Where the Sick Get Sicker and the Sane Are Driven Mad: Behind Bars – Serialpressit (News)



The Madness of American Incarceration

By Christine Montross

When Christine Montross approached the end of her residency program in psychiatry, she met with a mentor for help evaluating two attractive job opportunities. Ignoring both options, her adviser raised the possibility of a third: “What about the prisons?” Montross balked at this unsolicited, unwanted suggestion. She deemed it an imprudent, even absurd use of her training, given the nation’s dearth of psychiatrists and broad demand for mental-health services. “Why would I want to work in the prisons?” Montross wondered. “Why devote my time and attention to people who had committed crimes when there were so many innocent people who needed care?”

She accepted a position with a psychiatric hospital in Rhode Island. It did not take long, however, for her to realize that her tidy binary — dividing the guilty criminal from the innocent patient battling mental illness — was a crude one, belied by complex realities. Many psychiatric patients, she observed, had previously served time behind bars, with some being admitted to her hospital only hours after being released. When she noticed that a few of her regular patients had not come to the hospital for surprisingly long stretches, she began searching state records and often discovered that they were in jail or prison. “The distinction I once imagined between hospital and prison populations exists only faintly,” she reflected, “when it exists at all.”

This realization prompted Montross to start exploring how the American legal system manages mental illness. Initially, she visited jails to assess whether criminal defendants were competent to stand trial. Those competency evaluations led her to broaden her investigation and, eventually, to write “Waiting for an Echo,” a haunting and harrowing indictment of the deep psychological damage inflicted by the nation’s punitive structures. “Incarceration in America routinely makes mentally ill people worse,” Montross contends. “And just as routinely it renders stable people psychiatrically unwell. Our system is quite literally maddening.”

Montross is a gifted, often compelling storyteller. She opens her book with an explanation of how the whims of police officers can lead two similarly situated people battling psychosis to experience divergent, life-altering fates. If one officer delivers someone exhibiting psychiatric symptoms to a mental hospital, that person may receive the treatment required to stabilize and improve. But if another officer delivers someone exhibiting the same symptoms to jail, that person enters a world almost perfectly calculated to exacerbate despair.

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To illustrate this point, Montross recounts the history of a jailed man she calls Henry. Following Henry’s arrest, he refused to leave his cell, perhaps owing to paranoia. This refusal led correctional officers to subject him to a “cell extraction,” an anodyne term for a vicious practice. Predictably, Henry disliked the experience, and expressed his displeasure by striking the extractors. These blows could be deemed an assault on an officer, rendering Henry vulnerable to an extended stay in solitary confinement, which would, of course, only further harm his already precarious mental state. Moreover, if convicted of the assault, Henry could face imprisonment for more than a decade — ample opportunity to accrue additional charges and punishment.

Montross traveled extensively across this country, bearing witness to how jails and prisons both initiate and intensify mental illness. The strongest portions of her searing book appear in its parade of alarming vignettes. I will not soon forget some of her grotesque images. When she toured a high-security prison for male adolescents, she noticed several prisoners in single-occupancy cells striking an identical, bizarre pose: standing atop their toilets, with necks and heads contorted toward the ceiling. While Montross assumed the first person she encountered in this posture was mentally ill, it became apparent that the young men were simply attempting to converse with their neighbors through the building’s ducts. This moment, more than any other in Montross’s career, underscored “the fundamental need for connection,” she writes. “These are children in a critical period of neurodevelopment … trying desperately not to go through it all alone.”

At another facility, the Northern Correctional Institution, a “supermax,” built in Connecticut in the 1990s, Montross commented on the noise in a particularly cacophonous ward. A white nurse accompanying her replied: “I call this the monkey house.” Montross recoiled at the racist remark, which transformed a unit teeming with Black and brown men into beasts. Even by the grim standards of prisons, Montross found Northern’s layout forbidding. This ominous ambience, it turns out, was no accident. In a chilling passage, she notes that the facility’s architect has publicly boasted that it was specially designed to elicit alarm and distress from its inhabitants. Most are confined to their cells for 23 hours a day. In such reprehensible conditions, the marvel is less that some men are driven mad than it is that any retain their sanity.

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But Montross’s typically formidable narrative skills sometimes go awry, most notably when she shoehorns herself and her family into the story. One woman she encounters recalls being given crack cocaine at 11. This fact prompts Montross to insert a sustained riff about her daughter’s very different life at that age — one filled with Harry Potter, woven ankle bracelets and ice-cream cones. Elsewhere, in an effort to underscore the eternity of a 10-year prison sentence, Montross details the life events that have occurred during her last decade. Her “partial list” includes not only major occurrences but “10 autumns of raucous college Saturdays — a period during which my beloved Michigan Wolverines cycle through three head coaches and hordes of forgettable quarterbacks, and a point in every season when I’m lying on the floor and moaning after yet another interception and my children giggle uncontrollably at my agony.” Such passages needlessly distract from the gravity of her subject.

This tendency reaches its nadir in the book’s conclusion, where Montross recollects writing at a lake cottage during winter and wrestling with how to handle a coyote outside her window that is behaving strangely. The episode stretches over five pages and produces at best a modest payoff: a belabored analogy for society’s response to the spectacle of mental illness, the way we allow fear and a desire for control to overcome more humane impulses. “Waiting for an Echo” would have been improved had these discursions been excised.

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Montross’s travelogue-based approach may also leave some readers pining for a comprehensive treatment of this issue, one more attentive to scholarly debate. They would do well to secure a copy of Alisa Roth’s “Insane: America’s Criminal Treatment of Mental Illness.” That book, published two years ago, covers similar terrain from a more broad-gauge perspective. Yet Montross’s stumbles should not overshadow her significant achievement. I hope that she successfully pricks the nation’s conscience about our shameful punishment of mental illness. It is impossible to read her captivating account without concluding that our various departments of corrections are themselves in intense need of correcting.

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