In the jail cell I had appropriated as an office, the toilet was broken. The metal toilet bowl was wrapped carelessly in heavy plastic and the plastic was anchored in place by gray duct tape. The window opened hopefully to about 4 inches, just enough to let in the August humidity. Outside, the temperature reached 90 F. Inside the cell, the temperature was easily over 100° F. I was wilting, my patients were wilting, and I left the building at the end of the morning soaked in sweat carrying stacks of damp paper. For the first time since I was an intern, I donned a pair of surgical scrubs because the building was too intolerable for wearing street clothes. This was the legacy of my jail. The facility was opened in 1859, well before the invention of modern heating and air conditioning.
Thanks to the intervention of the Department of Justice, some improvements were made. Certain tiers were given air-conditioning units and designated for the housing of inmates vulnerable to heat exhaustion. Intake procedures were modified to identify and stratify new detainees according to their medical needs and heat tolerance. Inmates were given education on the symptoms of heat exhaustion and how to prevent it. Eventually summer passed, and I was able to lose the surgical scrubs and slip back into street clothes.
Yet the remaining need for a new jail was obvious to anyone working in the facility or incarcerated there. A recent legislative inquiry pointed out the security risks posed by the antiquated tier structures and other hazards. In the report published later, the cost of a new jail was estimated to be $553 million.
The protest started almost immediately. People wrote to the local newspaper to object to the idea of spending money on incarceration rather than crime prevention. Advocacy groups carved out territorial niches to promote diversion of juveniles, pregnant women, and the mentally ill, apparently leaving any prisoner who didn’t fit into one of those categories to fend for himself. In the end, the jail – which opened at a time when there were only 33 states in the union, the year that "A Tale of Two Cities" and "On the Origin of Species" were published, and when the works of Johannes Brahms were being heard for the first time – remained untouched.
These memories returned quickly after reading a recent New York Times story about a homeless veteran with mental illness who died in his jail cell, presumably because of excessive heat. The man had been incarcerated for a misdemeanor and held only because he couldn’t make bail. The fact that this happened in winter tells me a lot about the nature of the facility’s heating and ventilation system.
The first thing that struck me about this story was the need to invoke certain adjectives, as though readers would not care about the story if the prisoner who died was not mentally ill or was not a veteran. There may be some truth to that concern. When it comes to prison reform, I’ve seen the tendency within psychiatry to limit discussions only to conditions as they affect the mentally ill. This was not always the case. Dr. Benjamin Rush, founder of Pennsylvania Hospital, also founded one of the first prison reformation societies. He advocated humane care for everyone in the facility, not just a certain faction.
Unless someone figures out how to "cure" crime, we will always need jails and prisons. Building a new facility is neither a failure nor a waste of resources. It may be the beginning of a long-term commitment to rehabilitation.
Dr. Hanson is a forensic psychiatrist and coauthor of "Shrink Rap: Three Psychiatrists Explain Their Work." The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.