Peeling Back the Mundane Veneer: Examining Bodily Autonomy at the Intersection of Mental Health and Mass Incarceration through the Lens of Drug Formularies

Michelle A. Young, Bowling Green State University

Mainstream news is awash in stories about bodily autonomy, from vaccinations to abortion access and gender-affirming care. However, many policies that cause profound and even irreversible health consequences remain at best unnoticed, if not intentionally ignored or perpetuated by policymakers. Many are further obscured by their mundane nature, masked behind fine print and technicalities. One issue that exemplifies harms buried amidst technicalities are psychiatric drug formularies within carceral systems and, importantly, the discrepancies between formularies in prisons, state psychiatric hospitals, and Medicaid.

Many of the most blatant forms of medication-related abuses in carceral settings stem from staff policies and practices, as in the case of chemical restraints, medical neglect, and malpractice (Fabris & Aubrecht, 2014; Novisky et al., 2022; Vaughn & Collins, 2004). However, drug formularies themselves can influence how medications are used to attain control. Consider, for example, the case of the antipsychotic drug Seroquel (quetiapine fumarate). Originally FDA- approved for schizophrenia and bipolar mania, Seroquel rapidly became well-known for its sedative properties, leading to its widespread off-label use as a sedative and insomnia treatment, particularly in prisons (Reeves, 2012). Unlike most traditional insomnia drugs, however, Seroquel—an atypical antipsychotic and powerful dopamine antagonist—carries the risk of permanent neurological side effects, including tremors, facial twitches, impaired use of the lips and tongue, and abnormal gait (Dev and Raniwalla, 2000; Lin, 2023). In the context of frequent off-label prescribing and high availability in prisons, Seroquel became a drug of abuse, gaining street names, “baby heroin,” “Susie-Q,” and “quell” (Sansone & Sansone, 2010). Indeed, problems became so severe that the New Jersey Department of Corrections removed it from the formulary altogether (Tamburello et al., 2012). Tellingly, 44% of the patients who transitioned off Seroquel required no further antipsychotic treatment, suggesting that many patients receiving Seroquel did not have psychotic illness (Tamburello et al., 2012). In most of healthcare, greater access to wide variety of pharmaceutical treatments is a key priority; however, in carceral settings, unbridled power to prescribe from liberal formularies without disorder-specific restrictions carries its own dangers.

The picture becomes yet more complex in systems where individuals ricochet between jails, prisons, state psychiatric hospitals, and Medicaid. One study led by Dague et al. in Wisconsin found that only 41.4% of people treated for severe mental illness in prison who transitioned to Medicaid upon release received a new prescription in the first month after their release date (2025). Many reasons for discontinuity stem from carceral institutions, such as poor medical recordkeeping and insufficient discharge planning, and others relate to general accessibility issues like long waitlists, transportation, and cultural competency (Hatch, 2019; West et al., 2009). However, several reports have discrepancies in drug formularies as a top barrier: in other words, drugs covered under Medicaid may not be covered in prison, or vice versa, leaving individuals with legitimate mental health concerns who had attained remission to destabilize again due to differences in prescription drug coverage (Goldman et al., 2015; West et al., 2009).

One might conclude that the drug formulary crisis stems from the fine print in insurance and pharmacy documents, and, indeed, these have played a critical role. However, another set of fine print bears mention. Many of the side effects of antipsychotics or other sedating drugs mirror those of depressive disorders (i.e., hypersomnia, fatigue, weight gain, anhedonia, etc.).

Critically, however, even if a prisoner presented with severe symptoms after receiving medications, Major Depressive Disorder (MDD) could not be diagnosed, due to an exclusion criterion in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision that states that MDD is only indicated if, “the episode is not attributable to the physiological effects of a substance or another medical condition,” (APA, 2022).

In recent years, depression has become a major research priority (NIH, 2024). However, by excluding medication-induced symptoms, the consequences of prescribing practices and policies are cast out of sight from many who study and treat mental health. Notably, symptoms could still be diagnosed as Substance/Medication-Induced Depressive Disorder (SMIDD).

However, the SMIDD is rarely studied outside of substance use; a keyword search for its name conducted in May 2025 yielded only six results in APA PsycInfo and none in APA PsycNet.

In some ways, the story of drug formularies is a cautionary tale, illustrating the power of fine print and technicalities in shaping health outcomes. However, most critically, it represents an urgent and ongoing crisis. The abuse of unfree bodies—particularly Black bodies—in American medicine is as old as American medicine itself, and, if history is any guide, then pathologizing unfree peoples is unlikely to lead to liberation (Hatch, 2019; Nuriddin et al., 2020). However, to the extent that psychology aims to heal, it must first bear witness to the injuries causing the harms, including those most thoroughly hidden from view.

References

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR®) (5th ed.). American Psychiatric Association Publishing Inc.

Dague, L., McNamara, C., Westergaard, R., Look, K. A., & Burns, M. (2025). Continuity of Prescription Medication Use Among Adults Leaving State Prison. JAMA Network Open, 8(2), e2461982. https://doi.org/10.1001/jamanetworkopen.2024.61982

Dev, V., & Raniwalla, J. (2000). Quetiapine. Drug Safety, 23(4), 295–307. https://doi.org/10.2165/00002018-200023040-00003

Fabris, E., & Aubrecht, K. (2014). Chemical Constraint: Experiences of Psychiatric Coercion, Restraint, and Detention as Carceratory Techniques. In L. Ben-Moshe, C. Chapman, &

A. C. Carey (Eds.), Disability Incarcerated: Imprisonment and Disability in the United States and Canada (pp. 185–199). Palgrave Macmillan US. https://doi.org/10.1057/9781137388476_10

Goldman, D., Joyce, G., & Seabury, S. (2015). Medicaid Access Restrictions on Psychiatric Drugs: Penny-Wise or Pound-Foolish? - February 2, 2015 [Issue Brief]. USC Leonard

D. Schaeffer Institute for Public Policy & Government Service. https://schaeffer.usc.edu/research/medicaid-access-restrictions-on-psychiatric-drugs-penny-wise-or-pound-foolish/

Hatch, A. R. (2019). Silent Cells: The Secret Drugging of Captive America. University of Minnesota Press. https://doi.org/10.5749/j.ctvf34hkf

Hupé, C., Larue, C., & Contandriopoulos, D. (2024). Defining chemical restraint: A preliminary step towards measurement and quality assessment. Aggression and Violent Behavior, 77, 101926. https://doi.org/10.1016/j.avb.2024.101926

Lin, C.-Y., Chiang, C.-H., Tseng, M.-C. M., Tam, K.-W., & Loh, E.-W. (2023). Effects of quetiapine on sleep: A systematic review and meta-analysis of clinical trials. European Neuropsychopharmacology, 67, 22–36. https://doi.org/10.1016/j.euroneuro.2022.11.008

National Institutes of Health. (2024). Estimates of Funding for Various Research, Condition, and Disease Categories (RCDC) (Research Portfolio Online Reporting Tools). https://report.nih.gov/funding/categorical-spending#/

Novisky, M. A., Narvey, C. S., & Piquero, A. R. (2022). The Keepers: Returning Citizens’ Experiences With Prison Staff Misconduct. Criminal Justice and Behavior, 49(7), 1010– 1030. https://doi.org/10.1177/00938548211028895

Nuriddin, A., Mooney, G., & White, A. I. R. (2020). Reckoning with histories of medical racism and violence in the USA. Lancet (London, England), 396(10256), 949–951. https://doi.org/10.1016/S0140-6736(20)32032-8

Opton, E. M. (1974). Psychiatric violence against prisoners: When therapy is punishment. Mississippi Law Journal, 45(3), 605–644.

Reeves, R. (2012). Guideline, Education, and Peer Comparison to Reduce Prescriptions of Benzodiazepines and Low-Dose Quetiapine in Prison. Journal of Correctional Health Care, 18(1), 45–52. https://doi.org/10.1177/1078345811421591

Skolnick, A. A. (1998). Critics Denounce Staffing Jails and Prisons With Physicians Convicted of Misconduct. JAMA, 280(16), 1391–1392. https://doi.org/10.1001/jama.280.16.1391-JMN1028-3-1

Tamburello, A. C., Lieberman, J. A., Baum, R. M., & Reeves, R. (2012). Successful Removal of Quetiapine From a Correctional Formulary. The Journal of the American Academy of Psychiatry and the Law, 40(4).