Collaborative Unity in the Diversity of Positions A clinical approach to the paradoxes in the relationship between drugs and prisons

Abstract

This article explores the paradoxes surrounding prisons and drug use from a clinical perspective grounded in psychoanalytic and institutional frameworks, taking as its point of departure the phenomenon of death by withdrawal among incarcerated individuals in Ecuadorian prisons. It argues that the coexistence of prohibition and tolerance regarding drug use within prisons reflects a structural contradiction—a mirror of broader cultural and social tensions. This paradox is analyzed not merely as dysfunction but as a systemic symptom and a clinical opportunity.

The methodology employed is qualitative, based on action-research conducted by a team of clinical psychologists. Group-based clinical interventions were implemented with both incarcerated individuals and prison staff, aiming to create humanizing spaces within environments marked by desubjectivation. The information gathered was then processed through analytic seminars and a systematic review of key learnings. Findings indicate that the militarization of prisons, coupled with an ambiguous approach to drug use, turns institutional neglect into a form of violence. Drugs in prison serve as regulatory mechanisms for psychic distress, thereby becoming a paradoxical tool of institutional management.

The article concludes by advocating for a shift in focus—from the crime to the subject—arguing that death by withdrawal is not accidental but rather a predictable consequence of an institutional structure that denies the right to mental health. Drawing from clinical and psychoanalytic insights, the article proposes treating paradox not only as contradiction but as a gateway to critical intervention within the penal system, enabling the emergence of practices that restore social bonds.