Lock and a hard place
Our treatment of the mentally ill hasn’t changed much from the dark days of 1887
REPORTER Nellie Bly called Blackwell’s Island “a human rat trap” in 1887.
In “Damnation Island,” a new history of the 2-mile strip in the East River that housed the city’s women’s “lunatic asylum,” Stacy Horn details the daily atrocities visited on its charges. Nurses beating patients to death, six women trapped in cells meant for one, a pregnant woman confined to a straitjacket while giving birth, hundreds of patients — some with open syphilitic sores — made to bathe in the same bathwater. All of this meted out to punish or “treat” people with mental illness.
Reading “Damnation Island,” you may be lulled into thinking that we’ve come a long way since that real life, 19th century horror show. We don’t even call it Blackwell’s Island anymore — it’s now called Roosevelt Island, and luxury apartment buildings stand where the asylum once loomed.
But, in reality, we haven’t come that far at all.
To understand how little has changed, it’s best to turn to another recent release, “Insane: America’s Criminal Treatment of Mental Illness” by journalist Alisa Roth.
The good news is that our sickest aren’t warehoused in asylums or hospitals anymore. The bad news is that today they’re locked up in jails and prisons. Around 365,000 people with mental illness are behind bars — far outnumbering those in hospitals. By some counts, as much as half of the prison population have mental illness. (This figure is higher for women. In state prisons, one study estimated that 75 percent of women have mental illness.)
Instead of overcrowded “asylums,” which closed en masse starting in the middle of last century, today’s prisons and jails serve as our new de-facto institutions.
And prisons are the worst place for people with serious mental illness.
All you need to do is visit another island off Manhattan where an estimated 45 percent of its inmates suffer from mental illness — Rikers Island.
There was Jason Echevarria, a 25year-old Rikers inmate with bipolar disorder, who in 2012 was placed in a solitary mental-health unit after a suicide attempt. When sewage backed up in his cell, an officer handed him a toxic packet of detergent. Echevarria ate it.
“He was yelling off the top of his voice,” the officer later testified, “panting as if he couldn’t breathe . . . saying he needs a doctor. Get me a doctor. I can’t breathe.”
The supervising officer, Terrence Pendergrass, who was later sentenced to five years for his role in Echevarria’s death, refused to help, telling his officer: “Don’t call me if you have live, breathing bodies.”
Echevarria was found dead in a pile of blood and foam in his cell the next morning.
Two years later Jerome Murdough, a homeless veteran who was arrested for vagrancy, was found dead in a mental-health unit after the heating system in his Rikers cell malfunctioned so that he “basically baked to death,” an official said at the time.
It’s not just Rikers. At Florida’s Dade Correctional Facility in 2012 Darren Rainey was forced into a “special shower” which hit a scalding 160 degrees after he had smeared feces in the cell of the mental-health unit.
Roth describes the scene: “Officers left him in the scalding water for two hours; by the time they took him out, he was dead, his skin so red it looked as if he’d been ‘boiled’ and peeling like ‘fruit roll-ups.’ ”
This all sounds uncomfortably close to Blackwell’s Island’s “human rat traps.”
“We have recreated much of the same dysfunction that pervaded the asylums of the 19th and 20th centuries and the very abuses we sought to end by shutting them down,” writes Roth. “None of the rest of it has gone away, not the cruelty, the filth, the bad food or the brutality.”
Though these are extreme stories, they highlight the absurdity of leaving mental-health care to our corrections facilities.
The depersonalized nature of incarceration, including the use of solitary confinement as a punishment, actually heightens (and sometimes creates) symptoms of serious mental illness.
People with mental illness are less likely to make bail and face longer sentences — keeping them locked up longer.
At Rikers the average length of stay for all inmates is 42 days, but for those with mental illness it’s 215 days, according to the Treatment Advocacy Center.
Mentally ill inmates are more likely to be charged with rule violations and end up in solitary confinement — where they spend 23 hours in cells without human contact, conditions that exacerbate psychosis and suicide risk.
Mentally ill prisoners are also much more likely to be abused. One 2007 study showed that one in 12 inmates with severe mental illness were sexually victimized by their fellow prisoners, compared to one in 33 without mental illness.
To top it all off: Treatment is rare, if not nonexistent.
When “therapy” does happen, it typically involves administering meds and “cell-side treatment, where understaffed clinicians have to shout through cell doors or the food slot,” writes Roth.
A 2017 class action lawsuit in Lewisburg, Pa., alleged that the socalled therapy provided by the prison system “consists of a prison staff passing out coloring books and puzzles.”
How have we allowed ourselves to treat sick people the same way we did in the 19th century, when we didn’t know our blood came in types, women couldn’t vote and the “one drop rule” was state law?
“We have known for more than 200 years that keeping people with mental illness locked up in jails and prisons does little but make them worse. We know how to lock up masses of people. Now we need to figure out how to treat them,” writes Roth.
Maybe one day we’ll look back on our jails and prisons with the same horror Nellie Bly greeted Blackwell’s Island — but we have a hell of a long way to go.