Pathway to prison often paved with unfair labels, misdiagnosis

David Ramey, Paula Caplan, and Elisabeth Ryan
David Ramey, Paula Caplan, and Elisabeth Ryan

November 18, 2015 – The road to incarceration and social isolation in the U.S. often begins when a child is labeled a troublemaker by a teacher or is diagnosed with a mental illness that may or may not be accurate, speakers told a Harvard T.H. Chan School of Public Health audience on November 16, 2015.

The issue of labeling — whether by gender, race, sexual preference, criminal record, or medical diagnosis — and its repercussions on health and quality of life was a topic of the dLOV (Different Lenses, One Vision) conference, which began November 16 and is going on with daily events at the School through November 19. The week’s events included the panel discussion “Prison Cells and Psychiatric Units: On Deviance and Social Control.” Upcoming events, which are open to the public, can be found here.

The conference was organized by a planning committee that included Morgan Shields, SM ’16, a project manager in the Department of Health Policy and Management. Shields organized the first dLOV conference last year as an undergrad at Kent State University to bring together students and others to share experiences related to diversity and inclusion.

Shields and Octavious Talbot, a second-year student in biostatistics, co-moderated the panel, which included David Ramey, assistant professor of sociology and criminology at Pennsylvania State University, and Paula Caplan, an activist, book author, and filmmaker whose film, Is Anybody Listening, was shown during the conference. Also on the panel was attorney Elisabeth Ryan, MPH ’16, who has worked to improve conditions for the treatment of mentally ill people in the criminal justice system in Massachusetts.

Among the issues discussed by the panel was the high number of mentally ill in U.S. prisons.  According to a June 2015 Atlantic article on the Cook County Jail, at least 400,000 inmates in U.S. prisons have mental illness—a population larger than the cities of Cleveland, New Orleans, or St. Louis—according to the National Alliance on Mental Illness. NAMI estimates that 25% to 40% of all mentally ill Americans will be jailed or incarcerated at some point in their lives.

Ramey, who works with children, said racism often is involved in how children with behavior issues are treated. The parents of white youngsters with school behavior problems often are encouraged to get therapy and medications for the child, while African American and Hispanic children may be viewed as troublemakers. This can accelerate their problems at school, and disproportionately “put them into the pipeline for prison,” he said. While medication can improve some students’ school performance, he said, “perhaps we’d be better served by letting 12- and 13-year-olds go outside and play before math class…and not rush to medicalize kids.”

Caplan said the number of children getting psychiatric diagnoses and medications is “of alarming concern.” She served on the taskforce to update the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, but resigned “in alarm” over the “unscientific and highly political” way in which decisions are made about what diagnostic criteria to include.

She said that psychiatric diagnosis is entirely unregulated and, as a result, untold numbers of people suffer a wide array of kinds of harm. This is all the more worrying, she said, given that “there is no consensus about a definition of mental illness in general, and choosing which label to apply involves tremendous subjectivity and virtually no science.”

“Insurance companies and therapists should get together and stop this nonsense,” she said. Instead of putting a label on a patient, they should “ask what problem the person has and wants help with, and whether it is getting better during treatment,” she said. “And therapists need to warn patients about potential harm from diagnosis.”

She has seen people lose jobs, custody of children, and other human rights when they were labeled with mental illness. “Anyone who’s going to get a label should be thoroughly informed,” she said. And those who are labeled should have recourse if they are harmed as a result, she added.

[This story was updated on November 25, 2015. Paula Caplan was incorrectly cited as a co-author of the DSM-IV.]

Marge Dwyer