Deinstitutionalization

Intro to Psychology

Deinstitutionalization

It is nearly impossible to walk between any two points in New Haven without being affected in some small way by our city's homeless problem. On seeing these people, in many cases, it becomes clear that they suffer from some mental disability that, unaided, will obviously impede their living a normal life. In fact, according to the Report of the Federal Task Force on Homelessness and Severe Mental Illness, one in every three homeless people suffers from a severe mental illness, most of which are treatable. In a country that devotes so many resources to various welfare programs for nearly every group, how can this problem persist? The answer to this question lies in a major national policy shift, deinstitutionalization, which occurred progressively between 1960 and 1980. Though deinstitutionalization addressed a necessary problem, in practice, it only worsens the problems facing the mentally disabled and society at large. What prevailing social ideas and changes brought an end to our nation's established system of state psychiatric hospitals? What is the logic behind our new and inefficient system of community centered outpatient mental health?

Until the middle of the last century, public mental health in the United States had been the responsibility, for the most part, of individual states, who chose to deal with their most profoundly mentally-ill by housing them safely and with almost total asylum in large state mental hospitals. Free of the stresses we all face in our lives, the mentally-ill faced much better prospects for peaceful lives and even recovery than they would in their conditions in ordinary society. In the hospitals, doctors were always accessible for help, patients were assured food and care, and they could be monitored to insure they never became a danger to themselves or others. Our nation's state hospital system was a stable, efficient way to help improve the lives of our mentally disabled.

Around the middle of the last century though, huge developments were made in treating many mental illnesses, which until then had largely been life-long problems. This change made many organizational hospital practices used to insure order and asylum to patients no longer fully necessary. These practices seemed inhumane and excessive on the promise that emerging science could provide alternative treatments to indefinite hospitalization. One huge development that helped turn public opinion against institutionalization of the mentally ill was the introduction of the prefrontal leukotomy. Widely attributed to Portuguese psychiatrist and statesman Dr. Antonio Egaz Moniz, the operation was actually the product of years of research, many of the most influential studies having happened here at Yale under Dr. Carlyle Johnson. An American psychiatrist, Dr. Walter Freedman, was so impressed with the operation's early results that he developed a faster, less precise form of the surgery which he publicly advertised as a new miracle treatment in psychiatry, and greatly increased its use. Instead of Dr. Moniz's two small holes drilled on either side of the forehead through which fine tools were used to sever the prefrontal lobe's syntaxes to the rest of the brain, Freedman pounded an ice pick through the eye cavity and swished the frontal lobe around with the same too until it was completely functionless. These quick and dirty "assembly line lobotomies" provided the perfect fodder for journalists already questioning what they saw as prison-like hospitals that stigmatized the mentally ill while depriving their lives of meaning.

The response to this sudden outcry against state mental hospitals was the formation of the Joint Commission on Mental Illness and Health which in 1961 published Action for Mental Health, which further decried the efficient state mental hospitals as inhumane, cold places where recovery was impossible. Throughout the next two decades, a string of government actions on both federal and state levels gradually transitioned the national system for the treatment of the mentally ill from state hospitals to community outpatient centers, attempting to mainstream the mentally ill into society, the process now commonly referred to as deinstitutionalization. Rather than re-examine the state hospital system, the nation frantically overturned the stable existing system for a yet unproven network of community care centers which, it was hoped, could handle more effectively and humanely those previously served by the state hospitals, as normal members of society, not stigmatized inmates of institutional asylums.

Ultimately, however, the process of deinstitutionalization seems to have failed. We have since learned that mainstream reintroduction of the severely mentally ill into society, a solution we hastily deemed acceptable, is really no solution at all. Though we initially decried the state mental hospitals as being inhumane, we are now seeing that asking the mentally ill to fend for themselves in mainstream society while taking their treatment into their own hands is far worse to everybody.

Asylum as a word has grim connotations today, owing to the prison-like mental hospitals referred to as such. The hospitals were commonly referred to as "asylums" or "insane asylums." Simply put, however, asylum is merely what the hospitals offered to patients, asylum from the struggles of normal life. The challenges we face on a daily basis in attempting to lead productive lives are nearly overwhelming even when we are healthy. Deinstitutionalization has shown that asking people to deal with all of these stresses on top of their existing condition can be an obviously overwhelming experience. Often, this leads to depression coupled with the existing condition, and the individual is still not able to fully assimilate into society. According to the Federal Task Force on Homelessness and Severe Mental Illness, persons with pre-existing mental illnesses are far more likely to develop depression in difficult situations than persons without. Also, the condition and stresses of homelessness tends to worsen the effects of most severe mental illnesses. Those with pre-existing conditions are far more likely to develop depression and give their condition greater control of their life when faced with the challenges of everyday life than they ever were in the hospital setting, where they held asylum.

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