Psychotherapy Bulletin

Psychotherapy Bulletin

Clinical Impact Statement: Psychology and abolition are linked in numerous ways. In this article, we argue that psychology has an important role to play in moving our society away from its reliance on punishment, and towards life-affirming modes of care and rehabilitation.

Though they may seem initially like an odd couple, psychology and abolition are inextricably linked. Abolition has meant many things throughout history, and in this paper, it is defined as the dismantling of the prison-industrial complex (PIC) and the creation of structures of accountability and care that are fundamentally non-punitive. Activist and organizer, Rachel Herzing, defines the PIC as “the symbiotic relationship between public and private interests that employ imprisonment, policing, surveillance, the courts, and their attendant cultural apparatuses as a means of maintaining social, economic, and political inequities” (Schenwar & Law, 2020, p. 8). PIC abolition targets the physical sites of jails and prisons, as the name suggests, but its aims are much broader than that; it includes opposing any institutions that operate under a logic of carceral control and supporting systems that meet people’s needs—from a pollution-free environment to food and housing. Abolitionist efforts to reduce our reliance on policing and punishment have been active for decades, with communities of color at the forefront of this work. Recent protests in the wake of several highly publicized police murders of Black people have brought abolitionist ideas to a wider audience, and calls to defund the police and redirect funds to community services are no longer seen as ideas belonging to some radical fringe. Many conversations surrounding racial justice have explicitly focused on mental health care and how it can be divorced from its current entanglement with policing. The discipline of psychology undoubtedly has an important role to play in making our society safer, and we argue that that role is not in reforming the current system but in abolishing it.

When we discuss how psychology has an inherent responsibility to work toward prison abolition, the most obvious connection between the two is the field of forensic psychology. Forensic psychology has been defined as “the application of clinical specialties to legal institutions and people who come into contact with the law” (Cronin, 2009, p.5). The American Psychological Association (APA) broadens the definition to include the application of research and scholarship in other fields of psychological study (e.g., cognitive psychology, developmental psychology) to legal issues and questions (Ward, 2013). Either way, it is the direct connection to people who have been swept up into the legal system that makes forensic psychologists (and forensic psychology training programs) uniquely positioned to advocate for abolition.

In forensic psychology training programs, we learn that people with mental illnesses are severely over-incarcerated, at an estimate of two to four times the general population (Prins & Draper, 2009). We learn that incarcerated environments are ill-equipped to treat mental illness, and in some cases, even create symptoms of mental illness in people who previously had none (Davies, 2020). We are taught that our places within the field of psychology include, but are not limited to, assisting local police with calls that involve a potential mental health crisis, assessing people for competency to stand trial, providing mental health care within jails and prisons, and working in drug courts. Although these options may allow us to help many individuals, they all operate under the same base assumption that our current systems of policing and incarceration will always need to exist. Most, if not all, career options for a forensic psychologist came to fruition from the realization that mental illness, when accompanied by other important risk factors, greatly increases the likelihood that a person will come into contact with the criminal justice system (Skeem et al., 2008). Thus, forensic psychologists have been at the forefront of advocating for criminal justice reforms that, on the surface, offer a better option than a regular prison sentence for those with mental illness and/or substance use disorders.

In our haste to reform the system by making mental health care a bigger priority in criminal justice reforms, we tend to ignore the fact that a system whose intention is to punish and control will always work against reforms that leave its foundation intact. Clinical professionals that work within correctional settings work hard to provide a much-needed service, but the fact remains that the conditions of incarceration create harm at a rate that would be difficult for any therapist to keep up with, let alone stop. This calls for us to seriously question the underlying goals of the systems in which these programs operate. Just as a therapist is concerned for a client’s well-being when they are in the room, so should they be concerned with how the conditions of incarceration are also a detriment to their well-being. Many popular mental health prison reforms attempt to make a carceral system more therapeutic, but the most therapeutic reforms necessitate reducing the scope of the system itself. Forensic psychologists have a unique perspective and wealth of experience to draw upon; they can provide services to people involved in the criminal legal system while simultaneously working to create societal conditions that ensure that no one has to rely on that system to access care.

Although the most direct link between abolition and psychology may lie in forensic psychology, the broader field of clinical psychology must also be examined with a critical eye. Mental hospitals and prisons in the United States developed alongside one another, and in many ways, the logic of psychiatric institutions became a carceral one, prioritizing confinement over care (Chapman et al., 2014). In the mid to late 1800s, as asylums proliferated and subsequently became overcrowded and understaffed, the institutional focus shifted to custodial care, and treatment came to be seen as a lost cause for many of those confined (Braddock & Parish, 2003). A review of articles published from 1844 to 1900 in the American Journal of Insanity (renamed the American Journal of Psychiatry in 1922) found a host of literature on the architecture and management of asylums, but fewer than ten articles on patient care (Braddock & Parish, 2003). Asylum patients came to be seen as helpless, and confinement was regarded as a necessary action taken both for their own good and for the good of the greater community.

There is no doubt that modern psychiatric institutions are more humane than early asylums; however, in certain ways, the underlying assumption that individuals with mental illness are a problem to be managed rather than people entitled to quality treatment has not faded. Today, decisions about whether a person should be hospitalized against their will are ostensibly governed by the legal standard of whether there is “clear and convincing” evidence that a person is at imminent risk of harming themselves or others (Mossman et al., 2011). The subjectiveness inherent to that standard and the bias in its implementation is important to note—research indicates that African American and Indigenous populations are disproportionately represented in inpatient settings (Snowden, 2003). Moreover, what of the risk that involuntary hospitalization poses to a person? A 2018 survey of people formerly hospitalized for psychiatric reasons conducted by Mad in America, an organization that seeks to “serve as a catalyst for rethinking psychiatric care,” yielded the following results: regarding their time in the psychiatric ward, over half of the respondents described their experience as “traumatic,” 37% said they were physically abused in some way (with forced treatment included as an example of physical abuse), and 7% said they were sexually abused (Simonson, 2018). Only 27% said they felt “safe and secure” while on the psychiatric ward, and only 17% said they were “satisfied with the quality of the psychiatric treatment” they received. These numbers are alarming. Patterns of abuse and neglect (including restraints being used as a punishment) within U.S. mental health treatment settings have also been highlighted in reports by the Department of Justice and the United Nations (Hartocollis, 2009; Minkowitz, 2017).

Further, it is worth considering how a treatment that takes place involuntarily may undermine its own aims. For example, research suggests that the therapeutic alliance—a key predictor of positive treatment outcomes—is strengthened when patients are assured that they have input and influence over their own treatment (Safran & Muran, 2000; Applebaum & Gutheil, 1982). Involuntary outpatient treatment has been touted as a favorable alternative to hospitalization and is now allowed by law in 46 states (Carrol, n.d.). Although this option allows individuals to remain in the community, the threat of arrest or hospitalization is never far off. Thus, this reform still effectively denies people their autonomy, which may drive them away from seeking mental health treatment in the long term. Rather than invest in a mental health system that is robustly funded and able to address the various and complex needs of its consumers in earnest, we continuously turn to law enforcement as a delivery mechanism for mental health services.

In light of this evidence of abuse and traumatization, our professional, ethical guidelines compel us to reconsider the way we operate, from the ground up, in order to uphold principles of beneficence, nonmaleficence, and respect for people’s rights and dignity (American Psychological Association, 2017). How can we move away from our reliance on forcible confinement and toward forms of care that provide genuine healing? How can we radically expand the forms of non-punitive treatment that exist and ensure that they are accessible to all? How can we make treatment something that people want to seek out when they are in need and something that they can rely on, rather than something that many people have come to fear? These abolition-minded questions apply to all of us in the field of psychology, not just those who identify with the subfield of forensic psychology.

Although some hold tight to the view of psychology as an apolitical discipline, history provides many examples to the contrary. Diagnostic labels have long been tied to race and gender-based oppression. Black people are diagnosed with schizophrenia at a rate three to five times higher than white people (Schwartz & Blankenship, 2014). Until 1973, homosexuality was listed as a disorder in the DSM (Braddock & Parish, 2003). However, notably, psychology has also taken explicit political action at critical junctures to promote the common good; the APA contributed an amicus brief to the U.S. Supreme Court in the case of Obergefell v. Hodges to put forth evidence supporting the validity of same-sex partnerships and has made public statements against the use of solitary confinement for juveniles (American Psychological Association, 2015; Anderson, 2017). Although the APA’s willingness to offer public positions on criminal justice issues is a welcome step, positions that do not address the root causes of the problems at hand can be seen as somewhat nearsighted. Reforms enacted only for the sake of reform put a glossy finish on institutions that were never meant to better human lives. So, then, reforms for the sake of what? Abolition. If psychology can offer evidence that racial bias is rampant in policing, why then can it not advocate for abolishing the police? If psychology can recognize the immense harms of solitary confinement, why then can it not advocate for the eradication of all forms of confinement disguised as justice? No discipline that deals with the well-being of people can be apolitical, so long as people’s lives are impacted by policies. If the field of psychology wants to continue to uphold its goal of bettering human life, it must expand its collective imagination to directly address social determinants of mental health that exist outside the DSM.

As the field of psychology begins to embrace its role in social justice efforts, we must ask whether the changes we advocate for are likely to move us towards the creation of long-lasting healing for individuals and communities or whether they simply make superficial tweaks that leave a system of punishment and control intact. While multifaceted in the questions it poses, PIC abolition makes the definitive statement that human beings do not belong in cages—a statement that directly aligns with psychology’s ethics and value system. Yet, there seems to be a disconnect both currently and historically between what the field of psychology preaches and what we practice. Long-standing professionals, first-year undergraduate students, and all psychologically minded people in between are currently in a unique position to consider the ways in which psychology has been complicit in oppression, to listen to those who have been harmed, and to create more modes of treatment and care that respect the autonomy and personhood of the people we serve. Confronting the harm that our current systems inflict on many people is a difficult but necessary first step, which can serve as a catalyst for the growth and development of our field in a positive direction.

Cite This Article

Klukoff, H., & Kanani, H. (2020). A better world is possible: Psychology’s responsibility to abolition. Psychotherapy Bulletin, 55(4), X-X.

References

APA Continues to Oppose Juvenile Solitary Confinement. (2017, June 8). Retrieved August 11, 2020, from https://www.apa.org/advocacy/criminal-justice/juvenile-solitary-confinement.pdf

Applebaum, P., & Gutheil, T. (1982). Clinical aspects of treatment refusal. Comprehensive Psychiatry, 23. 560-566. https://doi.org/10.1016/0010-440X(82)90048-7

Braddock, B. L., & Parish, S. L. (2003). Social policy toward intellectual disabilities in the nineteenth and twentieth centuries. The human rights of persons with intellectual disabilities: Different but equal, 83-114.

Carroll, H. (n.d.). Know the Laws in Your State. Retrieved August 11, 2020, from https://www.treatmentadvocacycenter.org/component/content/article/183-in-a-crisis/1596-know-the-laws-in-your-state

Chapman, C, Carey, A. C., & Ben-Moshe, L. (2014). Reconsidering confinement: Interlocking locations and logics of incarceration. In L. Ben-Moshe, C. Chapman, & A. C. Carey (Eds.), Disability incarcerated: Imprisonment and disability in the United States and Canada. (pp. 3-24). Palgrave Macmillan. https://doi.org/10.1057/9781137388476_1

Cronin, C. (2009). Forensic psychology: An applied approach. Kendall Hunt Publishing Company.

Davies, D. (2020, July 16). Psychiatrist: America’s ‘extremely punitive’ prisons make mental illness worse [Radio broadcast]. NPR. https://www.npr.org/sections/health-shots/2020/07/16/891438605/psychiatrist-americas-extremely-punitive-prisons-make-mental-illness-worse

Ethical Principles of Psychologists and Code of Conduct. (2017, January 1). Retrieved August 11, 2020, from https://www.apa.org/ethics/code/

Gorwitz, K. (1974). Census enumeration of the mentally ill and the mentally retarded in the nineteenth century. Health Services Reports, 89(2), 180. https://doi.org/10.2307/4595007

Hartocollis, A. (2009, February  5). Abuse is found at psychiatric unit run by the city. The New York Times. https://www.nytimes.com/2009/02/06/nyregion/06kings.html

Minkowitz, T. (2017, October 24). UN to USA: Forced treatment is prohibited. Mad in America. https://www.madinamerica.com/2017/10/un-to-usa-forced-treatment-prohibited/

Mossman, D., Schwartz, A. H., & Elam, E. R. (2011). Risky business versus overt acts: What relevance do actuarial, probabilistic risk assessments have for judicial decisions on involuntary psychiatric hospitalization. Hous. J. Health L. & Pol’y, 11, 365.

Obergefell v. Hodges (Supreme Court). (2015, March). Retrieved August 12, 2020, from https://www.apa.org/about/offices/ogc/amicus/obergefell-supreme-court

Prins, S. & Draper, L. (2009). Improving outcomes for people with mental illnesses under community corrections supervision: A guide to research-informed policy and practice. Council of State Governments Justice Center. Retrieved from https://www.ncjrs.gov/App/AbstractDB/AbstractDBDetails.aspx?id=249355

Safran, J. & Muran J. (2000). The therapeutic alliance: introduction. Journal of Clinical Psychology, 56(suppl 2): 159-161. https://doi.org/10.1002/(SICI)1097-4679(200002)56:2<159::AID-JCLP2>3.0.CO;2-D

Schenwar, M., & Law, V. (2020). Prison by any other name: The harmful consequences of popular reforms. The New Press.

Schwartz, R. C., & Blankenship, D. M. (2014). Racial disparities in psychotic disorder diagnosis: A review of empirical literature. World Journal of Psychiatry, 4(4), 133. https://doi.org/10.5498/wjp.v4.i4.133

Simonson, M. (2019, December 29). MIA Survey: Ex-patients tell of force, trauma and sexual abuse in America’s mental hospitals. Mad in America. https://www.madinamerica.com/2018/12/mia-survey-force-trauma-sexual-abuse-mental-hospitals/

Skeem, J., Nicholson, E., & Kregg, C. (2008). Mental illness in criminal justice settings. [PowerPoint slides]. The council of state governments. https://csgjusticecenter.org/topics/mental-health/

Snowden, L. R. (2003). Bias in mental health assessment and intervention: Theory and evidence. American Journal of Public Health, 93(2), 239-243. https://doi.org/10.2105/AJPH.93.2.239

Ward, J. T. (2013). What is forensic psychology?. APA.org. https://www.apa.org/ed/precollege/psn/2013/09/forensic-psychology

0 Comments

Submit a Comment

Your email address will not be published. Required fields are marked *