Radical Psychology


Editors note -- This article was originally scheduled to appear in a previous issue.  We are similtuaneously publishing it in the current and the previous issue.

Governance through Psychiatrization: Seroquel and the New Prison Order

Jennifer M. Kilty

Women and Psy

The psy-sciences, generally consisting of the disciplines of psychology and medical psychiatry, emerged during the nineteenth century with promises of identifying, treating, curing, and managing populations seen as risky because of their strange or inappropriate behaviours.  Early psy diagnoses focused on naming behaviours viewed as different, dangerous or immoral to provide a medical basis for treatment or intervention.  In so doing, ‘psy’ surfaced as a new form of medical and correctional expertise, whose practitioners quickly sought a great degree of control and governance over populations diagnosed as mentally ill.  ‘Treatment’, however, was similar to political responses to criminality, in that those diagnosed with mental illness were confined against their will to mental asylums (Goffman, 1961; Rhodes, 1995; 2004).  The ability of psy-experts to commandeer authority over the lives of individuals under their care is rooted in claims of objectivity that allow psy knowledges to possess incontrovertible truths regarding human behaviour and emotion (Penfold & Walker, 1983; Farber, 1990).  This power to define rational and irrational or sane and insane behaviour has given the men who have historically theorised women’s mental illness “the power to prescribe and proscribe the nature and the role of women in society” (Penfold & Walker 1983, p28).  For generations, these knowledges remained unchallenged because women’s knowledges remained subjugated; as a result, the psy-sciences propose explanations that categorise and diagnose based on social norms produced within a hierarchical and patriarchal social structure.  The construction of mental illness among women is thus highly gendered, where women are located on the derogated side of the gender binary.

Throughout psy’s history and ascendency to power with respect to the management of mental illness, women have been held to a higher moral standard than men because of stereotypical expectations of womanhood.  Based on their ‘emotionality’, women are often syndromised as mad (Ussher, 1991; Smart,1995; Maracek ,2002); for example, with respect to the diagnosis of hysteria, Foucault (1979, p146-147) writes:

The notion of hysterization of women, which involved a thorough medicalization of their bodies and their sex, was carried out in the name of the responsibility they owed to the health of their children, the solidity of the family institution, and the safeguarding of society.

Syndromising hysteria and more recently personality and mood disorders fails to take into account the different socio-political contexts within which women’s emotionality and criminality are born (Smart, 1995; Suyemoto, 2002).  Not only are women more likely than are men to encounter the psy-disciplines, but as Russell (1995, p96) writes:

From the perspective of biological psychiatry, nearly all women are disordered.  Even if we take into account only depression and premenstrual syndrome, it is difficult to imagine many women falling outside this net.  It is no surprise, then, that criminal women are viewed as psychiatrically disordered.

Russell demonstrates how the law refutes the production of a female criminal subject because psy-correctional experts so frequently deem criminalized women irrational and/or mad. For example, Tammy, a social worker who has worked with criminalised women for over ten years, stated:

The institution is quick to dispense medication. All it really takes is an appointment with a doctor and you’re prescribed medication. I mean, when I do programming in there and the nurse comes by dispensing meds, I don’t think there is ever one woman in the group I’m seeing that wasn’t getting medication.

The long held belief that the fallibility of women’s psyches created distress, unmediated by the conditions of their lives, has formed an almost insuperable obstacle against which women have had to struggle in attempting to have their perceptions and experiences taken into account in clinical practice and in the explanatory models that inform psychiatric practice (Astbury, 1996, p23-34).  This dynamic is most compelling within the prison setting, where women are encouraged and arguably coerced to engage with and embrace psy-diagnoses and psychopharmacological treatment (Penfold & Walker, 1983; Ussher, 1991; Russell, 1995; Smart, 1995; Penfold, 2001; Kilty, 2008). 

Prisons: The new asylums

The intersection of psy and criminal justice is a complex one that functions for a number of reasons.   With the advent of the decarceration movement of the 1970s increasing numbers of people housed in psychiatric asylums were released with little to no support back into the community (Rhodes, 2004).  One of the consequences of this movement was that over the next two decades many individuals diagnosed with all manners of mental illness were readmitted into state care, but into the criminal justice rather than the mental health system (Cohen,1985; Christie, 2000; Rhodes, 2004).  The growing prison industrial complex reflects the interconnection of capitalist economic motives, a diverse range of new expertises and thus governing authorities, political aims, and entrenched ethnocentrism, racism, sexism, and classism.  Paralleling and supporting the prison industrial complex is an ever-growing concern with technologies of security, surveillance, and governance, while disregarding treatment in the form of therapy or counselling.  Therefore, while psy gained significant control within the criminal justice system during the era of rehabilitation, practitioners redefined their approach in order to maintain their place of expertise within the correctional domain.  Resulting from the mass incarceration movement, fewer budgetary allocations to psy-care, and increasing numbers of prisoners with mental health issues in the criminal justice system, we have witnessed a disturbing shift in psy discourses.   Psy no longer stresses the importance of therapy in conjunction with psychopharmacological treatment; instead, it exists within the correctional system based almost solely on its ability to prescribe medications to prisoner populations. 

With the merging of mental health and criminal justice fields, practitioners working inside prisons use psy discourses to both assign and deny women agency.  This reflects one of many conundrums within psy discourse – that of choice versus disease.  To clarify, Jane Ussher (1991, p133) contends that the dominance of psy discourse is “based on the belief in a physical aetiology for madness, which serves political ends.  It allows psychiatrists to maintain the continuity between physical and mental illness and to deny the role of social, economic or political factors in madness”.  In so doing, the medical model shifts the focus onto some innate deficiency of the woman rather than addressing the fact that the problem may reside elsewhere, in differing social domains.  With respect to the construction of madness as irrationality in women, Ussher contends that:

…madness is the absence of reason or rationality is seen as an explicit assumption of the positivistic argument, for the model which sees madness in terms of ‘cause’ and ‘effect’ implies the person is not a rational agent, he or she having been made to behave in a particular way.  It is implicit within the positivistic discourse that the mad person has no control (Ussher, 1991, p146).

If it is the absence of reason that separates madness from badness, madness is beyond the individual’s control and should be treated differently from punishable behaviours.  Correctional authorities thus reconstruct prisoners as failing to self-responsibilise, as attention seeking, and as manipulative ‘bad women’ in order justify their carceral control (Kilty, 2008).  This reconstruction pushes psy, at least in the prison context, into a precarious position.  While steeped in a medical tradition that seeks to find a biological explanation for human behaviours and mental illness, in order to maintain power with respect to carceral governance, psy experts must now address behaviour as a choice.  However, the correctional use of prescription medications to effectively sedate rowdy or misbehaving prisoners, actually mollifies that choice.  Subsequently, the problematic behaviour remains an individual issue within each woman, and experts are able to use her (mis)behaviour to reinforce the hierarchy of psy within the prison (Farber,1990).
 
The Impact of Neoliberalism on the Practice of Psy in Prison

With the ascendance of neoliberalism in the late 20th century came a modification of the dependency argument, and a common psy goal became the empowerment of the individual (Cruikshank, 1994).  Empowerment strategies focus on individual agency given that correctional discourse constructs prisoners as responsible for managing themselves, particularly their health.  Neoliberalism diffuses state power exemplified in welfarism and demands that citizens become empowered and self-governing (Cruikshank, 1994; Garland, 2001; Hannah-Moffat, 1999; 2001).  This shift marginalises specific populations including the mentally ill, children, the poor, racialized minorities and prisoners who do not have the means to become ‘empowered.’ To clarify, the neoliberal idea that we must all be self-governing social agents stands at odds with traditional psy explanations that mental illness is beyond the individual’s control in addition to the common correctional zeal to control every aspect of a prisoner’s life in the name of the smooth operation of the prison.  Therefore, some correctional discourse constitutes criminalized persons as no longer in need of care, treatment, or rehabilitation but rather as ‘beyond repair’ (Melossi, 2000).  Despite this fact, correctional professionals claim to want to empower women prisoners, so they can become responsibilised agents of their own welfare (Blanchette, 2002; Verbrugge & Blanchette, 2002), but only through endorsed methods offered by the prison.

Prisoners are now responsible for their own reformation thereby eliminating the responsibility of psy and correctional experts to rehabilitate them (Mathiesen,1990).  If a woman recidivates it is because she failed to embrace correctional discourse and knowledge, which is saturated with psy explanations of behaviour.  Moreover, “one of the preconditions for a new form of governing appears to be the ability to reconstruct subjectivity – in this case the female criminal subject” (Hannah-Moffat, 2001, p166).  The subjectivity of women prisoners is now at stake (or ironically, at risk).  Attempts to control the mind, soul and ultimately the subjectivity of criminalized women are now key correctional programming initiatives.  This subjectivity is universalized, essentialist, and denies differences between women – particularly Aboriginal and non-Aboriginal women (Morin, 1999).  In fact, Aboriginal women report feeling treated with less respect and dignity than do other prisoners (Morin, 1999). 

Feminist criminologists have questioned the capacity of prison officials to empower women prisoners (Kendall, 2000; Hannah-Moffat, 2001).  As previously noted, there are inherent power imbalances between these parties and the suggestion that prisoners can be empowered by a system and people that maintain their oppression and imprisonment is suspicious at best.  For example, Hannah-Moffat (2001, p170) writes:

Prisons are organized to limit individual expressions of autonomy, control, and choice.  They are sites of repression; behind their walls we find an undeniable imbalance in the relations of power between the ‘keepers’ and the ‘kept’.  Rarely are the ‘keepers’ able or willing to relinquish their power to facilitate empowerment.  While incarcerated, women prisoners have little influence, collective or otherwise, over the conditions of their lives.  In the end, the techniques typically associated with empowerment are in the control of the prevailing organization.

The Correctional Service of Canada claims to have incorporated a women-centred model of penal governance (Blanchette, 2002; Verbrugge & Blanchette, 2002).  However, using the terminology of empowerment simply feminises the discourse of correctional practices (Hannah-Moffat,1999; 2001).  The correctional focus on empowerment suggests that all women prisoners lack self-esteem and self-worth, and that they do not know themselves or have incomplete or inadequate identities.  In this context, self-esteem is treated as essential to reformation and the prison’s raison d’être is to supply a new subjectivity, a new identity, and one that is empowered, self-responsibilised and reformed according to psy-correctional ideals.  Rather than empowering women, this system seeks to reformulate criminalized women according to idealized notions of what ‘good’ women should be.  As a result, prison psychiatrists and doctors frequently prescribe women psychiatric medications to combat everything from schizophrenia to low self-esteem.

Women who refuse to take the prescribed medication run the risk of receiving an institutional charge for being ‘difficult to manage’ (Hannah-Moffat & Shaw, 2001).  In this repressive context, women prisoners are disallowed any real way to vent their anger, sadness, or frustration.  In the end, institutional charges for swearing, yelling, or refusing medication are common occurrences that can lead to an increase in sentence length or to the denial of programming (Morin,1999).  Given that programming is the main method of intervention, withholding access to programs is punitive and reflects a deliberate attempt by correctional authorities to ensure that women are complicit in following their correctional plans, institutional rules, and in taking their prescription medications.

I suggest that coercing women in prison to take prescription medications is a violation of their rights as psy-citizens to health care and security (Kilty, 2008).  Citizenship functions as one component of contemporary attempts at population management through the allocation and denial of rights, privileges, and even services.  In the community, citizens are encouraged to seek second and even third opinions regarding their health and mental health diagnoses.  We are also encouraged to research our illnesses and the affiliated prescription medications in order to ensure a fully informed decision making process regarding our manner of treatment.  Such is the nature of our psy-citizenship. 

Moreover, whereas the biological body has the potential to free itself from some diagnoses or to become symptom free, psychiatric illnesses are constructed as chronic and ever-present even when managed.  For example, Islin (2004, p226) points out that “the transformation from neurotic subjecthood to citizenship involves responding to calls to adjust conduct via calculating habits but soothing, appeasing, tranquillizing, and, above all, managing anxieties and insecurities.” Citizenship ensures that should we decide to forego treatment, whether it is chemotherapy for cancer or taking Prozac for depression, we have the right to do so.  Therefore, while correctional discourse proclaims to be women-centred and empowering, we continue to deny prisoners the ability to determine their own mental health destinies.  Reminiscent of historic insane, criminal, and lunatic asylums, the current prison regimes remain repressive institutions that sacrifice treatment (and prisoner’s rights as psy-citizens) for social control.

Method

This article is based on 26 in depth interviews; 22 with former provincially and federally sentenced prisoners in Canada and four with social workers who work with criminalized women in the community.  Of the 22 former prisoners, eight (36%) had served both federal and provincial prison time, and 14 (64%) had served only provincial prison time.  Participants were located following initial contact with social workers at women’s organisations that provide housing, services, and programming to at risk and criminalized women.  The interviews were semi-structured in nature and aimed at eliciting detailed accounts of how participants coped with stress associated with but not limited to their imprisonment. 

By focusing on how women coped with stress, one of the main areas of discussion centred on how participants experienced psy-care while in prison.  More specifically, participants unanimously described the (over)use of prescription psychiatric medications throughout both levels of imprisonment.  The following analysis reflects this disturbing finding – women incarcerated in federal and provincial prisons as well as local detention centres in Canada are currently subject to violations of their rights to health care and security due to the psy-care (or lack thereof) they are receiving while inside.  With precious little therapeutic care, women in prison are frequently subject to varying levels of medicalization in order to secure their social control.

Moral Regulation: The Medicalization of Women in Prison

Moral regulation is a process that enables the social control of certain groups, the goal being regulation by way of changing the identity and/or behaviour of the targeted population.  However, “to present a project of moral regulation one has to believe that those subjected to it are capable of reflecting and changing their lives when properly enlightened by the regulators” (Ruonavaara, 1997, p286-288; Dean, 1994).  Whatever the moral project identified as worthy of reformation via regulation, those championing said moral projects must possess a coherent and detailed program that outlines the desirable conduct of the targeted population.  Therefore, not only must those in charge of the regulation project generate a suitable discourse of ideal conduct, they must also offer suggestions as to how those working directly with the population can actualize the moral project.   Practically speaking, moral regulators require an ever-expanding assemblage of individuals working to execute the moral project – all of whom cater to the party line by expressing the values and ideals of the overarching goal of change and reformation.  Ruonavaara (1997) distinguishes between social control and moral regulation by arguing that moral regulation is a kind of social control that functions within the social relationship between the regulators and the regulated via persuasion rather than coercion. 

The language and discourses of contemporary moral regulation projects are much less overt than they have been in the past; what I mean by this point is that moral wordsmiths couch current moral discourses in politically acceptable technical language.  For example, Ruonavaara (1997, p292) writes:

In the case of contemporary moral regulation, the ideologies are the ones that we ourselves are subjected to.  Moreover, they are often now expressed in technical language devoid of any overt moral exhortations, such as discourses on health promotion or management doctrine.

With respect to women in prison, several moral projects are typically underway at any given time (Gartner & Kruttschnitt, 2004; Hayman, 2006; Kilty, 2008).  Prison programming and psy-care serve as the two primary mechanisms through which, ‘frontline regulators’ present regulatory discourses to incarcerated women and which constitute the venues for the constitution of the social relationships between these two parties.  However, for the purposes of this article, I focus only on psy-care.  With this in mind, we must acknowledge the above-noted discrepancy between psy and moral discourse.  While moral regulation theory suggests that regulators believe that those subject to regulatory discourses and practices are capable of change, psy discourses often construct subjects as unable to change, where a psy-diagnosis reflects a kind of innate and unyielding abnormality. 

Analogous to Ruonavaara’s above statement, experts commonly present psy-discourses in promotion and/or management language to attempt to mitigate any moral overtones.  The process of psychiatrization exists in tension – on one hand it seeks to label criminalized women by identifying their individual barriers to reformation (i.e., whatever mental illness or diagnosis they are viewed as suffering from), and on the other, it operates within the neoliberal carceral constraints that lay all responsibility for change on the hands of prisoners themselves.  Therefore, psychiatrization is a unique moral project, in that psy-experts secure power within their social relationship with the regulated (prisoners) through their ability to prescribe psychiatric medications.  Additionally, it is essential to examine how correctional and psy experts both persuade and in some cases coerce women in prison to take psychiatric medication. 

Medicalization is a process through which we define and treat social and/or behavioural conditions as medical issues (Conrad & Schneider, 1980; Conrad, 2007).  The term refers to the course of action by which certain events or characteristics of everyday life become medical issues, and thus come within the purview of doctors and other health professionals to engage with, study, and treat.  Medicalization typically involves changes in social attitudes and terminology, and is commonly accompanied (or driven) by the availability of treatments.  In the realm of corrections, medicalization operates through the over-prescription of psychiatric medications.  Medicalization in this fashion is most predominant at the local jail or detention centre level where prisoners are so overcrowded that they are often double and triple bunked in their cells (Kilty 2008).  Over-prescription effectively subdues this population of women, who are often characterized as misbehaving or rowdy.  Brooke discussed this role of Seroquel at length, stating:
Everyone was on something, some kind of medication. Lots of Seroquel.  They gave me Seroquel as soon as I got there, my first night.  I was on it the whole time I was inside. It knocks you out, makes you sleep for like twelve hours – so if you were sad, depressed, or even angry, the Seroquel just makes you calm – but to the point where you just can’t react to anything.

Using prescription medications in this way fails to acknowledge the harmful impact that imprisonment itself has on criminalized women.  For example, Jane, a woman who spent time on and off in a provincial detention centre, discussed how imprisonment affects one’s emotional well-being:

Well it makes you crazy in there [prison].  You’re not well in your head.  Like they send a psychiatrist to see you once you’ve been there for about two weeks.  To see how you’re doing, and some people just get depressed or they go crazy and those people get sent to segregation.  In seg, they’re just on a whole bunch of medication.

Both Brooke’s and Jane’s narratives illustrate how prescription medications and the practice of segregation, as technologies of discipline, are effective tools used to render this population docile.  In her interview, Jane acknowledged that incarceration in and of itself has a negative impact on the women’s emotional well-being.  The reconstruction of sadness and stress resulting from one’s imprisonment and criminalization as indicative of some form of madness or potential dangerousness provides a fertile ideological ground from which to create illusory images of “crazy” or “rowdy” women prisoners who must be sedated and segregated.  For example, my interviews consistently demonstrated that women perceived as more rowdy, resistant, drug addicted, loud, and questioning of authority were prescribed higher dosages of sedation inducing drugs to ensure their compliance and docility.  Nellie discussed the increasing dosages of drugs she was given while incarcerated:

Every time I would go in it was usually in the middle of a drug binge, you know? And rather than getting me in to a proper doctor or a treatment centre or something, they just got me lots of dope. The Seroquel just let me sleep and sleep and sleep so that I didn’t get all agitated craving my drug.  I didn’t react at all, I just laid there.

Rather than understanding sadness and anxiety as a normal, rational, and reasonable response to being criminalized and imprisoned, psy-experts working within the correctional system reconstruct these ‘normal’ responses to their current life situations as abnormal.  Likewise, failing to seek alternative forms of intervention for the difficulty a prisoner is having coping, medicalising criminalized women has become the de facto policy for how psy is practiced in the correctional system as well as in the community, again illustrating the extension of carceral control strategies beyond prison walls (Cohen,1985).

Carrie, a social worker who works with ‘at risk’ and criminalized women in the community, articulated this very point:

This woman had good supports on the outside; good family, a house, had never been in trouble before.  You know all of these good things, and so when she got to GVI she is obviously upset.  She’s bawling her eyes out for the first few weeks she is there and they keep trying to push meds on her.  ‘Oh here, you need to go on an anti-depressant’.  And she’s like, ‘I’m in jail! That’s why I’m depressed.  I am going to be here for three and a half years! I am going to be here for three and a half years, like that’s why I’m crying.’ She had never taken meds in her life, and she didn’t want to start in prison.  She kept saying, that it had to do with where she was, and that it didn’t have anything to do with some kind of imbalance or any of those things.  You know, ‘I am in jail, that’s why I’m crying!’.

Within the correctional system there is a reconstruction of any kind of emotional response that deviates from contentedness as indicative of an inability to cope or of some kind of greater mental pathology (Chesler, 1972; Ussher, 1991; Russell, 1995; Suyemoto, 2002).  To suggest that sadness, anger or anxiety is an inappropriate response to being imprisoned is to ignore the well-documented impact imprisonment has on those we incarcerate (Heney, 1990; Rhodes, 2004, Sim, 2005; Kilty, 2008).  Current psy-correctional responses seek to separate the prison experience from an individual’s emotional well-being while inside and subsequently look to innate reasons for any prisoner responses they view as maladjustment.  In so doing, not only do the philosophies, discourses and practices of correctional institutions have notions of psy built into them, but also the process of psychiatrization reflects the larger moral regulation project operating in prisons. 

In contrast to the inconsistent prescription of psychiatric medications that occurs in the provincial system, several of the women discussed the ease with which they were able to attain prescription psychiatric medications in federal prison.  For example, Kellie, a former prisoner of the Grand Valley Institution in Kitchener, Ontario, stated:

The psychiatrist that’s another matter, she was great.  You tell her what you want, some psych pills and she’ll give them to you, no questions no nothing.  Oh you want this, you want that, no problem.  You know what they do, they medicate people to keep them calm.  They had me on three different antidepressants at the same time! The only time you talk to the psychiatrist is to get your medications.  You’re in there for ten minutes maybe.  Oh, I need this, I need that, this isn’t working, can we try this.  Write, write, write.  It’s ridiculous.

The fact that prescription medications are dispensed so readily illustrates how the federal correctional approach to psy intervention is one of medication over therapy or counselling (Heney 1990; Sim 2005).  Correctional plans reconstruct the over-prescription of psy medication as a preventative measure taken against a population characterised as being difficult to manage or resistant to correctional regulations and other forms of correctional intervention. 

In this light we begin to see how in the correctional arena, psy is practiced as an extension of the process of medicalization.  Joan, a provincially sentenced woman, likened the impact of this process on women prisoners to the sedation of mental patients in locked psychiatric hospitals or institutions:

Joan: There’s drugs and alcohol problems, okay that’s a primary problem.  That’s the one that’s affecting them now, but there’s also the underlying mental illnesses.  That they have anxiety, depression, bipolar, manic, there’s lots.  There’s so many people on medications for that in jail, you should see the med-line.

Jen: Do you think they prescribe too much?

Joan: Well, some of them really need it.  But then some of them that really need it aren’t getting the care they need in there, and then there are the ones that take it just to sleep through their whole time.  Some of them take Seroquel just to sleep through, or we used to call it bug juice, they used to give them Nozepam and they’d be like walking zombies; that’s what they give mental people in mental institutions to keep them sedated.  Like they’re drooling out of the sides of their mouths.

Joan’s narrative reflects a kind of ambivalence regarding the use of psychotropic medications for women in prison; while she acknowledges belief in mental illness and in medicalization as the appropriate method and course of treatment for some, Joan is clearly uneasy about the impact of such high dosages on the women.  Joan does not fully problematize medicalization, but she notes an important finding – that not all women prisoners are regulated solely through external means.  Reflective of the power of psy as a key operating moral regulation project for women in prison, it is interesting to note that not all women perceive and experience taking prescription medications as intrusive; in fact, some women engage in self-regulation by accepting and using psy discourses.  Such was the case with some participants who willingly took Seroquel, an antipsychotic medication that is currently the prescription drug of choice in prison due to its common side effect of sedating the individual.

Seroquel: The Current Correctional Wonder Drug

Seroquel is the market name for the antipsychotic drug Quetiapine, whose manufacturers claim appropriate for treating schizophrenia and the manic episodes in bipolar disorder.  However, prison doctors and psychiatrists frequently prescribe Seroquel to prisoners because its most common side effect is sedation.  Of the twenty-two former prisoners interviewed for this research, all but one was prescribed Seroquel while in prison.  Moreover, the one woman who did not take Seroquel served time in the now closed Kingston Prison for Women and was inside before Seroquel was on the market; alternatively, she took both Valium and Prozac while serving time.  Both former prisoners and community social workers criticized the use of Seroquel as a sedative, often referring to the drug’s potency, suggesting that it is overly powerful and an unnecessary sleep aid.  For example, Danielle, a former federal prisoner, stated, “I don’t want to be a zombie and I don’t want to, like I could sleep all day on that shit.” Similarly, Carrie, a social worker, spoke about the impact Seroquel had on one of the women she was working with:

There are a lot of women on medications.  One woman was on 500 milligrams of Seroquel a day.  For the first few weeks, she was comatose.  You know, and this was prescribed by a doctor from the jail.  He had said, ‘come back in two weeks and we’ll see how that goes’.  I mean, how can a doctor who doesn’t know the person give them grandiose doses of medication and then tell them to come back in two weeks when she hasn’t been assessed by a psychiatrist? Like there are so many problems.

Carrie’s narrative demonstrates a trend that was evident in many of the women’s accounts – that there is little correspondence between prison medical doctors and psychiatrists.  In fact, what occurred in more than one instance were dual prescriptions by doctors and psychiatrists and/or a battle for power between the two; for women in prison, this battle commonly resulted in their being placed on medication, then taken off it shortly thereafter.  This point also illustrates how other professions have absorbed psy expertise in order to actualize more completely the moral regulation project of ‘empowering women’ to become appropriately self-governing.

The dosages of Seroquel prescribed to women in prison vary substantially.  This fact alone is not abnormal given that varying dosages of any medication are common depending on how the individual reacts to the medication and the claimed seriousness of the diagnosis.  However, some women I interviewed had been prescribed twenty-five milligrams of Seroquel, while others were taking over five hundred milligrams of the same medication.  Stacey found that with respect to Seroquel as a prescription medication, the federal prison system adhered to a ‘more is better’ philosophy:

The one thing with prison is that they like to heavily medicate people, and I’m a prime example.  Yeah, Seroquel, stuff like that.  I was on a lot of medications.  I was a walking zombie.  I could not function.  I do not remember half of my time.  I don’t know how I functioned or how I made it from point A to point B.  I can’t even describe to you how many different medications I was on.  When I left prison my parole officer from Guelph was even asking, ‘How are you walking? How are you doing this?’ I actually went through withdrawals when I came off this stuff.

Given the fact that so many participants used the exact same phrase to describe the impact of Seroquel as making them become “walking zombies”, one must question whether our current system is creating, as noted by Russell (1995) prescription drug dependence among women prisoners.  Stacey’s claim to have experienced withdrawal from prescription drugs is a case in point.  Whether they had clinical diagnoses or not, many women said that they needed their medications to “get by” and that they “couldn’t sleep” and “couldn’t function” without them.  With few other avenues to help them cope in prison and the ease with which they are able to obtain them, many women seem to turn to prescription medications as a way to cope and get through their sentences.  For example, Joan stated, “I need to take these meds, or else I can’t sleep.  The meds just keep me normal so I won’t go out and get high and act crazy.”  As aforementioned, some women embraced their psy diagnoses and willingly took prescription medications because doctors told them that these medications were necessary for them to “get well”.

Contrastingly, despite some of the women’s attempts to explain that they did not want or need psychiatric medication, but rather that they needed only time to adjust and cope with their new surroundings, their self-assertions seem to go unacknowledged by correctional and psy-experts:

I lost my kids, I was in jail, I was addicted to drugs – all this shit and all they did was give me meds to calm me down.  They act like Seroquel is going to make me feel better, but no one talked to me or offered any real help.  The reason I was so depressed was because I was living in a cell with some other person I didn’t know and had no idea how my kids were.  Meds are not going to change any of that.

Getting criminalized women to take psy medication is thus not merely a feature in the practice of psy, it is a key component in the exertion of psy expertise reflected in corrections’ efforts to transform women ‘criminals’ into ‘inmates’ and then into ‘rehabilitated’ women.  In this light, psy expertise becomes an effective instrument for altering the conduct of criminalized women.  However, to assume that women must be medicated in order to cope with imprisonment does not help them in the long run; in fact, it may foster a kind of reliance on psychiatric medications that they may not have otherwise had.

Ultimately, some psy diagnoses reflect general assumptions about the nature of women (Chesler, 1972; Ussher,1991).  For example, to be told by psy-experts that they ‘need’ these medications to cope reinforces the characterisation of women prisoners as weak, passive, emotionally unstable, and unsuitable for other common attempts at coping with stress.  As Shannon suggested:

No one would listen to me and that would get me more and more upset. They just talk to you like you are a kid who can’t handle it or like you’re crazy. Every time I would have an encounter with the doctors or nurses, they just ignored everything I would say and would make me feel like I was losing it.

By encouraging, and in some instances, coercing women in prison to take prescription medications, psy-correctional discourse reconstructs women prisoners as incapable of determining the courses of their own mental health care.  In this light, we can see how psy-experts working within a neoliberal carceral context attempt to reclaim a certain degree of control over the emotionality as well as the management and mental health identities of women prisoners.

Particularly problematic is the fact that women are, in Kellie’s words, only in to see the psychiatrist “to get your medications” and that they are there “for ten minutes maybe”.  Very little intervention or discussion between psy-expert and patient occurs, thus minimizing the potential for any kind of ‘therapeutic’ involvement.  Given that there is only one clinical psychologist on staff at an institution that may house over one hundred women at any given time, it is obvious that access to therapy and counselling is limited.  Darla stated that upon arrival at GVI, the women are seen by the psychiatrist for “around an hour” to “see what your needs are and whether you’re suicidal, or what your problems are, or if you’re argumentative, you know, your background.” To expect women upon their initial arrival in prison to be ready to discuss their clinical history again ignores the traumatic impact that incarceration has on people.  This procedure is a component of the risk assessment strategy that is so ingrained in correctional discourse, and confirms my claim that correction’s main concern is always the security of the institution. 

Quickly looking to identify argumentative and therefore potentially resistant women illustrates a desire to identify those who will be subject to increased security, medication, and isolation practices (Hannah-Moffat & Shaw, 2001).  This investigatory procedure is hardly effective as a means of securing the kind of detailed information that should be required before prescribing psychiatric medication.  Despite this fact, many women in local jails and detention centres, and provincial and federal prisons are taking Seroquel for a number of diagnoses other than schizophrenia or bipolar disorder.   In fact, only one participant was prescribed Seroquel for a corresponding diagnosis of bipolar disorder; the rest of my participants were given Seroquel for the following reasons: substance use, substance withdrawal, anxiety, depression, and as aforementioned, to induce sedation.  As aforementioned, out of the twenty-two former prisoners interviewed for this research, all but one took Seroquel while incarcerated.

Julie provided insight about the conflicting psy approaches and strategies that exist at the federal level.  For example, she stated that once you have cascaded your way down to minimum security, institutional authorities give you a week’s worth of medication and you are entrusted to take it accordingly:

What they do is they give the girls all their medication for a week.  Some of them will give them to other people for stuff, trade them, sell them.  Some would use them to get high, or trade them for things.  That’s one thing I didn’t like about it [GVI] was the medical.  You know enough is enough.  I’m tired of people telling me I have to do this, I have to do that, I have to take this medication.  I want that control.  Like last week I just lost it.  I went off my meds.  I was on something for depression.  See that was another thing in federal, they’d say you have to take these.  And I didn’t want it.  You couldn’t refuse it.  Or else I would go to seg.  Because I was on Zoloft before I came to prison and then I needed it because I was drinking, going through some things, bad relationship, so ok I needed the medication.  But when I went in, I was still on it, and I felt that I didn’t need this.  So when they called the house and said for me to go to health care, and I went over and the guard that was in charge asked why I hadn’t taken my medication, I said that I don’t feel like I need it right now.  Then I had to go in to see the shrink, and the shrink said, ‘well I feel that you need to be on something,’ so I just said ok because I wanted to get out, you know.

The correctional practice of giving the women housed in minimum security a week’s worth of their medications at a time may be seen as an actual attempt by correctional officials to entrust a certain degree of control over their own mental health to the women themselves.  However, the women are still required to take the medication and if they refuse to do so, they run the risk of jeopardising their minimum-security status and even their potential for parole release (Pollack, 2006; Pollack & Kendall, 2005).  Allowing the women to manage the taking of their own prescription medications is indicative of a push by corrections to get the women to self-govern, but to do so according to corrections’ standards of acceptable psy-care.  For many criminalized women means continuing to take all those medications that are prescribed for them, whether they want to take them or not.  At times Julie was open to taking prescription medication when she felt stressed or when she was having difficulty coping, but wanted the ability to stop taking it.  Ultimately, Julie wanted the control and decision-making power regarding the medications she took, but knowing that failure to comply would result in a longer stay in prison she desisted from her attempts to exercise that control.  Similarly, she mentioned being somewhat amenable to the drug Zoloft because she did not experience side effects from the drug, unlike the long lasting sedative effects of Seroquel that made her feel “groggy”, “out of it”, and “unable to concentrate”.   Unfortunately, Julie had to take not only the Zoloft, but also the Seroquel as it was mandated as a part of her correctional plan.

Resistance may take different forms, and reflects the ability to struggle against, withstand the effect of, or not to be affected by something or someone.  In this light, Julie’s compliance in taking her medications is an act of resistance – as she was actively doing everything in her power to struggle against her imprisonment by securing her release.  Julie’s compliance in taking prescription medications was a way for her to withstand the punitiveness of the prison and thus not to be affected by those disciplinary technologies that exist behind prison walls.  While Julie viewed prescription medications as intrusive, she engaged in a form of self-regulation and compliance in order to make her time inside less rife with stress.  At the same time, Julie refused to accept the discourse of her own psychiatrization and of the value of the amount of prescription medications given to her and other women inside.

Conclusion

The overuse and reliance on prescription psychiatric medications reflects three broader political trends: first, what Conrad (2007) identifies as the medicalization of society; second, historic constructions of women more broadly and women prisoners more specifically as mad, irrational, or unstable; and third, ongoing correctional attempts to pacify prisoners with drugs in order to more easily foster the larger correctional moral regulation project, as well as to prevent resistance or the questioning of correctional authority.  Seroquel, while being the current prescription drug of choice, is merely one in a long line of medications that have been popular in prison. 

The main argument of this paper surrounds the rights to services that may help psy-citizens cope more effectively and in a manner, they see as most helpful.  Institutional mandates deny services and potential treatment options to criminalized women, which are available in the community.  Ultimately, there are three avenues available for the betterment of the health of criminalized women in their capacity as psychiatric citizens. First, we must re-evaluate the power of psy in the carceral context, with the hope of reducing reliance on psy-diagnoses and prescriptions.  Second, we must improve access to services and treatments desired by criminalized women so that they can function independent from corrections (which would require improved access to information and education regarding each individual’s mental health so that she can be involved in the decision making process – which by and large would be a step toward a woman-centred model). Finally, providing care in and through the community rather than through corrections would help to separate correctional power over the mental health care of criminalized persons.

Unfortunately, criminalized women lack the real freedom to make informed choices regarding their own mental health care, thus denying them agency with regard to their psy-citizenship; for example, correctional authorities use a woman’s pending parole release as an incentive to ensure that she continues to take medication.  Worse yet, these same authorities actually present their strategy as an attempt to help empower women.  Coercion is not empowering; it is in fact the exact opposite – it is disempowering.  Women in prison have not voluntarily signed themselves into a psychiatric hospital, nor have they given up their right to determine their own mental health welfare; they are incarcerated in a prison against their will.  Since psy-care in prison is provided by those who officially work for and thus report to correctional authorities, as opposed to being a distinctly separate and outside neutral party, there is no real sense of confidentiality or trust between ‘patient’ and doctor.  As Kathleen Kendall (1994) asked nearly fifteen years ago, is it even possible to have ‘therapy’ behind prison walls?

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