Prison Reform as Enlightened Self-Interest

by Katharine Blake McFarland

Newgate-3I'm sitting in the empty bathtub with all my clothes on and my laptop in my lap, because it's the only place I can't hear the neighborhood jackhammer, when a headline from The Onion catches my attention: 15 Years In Environment Of Constant Fear Somehow Fails To Rehabilitate Prisoner. “About time,” I shout, to the empty bathroom. The satirical article goes on:

[O]fficials at Woodbourne Correctional Facility struggled Tuesday to make sense of how the prisoner had not been rehabilitated by 15 years of constant threats, physical abuse, and periodic isolation. “It just doesn't seem possible that an inmate could live for a decade and a half in a completely dehumanizing environment in which violent felons were constantly on the verge of attacking or even killing him and not emerge an emotionally stable, productive member of society”…

A story's inclusion in The Onion signals its self-evidence. The story—in this case, the inefficacy of incarceration—must be so obvious, so incontrovertible, that it's funny to dress it up as breaking news. It bodes well, I think, that this particular joke is getting some mainstream laughs because it hasn't always. (To be clear, by “joke” I mean “farce” and by “laughs” I mean “attention.” The distinction is important because lately prisons have become the object of increased media consideration, but sometimes the spotlight takes a precarious form. Does entertainment like Orange is the New Black help or hurt? Do we care? When it inspires fans to dress up in blackface and orange prison garb for Halloween, you might see the risk. A young friend of mine, someone who narrowly escaped the pipeline to prison himself, interpreted the name of the show as a reference to skin color, rather than fashion: “the new black,” he said, pointing to his bare arm. The intended joke was lost on him.)

And the notion that the prison system works—that it makes us safer, that it doles out appropriate punishment to deserving offenders and offers meaningful rehabilitative opportunities to those willing to change—has become a notion deserving of derision. It remains one of the greatest farces of our current justice system. I know a few who have served time and had an experience, sometimes a miracle, that changed them for the better. But mostly these experiences transpired in spite of, not because of, the environment. Incarceration, in its current form, does not rehabilitate but rather exacerbates criminality and mental illness.

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There Was No Couch: On Mental Illness and Creativity

by Jalees Rehman

Siemens_konvulsator_III_(ECT_machine)The psychiatrist held the door open for me and my first thought as I entered the room wasWhere is the couch?”. Instead of the expected leather couch, I saw a patient lying down on a flat operation table surrounded by monitors, devices, electrodes, and a team of physicians and nurses. The psychiatrist had asked me if I wanted to join him during an “ECT” for a patient with severe depression. It was the first day of my psychiatry rotation at the VA (Veterans Affairs Medical Center) in San Diego, and as a German medical student I was not yet used to the acronymophilia of American physicians. I nodded without admitting that I had no clue what “ECT” stood for, hoping that it would become apparent once I sat down with the psychiatrist and the depressed patient.

I had big expectations for this clinical rotation. German medical schools allow students to perform their clinical rotations during their final year at academic medical centers overseas, and I had been fortunate enough to arrange for a psychiatry rotation in San Diego. The University of California (UCSD) and the VA in San Diego were known for their excellent psychiatry program and there was the added bonus of living in San Diego. Prior to this rotation in 1995, most of my exposure to psychiatry had taken the form of medical school lectures, theoretical textbook knowledge and rather limited exposure to actual psychiatric patients. This may have been part of the reason why I had a rather naïve and romanticized view of psychiatry. I thought that the mental anguish of psychiatric patients would foster their creativity and that they were somehow plunging from one existentialist crisis into another. I was hoping to engage in some witty repartee with the creative patients and that I would learn from their philosophical insights about the actual meaning of life. I imagined that interactions with psychiatric patients would be similar to those that I had seen in Woody Allen’s movies: a neurotic, but intelligent artist or author would be sitting on a leather couch and sharing his dreams and anxieties with his psychiatrist.

I quietly stood in a corner of the ECT room, eavesdropping on the conversations between the psychiatrist, the patient and the other physicians in the room. I gradually began to understand that that “ECT” stood for “Electroconvulsive Therapy”. The patient had severe depression and had failed to respond to multiple antidepressant medications. He would now receive ECT, what was commonly known as electroshock therapy, a measure that was reserved for only very severe cases of refractory mental illness. After the patient was sedated, the psychiatrist initiated the electrical charge that induced a small seizure in the patient. I watched the arms and legs of the patients jerk and shake. Instead of participating in a Woody-Allen-style discussion with a patient, I had ended up in a scene reminiscent of “One Flew Over the Cuckoo's Nest”, a silent witness to a method that I thought was both antiquated and barbaric. The ECT procedure did not take very long, and we left the room to let the sedation wear off and give the patient some time to rest and recover. As I walked away from the room, I realized that my ridiculously glamorized image of mental illness was already beginning to fall apart on the first day of my rotation.

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