Waiting for an Echo: The Madness of American Incarceration

By Christine Montross. Penguin Press, 2020. 352 pages. $28/hardcover; $18/paperback (available in July); $14.99/eBook.

Why does the United States have such an overwhelming number of people in prison, even now that we have begun to recognize the injustices that produced those shocking numbers? Christine Montross has studied U.S. prisons, solitary confinement practices, and the conditions in high security prisons for those incarcerated people considered the most difficult to control. Her answer after thorough observation: “We say we want safety, justice, accountability, but our practices reveal that we actually want revenge.” Sometimes this is against a person with a severe mental health issue that should lead to treatment, hospitalization, or both, not incarceration.

Montross is an associate professor of psychiatry and human behavior and a practicing psychiatrist. Because her patients so often become entrapped in the legal system, she set out to investigate why that happens and what happens to people in that system.

Widespread closures of state residential psychiatric hospitals happened in the 1960s–80s. A plan to open community mental health centers all around the country led to the release of thousands from psychiatric care. Then the key component of the plan was denied: funds were not allocated for community mental health centers, psychiatric treatment, social support, and vocational training. Before long, large numbers of mentally ill people were in U.S. prisons.

Montross tells us that there were 500,000 patients with severe mental illness in state psychiatric hospitals in 1955. In 2014, there were 356,000 inmates with serious mental illness in jails and state prisons and only about 35,000 such people being treated in state psychiatric hospitals. The cases she describes of severely ill people being held for months as they await trial are horrifying.

Montross describes conditions in “super maximum security” facilities that house inmates who have committed the most serious violent crimes; are being victimized by other inmates; or who are mentally ill and violent, or prone to self-harm. There are so many mentally ill inmates in these high security facilities and so few psychiatrists that one warden reported to Montross that a psychiatrist sees each of these inmates less than 15 minutes per week, which means it can take a year to understand the patient’s condition and provide appropriate response.

In U.S. high security prisons, violent force is the standard means of controlling inmates; that means is not designed to help people with mental illness. On top of that, Montross explains, prison conditions can cause mental illness in inmates who were mentally sound when they entered prison. Nevertheless, prison is viewed as a treatment option for mental illness in the United States.

The First Step Act of 2018 modified federal sentencing laws for nonviolent drug offenders, expanded early-release programs, and eased federal mandatory minimum sentences. But Montross has seen harsh sentencing and adverse practices in the prisons continue. Although use of marijuana is now legal in many states, young people, with their youthful propensity to defy rules, get long sentences for possession or sale of it. In prison, they may find themselves in solitary confinement, risking their mental health and healthy development of their social skills and emotional well-being. It would seem they have been robbed of their lives. Often, they have: they are not nurtured or led to a better path in prison, so they are eventually released to the streets with little guidance and with inadequate resources. One young man who was arrested and imprisoned with his brother was released while his brother remained in prison. The night before he left, they cried together; then his brother said, “Don’t worry, I’ll leave the light on for you.”

Many jurisdictions are working now to improve conditions in a host of ways: citations instead of pre-trial detention, opportunities for vocational training or higher education, effective pre-release programs, ending solitary confinement, expungement of records, banning the job application question about convictions, and more; we have many wrongs to right. This work goes slowly and is incomplete. It requires changes in the law and the commitment of society.

To provide contrast, Waiting for an Echo describes the penal systems in Sweden and Norway, where the treatment of inmates is humane. Montross describes their philosophy of producing better neighbors. While serving a sentence, each person gets help in determining what are unmet needs and finding ways to meet those needs. There is a vast difference between the philosophies of their systems and of the U.S. system: objective analysis, improvement of the individual, and strengthening of the community versus vengeance, punishment, and suffering. The intent of their systems is to make their fellow citizens better neighbors; in the United States, the system intends that they should never be our neighbors.

Montross has seen much more than most of us about what we do to some two million U.S. Americans, and she has seen that it is not the only option. We, as a nation, as a community, need to know this and to repent of it. Let’s clean up our act!

Rosalie Dance is a member of Stony Run Meeting in Baltimore, Md., and a member of the Maryland Alliance for Justice Reform.

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