Recovery From Schizophrenia: Psychiatry And Political Economy

178 THE POLITICAL ECONOMY OF SCHIZOPHRENIAprisons in 1999 was more than 1.9 million, 45 and a modest estimate would allowthat six out of every hundred of these jail inmates and five out of every hundredprison inmates is suffering from schizophrenia. Thus, there may be as many as100,000 prisoners with schizophrenia in the US. But if only two per cent of the11.4 million US jail admissions a year 46 were suffering from schizophrenia, thenhundreds of thousands of people with schizophrenia spend some time behind barsannually (even allowing for the repeated admission of many).Under the ever-present threat of litigation, services for the mentally ill in USjails have improved in recent years. Intake screening to detect mental illness andcase management services for mentally ill inmates are now provided in four-fifthsof the jails in the country. 47 While conditions have improved, they are still oftendisgraceful. Large jails in the US generally have so many mentally ill inmates,often acutely disturbed, that they establish cell blocks as “hospital units.” In suchunits mental patients may be seen sitting on their beds in bare cells gazing blanklyinto space. In the old asylums, conditions as bankrupt and deadening as thesewere rare. Mentally ill inmates may be found nude and agitated in isolation cells.The disruptive behavior of the mentally ill in jail is often regarded as a“disciplinary problem;” such individuals are often held in bare cells of solitaryconfinement, shackled to the wall if necessary. 48 Only 40 per cent of the mentallyill in US jails received mental health treatment in 1998—usually medication,rarely counseling. 49An administrator of the US Department of Justice has stated that “Jails arewithout question, brutal, filthy cesspools of crime—institutions which serve tobrutalize and embitter men to prevent them from returning to a useful role insociety.” 50 Open toilets in overcrowded cells, vermin, filth, dilapidation,brutality, homosexual rape and lack of medical care, of hygiene or of constructiveprograms have all been documented as existing widely in US jails and prisons. 51To attempt to treat patients with psychosis in such settings by the mere addition ofantipsychotic drugs is scarcely calculated to improve their chances of recovery.What accounts for such treatment of the mentally ill in a civilized society? In aword, money. State governments have drastically cut back the funding forpsychiatric hospitals and have failed to maintain community mental healthservices at an adequate level. Police and judges have responded as they feel theymust to protect the community from the crime, disruption and violence thatresult from the lack of support and treatment of people with psychosis. Statelegislators do not counter this problem by boosting mental health funding because,in the first place, prison care is cheaper than hospital treatment (about four timescheaper in Colorado) and, in the second place, the expense of law enforcementand the upkeep of local jails is borne, not by the state government, but by thecounties and municipalities.In the broadest sense, however, the mentally ill are incarcerated in thesedegrading conditions because, where there exists a massive reserve army ofunemployed, the concern to establish social control over the deviant takesprecedence over the concern to provide effective rehabilitation. The same is true