Protecting the Mental Health of Prisoners

The treatment of prisoners continues to be at the forefront of global discussions on human rights. August 10th is Prisoner’s Justice Day, a day of observance that began in 1975 after Edward Nalon committed suicide in a prison segregation unit in Ontario, Canada. The day commemorates all those who have died in custody and challenges the confinement conditions that encroach on basic human rights.

Imagine spending nearly 24 hours a day alone, confined to an 8’ x 10’ windowless cell. This is the reality of approximately 100,000 inmates in solitary confinement in the United States today. Psychiatrist Terry Allen Kupers, author of Solitary: The Inside Story of Supermax Isolation and How We Can Abolish It, shares how the psychological affects of solitary confinement can cause harm, including anxiety attacks, paranoia, depression, and other mental illness—and can sometimes lead to suicide. Solitary can be considered a practice that qualifies as an human rights abuse. And inmates have suffered by their own hand when repeated warnings about their mental stability are ignored. Legal actions continue to attempt to change the prison culture so mentally ill inmates can receive the services they need. Here, Kupers notes in Solitary:

[I]t has been known for decades that while suicide is approximately twice as prevalent in prison as it is in the community, fully half of all successful suicides that occur in a correctional system involve the 3 to 8 percent of prisoners who are in some form of isolated confinement at any given time.

It is by now clear that for prisoners prone to serious mental illness, time served in isolation exacerbates their mental illness and too often results in suicide. This is the main reason that federal courts have ruled that prisoners with serious mental illness must not be subjected to long-term isolation. Federal judge Felton Henderson, ruling in Madrid v. Gomez regarding the SHU [Special Housing Unit] at Pelican Bay State Prison, wrote: “Many if not most, inmates in the SHU experience some degree of psychological trauma in reaction to their extreme social isolation and the severely restricted environmental stimulation in SHU.” Further, he asserted, “The conditions in the SHU may press the outer bounds of what most humans can psychologically tolerate.”

In court I argue that the harsh conditions of solitary confinement that cause severe psychiatric symptoms in previously healthy prisoners inevitably have a devastating effect on prisoners prone to mental illness. In far too many cases the effects include psychosis, mania, compulsive acts of self-abuse or suicide, and often some combination of the three.

What are your thoughts on the current criminal justice policies and the treatment of mentally ill inmates in solitary confinement?

Our Most Troubling Madness

by Tanya Luhrmann and Jocelyn Marrow, co-authors of Our Most Troubling Madness: Case Studies in Schizophrenia across Cultures

This guest post is published in conjunction with the American Anthropological Association conference in Minneapolis. Check back regularly for new posts through the end of the conference on November 20th.

UC Press is proud to be part of the AAUP’s fifth annual University Press Week. Check out our blog and social media channels through Nov. 19th (plus follow hashtags #ReadUp #UPWeek), and learn how we, along with 40 of our scholarly press colleagues, work diligently to publish vital works benefitting educational, specialized research, and general interest communities.

9780520291096Anisha, Veena, Priyanka, Madhu, Sita, and Sunita are Indian women diagnosed with schizophrenia. In Our Most Troubling Madness: Case Studies in Schizophrenia across Cultures, we show that despite their struggles, they succeed in fulfilling valued social roles in their families and communities in urban and rural locations across North and South India. They are proud of being responsible members of their social world. To be sure, some are less successful than others. But all remain optimistic that they might reach their life goals at some point in the future. Most of them have family who tolerate their odd behave as long as they can cook and care for their parents or their children.

In contrast, the life histories of John, Violet, Zaney, and Meg are bleaker. While none of the Indian women in our case studies knew their diagnosis, all four of these citizens of highly developed economies with state-of-the-art mental health care feel defined and limited by the label. To them, “schizophrenia” is a judgment that they are defective persons with little hope for a normal life. This is true even though they had been exposed to mental health activism asserting exactly the opposite. The good life in the United States and the United Kingdom—employment, financial self-sufficiency, and care of children and spouse—was unrealized and seemed unrealizable. They felt defeated.

Case studies of these ten lives, plus others from Ghana, Romania, and Thailand, provide intimate accounts of the social and cultural contexts in which persons with psychotic disorders live. They give depth to earlier, replicated findings of the World Health Organization that the course and outcomes for schizophrenia are different across the world, with some of the best results coming from India.

With a commitment to engaged anthropology, Our Most Troubling Madness examines the lives of those with psychotic disorders to suggest how we might redeem U.S. mental health services that do harm while they do good. Most importantly, we argue that creating a society in which those with psychosis may flourish involves altering our approach to psychosis. Downplaying the importance of diagnosis, respecting the experience of psychosis, allowing individuals to engage with voices, and focusing on interpersonal behavior in social settings, are tasks we may undertake to make our own culture more benign for those with psychosis.

When sharing on social media, please be sure to use the #AAA2016 hashtag!

T. M. Luhrmann is Professor of Anthropology at Stanford University. She is the author of When God Talks BackOf Two Minds, and Persuasions of the Witch’s Craft.

Jocelyn Marrow is a cultural anthropologist and Senior Study Director at Westat in Rockville, Maryland.

“The Best I Have Read”: A Mental Health Professional on Listening to Killers

James Garbarino’s Listening to Killers grants readers an inside look into two decades of murder suspects, and his in-depth account, rather than showing these individuals as singular cases, paints a more complicated picture that mental health professionals are keen for the public to recognize.

In a recent review, Joshua Eudowe praised Garbarino’s work: “[Garbarino’s] knowledge, compassion, insight, and unmatched experience provide us with an amazing opportunity to learn the path that lead children to violence. Listening to Killers, his most recent book, is the best I have read.”


Joshua Eudowe has served in emergency services for over 16 years, having provided psychotherapy to young victims and witnesses of extreme violence and psychoanalytic/behavioral therapy to young adult patients in Connecticut’s State psychiatric hospital Young Adult Services unit. He is completing his doctoral studies in clinical and forensic psychology at the Illinois School of Professional Psychology, with an emphasis in forensics, particularly in mental disorders induced organically or through trauma. He also specializes in the behavioral precursors to violent action.

Like Garbarino, Eudowe notes that broader social and cultural issues can create toxic environments and mentalities for children, especially young victims of trauma. Sometimes, this is enough to drive a youth from innocence to violence.

“For those of us in the field of mental health, law enforcement, and education,” says Eudowe, “it is our role to understand where these behaviors originate in order to be more effective in the delivery of our respective services. But society has a tremendous responsibility that often gets overlooked or ignored. . . society must learn to identify its own contribution to the emotional damage and effect on how these children become killers.”

See the full text on the eA Risk Management Group’s blog.