Psychiatry and the Politics of Incarceration: In the United States, Incarceration of Mentally Ill Persons Has Increased to the Levels of the 1840s

By Nasrallah, Henry A. | Current Psychiatry, October 2012 | Go to article overview

Psychiatry and the Politics of Incarceration: In the United States, Incarceration of Mentally Ill Persons Has Increased to the Levels of the 1840s


Nasrallah, Henry A., Current Psychiatry


I have always regarded the French saying "plus ca change, plus c'est la meme chose" (the more things change, the more they are the same) to be a quote for the ages. Nowhere is this truism more evident than in the fluctuations in incarceration of individuals with serious mental illness (SMI) in the United States and persecution of real and faux patients in certain regimes around the world

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A truly jarring 2010 report by E. Fuller Torrey et al (1) revealed the shocking deterioration and regression of the United States mental health system. In 2010, the percentage of persons with SMI in jails and prisons ballooned to the same as it was 170 years ago! The deplorable mistreatment of the mentally ill in 1840, due to pervasive ignorance, prompted legendary reformer Dorothea Dix to launch her historic campaign for a more humane (asylum-based) treatment of persons afflicted with severe mental disorders. How troubling it is that the iconic Dorothea Dix Hospital in Raleigh, NC was shuttered earlier this year! Built on >2,300 acres and eventually growing to 282 buildings (in 1974), housing approximately 3,000 patients cared for by >6,000 employees on 3 around-the-clock shifts, this institution was a revered symbol of the transition from unjust criminalization to humane medical treatment of the SMI population. All other states eventually established similar medical institutions to house, protect, and care for the severely mentally ill, even though no effective treatments were available until the serendipitous discovery that an anesthetic adjunctive agent, a phenothiazine called chlorpromazine, could miraculously suppress delusions, hallucinations, and bizarre behavior.

Throughout the 20th century, while patients with SMI in the United States were hospitalized instead of incarcerated, several despotic regimes abused the mentally ill or misused psychiatric institutions as proxies for prisons. The malevolent and criminal Nazi regime determined that mentally ill or mentally challenged individuals were "unworthy to live" and turned many psychiatric institutions into "killing centers" to "euthanize" persons with SMI with lethal injections, and later with carbon monoxide. Some psychiatrists and clergy raised objections but they were ignored or suppressed.

The totalitarian Soviet Union was notorious for abusing psychiatry by "diagnosing" political dissenters as "schizophrenic" and incarcerating them for life in psychiatric hospitals, which eventually were transformed into political prisons for those protesting the dictatorship of the Soviet regime. Other communist countries adopted a similar approach to silence dissenters and some reportedly still are doing this today. Regrettably, a regressive event took place in America, a paragon of freedom and social justice in the world. In 1983, 6.4% of prison inmates had SMI. This proportion almost tripled to 16% in 2010 and continues to grow steadily. This tragic deterioration is embodied in the following statistics from Torrey et al (1): today there are 300% more patients with SMI in jails and prisons than in hospitals around the United States. …

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