Prisons Replace Health Care: Foucault at the General Hospital Today
Throughout capitalist modernity prisons have always been spaces of class rule and social control. Social theorist Michel Foucault noted in his influential book Madness and Civilization the role of the General Hospital in Paris of containing and medicalizing poor people who would not or could not work for capital. It was largely made up by the criminalization of poor people (vagrants)—the unemployed, vagabonds, petty thieves, beggars, “the insane.”
This served the interests of the emerging class of merchants, landlords, and business people—capital—by removing so-called nuisances and also by providing a vast source of cheap labor. Over time a new category, “the insane” was developed to distinguish those who could not work from those who would not. Segregation emerged to keep “the insane” away from the reserve army of labor who they supposedly disrupted. These were economic reasons, not matters of public safety.
Prisons are still about punishing working class people (for not working for capital or for more openly resisting exploitation) and imposing the rules of the formal market economy. As neoliberalism has cut social services that working class people actually need, like health care, child care, social housing, education, social assistance, etc. the prison-industrial complex (policing through to prisons) have expanded and received more public money.
To keep budgets up, police have expanded into areas they have no place in, like “harm reduction,” and prisons have become substitutes for health care facilities. This is reflected in the disproportionate numbers of prisoners with mental health and drug use issues.
Still Disciplining and Punishing Mental Health and Drug Use Issues
Some basic statistics are telling (even if an undercount). Mental illness rates are about 4 to 7 times more common in prison than in the broader community. According to a report by the John Howard Society, 11 percent of federal offenders in Canada had a mental health diagnosis; 21.3 percent had prescribed psychiatric medication; 14.5 percent of male offenders had a past psychiatric hospitalization (all 2009 numbers).
Additionally, between 24-38 percent of a sample of 1,370 male offenders admitted over a 16 month period required further assessment.
We can see a similar situation when we look at the imprisonment of people with substance use issues. According to Correctional Services Canada, almost 70 per cent of prisoners admitted are assessed as having a substance abuse problem. A 2007 survey of prisoners reported that 17 per cent of men and 14 per cent of women admitted to using intravenous drugs while in federal prisons.
Class and Criminalization
Drug use and mental health issues can be related to unemployment and poverty. Law and order and “tough on crime” policies reinforce the class punishment of poor people. The more that policing occurs in poor communities the more people with mental health and drug use issues will be incarcerated.
Policing is concentrated in poorer neighborhoods and arrest rates are higher in poorer communities. That is because policing is about surveillance, control, and regulation of the working classes. It is also because it costs the system less to target poor people (who often lack secure residences, who have fewer resources to mount a defense, and who are more likely to be convicted—to secure a system outcome).
In Canada in the twenty-first century, prisons maintain the function outlined by Foucault in his analysis of the General Hospital of Paris. Containing and controlling working class people on a basis of medicalization and psychology—related to their labor within the formal market economy.
Foucault, Michel. 1965. Madness and Civilization: A History of Insanity in the Age of Reason. New York: Random House