It has long been clear that the US prison system is brutal, that mentally ill people are likely to be imprisoned, and that imprisonment is likely to either cause or worsen mental illness in prisoners. In Waiting for an Echo, Christine Montross spells out exactly how bad the situation is in the USA, and it is terrible. She makes clear that the system serves no purpose for social good and indeed goes plenty of harm. 

Montross is a psychiatrist who specializes in working with the prison population, doing forensic examination. This is her third book, the first two having won high praise.Her writing is personal, including her perspective as a psychiatrist and a mother, but her outstanding ability is to combine telling people’s stories, while putting them in context with facts and statistics. 

The main contrast Montross provides is between the US system and that in Norway. Norway used to have similar problems as the US decades ago, but starting as recently as 1995 they humanized their system and provided good treatment. The result is simply that the system in Norway works a lot better. While it is clear there are moral problems with how the US prisons are run, it is even clearer that US prisons do not serve society well just in terms of making society safer and not wasting resources. 

In Norway, as in every other western country, the rate of incarceration is far less, sentences are shorter, and prisoners are treated with more respect. They are given training so that they can return to society. While there are signs of improvement in the US system, there is considerable emphasis on long sentences, harsh conditions, and liberal use of solitary confinement. The result is a system that renders many people unable to work, far more likely to reoffend, and ultimately a further cost to the state.

There are issues of justice and retribution which Montross also addresses. There is a rhetoric of making people pay for their crimes, with the payment being in the loss of their productivity as human beings. Montross highlights how the US engages in dehumanization of criminals to make the public and also those in the criminal system feel that prisoners deserve to be treated as they are. This affects not only how they are perceived but also how they behave — calling people ‘animals’ does not bring out the best in them. 

While Waiting for an Echo is often upsetting and dispiriting, the book is always interesting since it highlights personal experience so much, Montross consistently provides a thoughtful perspective, considering the strengths of the claims that people make and pointing to more helpful ways of looking at problems. It highlights the extent to which mental illness and incarceration are enmeshed in the US, so also highlighting the dilemmas that psychiatrists working in that system constantly face. It is an important book that has the capacity to change minds. 

Christian Perring is President of AAPP.

Categories: General, MentalHealth

Keywords: prisons, mental illness