Despite the recognised failure in the US of, one, the over reliance on drugs and two, the inadequacy of the funding models by the mid 80s, mental asylums continued to disappear. When the words ‘mental asylum’ come up against those fuzzy warm words ‘community care’ the concept of asylum never stood a chance. Though I would argue that, just as we accept the concept of political asylum from oppressive regimes so why not asylum from personal anguish. A secure physical space to be able to experience psychic trauma within a supportive but not necessarily regimented environment. Therapy would emerge naturally from the human interactions which would occur daily in myriad settings. The underlying philosophy of such a place should be to encourage the most amount of autonomy for decisions about daily living. For example, the timing of meals should be up to the inmates/patients/clients/customers/sufferers rather than some union management negotiated scheduling roster imposed by a distant bureaucracy.
Many large mental hospitals were situated in pleasant surroundings with plenty of land available for small market gardens. So that most basic human need – food– could form the basis of a complex of different occupations from soil preparation, seed selection and planting to harvesting, food preparation and cooking. Decisions about menu planning informed by healthy nutritional information could be taken collectively. Likewise, food shopping decisions within a predetermined budget and also rosters for daily cleaning would further involve individuals in meaningful occupations. Life maintenance tasks needn’t end there. Individual responsibility for clean clothes and bed linen would be encouraged. Ideas about what could be manufactured in sheltered workshops could be sourced from institutions where they have operated successfully. For the creation of a genuine ‘community’ participation in some sort arts pursuit would also be encouraged. Drawing, painting, writing, singing in a choir or simply walking about the leafy grounds might distract from inner turmoil enough for a spark of connection with others to build a sense of belonging. Even as Largactil crushed the manic and elevated apathy within me I still enjoyed good human connections in the art therapy shed at Longrove.
Of course, with proper staffing and re-purposing old wards the costs of this approach to ‘treatment’ would be much higher than conventional churn them through with heavy tranks and spew them into community care system. Besides cost cutting as a major driver of deinstitutionalization from the ’70s onwards there was something else going on. That something relates to the broader societal transition to neoliberal politics in government which produced a more instrumental competitive individualism in the populace. To illustrate this, we could look at what happened to the legacy of Thomas Szasz’s 1961 Myth of Mental Illness and the anti-psychiatry movement it spawned which evolved into mental health consumerism. (D. and J. Rissmiller, Evolution of the Antipsychiatry Movement into Mental Health Consumerism, June 2006, MIA)
Ex-patients expressing criticism of their treatment in mental asylums date as far back as 1868 when Elizabeth Packard made her experiences available to the public “…by publishing a series of books and pamphlets…” (Wikibooks, History of the Mental Health Consumer Movement, Oct 2016) More public support for the plight of mental patients was garnered by Clifford Beers who published a book about his asylum experiences in 1908. These and other 20th century manifestations of critiques of psychiatric treatments were the forerunners of 1960s antipsychiatry movement itself. You could say this consumerist movement was radicalized in the 60s through the influence of all the other liberation movements of the time and underpinned by the theoretical positions of Laing and Szaz. By the 1980s that radical edge in the anti-psychiatry movement had been blunted by psychiatry itself reforming and the drop off in counter-cultural support. The shift back to the consumerist approach to mental health illustrates my point about instrumental competitive individualism. But at least competing treatments were chosen on the benefits of practical outcomes by the individual which is no bad thing.