My friend showed me her arms, covered in bruises from the security guards. That day, I could not believe what she was telling me about what had happened to her on the inside. “I recorded some of it on my Apple Watch, I think? But then it died, so I don’t know if it was saved or not,” she recalled to me. “They restrained me three times. I was in a solitary confinement room and one of the security guards strangled me.”
What does the vocabulary of “inside,” “solitary confinement,” “restrained,” and “security guards,” make you think of? What place would you guess we were talking about?
Are you thinking of jail? That is a reasonable assumption, as my friend’s experience of brutal violations of human dignity are everyday systematic attributes of prisons, jails, and detention centers.
In this particular conversation, we were not talking about jail. We were talking about a medical center in Downtown Berkeley. You probably know a similar one. This building has urgent care and counseling. It has a meditation room, a cafeteria, and services where you can get screened for cancer or visit a physical therapist.
But have you ever asked yourself what happens on the other floors of medical centers that you never visit? What might be happening on those floors that are blanketed with euphemistic labels of ‘behavioral health’ and ‘psychiatric inpatient units’?
Maybe you have chosen to take a trip to your local medical center for your health, or maybe you got unlucky like we did; perhaps you innocently believed telling a medical professional, “I’m going to kill myself,” would lead to support, rather than accidentally consenting for them to strap you to a gurney and drive you to a mental institution. A consent process that is unbeknownst to you, the person who is allegedly consenting. This latter process is what my friends and I would refer to as being “5150’d:” involuntary detainment in a psychiatric hospital under a 72-hour order. Though, you are usually there for much longer.
Thinking back to that conversation with my friend, I did not know what to say when she told me what she experienced. I felt clueless, useless. All I said was, “Wait, they have a solitary confinement room?”
The two of us were detained in the same place, but we were treated very differently based on our race, how we present, and how much we were or were not willing to submit to the system.
I used to be a “keep my head down” type of patient, wanting to get in and out as fast as possible. And it did, kind of, work. I have been known for being on my best behavior (when they are recording my every move). Over the years, as I have learned and experienced more, my orientation has changed, and I no longer want to be that type of patient anymore. While it can feel like I am alone due to the isolating nature of institutionalization, I am definitely not. I am actually part of a system, of entire groups of people hospitalized together, and having solidarity with one another is an act of survival. I have learned that when you keep your head down and your eyes away from what is going on around you, you are missing out on bearing witness to the full truth of the situation.
My community and I’s lived experience has led me to embrace the struggle against the mental health industrial complex (MHIC). Dr. Eric M. Greene coined the term after building on previous work, stating, “[the system] elicits mantras of self-blame while exploiting humans as patients for the bottom-line dollar. In short, the definition and diagnosing of mental illness is political.”
The MHIC is a developing concept that I hope to someday see gain more traction, especially among abolitionist and Disabled organizers, advocates, and thinkers. We are building for it.
The purpose of adopting MHIC into our terminology comes from the work of the Mad Community,—a reclaimed term by users of psychiatric services, and people otherwise positioned in the mental health struggle, which is another example of using language to interrupt the dominant narrative that centers on diagnosis and the psychiatric system—who are calling for abolition of the eugenicist, racist systems that created Western psychiatry. America and Britain were especially guilty of systematizing the eugenics project in the psychiatric context. California, where I am from, has been an especially terrible proponent of eugenics, and still is.
The origins of our current psychiatric systems are not ambiguous: they wanted us gone. They wanted Mad people gone. They wanted Disabled people gone. They prided themselves on being able to, at the very least, forcibly remove our communities from the public view of non-disabled people, and at the most—what it’s really about—get rid of us altogether.
To be clear, we are not advocating for abolition of services that people want to have. That is not realistic or helpful. What we are calling for is optional, non-punitive, and community-curated psychiatric services. As the popularized Disability Justice saying goes, “Nothing about us without us.” The emphasis here is on autonomy and choice. There should always be a choice. There is no world in which my friend should have endured brutality from the institution’s security guards for resisting medical treatment. No state or system should have the power to control what choices you make for your health. State-sponsored violence and coercion has no place in our health. People should not be restrained, detained, or forced to receive psychiatric services if they do not want them. The ground zero for that fight is the psych ward.
Are Prisons and Psychiatric Facilities Similar?
“No, it’s the literal same.” These are the words of a friend of mine who works in a juvenile detention center in Texas. He was comparing his experiences working as a center supervisor with the experience of his housemate, a nurse in a psychiatric hospital. You are forced in, and you cannot leave until the authorities determine you can. You are trapped within these walls, and your best hope is some of the staff are a little nicer than others. You are deprived of freedom of movement through two methods: enclosure and control.
The overarching logic that prisons, mental institutions, nursing homes, and boarding schools follow are all carceral in nature and have a shared name: the total institution.
Erving Goffman, a social psychologist from the 20th century, coined the term “total institution.” A total institution is made up of people who cannot leave the institution, governed by people who can. At the heart of the total institution is a barrier to the world: “locked doors, high walls, barbed wire, cliffs and water, open terrain, and so forth.” This barrier serves a political purpose, materially and discursively: to disappear people from the public eye under the guise of “getting them help;” to grant the elites and the politically unconscious their wish of “out of sight, out of mind;” and dehumanize, segregate, and demoralize a people in a controlled space. It is the same tactic that California Governor Newsom has been pushing on houseless communities, as recently as a few days ago.
Goffman described four key aspects that define a total institution:
- A place where all aspects of life are lived out, under the same single authority;
- Activities occur in groups, who are all required to do the same thing;
- The day’s activities are scheduled from above and enforced;
- The activities are part of an overall plan designed to fulfill the official aims of the institution.
I remember on my sixth day in a psychiatric hospital, they let me go outside and take a walk around the hospital in a group guided by staff. I almost cried, breathing fresh air for the first time in almost a week. However, I was not allowed to see the world beyond the bordering parking lot and the outskirts of a nearby neighborhood. I felt like I was part of an embarrassing parade, costumed in pajamas and crowned in matted hair for an audience of six: five of whom were pedestrian passersby giving us strange looks, with the remaining one being the supervisor.
Concepts of the total institution interplay with Michel Foucault’s subsequent, more expansive theory of the “disciplinary society” where a mass is expected to act a certain way under a certain authority (e.g., work, school, prison, even many religious spaces), and the mass generally obeys due to acceptance of and fear of discipline. This theory brings attention to the universal traits that these institutions follow: systems of privileges, rewards, and punishments; specific “lingo” used by both “staff” and “inmates” to refer to events and structures within the institution, used especially by staff about inmate life.
“Privileges” meaning, of course, the absence of deprivation.
Why is it important to understand the relationship between the total institution and the theory of disciplinary society when considering MHIC in the abolitionist movement? It is because of how these structures interact and adapt to our resistance, and how the lessons learned in these microcosms of our world systems will be exported to additional and larger contexts. When there is a mass of people who are in a place together, and the one commonality is that they are in some way tied to that place and are all being subjugated there, and then they realize the authorities are usually a way smaller group, then people under oppression start to the connect the dots: we actually have quite a lot of power due to our majority numbers. It is the same logic behind unions, collective action, and mass movement. It is the same agitational point that propels class consciousness, mass uprisings, and mass organization. The people at the top who try to control our realities do everything they can to prevent us from realizing that we are all united in our shared oppression. The people at the top are beginning to fail at this in a very substantive way, and I would argue there is a moment approaching for the abolitionist movement to seize.
We are beginning to see the sprouts bloom from the seeds of thought planted over the years in the fight for total abolition, led by Black women organizing for prison and police abolition. In the 2010s and 2020s, we have seen an amazing uptick in the American public’s awakening to the shared systems of carcerality that dictate our lives. These overarching frameworks can be dubbed “carceral logics.”
Carceral logics are, as defined by Professor Christy E. Lopez, “a punishment mindset that views retribution and control, including by physical constraint (e.g. imprisonment), surveillance (e.g. electronic monitoring via ankle bracelet), or violence, as central components of a public safety system.” This type of system and systematized thinking is also termed “prison culture.” The total institution has moved beyond spaces and structures, into interpersonal relationships and our very own minds, creating not just buildings where people get hurt, but culture.
The arms of the carceral creature stretch toward all of us: our BIPOC kin, our sick, our elderly, our Disabled, our queer, our poor, our noncitizens, our protestors—anybody who challenges the supremacy of the state necropoliticking project, whether through direct efforts to hold it accountable, or simply existing as a marginalized person. And, the hands reach even further than the total institution.
The Total Institution is Not Limited to Buildings. Our Resistance Shouldn’t Be Either.
Stella Akua Mensah, a Black Neurodivergent writer and psych survivor, wrote in 2020, “Our discussions of psychiatric abolition are deepened when we look to the history of prison culture in its many forms — policing, the death penalty, disposal of the divergent, and underneath it all, an allegiance to the binary notion that there are good people, and there are bad people.”
Where else might our “allegiance” to these systems, in the stirring observation made by Mensah, be showing up in our lives? Consciously or unconsciously?
I notice that my unconscious allegiance to prison culture attempts to erode all aspects of my life. I find it in my self-talk, when I am punitive toward myself for missing a deadline or falling behind on housework. I find it in my relationships, when I keep mental totals of if I have “done enough” for my friendships to be in “good standing.” I find it in my school attendance policies, where the professors instruct me to show up to class or not pass. I find it in the remains of People’s Park in my neighborhood, which used to be the only park in my district and is now walled up entirely by 17-foot cargo containers to prevent neighborhood resistance to the UC building on the land. I find it in small, invisible places. I find it in large, very visible places.
Here is a journaling question for you, based on the work of Mensah: where do you find your unconscious allegiance to prison culture may be hurting you most right now?
The total institution is a model with shared attributes, systems, and characterizations that can be and are replicated for oppressive violence across different communities. When an asylum is no longer technically an asylum, or a prison is no longer technically a prison, it does not mean the state won’t adapt the total institution model to a slightly different framing, attempting to trick us into believing our struggles are separate instead of joint: no matter the specific name, the total institution is the same.
We saw this play out in real time very recently, as news broke that not even one year after grassroots organizing efforts successfully shut down the infamous Bay Area women’s prison FCI Dublin in April 2024, known for horrific sexual abuse, that in February of 2025, it was announced ICE is considering turning the empty building into an ICE detention center. Carceral logics must be completely and totally abolished, lest they evolve. (They have the money for it.)
The sequel to Foucault’s theory of disciplinary society is Deleuze’s 1990 essay, “Postscripts on the Societies of Control,” theorizing a continuous variation of what disciplinary total institutions might look like when they became more integrated into our daily lives; more attuned to deeply changing, moderating, and monitoring our behavior beyond the walls of the institution. This is where prison expands to tactics like ankle monitors or weekend jail, and institutionalization expands to a psychiatric outpatient modality.
For me, it looked like, “If you enter outpatient, we’ll discharge you,” as my assigned psychiatrist explained to me in one of the offices. “This is like tapering out of the mental hospital. It becomes a day program, 9 to 4, and it will become less and less hours if you start to do better until total discharge. If you miss days or you start to get worse, you can come back here.”
I open up the app where my supervisory staff leave notes on my visits with them, which are, for some reason, available for me to read. “Superficially bright, good use of humor.” Superficially bright? What the fuck? I don’t remember “superficially bright” being a diagnosis in the DSM-5. But, I am glad they think I’m funny.
I am more self-conscious now of my “flat affect” and “disorganized thought process,” as they put it. One has to wonder if anyone there really ever cared about trying to make me better, or if perhaps instead, the total institution is really just a black box that they input some of us into, hoping that with enough medication, stale food, dehumanization, and time, our moods will turn around so that we are well enough to return to work. That is how we will know we are “cured,” right?
There is no use in wondering what the intentions of these systems are. I know the brutality I have seen, the life-threatening abuses I have experienced, and that brings me to my central thesis which is that the fight for prison abolition and psychiatric abolition are one and the same: a joint struggle against the total institution, and all the ways they try to extend it into our everyday lives.
The work of abolition will either get done or it will not, and it is in the hands of people like you and me, among thousands of others.
Until we see the end of the psychiatric ward, until we see the end of solitary confinement, until we see the end of the total institution—we keep fighting. Right now, we are witnessing a world that not only permits the existence of total institutions, but encourages the state to take it to its logical end: entire populations of people becoming total institutions (Kashmir, Gaza), and the collaboration of oppressive tactics between prisons and psychiatric institutions being jointly employed for maximum control and harm. It is happening in our world right now, one only has to look to the abhorrent conditions at CECOT in El Salvador and Gaza being the world’s largest open-air prison for fifteen years as pretext for the horrific ongoing genocide.
In the words of Deleuze, “There is no need to ask which is the toughest or most tolerable regime, for it’s within each of them that liberating and enslaving forces confront one another. For example, in the crisis of the hospital as an environment of enclosure, neighborhood clinics, hospices, and day care could at first express new freedom, but they could participate as well in mechanisms of control that are equal to the harshest of confinements. There is no need to fear or hope, but only to look for new weapons.”
The logical end of the total institution lies in the name: total. It is a hungry imperialist logic that will expand and capture until it has it all. Recognizing that there is joint struggle in the total institution between prisons and psychiatric wards means we can build our collective capacity, share resources, and figure out points of collaboration to make abolition a reality. Let’s get to work, because we have a lot to learn from each other.
Authored by Danielle Leard
Danielle Leard (they/she) is an organizer, writer, and creative based in the San Francisco Bay Area, with an orientation on abolition, anti-imperialism, and disability justice. With their work, they aim to contribute to our collective political imagination for resisting and building from our sites of struggle. Danielle also thinks she is really funny, though that has been contested.
