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Radical Psychology
Editors note -- This article was originally scheduled to appear in a previous issue.
We are similtuaneously publishing it in the current and the previous issue.

Governance through Psychiatrization: Seroquel and the


New Prison Order
Jennifer M. Kilty
Women and Psy
The psy-sciences, generally consisting of the disciplines of psychology and
medical psychiatry, emerged during the nineteenth century with promises of
identifying, treating, curing, and managing populations seen as risky because of
their strange or inappropriate behaviours. Early psy diagnoses focused on
naming behaviours viewed as different, dangerous or immoral to provide a
medical basis for treatment or intervention. In so doing, psy surfaced as a new
form of medical and correctional expertise, whose practitioners quickly sought a
great degree of control and governance over populations diagnosed as mentally
ill. Treatment, however, was similar to political responses to criminality, in that
those diagnosed with mental illness were confined against their will to mental
asylums (Goffman, 1961; Rhodes, 1995; 2004). The ability of psy-experts to
commandeer authority over the lives of individuals under their care is rooted in
claims of objectivity that allow psy knowledges to possess incontrovertible truths
regarding human behaviour and emotion (Penfold & Walker, 1983; Farber, 1990).
This power to define rational and irrational or sane and insane behaviour has
given the men who have historically theorised womens mental illness the power
to prescribe and proscribe the nature and the role of women in society (Penfold &
Walker 1983, p28). For generations, these knowledges remained unchallenged
because womens knowledges remained subjugated; as a result, the psy-sciences
propose explanations that categorise and diagnose based on social norms
produced within a hierarchical and patriarchal social structure. The construction of
mental illness among women is thus highly gendered, where women are located
on the derogated side of the gender binary.
Throughout psys history and ascendency to power with respect to the
management of mental illness, women have been held to a higher moral standard
than men because of stereotypical expectations of womanhood. Based on their
emotionality, women are often syndromised as mad (Ussher, 1991; Smart,1995;
Maracek ,2002); for example, with respect to the diagnosis of hysteria, Foucault
(1979, p146-147) writes:
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The notion of hysterization of women, which involved a thorough


medicalization of their bodies and their sex, was carried out in the name of
the responsibility they owed to the health of their children, the solidity of the
family institution, and the safeguarding of society.
Syndromising hysteria and more recently personality and mood disorders fails to
take into account the different socio-political contexts within which womens
emotionality and criminality are born (Smart, 1995; Suyemoto, 2002). Not only are
women more likely than are men to encounter the psy-disciplines, but as Russell
(1995, p96) writes:
From the perspective of biological psychiatry, nearly all women are
disordered. Even if we take into account only depression and premenstrual
syndrome, it is difficult to imagine many women falling outside this net. It is
no surprise, then, that criminal women are viewed as psychiatrically
disordered.
Russell demonstrates how the law refutes the production of a female criminal
subject because psy-correctional experts so frequently deem criminalized women
irrational and/or mad. For example, Tammy, a social worker who has worked with
criminalised women for over ten years, stated:
The institution is quick to dispense medication. All it really takes is an
appointment with a doctor and youre prescribed medication. I mean, when I
do programming in there and the nurse comes by dispensing meds, I dont
think there is ever one woman in the group Im seeing that wasnt getting
medication.
The long held belief that the fallibility of womens psyches created distress,
unmediated by the conditions of their lives, has formed an almost insuperable
obstacle against which women have had to struggle in attempting to have their
perceptions and experiences taken into account in clinical practice and in the
explanatory models that inform psychiatric practice (Astbury, 1996, p23-34). This
dynamic is most compelling within the prison setting, where women are
encouraged and arguably coerced to engage with and embrace psy-diagnoses
and psychopharmacological treatment (Penfold & Walker, 1983; Ussher, 1991;
Russell, 1995; Smart, 1995; Penfold, 2001; Kilty, 2008).
Prisons: The new asylums
The intersection of psy and criminal justice is a complex one that functions for a
number of reasons. With the advent of the decarceration movement of the 1970s
increasing numbers of people housed in psychiatric asylums were released with
little to no support back into the community (Rhodes, 2004). One of the
consequences of this movement was that over the next two decades many
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individuals diagnosed with all manners of mental illness were readmitted into state
care, but into the criminal justice rather than the mental health system
(Cohen,1985; Christie, 2000; Rhodes, 2004). The growing prison industrial
complex reflects the interconnection of capitalist economic motives, a diverse
range of new expertises and thus governing authorities, political aims, and
entrenched ethnocentrism, racism, sexism, and classism. Paralleling and
supporting the prison industrial complex is an ever-growing concern with
technologies of security, surveillance, and governance, while disregarding
treatment in the form of therapy or counselling. Therefore, while psy gained
significant control within the criminal justice system during the era of rehabilitation,
practitioners redefined their approach in order to maintain their place of expertise
within the correctional domain. Resulting from the mass incarceration movement,
fewer budgetary allocations to psy-care, and increasing numbers of prisoners with
mental health issues in the criminal justice system, we have witnessed a
disturbing shift in psy discourses. Psy no longer stresses the importance of
therapy in conjunction with psychopharmacological treatment; instead, it exists
within the correctional system based almost solely on its ability to prescribe
medications to prisoner populations.
With the merging of mental health and criminal justice fields, practitioners working
inside prisons use psy discourses to both assign and deny women agency. This
reflects one of many conundrums within psy discourse that of choice versus
disease. To clarify, Jane Ussher (1991, p133) contends that the dominance of psy
discourse is based on the belief in a physical aetiology for madness, which
serves political ends. It allows psychiatrists to maintain the continuity between
physical and mental illness and to deny the role of social, economic or political
factors in madness. In so doing, the medical model shifts the focus onto some
innate deficiency of the woman rather than addressing the fact that the problem
may reside elsewhere, in differing social domains. With respect to the
construction of madness as irrationality in women, Ussher contends that:
madness is the absence of reason or rationality is seen as an explicit
assumption of the positivistic argument, for the model which sees madness in
terms of cause and effect implies the person is not a rational agent, he or
she having been made to behave in a particular way. It is implicit within the
positivistic discourse that the mad person has no control (Ussher, 1991,
p146).
If it is the absence of reason that separates madness from badness, madness is
beyond the individuals control and should be treated differently from punishable
behaviours. Correctional authorities thus reconstruct prisoners as failing to
self-responsibilise, as attention seeking, and as manipulative bad women in order
justify their carceral control (Kilty, 2008). This reconstruction pushes psy, at least
in the prison context, into a precarious position. While steeped in a medical
tradition that seeks to find a biological explanation for human behaviours and
mental illness, in order to maintain power with respect to carceral governance, psy
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experts must now address behaviour as a choice. However, the correctional use
of prescription medications to effectively sedate rowdy or misbehaving prisoners,
actually mollifies that choice. Subsequently, the problematic behaviour remains
an individual issue within each woman, and experts are able to use her
(mis)behaviour to reinforce the hierarchy of psy within the prison (Farber,1990).
The Impact of Neoliberalism on the Practice of Psy in Prison
With the ascendance of neoliberalism in the late 20th century came a modification
of the dependency argument, and a common psy goal became the empowerment
of the individual (Cruikshank, 1994). Empowerment strategies focus on individual
agency given that correctional discourse constructs prisoners as responsible for
managing themselves, particularly their health. Neoliberalism diffuses state power
exemplified in welfarism and demands that citizens become empowered and
self-governing (Cruikshank, 1994; Garland, 2001; Hannah-Moffat, 1999; 2001).
This shift marginalises specific populations including the mentally ill, children, the
poor, racialized minorities and prisoners who do not have the means to become
empowered. To clarify, the neoliberal idea that we must all be self-governing
social agents stands at odds with traditional psy explanations that mental illness is
beyond the individuals control in addition to the common correctional zeal to
control every aspect of a prisoners life in the name of the smooth operation of the
prison. Therefore, some correctional discourse constitutes criminalized persons
as no longer in need of care, treatment, or rehabilitation but rather as beyond
repair (Melossi, 2000). Despite this fact, correctional professionals claim to want
to empower women prisoners, so they can become responsibilised agents of their
own welfare (Blanchette, 2002; Verbrugge & Blanchette, 2002), but only through
endorsed methods offered by the prison.
Prisoners are now responsible for their own reformation thereby eliminating the
responsibility of psy and correctional experts to rehabilitate them
(Mathiesen,1990). If a woman recidivates it is because she failed to embrace
correctional discourse and knowledge, which is saturated with psy explanations of
behaviour. Moreover, one of the preconditions for a new form of governing
appears to be the ability to reconstruct subjectivity in this case the female
criminal subject (Hannah-Moffat, 2001, p166). The subjectivity of women
prisoners is now at stake (or ironically, at risk). Attempts to control the mind, soul
and ultimately the subjectivity of criminalized women are now key correctional
programming initiatives. This subjectivity is universalized, essentialist, and denies
differences between women particularly Aboriginal and non-Aboriginal women
(Morin, 1999). In fact, Aboriginal women report feeling treated with less respect
and dignity than do other prisoners (Morin, 1999).
Feminist criminologists have questioned the capacity of prison officials to
empower women prisoners (Kendall, 2000; Hannah-Moffat, 2001). As previously
noted, there are inherent power imbalances between these parties and the
suggestion that prisoners can be empowered by a system and people that
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maintain their oppression and imprisonment is suspicious at best. For example,


Hannah-Moffat (2001, p170) writes:
Prisons are organized to limit individual expressions of autonomy, control,
and choice. They are sites of repression; behind their walls we find an
undeniable imbalance in the relations of power between the keepers and the
kept. Rarely are the keepers able or willing to relinquish their power to
facilitate empowerment. While incarcerated, women prisoners have little
influence, collective or otherwise, over the conditions of their lives. In the
end, the techniques typically associated with empowerment are in the control
of the prevailing organization.
The Correctional Service of Canada claims to have incorporated a women-centred
model of penal governance (Blanchette, 2002; Verbrugge & Blanchette, 2002).
However, using the terminology of empowerment simply feminises the discourse
of correctional practices (Hannah-Moffat,1999; 2001). The correctional focus on
empowerment suggests that all women prisoners lack self-esteem and self-worth,
and that they do not know themselves or have incomplete or inadequate
identities. In this context, self-esteem is treated as essential to reformation and
the prisons raison dtre is to supply a new subjectivity, a new identity, and one
that is empowered, self-responsibilised and reformed according to
psy-correctional ideals. Rather than empowering women, this system seeks to
reformulate criminalized women according to idealized notions of what good
women should be. As a result, prison psychiatrists and doctors frequently
prescribe women psychiatric medications to combat everything from
schizophrenia to low self-esteem.
Women who refuse to take the prescribed medication run the risk of receiving an
institutional charge for being difficult to manage (Hannah-Moffat & Shaw, 2001).
In this repressive context, women prisoners are disallowed any real way to vent
their anger, sadness, or frustration. In the end, institutional charges for swearing,
yelling, or refusing medication are common occurrences that can lead to an
increase in sentence length or to the denial of programming (Morin,1999). Given
that programming is the main method of intervention, withholding access to
programs is punitive and reflects a deliberate attempt by correctional authorities to
ensure that women are complicit in following their correctional plans, institutional
rules, and in taking their prescription medications.
I suggest that coercing women in prison to take prescription medications is a
violation of their rights as psy-citizens to health care and security (Kilty, 2008).
Citizenship functions as one component of contemporary attempts at population
management through the allocation and denial of rights, privileges, and even
services. In the community, citizens are encouraged to seek second and even
third opinions regarding their health and mental health diagnoses. We are also
encouraged to research our illnesses and the affiliated prescription medications in
order to ensure a fully informed decision making process regarding our manner of
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treatment. Such is the nature of our psy-citizenship.


Moreover, whereas the biological body has the potential to free itself from some
diagnoses or to become symptom free, psychiatric illnesses are constructed as
chronic and ever-present even when managed. For example, Islin (2004, p226)
points out that the transformation from neurotic subjecthood to citizenship
involves responding to calls to adjust conduct via calculating habits but soothing,
appeasing, tranquillizing, and, above all, managing anxieties and insecurities.
Citizenship ensures that should we decide to forego treatment, whether it is
chemotherapy for cancer or taking Prozac for depression, we have the right to do
so. Therefore, while correctional discourse proclaims to be women-centred and
empowering, we continue to deny prisoners the ability to determine their own
mental health destinies. Reminiscent of historic insane, criminal, and lunatic
asylums, the current prison regimes remain repressive institutions that sacrifice
treatment (and prisoners rights as psy-citizens) for social control.
Method
This article is based on 26 in depth interviews; 22 with former provincially and
federally sentenced prisoners in Canada and four with social workers who work
with criminalized women in the community. Of the 22 former prisoners, eight
(36%) had served both federal and provincial prison time, and 14 (64%) had
served only provincial prison time. Participants were located following initial
contact with social workers at womens organisations that provide housing,
services, and programming to at risk and criminalized women. The interviews
were semi-structured in nature and aimed at eliciting detailed accounts of how
participants coped with stress associated with but not limited to their
imprisonment.
By focusing on how women coped with stress, one of the main areas of discussion
centred on how participants experienced psy-care while in prison. More
specifically, participants unanimously described the (over)use of prescription
psychiatric medications throughout both levels of imprisonment. The following
analysis reflects this disturbing finding women incarcerated in federal and
provincial prisons as well as local detention centres in Canada are currently
subject to violations of their rights to health care and security due to the psy-care
(or lack thereof) they are receiving while inside. With precious little therapeutic
care, women in prison are frequently subject to varying levels of medicalization in
order to secure their social control.
Moral Regulation: The Medicalization of Women in Prison
Moral regulation is a process that enables the social control of certain groups, the
goal being regulation by way of changing the identity and/or behaviour of the
targeted population. However, to present a project of moral regulation one has to
believe that those subjected to it are capable of reflecting and changing their lives
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when properly enlightened by the regulators (Ruonavaara, 1997, p286-288;


Dean, 1994). Whatever the moral project identified as worthy of reformation via
regulation, those championing said moral projects must possess a coherent and
detailed program that outlines the desirable conduct of the targeted population.
Therefore, not only must those in charge of the regulation project generate a
suitable discourse of ideal conduct, they must also offer suggestions as to how
those working directly with the population can actualize the moral project.
Practically speaking, moral regulators require an ever-expanding assemblage of
individuals working to execute the moral project all of whom cater to the party
line by expressing the values and ideals of the overarching goal of change and
reformation. Ruonavaara (1997) distinguishes between social control and moral
regulation by arguing that moral regulation is a kind of social control that functions
within the social relationship between the regulators and the regulated via
persuasion rather than coercion.
The language and discourses of contemporary moral regulation projects are much
less overt than they have been in the past; what I mean by this point is that moral
wordsmiths couch current moral discourses in politically acceptable technical
language. For example, Ruonavaara (1997, p292) writes:
In the case of contemporary moral regulation, the ideologies are the ones that
we ourselves are subjected to. Moreover, they are often now expressed in
technical language devoid of any overt moral exhortations, such as
discourses on health promotion or management doctrine.
With respect to women in prison, several moral projects are typically underway at
any given time (Gartner & Kruttschnitt, 2004; Hayman, 2006; Kilty, 2008). Prison
programming and psy-care serve as the two primary mechanisms through which,
frontline regulators present regulatory discourses to incarcerated women and
which constitute the venues for the constitution of the social relationships between
these two parties. However, for the purposes of this article, I focus only on
psy-care. With this in mind, we must acknowledge the above-noted discrepancy
between psy and moral discourse. While moral regulation theory suggests that
regulators believe that those subject to regulatory discourses and practices are
capable of change, psy discourses often construct subjects as unable to change,
where a psy-diagnosis reflects a kind of innate and unyielding abnormality.
Analogous to Ruonavaaras above statement, experts commonly present
psy-discourses in promotion and/or management language to attempt to mitigate
any moral overtones. The process of psychiatrization exists in tension on one
hand it seeks to label criminalized women by identifying their individual barriers to
reformation (i.e., whatever mental illness or diagnosis they are viewed as suffering
from), and on the other, it operates within the neoliberal carceral constraints that
lay all responsibility for change on the hands of prisoners themselves. Therefore,
psychiatrization is a unique moral project, in that psy-experts secure power within
their social relationship with the regulated (prisoners) through their ability to
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prescribe psychiatric medications. Additionally, it is essential to examine how


correctional and psy experts both persuade and in some cases coerce women in
prison to take psychiatric medication.
Medicalization is a process through which we define and treat social and/or
behavioural conditions as medical issues (Conrad & Schneider, 1980; Conrad,
2007). The term refers to the course of action by which certain events or
characteristics of everyday life become medical issues, and thus come within the
purview of doctors and other health professionals to engage with, study, and
treat. Medicalization typically involves changes in social attitudes and
terminology, and is commonly accompanied (or driven) by the availability of
treatments. In the realm of corrections, medicalization operates through the
over-prescription of psychiatric medications. Medicalization in this fashion is most
predominant at the local jail or detention centre level where prisoners are so
overcrowded that they are often double and triple bunked in their cells (Kilty
2008). Over-prescription effectively subdues this population of women, who are
often characterized as misbehaving or rowdy. Brooke discussed this role of
Seroquel at length, stating:
Everyone was on something, some kind of medication. Lots of Seroquel. They
gave me Seroquel as soon as I got there, my first night. I was on it the whole time
I was inside. It knocks you out, makes you sleep for like twelve hours so if you
were sad, depressed, or even angry, the Seroquel just makes you calm but to
the point where you just cant react to anything.
Using prescription medications in this way fails to acknowledge the harmful impact
that imprisonment itself has on criminalized women. For example, Jane, a woman
who spent time on and off in a provincial detention centre, discussed how
imprisonment affects ones emotional well-being:
Well it makes you crazy in there [prison]. Youre not well in your head. Like
they send a psychiatrist to see you once youve been there for about two
weeks. To see how youre doing, and some people just get depressed or
they go crazy and those people get sent to segregation. In seg, theyre just
on a whole bunch of medication.
Both Brookes and Janes narratives illustrate how prescription medications and
the practice of segregation, as technologies of discipline, are effective tools used
to render this population docile. In her interview, Jane acknowledged that
incarceration in and of itself has a negative impact on the womens emotional
well-being. The reconstruction of sadness and stress resulting from ones
imprisonment and criminalization as indicative of some form of madness or
potential dangerousness provides a fertile ideological ground from which to create
illusory images of crazy or rowdy women prisoners who must be sedated and
segregated. For example, my interviews consistently demonstrated that women
perceived as more rowdy, resistant, drug addicted, loud, and questioning of
authority were prescribed higher dosages of sedation inducing drugs to ensure
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their compliance and docility. Nellie discussed the increasing dosages of drugs
she was given while incarcerated:
Every time I would go in it was usually in the middle of a drug binge, you
know? And rather than getting me in to a proper doctor or a treatment centre
or something, they just got me lots of dope. The Seroquel just let me sleep
and sleep and sleep so that I didnt get all agitated craving my drug. I didnt
react at all, I just laid there.
Rather than understanding sadness and anxiety as a normal, rational, and
reasonable response to being criminalized and imprisoned, psy-experts working
within the correctional system reconstruct these normal responses to their current
life situations as abnormal. Likewise, failing to seek alternative forms of
intervention for the difficulty a prisoner is having coping, medicalising criminalized
women has become the de facto policy for how psy is practiced in the correctional
system as well as in the community, again illustrating the extension of carceral
control strategies beyond prison walls (Cohen,1985).
Carrie, a social worker who works with at risk and criminalized women in the
community, articulated this very point:
This woman had good supports on the outside; good family, a house, had
never been in trouble before. You know all of these good things, and so
when she got to GVI she is obviously upset. Shes bawling her eyes out for
the first few weeks she is there and they keep trying to push meds on her.
Oh here, you need to go on an anti-depressant. And shes like, Im in jail!
Thats why Im depressed. I am going to be here for three and a half years! I
am going to be here for three and a half years, like thats why Im crying. She
had never taken meds in her life, and she didnt want to start in prison. She
kept saying, that it had to do with where she was, and that it didnt have
anything to do with some kind of imbalance or any of those things. You know,
I am in jail, thats why Im crying!.
Within the correctional system there is a reconstruction of any kind of emotional
response that deviates from contentedness as indicative of an inability to cope or
of some kind of greater mental pathology (Chesler, 1972; Ussher, 1991; Russell,
1995; Suyemoto, 2002). To suggest that sadness, anger or anxiety is an
inappropriate response to being imprisoned is to ignore the well-documented
impact imprisonment has on those we incarcerate (Heney, 1990; Rhodes, 2004,
Sim, 2005; Kilty, 2008). Current psy-correctional responses seek to separate the
prison experience from an individuals emotional well-being while inside and
subsequently look to innate reasons for any prisoner responses they view as
maladjustment. In so doing, not only do the philosophies, discourses and
practices of correctional institutions have notions of psy built into them, but also
the process of psychiatrization reflects the larger moral regulation project
operating in prisons.
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In contrast to the inconsistent prescription of psychiatric medications that occurs in


the provincial system, several of the women discussed the ease with which they
were able to attain prescription psychiatric medications in federal prison. For
example, Kellie, a former prisoner of the Grand Valley Institution in Kitchener,
Ontario, stated:
The psychiatrist thats another matter, she was great. You tell her what you
want, some psych pills and shell give them to you, no questions no nothing.
Oh you want this, you want that, no problem. You know what they do, they
medicate people to keep them calm. They had me on three different
antidepressants at the same time! The only time you talk to the psychiatrist is
to get your medications. Youre in there for ten minutes maybe. Oh, I need
this, I need that, this isnt working, can we try this. Write, write, write. Its
ridiculous.
The fact that prescription medications are dispensed so readily illustrates how the
federal correctional approach to psy intervention is one of medication over therapy
or counselling (Heney 1990; Sim 2005). Correctional plans reconstruct the
over-prescription of psy medication as a preventative measure taken against a
population characterised as being difficult to manage or resistant to correctional
regulations and other forms of correctional intervention.
In this light we begin to see how in the correctional arena, psy is practiced as an
extension of the process of medicalization. Joan, a provincially sentenced
woman, likened the impact of this process on women prisoners to the sedation of
mental patients in locked psychiatric hospitals or institutions:
Joan: Theres drugs and alcohol problems, okay thats a primary problem.
Thats the one thats affecting them now, but theres also the underlying
mental illnesses. That they have anxiety, depression, bipolar, manic, theres
lots. Theres so many people on medications for that in jail, you should see
the med-line.
Jen: Do you think they prescribe too much?
Joan: Well, some of them really need it. But then some of them that really
need it arent getting the care they need in there, and then there are the ones
that take it just to sleep through their whole time. Some of them take
Seroquel just to sleep through, or we used to call it bug juice, they used to
give them Nozepam and theyd be like walking zombies; thats what they give
mental people in mental institutions to keep them sedated. Like theyre
drooling out of the sides of their mouths.
Joans narrative reflects a kind of ambivalence regarding the use of psychotropic
medications for women in prison; while she acknowledges belief in mental illness
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and in medicalization as the appropriate method and course of treatment for


some, Joan is clearly uneasy about the impact of such high dosages on the
women. Joan does not fully problematize medicalization, but she notes an
important finding that not all women prisoners are regulated solely through
external means. Reflective of the power of psy as a key operating moral
regulation project for women in prison, it is interesting to note that not all women
perceive and experience taking prescription medications as intrusive; in fact, some
women engage in self-regulation by accepting and using psy discourses. Such
was the case with some participants who willingly took Seroquel, an antipsychotic
medication that is currently the prescription drug of choice in prison due to its
common side effect of sedating the individual.
Seroquel: The Current Correctional Wonder Drug
Seroquel is the market name for the antipsychotic drug Quetiapine, whose
manufacturers claim appropriate for treating schizophrenia and the manic
episodes in bipolar disorder. However, prison doctors and psychiatrists frequently
prescribe Seroquel to prisoners because its most common side effect is sedation.
Of the twenty-two former prisoners interviewed for this research, all but one was
prescribed Seroquel while in prison. Moreover, the one woman who did not take
Seroquel served time in the now closed Kingston Prison for Women and was
inside before Seroquel was on the market; alternatively, she took both Valium and
Prozac while serving time. Both former prisoners and community social workers
criticized the use of Seroquel as a sedative, often referring to the drugs potency,
suggesting that it is overly powerful and an unnecessary sleep aid. For example,
Danielle, a former federal prisoner, stated, I dont want to be a zombie and I dont
want to, like I could sleep all day on that shit. Similarly, Carrie, a social worker,
spoke about the impact Seroquel had on one of the women she was working with:
There are a lot of women on medications. One woman was on 500
milligrams of Seroquel a day. For the first few weeks, she was comatose.
You know, and this was prescribed by a doctor from the jail. He had said,
come back in two weeks and well see how that goes. I mean, how can a
doctor who doesnt know the person give them grandiose doses of
medication and then tell them to come back in two weeks when she hasnt
been assessed by a psychiatrist? Like there are so many problems.
Carries narrative demonstrates a trend that was evident in many of the womens
accounts that there is little correspondence between prison medical doctors and
psychiatrists. In fact, what occurred in more than one instance were dual
prescriptions by doctors and psychiatrists and/or a battle for power between the
two; for women in prison, this battle commonly resulted in their being placed on
medication, then taken off it shortly thereafter. This point also illustrates how other
professions have absorbed psy expertise in order to actualize more completely the
moral regulation project of empowering women to become appropriately
self-governing.
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The dosages of Seroquel prescribed to women in prison vary substantially. This


fact alone is not abnormal given that varying dosages of any medication are
common depending on how the individual reacts to the medication and the
claimed seriousness of the diagnosis. However, some women I interviewed had
been prescribed twenty-five milligrams of Seroquel, while others were taking over
five hundred milligrams of the same medication. Stacey found that with respect to
Seroquel as a prescription medication, the federal prison system adhered to a
more is better philosophy:
The one thing with prison is that they like to heavily medicate people, and Im
a prime example. Yeah, Seroquel, stuff like that. I was on a lot of
medications. I was a walking zombie. I could not function. I do not
remember half of my time. I dont know how I functioned or how I made it
from point A to point B. I cant even describe to you how many different
medications I was on. When I left prison my parole officer from Guelph was
even asking, How are you walking? How are you doing this? I actually went
through withdrawals when I came off this stuff.
Given the fact that so many participants used the exact same phrase to describe
the impact of Seroquel as making them become walking zombies, one must
question whether our current system is creating, as noted by Russell (1995)
prescription drug dependence among women prisoners. Staceys claim to have
experienced withdrawal from prescription drugs is a case in point. Whether they
had clinical diagnoses or not, many women said that they needed their
medications to get by and that they couldnt sleep and couldnt function
without them. With few other avenues to help them cope in prison and the ease
with which they are able to obtain them, many women seem to turn to prescription
medications as a way to cope and get through their sentences. For example,
Joan stated, I need to take these meds, or else I cant sleep. The meds just keep
me normal so I wont go out and get high and act crazy. As aforementioned,
some women embraced their psy diagnoses and willingly took prescription
medications because doctors told them that these medications were necessary for
them to get well.
Contrastingly, despite some of the womens attempts to explain that they did not
want or need psychiatric medication, but rather that they needed only time to
adjust and cope with their new surroundings, their self-assertions seem to go
unacknowledged by correctional and psy-experts:
I lost my kids, I was in jail, I was addicted to drugs all this shit and all they
did was give me meds to calm me down. They act like Seroquel is going to
make me feel better, but no one talked to me or offered any real help. The
reason I was so depressed was because I was living in a cell with some other
person I didnt know and had no idea how my kids were. Meds are not going
to change any of that.
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Getting criminalized women to take psy medication is thus not merely a feature in
the practice of psy, it is a key component in the exertion of psy expertise reflected
in corrections efforts to transform women criminals into inmates and then into
rehabilitated women. In this light, psy expertise becomes an effective instrument
for altering the conduct of criminalized women. However, to assume that women
must be medicated in order to cope with imprisonment does not help them in the
long run; in fact, it may foster a kind of reliance on psychiatric medications that
they may not have otherwise had.
Ultimately, some psy diagnoses reflect general assumptions about the nature of
women (Chesler, 1972; Ussher,1991). For example, to be told by psy-experts that
they need these medications to cope reinforces the characterisation of women
prisoners as weak, passive, emotionally unstable, and unsuitable for other
common attempts at coping with stress. As Shannon suggested:
No one would listen to me and that would get me more and more upset. They
just talk to you like you are a kid who cant handle it or like youre crazy.
Every time I would have an encounter with the doctors or nurses, they just
ignored everything I would say and would make me feel like I was losing it.
By encouraging, and in some instances, coercing women in prison to take
prescription medications, psy-correctional discourse reconstructs women
prisoners as incapable of determining the courses of their own mental health
care. In this light, we can see how psy-experts working within a neoliberal
carceral context attempt to reclaim a certain degree of control over the
emotionality as well as the management and mental health identities of women
prisoners.
Particularly problematic is the fact that women are, in Kellies words, only in to see
the psychiatrist to get your medications and that they are there for ten minutes
maybe. Very little intervention or discussion between psy-expert and patient
occurs, thus minimizing the potential for any kind of therapeutic involvement.
Given that there is only one clinical psychologist on staff at an institution that may
house over one hundred women at any given time, it is obvious that access to
therapy and counselling is limited. Darla stated that upon arrival at GVI, the
women are seen by the psychiatrist for around an hour to see what your needs
are and whether youre suicidal, or what your problems are, or if youre
argumentative, you know, your background. To expect women upon their initial
arrival in prison to be ready to discuss their clinical history again ignores the
traumatic impact that incarceration has on people. This procedure is a component
of the risk assessment strategy that is so ingrained in correctional discourse, and
confirms my claim that corrections main concern is always the security of the
institution.
Quickly looking to identify argumentative and therefore potentially resistant women
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illustrates a desire to identify those who will be subject to increased security,


medication, and isolation practices (Hannah-Moffat & Shaw, 2001). This
investigatory procedure is hardly effective as a means of securing the kind of
detailed information that should be required before prescribing psychiatric
medication. Despite this fact, many women in local jails and detention centres,
and provincial and federal prisons are taking Seroquel for a number of diagnoses
other than schizophrenia or bipolar disorder. In fact, only one participant was
prescribed Seroquel for a corresponding diagnosis of bipolar disorder; the rest of
my participants were given Seroquel for the following reasons: substance use,
substance withdrawal, anxiety, depression, and as aforementioned, to induce
sedation. As aforementioned, out of the twenty-two former prisoners interviewed
for this research, all but one took Seroquel while incarcerated.
Julie provided insight about the conflicting psy approaches and strategies that
exist at the federal level. For example, she stated that once you have cascaded
your way down to minimum security, institutional authorities give you a weeks
worth of medication and you are entrusted to take it accordingly:
What they do is they give the girls all their medication for a week. Some of
them will give them to other people for stuff, trade them, sell them. Some
would use them to get high, or trade them for things. Thats one thing I didnt
like about it [GVI] was the medical. You know enough is enough. Im tired of
people telling me I have to do this, I have to do that, I have to take this
medication. I want that control. Like last week I just lost it. I went off my
meds. I was on something for depression. See that was another thing in
federal, theyd say you have to take these. And I didnt want it. You couldnt
refuse it. Or else I would go to seg. Because I was on Zoloft before I came
to prison and then I needed it because I was drinking, going through some
things, bad relationship, so ok I needed the medication. But when I went in, I
was still on it, and I felt that I didnt need this. So when they called the house
and said for me to go to health care, and I went over and the guard that was
in charge asked why I hadnt taken my medication, I said that I dont feel like I
need it right now. Then I had to go in to see the shrink, and the shrink said,
well I feel that you need to be on something, so I just said ok because I
wanted to get out, you know.
The correctional practice of giving the women housed in minimum security a
weeks worth of their medications at a time may be seen as an actual attempt by
correctional officials to entrust a certain degree of control over their own mental
health to the women themselves. However, the women are still required to take
the medication and if they refuse to do so, they run the risk of jeopardising their
minimum-security status and even their potential for parole release (Pollack, 2006;
Pollack & Kendall, 2005). Allowing the women to manage the taking of their own
prescription medications is indicative of a push by corrections to get the women to
self-govern, but to do so according to corrections standards of acceptable
psy-care. For many criminalized women means continuing to take all those
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medications that are prescribed for them, whether they want to take them or not.
At times Julie was open to taking prescription medication when she felt stressed
or when she was having difficulty coping, but wanted the ability to stop taking it.
Ultimately, Julie wanted the control and decision-making power regarding the
medications she took, but knowing that failure to comply would result in a longer
stay in prison she desisted from her attempts to exercise that control. Similarly,
she mentioned being somewhat amenable to the drug Zoloft because she did not
experience side effects from the drug, unlike the long lasting sedative effects of
Seroquel that made her feel groggy, out of it, and unable to concentrate.
Unfortunately, Julie had to take not only the Zoloft, but also the Seroquel as it was
mandated as a part of her correctional plan.
Resistance may take different forms, and reflects the ability to struggle against,
withstand the effect of, or not to be affected by something or someone. In this
light, Julies compliance in taking her medications is an act of resistance as she
was actively doing everything in her power to struggle against her imprisonment
by securing her release. Julies compliance in taking prescription medications was
a way for her to withstand the punitiveness of the prison and thus not to be
affected by those disciplinary technologies that exist behind prison walls. While
Julie viewed prescription medications as intrusive, she engaged in a form of
self-regulation and compliance in order to make her time inside less rife with
stress. At the same time, Julie refused to accept the discourse of her own
psychiatrization and of the value of the amount of prescription medications given
to her and other women inside.
Conclusion
The overuse and reliance on prescription psychiatric medications reflects three
broader political trends: first, what Conrad (2007) identifies as the medicalization
of society; second, historic constructions of women more broadly and women
prisoners more specifically as mad, irrational, or unstable; and third, ongoing
correctional attempts to pacify prisoners with drugs in order to more easily foster
the larger correctional moral regulation project, as well as to prevent resistance or
the questioning of correctional authority. Seroquel, while being the current
prescription drug of choice, is merely one in a long line of medications that have
been popular in prison.
The main argument of this paper surrounds the rights to services that may help
psy-citizens cope more effectively and in a manner, they see as most helpful.
Institutional mandates deny services and potential treatment options to
criminalized women, which are available in the community. Ultimately, there are
three avenues available for the betterment of the health of criminalized women in
their capacity as psychiatric citizens. First, we must re-evaluate the power of psy
in the carceral context, with the hope of reducing reliance on psy-diagnoses and
prescriptions. Second, we must improve access to services and treatments
desired by criminalized women so that they can function independent from
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corrections (which would require improved access to information and education


regarding each individuals mental health so that she can be involved in the
decision making process which by and large would be a step toward a womancentred model). Finally, providing care in and through the community rather than
through corrections would help to separate correctional power over the mental
health care of criminalized persons.
Unfortunately, criminalized women lack the real freedom to make informed choices
regarding their own mental health care, thus denying them agency with regard to
their psy-citizenship; for example, correctional authorities use a womans pending
parole release as an incentive to ensure that she continues to take medication.
Worse yet, these same authorities actually present their strategy as an attempt to
help empower women. Coercion is not empowering; it is in fact the exact opposite
it is disempowering. Women in prison have not voluntarily signed themselves
into a psychiatric hospital, nor have they given up their right to determine their own
mental health welfare; they are incarcerated in a prison against their will. Since
psy-care in prison is provided by those who officially work for and thus report to
correctional authorities, as opposed to being a distinctly separate and outside
neutral party, there is no real sense of confidentiality or trust between patient and
doctor. As Kathleen Kendall (1994) asked nearly fifteen years ago, is it even
possible to have therapy behind prison walls?
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