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One of the occupational hazards of a psychoanalytic private practice is selective inattention to some of the areas of greatest social injustice and suffering in our society. Terry Kupers has consistently been available as our eyes and ears in these marginalized areas, from his ground-breaking (and, sadly, out-of-print) 1980 book on psychotherapy in the public sector, to the current book under review: Prison Madness: The Mental Health Crisis Behind Bars and What We Must Do About It.
For those of us who may have been only minimally aware of these developments, Kupers reminds us that the upshot of the “deinstitutionalization” of the mentally ill has been that many of them have ended up in prison. Closing mental hospitals in the 60s was accompanied by the Community Mental Health Act, which was supposed to provide care in the community to those who otherwise would have languished on back wards. With governmental budget cutting and the advent of managed care since then, the promise of community mental health has faded, and many of the mentally ill have ended up homeless and uncared for, and/or reliant on illegal substances in an effort to regulate their mental state. Either way, they are likely to end up in prison sooner or later.
Kupers (p. xvi) says that the number of mentally ill inmates in the United States is between 120,000 and 200,000, which is more than the total number of psychiatric inpatients nationwide. Kupers also reminds us that prisons have become big business in recent years, as mayors, governors, and legislators have courted political popularity by clearing the streets of the homeless and the non-violent drug dealer and user, and sending them away for long prison terms along with violent criminals. Three-strikes-and-you're-out laws and mandatory jail terms for non-violent drug offenses have