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Historical Reflections on Deinstitutionalization
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16008 |
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Section : |
MODERN THOUGHT
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| Issue
Date : |
7 / 1989 |
4,234 Words |
| Author
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Ian Dowbiggen
Ian Dowbiggen teaches at the Faculty of Education at the
University of Western Ontario. |
In recent years there has been a historically unreflective debate about the virtues of the present-day system of community care and treatment for the mentally disabled. Critics charge that community health services are doing little to reintegrate those suffering from mental illness into everyday life. They allege that mentally ill are inadequately housed and receive little active supervision and support from physicians, psychiatric counselors, and social workers. In their view, schizophrenics are being left free to roam the streets and pose dangers to themselves and society at large.
At the same time, in what is a seemingly unrelated development, physicians and medical researchers are talking hopefully of identifying the biochemical and genetic roots of mental disease. They argue that medical science is on the verge of great discoveries after many years of virtual ignorance about the organic and hereditary mechanisms underlying the personality disorders that characterize madness. For example, researchers maintain that they have found a gene for schizophrenia and that they now know a great deal about the chemical neurotransmitters responsible for mental activity. On the one hand, then, there is growing pessimism about the effectiveness of contemporary forms of deinstitutional public assistance to the mentally ill as well as the chances of restoring many schizophrenics to mental health. On the other hand, there is considerable optimism that the profound mysteries surrounding the causes and pathology of madness will soon be solved.
To many people today, these two developments appear to have little in common. However, from a historical perspective, the current concerns expressed about the treatment and management of mental health have a familiar ring. If our contemporary policymakers were to examine the history of modern psychiatry, they would quickly see that the features of our present-day debate over deinstitutionalization are not unprecedented. In fact, since the early 1960s a growing historical literature has dealt with the relationship between psychiatric theories about insanity and the social provisions for public mental health.
Scholars in the history of psychiatry increasingly are exploring the nineteenth-century origins of psychological medicine. What they are discovering is that the controversy over whether to institutionalize or deinstitutionalize has less to do historically with the effectiveness of methods of care and cure than with the shifting cultural attitudes toward the threat posed by the insane to our personal safety, private property, and civil
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