Week 9 - Institutions

Question 1

Revisit Asylums

Answer 1

• Those that couldn’t be changed turned to custodial care (higher patient population)
• Other goals of moral treatment (eg. restraints, patient programming) this failed
• By 60s: 500k Americans in long term psychiatric care

Question 2

19th C. Rise of public institutions

Answer 2

• Part of “progressive” reforms to “bring people up to normal standards”
• Social control critique: reflected broader belief that individuals could be tutored for “responsibilities of economic freedom”
• Belief that hospitals should be governed by discipline and scheduling
• NOT GOVERNMENT CONSPIRACY: cultural shift coming out of Enlightenment towards individualism
  –> Turn people into specific beings to fit into new economics/ society

Question 3

Total Institutions

Answer 3

“asylums”, closed circuits, completely disconnected from society
- People have no choice but to comply
- At whims of hospital authorities
- Involves “mortification of self” replaced by institutional identity (eg. diagnostic label)
- Refer to them as inmates (not patients)

Question 4

Criticisms of institutionalization

Answer 4

• Goffman
• JFK: because people “rarely” improve and because of highlight of asylum conditions, people began to question the utility of this system
• Too many long term stays, too many failures after release
• Inhumane conditions
• Scholar and government critiques supplemented by pressure from service users and anti-psychiatry

Question 5

Deinstitutionalization

Answer 5

• Aimed at reducing psychiatric hospitals and raising the criteria for administration
• USA: Community Mental Health Act (63) made involuntary confinement much less common, decreased patient population
• CAD: 60s-80s 70,000 > 20,000 beds
• Community care grown slowly, but patients released rapidly

Question 6

Homelessness and mental illness

Answer 6

• Institutional Neurosis
• Critics: not simply hospital closures, but the decimation of the welfare state
  –> Also individualizes issues, misses contextual piece
  –> Poverty and homelessness drive mental illness
  –> Implies the solution is more treatment (NOT ROOT ISSUE)
• So severe that people are now pushing for reinstitutionalization (eg. Braslow*)
  –> Reflects psychiatric tendency to take social problems and reimagine them as individual issues

Question 7

Residential Care Facilities (RCFs)

Answer 7

• Money from closing hospitals used to fund RCFs (group homes)
• Typically private-run, financed with public funds, and owners are licensed

Question 8

Critiques of RCFs

Answer 8

• Poor conditions, pay a lot of their disability benefits to cover their care
• Many homes in Hamilton owned by Mafia
• Staff underpaid/ understaffed
• Sites of social problems as residents are vulnerable (eg. addiction, door removal)

Question 9

Prisons and mental illness

Answer 9

• Institution that houses the largest number of people with mental illness
• USA: 15-20% prison population diagnose(d)(able) with “severe” mental illness; 50% “mild”
• CAD: 15% prison population has schizophrenia
• Consequences of trans-institutionalization
  –> From non-existent issue to “1 of the biggest problems of our time”

Question 10

How are prisons indicative of growth of the “psy-complex”

Answer 10

• High number of diagnoses indicate psychology seeping into society
• Increased population reflects think psychologically
• Linking mental illness to prisons is not just a sign of hospital closure (changes ways of thinking about incarcerated people)

Question 11

What are the conditions within Prisons

Answer 11

• Compared to non-diagnosed, mentally ill prison population stays longer, suffers more violence, and commits more suicide
• Despite having the legal right to equal healthcare, services are limited to crises
• Because inmates cannot cope in “normal” prison settings, segregation is used
• Are prisons treating mental illness or driving mental illness? What are prisons, punishment or rehabilitation?

Question 12

Are we criminalizing mental illness or medicalizing crime?

Answer 12

• 60-80% prison population qualify for Antisocial Personality Disorder
• Sin > bad > mad
• Indicative of trend to expect psychiatry to explain all aspects of human condition
• Double-bind: blame criminality on mental illness, but prisons don’t address mental health issues

Question 13

Ashley Smith

Answer 13

• Threw crab apples are postal worker; tried by judicial system, brief examination said she had BPD
• 4 yer stay, mostly segregated, subject to force, poor living conditions
• died to suicide at 19. After inquest, death ruled a homicide

Question 14

Beyond bricks and mortar (buildings)

Answer 14

• UN describes institutions: people admitted dont get to decide who provides assistance, day-to-day decisions, with whom a person lives
• Institutions are more than just the building

Question 15

Why do institutions persist?

Answer 15

• People need care and institutions: Gives access to treatment, housing, protection, offer caregivers relief, secure settings
• They arent humane: are sites of confinement and control, medical industrial complex, solutions to the “eyesore” of mentally ill