Inside America’s Mental Health Crisis and the Case for Prison Abolition
The new PBS documentary “Bedlam,” produced by Dr. Ken Rosenberg, examines our severely broken mental health system—and how it’s a pipeline to prison.
The mainstream conversation around mental health in the U.S.—and throughout much of the Western world—focuses on the relatively mild afflictions of the decently well-off. Sometimes, during times of fear and crisis, cynical politicians may zero in on the possible mental illness of individuals who commit acts of mass violence. But rarely do we talk about conditions of those with severe mental illness who, instead of receiving compassionate lifelong care, are usually tossed into prisons and onto the streets, typically out of view of those of us who can waltz in and out of psychologists’ offices as regular or occasional acts of “self-care.”
Psychiatrist and filmmaker Dr. Ken Rosenberg’s latest documentary, Bedlam, premiering on PBS April 13, asks the American public to seriously contend with the extreme neglect and punitive measures Los Angeles County, as well as the rest of the country, has leveraged against those who most desperately need consistent and competent care. To do this, Rosenberg fuses both the personal story of his own sister’s struggle with schizophrenia (and his subsequent choice to pursue a career in psychiatry) and the stories of several patients and their families who are routed in and out of the overburdened emergency psychiatric healthcare system.
Long-term care for those with severe mental illness—particularly among the poor and working class—has essentially been eradicated from the U.S. in the decades since the middle of the last century, as mental health institutionalization became seen as inhumane—and many of the practices in most institutions were—the U.S. government, under JFK (whose own severely mentally ill sister was irrevocably harmed by a lobotomy), decided to turn patients out into society with little or no support. Instead of reimagining what compassionate lifetime care for those who needed it could look like, the state and federal government decided it would be easier to take the laissez-faire route.
Dr. Rosenberg wasn’t originally going to include his family and sister’s story, and in the film, you can tell that the rehashing he does is painful. “I intended to make a film that had nothing to do with me. [A film] that would show life in the emergency room, because that’s always interesting and exciting. But it was not really fair to the viewers because they wouldn’t know why I was there and why I was doing it,” Dr. Rosenberg explained. “When you film someone in the emergency room, you get a glimpse of someone in a moment in time, but it’s not really the whole picture. You don’t know what they’re like when they’re well, with their family, at work; there’s so much you don’t know about them.”
But the effect is one of visible solidarity with his subjects: Bedlam doesn’t gawk at or scrutinize the people with mental illness it encounters or their families; instead, the film becomes a charged vessel for action. “I felt that to really do justice to the subjects in the film, I’d really have to go to homes and collaborate with them and find them,” said Dr. Rosenberg. “And the beauty of filmmaking is in doing that, I found Patrisse, Monte’s sister, who ended up being one of the world’s foremost activists by the time the film was over.”
That is Patrisse Cullors, a co-founder of the Movement for Black Lives and member of prison abolition organization JusticeLA (she’s also a writer on the Hulu show Good Trouble). Her brother, Monte, goes in and out of the ER and prison due to his schizoaffective and bipolar disorders, and Patrisse’s lifelong activism coalesces around the act of caring and thus advocating for him. We first meet Monte in 2013, in the psych ER, where he is kind, energetic, and also in the middle of an episode—he had previously stopped taking his medication, and is having visions of fantastical horned adversaries.
Patrisse understands that caring for her brother will be lifetime work—and it’s work she’s honored to do. In the film, she explains that when her brother was first diagnosed, she made the decision she would never let his condition negatively affect how she sees him. It’s a theoretically simple sentiment, but one you see play out in the documentary in incredible ways. Monte is a big black man, and so racism—wherein he is seen as a threat to the state not only because of his illness but because of his racial identity—becomes yet another preexisting condition. So, in co-founding the Movement for Black Lives and JusticeLA, Patrisse had the question of mental illness at the front of her mind.
For a number of reasons, there don’t seem to be a huge number of people who are (currently) able or willing to show up for severely mentally ill family members and friends with the same solidarity and acceptance (not to mention the degree of advocacy) that Patrisse offers to her brother Monte and others. Dr. Rosenberg’s own family story shows how this widespread reality is not necessarily due to a lack of love but because both our social fabric and the provisional mental healthcare system we have are designed to undermine or prevent any and all love expressed between the severely mentally ill and their communities.
Because of Monte and Patrisse, as well as Todd—a middle-aged white houseless man with HIV and an undisclosed mood disorder—Bedlam becomes a film that is not about severe mental illness as its own isolated issue or identity, but about prison abolition, which is to say the coalition-based, momentous social change necessary to begin building a society based on cooperation and care rather than fear and punishment.
The idea of prison abolition is critiqued by both left and right, with extreme cases brought up as supposed evidence that prisons must continue to exist in some form, for some people. For liberals, that typically means those who commit acts of violence (rapists and serial murderers, especially) and for some leftists, that means white-collar capitalist criminals (the ruthless billionaires, profiteers, and exploiters). There are also racialized people otherwise open to abolition whose limit may be found at the very real existence of violent racists. Prison abolitionists are well aware of and sensitive to the harm of violence in communities and for survivors, but don’t believe prisons have solved or can solve its trouble and terror.
“I think there is a lot of misunderstanding [about] what we mean when we say ‘abolish the prison/police state,’” Patrisse told me over the phone, “Because the idea of abolition is about getting rid of one thing, but it’s also about imagining anew. And abolitionists practice at the intersection of healthcare, our legal system, [and] how we fundamentally take care of each other as human beings. We have designed a system that is punitive, that is about othering people, shaming people. We’ve designed a system that really does value people based [on] their skin color, their size, their ability, their gender; and abolition is actually challenging us to evolve as human beings, to relate to harm and violence from a place of compassion, interdependence, dignity, and care. The abolitionist approach is a philosophy, a theory, and in that theory we try to figure out how we process it.”
When someone like Lis Smith, former Democratic presidential candidate Pete Buttigieg’s senior communications adviser, accuses abolitionists of posturing for Twitter retweets and preventing “reasonable” incremental change, she is really admitting the current system suits her—and her career—just fine. But Patrisse insists that “no one is safe in the process and the theory we live under right now.” Prison abolition demands us to imagine a collective future of care, not a top-down rationing of it. And abolitionists aren’t against meaningful reform: With the March 3 primary election, Patrisse and the organization she chairs, Reform L.A. Jails, was able to make an important step forward by getting a majority of votes for measure R, which requires Los Angeles County to invest in rehabilitation and mental health treatment while reducing jail populations.
Dr. Rosenberg, for his part, believes coalition is essential to a mental healthcare movement that doesn’t meaninglessly split hairs over, for instance, drug treatment versus psychotherapy or a medical model versus a psychological model (he writes more extensively about these differing perspectives in the book version of Bedlam). “Because we are so at odds with each other and because we are so ashamed of this and deny it and don’t talk about it, as a consequence, that’s where we get taken advantage of—by pharmaceutical companies, prisons and jails. And the care of the mentally ill ends up going to the highest bidder.”
Bedlam makes a compelling argument for why mental health cannot be treated like a niche issue, separate from either the material or social conditions of the 99 percent. As we’ve seen with the coronavirus pandemic, the failure of the U.S. healthcare system is tied up in the failure of the state itself. To do anything about it, we’ll have to get at the root.