Earlier this month we collaborated with the organizers the Socialism Conference to put together five sessions at this year’s conference on the political economy of health and disability.

In this session, "Resisting Carceral Sanism" Death Panel podcast co-host, Beatrice Adler-Bolton, is joined by criminologist, author and disability theorist, Liat Ben-Moshe, and mad advocate, author and activist, Leah Harris, discuss the increasing wave of policies and legislation—from Eric Adams’ stance on involuntary hospitalization to Gavin Newsom’s Care Courts—that seek to criminalize madness and people with intellectual and developmental disabilities. They also discuss why it is so critical for the left to work against these policies, and how to understand the politics of what Ben-Moshe has termed “carceral sanism.”

This session was live streamed and also available as a video.

Thanks to Han Olliver for our Death Panel x Socialism Conference 2023 poster image, which is being used as the cover image for this episode on platforms that support it. See the full poster below, and find and support Han's work at hanolliver.com

Transcript by Kendra Kline. (Kendra is currently accepting freelance transcript work — email her if you need transcripts!)

DP x S23: TRANSCRIPT
How Capitalism Kills: Social Murder and COVID-19

[Beginning of transcript]

Beatrice Adler-Bolton 0:00
Hello everyone. Welcome to this conversation about carceral sanism, what it is and why resisting carceral sanism is central to our current political struggles and those to come. This session is being live streamed, so hello to everyone who is listening or watching remotely.

My name is Beatrice Adler-Bolton. I'll briefly introduce myself momentarily, but first I'm going to begin with the COVID-19 community safety announcements and then I will introduce the session and participants. So first, the COVID-19 announcement: reminder, all Socialism Conference attendees are required to wear masks fully covering the nose and mouth while indoors in conference spaces including hallways, and meeting rooms. Speakers from the front of the sessions will not be removing their masks in order to deliver their presentations at this session, and audience members are required to wear masks even when asking questions or making comments. The mask policy is in place to protect all of us, especially the immunocompromised from the risks of contracting COVID-19.

Second, the community safety announcement, the conference community safety plan relies in part on badge checkers at the door of each room. And all attendees are expected to wear their conference badges at all times to enter conference meeting rooms. And thank you also to our interpreter, or interpreters.

Okay, so today we are here to talk about a recent resurgence of forms of carcerality that contribute to the targeted oppression and removal of mad and mentally ill populations under the guise of providing treatment or care. So, first, thank you so much for being here today to be a part of this ongoing conversation that we've been having throughout the sessions that Death Panel has been putting together about the ways that health and disability intersect with all of our movements. This session is really attempting to bring together some important and sometimes disparate ideas. So this one is actually going to have a shorter discussion portion than our other sessions. We'll be taking a smaller stack, but you know, it is being live streamed. This is the kind of thing where some of the conversations we want to have we don't necessarily want like broadcast publicly.

So my name is Beatrice Alder-Bolton, again. I'm the co-author of the book, Health Communism, and a co-host of the Death Panel podcast, which is sponsoring this session. And I am truly, truly honored to be joined onstage today by my comrades, Liat Ben-Moshe and Leah Harris. Liat Ben-Moshe is Associate Professor of Criminology, Law and Justice at the University of Illinois at Chicago and author of the fantastic book, really fucking good, Decarcerating Disability: Deinstitutionalization and Prison Abolition. Leah Harris is a mad and disabled writer, facilitator and advocate, whose work has appeared in The Progressive, The Milwaukee Journal Sentinel, and Mad in America. So thank you both so much for being a part of this.

As many survivors of psychiatric systems will tell you, psychiatric incarceration is not treatment, it's violence. Liat, as you write about in your book, the movement to close the old massive systems of warehousing, the asylum, the state hospital system, can be thought about as part of the continuum of organizing against the prison industrial complex. And there are many lessons to be learned from looking at psychiatric care through the lens of prison abolition. So that's what we're going to do today. For example, if we're very successful in closing a site of imprisonment, but people end up incarcerated in a different side of imprisonment, this is not a win. This is a reformist reform. And this is a case in which we learn. And we're here today to learn together, because after decades of struggle to end psychiatric incarceration, recently there has been a deeply worrying and rising return to past practices. It can be really hard to spot and this is what we're going to focus on today. Because what carceral sanism actually delivers us is back to an era akin to the age of the carceral psychiatric ward, and that is why resisting carceral sanism must be central to the left's agenda, and especially to work that is already a part of the abolitionist movement. So let's jump right in. Liat, can you start off by talking about this term that you coined actually, carceral sanism. Let's walk through what it is and how to spot it.

Liat Ben-Moshe 4:30
All right. Hello, everybody. Thank you. Thank you, Beatrice. Thank you so much for your work. Thank you for the amazing Death Panel podcast. How many of you know about the Death Panel podcast, raise your hand or another body --

Beatrice Adler-Bolton 4:44
[joking, feigns embarrassment and hides face] Now you're embarrassing me.

Liat Ben-Moshe 4:44
Yes, yes, yes. So vast majority, but if you don't, you should totally listen in. And just, I don't know if it's a spoiler alert or you were gonna kind of say it at the end, but Leah and myself and Vesper Moore are going to do a podcast with Beatrice on this very topic. We're going to record it in about two weeks. So stay tuned for that. And I wanted to say that at the beginning, because we're not going to have time to kind of delve into all of the issues in depth, but in the podcast, I think we will much more. So stay tuned for that.

So first of all, what is carceral sanism? Which is a term that I use, so I want to first of all give a definition of both of those words, just to kind of get us started. So for people who don't know what ableism and sanism is, I'll just give a brief definition. Ableism is the oppression that people face due to disability and it could be perceived, or actual lived disability, which not only says that disability is a form of difference, but it makes it inferior. So that's what ableism is. And sanism, very similarly, is the oppression faced by those who are deemed mad or crazy, mentally ill, psychologically disabled, and also sanism is the imperative to be sane, to be rational, to be not crazy and mentally ill and psychiatrically disabled. So that's the second part of the word. Carcerality, what we mean by that is confinement, but also the logics of kind of capture, of locking up, not only through criminalization and this is really important, but also carcerality can come from medicalization and through pathologization. And by the way, when we say here medicalization, I want us to be clear that we're not conflating that with medical care.

So if you didn't go to the first Death Panel panel [laughing] yesterday [ Health and Capital ], where they kind of explained that, just so you know, that for us, medicalization is a process, much like pathologization, criminalization, it's a process that's done. It's not -- doesn't mean access to medical care. So carcerality is about pathologization and both of those things entail both medicalization and criminalization, entail surveillance, they entail policing, they entail confinement, and yet usually when we say carcerality, we usually talk about criminalization but not medicalization. And today, we want to do both.

So that is what carceral sanism does, is that it brings those two nexuses, the medicalization and the criminalization. I also want to say that carceral sanism, and sanism and ableism generally, and their uneven relation to labor extraction, to disablement, to confinement, to surveillance, to policing, they are constructed on anti-Blackness and on colonialism. So I want that to be clear that whenever we say sanism, that's what we mean. The way that it's connected to anti-Blackness and colonialism, even if it doesn't only affect people of color and indigenous people. It's based on that formation.

So lastly, the actual definition of carceral sanism, which will help us spot it, is that it's the praxis and belief that people with disabilities need special or extra protections, that people with disabilities need special or extra protections in ways that often expand and legitamate their further marginalization, and incarceration. So for example, that people with disabilities need special units in prison, that they need their own institutions, that they need special treatments, special professionals, things like mental health courts, solitary units in prison, social workers instead of police in mental health crisis, and so on. So it's the expansion of the carceral state through other means. So it's built on -- the concept of carceral sanism builds on concepts like carceral humanism that Jim Kilgore uses, carceral feminism, the ways in which the carceral state expands over the backs of particular populations, in this case people with disability, and the use, the way pathologization, medicalization is used as justification for this carceral expansion. You need this care, it's benevolent, it's for you. It's for your own good, but it's carceral.

Beatrice Adler-Bolton 9:45
Thank you so much, Liat. Liat's work is so tremendously central to the work that we do on Death Panel. And the rise in carceral sanism that we have seen over the last five years, but especially accelerating during the pandemic has been incredibly frustrating, because sometimes we see these narratives advanced by our own comrades, by folks on the left. This is not something that any one part of the political spectrum has dominion over, right? Like there's no monopoly on this ideology.

And as I mentioned at the top of the conversation, the call to reopen the massive total institutions, that the mad pride, disability rights, disability justice, self-advocacy, and neurodivergent movements have worked for -- I said decades in my notes, but it's actually centuries -- to try and dismantle, is a hot topic. Recently mentioned as a kind of magical thinking silver bullet solution to literally just get rid of folks living on the streets by removing them visually, out of sight, out of mind, has been the strategy for managing madness for many, many centuries now.

And from all across the political spectrum, we're seeing attempts to return to the heyday of the total institution, from conservative Republicans like Florida politician, Matt Gaetz, who called for reopening the asylums because:

"The Democrats are purposely riling up their nutty shock troops in the hopes they will terrorize normal Americans into submission."

But to Democrats, like New York City Mayor, Eric Adams, who has expanded involuntary hospitalization, and California Governor Gavin Newsom's care courts. They police houselessness and funnel people into what tenants organizer, Tracy Rosenthal, has called forced alternatives. This is not something that we are seeing exclusively from Republicans, conservatives, etc. There's no ideological monopoly, as I said, on calls to lock people up under the guise of treatment.

Sometimes, you know, carceral sanist reforms sometimes are even bound up in things that we want and are working towards, like diverting funding away from the police, or setting up new systems of 911 call diversion to stop the police from showing up when someone's in a mental health crisis. As Liat's talking about, some of the ways that carcerality expands under the guise of treatment fits into things that are very common talking points in the abolitionist movement, like social workers are sometimes cops, right. But we have to understand it as part of a broader process, not just as like this job function is bad, right? It's not about good or bad people. It's about how is this being instrumentalized. So Leah, you have been following a lot of these resurgent calls to reopen the asylum, part of the broader resurgence to roll back all sorts of protections that have been really hard fought. So can you talk about some of the things that have been so far tangibly eroded under this recent resurgence of carceral sanism and how that's being justified, to just sort of set up what the landscape is right now?

Leah Harris 13:02
Absolutely. And yeah, I'm just so grateful to be here today with you all, and just wanted to add my appreciation for Liat's work, for the Death Panel's work on this. And just to share that, you know, I really come at this as a second generation survivor of psychiatric oppression. This is a generational struggle. And I really hope that that gets highlighted in what we're going to be talking about today.

So just to kind of like touch on the current moment, I mean, there's so much we can talk about here, and I hope we'll get into it. But it's so hard also to disentangle it from the history, right, which we'll also get into a little bit later in the discussion. But yeah, like Beatrice said, this carceral sanism is really exemplified by this very alarming and rising tide of policy pushes that are meant to erode and eradicate hard won legal standards, right, regarding for psychiatric intervention, who gets it, who does not get it, right? And in addition to Liat's book, and the work that Death Panel is doing, I also, if you want to look more in depth in this, I recommend the book, Your Consent is Not Required by Rob Wipond, which came out earlier this year. It's a good resource.

So, you know, I'm no believer that the legal system can save us or that it should be the primary lever of change necessarily, but it's really important to understand that these are some of the only due process protections that we as mad and disabled people have right in this country. And there's this really disturbing framing, and maybe you'll spot it in the media and with the politicians and the pundits, but that rights exist on a continuum, right? And it's like, oh, we've gone way too far in this direction. We need to fix the pendulum swing that has gone too far in the direction of mad people's rights, right? And there's this ongoing effort by the ruling class to correct this, right. And so, you know, as Beatrice said, these ideas are really embedded in both liberals' thinkings, in conservatives' thinking, across the right and even can be found in left movements. So, you know, of course, there's these calls to reopen the asylum or bring back the asylum. There was a really shitty Wall Street Journal piece about this quite recently.

But what we're really seeing today is a far more diffuse asylum, right, involving this maze of outpatient commitment schemes and "specialty," or "problem solving courts," like mental health and drug courts and veterans courts, right, that have evolved over the last couple of decades. So essentially extending the asylum into the community through these tentacles of coercion, right. And another resource on that, that I really recommend, is the Beyond Problem-Creating Courts, a document that's put out by Interrupting Criminalization. And what I want to say, just before I get into like some of the current stuff, is that multiple studies have shown, over decades now, that all forms of psychiatric force and coercion, the "serious mental illness" designation, and these associated diagnoses, land hardest on Black and brown folks due to the very well established white supremacist foundations of psychiatry and all of these systems. And for more on this, I really recommend The Protest Psychosis: How Schizophrenia Became a Black Disease, that's by Jonathan Metzl -- M E T Z L.

And there's also a very strong intersection here with the anti-trans legislation and policies that are taking over as well. There's an account called @MercifullyMad on Instagram, who's been writing about this, and saying”

"Transphobia and sanism are built upon each other, with the idea that being trans is 'crazy,' and to be crazy is to be deserving of having your autonomy removed by the state."

So really, really bringing forth how all of these forms of oppression are intersecting and interlocking in this carceral sanist way. So, as houselessness grows in this country, for all the reasons we here at Socialism Conference know very, very well, there's been this trend, I'm sure many of you are following this, it's been covered wonderfully on Death Panel, of these Democratic mayors and governors pushing regimes of force on the so-called untreated mentally ill population who is living outside, right? So we see this in the form of Mayor Eric Adams' involuntary removals policy. I mean, it's just so disgusting that it's like just laid out there so bare. And when he announced this policy last November, he really, really doubled down on the coercion as compassion trope, right? So saying -- he said, If severe mental illness is causing someone to be unsheltered and a danger to themselves, we have a moral obligation to get them the treatment and care that they need, right, so it's couched in this language of morality.

And the intro to Adams' terrible legislative plan, which you all tore apart on Death Panel in excellent detail, it says:

"While voluntary care is always preferable, it is not always a realistic expectation when a person in the throes of psychosis does not believe they are ill."

We're going to definitely come back to this theme over and over again. And this is the best part of it, he says:

"and/or has delusions that the mental health professionals seek to harm rather than help them."

So just really highlighting that in this framework, if you object to your treatment, if you object to any of that, that's seen as a symptom of your serious mental illness. It's really, really terrifying. So again, you know, this is like blaming houselessness on individual's brains, rather than these structural causes.

And even responding to Jordan Neely's murder, you know, he doubles down on this trope, you know, saying:

"I want to say upfront that there were many people who tried to help Jordan get the support he needed. But the tragic reality of severe mental illness is that some who suffer from it are at times unaware of their own need for care."

So again, coming back to this calling people unaware, lacking insight. I'll go into like, there's a whole scientific designation -- pseudoscientific designation for this as well. And then shifting over to California. But I do want to just emphasize, we can't talk about it all today, but these policies are occurring all across the country. It's not just a New York, California thing at all. But yeah, there's the rise in this regime of so-called "care courts." Have y'all heard about the care courts? [pauses for participants’ response]

Okay, I see a lot of heads nodding. Again, compelling "care" on the same groups of people living outside under the threat of a conservatorship if they don't comply with their "care plan." And again, just noticing the similarities in language, when care court legislation was enacted, it was about a year ago, I think it was September of 2022, Governor Newsom used the same kind of coercion as compassion, moral obligation language, as Adams did, saying:

"Today's passage of the Care Act means hope for thousands of Californians suffering from severe forms of mental illness, who too often languish on our streets without the treatment they desperately need and deserve."

And this is, you know, we all know this is extremely disingenuous, but it's also like -- there was last -- or I think, yeah, it was this year, UC San Francisco did the largest survey of unhoused people since like 1999. And they found -- this is not going to be a surprise to anyone in this room, but that the primary cause of houselessness was people not being able to afford rent. Like shocker, right? Wow. You know, like, amazing, we had to study this and come to this conclusion, not "untreated mental illness" and substance use, which is always, right, the stated pretext for all of this policy.

And then just the last couple of things I'm going to say, I know I've been talking a lot, is that Governor Newsom is also seeking, right now as we speak, this legislation is moving to "modernize the system," that's the language they're using, by overhauling the 2004 Mental Health Services Act, right, which is funded by taxing the rich, and he wants to divert funds away from community and peer led organizations to programs really that are designed to administer the disappearance, surveillance and cure of unhoused people, right? One of the advocates called it big box programs. And this modernization scheme also includes SB 43, which is this bill that's currently making its way through the legislature and it expands the definition of grave disability, right. So making it much easier to involuntarily commit people to locked facilities.

And if you all follow the California's Big City Mayor's movement, they have come out swinging, very excited about this, what is called conservatorship reform. And just the very last thing I'll say on this for now is that, you know, impacted folks who actually worked very hard to input into the Mental Health Services Act like 20 years ago, and peer workers and advocates, they've been totally shut out of this process. That's what folks on the ground are saying, which is, you know, this process is being led by Newsom and the social worker turned state senator, Senator Eggman. So I'll just leave it there for now. Thank you.

Beatrice Adler-Bolton 23:36
Leah, thank you so much for laying that out. I mean, just my blood pressure went up with -- like, I know those quotes so well, right, and even just hearing them read out loud, the faux compassion, the faux morality, it's almost the standard way that people talk about this, right? Like, this is not some outlier of terrible speech against people with mental illness labels. This is very common. You know, you probably have friends that may have talked to you like this before, and it can be really hard. But I think to be able to properly talk about what is at stake here, we need to take a moment now and look back at history. I mentioned the idea of deinstitutionalization a couple of times now, and Liat's book is obviously concerned with the movement for deinstitutionalization.

And Liat, I really appreciate and I know you know that I appreciate this, but it's so important, the way that you talk about deinstitutionalization in your work as being and meaning many things at once, specifically kind of three overlapping things. So can you walk through sort of what deinstitutionalization is and how you think about it, because to kind of understand what we're potentially losing here, the things that Leah has set up, we kind of have to understand what the system was like before.

Liat Ben-Moshe 25:05
Thank you for that question, Beatrice. I also wanted to say something about, before we kind of go back in time, to talk about just for one second some of the like Chicago examples in regards to what Leah was mentioning, which is related to the deinstitutionalization, because what happened in Chicago, you know, now there's ordinances to basically take money off from the police, or like put defund the police into action, and use that money to reopen the mental health clinics, especially on the south side, that Rahm Emanuel closed in 2012. And some people kind of conflate that with deinstitutionalization, that was a little bit different, and I'll talk in a second why.

But my point is that the reason why, and I think we're all on the panel very much for defunding the police and taking the money, and putting that into the hands of mental health service users or, you know, community centers. But we're kind of a little bit wary of taking the money and saying we're going to open like medical clinics, you know, with it. And so I think that the last point you were mentioning, Leah, is really, really, really, really important, and I don't know how much more to emphasize it, that things were taken from service users, from mad movements, from peer led movements that knew this was coming, they knew what they wanted, and nobody's asking us anymore. And so, when we're not at the table, I think that this is where some of the issue is coming from.

And I think that this is why, for me, deinstitutionalisation is, like Beatrice was saying, was three things. One of them was, I think, what people understand deinstitutionalization to be, which is the closure of the psych hospitals, the closure of institutions for people with intellectual and developmental disabilities.

Secondly, it was the kind of movement of people into community living. So it's not just that sites of incarceration close, but also that it changed people's lives, right, into living in the community.

But thirdly, that it was a movement -- you know, that deindustrialization was a movement, and it was led by a lot of people, some of them were people who were institutionalized and self advocates, med movements, also allies, you know, like doctors and physicians and nurses, and practitioners that were like, what is this, you know, what is this mess, lawyers, activist lawyers, I mean, parents, a lot, a lot of people.

But it's really important to think about it in this three pronged way. Because when we don't think about it as a movement, we just think about it as a process, like that happened over time. That Reagan closed all the institutions, that was deinstitutionalization. And okay, you can -- in a very narrow way, you can look at it like that, but I'm trying to push for a more kind of -- there were strands of abolition in deinstitutionalization and I think those need to be celebrated. And they weren't always, and they weren't all the time, and they sure weren't when Reagan closed psychiatric hospitals, but I think if we only leave one version of the story, then we get a story of failure, we get a story of, what have you done, you know, mad activists and self advocates and disability activists. And I think that that is very problematic.

So I wanted to leave us with kind of three questions, one in relation to each of the three prongs before we move on. So if we look at deinstitutionalization as the transition of people with psychiatric, and intellectual or developmental disabilities, from state institutions into community living, the question is, where did people end up? And I think that the story is a little bit different in terms of people with intellectual and developmental disabilities and people with psychiatric disabilities. And we don't have time to get into it, but it's about historical processes and funding, a lot of stuff. But the question still remains is like, where did people end up? And what kind of community living did they get? I think that that's a really important question. And also the gendered and race distribution of caregiving and labor, that people ended up outside of the institution, which meant that, for example, for people with intellectual and developmental disabilities that get funding from the state, and so we can track this, a lot of the labor is done by a family caregiver, mostly a mother or a sister. And even though this means that people can live in the community, they live with their family, as a lot of us have until a particular age, and that's great, but there's no kind of financial or other support for that, so it becomes really kind of a feminist and a racial justice issue and sometimes an immigration issue as well.

And the other question in relation to that, where did people end up is, you know, there's a discussion in Australia right now about reparations for people who were institutionalized. Also in Massachusetts, by the way. But in Australia, more generally, they're trying to kind of push for literal like reparations for people who were institutionalized, or people, including in nursing home facilities, that's starting to be kind of a conversation, but particularly in kind of these large state institutions.

Secondly, if deinstitutionalization was the closure of large institutions and psychiatric hospitals, the question is what happened to the buildings? And one of the things that happened, we talked a little bit about that yesterday is, you know, some of them became prisons, as you might imagine, some of them became other sites of, you know, carcerality, in some kind of way. And some of them became like haunted attractions, so just keep your eyes out for Halloween. Some of them were actual facilities and where people lived and died, don't go on those haunted things.

And then lastly, if deinstitutionalization is a process, it's a movement, it's a movement about anti-segregation. It's a movement in which people, particularly people with intellectual disabilities, and I can't emphasize this enough, which are people that we often don't listen, we never kind of ask what people with intellectual disabilities need or want. And they said very early on, like in the 70s, that nobody should be incarcerated. They even use the words, but nobody should be incarcerated or instituationalized in an institution, regardless of the disability, because what they were trying to push on them, very much related to what you were saying, is that, yes, people deserve to live in the community, but you know, if they have very complex medical needs, or if their disabilities are very severe, you know, surely they need to live in the institution. And so self-advocates organization early on said, no, nobody should live in an institution, period. Never. And that became, you know, a very -- the stance of self-advocacy and other disability movements.

Beatrice Adler-Bolton 32:16
Thank you so much, Liat, I feel like so often, you know, you just look at facility closure, and you're like, oh, that's deinstitutionalization, right? But part of what Liat's book does so well is talks about really how things like Rahm Emanuel closing a couple of mental hospitals or Ronald Reagan, you know, the way that these proposals also are fronted, right, like the idea's like okay, well, you know, we got to close these things. They're so expensive, but the money doesn't get funneled back into anything else, right? Like, the programs aren't there. Some of these institutions closed and group homes and small treatment centers popped up on the perimeter of the old facility. That's an example Liat talks about in her book, like people who were moving into homes in the community, into group homes, their neighbors fire bombed and bombed the group home before people -- I mean, people have burned to death in group homes that have been bombed while people were in them.

But you know, there is -- there is a kind of logic to deinstitutionalization, right, where it's not simply the closure of an institution. It's also the building of something else. And many, many other options that could be on the table have never, ever been on the table. And that's really important to understand, which is that people like Gavin Newsom, Matt Gaetz, Eric Adams, they pretend like we've tried everything already. And so all we have left is to go back to the one thing that was working, right, which is large scale institutions, and this is the framework that we're seeing all over.

So you know, just to sort of zoom in actually on the example of California again for a moment, you know, prior to the late 1960s, many, many more people with disabilities, and mental health diagnosis labels lived their entire lives, or most of their lives, in state hospitals or large institutions. In 1967, California passed the Lanterman-Petris-Short Act, LPS, that sought to end inappropriate and indefinite confinement of people diagnosed with mental health disorders by establishing like a couple of controls, you know, like really simple things -- right to prompt psychiatric evaluation and treatment, for example. And it's not a rare occurrence to be doing archival research on folks living in asylums and institutions and read in their file that in 30 or 40 years, they never once received one session of therapy, for example.

In Health Communism, we talk about a woman named Margaret incarcerated in New York State's Willard Hospital from 1941 until she died in 1973. She never once had a single session of psychotherapy, which is what she was there to receive. That's why her doctor sent her there. Every day, she was given a heavy dose of Thorazine. And she described her experience as like being a fly trapped in a spiderweb. So I just want to emphasize the landscape of so-called care and treatment that this legal framework in California was sort of trying to intervene in, right. So Leah, can you talk us through some of these weeds-y, historical moments that I think offer us not just a picture into what things were like, and what we're trying to resist a return to, but help us also understand sort of how this fits into structurally, some of the other movements that I think a lot of people are also involved in?

Leah Harris 35:57
Yeah, absolutely. So yeah, I think again, it's so critical to really, to understand this history, because it's actively what they're trying to eradicate and roll back the clock half a century right now. So yeah, just even that, you know, to think that just 50 years ago, people could be committed to asylums, just like Beatrice talked about, even for life, solely based on the testimony of a few psychiatrists, right. And the judge almost always sided with the psychiatrist's recommendation. And the prevailing legal document or doctrine that allowed for this was called parens patriae. I don't know if I'm pronouncing that right. But it essentially assumes the state, right, to be this benevolent force, right, that is intervening for the "best interests" of people seen unable, deemed unable to care for themselves, right.

And again, that's really what's at stake here, given all of these concerted efforts among the ruling class to roll back the clock to these parens patriae days. So just to kind of talk a little bit more about the deinstitutionalisation process and how that unfolded in law in the 60s and 70s, you can really see a wave of what was called the due process revolution, right? And it shifted to this legal orientation where psychiatric incarceration was seen as similar to incarceration in jails, prisons, right, other carceral sites, and in need of due process protections, right.

So it shifted the burden to the state to prove these standards of imminent danger, which, you know, I'm not a fan of, but that's how it unfolded, imminent danger to themselves or others, right. And then also kind of it evolved into different definitions of grave disability, which is very much at stake here right now, in terms of whether or not one is able to care for themselves, care for their needs, which gets into the rhetoric stated by Newsom and Adams and folks like them. So yeah, the due process revolution, it includes the Lanterman-Petris-Short Act, which Beatrice just talked about, right, establishing a much higher bar for taking away someone's liberty and institutionalizing them against their will. And it also put in a number of safeguards around protecting people from conservatorships, right, where you just literally have no decision making control over any aspect of your life.

Beatrice Adler-Bolton 38:38
[joking, and responding to looks of confusion from the audience] Like Britney.

Leah Harris 38:39
Yes, exactly. Exactly. And, you know, and Britney, as y'all can imagine, is not really like the face of conservatorship, but really helped to get this issue on the map, you know, thankfully. So it's really looking at these LPS protections, when we're talking about California, it's precisely what is being targeted by the Newsom administration, right, in the name of modernization. That's what makes it such an extra mindfuck. Because it's like they're talking, they're using the language of progress, but this is actually very, very regressive.

And so just again, at the same time that LPS was established in California, there's also similar reforms happening around the country. I'm not going to go into all the cases of this time period, but one that I've studied in depth, being from -- born in Wisconsin, is the Lessard decision of 1972, which is very similar. Alberta Lessard was this Milwaukee woman who was actually facing lifetime commitment to this horrific facility built in the 1880s, just basically for being an outspoken person who was like probably seen by people as eccentric, right, but she really fought back and won. So the Lessard decision, similar to LPS, made it difficult, again, to commit someone against their will and it had this kind of national impact because a lot of other states immediately followed suit with reforms based on Lessard.

Of course, since then, these very, very stringent standards have continued to be eroded, and we have this like hodgepodge of state laws that y'all have talked about on Death Panel. And I also, if you kind of want to learn more about the hodgepodge, I definitely recommend The Committable podcast, which has been systematically covering the laws state by state, talking to folks from those states, so you can get a sense of how they're similar and how they differ. But even after you had this due process revolution, you know, it did -- it did change things, but you still absolutely had this phenomenon of mad and disabled people being forced into institutions, like continuing into the 90s.

So you know, if you get to the -- once we get to the mid 90s, there's another really, really landmark case with Lois Curtis and Elaine Wilson, who were women living with intellectual and psychiatric disabilities. And they were being confined against their will in Georgia institutions, right, and became the plaintiffs in Olmstead v. LC. And this case went all the way to the Supreme Court. And in 1999, they held that institutional confinement is a violation of the Americans with Disabilities Act. And it really moved forward this unqualified right that Liat was talking about for people to receive supports in the community in what is known as the least restrictive setting. So then you had this whole wave of Olmstead cases that followed, ushering in this kind of next phase of deinstitutionalization.

But then, you know, I'm thinking about what Dr. Angela Davis said yesterday [at the S23 opening plenary session] about the backlash, right? Because immediately after, or at the same time as the Olmstead reforms are happening, you had this push for involuntary outpatient commitment, right? Moving the commitment, not in the traditional asylum with four walls but taking it into the community, right? So at the same year that Olmstead was decided, in 1999, Kendra's Law was the first involuntary outpatient commitment law that was passed in New York City, right, in New York. And this term, so you will hear this term euphemized and sold to the public as assisted outpatient treatment.

Do you see how that changes from involuntary outpatient commitment, which is like what it is, to this very sane-washed, whitewashed kind of way of talking about it. It's called AOT. So now these laws are in 47 states, and they are relying on what's called the black robe effect with these judges compelling folks to comply with treatment, generally in the form of medication, whether they want it or not, under the threat of inpatient hospitalization, right, if you do not comply with your court ordered plan. And so just to kind of show how it's like the same players are coming around and around with this shit, this key guy who was part of enacting Kendra's Law, his name is Brian Stettin. He now advises Mayor Adams, 20 years later, 30, whatever, I can't do math. But all these years later, on his serious mental illness policy, right, so it's the same people. And you know, he used to be -- Stettin used to be the Policy Director of the Treatment Advocacy Center, which is this right leaning think tank that has really been pushing the AOT laws and fighting for these laws to get on the books all across the country.

And just want to share just a few extra things about the backlash, that these efforts to roll back the clock are not new. Almost immediately after the Lessard decision, there was this Wisconsin psychiatrist named Darold Treffert. And he began sharing anecdotes about people who were found not committable under the new laws and who went on to die by suicide or other causes, and he coined the term "dying with their rights on." Has anybody ever heard this before? It has become this rallying cry among coalitions of medical authorities, family advocates, policymakers trying to rollback these laws. And you can hear that trope to this day, right? When you talk about people's rights , they're saying, well, you just want them to just die with their rights on, it's like you're pro death, you know, if you're kind of speaking up for people's bodily autonomy. So you'll hear politicians say this all the time. The state senator in California who's pushing the modernization with Newsom was quoted as using that language.

And if you object to what they're doing, it's like, oh, you're fine with people just being on the streets and in prisons, like you know, that's how they shut folks down. And then the last thing I'll say is like there's this kind of groundhog phenomenon, Groundhog Day phenomenon. I keep kind of thinking of these as like undead policies that just keep popping up over and over. So I found this New York Times article from 1987, describing almost identical initiative to Adams, spearheaded by Mayor Koch, who argued that the pendulum -- again, pendulum swinging too far, you know, and so they were rounding people up with vans right. And of course, the difference with the Adams policy now is it's cops, where the vans before were like social workers and nurses and psychiatrists.

And what's really interesting is, of course, that policy failed, because it's not addressing the root causes of houselessness and everything we're talking about. But what came out of that failure was the rise of the housing first model in the early 1990s, which is still considered the best practice in permanent supportive housing. It's not perfect, but it's really good practice. And, you know, unlike the kind of services that are being pushed by conservatives who want to predicate any access to housing, even temporary housing, with sobriety requirements, or medication compliance, housing first does not have preconditions and it's more aligned with like a harm reduction framework. And then, unfortunately, this is kind of where we're at today, is that housing first has also been at the center of these wars of criminalization with conservatives arguing that like deinstitutionalisation, housing first has failed, right? You'll see that in the news, in the conservative publications and whatnot, when in reality, it actually has never been funded or tried on anywhere near the scale that's needed, but they're declaring it dead. And now we need to force people into housing with all of these preconditions and requirements. So I will leave it there.

Beatrice Adler-Bolton 46:49
No, I love that you brought up the way that this really is kind of like such a throwback in New York to the late 80s. I pulled up a quote from Koch from an early draft of Health Communism, from a chapter that got pulled out to be its own book, actually.

"Ed Koch, the then Mayor of New York City, insisted in 1986 that, 'Families were voluntarily becoming homeless and taking the welfare hotel route in order to get better apartments.' Koch was pushing back on a report his own administration had ordered, which demonstrated that gentrification and redevelopment was largely responsible for the sudden rise in the city's homeless population. Koch said that the report contradicted his gut feelings [laughter] and what he had observed anecdotally in New York City shelters."

I mean, sounds so fucking familiar, right?

"...which he charged were full to the brim with the criminally mentally ill. Two years later, Koch maintained that, 'These homeless people, you can tell who they are, they're sitting on the floor talking to themselves. Many, not all, but many are panhandling.'"

And the thing that was like so frustrating is we had pulled this chapter out, like this has to be its own book. And then, Eric -- what does Eric Adams do a year later after the manuscript's locked in, but repeat exactly the same line, right, like you can tell who they are. That is such an important sort of touchstone here. And Leah, I really so appreciate the way you laid it out. It's takes, a lot of work to make the weeds really accessible like that. And I feel like one of the things that is important here is like, as we've said, a lot of the justification for this is the idea that deinstitutionalization failed, right? We tried to let people go and look at what happened. Sometimes the narrative is that we let people go and all those people are now in prisons, which is absolutely not true.

And Liat, you know, as we're saying, your work is really, really important to understanding this analysis. Can we talk about like what, if any, truth there might be behind the idea that deinstitutionalization failed? But more importantly, I think, you know, why is it such a common narrative, right? The sort of idea that the closure of institutions and asylums resulted directly in the rise of folks living on the streets. And I think, really importantly, this common sense narrative, I'd love for us to talk about also who that serves.

Liat Ben-Moshe 49:17
I'll try to do this in like three minutes. But there's a whole book I wrote about it [laughter], but -- and I'm very wordy. The book is very long, so I'm really sorry. So I can't do justice in three minutes. But I would say that there's a lot of actual empirical reason, I'm in my day job like a social scientist, so there's actually empirical ways to show that deinstitutionalization did not actually lead to the rise in homelessness and then to the rise of incarceration, including the fact that these are not the same populations. It didn't happen at the same time. All these kinds of things you can read about. It's also available for free on my website, like the chapter that this is from.

But the more interesting question I think for us that I can do in three minutes is why, you know, why deinstitutionalization is basically blamed for the rise in incarceration? And then what does it do and who does it serve? So, very, very broadly, what it does is that it reduces a very complex process about home loss, and the kind of -- also the laws that Leah was talking to us, you know, just now, as well as the rise in incarceration, and then puts the blame on a very easy target, which is deinstituationalization, that for some of these processes didn't even happen at the same time, right. So in some ways, it happened like much earlier, like in the 60s, and then we see the rise in homelessness in the 80s.

And you're like, wait a minute, why are we blaming this on -- like it doesn't even make logical sense, not even empirical? And what it does is that it diverts our attention and discussion from these neoliberal policies that led simultaneously to the growth of the prison system, same time, and to the lack of financial support for people with disabilities to live in the community, and for the rise in housing insecurity. And I'm saying neoliberal not just as a catchphrase, but literally, this was the beginning of neoliberalism as a policy, as a cultural phenomena, as an economic praxis that was imported from Margaret Thatcher by Reagan.

And for those of you who went to the drag show yesterday, we were treated with the ghost of Nancy Reagan in the drag show. It was phenomenal. But this is the -- this is the ghost of the Reagans, right? This is it. This is part of the Reaganism legacy is the figure of the welfare queen, and the failure of deinstitutionalization. And the fact that some of us sometimes on the left, like we reproduce that, should give us pause, to who are our bedfellows here, in reproducing this discourse, because what has happened, of course, during the 80s is the evisceration, or starting in the 70s and then definitely solidified in the 80s, the evisceration of accessible, affordable housing and services.

And deinstitutionalization, of course, did not lead to housing insecurity, and to increased incarceration. But racism and neoliberalism did through privatization, budget cuts in services and welfare, with no funding for housing and any kind of social services. And at the same time, the budgets to corrections, to policing, to punishment skyrocketed. So, you know, we say in the social sciences, correlation is not causation. Just because two things happen at the same time doesn't mean they lead -- one lead to the other. So deinstituationalization did not lead to the rise of incarceration. And the reason why this is so important is because now we're seeing especially in New York, but a little bit in California as well, that people who are housing insecure, who are "mentally ill" are kind of blamed. It's blamed on deinstitutionalization because in a different era, they would have been in an institution, as if an institution is a home, you know, and I think this is why it's so important to learn from mad movements and mad people, to say, what are you all even thinking about saying a phrase like that, you know, like, in a different era, they would have had a home. What home? This was never a home, this is a site of incarceration.

And I think not understanding that is, you know, the problem that we have. And so for people, you know, the second thing that it does then is that it neutralizes this category of the homeless mentally ill, as if it's like a group of people. It is not. All those words are socially constructed. There is no homeless mentally ill. The concept of mental illness is a constructed concept. People who embody it sometimes kind of take up the label, sometimes they don't. But it's really important to understand madness as a difference, as a part of biodiversity. That the line between normal and abnormal is not clear cut, that madness is normal for the people who embody it, that madness is sometimes generative and sometimes it sucks, just like being a woman or being a person of color or being queer, you know, it's magical and unicorn, and also you get to, you know, to go to prison, you know, whatever. And I'm saying "get to go," right, like in scare quotes. And so, you know, that's -- to say something like, we need to help the homeless mentally ill, as if that group of people actually exists, is incredibly problematic. And I really hope that, you know, leaving the session, we don't reproduce that.

And lastly, the consequences of this kind of idea that Beatrice is talking about, painting deinstitutionalization as the culprit for the rise in incarceration is that it leads to this perverse reality of exactly where we are, which is calling to bring back the asylum. Literally. It's not even hidden, like Leah was saying, it's cops who are taking people away. It's not even the social workers, like we don't even need the facade, right? It's literally calling for re-institutionalization. So the 80s are back, y'all, not just in fashion, and not just in fascism, I guess. Also in terms of carceral sanism. And the last thing is that what this narrative does is that it really dissuades us from understanding deinstitutionalization as the largest decarceration movement in US history, the largest decarceration movement, think about that, in US history. And if we don't understand it as such, then we can't learn the lessons of both what to do and what not to do, in terms of carceral abolition. [applause]

Beatrice Adler-Bolton 56:03
Thank you so much. I mean, I love the way you framed, bringing in the return of the 80s, right, because so much of what we've been talking about, in a way, is another way to talk about like privatization, right? We're saying that, in some ways, like, we need to remove people from public life and public sight, if their families can't provide to keep them out of sight themselves, right? When people say we need to meet the needs of the homeless mentally ill, of the dangerously mentally ill, they mean their needs of not having to see that person, right. They mean their needs of not having to share space with that person, not having to feel any type of way about what kind of care that person might not have, or what kind of housing that person might not have, or food that person might not have. Jordan Neely was murdered for that. On the subway, in front of everyone.

And I think, you know, it's not unreasonable to assume that there were people in that car that felt relief. And that's a terrible sort of thing to have to admit to ourselves, right? But part of what's going on here is also in this whole framing is the foreclosure of so many other options, right? And I think a great example of this is also when you see people studying cash transfer programs, right, and you see a study that says like, unconditional cash improves homelessness. And then our friend, our good friend of the show, Nathan Tankus, was tweeting about the other day, he's like, and then you go into the methods section of the paper and you see how they cut out everyone who had been homeless for more than two years, anyone with a drug diagnosis, anyone with a suboxone prescription, anybody with a mental health diagnosis.

And so you really start to get a picture also of what this does in terms of both absolving the state of responsibility, absolving each of us of responsibility, every one of us in many ways, and also in sort of privatizing these problems, and taking them out of the realm of any kind of framework that could reflect interdependence, or a desire to live in community with each other, regardless of how each of our brains and minds are at any particular moment.

So, with that in mind, I'd love for us to return back to our current moment, and sort of walk through the stakes again, and discuss the big question, right, which is, what the fuck do we do? What is to be done? And how do we do it without reproducing carceral sanist reforms, right? Because what is at stake is so big here.

And then later, maybe during the discussion, maybe later in the park across the street, I'm sure we'll get a chance to go in even deeper on sort of how to get involved in psychiatric abolition organizing, or how to incorporate resistance to carceral sanism into other organizing work that you're doing or might want to do. But you know, as we're saying, like, we have seen an incredible resurgence of calls for the end to forced treatment, just as we've seen the resurgence of calls to reinstate things like asylums, and to make it easier to force treatment.

So can we get into, for example, you know, this has been sort of part of a broader series of movements. Mad pride is a movement with a very long history. And carceral sanism as an idea builds on the work that the mad pride movement has done to sort of collectivise, organize, and dismantle the discrimination and sanism associated with our current standards of care. And these activists have not only fought for system change, they've organized to free comrades trapped in the system. They have experimented and piloted alternatives to psychiatric hospitals and other places of confinement, some of which we'll hopefully touch on in a little bit. But all of this has been built on a foundation of the analysis of sanism that really looks towards the structural and material conditions that not only demand the removal of mad people from society, but mark them as surplus, mark them as dangerous, mark them as threat. So Leah, I'd love if you could maybe start us here.

Leah Harris 1:00:30
Yeah, absolutely. And, you know, I mean, one piece that we just didn't have a huge amount of time to get into is really at the same time as deinstitutionalization, there's this rise of organized folks fighting for mad liberation, right. And I think of things like the Madness Network News publication, and the people who wrote in that, a lot of them called themselves ex-inmates, really as a form of solidarity with all incarcerated people, right. And then, of course, you have the concurrent anti-psychiatry movement led by the professionals, which is very, very flawed and imperfect. We can't get into all of that. But the combination of these movements, it really was an abolitionist, anti-sanism approach very, very much. So there, you can trace this line, right, going over 50 years to this thread of abolition, even if maybe that wasn't exactly the language that was used all of the time.

And so now, you know, there really is this continuity and this kind of resurgence that's really exciting, of people talking about psychiatric abolition, right, as a solidarity movement, as inextricably connected to larger struggles for liberation and abolition. So, you know, I think touching on the what do we do? I think it's really kind of like, how can we all kind of raise those voices and raise our own voices in talking about psychiatric abolition as a concept and educating about it and getting involved in pushing for it. And yeah, one thing I was gonna say, I really recommend reading, there's an article, a blog in the Disability Visibility Project called Abolition Must Include Psychiatry, and that's by Stella Akua Mensah and Stefanie Kaufman-Mthimkhulu. And also, there's the Campaign for Psych Abolition in the UK.

So those are just a couple of the current efforts in movement building that maybe I'll just touch on and see if y'all have other things you want to add. I could keep going. Okay. If you're in Massachusetts, or know comrades in Massachusetts, there's an effort -- there's only three states in the US that don't have assisted outpatient treatment, you know, involuntary outpatient commitment. And so if you are in Massachusetts, or know folks, you can point them to the Wildflower Alliance, at wildfloweralliance.org. They're working very, very hard to resist this coming to Massachusetts.

Also, I want to shout out peer-led, non-carceral approaches to community support, you know, like getting involved with those, helping to start those in a community. I just was certified as a Hearing Voices Network facilitator. And that's like an international movement that's really about for folks who get diagnosed with psychosis or people who experience altered states, it's this way for people to make meaning and find solidarity in their experiences. And it's not automatically viewed as pathology, right, as the rest of society does. So like, this is an international movement.

There's not a huge ton of groups in the US. So it's like a really cool opportunity to grow this non-carceral alternative -- not even alternative, but peer-led movement. So yeah, just checking out opportunities with the Hearing Voices Network USA to get trained up in that, if that's something you'd be interested in. As well as the Alternatives to Suicide is another non-carceral approach because we know it's like, you know, the danger to self or others. That's what gets people involuntarily locked up. It's non-carceral, it's developed by folks with their own lived experience of wanting to die, started also at the Wildflower Alliance. There's even a training this month that's going to be happening if y'all want to check it out, and they're pushing this whole instead of suicide prevention month, which is, you know, that's a very carceral concept, alternatives to suicide month. They're trying to raise that kind of language and framing. Also peer delivered respite, right, in the community. I mean, that is so important and people have been fighting for that for years. Places where people can go, alternatives to emergency rooms and other carceral sites when people are in crisis, to get 24/7 peer support and nothing is mandated, right? It's open door, it's like a home like environment. And then just really pushing back on these ideas that housing first has failed. I think that's really, really critical.

Demanding community and civilian led initiatives that are based in abolitionist praxis, right, like to these co-responder models or other ways of responding. One of the ones I'm thinking of is Revolutionary Emergency Partners based in Minneapolis, but there's many of them, you know, across the country, and we need more and more support for that. And just I guess one other thing I would add, and you know, love to hear from y'all, is just pushing back on casual sanism, right, in conversations when this pops up, right? People who are falling into that rhetoric that prisons are the new asylums or just kind of any of these other sound bites that are really not accurate, just to really have those conversations so that we can keep educating each other and raising consciousness and raising awareness on that. So there's tons more that I can say about it, but these are just kind of some ideas. And then the very last thing is there are like a lot of different efforts happening, coalitions forming of people who want to organize under the banner of psychiatric abolition. So if you would like to be -- keep up with that, get involved in that, we created a little signup sheet, and it's bit.ly/psychiatricabolition. So, as things are developing, we'd love to have you all be in the mix. Thank you.

Beatrice Adler-Bolton 1:06:55
Thank you so much, both of you.

[End of transcript, remainder of the session focused on discussion between panelists and participants which has not been shared to preserve privacy of participants]

Transcript by Kendra Kline. (Kendra is currently accepting freelance transcript work — email her if you need transcripts!)