Unfortunately, institutionalization and imprisonment were and continue to be the “default” solution for dealing with serious mental illness.
As a society, we have continually failed those with serious mental illness. (An overview of mental illness and its treatment can be found here.) For centuries, physicians, philosophers, scientists, psychologists, and theologians have struggled to define, describe, and cure mental illness. We hear less about the painful struggle of individuals, families, and communities to handle the day-to-day problems of mental illness and to know what to do with those who suffer from the most severe forms of it.
In the 1800s, insane asylums flourished. There, inmates were cared for physically, but received little or no psychological treatment. What “treatment” administered for insanity was often harsh, abusive—and ineffective. As the fields of psychology, neurology, and psychiatry developed, asylums were turned into mental institutions, and inmates began to be referred to as patients. For the first half of the 20th century, many new and experimental treatments were developed, including talk therapies, drug therapies, and even electroshock therapy and lobotomy. (My Lobotomy, based on this NPR story, is the poignant memoir of one man’s quest to understand his history of mental illness and the system of the time.) Still, many institutions remained ineffective at best and abusive at worst.
By the 1960s, the inadequacies and abuses of many mental institutions were revealed. Rather than reform the institutional system, most mental hospitals were closed down and replaced with…nothing. The idea was to use community mental health services to treat patients in the “least restrictive environment.” However, an environment with no restrictions is also an environment with no structure or support. As a result, many formerly institutionalized individuals ended up homeless—or in prison (requires free membership to access).
Just as emergency rooms are the default health care setting for the poor and desperate, prisons frequently end up as the default institutional setting for the untreated mentally ill. Unfortunately, prisons are designed to be punitive, not therapeutic. These high-stress environments often exacerbate mental illness, punish symptoms, make already-vulnerable people the targets of violence and abuse, and create even more obstacles to obtaining mental health care in the future.
This situation is made more tragic by the fact that, as Elder Alexander B. Morrison rightly points out, “Most mentally ill people—like those this physical illnesses—can live productive lives in their communities. They do not need to be locked up. Like everyone else, most mentally ill persons receiving proper treatment have the potential to work at any level in any profession, depending solely on their abilities, talents, experience, and motivation.” Having mental illness makes it difficult to experience joy. Punishing mental illness makes joy nearly impossible; it hinders progress, wastes potential, and breaks hearts.
We can do better.