State of Mind: The ‘Lunatic’ in Prisons 

The prevalence of mental illness in prison settings is significantly higher than in the general population—approximately 3-6 times higher, as available evidence indicates (Andersen, 2004; Fazel & Danesh, 2002; Lamb & Weinberger, 1998; Taylor, 2010; Wilper et al., 2009). Substance use disorders (alcohol, nicotine, cannabis, opioid, cocaine, benzodiazepines and other drugs) are the most frequently diagnosed condition (Wilper et al., 2009). Other commonly occurring mental disorders are depression, anxiety disorders, personality disorders, and psychosis (Andersen, 2004; Fazel & Danesh, 2002; Lamb & Weinberger, 1998). 

There is a strong medical rationale for this high prevalence, what can be called the presence of environmental and emotional stressers. There are both external and internal factors that contribute to the worsening of mental health conditions within prisons. External factors largely stem from the prison environment itself—including overcrowding, unsanitary and unhygienic living conditions, poor-quality food, inadequate healthcare, and exposure to physical or verbal aggression from other inmates. The lack of meaningful or purposeful activities, the availability of illicit substances, and the experience of either enforced isolation or the absence of privacy further compound psychological distress. Internal factors, on the other hand, are emotional and psychological in nature. Prisoners are likely to  experience guilt, shame, and stigma associated with their offences and imprisonment. Many struggle with anxiety about their families, feelings of social alienation, and uncertainty about reintegration into society after release.The cumulative impact of these environmental and emotional stressors—when left unaddressed—can severely exacerbate mental morbidity, undermining not only the mental health and wellbeing of inmates but also that of prison staff who operate within such strained environments (Blaauw & Van Marle 2007). With regards to US prisoners, 56% of the state prison inmates had some mental health problem, while 45% of the federal prison inmates and 64% of the local jail inmates had symptoms of a mental health problem. Symptoms of psychotic disorders were present among 20% of the state prisoners (James et al., 2006). 

Despite such strong evidence, there is a lack of research on mental health in prisons in the Indian context. Rabiya and Raghavan (2018) found only twelve studies on prison mental health between 2000 and 2017, underscoring the lack of empirical engagement. Even with the rights-based Mental Healthcare Act, 2017, which replaced stigmatizing terminology, there is a clear dearth of any large-scale systematic study of the incidence of mental illnesses in prisons in India. This is despite a strong rationale for high incidence as well as a strong demonstration of presence of mental illnesses in prisons around the world. In the Indian context, recently, a study by the National Institute of Mental Health and Neuro Sciences consisted of almost 5000 inmates in the Bangalore prison. The incidence of major mental illnesses among the inmates was quite low, but the high prevalence of these illnesses and the presence of emotional and environmental factors that could aggravate the incidence, calls for a large-scale study of the status of mental illness in Indian prisons. This would help drive academic and policy engagement on questions of prison reforms of the mentally ill. Other studies like Tirumani et al. reported an  overall 83.5% prevalence of psychiatric illness in  prisoners having depression (46.5%) as the major illness (Tirumani et. al , 2020)

The Criminal, the ‘Lunatic’, and the Order 

It is insightful to try and place both the criminal and the ‘lunatic’ in contrast to the normal, for they are both seen as ‘deviants’. They stand on the other side of the point between normal and abnormal, rational and irrational, sane and insane. Looking at the mentally ill persons within prisons could, therefore, be all the more revealing as to how our and the state’s understanding of the ‘deviant’ emerges and evolves. 

It is crucial to begin with the central question of perception. How does the state see prisoners and  the ‘lunatics’, and the ‘lunatics’ who are prisoners or prisoners who are ‘lunatics’? The Mulla Committee, which is probably the most prominent source on prison reforms, asks a similar question of perception about prisons, which forms the bedrock of all its enquiries. Is prison a place for detention or is it a place for reform? It draws on the history of understanding jails to situate two opposing views. A human-rights centric view argues for the prisons as places of reforms, post which prisoners could be moved back to the society. The report quotes Gandhi “If we were not under the spell of a long-lived custom, we should not find it a difficult task to turn our prisons into reformatories” (Committee on Jail Reforms, 1983). It rues a missed opportunity when moving to present the opposing view. The custom that Gandhi refers to is the dominant approach of the state globally—of keeping prisons as places of isolation, and that has been no different in the Indian case. 

Looking at the Article 433A amendment can be a useful case study. The committee notes that ‘lifers’ (those sentenced for life) made up a large portion of the jail population, and therefore, was one of the major categories of prisoners it focussed on. “ Our survey of jails shows that if the ‘lifers’ and the undertrials are not counted, the jail population will come down to between 25 and 30 per cent of its present strength” (Committee on Jail Reforms, 1983). The presence of a high quantity of these lifers can be interpreted in numerous ways but it certainly does paint the prison as the place for ‘deviants’ in the eyes of the state. But this can be more concretely linked if the lifer is seen in relation to the 433A amendment. It states that if a person is sentenced to life imprisonment for a crime where death could also have been given as punishment (for example, murder), or if their death sentence has been changed to life imprisonment, then they must at-least serve 14 years in prison (Devgan, 2022). The Royal Commission on Capital Punishment 1949-53, mentions that those handed life imprisonment in-fact have a higher incentive to have best behaviour (Royal Commission on Capital Punishment, 1953). Enactment of section 433 A  ensures the incentive to be well behaved is gone. A demonstration of the tendency of the state to detain rather than reform (Committee on Jail Reforms, 1983)¹.