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

Anne E. Parsons's From Asylum to Prison: Deinstitutionalization and the Rise of Mass Incarceration after 1945 traces the history of Pennsylvania mental health institutions as carceral spaces as well as the deindustrialization they underwent in the second half of the twentieth century. As asylums diminished, prisons replaced them as carceral sites in Pennsylvania. In addition, prisons became destinations for men and women with mental illnesses, conditions that became criminalized in the century's closing decades. The author skillfully relates these changes in Pennsylvania to what was happening at the national level; she analyzes local, state, and national trends. Moreover, Parsons does an excellent job incorporating primary source evidence from politicians, experts, and patient and prisoner activists.

In pre– and post–World War II Pennsylvania, mental health asylums restricted patients' freedoms through involuntary commitment and through the application of various psychiatric treatment procedures. In these ways, mental institutions functioned, according to Parsons, as carceral spaces. As the twentieth century progressed, liberal policies increased funding for state asylums; additional buildings were constructed, staff was better compensated, and treatments, like electroconvulsive therapy and lobotomy, continued to be used. Despite increased financial and political support for the institutions, the men and women housed at them were sometimes mistreated and confined there without consent and for long periods of time. Due to this poor care, former patients criticized the asylums and their experiences there. Inspired by and using civil rights rhetoric, they argued against nonconsensual incarceration in mental health facilities. At the same time, Pennsylvania political leaders sought to transform the state's mental health care by placing it under the authority of the Commonwealth, not local government. State leaders advocated for and funded community-based programs. By the 1960s these policies were, likewise, pursued by the federal government, which supported mental health care via federal monies.

Prisons, like mental health care, began to focus on community-based programs such as work-release and furloughs. By the 1970s the funding and political support for these community programs were diverted to punitive facilities. Men and women with mental illnesses, who had been released from the asylums and who were to have been helped by community mental health centers and social programs, were set adrift without adequate resources. The criminalization of mental illness compounded the difficulties that such persons faced. People with psychiatric disabilities went to prison instead of mental asylums or community health programs. Parsons says this move away from "social welfare to policing and imprisonment" (125) occurred in the 1980s. As a result, the United States undertook the "largest public works projects of the twenty-first century" (139)—the construction and expansion of correctional facilities. By 2000 the US had 1.3 million prison beds. In Pennsylvania some former mental institutions became correctional facilities and often the family members of former state mental hospital staff became correctional officers.

Outstanding primary source research and analysis support Parsons's well-written history. She evaluates the actions and ideas of political leaders, experts, and patient and prisoner activists by studying archival records, newspapers, periodicals, correspondence, memoirs, and poems and by conducting interviews. Chapter 3, "Flying the Cuckoo's Nest," is especially noteworthy. Assessing the anti-institutionalism of the 1960s, Parsons interweaves evidence drawn from political leaders at both the state and federal levels, from mental health advocates like Daniel Blain, who was the head of the American Psychiatric Association and the Philadelphia State Hospital at Byberry, and from previously institutionalized writers, including Allen Ginsberg, Jack Kerouac, and Anne Sexton. The second chapter exemplifies Parsons's ability to simultaneously and expertly reflect on local, state, and national trends. In chapter 5, "Cruel Choices," Parson capably analyzes the significant role that Governor Dick Thornburgh played in supporting the deinstitutionalization of mental hospitals and the growth of correctional institutions. Motivated by personal circumstances, specifically his son's physical and intellectual disability...