The coronavirus has devastated the American penal system, with close to four hundred thousand inmates contracting the disease. Desperate to control the spread, jails and prisons have increased their use of solitary confinement, resulting in a nearly 500-percent increase in the number of people held there between February and June 2020. This is a troubling development: though we have long understood the ways in which solitary confinement damages human beings physically, psychologically, and spiritually, sick inmates are nevertheless now regularly housed in isolation units designed for punitive, rather than curative, purposes.
It’s therefore timely that Christine Montross, a clinical psychiatrist with years of experience working in jails and prisons, has published a book on mental illness in the U.S. penal system. Montross writes compassionately and compellingly, correctly indicting our penal system for its failures. Yet her analysis also falls short in significant ways: she often ignores past and present abuses carried out by psychiatry and psychology, and too readily reduces complex philosophical questions to simple biological causes.
Anyone who works or volunteers in jails or prisons quickly realizes just how widespread mental illness is within these institutions. Montross estimates that at least 356,000 U.S. inmates suffer from serious mental illnesses (which include schizophrenia, clinical depression, and bipolar disorder). Through the voices of former patients (masked by pseudonyms), she explores different facets of this terrible problem. In doing so, she conveys her respect for the personhood of individual inmates, as well as her conviction that jails and prisons are hardly the appropriate place for them. Montross’s chapter on the Cook County Jail in Chicago (where I’ve also conducted research) is particularly gripping: she captures well the fear that afflicts both inmates and employees. And her portrait is nuanced, pointing out how Cook County Sheriff Thomas Dart and his staff have worked to alleviate the suffering of incarcerated people with mental illness.
But the conscientiousness of some staff often conflicts with the coercive intent of prison design. Montross’s discussion of the architecture of supermax prisons (built to isolate inmates in solitary confinement) is particularly sobering. Since the nineteenth century, architects have designed prisons in order to inflict maximum suffering on inmates. The planners of today’s supermax prisons share this disturbing aspiration, as the architect of the Northern Supermax Prison in Connecticut proudly tells Montross. True, Montross balances such repulsive figures with more attractive ones, like Gerard Gagné, a psychiatrist who compassionately aids prisoners confined at Northern. But her assessment of the draconian sentencing and incarceration policies that prevail in the United States is unflinching: they’re rooted in fear and the desire to eliminate risk at any cost. Montross concludes by recommending that U.S. jails and prisons adopt more lenient, rehabilitative penal practices modeled on those found in Norway and Sweden.