Stir Crazy: Steel Bars Destroy the Human Mind

By  Robert Wilbur  and  James L. Knoll,IV,MD

God told Andre Thomas to kill his estranged wife and two daughters, and to gouge his own eyes out.  Thomas obliged.  He is currently awaiting execution in Huntsville, Texas, the capital punishment citadel of the state.  The Texas Court of Criminal Appeals deemed that Thomas is "clearly 'crazy' but ...also 'sane' under Texas law."  Putting out one's own eye, called "auto-enucleation" in psychiatric research, is virtually always associated with severe psychosis.

His lawyer, Maurie Levin, Co-Director of the University of Texas Capital Punishment Clinic, is frantically fighting for the life of this manifestly insane man in Federal Court, but the odds are against Levin, as they have been against mentally ill defendants and their lawyers ever since the insanity defense was dramatically reformed in the wake of John Hinckley's attempted assassination of Ronald Reagan.
 
Andre Thomas' plight underscores a crisis in our criminal justice system.  We spoke with former penologist Jeanne Woodford who, with a bachelor's degree in criminology from Berkeley, worked her way up the ranks until she became warden of San Quentin, when she quit because of her opposition to capital punishment.  Woodford told us that, nationwide, about 25% of prison inmates - including inmates like Andre Thomas, on death row - are mentally ill, and about 5% suffer from a serious mental illness. 

solitary confinement cell by Wikipedia

 
What are the illnesses that are commonly seen?  For expert guidance we talked with California forensic psychiatrist Terry Kupers, MD. Compared to the general population, Kupers told us, schizophrenia, bipolar disorder, and unipolar depression are over-represented.  Other conditions that are commonly seen in the "joint" are anxiety and dysthymia - a chronic form of depression typically associated with prior trauma.  And what did he think of Woodford's statistics?  Kupers told us that, out of a total prison population of an incredible 2 1/2 million, only Rwanda (70%) and Russia (50%) have a higher proportion of mentally ill inmates.
 
Elizabeth Kelley is an attorney in private practice who specializes in representing clients with mental illness.  One area of her expertise is representing plaintiffs with post-traumatic stress disorder (PTSD).  The condition was initially given the name of DaCosta's Syndrome, after the Civil War military surgeon who first described it clinically.  Since then it has paraded through the medical literature as irritable heart, railway spine, shell shock, effort syndrome, neurocirculatoria, battle fatigue, and panic disorder. As the plethora of names suggest, PTSD is not confined to the battlefield. The differences among them are slight and largely in the eye of the examiner.  The fear can be so intense that a soldier deserts.  In the Civil War the punishment for desertion was death.  Today, if a soldier is lucky, he or she is likely to be treated with a cocktail of Seroquel (a mood stabilizer), Zoloft (an antidepressant), and Klonopin (an anxiolytic).  The not-so-lucky may resort to alcohol or drugs for respite from anxiety, depression, and night terrors.  Some may encounter trouble with the law and end up in prison as their reward for serving their country.   
 
 
 
This state of affairs, Kupers told us, occurred hand in hand with the "deintitutionalization" of persons with mental illness the state hospital system.  The idea behind deinstitutionalization was a humane one: transition patients into the community where they could continue to receive mental health services.   The fatal flaw was that adequate treatment in the community never materialized.  State legislatures cut back on community care for the mentally ill.   The stigma surrounding mental illness only worsened, and communities wanted social distance from those they erroneously perceived as dangerous.  Adequate means did not exist to keep track of mentally challenged people, who fell through the strands of an increasingly tattered safety net.  These and other factors resulted in persons with untreated mental illness being arrested for what largely amounted to the symptoms of their illness.  With drastically diminished hospital beds and no where else to turn, police frequently resorted to "mercy arrests" which would ensure that the individual at least received some form of treatment in a local jail.  Thus, prisons became the new mental institutions.
 
The most vulnerable inmates - the ones most likely to be victimized by the prison culture - are the most ill and the most harmless.  Because they are emotionally challenged, they are most likely to commit essentially minor infractions of the prison rules - infractions that will land them in the worst possible place for a person with mental illness: solitary confinement.
 
Whether it is called solitary, secure housing, "protective custody," or punitive isolation, it adds up to the same thing: sensory deprivation.   One consequence that has been associated with placing inmates with serious mental illness in solitary is suicide, which usually occurs by hanging oneself by a bedsheet.  In a strange twist of logic, some prisons punish mentally ill inmates for attempting suicide.  Thus, we are aware of cases in which an inmate was slapped into solitary for attempting to commit suicide - which resulted in an increased suicide risk. Many departments of correction go to ever greater lengths to avert suicide, until the prisoner is encaged in a concrete cell with a single blanket to either lay on or sleep under.  Such is the world of the Supermax.
 
The present situation is dismal.  We spoke with Amy Fettig, Director, American Civil Liberties Union National Prison Project. Her team of lawyers is determined to end solitary.   It seems like an onerous task, with 44 states plus the Federal Government operating Supermax prisons.  An estimated 25,000 inmates are confined in Supermax prisons, and an estimated 80,000 more are locked away in solitary in virtually every prison in the country.  Ms. Fettig described a case of a prisoner who castrated himself and suspended his testicles from a ceiling fixture.  Other prisoners are so desperate for human companionship - any kind of companionship whatsoever - that they misbehave in solitary so that guards will beat them.

All the obstacles notwithstanding, the ACLU's National Prisons Project has filed class action suits to end solitary in Arizona, California, New York, Pennsylvania, and the Federal prison system.  And there has been some progress: Colorado and Illinois closed down their Supermax prisons, while Maine cut the Supermax population by 50% and in Texas a Federal judge appointed s special investigator to look into conditions in solitary confinement.
 
In spite of ongoing litigation and reforms, Fettig dismisses prisons as "the new asylums."  If change is ever to occur - and there is no evidence that change will occur quickly - then society must ask itself what it expects from its criminal justice system.  The 1950s and '60s were a heady period of reform, in which we believed that even perpetrators of the most heinous crimes could be salvaged.  Then, in the '70s and 80s with "get tough on crime" policies, the pendulum swung from reform to retribution.  The pendulum has yet to swing back again.  Indeed, it remains seemingly stuck to the side of "just deserts" despite the economic burden.  The experts with whom we spoke agreed that it is more economical to treat psychiatric illness than to try to sequester and contain it with cops and wardens.  


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Robert Wilbur is a consultant in pharmacology and a medical editor/writer.  His work has appeared in professional and popular publications.
 
James L. Knoll,IV,MD is Director, Division of Forensic Psychiatry, State University of New York Upstate Medical University in Syracuse, NY.  He is Editor-in-Chief of PSYCHIATRIC TIMES.