Insane Until Proven Sane: Realities of Prison Psych Wards

*I swear there are no spoilers in this post (but there may be some hints)

Recently, I decided to see what the fuss surrounding Orange is the New Black is about. I’m nearing the end of the first season and just finished an episode which depicted the environment of the prison psych ward. When it comes to the prison system, we like to think that any misery a person endures is only what they deserve after committing a crime. Psych wards are a bit different. I think most people have sympathy for those who have committed crimes due to mental instability. We accept that prison is punishment, but psych wards are supposed to help those with mental illness, right? At the very least, they’re supposed to do all they can to support the health and wellness of the patient.

That’s not what this scene depicted at all. Watching it, I couldn’t  help but think of the movie Sucker Punch. Were the actions of doctors in Orange any different from the doctors in Sucker Punch or did they just trade lobotomies for drugs? Certainly we’ve gained some additional amount of understanding on the human mind since the 1960s that we don’t need to use such crude methods.

I only know so much about the realities of prison systems and psych wards in the United States. Having never studied either, I’m uncomfortable claiming that Orange is the New Black is an accurate depiction. That said, I don’t find it hard to believe that our current system is corrupt. The general public has little sympathy for the 20 percent of the population behind bars and often figures they get whatever they deserve while incarcerated.

When I first realized a certain character was headed to the psych ward, I was happy. In that moment, I joined with the general public, lacking all sympathy for a person I considered to be evil. Then, the scene came. It was a short few seconds in a cell of a psych ward and my outlook was completely changed. I was disgusted and disturbed by what was happening in the show and I started to worry if that sort of thing really happens. Is that really how we treat prisoners? What about people who haven’t committed a crime and are just severely mentally handicapped? Certainly a person has to be dramatically dysfunctional to necessitate that. I don’t know, though, and the thought haunts me. The idea that, right now, there might be a sane person suffering in a psych ward because they said or did the wrong thing at the wrong time in front of the wrong person bothers me more than I can explain in words.

That’s another reason Sucker Punch came to mind. The girl in that movie wasn’t insane. Quite the opposite, she had witnessed a crime and ended up in a psych ward to keep it under wraps. Her claims were seen as hallucinations and only proved her lack of sanity. Maybe, if she had given up on turning in the criminal and accepted everything the doctors said to her as truth, she would have been spared from her fate.

This photo, “ahh.. that’s better.” is copyright (c) 2014 Jill Robidoux and made available under an Attribution 2.0 Generic license

There must be a fine line between sanity and insanity. Why else would relatively sane people get mixed up with the sane. We’d like to think the difference would be obvious, but it can’t be if scenes like that happen in real life. What struck me the most is that a sane person could find themselves permanently stuck in that ward simply due to their own ignorance.

Imagine an animal caught in a barbed wire fence. When the owner approaches, the animal lashes out. It’s in pain, its trapped and it’s afraid the owner will just add to the pain. It’s trashes threaten to harm it more and tear about the fence, so the owner has no choice but to shoot the animal. Compare that to an animal in the same situation who remained calm. Maybe they whimpered a bit. Maybe they shrunk back from the owner when he came to see what was happening. When the owner approached, the animal stays still, recognizing that, while they don’t trust the owner, they are the only ones who can help them escape. Sure, the owner can still choose to shot the animal if they wish, but there’s now a chance they won’t. Seeing the animal as a non-treat, they may choose to free it and leave it be.

In Orange is the New Black, the prisoner may as well have been an animal given the way the doctors and guards looked at her. Their actions were probably as based on fear (for their safety and the safety of other prisoners) as they were on their job descriptions. The balance seemed off somehow. A person doesn’t have to be proven insane in order to be forced into restraints, but, once in them, they need to prove their sanity in order to get out. Something about that doesn’t seem completely humane to me.

I’m keeping my fingers crossed, hoping that people in prison psych wards aren’t really being treated like Orange is the New Black depicted and that sane people really don’t get trapped in them. This is keeping me up at night, though, because I can believe that hell is a reality somewhere. My heart breaks at the thought there may be people suffering like that right now and I can’t think of anything I can do to save them from their torment.

Have you been watching Orange is the New Black? Do you think it accurately portrays women’s prisons? Does it accurately portray solitary confinement and prison psych wards? What do you think the environment is like in real life psych wards? Do you think the conditions and treatment of the patients is acceptable?


52 thoughts on “Insane Until Proven Sane: Realities of Prison Psych Wards”

  1. You know what I’ve wanted to watch the series too…after reading your post I think I will just check it out and see how I feel about the whole thing…cheers!

  2. I can’t speak for prison psych wards, but having had a stay in the “behavioral health wing” of my local hospital, I know that things outside of prisons are much, much better than before. I don’t doubt that conditions in prisons are significantly worse, though. Like you, I don’t know if a television show, which by it’s very nature is designed to take you on an emotional roller coaster, is an accurate depiction of the way things are, but I totally understand how easy it is to believe that, due to the general public’s lack of care about prisoners. (That sentence used about three commas too many, I know.)
    I don’t know. I personally find it difficult to not have empathy for ANY human being. I mean, they may have committed crimes, some of them atrocious, but they’re still someone’s kid, someone’s parent, someone’s sibling, and they’re still human. That’s not even considering the fact that the vast majority of criminals are in prisons because of drug charges, and they are treated pretty poorly, considering their crime. Take it a step further, and you see that time spent incarcerated makes it nearly impossible to find a job, and you get criminals who are caught in a horrible viscous cycle happening in part due to the system deciding that they can never not be a criminal ever again.
    This was a long comment, apologies for that, but I’m someone who feels pretty strongly that the current system is completely and totally broken, and that people get mistreated, and have their entire lives ruined by what is sometimes little more than a mistake.

    1. It was one of those things where I disliked the character so much that I thought she got what she deserved without fully understanding what she got. I think a lot of the public is like that. You think they deserve punishment but certainly no one deserves that.

      The way I see it, our rights are only as good as the least of us. Even the worst of prisoners are still human beings. No one deserves what that woman got.

  3. I have never seen Orange is the New Black, so I cannot comment on that, but I can shed a little light on psychiatric hospitals: they suck, and as I have said on my blog, they are my own personal hell on earth. I believe people are treated very unjustly in psychiatric hospitals, so I cannot imagine what might go on in prison.

    Psychiatric hospitals and the like are a ridiculous concept to me because people usually get put in them because they are detached from reality. And what better way to bring people back to reality than to put them in a place completely unrealistic, where they lose control of their life, lose their privacy, and lose their dignity even? (She says sarcastically). I just can’t help but think there is a better way to help people who suffer from mental illness. Having that said, I am thankful that I do not have bipolar disorder in the days of asylums.

    1. Asylums were definitely worse. I know a handful of people who were put in a government facility because they didn’t have insurance at the time. The only real way to get out is to follow the doctors to a T (from what I understand). Or maybe some good old fashioned positive enforcement. “You’re broken so we’re going to fix you” doesn’t make anyone feel good or motivated.

  4. I haven’t watched it yet. I see the ads for it, but I don’t know, I’m not fascinated by it. Maybe because I worked in law enforcement, so the curiosity is gone for me. As for psych wards, and prisons, yeah, I’d venture to say the entire system needs an overhaul. There are a lot of factors at play there, though.

    1. There are. I have a few loose opinions about how to improve the system but the whole thing is so complex. The only thing I can really know is that prison does little to help people change their ways. I think that’s my biggest problem. Especially for non – violent crimes, going to prison shouldn’t ruin the rest of your life.

  5. I personally really love OITNB and I already binge watched the second season as soon as it came out over the weekend…. Haha. I hope you continue and keep watching the second season because it goes even further into the theme of the injustice of the prison system, the horrible conditions many prisoners have to deal with and the corruption that is embedded in prison administration.

    I am certainly no expert on prisons, but I would go so far as to say that in some ways, the depiction of prisons shown in the show may be tamer than reality. I won’t give anything away, but in the new season there is a plumbing issue that causes sewage to come out of the drains of the showers if you take a shower that lasts longer than 30 seconds. Terrible, right? In real life, though, it has been known to be worse than this. Take this New Yorker article (, for instance, that describes the real life conditions of the prison in which OITNB is filmed. Apparently this sewage backup really does happen, except it can come up into the toilets of neighboring cells and even flood over onto the floors. Prisoners have complained that the water is undrinkable and that they have become sick and gotten rashes due to the poor conditions.

    As you and others have pointed out, it’s true that the people in prison are there because they committed a crime, but that doesn’t mean that they should be treated inhumanely. Especially when a) so many of them are non-violent offenders who really have not done much to hurt anyone and b) treating people in such a terrible way will probably make it more likely that they will end up back in prison. Making people feel as if they are animals won’t help to solve any of the issues that led to them ending up in prison in the first place.


    1. I listened to an NPR show about Orange. Apparently the show is inspired by a book written about a woman like Piper going to prison for the exact same crime and sentence as Piper. They aren’t trying to recreate the book but, given that it was based off of something like that, there’s got to be a little truth somewhere.

      Who knows what is true or not though. I mean, I’m sure they’re careful not to make the wrong people angry with the show. And if they make the conditions too depressing, people may not watch.

      I guess I’m rambling and, in the process becoming all the more confused.

  6. Much the same can be said of the history of private nursing homes. I think they generally are much better than they used to be, but abuses and mistakes still occur.

    Years ago I went with my dad when the family decided to put dad’s uncle in a nursing home in another part of the county. Dad’s uncle cried and begged not to go, as he was lucid enough to know two things: nursing homes sucked, and he would never leave.

    I was maybe 12 or 13 at the time, and while there waiting as he was checked in, I looked around a little. My shock at seeing a mentally and physically underdeveloped child my own age laying contorted in a bed shocked me. The image I have in my head was of a mostly dark room with only moderate daylight from an undersized window. Bed clothes in disarray. The child in only something like a hospital gown.

    My shock remains to this day. Could parents really leave their own flesh in a place like that? Why was there (apparently) no therapy or at the very least some light and brightly colored walls and things in the room? In spite of mental and physical incapacity, this was still a human being, after all. But then, so to was dad’s uncle.

    Both of my parents spent their last days in a nursing home. It was much better, newer, cleaner, in town and not half hidden out on a county road, and with friendly and compassionate staff. Still and all, I don’t look forward to the day when it’s my turn to be warehoused, to be stored away until I finally give up and die. But this is how it is for those who are so unfortunate as to not die suddenly of stroke, heart attack, or horrific accident.

    Those are some realities outside of the psych ward.

    1. I know my grandmother was completely against being in a nursing home. She visited friends there and that was enough for her. She’d rather die than go there. On the flip side, my great grandmother just went to a nursing home and it has actually improved her health and social life. I think nursing homes may be hit and miss (maybe you get what you pay for? I don’t know). I imagine psych wards may be the same way.

  7. I haven’t seen that show, but I have heard of it. As for the treatment, I’m sure it depends on the facility, but I have heard Podcasts on such things and you’re right that it’s a lot easier to get into them then it is to get out. The problem is that once you’re declared legally insane or mentally handicapped or something, in order to be released especially in a prison environment you have to be proven sane or cured in some fashion; that’s actually a lot harder to do, because of the uncertainty of are they lying or you know there has to be some scientific process applied to that and because of the uncertainty factor, there’s very few professionals willing to put their career on the line to say that a person is cured or sane. Of course, I’m not saying that’s right – there are people in these places that probably should’ve been released long ago. We can only hope that the ones that are suffering in the way you described are the minority.

    1. I think what makes is hard to prove sanity is partly because we don’t define insanity well when people go in. If there’s going to be some science or medical test to prove someone sane enough to leave, shouldn’t there be a similar test to put someone in there?

      Maybe that’s not possible yet. Last I checked, we still like a good understanding of how many mental illnesses really work.

      1. Very true. As for the test for sanity, all they really have at this point is anecdotal / observational bases for that evaluation, which is why it comes across as a risk. If you release someone into the wild and then they commit a murder then it can endanger someone’s career. That’s why there’s reticence, because they can’t point back to the science and say “that’s what failed us”, it would be more like “well he said and I thought . . . “

  8. If we look at prisons throughout history there is a cycle of how we see incarceration. This cycle goes as such the first is a harsh system of punishment harsh meaning treatment of prisoners no rights at all. then that moves into lesser forms of punishment as the rights of prisoners increase this continues until society returns back to the harsh mentality treatment of prisoners, Culture changes, society changes and these changes reflect the base element of how people view what constitutes criminality.When the lines are well defined with no blurring of those lines society looks at criminals in the same way, when those lines are blurred between criminal and non-criminal or what is right vs what is wrong what is moral or immoral what is good what is bad or even what is sinful and what is good then our focus on ‘the judicial side’ will also be blurred or well defined.

    1. Interesting. I never thought of it that way. As far as I’m concerned, regardless of how society views right and wrong, prison should be punishment but also a place where those people can improve themselves. When let out of prison, they should be able to positively contribute to society. I don’t know the answer of how to make that happen, but I feel like society as a whole would be better that way.

  9. I haven’t seen the show, nor have I ever been in a psych ward, but I can absolutely empathize on one point – the fear of having to prove oneself sane. My mother became psychotic when I was sixteen and she was very fond of threatening to have me locked up. Every time, I could imagine the very scenario you describe with the animal in the cage. Your very natural reaction would be to panic and start fighting and screaming – which would, of course, make you look crazy even if you weren’t. And then it would be incredibly difficult to prove otherwise, especially when being held in one of those places would be enough to drive anyone bonkers.

    1. It seems like there is some flawed logic there. Why do we try to make someone prove they are sane in an environment where it would be logical to panic? Of course, that’s operating on the idea that those caged images from the show have a bit of reality in them.

  10. I worked as a Correctional Officer for many years in an all male facility. Orange is the new black, does not portray an accurate account of what goes on. Back in the day, places such as Bridgewater State, had many issues to deal with but I truly believe our institutions here in Massachusetts have improved tremendously over the years. It depends on the facilities protocols. The laws of each state and the officers, doctors and nurses who have to uphold those laws.

    1. I’m sure you are right. The people in control of the prison are those in power after all. I can think of a few times were my boyfriend and I were discussing whether or nothing something a guard did could actually happen. My go to answer was that they could if they wanted. All it would take is a little bit of corruption among those in control of the prison. I tend to be an optimist, though, and while I can believe there may be places that are pretty bad, I have to believe most facilities are law abiding, humane environments.

  11. Great topic. As someone who has been admitted several times into psych wards. It isn’t a place where you are taken care of. It’s simply a holding room where you are studied like animals and force fed the doctors said meds. And in my experience if you refuse to take said meds you are then tied down and injected the proper dosage. Hope this clears some of your questions about what goes on in these places

    1. Well, that sounds terrible. I don’t know of anyone who has been in those facilities and had anything near a good experience. Sometimes I wonder if the whole point is to scare people into…. I don’t know…. you can’t really scare someone sane, but I guess you could scare someone into taking their meds under the right conditions….

      Given your experience, what sort of things do you think could be improved to make psych wards more beneficial to their patients? This is so difficult for me because I don’t want to say they shouldn’t exist. Clearly there are people who need help and it should be okay for them to get said help. Whether or not psych wards actually do that for people may depend on the facility. I wish I understood more about the laws and regulations surrounding those facilities.

      1. They’re just horrible places that I wish upon no one regardless of sanity level. I must agree that the care varies from facility to facility. Yet the outcome of the patient will almost always be the same. Every time I was taken and released from such places I felt as if I had been pushed back in life. While inside these places, one is usually very uncomfortable and in my case become claustrophobic. It’s as if your choices don’t matter. And your intellect is more often then not looked upon as not that of a regular person. My question is what’s the intellect of a regular person, when we all comprehend the world ddifferently. As for what should change inside these places. I’d say the desire of those who work there to make it a pleasant experience for the patient. Hope that helps.

  12. Having Had the (Mis)pleasure of having worked in psychiatric hospitals, it can be demoralising to both staff and visitors but they are not all horrible places.
    Gone are the old institutions that the tv programs like to scare people with.

  13. Thanks TK for posting and sharing your thoughts. You pose some very interesting questions about the mentally handicapped and the way they are treated. I am totally guilty of that feeling when I can see someone evil is going to prison not only because of the resulting consequence of fair justice, but that feeling of them getting what I think they deserve which may be justice, maybe not however totally unobjectionable. I know as I think most people do that prison is a far worst punishment a great deal of the time because of its contributing factors, rape, gangs, shanking’s, stabbing, additional criminal charges, beating, and etc….but whether we think a person is deserving of this or not, we accept these terms for relief that we are safe from that person, or do not have to deal with them. These are the same conditions to which Psyche patients are under, right and wrong are contributing factors maybe in some mind the sole factors but relief is centerfold still the more.

    1. I don’t think most people really understand what goes on in prisons or psych wards. I mean, when I saw that scene, I couldn’t help thinking she was getting what she deserved because she was always acting so crazy. A person who acts like that should be in a psych ward. However, I expected it to be more uncomfortable but aimed at helping her become sane. Since she wasn’t really – in any clinical sense- insane, I thought it would be a little funny to see her in the doctors in that confusing situation. But it was just bad. Now I wonder the same about any prison. There’s no doubt that a person who has committed a crime should go to prison, but prison is just a word. Is what they will actually experience really equal to the crime committed? Will they be any better after their time behind bars? Certainly both prisons and psych wards should be more than cages.

      1. Certainly they should, prisons should impress on the prisoned the reasoning of their sanction, and focus on equipping them to be consciously successful on the outsides of those walls, giving the yearly cost of an inmate is more than most college tuitions we should get the most bang for our buck. While imprisoning someone under the term “deserves” is honest its completely subjective and not thought out if we don’t really know what we are sending them into, the result, and even more telling, that these notions are secondary to what we feel someone deserves. Prison and psych wards should be turning out the best examples of law abiding citizens, whether than re-institutionalizing as we do. Perhaps, new ideas of what should be consequences of being in either of these categories rather than the comfort for us, that put them behind bars?

  14. It’s not just about prisons–if your medical files include any stays in a hospital for “depression”, particularly if you had an OD; if your list of prescribed meds includes any psychotropic drugs–good luck ever getting out of the box labeled “mental”. Once you’ve had a psych diagnosis, your credibility suffers–physical illness issues, or “life issues” are often dismissed or minimized by doctors as well as family/friends. It’s no wonder people are reluctant to ask for help–the fear of being stigmatized is not paranoia.

    1. I understand that. While I have never experienced something like that myself (unless you count insomnia), There are a few people close to me who had. The others who know about it were very confused. One even asked “so as long as they take pills they’re normal?” It was frustrating to me because it’s so much more than that. It’s crazy how mental illness is stigmatized. People shouldn’t be afraid to seek help when they need it. The people, doctors or facilities they go to should help them manage whatever it is rather major or minor. Once managed or overcome, they shouldn’t have to live with that stigma. Don’t they say 1 in 3 Americans will be on some kind of mind altering drug at some point in their lives? That’s a lot of people to place in that “mental” box.

      1. My heart goes out to everyone who has “bad days”–and then gets labeled. I’m having one today–am I crazy? I don’t care, I just want to get through it. It’s a crowded box indeed–God bless you.

        1. We take the word crazy both too seriously and too lightly. Someone having a bad day shouldn’t be called crazy any more than a person with a serious mental issue should be afraid of seeking help due to society stigmas.

  15. psych wards. I have been committed to the state of minnesota, more than once, and had to endure two months of ‘therapy’ locked inside for 60 days. Their was a guy there indefinitely, because they deemed him a ‘danger to society’. nice piece though, i’m glad you’r at least talking about it. but you really have no fucking idea how bad it truly is on the ‘inside’ of these ‘behavioral health units’ and ‘hospitals’ are. you have no clue. and it leaves marks on the victims, sorry, patients lives.

    1. Someone close to me was in a facility for about a week. We both watch Orange and when I said I thought she was getting was she deserved, they just shook their head and said there’s no way I could understand and that no one deserves that. They were right, I can’t understand… but once I saw the scene on the show, I agree no one deserves that.

      Honestly, I wish I knew more. We like to think of these facilities as places where people are helped and where most helped to the point where they can function well on their own. But now I’m wondering, is that what they are actually like? And if they are so bad, what can be done to improve them?

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