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To many, insane asylums are a relic of a bygone era. State governments took steps between 1950 and 1990 to minimize the involuntary confinement of people in mental hospitals, and many mental health facilities closed down. Yet, as this book reveals, the asylum did not die during deinstitutionalization. Instead, it returned in the modern prison industrial complex as the government shifted to a more punitive, institutional approach to social deviance, mental illness, and people with disabilities. Focusing on Pennsylvania, the state that ran one of the largest mental health systems in the country, the author tracks how the lack of community-based services, a fear-based politics around mental illness, and the economics of institutions meant that closing mental hospitals fed a cycle of incarceration that became an epidemic. This groundbreaking book recasts the political narrative of the late twentieth century, as the book charts how the history of asylums and prisons were inextricably intertwined. It argues that the politics of mass incarceration shaped the deinstitutionalization of psychiatric hospitals and social welfare policy, and vice versa. The book offers critical insight into how the prison took the place of the asylum and shaped the rise of the prison industrial complex and creating new forms of social marginality.