When they aren’t hurling ableist slurs at one another, it seems the only thing all sides of the U.S. political spectrum agree on is that we need more mental health care. This comes up especially after mass shootings, even when the shooter’s stated motivation was white supremacy, misogyny, etc. Madness is used as a scapegoat so no one has to confront the structures that create violence.
This is old news. The troubling part, however, is that prison reformers and even some prison abolitionists have allied themselves with this establishment talking point. The argument is that defunding prisons and shifting money into mental health services is a step toward decarceration and a society that no longer needs prisons.
This is true. But in my experience, many people advocating this solution are neurotypical and have not experienced the potential violence of the mental health system, or have only interacted with it as a relatively privileged person seeking therapy and antidepressants. For people who have more severe disabilities or come from marginalized communities, the mental health system can be much different.
I should start by saying of course I would rather take as many people as possible out of prisons and build more mental health clinics. The mental health system does a lot of good for a lot of people. It has kept people alive. My fear is that mental health care is being uncritically heralded as the solution without an accompanying call to radically transform it as well. The system is, first and foremost, a business controlled by for-profit corporations and neurotypical academics who are eager to “fix” us so we can go back to being productive workers in their shitty economy. Like prisons, the overall goal of the mental health industrial complex is to preserve the status quo of capitalism and oppression.
Unlike prisons, however, there are aspects of the mental health system that are worth keeping. I am not interested in entertaining the notion that mental illness or psychiatric disabilities do not exist or are merely fabrications of pharmaceutical companies. These experiences are real. Whether they are caused by trauma or genetics or both, they can be painful and even fatal. It is clear that many mental illnesses are actually healthy responses to an extraordinarily violent world, while others are forms of neurovariance that are just part of the complicated, beautiful, dangerous range of human experiences. I do not agree with aspects of the anti-psychiatry movements who would take away access to services such as hospitals, medication, or therapy which are vital to many people, including me. But we must not let this stop us from understanding and critiquing the ableist, racist, homo/transphobic, and misogynist history of the mental health system.
We need to understand that eliminating poverty, white supremacy, and other forms of oppression should be our priority and not let the ruling class distract us with empty promises to expand access to a broken mental health system. As we work toward a world without prisons, we also need to transform how our society treats trauma survivors, extreme emotions, and disabling conditions that are currently marked as mental illness.
I’m writing this because I want other abolitionists to learn about oppressed people’s experiences with the mental health system, the overlapping history of mental health care and prisons, and why mad liberation is indispensable to prison abolition.
Involuntary Commitment: How Prisons Replaced Mental Hospitals
A lot of people, including social workers and friends of people with psychiatric disabilities, believe hospitalizing someone is a more compassionate alternative to calling police. However, in addition to the fact that police will show up if you call an ambulance anyway, conditions within hospitals can feel a lot like jail and are extremely triggering for some people. It is important not to judge a person who calls upon this structure for support when community-based solutions fail or do not exist. Unfortunately, it is the only option many people have. And it is unquestionably better to trust hospitals over armed cops. Many people even have positive and beneficial experiences in hospitals.
But this is not always true. Historically, patients have not been allowed to contact friends and family, have had their possessions taken from them, been forcibly medicated, and put on a structured schedule dictating where, when, and how they eat and sleep. Thanks to tireless organizing and social change, much of this has improved – in some places and for some people.
As early as the 1620s, inmates of lunatic asylums were organizing for better treatment. Since the 1960s, organizing by psychiatry survivors and service users has escalated. Groups such as the Mental Patients Unions, the Mental Patient Liberation Front, Reclaim Bedlam, Mad Pride, and the Icarus Project have sought to create change in the system while building radical alternatives such as peer and community based support networks based on harm reduction. The movement has not always agreed on whether to reject the whole of psychiatry or to view it as a system we must engage with selectively and critically, but we are bound together by a shared desire to fight for our communities.
Yet, in spite of these efforts, all of these practices still occur. Policies vary from place to place and from hospital to hospital. What is written on paper is not always practiced by hospital staff, many of whom are underpaid, overworked, and traumatized themselves. The experience can be especially difficult for immigrants, people of color, poor people, and trans people.
Anyone can involuntarily (“civil”) commit a disabled person without even the pretense of proving we broke a law. All they need to do is convince a judge we might hurt ourselves or others. Neurotypical cops and abusers have used this tactic to harm people because they know judges and doctors will believe them over a diagnosed raving lunatic. The presence of self-inflicted bruises, burns, or cuts – things some people use to cope with emotional pain that can actually help prevent suicide – can be used as evidence that we need to be treated against our will. While there are usually periodic reviews by a judge, this detention can theoretically be extended in some places indefinitely.
Long-term forced commitment is currently rare in the U.S. except in cases where someone has been sentenced for a violent crime or has been ruled not guilty by reason of insanity. This is mostly because there are so few psychiatric beds left. From the 1970s on, most mental hospitals were closed during what was touted as “deinstitutionalization” and widely viewed as a progressive reform.
At the same time, the government began cutting welfare and initiated the drug war and mass incarceration. People who had previously been locked up in mental hospitals were now put out on the street with no social safety net. The ones who were unable to work stayed homeless. Many were (and are) arrested for vagrancy, self-medicating with criminalized substances, hustling to stay alive, or quality of life crimes such as sleeping in public.
Austerity policies only made the situation worse. The process for getting on Social Security income is long, complicated, often inaccessible, and requires that you adhere to prescribed medical regimes. In Illinois and most other places, there is only a handful of housing set aside for people with psychiatric disabilities and the waitlists can be years long. Against direct action and protest by service users, Chicago’s Mayor Rahm Emanuel closed six out of twelve public mental health clinics in 2012. Community centers, food pantries, and educational programs are disappearing because of the Governor and state legislature’s refusal to pass a budget since last year. Politicians on all sides have consistently refused to raise taxes on the wealthy to pay for services for poor and crazy people.
People have effectively been moved from psych wards into prisons on a massive scale. In some cases, large psychiatrist institutions like Ionia State Hospital in Michigan were literally turned into prisons. Some estimates show over half the male prison population and 73% of incarcerated women have a psychiatric disability. The National Alliance on Mental Illness has estimated up to 40% of people with psychiatric disabilities in the U.S. will be incarcerated at some point. Up to half of fatal police shootings in the U.S. involve an emotional crisis or altered state. All of these outcomes are more likely if you are trans, working class, or a person of color.
Further blurring the line between incarceration and mental health care, the Cook County Sheriff has said Chicago’s jail is the largest mental health provider in the United States and has begun training guards to double as social workers and nurses.
The Creation of the Two-tiered Mental Health System
The mental health system in the U.S. as it now exists looks like this: Corporations use mass advertising to convince ever-increasing numbers of neurotypical people they are ill and need drugs for common responses to stress and grief. Privileged people who can afford a nice therapist and don’t have to worry about confronting transphobia, racism, sexism, or ableism when they meet with psychiatrists will probably be treated well and then given some meds that have about the same efficacy rate as placebos. In the process, psychiatrists, therapists, and pharmaceutical companies make a lot of money.
On the other hand, poor people, undocumented people, and people with more severe disabilities are largely ignored and unable to access resources until we are in crisis, at which point too often our only option is to go to an emergency room. At the ER, doctors may tell us there is nothing wrong, it’s all in our head, and discharge us with a massive bill. Or, they might pump us full of antipsychotics and tranquilizers for three days before rushing us back out because they don’t have enough funding to keep us. Hospitalization has kept many people I know alive. But either way, once discharged we end up back with the same poverty, homelessness, violence, and threat of incarceration that probably led to the crisis in the first place. And a massive bill.
There are only two other ways we can get treatment. One is to go to prison. The other is public health insurance. If we are lucky enough to be eligible for Medicaid, reside in a state where it covers mental health services, and live within transportation distance from a clinic that accepts it, we might be able to find care. Many people have experienced mental health providers and staff at clinics for low-income populations to be rude and indifferent. My psychiatrists have routinely shown up to our appointments an hour late. Almost all of the psychiatrists I have ever met have been condescending, sexist, and transphobic. I have even been subjected to hour long investigations of my gender, genitalia, and how, why, and with whom I have sex.
Psychiatrists generally assume I could never understand myself because I am crazy and thus have disregarded almost everything I have said. When I have complained of physical illnesses or pain, I have been told by countless doctors and psychiatrists that it’s psychosomatic (and maybe it is, but its still fuckin real) and all have refused to treat it. Even requests for benign migraine pills that cause no euphoria have led doctors to put “drug-seeking behavior” on my chart and therefore cut off access to a wide variety of resources that might be helpful. This is infuriating because chronic pain, fainting, migraines, and stomachaches are commonly associated with Complex Post-Traumatic Stress Disorder, a condition caused by prolonged confinement, torture, child abuse, and domestic violence. It makes no sense that psychiatrists treat mental and physical illnesses as mutually exclusive.
The ways in which psychiatrists pick a diagnosis from a list of categories based mostly on messy clusters of symptoms has also been documented for its racism and sexism. If you’re a woman, you’re more likely to be diagnosed bipolar or borderline. If you’re Black, you’re more likely to get schizophrenia. Whether we are born with our disabilities or acquire them, the structural realities that make our lives harder are almost always ignored in favor of pathologizing our bodies.
After all this, I started a seven year long search for the right medication. Because they have no idea why any of their meds work, I have been cycled through toxic substances that have given me rashes, wrecked my memory and cognitive functioning, and made me sleepy all the time. They might even kill me or give me lifelong disabilities that are worse than the ones I started with. Statistically, people with experiences commonly called bipolar or borderline are misdiagnosed several times and given treatments that can make us worse, such as antidepressants or stimulants.
These experiences are widespread and typical. Many of us give up at this point. I did, for years. Compliance rates are extremely low for people with “severe” psychiatric disabilities not because we don’t know what’s best for us but because it’s usually not best for us. Not to mention, for people who are un- or underinsured, these medicines cost hundreds of dollars every month.
For people going through this, I do want to say that it might be worth waiting a month or two before giving up. At first many meds will make your symptoms worse, but unwanted effects may fade. It usually takes awhile for your body to adjust. It might take a long time to find the right one, but it also might be worth it. No medication, for any condition, is without side effects and dangers.
That said, we must unequivocally support the right of people to choose not to take meds, or to choose which meds they want. In addition to pressure, judgement, and victim blaming, if we refuse the meds they prescribe they often write “resistant client” on our chart and treat us even more like we don’t know what’s best for us. But, yes, if we are fortunate, we might eventually find a med (or a cocktail of them) that kind of helps make our lives a little bit easier enough that it outweighs the negative effects.
The Shared Histories of Psychiatry and Incarceration
Like prisons, the concept of mental health itself is steeped in histories of racism and patriarchy. Different forms of melancholia and lunacy (referring to our connection with the moon) had been documented for millennia, but early psychiatrists began to obsessively categorize what they understood as discreet illnesses. Their stated objective was to replace belief in magic, witchcraft, and possession with scientific rationalism and a disenchanted, mechanical understanding of the world. This was then applied in colonial contexts to attack indigenous and pagan worldviews.
Their ideology became unquestionable because it was the only logical one – despite the fact that the experiences they were attempting to describe are often irrational, spiritual, and emotional. Psychiatry and psychology have provided me with helpful frameworks for making sense of my experiences. Therapy and some meds have helped me out a lot. I don’t think everyone involved has malicious intentions. But it must not be allowed to assert itself as the only way to define our experiences. For example, my belief in visions and an inspirited world has been attributed to my psychosis, despite the fact that I am able to differentiate between them when I am not psychotic.
Pre-industrial and pre-colonial cultures varied in their views on neurovariant people, but sometimes people who experienced alternate realities or extreme emotions were viewed as having special wisdom, healing powers, and/or privileged contact with the spirit world. People in crisis could be treated with compassion and cared for collectively. Many indigenous nations continue to do so, but must contend with and resist dominant cultures – bolstered by psychiatry – that are hostile to these beliefs.
Early modern insane asylums such as London’s Bedlam, the first institution to specialize in mental health, were notorious dumping grounds for poor people. Some of the first mental health diagnoses included drapetomania, a condition that caused slaves to want to escape. Psychiatry proper was created in the late 19th century as a way to study hysteria, a condition that supposedly only affected women, and to prove it was a disease. Women, frequently sex workers, were literally exhibited as specimens on a stage. It wasn’t until later that psychiatrists decided to attempt to treat these conditions rather than merely document them.
Hysteria was famously explained by Freud as a disorder caused probably by deviant sexuality. It wasn’t until later that psychiatry realized many hysterical women were survivors of rape and abuse. The next major advance in understanding trauma came with the World Wars. For those who studied and treated shell shock, their only goal was to return men to the frontlines as quickly as possible. Eventually, they realized the condition afflicting some combat veterans was the same thing as hysteria and renamed it PTSD.
In the early 20th century, many psychiatrists endorsed eugenics, believing that “feeble minded” people should not be allowed to reproduce. By the middle of that century, mental hospitals routinely used nonconsensual treatments like electroconvulsive therapies that, while helpful for some, were also exceedingly dangerous. Homosexuality was officially listed as a mental illness until the 1960s, and being trans still is. As recently as the 1980s, gender nonconforming children were being admitted to psych hospitals by their abusive parents where they were forced to become more feminine or masculine.
Since the late 20th century, the unbalanced brain chemistry theory of mental illness has become increasingly favored over older psychoanalytical explanations, thus birthing the alliance between psychiatry and pharmaceuticals to form the mental health industry we now have. Thanks in part to feminist psychology, this theory has been refined to acknowledge the complex interplay between biology/neurology, the social environment, and individual psychological experiences – but the dominance of corporations has only become more entrenched. In many cases, providers are paid by pharma companies in the form of gifts and speaking engagements.
Over the years, the mental health industry has ignored their own role in the arbitrary construction of mental illness as a framework for understanding our experiences. They often ignore the trauma, abuse, and oppression which create many of these disabilities. And they often ignore the racism, sexism, ableism, and transphobia that informs the system in which they work and which they are upholding. To call upon such a system as a way to fix violence or as an alternative to prison is counterproductive. Mental health care, like prison, is currently a system that enables the ruling class to shift away from systemic problems and into blaming faulty individuals.
Now, private prison companies are seeing prison populations slowly begin to decline and are hedging their bets by investing in mental health treatment facilities. If this doesn’t make it clear that prison abolition and mad liberation are linked, I don’t know what will. Just as we need to replace prisons with non-punitive restorative justice models, we need to tear down existing healthcare structures and rebuild them from the bottom up. We need to get rid of the idea of mental health altogether and treat health holistically. We need to acknowledge that we will never be free or healthy until we demolish ableism and build a culture that nourishes us, respects neurodiversity, doesn’t treat altered states of consciousness as inherently pathological, and doesn’t measure health in terms of productivity.
Psychiatry survivors have already been organizing for decades to end compulsory treatment and hospitalization, for the right to know the effects of the drugs we are put on, for affordable housing and welfare, for better living conditions and the end of solitary confinement within psychiatric hospitals, and much more. Our struggle is your struggle. Prison abolition is mad liberation. Mad liberation is prison abolition.