Mental Health and The New Jim Crow

The New Jim Crow | Reading Response

Michelle Alexander’s seminal text on the racial caste system of mass incarceration in the United States penal system should be required reading for every student in the United States. Alexander’s bold claim is that the modern United States prison system functions as a method of racialized control, a new Jim Crow, and she supports her arguments with excellent research: although the text is short, it is packed with well-research information that is fully sourced and cited.

Alexander begins by taking the reader on a brief history of how class control was achieved through racialized systems so effectively that race became viewed as a valid reason to control a population in and of itself. This overview spans Bacon’s Rebellion to the post-Civil War Jim Crow system, and she identifies the parallels between these seemingly disparate institutions with an incisive perception. After establishing the premise that systems of racialized control are woven into the fabric of United States life, she turns her eye to the War on Drugs and how recent changes in the U.S. criminal justice system create a form of control which allows and even encourages both conscious and unconscious forms of racism to be implemented at every level of the criminal justice system, from intake to prosecution to sentencing to incarceration to release. Having established the evidence for this claim, Alexander moves on to the ways in which the U.S. criminal justice system has prevented regulation, oversight, or questioning of the new paradigm through the means of legislation and Supreme Court decisions which overturn past precedent and knock down the various boundaries intended to prevent such racism. She then lays out the disturbing parallels between the restrictions of Jim Crow and the restrictions placed on felons which allow for discrimination in housing, welfare, and voting. Finally, she examines what this institutionalized system of racial control means for the United States and various civil rights movements, as well as some solutions to address the human rights violations currently occurring.

This was my third reading of the text, and Alexander’s arguments and research have started to become familiar enough to allow new questions to arise during the reading. As Alexander says in the introduction,

“It is not possible to write a relatively short book that explores all aspects of the phenomenon of mass incarceration and its implications for racial justice. No attempt has been made to do so here. This book paints with a broad brush, and as a result, many important issues have not received the attention they deserve … What this book is intended to do — the only thing it is intended to do — is to stimulate a much-needed conversation about the role of the criminal justice system in creating and perpetuating racial hierarchy in the United States.” (loc. 34)

Keeping this in mind, one issue which looms as a silent elephant throughout the text is the state of mental healthcare in the United States. Concurrent with the rise of the New Jim Crow, mental healthcare has taken on new parameters and understandings in the United States. Various emotional and psychiatric disorders that were once believed to be caused by external factors, whether it be environment, nurture, or spiritual uncleanliness, are now considered to be inherent biological conditions. In the 1950s and 1960s, this new understanding of mental illness arose, coinciding with the various social movements advocating personal rights. For the first time in United States history, the ideas that mental illness has a biological root, and that mentally ill people are deserving of basic human rights, too, began to gain traction.

Unfortunately, as Alexander so clearly shows, an increase in social awareness that a form of bigotry is unacceptable is not the same as actually eradicating said bigotry. Bias against sufferers of mental health disorders has continued, and in fact worsened. A 2011 study titled, “Biogenetic explanations and public acceptance of mental illness: systematic review of population studies,” published in 2011 in The British Journal of Psychiatry, summarized the situation in these words,

“Overall, support for the claim that biogenetic causal attributions are associated with less stigmatising attitudes towards people with mental illness is small. Particularly with schizophrenia, biogenetic causal beliefs seem to increase rather than decrease rejection of those affected.” (Angermeyer, et al)

Despite advances in the diagnosis and treatment of mental health disorders, the bias against them has continued to grow, as have the costs of treatment. With high treatment costs and strong stigma against mental illness, individuals from poor communities face serious hurdles in acquiring and maintaining mental health treatment from the outset. Many individuals do not even get past the initial significant resistance to admitting there might be a neuro-biological cause to certain violent, addictive, or self-destructive behaviors in order to seek treatment. This is of especial concern in communities of color throughout the United States, where resistance to and stigma of mental illness intersect with the disparate impact effects of institutional racism. This in turn creates communities that are at high risk of experiencing mental illness, yet the individual actors are unlikely to seek assistance or form supportive communities to address the issues.

Even if an individual overcomes the stigma and seeks diagnosis and treatment, there is no guarantee they can afford or even access it. Until the Affordable Care Act passed, many states did not require parity in mental health treatments, which meant that prescription medications and doctor co-pays could be significantly higher for those in a position to seek private care. For those who are not in a position to seek private care, the funding for low-income mental health care is in a dismal state.

It began in 1961, when a joint commission of the American Medical Association and the American Psychiatric Association recommended a plan to deinstitutionalize long-term psychiatric patients. This plan was reliant on the establishment of community  mental health centers where patients who would not otherwise have access to mental healthcare could receive outpatient care. In 1963, Congress even passed a law to provide funding for such community mental health centers. Unfortunately, the funding never came through, due to a confluence of factors including public stigma against mental illness, the situation in Vietnam, and the economic crisis. Ultimately, the failure of deinstitutionalization was an over determined situation, occurring because of a multitude of factors. After 1963, with the congressional promise of future funding, hospitals bowed to the increasing pressure from patient’s rights movements and the medical community to release long-term psychiatric patients and decommission the long-term care facilities. This process went much more quickly than anticipated, even as it became apparent that the necessary funding for community mental healthcare centers would not materialize. As a result, mentally ill individuals from poor communities found themselves without access to healthcare, and often lost their homes, jobs, families, and even lives.

In 1980, Jimmy Carter signed the Mental Health Systems Act intended to increase mental health funding. Unfortunately, Ronald Reagan took office in 1981 and decreased federal spending on mental healthcare services by 30 percent, then shifted the remainder of the burden to state and local governments. Within 5 years, the federal government would cover a mere 11 percent of the budgets for treatment of mental health disorders. As a result, the rates of mentally ill homeless and incarcerated individuals continued to rise. Although most people in the U.S. will encounter some form of mental illness in their lifetime either through personal experience, a friend, or a family member, this does not translate to widespread acceptance or understanding of mental illness.

Mental illness alone, when left untreated, is usually devastating to both the individual and their family. This effect is compounded when the individual is living with a support system that doubts the validity of mental illness and stigmatizes the sufferer. Additionally, many individuals who are unable to access treatment for their illness turn to forms of self medication, such as drugs and alcohol. When a medical explanation for anti-social behaviors such as drug use as self-medication is taken off the table, the actions of a mentally ill individual are recast as the choices of a criminal. In this context, the deinstitutionalization of long-term psychiatric care and the nationwide funding cuts for community mental health services in low income neighborhoods become an inextricable part of the question of prison reform.

One in three hundred U.S. residents, which translates to over half a million people in the United States, lived in mental institutions by the 1950s. Within 20 years, only 160,000 Americans were institutionalized for mental health disorders, thanks to the aforementioned push for deinstitutionalization rather than restructuring of the existing mental health system. The prevailing belief was that the new antipsychotic medications would treat the biological root of mental illnesses, thereby allowing the mentally ill to live ordinary lives outside of psychiatric institutions — and, coincidentally, shutting down the taxpayer-funded institutions would save communities a lot of money. By 2013, there was one psychiatric bed per 7,100 Americans. To give some context to this data, it is estimated that 1 in 5 families have a family member who suffers from mental illness.

By 2009, 20 to 25 percent of the homeless population suffered from some form of severe mental illness, according to the Substance Abuse and Mental Health Services Administration (National Coalition). A 2010 study by the National Sheriff’s Association and the Treatment Advocacy Center showed that three times as many mentally ill people are housed in prisons or jails as in hospitals. About 40 percent of mentally ill people have been arrested at least once in their lifetime, often as a result of not being able to access treatment. A 2006 Justice Department study cited in the New York Times says that over half of the inmates incarcerated in United States prisons have a mental health disorder. To give some context to this data, only 6 percent of Americans are classified as severely mentally ill (Kristof).

Many people prefer to ignore the problem or blame the sufferer. This leads patients to engage in self-denial of diagnosis, lapsed treatment, and self-medicating behaviors which further cause individuals to isolate their support systems, lose their employment, and end up in prison or homeless. The stigma against mental illness also interacts with Federal law to create a discriminatory system relying on unconscious bias similar to the felon system — if an individual “outs” themselves in employment situations as undergoing treatment for a diagnosed mental illness, it is nearly as effective as checking the “felony conviction” box on an application in ensuring discriminatory treatment. The link between homelessness, mental illness, self medication, and incarceration is certainly exacerbated by the federal policies toward drug users and felons as outlined by Alexander.

The defunding of mental healthcare programs and the increased funding for prisons occurred nearly simultaneously, and as such they are intrinsically bound up on nearly every level. Indeed, Reagan’s invocation of “welfare queens” to defund social assistance programs relied on a particular story about an Illinois woman whose deception and welfare fraud took on legendary proportions. In a Slate feature written by Josh Levin on the woman in question, she is revealed as Linda Taylor, born Martha Miller. Linda Taylor was one of many identities; the little white girl named Martha Miller grew up to become a master of disguise who convinced people, at various times, that she was a woman of Black, Asian, or Native American heritage ranging in age from 25-40. She had seven husbands and claimed multiple children (many of whom were kidnapped) as her own, and was accused of several murders. Miller bounced between incarceration and freedom, and when she was out of prison she supported herself through various types of fraud. Levin asks,

“What kind of person behaves this way? In the 1970s, psychologist Robert Hare developed a checklist to assess a given subject’s personality. The symptoms on Hare’s list read like a catalog of Linda Taylor’s known behaviors and personal characteristics: glib and superficial charm, pathological lying, manipulativeness, lack of empathy, parasitic lifestyle, frequent short-term relationships, and criminal versatility. Of the 20 items on the Hare Psychopathy Checklist-Revised, nearly every one describes the welfare queen to some degree. Dr. Steve Band, a behavioral science consultant and an expert on criminal behavior, says “people with that personality know right from wrong.” Dr. James Fallon, a professor of psychiatry and human behavior at the University of California at Irvine and the author of The Psychopath Inside, says that Taylor “screams psychopathy.” Along with deriving pleasure from criminal behavior, he says, psychopaths “really like getting away with it”—that “the ones who have intelligence, they don’t want to get caught.” (Levin)

Levin acknowledges that armchair diagnosis is a dangerous game to play, yet his suggestions is supported with remarkable evidence and testimony. If he is correct and Martha Miller was a psychopath, the deinstitutionalization and defunding of mental healthcare in the 1960s may have, ironically, led to the lack of affordable and accessible treatment which might have prevented the creation of one of the most polarizing figures in the Reagan campaigns for the war on drugs and the defunding of social welfare programs. That said, the war on drugs and defunding of social welfare programs would have occurred with or without Martha Miller’s unwitting assistance; she was a pawn in an over determined situation.

Although Martha Miller may be a particularly notorious example of the intersections between lack of mental healthcare, poverty, and prison, she is hardly the only one. Consider Aaron Alexis, a young mentally ill black man who opened fire inside the Washington Navy Yard in Washington D.C. and killed 12 people. Alexis complained of delusions and hallucinations prior to the massacre and had a history of arrests for violent behavior, yet his mental health issues had gone ignored and untreated. He was former Navy working as a civilian contractor for the U.S. Military, and his FBI file shows that his superiors were not unaware of his delusions … yet he did not seek treatment, nor is there any indication that it was recommended to him or made a requirement by the military officials or civilian courts he came in contact with. Or, on a less dramatic but no less individually traumatic scale, consider India. Profiled in The New York Times, India is a 42 year old black woman who suffers from PTSD and bipolar disorder. She has tried to seek treatment for her psychiatric disorders, but has found affordable healthcare to be inaccessible. As a result, she does what many mentally ill individuals who cannot afford treatment or medication do — she self medicates. India’s medication of choice is heroin, and she has spent her entire adult life incarcerated due to drug related offenses (Kristof).

As these examples show, some mentally ill individuals are incarcerated for reasons that can be addressed by accessible treatment, such as India. Others, like Alexis or Miller, might have been better served by long-term care facilities. It is a sad truth that some mentally ill people do need lifelong in-care treatment, and cannot be incorporated into society as a whole. That is not to say all mentally ill people cannot live in society — in fact the majority of mentally ill persons can, with regular treatment, move through society as active and productive members. In this vein, writer Elijah Wolfson suggests in Newsweek that the ACA may be, “the biggest piece of prison reform the U.S. will see in this generation.” His argument is that the provisions for affordable and accessible mental healthcare will address that signification portion of the prison population imprisoned due to circumstances arising from the non-treatment of their mental illness, such as self-medicating with illegal drugs.

Wolfson is onto something, but it won’t address all the mentally ill who are shuffled to prison in lieu of healthcare. Even with accessible mental health coverage, there is still that 6 percent of the population who suffers from “severe” mental illness, that is, delusions, hallucinations, and violent tendencies. There is still endemic social stigma against mental illness, which leads to people resisting treatment and diagnosis, or discontinuing treatment once it becomes effective because they believe they have been cured. There is still the very serious problem that a small portion of seriously mentally ill people will simply never be able to integrate into society as functioning and productive members, and without the social support programs and the understanding of family members, the only long-term care facility available to them is the United States prison system.

History has shown us that it is necessary to put safeguards in place to prevent the psychiatric institutionalization of healthy individuals who hold politically deviant attitudes, and history has also demonstrated that it is absolutely necessary to have watchdog organizations to combat the extreme human rights violations that have so often occurred in psychiatric institutions and asylums … but the painful and confrontational reality is that long-term psychiatric institutions have not yet lost their place in society, and the incarceration of untreated and severely mentally ill persons is neither a humane nor adequate solution.

Alexander’s solution to addressing the racial caste system within the United States prison system is spot on, and a conclusion I absolutely agree with. Racial discrimination as we experience it today arose in the unique environment of United States capitalism, and is a direct and systemic result of the so-called “job creators” inculcating class warfare within the proletariat based on arbitrary racial divisions. White workers were given sops of privilege to coax them to repress their working class brethren of color, and it worked. Shamefully, it worked for centuries. Alexander is absolutely right in stating that a true and honest conversation about race needs to occur in America, and that to truly end racial caste systems in American, we must lay down our racial bribes and join hands with people of all colors to achieve working class solidarity in order to address the systemic racial bias in the prison system.

That said, we also need to address the role of mental health care in society, and especially in black communities. In The Immortal Life of Henriette Lacks, Rebeccca Skloot covered the various human rights violations perpetuated against black Americans in the 20th century alone, and showed how these human rights violations has led to a deep-seated distrust toward healthcare providers and seeking medical treatment. Intertwined and inseparable from the distrust of institutionalized medicine is the unhappy history of black Americans. In the antebellum South, many slave owners believed that ‘hard working’ slaves were less susceptible to nervous disorders than their white masters, as they were not exposed to the “disappointments” of a refined life.

Modern definitions of mental illness were often constructed around the experience, observation, and treatment of privileged patients in private care. For marginalized communities, mental illness and criminality have long been closely associated. Treatment for the socially marginalized mentally ill has been less compassionate, ranging from incarceration and neglect to human rights violations and medical experimentation. The issue of stigma toward mental illness and the resultant resistance to seeking diagnosis and treatment is a topic of much discussion in the mental healthcare community, and the connections between mental health stigma, access to treatment or lack thereof, and prison reform need to be examined as a whole.

For individuals of color, who are already subject to a discriminatory and damaging system, recognition of severe mental illness has historically only highlighted their vulnerability within the existing structure. Because of their unique situation and classification as property or non-legal persons (depending on location) in U.S. history, it has traditionally been far more dangerous for black Americans to acknowledge mental illness within their communities than it has for other marginalized communities throughout the history of the United States. This reality is bound up in the black American experience and understanding of mental illness, as well as the social repercussions.

~*~

Citations and References

Alexander , Michelle. The New Jim Crow. 2nd. New York: The New Press, 2012. eBook.

Angermeyer, Matthias, Anita Holzinger, et al, et al. “Biogenetic explanations and public acceptance of mental illness: systematic review of population studies.” British Journal of Psychiatry. 199. (2011): 367-372. Web. 6 Mar. 2014.

Kristof, Nicholas. “Inside a Mental Hospital Called Jail. “New York Times. 08 02 2014: n. page. Web. 6 Mar. 2014.

Levin, Josh. “The Welfare Queen.” Slate. 19 12 2013: n. page. Web. 6 Mar. 2014.

McClelland, Mac. “Schizophrenic. Killer. My Cousin.”Mother Jones. 05 2013: n. page. Web. 6 Mar. 2014.

Mental Illness and Homelessness.” Fact Sheet. Washington, D.C.: 2009.

Skloot, Rebecca. The Immortal Life of Henrietta LacksNew York: Crown Publishing Group, 2011. eBook.

Tomasky, Michael. “The Great GOP Mental-Health Hypocrisy.” Daily Beast. 20 09 2013: n. page. Web. 6 Mar. 2014.

Wolfson, Elijah. “How Obamacare May Lower the Prison Population More Than Any Reform in a Generation.” Newsweek. 03 03 2014: n. page. Web. 6 Mar. 2014.

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