In The Mountains We Call Home, mid-century state institutions are depicted as systems of control that methodically dehumanize vulnerable populations under the guise of medical treatment and social order. The novel argues that prisons and asylums wielded practices like forced eugenic sterilization, lobotomies, and medical experimentation as tools of power, stripping individuals of their bodily autonomy and fundamental humanity. The Kentucky State Reformatory for Women is portrayed as a site where the bodies and minds of inmates are subject to the arbitrary and often cruel whims of the state, under the guise of rehabilitation.

One of the most disturbing examples of this institutional abuse is the threat of forced medical procedures as a means of social and behavioral control. This practice is illustrated when, upon discovering Cussy is pregnant, Warden Sanders immediately schedules a forced abortion and eugenic sterilization. The medical board’s decision that Cussy does not “have the capacity to rear children” is based on prejudice against her skin color and her status as a prisoner rather than on any assessment of Cussy’s fitness as a mother (129). The threat of a lobotomy is similarly used to enforce conformity as an inmate in the Geriatric ward warns Cussy that the procedure is performed not only on “the crazy ones” but also on those who get “too lippy” (40). Bodily autonomy is nonexistent as the institution reserves the right to alter a woman’s mind and reproductive capabilities to make her more docile and obedient.

This dehumanization is further evident in the extreme neglect suffered by the prison’s most vulnerable inmates. The Geriatric and Forensic wards are portrayed as places of profound suffering, where women are treated as less than human. For instance, Marigold, an elderly inmate, is left to sit in her own waste, a cruel act of humiliation that emphasizes the guards’ indifference to her basic dignity. Meanwhile, the women in the Forensic Ward are heavily drugged into submission, their complex psychological needs reduced to a problem of control. Cussy’s library service offers a stark contrast to this abuse, as the simple act of reading and human connection provides more healing than any of the institution’s official “treatments.”

The state’s ultimate power over life and death is shown to be both arbitrary and grotesquely political in the case of Sassyann, the inmate on Death Row. Her botched electrocution becomes a public spectacle, leaving her in a “vegetative” state, stripped of her personhood. The governor’s public debate over a second execution, based on political pressure, renders Sassyann’s suffering irrelevant. Her life is a pawn in a larger game of state power. Through these intersecting narratives of abuse, the novel powerfully condemns a system that prioritizes control over care and punishment over humanity. The novel ultimately exposes these abuses as the predictable consequences of institutions built upon prejudice and unchecked authority.