From the Asylum to the Prison: Rethinking the Incarceration Revolution

The incarceration revolution of the late twentieth century fueled ongoing research on the relationship between rates of incarceration and crime, unemployment, education, and other social indicators. In this research, the variable intended to capture the level of confinement in society was conceptualized and measured as the rate of incarceration in state and federal prisons and county jails. This, however, fails to take account of other equally important forms of confinement, especially commitment to mental hospitals and asylums. When the data on mental hospitalization rates are combined with the data on imprisonment rates for the period 1928 through 2000, the incarceration revolution of the late twentieth century barely reaches the level of aggregated institutionalization that the United States experienced at mid-century. The highest rate of aggregated institutionalization during the entire period occurred in 1955 when almost 640 persons per 100,000 adults over age 15 were institutionalized in asylums, mental hospitals, and state and federal prisons. Equally surprising, the trend for aggregated institutionalization reflects a mirror image of the national homicide rate during the period 1928 through 2000. Using a Prais-Winsten regression model that corrects for autocorrelation in time-series data, and holding constant three leading structural covariates of homicide, this Article finds a large, statistically significant, and robust relationship between aggregated institutionalization and homicide rates. These findings underscore, more than anything, how much institutionalization there was at mid-century. The implications are both practical and theoretical. As a practical matter, empirical research that uses confinement as a value of interest should use an aggregated institutionalization rate that incorporates mental hospitalization rates. At a theoretical level, these findings suggest that it may be the continuity of confinement-and not just the incarceration explosion-that needs to be explored and explained. I. Introduction The classic texts of social theory from the 1960s tell a consistent story not only about the rise and (in some cases) fall of discrete carceral institutions, but also of the remarkable continuity of confinement and social exclusion. This pattern is reflected in the writings of Erving Goffman on Asylums,1 Gerald Grob on The State and the Mentally Ill,2 David Rothman on The Discovery of the Asylum,3 and Michel Foucault.4 In Madness and Civilization, for instance, Foucault traces the continuity of confinement through different stages of Western European history, from the lazar houses for lepers on the outskirts of Medieval cities, to the Ships of Fools navigating down rivers of Renaissance Europe, to the establishment in the seventeenth century of the Hopital General in Paris-that enormous house of confinement for the poor, the unemployed, the homeless, the vagabond, the criminal, and the insane.5 Surprisingly, this literature never made its way into the empirical social science research on the incarceration revolution of the late twentieth century. With the marked exception of a few longitudinal studies on the interdependence of mental hospital and prison populations,6 as well as a small subset of the empirical research on the causes of the late-twentieth century prison explosion,7 no published empirical research conceptualizes the level of confinement in society through the lens of institutionalization writ large. Uniformly, the research limits the prism to rates of imprisonment only. None of the research that uses confinement as an independent variable-in other words, that studies the effect of confinement (and possibly other social indicators) on crime, unemployment, education, or other dependent variables-includes mental hospitalization in its measure of confinement.8 Moreover, none of the binary studies of confinement-in other words, research that explores the specific relationship between confinement and unemployment, or confinement and crime, or confinement and any other non-mental-health-related indicator-uses a measure of coercive social control that includes rates of mental hospitalization. …