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

The closure of mental health facilities and the explosive growth of prisons in the United States during the second half of the twentieth century are dynamically related phenomena. Anne Parsons's excellent new book, From Asylum to Prison, examines these developments in terms of changing policies, attitudes, and legal frameworks, demonstrating "how society shifted its approach to institutionalization—rejecting it for people with diagnoses of mental illness and increasingly approving it as a response to law-breaking" (46–47). Parsons foregrounds not only officials, such as state governors and superintendents, who were key agents of change, but also the activists and institutionalized people who resisted confinement and incarceration.

Though From Asylum to Prison addresses shifting approaches to institutionalization across the US, the book's archival foundation and focus concern Pennsylvania's state-run facilities. After World War II, Pennsylvania's institutional landscape was vast, including eighteen psychiatric hospitals and a handful of prisons and facilities for the "feeble-minded." By the century's end, many of Pennsylvania's mental hospitals had been closed and converted to prisons, in a recycling of the state's institutional infrastructure.

Since the 1980s, many US voters and policymakers, as well as journalists and scholars, have blamed deinstitutionalization for the high number of people with mental illness in prison. The closure of mental hospitals, the familiar narrative goes, displaced people onto the streets, forcing US prisons and jails to become the largest mental health "care providers." Although in some moments From Asylum to Prison evokes the notion of a "hospital-to-jail pipeline" (124), Parsons's analysis points to the aggregate effects of policies, such as the dismantling of social welfare, combined with aggressive policing and harsher sentencing. In short, "the overincarceration of people with psychiatric disabilities has stemmed in large part from the rapid growth of the criminal legal system itself" (5).

Each chapter covers roughly one decade and traces parallel developments in the mental health and criminal legal systems. Chapters one through three survey critiques of state-run mental health facilities by conscientious objectors, journalists, and psychiatric patients, demonstrating how appeals to expand and modernize subpar institutions in the 1940s were gradually replaced by a wholesale critique of state psychiatric power by the 1960s. The same period witnessed experimentation with community-based rehabilitation for people with psychiatric disabilities, and the growth of rehabilitative models within the criminal justice system. At the same time, certain groups, including African Americans, juveniles, and homosexuals, became increasingly subject to criminalization.

By the 1960s–1970s (chapters three and four), a series of legal cases established the right to treatment and to due process for involuntary commitments to mental hospitals, and psychiatric and penal institutions began to exchange some of their functions. Commitments in psychiatric institutions were being made on the basis of criminality or diagnoses of dangerousness, while people with mental illness were increasingly likely to be arrested and jailed. Chapters four and five examine the movement away from anti-institutionalism in criminal justice and the rapid growth of the prison system in the 1980s. At the same time, as psychiatric intuitions continued to downsize, state and federal fiscal policies ensured that medical and social supports in the community for people with mental illness were woefully inadequate. In the Epilogue, Parsons argues cogently that institutions (whether asylums or prisons) are not the solution to this problem, but rather decarceration and the reallocation of funding to ensure housing, medical and mental health care, and social services are accessible.

The periodization in From Asylum to Prison is at times overly tidy, with the themes of each decade/chapter summed up in a single cultural artifact. Take, for example, the assertion that the National Mental Health Association's 1953 "Mental Health Bell," made from the melting down of chains and restraints from psychiatric institutions, "symbolized a new era" (68). Of course...