Sean E. Evans and Shannon M. Bader
Perhaps one of the most outstanding weaknesses of contemporary psychological theory is the relative neglect of the environment by many of the most influential theoretical viewpoints.
Isidor Chein, The Environment as a Determinant of Behavior
History may not repeat itself, but there seem to be reverberating themes. One such theme is the challenge of “how” and “where” to manage people who behave in dangerous, scary, or unacceptable ways. Throughout time, these individuals have been placed in institutional settings or facilities; the names of which often belied the philosophical approach popular at the time. Reform schools and correctional institutions were providing discipline, instruction, and behavioral guidance while asylums and sanatoriums were places of rest and recovery. In the 1840s, Dorothea Dix began to argue that individuals with mental illness were distinct from criminals and should not be housed in jails or prison.2 Her descriptions of inhumane treatment within jail settings resulted in the establishment of state psychiatric hospitals around the country. Now, after nearly 200 years of advancements in medicine, penological research, psychological treatments, and public policies, the question of “how” and “where” to best manage people remains unanswered. Modern day jail diversion programs and mental health courts continue to promote Dix’s perspective that mentally ill individuals should be provided appropriate treatment, not languish in jail or prison. However, this ideal has not become a reality. The living conditions and medical treatment for people with mental illness within facilities remain a primary public policy issue for the American Civil Liberties Union and the National Alliance on Mental Illness with large class action lawsuits occurring each year. Similarly, the Department of Justice continues to order jails and prisons into receivership for inadequate care. Dix’s proposition was a simple one. Criminals and antisocial individuals should be housed and safely contained in jails and prisons but individuals with mental illness should be admitted to hospitals for treatment. Unfortunately, the question of “how” and “where” remains because the reality of people who behave in dangerous, scary, or unacceptable ways is much more complex. We argue that there is a population of individuals not so clearly criminal or mentally ill (see Figure 26.1). Furthermore, individuals in this indistinguishable group can be incorrectly placed either at a correctional institution or psychiatric facility and experience possible harm, poorer outcomes, and potential for further misclassification.
The criminalization of mental illness – the “bad” versus “mad” dichotomy.