Chapter Ten

Mitigation

America’s prisons have become warehouses for the mentally ill.
Mass incarceration has been largely fueled by misguided drug policy and excessive
sentencing, but the internment of hundreds of thousands of poor and mentally ill people has
been a driving force in achieving our record levels of imprisonment. It’s created
unprecedented problems.
I first met Avery Jenkins over the telephone. He called me, but he was pretty incoherent.
He couldn’t explain what he had been convicted of or even clearly describe what he wanted
me to do. He complained about the conditions of his confinement until a random thought
caused him to abruptly switch topics. He sent letters, too, but they were just as hard to follow
as his phone calls, so I decided to speak with him in person to see if I could make better sense
of how to help.

For over a century, institutional care for Americans suffering from serious mental illness
shifted between prisons and hospitals set up to manage people with mental illness. In the late
nineteenth century, alarmed by the inhumane treatment of incarcerated people suffering from
mental illness, Dorothea Dix and Reverend Louis Dwight led a successful campaign to get the
mentally ill out of prison. The numbers of incarcerated people with serious mental illness
declined dramatically, while public and private mental health facilities emerged to provide
care to the mentally distressed. State mental hospitals were soon everywhere.
By the middle of the twentieth century, abuses within mental institutions generated a lot of
attention, and involuntary confinement of people became a significant problem. Families,
teachers, and courts were sending thousands to institutions for eccentricities that were less
attributable to acute mental illness than resistance to social, cultural, or sexual norms. People
who were gay, resisted gender norms, or engaged in interracial dating often found themselves
involuntarily committed. The introduction of antipsychotic medications like Thorazine held
great promise for many people suffering from some severe mental health disorders, but the
drug was overused in many mental institutions, resulting in terrible side effects and abuses.
Aggressive and violent treatment protocols at some facilities generated horror stories that