Pfeiffer focused on prison special housing units because “here in these tomblike cells, the problem of America’s mentally ill could be seen in its most unvarnished, extreme form. Some had broken the law when they were too sick to know the difference. Others had climbed a ladder of petty, illness-driven crimes into prison, racking up so many disorderly conduct charges that they drew hard time for simple drug possession. All lived in a society in which their mental illness was managed by a system described in a 2002 Presidential Report as ‘in a shambles.’”
Beginning in the 1960s, mental hospitals were shut down for lack of funding, and in the ’90s—as politicians rediscovered the strategy of vote-grabbing by fear-mongering—new supermax prisons were built to service the country’s booming prison-industrial complex. The mentally ill, those most vulnerable and least able to care for themselves, were shunted into these prisons after being cast onto the streets and running, inevitably, into the tall brick walls of the American criminal justice system.
The book examines the cases of six individuals who, as a result of psychiatric disability, clashed with that system. Of the six, three committed suicide while in solitary confinement. Two died in police custody. Collecting interviews with family members and friends, as well as court records, police reports, and transcripts of recorded prison phone calls, Pfeiffer pieced together the disjointed narratives of these tortured lives. She renders them on the page in straightforward prose that is often unsettling, intertwining the stories with an analysis of the mental healthcare system and unabashedly pressing for reform. Professionals and others involved in the care of the mentally ill, and lay readers interested in the topic, will find the book both absorbing and discomfiting.
There are photographs. We see Shayne, the only survivor of the individuals profiled, at age nine in a school photo, her smile the least bit tentative. Some 30 years later, having been shuffled between inadequately staffed, budget-constrained community mental health centers and county jails, and suffering from schizophrenia (as she had since adolescence), Shayne plucked out her eye while in solitary confinement on suicide watch in an Iowa prison.
As part of her argument for compassion in dealing with the mentally ill, Pfeiffer cites a litany of sobering statistics to make her case for housing them in psychiatric facilities, or at least creating separate units within prisons and staffing them sufficiently with guards trained to recognize the difference between a psychotic episode and an instance of malingering or attempting to manipulate the system.
Pfeiffer makes a case for significant change that would be less costly, both financially and morally, and urges a return to treatment for the mentally ill. Punishment, she says, for the six individuals in this book and the thousands of mentally ill presently confined in our nation’s overcrowded prisons, is ineffectual, pointless, often cruel, and frequently fatal.