overdetermined trait (color, gender, health status) it was part of broader civil rights movement of the 1960s and 1970s.

Of course, as is now the case in the Los Angeles County decision, the human rights impetus for deinstitutionalization was combined with economic motives (keeping people in state hospitals for decades costs more than outpatient treatment in the community.) But the shocking message in One Flew Over the Cuckoo’s Nest was unambiguous: Randle Patrick McMurphy (Jack Nicholson in the film) thought he was beating the system by getting himself transferred from prison to a mental hospital. In the end, the system beat him: Medication, electric shock therapy, and then the final scenes of the book and film portray the once feisty Randle reduced to a lobotomized shell of a human being.

The deinstitutionalization movement was, on the face of it, successful: State mental hospitals around the country closed down. I qualify the success because we now know that rather than deinstitutionalizing we actually transinstitutionalized – moving marginalized and unwanted populations from mental hospitals to homeless shelters to prisons. When I read the news out of Los Angeles I can’t help but wonder if the proposed more “humane” treatment facility is simply the wheel coming full turn.

My concern is this: Even with all the best of intentions, when massive numbers of people are classified as mentally ill and locked up in “treatment” facilities, we set into place a landscape that circumvents basic rights to due process and precise sentencing in courts of law. The doctor’s expert word trumps the rights of prisoners to fair hearings held on a level playing field in which the opposing agendas of the prosecution and the defense are, in theory if not in practice, clearly defined. (Plea bargaining, normative throughout the system, obscures and may even eliminate that clarity.)

I worry that rebranding from “offender” to “sick” encourages the proliferation of psychiatric medication to be used as chemical restraints (less visible but no less repressive than physical restraints.) When I visit my friends in prison in Massachusetts I am struck by three things: That the prison officials really believe that most of the women in their custody are mentally ill and need help, that most of the women share that assessment, and that around half of women inmates are on psychiatric medication. How can one participate effectively in one’s own defense, much less participate in organized resistance, when under the influence of cocktails sedatives and antipsychotic medication? And how can one identify the social forces that drive mass incarceration when one is led to believe that her problems lie within her own damaged psyche?

Most of the criminalized women I know were sexually abused and living in poverty before being sent to prison. And yes, they are miserable a great deal of the time, proclaim that they use drugs to “self-medicate,” and often describe themselves as “screwed up.” But when, even with the best of intentions, we define their suffering in terms of mental illness then we stop thinking about human rights or criminological social conditions. We draw attention away from real issues such as gun control (in the wake of each horrible school shooting the national consensus seems to be that the “solution” is better mental health diagnosis and treatment; we have not yet passed meaningful gun control legislation.) We disregard the fact that prison in and of itself causes mental and emotional distress that leaves lasting scars on ex-inmates. And, given the gross overrepresentation of people of color in America’s jails and prisons, we risk adding “insane” to the long list of incurable flaws assigned to Black and Brown Americans by White America.

If you found this post interesting, you might want to read this: Civil Commitment: If You Build It They Will Come