By ANN HEFFERNAN and KAREN TANI
Review of From Asylum to Prison: Deinstitutionalization and the Rise of Mass Incarceration after 1945, by Anne E. Parsons
Chapel Hill: University of North Carolina Press, 2018
As the new year unfolds and presidential hopefuls vie to advance the most appealing vision of the American future, mass incarceration is a universally recognized problem. President Donald Trump claimed to have tackled it in December 2018, when he signed the First Step Act, which emphasized “rehabilitative programs, fair sentencing, and smart confinement.” The Koch family empire, famously influential among Republican politicians, has also prioritized criminal justice reform, highlighting how the status quo grates against libertarianism and fiscal conservatism. Candidates pursuing the Democratic nomination, meanwhile, have nailed down their positions on a range of issues known to have contributed to mass incarceration, including mandatory minimum sentences, harsh punishment of low-level drug offenders, and government contracts with for-profit prisons. Those candidates associated with “tough on crime policies” have found that history to be a liability, rather than—as it used to be—crucial armor against conservative attacks.
An underappreciated resource at this moment of bipartisan enthusiasm for decarceration is Anne Parsons’s From Asylum to Prison (2018), for it addresses head-on a development that many criminal justice reformers do not: the growing prevalence of psychiatric illness among prison inmates. The standard explanation for this phenomenon is that it followed logically from deinstitutionalization, combined with a simultaneous decline in mental health funding. No longer able to access mental hospitals and deprived of needed services, the story goes, former patients wandered the streets until, at some point, their untreated symptoms brought them into contact with the criminal justice system.
Parsons instead traces a more winding path from the asylum to prison, and in doing so paves over these too-simple explanations for the status quo. Focusing on the efforts of politicians, bureaucrats, and advocates in Pennsylvania between 1945 and 1985, Parsons shows how the processes of deinstitutionalization and incarceration were entangled; how logics of “rehabilitation and confinement worked in tandem” to contain perceived social disorder (9); and how the “freeing” of institutionalized populations was entirely compatible with—sometimes downright helpful to—a broad-scale shift toward a more punitive mode of governance. If crafting today’s reforms requires understanding the past—and we believe it does—then From Asylum to Prison is essential reading.
Prisons as the “New Asylums”
Deinstitutionalization refers to the emptying out of state-run asylums, mental hospitals, and residential schools in the second half of the twentieth century. By the 1960s, such institutions were widely recognized as sites of degradation and neglect, warehouses for people who today would be described as mentally ill, or as having a developmental or intellectual disability. As this linguistic evolution might suggest, deinstitutionalization can be framed as a story of progress, of a piece with the disability rights gains of the late twentieth century.
And yet, as Parsons emphasizes, deinstitutionalization also coincided with the rise of neoliberal policies directed toward shrinking the welfare state. If this hastened the closure of large, state-funded mental hospitals, it also had devastating effects for their former inmates. Society did not suddenly deem them “cured” or “normal.” Deinstitutionalization meant that the state interfaced with such individuals in other ways—through local social service provision, through government-run or government-subsidized nursing homes, and, sometimes, through confinement in prisons and jails.
This last phenomenon, of the reinstitutionalization of former patients in prisons and jails (or “transinstitutionalization”), offers a partial explanation for the current prevalence of psychiatric illness among incarcerated populations and has contributed to the characterization of carceral spaces as “the new asylums.” (According to a 2015 Department of Justice Report, 2 in 10 prisoners and 3 in 10 jail inmates reported having a cognitive disability; within those two populations, 33 percent and 47 percent, respectively, reported experiencing “past 30-day serious psychological distress.”) A central claim of Parsons’s excellent book is that this framing does not accurately capture the historical relationship between the asylum and the prison.
The first problem with “the new asylum” framing is that it seems to cast the “old” asylum as non-carceral. In an era when civil commitment laws were much more lax, Parsons argues, “[m]ental hospitals served as sites of confinement,” part and parcel of the mid-twentieth century carceral state (41). Parsons is not alone, of course, in recognizing the family resemblance between mental institutions and prisons (Erving Goffman’s “total institutions”). She joins a growing number of scholars—among them Liat Ben-Moshe, Bernard Harcourt, and Jonathan Metzl—who have seen in these institutions similar logics of confinement and control. But Parsons’s careful archival research gives concrete grounding to these observations.
For example, in explaining why psychiatric institutions declined in Pennsylvania in the later decades of the twentieth century, she emphasizes two forces that caused them to lose their functionality as sites of confinement: (1) the patients’ rights groups and lawyers in the 1960s whose efforts made it more difficult to have a person committed; and (2) the related campaign, via the courts, to mandate that treatment accompany confinement. As these legal reforms pushed psychiatric institutions to become less carceral—and more expensive—states like Pennsylvania came to see the maintenance of such institutions as less worthwhile (especially after 1965, when Medicaid incentivized state officials to shift some institutionalized residents into general medical settings). In dubbing prisons “the new asylums,” we should not forget asylums’ historical position on the carceral continuum.
Parsons qualifies the prisons-as-the-new-asylums framing in a second useful way: by noting that many people who once resided in state-run psychiatric facilities did not actually end up in prison. Some returned to their communities, tapping into the highly variable system of mental health treatment and social services that exists at the local level. Many others ended up in general hospitals and nursing homes—thanks, again, to the incentive structure of Medicaid. Neither of these paths, to be clear, has been a panacea. (The modern nursing home is but one more manifestation of “the disability gulag,” the late Harriet McBryde Johnson famously observed.) The point is simply that not all of deinstitutionalization’s roads have led to prison.
So who did end up in prison? The book flags a key disparity: patients in state psychiatric hospitals “have been predominantly white and middle-aged,” Parsons summarizes, whereas incarcerated people with psychiatric disabilities “are disproportionately African American and under the age of forty” (5). Recognizing these differences is crucial, for it undermines the notion that the state has simply shifted its responsibility for people with mental illness to its criminal legal apparatus, or that the state constructed prisons specifically to reinstitutionalize a previously institutionalized population. Some people with psychiatric disabilities have managed to avoid the increasingly long reach of the criminal law; to the extent they interact with the state, it is through welfarist programs (meager as they may be). For others, especially those who lack wealth and whiteness, the “tough on crime” laws and policies of the last half century dramatically increased their likelihood of being branded as criminals. It is this group that has had to rely on whatever mental health resources are available in prisons and jails.
Reduce, Reuse, Recycle
As Parsons dismantles too-simple stories about deinstitutionalization and mass incarceration, she replaces them with more nuanced narratives. For example, in Chapter 3 she describes how in Pennsylvania some of the forces that impelled deinstitutionalization also, for a brief period, manifested in the criminal justice arena. A prisoners’ rights movement coalesced with a mental patients’ rights movement, and in both realms reformers advanced non-custodial, community-based alternatives to institutionalization: “foster homes” and independent living programs for residents of psychiatric institutions, for example; furloughs and “non-prison” “community treatment centers” for people convicted of crimes. In other words, deinstitutionalization did not always go hand-in-hand with massive prison growth and tough-on-crime policies.
What is clear is that once a more “punitive turn” became apparent in criminal law and corrections (for reasons that many other scholars have now documented), deinstitutionalization facilitated prison growth (108). It did so in at least two ways, Parsons argues. First, funds that state officials once earmarked for mental hospitals shifted to prisons and jails, rather than to non-institutional forms of social welfare provision. Pennsylvania Governor Dick Thornburgh (1979-87), whom Parsons discusses in Chapter 5, offers an archetypal example of the mentality that allowed this. Sharing that era’s faith that mental illness could be cured, and embracing a Reaganite skepticism of the welfare state, Thornburgh showed scant appreciation for the ongoing, long-term needs of people with psychiatric disabilities. (He had a keener understanding of other disabilities, Parsons notes, owing to his experience supporting a son with intellectual and physical disabilities.) Meanwhile, Thornburgh felt little pressure to be more generous. Landmark court cases articulating a “right to treatment” (most notably Wyatt v. Stickney (1972)) said nothing about what states owed to people whom they did not confine.
Under Thornburgh, Pennsylvania took the cost-savings from deinstitutionalization and re-directed them towards a policy area that seemed more pressing: policing and punishment. Heralding what Parsons refers to as “the punitive turn in corrections” (108), Thornburgh’s policies “reveal a central contradiction of neoliberal policies in the 1980s” (66): a sharp decline in social welfare spending—consistent with neoliberalism’s anti-statist, de-regulatory messaging—combined with the rapid and expensive growth of the state’s carceral arm.
The second way in which deinstitutionalization facilitated prison growth is even more direct: states like Pennsylvania literally repurposed the infrastructure of psychiatric institutions—the land, the buildings, the workforces—as they rushed to create new prisons. In noting the tendency of shuttered mental health institutions to “tak[e] on new life” as correctional facilities (9, 145), Parsons builds on the work of Jonathan Metzl, whose 2009 book The Protest Psychosis vividly recounts the rapid conversion of the Ionia Riverside Center into the Riverside Correctional Facility in January 1977—so rapid that only roughly 40 hours elapsed between when the last patients left and the first inmates arrived. Likewise, Liat Ben-Moshe has traced the evolution of what in 1984 became the Oneida Correctional Facility from its late 19th century origins as an almshouse and its later transformation into the Rome State Custodial Asylum for Unteachable Idiots.
What Parsons adds to these works, in addition to her Pennsylvania findings, is a much more comprehensive account of the practice of “institutional recycling” (9). Her national survey of this phenomenon finds that, from the 1970s into the twenty-first century, “at least seventy state hospitals, developmental centers, and tuberculosis sanatoriums” experienced new life as correctional institutions (145). This does not count prisons that government officials deliberately located in former institution towns, another form of “institutional recycling.”
The Path Forward
Perhaps the most important reason to read Parsons’s From Asylum to Prison is for the questions it leaves unanswered. Was institutional recycling simply a pragmatic answer to the twin problems of surplus infrastructure and the downstream effects of deinstitutionalization on already economically depressed rural communities? Or does it point, as Parsons provocatively suggests, to a “reinstitutionalization” by other means—that is, not a literal re-housing of former residents, but rather a return to institutionalization as the primary response to social deviance (145)? And if that is true, what further lessons might we extract about past and current understandings of deviance?
The relationship between race, disability, and deviance remains especially worthy of further exploration. To be fair, race is a topic that Parsons surfaces repeatedly. She references the demographic characteristics of psychiatric institutions (predominantly white) and their eugenic origins. She is alert to how proponents of deinstitutionalization racially coded their efforts, namely, as a benefit to deserving white people. When she discusses mass incarceration, she likewise foregrounds the demographic characteristics of incarcerated populations (disproportionately nonwhite, and ever more so over time). She also discusses the racial politics of the “war on crime,” including its relationship to the civil rights movement and its un-subtle targeting of Black men.
And yet race tends to sit just outside the book’s main arguments, flagged but not integrated. Does the racialization of crime, combined with perceptions about rising crime rates, explain the “assault on rehabilitation” that is a pivot point of the book? Why or why not? To what extent was the criminalization of mental illness—discussed in Chapter 4—a manifestation of the racialization of crime? To what extent was it something else?
These kinds of questions are as much for the field—or rather, fields—as they are for Parsons. Many scholars of U.S. politics and policymaking are now alert to race and deploy that concept in sophisticated ways, but are content to leave disability entirely on the margins. Having failed to incorporate disability into the frame, they are even less capable of seeing the entanglements of race and disability. As for Disability Studies, it has had “a tenuous relationship with race and ethnicity,” to borrow Christopher Bell’s summary. “[T]he field readily acknowledges its debt to and inspiration by inquiries such as Black Studies,” but “its efforts at addressing intersections between disability, race, and ethnicity are, at best, wanting.” Since Bell wrote those words in 2006, scholars such as Liat Ben-Moshe, Nirmala Erevelles, Dorothy Roberts, and Sami Schalk have offered incisive analyses of the intersections between race and disability. In important ways, however, the field remains “White Disability Studies”—as white as the old asylums. From Asylum to Prison suggests the potential of state and local history, in particular, to yield vital advancements in years to come.
In the meantime, we applaud the history that Parsons has already given us and the lessons it offers for the present.
Posted on 12 March 2020
ANN HEFFERNAN is a Ph.D. candidate in the Department of Political Science at the University of Chicago and a dissertation fellow at the Pozen Family Center for Human Rights. Beginning in Fall 2020, she will be an LSA Collegiate Fellow in Political Science at the University of Michigan. KAREN TANI is currently Professor of Law at the University of California, Berkeley, School of Law. In July, she will become the Seaman Family University Professor at the University of Pennsylvania Carey School of Law and Department of History.
