Psychiatric Care

History

Psychiatric care for prisoners can be traced back to at least the 19th century. As the number of prisoners increased, new systems of categorization and management were introduced to aid in their management. Convicts deemed to be “mad” were seen as disruptive and threatening to the good running of the institution. Attempts were therefore made to separate them out from the general population. “Alienists,” or nascent psychiatrists, claimed special expertise in their ability to identify a new category: criminal lunatics or the criminally insane. While this helped to extend the power of psychiatrists into the legal domain, the actual care provided to this population [Page 787]was quite limited and problematic. Fundamentally, there was a philosophical contradiction between criminality, implying responsibility for one's action, and lunacy, suggesting a loss of reason and therefore absence of responsibility. This conundrum meant that opinion varied as to whether criminal lunatics should be punished or treated.

Regarded as troublesome by both prison wardens and asylum keepers, “criminal lunatics” were often shunted between prisons and asylums or kept in separate temporary, makeshift, and hazardous quarters within prisons and asylums. Many feared that inmates feigned madness in order to escape the harshness of prison. At the same time, there was concern that brutal prison conditions created madness. Some of these problems appeared to be solved with the creation of purpose-built institutions for the “criminally insane.” However, many prisoners considered to be mentally ill were not admitted to these establishments. Furthermore, institutions for the criminally insane were plagued by an overriding concern with security that often undermined treatment attempts. Even when treatment was administered, it was often invasive and potentially harmful. Common therapies for the treatment of madness included blood-letting, leeching, purging, vomiting, and restraint.

The Rehabilitative Ideal

During the 20th century, psychiatry grew in power and influence. Following World War II, it appeared to offer a way out of the impasse created by mentally disordered offenders by suggesting that all prisoners suffered from an illness that caused them to commit crimes. As such, many argued that prisoners should be treated or cared for through different psychiatric and/or psychological interventions rather than be punished. This view, referred to as the “medical model” of crime, became institutionalized through the rehabilitative ideal that was introduced into prison policy and practice during the 1950s.

A wide array of psychiatric interventions were used with the prison populations, including drug therapy, individual and group counseling, therapeutic communities, conditioning, psychosurgery, and electroconvulsive treatment. Experiments with mind-altering drugs, such as LSD, were also conducted inside U.S. and Canadian prisons. Some of these were undertaken for the Central Intelligence Agency with the purpose of developing mind-control technology. Many of these practices were condemned as harmful and ineffective. Critics further argued that the dangers imposed by psychiatric practice were masked by claims that it was scientific and benevolent. These concerns contributed toward the withdrawal of some forms of psychiatric treatment and the larger decline of the rehabilitative ideal in prisons. Skepticism toward psychiatric care within prisons reflected a broader anti-psychiatry movement that likened much of psychiatric care to cruel and unusual punishment. Indeed, according to this view, psychiatric care is an oxymoron.

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