Medicine and Health Drift 21, Rm. 005 Organized Session
25 Jul 2019 01:30 PM - 03:30 PM(Europe/Amsterdam)
20190725T1330 20190725T1530 Europe/Amsterdam Anti-Psychiatry, Deinstitutionalization, and Community Mental Health

In the 1960s and 1970s, the care of individuals with severe and persistent forms of mental illness in mental hospitals came under sustained critique in the developed world. Asylum care was criticized as dehumanizing while several anti-psychiatrists questioned the scientific status of psychiatry. Several countries, led by the United States, the United Kingdom, and Italy, moved to deinstitutionalize individuals with mental illness while making alternative forms of care available in the community. It turned out that initiatives in community mental health were insufficient to meet the needs of individuals with mental illness. The critique of mental hospital care was shared by politicians and mental health personnel in several Western countries. The response to this critique, the commencement of deinstitutionalization, the degree to which mental hospital care was maintained, and the development of community mental health services varied significantly between countries. The participants in this panel review developments in Italy, Germany, the Netherlands, and Australia to gain insights into international variations in the process of deinstitutionalization.

Organized by Hans Pols

Drift 21, Rm. 005 History of Science Society 2019 meeting@hssonline.org

In the 1960s and 1970s, the care of individuals with severe and persistent forms of mental illness in mental hospitals came under sustained critique in the developed world. Asylum care was criticized as dehumanizing while several anti-psychiatrists questioned the scientific status of psychiatry. Several countries, led by the United States, the United Kingdom, and Italy, moved to deinstitutionalize individuals with mental illness while making alternative forms of care available in the community. It turned out that initiatives in community mental health were insufficient to meet the needs of individuals with mental illness. The critique of mental hospital care was shared by politicians and mental health personnel in several Western countries. The response to this critique, the commencement of deinstitutionalization, the degree to which mental hospital care was maintained, and the development of community mental health services varied significantly between countries. The participants in this panel review developments in Italy, Germany, the Netherlands, and Australia to gain insights into international variations in the process of deinstitutionalization.

Organized by Hans Pols

The Global Impact of Franco Basaglia and the Italian Radical Psychiatry MovementView Abstract
Organized Session 01:30 PM - 02:00 PM (Europe/Amsterdam) 2019/07/25 11:30:00 UTC - 2019/07/25 12:00:00 UTC
Franco Basaglia was the acknowledged leader of a vast movement of psychiatrists, patients, administrators, students, politicians and others to reform the psychiatric system in Italy in the 1960s and 1970s. This movement transformed individual asylums in Italy and the treatment of patients, and led to the 1978 180 Law (also known as the ‘Basaglia Law’), which eventually closed down the psychiatric hospital system entirely (although this ‘closure’ remains controversial at a number of levels). The impact of the ‘Basaglian movement’ and the 180 law was vast across the world, but very different from country to country and even from city to city. This paper will trace the different forms of acceptance, rejection and non-interest in a number of countries, drawing on research that will (in part) be published in a book co-edited by myself and Professor Tom Burns, to be published by OUP in 2019. This impact or non-impact will also shed light on the varying outcomes of the Italian experience itself, and the debates within Italy over the Basaglian legacy which are ongoing today.
Presenters
JF
John Foot
Historian, University Of Bristol
"Despite the Asylum, Not Instead of It": Community Psychiatry in West Germany (1960-1980)View Abstract
Organized Session 02:00 PM - 02:30 PM (Europe/Amsterdam) 2019/07/25 12:00:00 UTC - 2019/07/25 12:30:00 UTC
Histories of the German psychiatric reform usually identify the origin of this process with the so-called Psychiatrie-Enquete. The Enquete, published in 1975, consisted of a comprehensive report of the status quo and concrete recommendations for a structural reorganization of the West German psychiatric care system: community orientation; patient-centred care; coordination of all service institutions and providers; equal treatment and opportunities for the mentally and physically ill. The scholarship seems unanimous in highlighting the importance of some contemporaneous international developments as an intellectual and institutional blueprint for the German reform, especially the Italian initiative led by Franco Basaglia. Some points of the 1975 reform program, however, had already been actualised in the 1960s, most notably some elements of community care. For example, the considered fruitful relationship between psychiatry and anthropology was to be tested on the grounds of community care. This paper considers two of these early instances, later taken as models: the Zentralinstitut für seelische Gesundheit (Central Institute for Mental Health) in Mannheim and the community psychiatry set in place in Mönchengladbach (NRW). The focus will be on their epistemological setting and their concrete solutions, such as day- and night-clinics, sheltered housings and patient clubs. Finally, we will discuss how far at the time and at the direct aftermath of the Enquete the international developments were mobilised as models for the national reform, or if the Germans tired of affirming their own tradition. This paper as been written by Chantal Marazia and Heiner Fangeru, Heinrich Heine Universität Düsseldorf
Presenters
CM
Chantal Marazia
Heinrich Heine University Düsseldorf, Germany
Deinstitutionalization: The Dutch way?View Abstract
Organized Session 02:30 PM - 03:00 PM (Europe/Amsterdam) 2019/07/25 12:30:00 UTC - 2019/07/25 13:00:00 UTC
Inspired mainly by the example of Italian ‘Democratic psychiatry’, around the mid-nineteen eighties, the policies of both Dutch government and the field of mental health care turned towards the aim of deinstitutionalization. Official governmental directives included the gradual dismantling of some of the larger mental hospitals, the increase of the number of sheltered homes, and the introduction of e.g. assertive community treatment and rehabilitation. These contributed to a shift towards community psychiatry during the nineties. Nevertheless, at the beginning of the 21st century, the Netherlands figured amongst the European countries with the highest number of institutional beds. The reasons for the ‘lagging behind’ or the different pathway of Dutch mental health care are still a matter of discussion and a subject for historical research. Some possible causes can already be hypothesized. Around 1970 Dutch institutional mental health consisted of medium-sized psychiatric hospitals with comparatively high standards of care. Starting during the 1920s, the Netherlands had a pioneering role in the development of a nationwide system of community psychiatry, which probably resulted in a situation in which the pioneer is lagging behind once all the others followed. Furthermore, parallel and interfering developments in society and government policies during the last decades of the 20th century – e.g. the demise of the welfare state and the liberalization of health insurance – had a negative effect on the reorganization of mental health care. In this paper the development of deinstitutionalization in the Netherlands will be analyzed against the background of the international historiography on this subject, aiming both at the distinction of different (national) models and phases in the history of the transfer of psychiatric care to the community.
Presenters
JV
Joost Vijselaar
Descartes Centre, Utrecht University
On Being Sane in Insane Australian Places: Robin Winkler’s Pseudo-Patient ExperimentsView Abstract
Organized Session 03:00 PM - 03:30 PM (Europe/Amsterdam) 2019/07/25 13:00:00 UTC - 2019/07/25 13:30:00 UTC
After conducting path-breaking experiments on introducing token economies in mental hospitals, Australian psychologist Robin Winkler spent a sabbatical in the United States (1970-1971). There, he became acquainted with anti-psychiatry and initiatives in community mental health. After returning to Australia, he repeated David Rosenhan’s famous experiment On Being Sane in Insane Places. After two (mentally healthy) psychology students were admitted to a mental hospital, they behaved normally and made observations about the care provided (which left much to be desired). He also conducted a pseudo-patient experiment with general practitioners; students visited them and presented symptoms of depression. In general, discussions between physicians and pseudo-patients were short, no referrals were organised, and all received prescriptions. Winkler conducted these experiments for two reasons. First, he thought that they provided unique insights into the nature of mental hospitals and general practice (he recommended that they were repeated every few years). Second, these experiments were part of a broader critique on the place of medicine in modern society. Winkler was part of a small group of radical psychologists that criticized psychiatry and medicine during the 1970s and 1980s to realize change.
Presenters Hans Pols
University Of Sydney
Historian, University of Bristol
Heinrich Heine University Düsseldorf, Germany
Descartes Centre, Utrecht University
University of Sydney
Prof. Hans Pols
University of Sydney
PhD Candidate, UCLA
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