Psychiatric Quarterly, Vol. 72, No. 1, 2001
THE LAST MENTAL HOSPITAL
James Gilligan, M.D.
The public mental hospital system was created in part because many men-
tally ill people were being held in prisons and jails. Support for those hospi-
tals waned over time, however, and by the time they had degenerated into
‘‘snake pits’’ a consensus was reached to close them down. Unfortunately,
they were not replaced with adequate community mental health resources, so
as the hospitals have emptied, the prisons and jails have ﬁlled, partly with
the mentally ill. That is the destructive reason for the growth of prison psy-
chiatry in this country: the prison has become the last mental hospital. The
constructive one has been a new emphasis on bringing psychiatric treatment
to a previously neglected population: people who have committed serious vio-
lence, whether because of Axis I mental illnesses or Axis II character disor-
ders. Unfortunately, four inter-related, mutually reinforcing nationwide
trends threaten to reinforce that destructive development and vitiate the con-
KEY WORDS: deinstitutionalization; prisons; mental hospitals; violence.
Over a century and a half ago, a great social reformer, Dorothea Dix,
visited prisons and jails throughout the country and noticed that
many of the prisoners were mentally ill. She protested against the
practice of criminalizing mental illness, arguing that it would be bet-
ter for both the mentally ill and society as a whole if we treated them
in hospitals, in as humane a setting and manner as possible. Her
campaign contributed importantly to the creation of the modern, pub-
licly supported mental hospital system. The purpose was to transfer
the mentally ill from places of punishment to houses of healing. Over
James Gilligan, M.D., is with the Department of Psychiatry, The Cambridge Hospi-
tal, Harvard Medical School; President, International Association for Forensic Psycho-
therapy; Director, Center for the Study of Violence.
Address correspondence to James Gilligan, M.D., P.O. Box 385, 12 Red Rock Road,
West Stockbridge, MA 01266; e-mail: email@example.com.
0033-2720/01/0300-0045$19.50/0 2001 Human Sciences Press, Inc.