From Asylum to Prison: Deinstitutionalization and the Rise of Mass Incarceration after 1945 by Anne E. Parsons (review)

In the United States, the history of state public institutions for people identified today as psychiatrically disabled stretches back at the least to the first quarter of the nineteenth century. By the end of World War II, these public institutions had become crowded, self-contained facilities housing thousands of American citizens. Given the scarcity of public funding caused by the Great Depression and the staffing shortages as a result of the war, these institutions in 1945 had truly degenerated into concentration camps. In her thoroughly researched and beautifully written book, From Asylum to Prison, Anne Parsons traces institutionalization and deinstitutionalization in the nation’s state psychiatric hospitals as well as their linkage with incarceration in state prisons. As such, she finds that, “the politics of mental hospitals and prisons did not occur separately but were intricately intertwined” (p.122).

Exposés of psychiatric facilities in the postwar years left little doubt that the hospitals were overcrowded and underfunded. Mary Jane Ward’s book, The Snake Pit, for example, pictured a facility where there was the absence of care, and the presence of physical and emotional abuse. Among critics like Albert Deutsch, the institution could be improved, not dismantled. Federal funding in the form of the Hill-Burton Act, along with larger state appropriations saw state institutions grow in number and in size until the mid-1950s. The 1950s also saw a time of optimism about the amelioration of chronic psychiatric conditions. The advent of the drug, Thorazine, and the use of electroconvulsive therapy were two examples that suggested that patients might not need to remain in custodial institutions for long periods of time. In the hospital and in the prison as well, there was a new mood for rehabilitation. Ironically, as the prison systems became more rehabilitative, they often began to give mental health services once provided by the hospital.

The 1960s ushered in a time of mental health contradictions. The writings of critics like Thomas Szasz and films like One Flew over the Cuckoo’s Nest reflected a growing doubt about the efficacy of psychiatry and with it doubts about the public custodial institution. Taking Pennsylvania as her principal case study, Parsons explores a trend toward reducing the size of these facilities – both the psychiatric hospital and the prison. In their place, it was the hope among officials and professionals alike that community-based programs and services to prevent institutionalization and to facilitate deinstitutionalization would replace the need for large asylums and prisons. With the coming of Johnson’s Great Society, and especially with its Medicare and Medicaid programs, a way seemed possible to shift funding from state operated large institutions to federally funded community-based accommodations and services. In the prison systems also, there was in the early and mid-1960s hope for rehabilitation and community reintegration.

In 1969 Richard Nixon became president, and with him came a growing proto-neoliberalism. Given the civil disruptions that occurred in many cities during 1967 and 1968, many conservatives of both political parties began to talk about “law and order” and “getting tough on crime.” With the ascent of Ronald Reagan to the White House in 1981, these calls for “getting tough on crime” only increased, and in turn community-based programs for offenders began to wane. The wave of neoliberalism also ensured that there was inadequate funding for people who had been discharged from public psychiatry facilities and were now in American communities. Some of these individuals went to community nursing facilities where confinement was just as extensive as the asylums. Other deinstitutionalized people found themselves home-less with little community structures and systems for treatment, Finally, other people discharged from these facilities found themselves reinstitutionalized in jails and prisons.

As Parsons writes “while deinstitutionalization continued for people in mental hospitals, it largely ended for...