Carceral Histories of Disability: AN ABOLITIONIST ANALYSIS

Originally published at Spectre Journal

In 2013, investigative reporting revealed that nearly 150 women incarcerated in the California prison system had been sterilized between 2006 to 2010. The gynecological prison official who oversaw the procedures – and was paid nearly $150,000 by the state per sterilization – defended the payments and the procedures, stating, “Over a 10-year period, that isn’t a huge amount of money, compared to what you save in welfare paying for these unwanted children – as they procreated more.” It is certainly outrageous that interned women were coerced into undergoing sterilization – oftentimes at the precise moment when they were “under sedation and strapped to an operating table.” But such practices are neither rare within the long scope of U.S. history, nor are they even technically prohibited by law in all circumstances.1

THE INSTITUTION AND THE PRISON

Given the disproportionate rates at which people of color and disabled people are over-represented within the U.S. prison population, the above abuses were essentially a case of modern eugenics being carried out against precisely those populations that have been historically targeted – disabled people, people of color, and women in poverty. What this demonstrates is the insidious ways in which the matrix of institutional confinement, disability oppression, and eliminationist social policy has remained a persistent feature of modern capitalist society, even as it has undergone mutations, adaptations, and reconfigurations over past decades and centuries.

Insofar as the ruthlessly competitive accumulation of capital via exploited labor has been the constant guiding imperative of historical capitalism, disabled people have ever represented a troublesome source of non- (or even counter-) profitability to the ruling class. The labor power that disabled people possess – the basic unit of commodity value under capitalism – is deemed an invalid, defective, or otherwise undesirable resource vis-à-vis the productive economy.2As the U.S. federal government defines it, to be disabled is to be “unable to engage in substantial gainful activity”;3 in other words, to be unable to competitively acquire a paying job within the prevailing conditions of capitalist wage-labor.3

In this way, disabled people have historically been cast into that sub-class of people under capitalism who rely on state welfare payments, are marginal to the formal process of capital accumulation, and are considered ‘disposable’ from the standpoint of political economy. In truth, and conceptualized broadly, disabled people occupy a class position that spans the proletariat: the active working class, the reserve army of labor, and the so-called lumpenproletariat.4 Under any conception, however, disabled people under capitalism are, by definition, so many ‘damaged goods’; commodities systematically devalued as a result of inherited or acquired ‘deficits’ in their functioning as components of capital accumulation. Thus, to the capitalist ruling class, disabled people represent an economic ‘problem’ necessitating a political ‘solution.’

Beginning in the late nineteenth century, and reaching its peak maturation in the early-to-mid twentieth century, the prevailing ‘solution’ to the ‘problem’ of disability was the erection of a system of mass institutionalization, sterilization, and social elimination, which claimed the lives of hundreds of thousands of disabled and other marginalized and oppressed peoples in the U.S. This system was codified and executed at the state level, and rendered licit at the federal level.5 Then, as now, a central pillar of the overarching regime of control, separation, and social exclusion of the disabled and other marginalized populations was the carceral institution. This is a complex of controlling and controlled spaces ranging from asylums, hospital wards, state facilities, nursing homes, penal colonies, poorhouses, halfway homes, jails, and prisons. The form has changed over the years, but the function – control, separation, and social exclusion – has remained. At its peak, in the mid-1950s, there were an estimated 550,000 people confined to the nation’s mental asylums and hospitals.6 Today, the number of people with mental illnesses and disabilities confined to the nation’s prisons and jails is estimated to be close to 1.25 million.7

The red thread connecting the erstwhile system of incarceration in institutional asylums and that of the prison system today, is more than abstractly analogous. Both represent forms of segregation, subjugation, and constraint as coercive mechanisms of social policy. Behind the paper-thin pretense of being ‘rehabilitative’, both structures eschew the latter in favor of the social removal and warehousing of putatively deviant, degenerate, or maladjusted populations. Involuntary confinement and loss of autonomy are equally characteristic of the institution and the prison. Through the mid-twentieth century, the majority of people in state mental hospitals were forcibly committed by lunacy commissions, medical professionals, state welfare agencies, or the judiciary.8

Moreover, whether committed on a voluntary or involuntary basis, institutionalized residents had no control over when they would be discharged, what treatments they would receive, or the nature of their living conditions (this remains the case for those committed to psychiatric wards and institutions to this day). In similar fashion to the way that durations of prison sentences are determined by Parole Board bureaucracies, release from the institution was contingent upon the subjective determination of bureaucrats (which determination was likewise influenced by a resident-inmate’s exhibit of “good institutional behavior”).9 In sum, the high degree of continuity between these various carceral systems suggests a shared function across wide-ranging forms.

CAPITALISM, DISABLEMENT, AND SOCIAL POLICY

The modern phenomena of both disability, qua categorical social classification, and edifices of mass incarceration, are rooted in the advent of modern industrialized capitalism. As seismic changes were being wrought in the nature of labor, community, and resource ownership, and as the mass of the populace was increasingly alienated from the means of production, people newly recognized as “disabled” came to occupy increasingly precarious, marginalized, and stigmatized (both materially and ideologically) social positions. While people with sundry impairments could not be said to have previously enjoyed full integration or economic parity, in a general sense, under pre-capitalist socioeconomic modes of existence, as Stewart and Russell argue, “many occupied a niche in small workshops and family-based production, where they could contribute according to their ability.”10

However, with the growth of standardized, uniform, competitive, and time-regulated norms of factory-based waged labor, bodies and minds that less (profitably) conformed to the newly organized standard were increasingly excluded from the economy. Such disabled individuals were seen as less-productive liabilities, rather than lucratively exploitable ‘human resource’ assets. Capitalist social policy shunted disabled people out of the economy and into institutions, where they were placed under the purview of the medical industry. The medical industry concomitantly pathologized a litany of impairments and traits – such as blindness, deafness, neurodiversity – that had “naturally appeared in the human race throughout history.”11

The “total institution”, to use sociologist Erving Goffman’s phrase, thus emerges as a means of social control and regulation.12As an imposing and visible social monument, the total institution plays an important material as well as ideological role in the maintenance of the prevailing hegemony. As a carceral space, its function is to remove “all those who either cannot or will not conform to the norms and discipline of capitalist society.”13As a mechanism of ideological coercion, it sends the message to all those who do conform that the institution awaits those who fail to do so in perpetuity.

Part of the imperative guiding the social exclusion and institutionalization of disabled people (both then and now) is the principle of political economy referred to as “less eligibility”.14The notion behind it is simply that the prevailing level of welfare assistance doled out to those relying on public support must remain below the level of the lowest wage rate prevailing in the labor market. In this way, the ‘deserving’ can be separated from the ‘undeserving’ poor, and all those able to engage in wage-labor can be coerced into its undertaking on pain of being rendered a pauper. As Marco D’Eramo has pithily put it, whereas “the wage relation [may be] considered a hellscape … true damnation consists in being banished from it.”15

Comprising a “surplus” or “superfluous” population of non-productive individuals, essentially ‘disposable’, or worse, impedimentary, from the standpoint of capitalist political economy, disabled people became targets of social eliminationist practices, involving incarceration, neglect, torture, and sterilization.16 Owing to the particular history of white supremacy, settler-colonialist expansionism, and racialized slavery-cum-capitalism in the U.S., this class of people disproportionately comprises Black people, immigrants, indigenous people, and the indigent generally, in addition to the disabled.

THE PROCESS OF DEINSTITUTIONALIZATION

Between the end of the nineteenth and the middle of the twentieth century – as industrial capitalism in the U.S. matured into one of the more developed economies in the world, and the state developed into a more sophisticated instrument for managing the social affairs of capitalism – the system of carceral disablement became an increasingly ‘perfected’ public institution. Especially during the postwar period, when U.S. political economy was characterized by a relative Keynesian, state-managed social welfare ethos, the regulation of the disabled was the purview of a medical-welfare-carceral government complex.17

By the 1960s and 1970s, however, this complex was coming under increasing criticism and protest. Radicalized and mobilized by the general civil rights, antiwar, and socially-rebellious ferment of the era, activists began decrying the institutional model as an inhumane system of domination and cruelty, unbefitting the image of a supposed ‘leader of the free world’. Relatedly, in San Francisco, New York City, and elsewhere, the modern disability rights movement was in the process of being born, replete with sit-ins, civil disobedience, and marches for access, equality, and self-determination for disabled people.

Significantly, disabled people confined within institutions were also active in this awakening of social unrest. Self-advocacy groups like Speaking for Ourselves and People First were populated by disabled people formerly or presently living in institutions. Members of these groups faced intense repression, intimidation, and violence at the hands of institution administrators and staffers bent on keeping their wards “in line”.18Persecution notwithstanding, the agency and activism of such people would ultimately come to play a key role in reforming and closing many state institutions.

Eventually, owing to a confluence of (what would prove to be contradictory) factors, including effective social movement campaigns and state budget restructuring, the vast bulk of state institutions for the disabled were shuttered. This process, known as deinstitutionalization, was accompanied by the notional mandate for former residents to receive services in community-integrated settings. In practice, however, such expectations were largely undermined by simultaneous changes occurring at the level of the national and global political economy. As deinstitutionalization progressed through the late-1970s and 1980s, the epoch of social-welfare, or state Keynesianism, was being actively deconstructed by dominant sections of the U.S. ruling class. The new mantra was that less government was better for the economy, and there was a generalized turn towards privatization of social services, austerity in state budgets, and emphasis on individual consumer choice. Neoliberalism, as this new model would come to be called, insidiously dovetailed with the desire to close the formerly budget-heavy state institutions. Autonomous choice was translated as fending for oneself in the private marketplace; freedom from state control as being freed from guarantees of state-provided welfare. Thus, the regulation and ‘care’ of the elderly and disabled by the state was increasingly turned over to private capitalist agencies and enterprises. Today, 68% of U.S. nursing homes – comprising roughly 1.5 million elderly and disabled people, including 150,000 young disabled people – are run as private, for-profit ventures.19

Many scholars of post-institutionalization have focused on the ambivalent character of the net results. Anne Parsons, author of From Asylum to Prison: Deinstitutionalization and the Rise of Mass Incarceration after 1945, argues that a “plethora of civil rights and freedoms” were gained by deinstitutionalized disabled people, but the “legal changes ultimately did not provide the right to adequate medical and social services in their communities…. As people who had been released from state mental hospitals struggled to find housing and employment, more ended up in jail.”20As the debate over deinstitutionalization was originally taking place, the fear that inadequate ‘community’ alternatives would replace the state institutions was, to be fair, a concern harbored by some people, including most notably many families of the institutionalized.21While such concerns would at least partially prove founded, it is important to recognize that blame lies not with the activists or advocates who pushed for deinstitutionalization, but rather with the various ruling agencies and state bodies that negligently ‘dumped’ their former charges into communities bereft of adequate supports or infrastructures.

The shortcomings of the community-based approach have been a result of a lack of resources, democratic accountability, and changes in the broader socioeconomic marginalization of disabled people. Studies of post-institution community-based conditions of disabled people have found what while many – especially those with less severe impairments – did indeed attain a degree of precarious “independent living”, others resided in group homes where days were spent in segregated or “sheltered” environments at a remove from community interactions.22 Today, the vast majority of people with disabilities do not live in institutions (at least as they were formerly conceptualized). Yet the dominant experience remains that of exclusion, marginalization, and isolation.23

In this vein, some scholars of disability and incarceration refer to a process of “trans-institutionalization” following that of deinstitutionalization.24Broadly construed, various institutional forms do in fact continue to dominate the lives of masses of disabled people. The disability rights group, Self-Advocates Becoming Empowered, defines an institution as “any facility or program” that segregates people based on disability and denies them control over their lives; this includes “[m]any services that have emerged ‘post-deinstitutionalization’,” such as public and private nursing homes, group homes, foster care homes, day treatment programs, and sheltered workshops.25

Paul Castellani, author of From Snake Pits to Cash Cows: Politics and Public Institutions in New York, provides an apt description of this trans-institutional process:

The problem of institutions was not one of size, auspice, or unique patterns of daily life. At the beginning of the twenty-first century, the overwhelming majority of individuals living in so-called community services were in congregate residential and day programs that replicated the highly routinized patterns of daily life typical of the downsized state institutions. Individuals living inside and outside formally designated institutions still received elaborately prescribed and monitored clinical-therapeutic services rather than supports for daily living most needed and would likely prefer….

Institutions “as we knew them” may have closed, but other types of institutions persevered, adapted, and achieved widespread professional and political support as their residents, their roles, and their relationship to other organizations continued to change.26

To be sure, there are many other disabled people who have simply fallen through the cracks, so to speak, in the decades and years since deinstitutionalization and the onset of the neoliberal shredding of the social safety net. Some – especially those with various psychological impairments – have ended up living on the street or in transient settings, often unsafe, precarious, and isolating. Many become entangled in various alternative systems of institutionalized control, abuse, and carcerality. The Center for Disease Control reports that between 1992 and 2003, the number of people with psychological impairments or disabilities visiting emergency rooms nationwide increased by 56 percent, from 2,381,000 to 3,718,000.27 Understaffed and underfunded, many emergency rooms often turn these people back out onto the street without providing either adequate treatment or support. The result is a situation that funnels disabled people into the extensive grasp of the sprawling U.S. system of mass criminal incarceration.

THE ERA OF MASS INCARCERATION

At the precise moment that deinstitutionalization was bringing one era to a close, a different era of institutionalization was just kicking off in the U.S. Referred to as “mass incarceration”, it has been characterized by the unprecedented and precipitous expansion of the nation’s state and federal system of criminal prisons and jails.28 As Figure 1 demonstrates, the rate of prison incarceration in the U.S. began to explode just as the rate of institutionalization was approaching its nadir.

Figure 1

Graph titled "U.S. Institutionalization Rates, 1928-2000." At around year 1975, the mental hospital rate approaches a nadir, while the prison rate begins a precipitous ascendancy. 

By the first decade of the twenty-first century, the U.S. incarcerated a greater share of its population than any other country; a rate of one per one hundred adults, or 2.28 million people.30 If all those under some form of supervision or control by the criminal-carceral system are included (i.e., prison, jail, probation, parole), then the population is closer to seven million, or one in every thirty-one residents. As with everything in the U.S., mass incarceration is structured, too, by systems of racial and gender inequity. Black men are 6.5 times more likely than white men to be imprisoned; Black women are 3 times more likely than white women to be imprisoned.31

Though not causally connected, the roughly sequential phenomena of deinstitutionalization and mass incarceration are related in significant material respects. Many states utilized the direct budgetary savings accrued from the closure of institutions in order to fund the construction of prisons. More directly, the very lands and buildings that formerly housed state institutions were often immediately repurposed and reopened as prisons.32In facilities across upstate New York, the process of deinstitutionalization was actually accelerated by the desire of state officials to obtain expanded prison space.33

Today, disabled people have come to account for a disproportionate segment of the incarcerated population.34This includes a particular over-representation of people with psychological impairments. A 2006 report from the Bureau of Justice Statistics put the number of jail inmates who “have a mental health problem” at 64% of the total, the number of federal inmates at 45%, and the number of state prisoners at 56%.35 There are several reasons for this.

1. Mass incarceration has led to an absolute increase in the total number of people in prisons and jails, which includes a constituent increase in the number of people with psychiatric disabilities who have been caught in the net of the criminal legal system.36
2. Disabled people tend to disproportionately be poor, homeless, and vulnerable. For this reason they tend to disproportionately experience far greater points of contact with police and other carceral state forces and agencies.
3. As part of the prison boom, and occurring contemporaneous to deinstitutionalization, former disabled institutional residents as well as those who had remained in the community, along with the newly disabled, found themselves increasingly persecuted by changes in the law. Disability Studies scholar Michael Rembis explains, “[L]awmakers, business owners, neighborhood residents, and some family members began fashioning local, state, and federal policies and programs designed primarily to segregate, isolate, and in many cases criminalize behaviors that in earlier decades or other settings may not have warranted legal or juridical intervention.”37
4. Poverty and prison, two intimately connected systems of oppression, are both eminently injurious and disabling. The experiences of imprisonment itself including internal regimes of punishment and confinement, isolation from social contact with family, friends, and communities, the self-alienation inherent to carceral dehumanization, and the constant (re)traumatization are all incredibly generative of mental illness and psychological debilitation. The same goes for the production of physiological impairments, which are rife in carceral spaces. They are produced or deepened by unsafe and unregulated working conditions, unhealthy quality of air, food, and sanitation, violence and sexual assault, and poor or non-existent access to and standards of medical care, especially vis-à-vis the spread of infectious diseases.38

THEORIES OF DISABILITY INCARCERATION

There are different ways to think about the intersection of various forms of social oppression and prison through an abolitionist framework. Viewed through a lens of racialized capitalism and the history of the caste-like exploitation and oppression of Black people in the U.S., the present era of mass incarceration and expanded criminalization can be likened to a novel, de facto “Jim Crow”, the colloquial name for the de jure matrix of racial segregation and domination that prevailed after the end of Reconstruction.39Mass incarceration can also be understood as a function of political economy with respect to the control of “surplus populations.” This refers to those who are rendered redundant or unassimilable by the prevailing conditions of capitalist production (and distribution), and who are thereby effectively cut off from routes to social integration.

Surplus population theory can be used to explain the disproportionately high rates of impoverishment, unemployment, and imprisonment of a number of historically oppressed social groups, including Black and disabled Americans.40However, it is important to clarify that such groups are considered “surplus” or “superfluous” people from the standpoint of capital. In absolute terms, there exists more than enough wealth and resources to be comfortably shared by all humans, and all humans in turn have the unique capacity to contribute in some integral form to the general wealth of collective human experience.

Another view worth considering is what might be termed critical behaviorism. This view holds that there are deep connections between the neoliberal elimination of the social-welfare safety net and the rise of mass incarceration. It describes a new paradigm jointly pathologizing, criminalizing, and persecuting an array of behaviors, mind states, and medically-diagnosed psychological phenomena, collectively referred to as “madness.”41 This process has been both politically-motivated and racially-driven, and has been attended by the vast expansion of the psychiatric-industrial complex.

For instance, starting in the 1960s schizophrenia morphed from a disease disproportionately assigned to White women into one disproportionately assigned to Black men, simultaneously taking on an association with violent social behavior.42In The Protest Psychosis: How Schizophrenia Became a Black Disease, author Jonathan Metzl reviews articles and studies published in psychiatric journals between the 1970s and 1990s, which revealed that Black patients were up to seven times more likely than White patients to be diagnosed with schizophrenia, and far less likely than White people to be diagnosed with mental illnesses such as depression.43

This argument strongly undercuts a particularly specious and reactionary thesis advanced in the wake of deinstitutionalization. Whereas one side accuses the system of mass incarceration of exposing entirely new swathes of the population to the reach of institutional carcerality, the other proposes a direct causal link between deinstitutionalization and mass incarceration. A number of articles written in the 1980s and 1990s, including one published as recently as 2015 in the Journal of the American Medical Association, argued that deinstitutionalization went too far and that the closure of mental hospitals led to the dramatic rise in homelessness and incarceration. What is needed now, they argue, is stricter involuntary treatment laws and a return to the institutional asylum model of yesteryear.44 This not only shifts the blame for capitalist economic inequality and repressive ruling class policy onto disabled people, it undermines the very notion that disabled people are capable of living autonomous lives free of carceral oppression.

The image of deinstitutionalization as a mass transfer from the state hospital to the state prison, is hyperbolic and counterfactual. Indeed, a significant number of deinstitutionalized people did return to, and remained, in their communities (relative lack of state funding and assistance notwithstanding).45 Another large portion of this population came to reside in or rely upon general hospitals and nursing homes, not prisons.46 Significant data also comes from a 1999 case study of a Philadelphia psychiatric hospital, in which it was found that a scant two percent of discharged patients ended up getting arrested.47 Finally, there is critical demographic inconsistency in the ‘hospital-to-prison pipeline’ argument. Whereas the former inmates of state institutions were largely White and middle-aged, those incarcerated in prisons are disproportionately Black and younger.48

If the hospital-to-prison pipeline argument has any currency, however, it is because it speaks to the empirical fact that there has been an explosion in the numbers of incarcerated people with various psychological and physical disabilities. This has led to the rise of a distinct, and more popular argument, that “prisons have become our new asylums.”49 As the 2007 declaration of the Council of State Governments put it:

The three largest inpatient psychiatric facilities in the country are jails, with the Los Angeles County Jail, Rikers Island Jail in New York City, and the Cook County Jail in Chicago each individually housing more persons with mental illnesses than any psychiatric institution in the United States.50

While in a general sense this argument, that prisons are the new asylums, may be useful in conceptualizing the extent to which many disabled people who otherwise would have been committed to state institutions are now being incarcerated in prisons, it is often deployed in problematic ways. The closure of the institutional system created a carceral vacuum for disabled people, the argument goes, which has been filled by the prison system – an inappropriate and ill-suited site for the ‘care’ of such populations. While one can certainly agree that prisons are inappropriate sites for the wellbeing of any population, let alone those with disabilities, we should be wary of contrasting prisons with supposedly more benign carceral settings, such as the old state asylums and institutions. First of all, as this article has argued, the socioeconomic function of the prison and institution are not without significant analogy. Second, the form of the prison and institution share comparably horrific characteristics – involuntary confinement in conditions and durations not of the inmate’s choosing; punitive-rehabilitative tortures consisting of solitary confinement, physical restraint, and violence.51

Moreover, this argument is premised upon the notion that prisons are otherwise neutral institutions that have an ‘appropriate’ function within society. Indeed, in such a view the over-capacitated prison system is just as much a ‘victim’ in this circumstance as the disabled people who wind up there for lack of anywhere else to turn. Relatedly, there is an embedded assumption here that until ‘appropriate’ alternatives are established, disabled people will inevitably fall under the purview of the prison. These assumptions should be rejected – the criminalization and incarceration of disabled people, much the same as all people, is not some inexorable result of natural social laws, but the historical result of deliberate repressive policies pursued by capitalist states. In sum, disabled people neither need nor want an institutional alternative to the prison system, but rather the end of the criminalization and oppression of disability. The logic of abolition holds for both in equal measure.

ABOLITION AND EMANCIPATION

Deinstitutionalization was certainly a ‘freedom’ struggle, but it ultimately proved to be a one-sided, negative sort of freedom. It was a freedom from state internment (of a particular kind), but it did not simultaneously engender a freedom to access the resources and supports necessary to engage in a truly emancipated, integral, and self-actualizing development of one’s life-potential. A positive freedom would involve meaningful, socially valued, and unalienated labor accommodated to one’s abilities and interests, unconditional access to the education of one’s choosing, universal and comprehensive health care, and decent standards of living on par with an expansive notion of social needs. As W. E. B. Du Bois wrote of the abolition of racial slavery in the U.S., abolition is not necessarily coterminous with emancipation. Put differently, abolition must comprise both a process of deconstruction and reconstruction.52

When it comes to trans-institutional systems of coercion, domination, and incarceration, the question of abolition must be inextricably tethered to the question of emancipation. As long as the basic social relations, economic class hierarchies, and political inequities remain unchanged at the bedrock level of society, the dissolution of one particular institution, artifice, or manifestation of oppression will prove ephemeral. The conditions that necessitated or encouraged the rise of said institution will simply produce another in its stead. Without a revolution in the very mode of socioeconomic existence, a genuine trans-deinstitutionalization will remain elusive.