I began the investigations that would turn into this book during a 2009 National Institute of Mental Health (NIMH) fellowship at the Morehouse School of Medicine in Atlanta. The fellowship was focused on mental health, substance use, and HIV/AIDS in correctional settings, and experts in the field of correctional health made scholarly presentations that were supposed to help the fellows get the lay of the land in prison health research. Occasionally, the conversations took interesting turns. One day, a former prison psychiatrist came to visit. She was a well-dressed African American woman who had recently left the Georgia Department of Corrections for work in greener pastures as an executive at a for-profit prison health care corporation. After her talk, I asked her what she thought about the use of psychotropic drugs inside America’s prisons. Psychotropics is an umbrella term for prescription drugs that change brain chemistry and affect the functioning of the central nervous system; such drugs are prescribed routinely across the United States to treat everything from everyday emotional problems to serious psychiatric disorders. They include the antidepressants, antipsychotics, mood stabilizers, stimulants, and tranquilizers that an alarming number of citizens, both free and unfree, take on a daily basis. The former prison psychiatrist, now prison profiteer, rocked back on her heels, gave a wry smirk, and replied, “Each year, the warden would send me and my staff a nice bottle of something, because he knew we kept the prison quiet.”
Her candor was striking, sparking my curiosity about the role that psychotropic drugs might play not just in maintaining mass incarceration but also in generating new modes of neurobiological control over people’s minds—and lives. Psychotropics keep prisons quiet? The good doctor’s response suggested that mental health staff, working in close consultation with guards and administrators, administer psychotropic drugs to prisoners not only to treat their mental illnesses but also to ensure that they are more docile, more compliant, less likely to cause trouble or be violent. Is that really how the system works? Or was she just being hyperbolic in an insider conversation among experts in training? Even the suggestion that prisons might use psychotropics for the purpose of silencing prisoners, both sociologically and mentally, reflected a sinister injustice that I was not prepared to accept. That moment was the genesis for this book.
I wanted to know how prisons use psychotropics—in particular, I wanted to know if there was any truth to what the former prison psychiatrist had said. In pursuing the question, however, I found that I faced a number of barriers. First, it was made clear that the main objective of the NIMH fellowship was for the fellows to design science projects that the National Institutes of Health would consider worthy of funding and that would lead to a series of liberal reforms designed to improve various features of American prison systems’ approaches to health. The other fellows and I were all early-career professors of color (we were all African American), and we were encouraged to develop politically safe projects that would lead to federal funding, peer-reviewed research articles, tenure, and other professional rewards. All of that sounded sweet, especially to new young research professors who wanted economic and professional security, but I had an uncomfortable feeling that our science was supposed to be intended to benefit us first. Then, if we were both smart and lucky, our work might, at some point in the future, lead to better institutional policies in prisons and improved health outcomes for prisoners. In other words, we were encouraged to create liberal science that could be used to achieve liberal health policy reform. For example, we might design an intervention to encourage prisoners to make better health choices. Or we might study postrelease planning services that help formerly incarcerated people reenter society. Many of the fellows pursued solid liberal projects like these—and there is definitely a place in the world for good liberal science.
But I did not want to participate in liberal science. I wanted to do liberatory social science that would challenge whatever made the uniquely American version of mass imprisonment possible. Earlier that year, I had completed a dissertation that formed the basis for my book Blood Sugar: Racial Pharmacology and Food Justice in Black America, and I recognized through that work that I was not at all interested in doing liberal social science. My aim in that project was not to improve the science of metabolic syndrome; rather, I wanted to end the science of metabolic syndrome, or at least end its racist variations. Similarly, it seemed an unconscionable waste of time to design a science project focused on prison health that would only tinker with certain aspects of the prison health care system. All of the fellows knew that U.S. prisons were part of a vast and violent system of social and political control; the practices of the associated network of private prison health care companies and vendors just compounded the injustices of the system. I could not bear the thought of producing scholarship that aimed merely to reform this system.
Strangely, few feminist and critical race scholars who study science and technology have examined the prison as a site of the enmeshing of natures and cultures made possible through technoscience. By allowing the technoscientific practices that support mass incarceration to remain unquestioned, the field of science and technology studies remains politically disengaged from one of the most important struggles for human freedom in our time. This oversight is curious given the centrality of philosopher Michel Foucault’s work to political analyses of technoscience. Foucault theorized the prison as a “complete” or “austere” institution that manufactures disciplined bodies through a tightly coordinated system of architectural structures, social practices, and institutional procedures.
The second barrier that I faced, linked to this question of liberal science, was methodological. I imagined the futility and frustration of seeking admission to prisons to interview officials and mental health providers about any punitive, unethical, nonmedical drugging of prisoners. What prison officials in their right minds would ever admit to unethical or unconstitutional psychotropic drugging practices? Beyond that impossibility, the methodological challenge of studying practices inside prisons opened up a new line of inquiry for me. I began to envision a study that would try to document what we know and do not know about the use of psychotropics in prisons and would consider only publicly available sources as evidence. Imprisonment is carried out in the name of protecting the citizenry and is done with the public’s consent. The government pays the bills for prisons, and we, as citizens, sign the checks that pay for prisoners’ medical care, including psychotropics, and the entirety of the system. What information had the government provided its citizens about psychotropic drugs in prisons? What had other scientists and activists and advocates uncovered?
I began to wonder what a reasonably well-trained scientist-citizen could uncover about the use of psychotropics in U.S. prisons without speaking to any prison officials or health care providers directly. While I knew that there were good people with good hearts working ethically within prisons, I was not interested in their opinions and beliefs about prisoners’ psychotropic drug use. I wanted to evaluate what the documentary record said and did not say about the practice. I searched the biomedical and social science research literature, usually an archive full of information, but I didn’t have much luck. I traveled to the National Library of Medicine, housed at the National Institutes of Health in Bethesda, Maryland, and found surprisingly little there about psychotropics in prisons. Even the Bureau of Justice Statistics, the government agency responsible for producing and compiling data on criminal justice in the United States, had produced only a few official reports, based on limited prison surveys, on the subject of psychotropics, and these left many questions unanswered. Even some very basic questions could not be answered because there were no sources of data that could be analyzed to answer them.
For instance, when did prisons start giving psychotropic drugs to prisoners, and why? How were the drugs administered exactly, and how did prisons control the flow of their pharmaceutical inventories? Which drugs were distributed in prisons, and why those drugs and not others? Which prisoners were given drugs, and why? What role did psychiatry and diagnoses of mental illness play in this process? And, most important for me, what evidence existed to indicate that psychotropics were being used to silence people living in state custody?
To my great shock, these questions had not been addressed anywhere in a systematic way. As I looked for other scholars’ answers to these questions and considered a wide range of source material for this project, I began to encounter troubling linkages between the ways in which prisons might be using psychotropic drugs to silence populations of prisoners and the use of psychotropics in other sectors of the “carceral state”—nursing homes, the foster care system, the active-duty military, immigrant detention facilities, the schools that educate our children. I knew that psychotropics had become ubiquitous in American society, but was I onto something much bigger? Had these drugs become a mode of control and pacification not limited to prisoners but affecting the entirety of captive America? This book represents my effort to figure that out.
Psychotropics may serve to keep the prisons quiet, but if we listen carefully, we can also hear the clarion call for transformation of America’s prison system. In a movement harking back to the prison abolition movements of the 1960s and 1970s, millions of Americans, led by organizations like Critical Resistance, are now calling for an end to mass incarceration in the United States. In his last year in office, President Obama commuted the sentences of many nonviolent drug offenders, and both of his attorneys general, Eric Holder and Loretta Lynch, seemed to be on the side of solid liberal sentencing reform. In 2014, the U.S. Sentencing Commission added its weighty opinion to arguments for changes in the mandatory sentencing guidelines for nonviolent drug offenses, which have, in large part, been responsible for the ballooning of federal prison populations over the past forty years. Even in the era of Donald Trump, bipartisan coalitions have called for reforms that may serve to slow the rate of incarceration, reduce prison terms, and begin to rethink the U.S. prison system. We can hear the voices calling for change. Will our political leaders listen? Will they, for once, have the courage to act in the name of freedom?