In the racially charged 1960s, dissent was redefined as insanity, and insanity as criminal behavior. Countless patients are still living with the consequences.

Question: How did mental illness become increasingly criminalized in America?

Jonathan Metzl: Really one of the things I really try to do very consciously in the book is to track a particular evolution of that process, and part of what I show is that even though we had all these asylums in the 1930s and ‘40s and ‘50s where we locked away all of these people there was this… and often for long periods of time, but not always. There was this assumption that we were kind of treating people in a certain kind of way, that there was a possible recuperation or cure. Obviously didn’t happen for a lot of people, but you know there was an investment. I mean people were being locked away, but they were also seen as responsibilities, particularly in schizophrenia, of the state and part of what happens with this definitional and racial change in the way schizophrenia is understood in the ‘60s is a feeling that these people aren’t just docile dependants of the state. They’re also threats to the state. Particularly with schizophrenia you see a lot of concern that these people could escape and kill people, or they could threaten our political order, and particularly in the 1960s when schizophrenia becomes linked to civil rights protest. It’s also schizophrenia could bring down the state in a very… You know this has happened in other countries, so it’s not surprising, but we don’t often think about that in the United States, but I think part of why schizophrenia got linked to civil rights protest in the ‘60s was because mainstream society was coding threats against the smooth running of the state as insanity and treating it as such, and so as that happens you see the evolution of a process in which people with schizophrenia are increasingly feared and our hospitals, particularly the kind of hospital that I look at in the book become to look more and more like prisons, to the point where many of them including the one I talk about actually become prisons.

And that is something that didn’t just happen near Detroit where I look, but across the country. According to Human Rights Watch for example in the present day if you are a person diagnosed with schizophrenia and you are in a state institution you’re chances are exponentially greater that that institution is going to be prison rather than a hospital. Bernard Harcourt, a law professor at the University of Chicago, talks about the transformation from a hospital-based institution to a prison-based institution, and it’s something that happened across the country and that happened obviously for many reasons, but part of it is this transformation and in which prisons became our de facto mental hospitals, and we saw mental illness as in some way threatening not just to the people who suffered from it, but also us, mainstream society.

Recorded on January 29, 2010
Interviewed by Austin Allen