1.7 Chapter Summary
- Mental disorders include mental health diagnoses as well as intellectual and developmental disorders. Though some mental disorders are not disabling, many people with mental disorders are part of the larger population of people with disabilities who struggle to have equal access to opportunities.
- Criminal justice facilities are the United States’ largest facilities for treating mental disorders. This is a result of a lengthy and complex history of failure to meet the needs of this population in humane and productive ways.
- Measures meant to treat or manage mental disorders throughout history have ranged from exclusionary to cruel, and even murderous, revealing a societal disdain for people with mental disorders that, to some extent, continues into the modern day.
- Reforms over time have eliminated or reduced obvious cruelties, but often created new problems. For example, the shift of people with mental disorders into state hospitals to be “cured” ushered in a century of institutionalizing people, taking them away from community and family, to the detriment of all.
- Institutions meant to shelter people with mental disorders devolved into overcrowded, prison-like facilities with rampant abuse and use of techniques such as forced sterilization that thoroughly dehumanized their occupants.
- Closure of institutions for people with mental disorders, in the process called deinstitutionalization, was both an enormous victory for people with mental disorders — and an introduction of a new set of challenges.
- The needs of people with mental disorders have not been met adequately in the community. Deinstitutionalization collided with a rise in substance use issues and a rapid increase in criminal prosecution and use of prison sentences to deal with these problems, to add to the mentally ill and disabled population in America’s criminal justice system. Issues such as housing shortages and unavailability of health care add to this problem.
1.7.1 Key Terms
- Antipsychotic medications: Medications that treat psychosis, a debilitating aspect of mental illness that impacts a person’s ability to distinguish what is real.
- Asylum: Facilities that were originally intended as a refuge for confinement and care of those with mental disorders, and later emerged in Europe and America as precursors to mental hospitals and psychiatric facilities.
- Cognitive disabilities: Mental disorders that impact the ability to do things like think, problem-solve, or pay attention.
- Community Mental Health Act: A 1963 act that was intended to provide federal funding to shift mental health care from institutional to community settings.
- Deinstitutionalization: The dramatic downsizing and closure of the large institutions, mainly the state hospitals, that housed people with mental disorders.
- Dignity of risk: The ability to potentially fail that comes along with an opportunity for growth.
- Disability Rights Movement: a broad push towards securing equal rights and opportunities for people who experience disabilities.
- Electroconvulsive therapy (ECT): A medical procedure that involves passing small electric currents through a patient’s brain, creating changes in brain chemistry that have been highly effective in treating conditions such as severe depression
- Eugenics: An American movement beginning the 1890s that encouraged practices such as forced sterilization to remove “unfavorable” characteristics in the gene pool. Eugenics became disfavored in the late 20th century.
- Institutionalization: Confining people with disabilities or mental illness in facilities rather than supporting their integration into communities
- Lobotomy: A surgery where part of the brain was removed with a goal of managing or curing mental illness. Lobotomies were performed on patients up until the 1950s in America.
- Mental disorders: A mental disorder is a mental illness or a disability that impacts a person’s cognitive, emotional, or behavioral functioning.
- Moral treatment: Treatment of those with mental disorders that specifically rejected the harsh treatments that had previously been used, and instead fostered the idea that ill patients could become well if they were treated kindly.
- National Mental Health Act: A 1946 act that significantly expanded America’s commitment to use science to understand and treat mental illness
- State hospitals: psychiatric facilities, in the model of the asylum, funded by the government to serve the public.
- Stigma: the persistent and unfounded negative reputation surrounding people with conditions such as mental disorders
- Transinstitutionalization: a hypothesis suggesting that people during the deinstitutionalization movement were simply moved from one institution (hospitals) to another (prisons).
1.7.2 Discussion Questions
- Are there any particular parts of the history relayed in this chapter that you found surprising? What, if any, elements of this history help you to better understand the challenges facing people with mental disorders in today’s society, in your own community?
- Consider the concept of “dignity of risk” as discussed in the video in Figure 1.15 and discuss how this concept might inform the goals of people with disabilities generally and people with mental disorders specifically.
- What do you think of the term “transinstitutionalization”? Describe the complex reasons that people with mental disorders are overrepresented in the criminal justice system.
- When future students look back on our current practices regarding mental disorders – especially in the criminal justice system – are there things you believe will make them wonder: how could humans do this to other humans?