Functional to the way a capitalist state operates, prisons are created and naturalised as commonsensical; framed as a means to guard the public from chaos, disorder and ‘anarchy’. The state (re)defines categories of people and their value politically, economically and socially with respect to markets. Prisons are an expression of this conceit. They not only manage populations surplus to the needs of capital but are extensions of the Euro-American settler colonial and dispossession projects which continue to ‘manage’ already marginalised people.
There are excellent resources and campaigns on prison abolition, particularly in the United States, from podcasters, to community street activists, marching agitators and a host of local organising campaigns. Many of these campaigns and resources build on an anti-carceral politic – a politic which rejects the carceral state and a liberal consensus that drives and coerces society’s understandings of the ‘productive’ subject under capitalism, and consolidates and maintains historical processes of racialisation, whiteness, class and gendered injustice inherent in state institutions.
The drive towards anti-carceral struggle in prison abolition has been borne out of the state’s devastating hold on people at the sharp end of this struggle – a universal experience which is unevenly suffered. With changes in the global capitalist economy, industrial and productive innovation over the last several decades, and a forced dispersal of working class resistance struggles in the UK and United States – together with changes to policing and the nature of the surveillance state – mass incarceration continues to grow through an expanding and highly profitable prison-industrial complex. An anti-carceral politic, anti-racist or feminist politic is not a choice, it’s an imperative.
Despite parallels frequently being drawn with immigration detention, abolition is typically framed and resisted explicitly with reference to prisons. Of course there are many reasons for this, among them, the ‘mass’ in mass incarceration (of which the numbers are staggering, again particularly in the U.S), but also because the prison system most obviously demonstrates (for those who care to interrogate it) an injustice. However, resistance to the most overtly punishing (and disciplining) state violence can’t just be seen in terms of the prison. People are quietly removed and detained by functionaries of the state, with little outrage, through the law and order of the institution of psychiatry. We don’t tend to discuss this on its own terms as much as we should – prisons, although sometimes very visibly connected to the institutional framework of mental health through many cases of deaths in custody and interaction with police, are not the only means of targeting certain groups of people and they are not the only spaces where people are traumatised or lose their sense of self and basic freedoms.
Although the institution of psychiatry may not incarcerate en masse to the same degree as the prison system, it is important to note that carceral logics are reproduced within mental health services and psychiatry. As with prisons and immigration detention centres, there remains a disproportionate response to the targeting of certain marginalised people with specific kinds of mental health experience (or at least who are quick to be labelled as having these kinds of mental health conditions) who endure the worst effects of mental health institutionality – psychosis and psychotic disorders in particular. People diagnosed with these disorders are more susceptible to what I will refer to in this text as Forced Inpatient Hospitalisation and Treatment (FIHT).
The terminology of FIHT used here covers sectioning, but sectioning can often limit our assumptions about involuntary hospitalisation and treatment, which we need to broaden and remove from strictly legalistic and psychiatric associations. FIHT also covers involuntary, forced or coerced treatment, ranging from forced medication to Electroconvulsive Therapy (ECT) and use of restraint. FIHT can affect people regardless of whether one has a diagnosis, a long-term history of poor and fluctuating mental health, or more recent manifestations and new experiences – for many reasons not everyone has the capacity to access mental health services, but they may still find themselves subject to FIHT should someone deem their behaviour warrants it.
The processes surrounding FIHT employ multiple institutional forces that prison abolitionists seek to dismantle. People undergoing and discharged from FIHT share many difficult experiences with those released from prison: discrimination, difficulties accessing housing and benefits from local authorities, to name a few. There are enforced expectations of a return to work, to ‘integrate’ into local communities, society and family life, together with fighting the routine and highly discursive narratives promulgated about what psychosis is and who people with schizophrenic conditions, in particular, are.
A routine set of signifiers and biases have formed around conditions such as schizophrenia; it is a product of an insular psychiatric framework, itself a symptom of broader relationships which are dispersed through popular culture and media, which isolate and discipline. Schizophrenia and many other experiences of psychosis are relegated to the medical (‘Psychiatric’), but also to the ‘private’ and ‘internal’ at the level of the individual. The effect of confining socio-political and economic struggles (for these are struggles of welfare and survival) to the level of the ‘personal’ is two-fold: the positioning cements the role of healthcare institutionalism to deal with people often in crisis situations (a division and hierarchy of knowledge), while simultaneously depoliticising and mystifying the reality of FIHT and its impact on those whose experiences and identities will lend themselves more readily to state violence. This essentialising approach could also help explain the neglect of FIHT from discussions and work around abolition, along with the capacity of psychiatry and the realm of ‘mental health’ to hide behind the language of treatment and support.
Mental health provision has seen dramatic shifts in perception and treatment over time and to varying degrees, despite the underlying dynamics remaining the same with respect to its relationality and perception. Notwithstanding the criticisms levelled at Michel Foucault, his historiography of incarceration and how we have developed our understandings of the ‘sick’ has been a useful launching point. But it has not suitably predicted the current relationship of mental health and the ‘abnormal’ to the current socio-economic and political forces that penetrate our lives: workfare, the disciplining of the working class, migrant labour and access to state-provided support services, or the headline moralising which, ironically of course, remains disconnected from any large scale substantive action on supporting people with mental illness and particularly psychotic disorders. Rather, many people with these kinds of mental health experiences still tend to be treated as curiosities at best, or vilified as criminal ‘psychopaths’ at worse.
Mental health slurs are for another time, but it is important to recognise how words like ‘stupid’ ‘schizo’ ‘insane’ ‘dumb’ ‘psycho’ etc, help to reinforce already pejorative and negative conceptions which lend themselves to ableism and propping up a systematic network of harm – these terms have a history and this history has brought with it into the present a whole accumulation of terrible classifications and treatments, again, especially for people experiencing schizophrenia who are already often classed, racialised and gendered in certain ways.
Up until relatively recently, people experiencing schizophrenia and other psychotic conditions have been fair game for experimentation and the most vile forced treatments in an effort to establish a body of philosophical and empirical works in the name of science. As the figure of the enlightened, rational, leisurely, philanthropic (white) man of the 18th and 19th centuries consolidated into (and co-produced) mass industrial production processes constituting capitalist social relations, the language of discipline and control became more pervasive. This later gave way to socially progressive and morally principled individualised care and treatment ‘packages’ later in the 20th century with both legislative and non-legislative tendencies, which this text pulls under the label of FIHT, framed as support for vulnerable people on the basis that they were in fact still human but simply ‘sick’. That said, the confinement and seclusion of the 1700s and the idea that the mentally deranged were without the reason accorded to the white bourgeois man, continued to pervade these newer frameworks of morality and the structural and social practices of the late 20th century.
The more unhelpful diagnostic and social perceptions surrounding psychotic disorders remained in place and mental health institutions became a version of everything that came before with a different gloss – FIHT wasn’t simply a powerful tool for treating and protecting the self and managing ways of being and experiencing the world (a risk to harm or not), it was about protecting others from those who overstepped the bounds of ‘normal’ and ‘acceptable’ composure and conduct – a ‘civilising’ mission with forced treatment still being everyday practice in inpatient wards across the UK and elsewhere.
Understanding the sustained conceptualisation of psychotic experiences in society over time, and how these are woven into the very fabric of institutional medical and psychiatric frames, is important for establishing insight into why discussing psychiatric FIHT in abolition movements more broadly is a bit lacklustre. And despite being perhaps perceived as ‘small fry’ in comparison to mass incarceration, it remains important to think about how structural violences and the language of care and treatment operate throughout medicalised psychiatric spaces in the first place. Who is more likely to face FIHT and why? How are people affected by gatekeeping to services they might want or need in different ways? Who will be more likely to be medicated? And what set of assumptions will people make when disclosing less common mental health experiences? As well as asking: how will we perceive ourselves should we accept the logics of these dynamics?
A distinctive feature of FIHT is its justification through the language of treatment and it is important not to throw out necessary and vital support services that people choose to engage with and use. We can’t deny the violence inherent in any detainment (having things done to you against your will in the name of treatment at the hands of the state is a terrible experience with often lasting trauma), but understanding the history of how people with certain experiences have been treated, is important for contextualising just how dangerous such justifications can be and how there is very little oversight when things go from bad to worse. Acknowledging this and folding FIHT into our work on abolition whilst also having ways to think about alternative networks of care – that don’t simply rely on the labour of our interpersonal relationships, the family, the already struggling, to support people in crisis – is very necessary. We need a community to start building and educating itself as to what people with different mental health conditions might require in terms of support and care. Of course in the meantime, under current conditions which make this very difficult, access to decent support through NHS services is still vital for many people, and that requires a well-funded set of access point services that have properly trained people delivering support without any quick judgement to engage FIHT.
One potential problem now with providing support for people who need it is the worry of caring and well-intentioned people filling in the gaps of much needed but cut or readily devalued state and outsourced services (remembering that such services are not a panacea, but until we have sustainable and locally scalable organising networks which deal in direct action attached to everyday life to combat structural violence, this is all a lot of us have). People often see a clash between immediate material needs, and longer term organising, though these do not need to be mutually exclusive things. Rather they work together and reinforce one another, but without a supportive organising framework behind people who can care for others, often unpaid, we cannot ignore the relationship this carves out.
A huge area for discussion in left circles which has more explicitly been brought to the fore with respect to instances of sexual assault and violence, includes forming networks that are accountable to those harmed and for people who might have caused harm. Mental health is no different. This will involve an active willingness of people to commit to engaging in this work, educating ourselves and our networks and being prepared to take responsibility. It might be painful, difficult and upsetting, but it is necessary in everyday life and, perhaps more obscurely, with avoiding the lasting traumas of FIHT.
by @Blurjeebie
