Understanding incarcerated populations

AORN Journal,  March, 2002  by Cheryl L. Cooke

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The public, health care providers, and members of the criminal justice community sometimes casually use labels such as "psychopath" or "sociopath" when talking about people who are incarcerated. One author asserts that terms like these often are reserved for minorities in custody who are least likely to be able to afford less destructive diagnoses. (33) Many African American family members are reluctant to participate in the mental health system as a result of

* historical injustices,

* costly services,

* decreased insurance coverage or lack of coverage, or

* ongoing feelings of distrust of the system related to historical medical racism (eg, the Tuskegee Syphilis Study) or the paucity of mental health care providers who understand the particular concerns of African Americans.

African American boys often are labeled in early life with destructive psychiatric diagnoses such as "conduct disorder," a behavioral diagnosis that often is translated later in life to "antisocial personality disorder," a more serious diagnosis that can be anxiety producing for those working in the criminal justice or mental health systems. If parity in mental health care services existed, African American children might be able to avoid such diagnoses through appropriate mental health care assessment and treatment, thus lessening the chance of receiving labels that can be interpreted negatively within the criminal justice system.

This same author also suggests that young African American men receive Diagnostic and Statistical Manual of Mental Disorders diagnoses of conduct and personality disorder with alarming regularity. (34) This manual is used by mental health care providers to diagnose psychiatric illnesses. These diagnoses often affect the treatment of African American men while they are incarcerated. Those diagnosed with mental disorders may be considered "dangerous" regardless of their actual behavior while in prison or jail because of the criteria for such diagnoses. These diagnoses often are made at an early age, frequently through interactions in the school system. (35)

Stereotypical and negative media representations of minority youth, particularly African American young men, enhance the meaning of these medical diagnoses, increasing the likelihood that minority youths' experiences in the criminal justice system will be more complex. The experiences of incarcerated African American youth and men are complex because of labeling. When negative media representations are added to the picture, the experiences of African American men become even more complex. It becomes difficult to overcome such representations in the minds of people who believe they are accurate portrayals of African American youth and men. An example of negative media representation can be found in the case of Susan Smith, the South Carolina mother who accused an African American man of car-jacking her car with her children inside, when, in fact, it was she who murdered her children by drowning them in a local lake. These types of representations complicate an already challenging picture for African American men by increasing the perception that they are dangerous. Being labeled dangerous does not accurately reflect their behavior after entering the criminal justice system, but a label of "dangerous" influences how they are processed through the system. (36)