When I was first diagnosed with bipolar over the course of 36 months, I was hospitalized 18of those months. I was pulled out of my job, put on medication and basically made to feel as if I was a failure. It wasn't until my last 6 week bout in hospital that my then therapist asked me whether I wanted to sink or swim. Instead of becoming a social outcast, I relearned how to function in this crazy mixed up world.
For others, however, Geel was a beacon of the progressive ideas that came to be known as ‘moral management’. Freeing the insane from their chains and madhouses, providing them with fresh air, occupational therapies and the chance to patch themselves back into normal life — this was treatment in itself. Philippe Pinel, the founding father of French psychiatry who was legendary for ‘striking the chains off the mad’ at the Salpetrière asylum in Paris, declared that ‘the farmers of Geel are arguably the most competent doctors; they are an example of what may turn out to be the only reasonable treatment of insanity and what doctors from the outset should regard as ideal’.It is sad to see that this "old way" is slowly fading as modern improvements become the "norm." Sometimes modern isn't always better. Yes medications helped stabilize so I could once again function, but with that also came the "side-effects."
More optimistically, the decline of the system can be seen as a reflection of modern improvements. Psychiatry has met the town halfway: the choice is no longer limited to the stark alternative of Geel or the horrors of the asylum. Care in the community, of which the town was once the leading example, has become the norm. For most mental health service users, the combination of medication and community mental health teams has made the line between ‘inside’ and ‘outside’ more porous, with ‘outside’ the preferred option for doctors and patients alike, on grounds both of cost and quality of life.I like this model much better thean some of the newer stuff being shoved down peoples throats,,,
In 1349, a church was built on the outskirts of the town around Saint Dymphna’s memorial, and in 1480 a dormitory annex was added to accommodate the growing number of pilgrims. When the stream of visitors overflowed the allotted space, townspeople started to house them in their homes, farms and stables. During the Renaissance, Geel became famous as a place of sanctuary for the mad, who arrived and stayed for reasons both spiritual and opportunistic. Some pilgrims came in hope of a cure. In other cases, it seems that families from local villages took the chance to abandon troublesome relatives whom they couldn’t afford to keep. The people of Geel absorbed them all as an act of charity and Christian piety, but also put them to work as free labour on their farms.
Today, the system continues along much the same lines. A boarder is treated as a member of the family: involved in everything, and particularly encouraged to form a strong bond with the children, a relationship that is seen as beneficial to both parties. The boarder’s conduct is expected to meet the same basic standards as everybody else’s, though it’s also understood that he or she might not have the same coping resources as others. Odd behaviour is ignored where possible, and when necessary dealt with discreetly. Those who meet these standards are ‘good’; others can be described as ‘difficult’, but never ‘bad’, ‘dumb’ or ‘crazy’. Boarders who are unable to cope on this basis will be readmitted to the hospital: this is inevitably seen as a punishment, and everyone hopes the stay ‘inside’ will be as brief as possible.
The people of Geel don’t regard any of this as therapy: it’s simply ‘family care’. But throughout the town’s long history, many both inside and outside the psychiatric profession have wondered whether this is not only a form of therapy in itself, but perhaps the best form there is. However we might categorise or diagnose their conditions, and whatever we believe their cause to be — whether genetics or childhood trauma or brain chemistry or modern society — the ‘mentally ill’ are in practice those who have fallen through the net, who have broken the ties that bind the rest of us in our social contract, who are no longer able to connect. If these ties can be remade so that the individual is reintegrated with the collective, doesn’t ‘family care’ amount to therapy? Even, perhaps, the closest we can approach to an actual cure?
Geel's ancient community cares for the mentally ill – Mike Jay – Aeon
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