Docile bodies? Chemical restraints and the female inmate.

• Author: Auerhahn, Kathleen

INTRODUCTION

This paper addresses a little-discussed but apparently common phenomenon--the administration of psychotropic drugs to jail and prison inmates for primarily nonmedical reasons.(2) Psychotropic drugs, which include antidepressants and antipsychotic agents, are used in the treatment of psychiatric disorders such as schizophrenia, severe depression, panic disorder, and bipolar disorder (manic depression). The use of these drugs in prisons has raised suspicion as to the motives of those administering the drugs for nearly three decades; criticisms of these motives have appeared in the form of autobiographical writings of prison inmates(3) as well as in scholarly writings.(4) In this paper, we examine the historical antecedents of the use of chemical restraints on female inmates in the context of other responses to women's deviance, and examine the consequences of this practice through the use of in-depth, semi-structured interviews with forty-two female inmates of a California prison.(5)

The use of psychotropic medications as a means of controlling inmate populations is not a new phenomenon. Spieglman's 1976 study of medical and psychiatric care in prison documented the common practice of "chemical pacification" with Thorazine in a California prison; additionally, inmate-author Jack Henry Abbott writes of the practice from personal experience:

I've myself been crucified a hundred times and more by those institutional drugs that are for some sinister reason called "tranquilizers."(6) They are phenothiazone drugs, and include Mellaril, Thorazine, Stelazine, Haldol. Prolixin is the worst I've ever experienced. One injection lasts for two weeks. Every two weeks, you receive an injection. These drugs, in this family, do not calm or sedate the nerves. They attack. They attack from so deep inside you, you cannot locate the source of the pain. The drugs turn your nerves upon yourself. Against your will, your resistance, your resolve are directed at your own tissues, your own muscles, reflexes, etc. These drugs are designed to render you so totally involved with yourself physically that all you can do is concentrate your entire being on holding yourself together. (Tying your shoes, for example). You cannot cease trembling.(7) In Life Without Parole: Living in Prison Today, an insightful memoir, author Victor Hassine devotes a chapter to the practice of drugging inmates in both prisons and jails. Hassine asserts that the number of inmates "doing the brake-fluid shuffle" has risen in response to facility overcrowding:

This new system of mind-altering and mood-altering psychotropic drugs was rapidly becoming the prison administration's "quick, cheap, and effective" solution to warehousing masses of inmates into smaller spaces, while using fewer support services. The reasoning seemed to be that every dose of medication taken by an inmate equaled one less fraction of a guard needed to watch that inmate, and one less inmate who may pose a threat to anyone other than himself. Hence, overcrowding had brought about a merging of the psychiatric and corrections communities.(8) While it may have taken overcrowding to facilitate the "merging of the psychiatric and corrections communities" for the male inmate, these two communities have happily coexisted for centuries with respect to the female criminal. In this paper, we will show that female crime--as well as other forms of misbehavior--has a long history of being attributed to medical or physio-psychological causes, and that the medication of female prisoners is a logical consequence of the "treatment" metaphor that pervades the response to the female criminal.

The issue of chemical restraints in prisons and jails is a problem that has received some judicial attention in recent years. In Harper v. State,(9) the Washington Supreme Court held that prison inmates had the right, under the protections of the United States Constitution, to refuse to take antipsychotic drugs prescribed by prison authorities, and that this right could be overridden only when the state: proves (1) a compelling state interest to administer antipsychotic drugs, and (2) the administration of drugs is both necessary and effective for furthering that interest.(10)

Incredibly, the United States Supreme Court reversed the ruling of the lower court in Washington v. Harper.(11) The Washington Court upheld the right of inmates to refuse medication, but found that the burden of proof placed upon the state by the Washington Supreme Court was excessive, and that inmates can be medicated against their will if the state can show that medicating the inmate is "reasonably related to legitimate penological interests," which, according to the Court, included the "maintenance of order in the prison environment."(12) The Court further opined that "the fact that the medication must first be prescribed by a psychiatrist, ensures that the treatment in question will be ordered only if it is in the prisoner's medical interests, given the legitimate needs of his institutional confinement."(13)

Three Justices offered a dissenting opinion, which highlighted the serf-referential and insular character of the determination of "legitimate penological interests."(14) Since the review that determines whether the administration of the drug is "appropriate" is conducted within the institution, by representatives or agents of the institution, the Justices argued that such a review process is necessarily biased toward the protection of the interests of the institution, rather than those of the inmate.(15)

Riggins v. Nevad(16) dealt with the issue of drugging pretrial detainees against their will. The Court, in Riggins, held that the administration of antipsychotic drugs to jail detainees violates the right to due process guaranteed by the Sixth Amendment by introducing the "strong possibility" of prejudice into the trial process since "the effects of antipsychotic drugs may have impacted Riggins" outward appearance, his testimony, and his ability to follow the proceedings and communicate with his attorney."(17)

The Riggins Court further held that a departure from the standard set down in Washington v. State was warranted given the differences in the legal status and constitutional protections afforded pretrial detainees relative to convicted prison inmates.(18)

These court decisions, however, do not address the common practice of chemically restraining healthy inmates that is revealed in our interviews with incarcerated women. The crucial difference between this practice and the cases heard by the Court is that both Harper and Riggins were diagnosed with mental illness--the fact of their mental illness was not in dispute. There/s court precedent for the rights of mental patients to refuse drugs (Rogers v. Okin(19)), which may have influenced the movement of these cases up to the high court. However, as the narratives we present (as well as numerous other sources) demonstrate, jail and prison inmates in the United States are frequently medicated without diagnosis or proper psychiatric and physical assessments.(20) This is what we mean when we speak of "chemical restraints"--the forcible or indiscriminate use of powerful psychotropic drugs in the absence of appropriate medical justification.

The highest court in our nation has yet to address this type of psychiatric abuse(21) in prisons and jails. One of the first cases to receive significant public attention was that of Liles v. Ward.(22) In 1976, several women in a New York state prison were transported (after being strip-searched and shackled) to a state mental hospital because it was determined by the correctional staff that they were "disciplinary problems."(23) Immediately upon arrival at the state hospital, the women were medicated with Elavil (an antidepressant); a few days later the medication was changed to Thorazine (an antipsychotic).(24) Other drugs were added to the regimen over the course of the women's confinement in the hospital.(25) These included the antipsychotic agents Haldol, Sparine, Loxitane, and Prolixin; antidepressants Elavil and Sinequan; sedative-hypnotics Sodium Amytol and Chloral Hydrate; and tranquilizers, such as Valium and Vistaril.(26) Although the staff psychiatrists conducted brief interviews and physical examinations of each of the women (totaling about ten or fifteen minutes each), no clinical diagnosis of mental disability was made in any of the cases.(27)

Later, when the women brought action in the courts, the staff psychiatrists admitted that the drugs were not administered for treatment but rather "to maintain peace and tranquillity on the ward."(28) The hospital staff also acknowledged that, because of this, it was not deemed necessary to make diagnoses in these cases, since they were prison inmates, not mental patients.(29) Staff members admitted that the drugs were sometimes forcibly administered via intramuscular injections; one hospital staff member confessed that "the women did not like taking Thorazine and Sparine because of the effects."(30)

Liles v. Ward was settled out of court (resulting in the hospital paying damages of $4,857.14 to each prisoner),(31) and the question of the use of psychotropic drugs was never litigated. As a result, the apparently common practice of forcibly and/or indiscriminately medicating prisoners who are not diagnosed with mental illness has yet to be resolved by the courts. Another case, that of Jane "Daisy" Benson, is currently pending on appeal in the California Supreme Court. Convicted of second-degree murder in 1988,(32) Benson is petitioning for a new trial on the grounds that she was unable to participate in her own defense due to the multiplicity of drugs administered to her in jail without her knowledge or consent, and that these drugs altered her behavior in such a way that prejudiced the jury, including: "jerking limbs, making inappropriate outbursts, sprawling inappropriately in...