The Forgotten History: The Deinstitutionalization Movement in the Mental Health Care System in the United States

The development of ideas on deinstitutionalization of mental patients has a much longer history in the United States than is commonly acknowledged. Evidence of intense discussion on the rights of the mentally disturbed, curative as opposed to control measures in their treatment, and the drawbacks of congregating the afflicted in large institutions can be found as early as the middle of the 19th century. This discussion was provoked by dissemination of knowledge about the oldest community care program of all: the colony of mental patients in Gheel, Belgium. Based on document analysis of publications in the American Journal of Insanity from 1844 to 1921, this study attempts to trace how this discussion resulted in the first wave of deinstitutionalization in the American mental health care system, and the successful implementation of the alternative of hospital treatment. My study further documents how the development of this program was inhibited by the need of psychiatry to attain professional legitimation. In its struggle to acquire public respect and occupational authority, the profession focused on somatic explanations of disease that could justify categorization of psychiatry as a branch of medical science. While this claim was not decisively supported by laboratory findings, or the ability to cure patients, psychiatry put forward genetic explanations of mental disorder. This took the profession to the extreme of the eugenics movement, and eventually positioned it as an institution of social control instead of medical authority. Having thus failed to achieve the ultimate professional legitimation in the medical field, psychiatry was exposed to a new wave of criticism in the 1960s, which led to the second wave of deinstitutionalization. History repeated itself with the same outcome. In the absence of overall support within psychiatric circles, and a lack of appreciation of family care as a viable alternative to hospital treatment among social scientists, deinstitutionalization could not but fail again. The contribution of the study lies in the areas of deinstitutionalization, professionalization of expert labor, and the social construction of mental illness and deviance