Deinstitutionalization Essay

This essay has a total of 1662 words and 7 pages.


Intro to Psychology

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
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