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THE CRISIS OF SOCIAL PSYCHIATRY
by JOSHUA BIERER & SOC.SC. (VIENNA), DIP.INDIV.PSYCH. D.ECON. M.D., F.R.C.PSYCH., of you may think it superfluous to discuss this problem denying that there any crisis. Some may think we are maybe approaching a crisis, while others may be convinced that we are already in it. In my opinion it is not important who is right. If we follow one of our beliefs, namely that prophylaxis is preferable to treatment, an early discussion of this existing or future problem is urgently needed. Over 50 years ago, when we pioneers of Social Psychiatry first began to dream of the revolution that has become known as Social and Community Psychiatry, what did we have in mind ? 1. We questioned that the long accepted method of locking people up because they were allegedly suffering from a &dquo;mental illness or disorder&dquo; had enough scientific proof to make it morally justifiable. 2. We, therefore, questioned the use of established diagnostics and in consequence the established approach to the whole problem. 3. We proved that mental illness in the established and generally accepted form does not exist and that there is no specific relationship between the individual treatments and the alleged pathological entities they are supposed to cure. 4. We proved that locking people up in so-called &dquo;snake pits&dquo; or even in so-called &dquo;country clubs&dquo; is not productive, but the opposite. They often re-create symptoms, which makes the patient worse-on the whole they are contrary to human logic. (When one starts with the assumption that, on the whole, mental illness is an escape from reality and responsibility, locking up patients away from a reality situation, with no responsibility, is obviously illogical.)
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5. We proved that violent behaviour can be considerably reduced by opening the doors of mental hospitals. 6. We proved that in some countries the numbers of beds in mental hospitals could be considerably reduced and that in some hospitals all doors could be unlocked, without endangering the community. 6. We proved that in some countries the numbers of beds in mental hospitals could be considerably reduced and that in some hospitals all doors could be unlocked, without endangering the community. 7. We proved that the attitude of the staff and the relatives and that of the whole community towards the problem of mental illness could be changed. 8. We proved that full-timehospitals can be successfully replaced by different types of part-time institutions. 9. We proved that people who would otherwise be hospitalised could be kept in full-time work by attending night hospitals and weekend hospitals. 10. We proved that so-called &dquo;unapproachable&dquo; patients can be easily approached. 11. We proved thatnco-,op~rati and resentful patients can be won over to f@1
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THE CRISIS OF SOCIAL PSYCHIATRY
by JOSHUA BIERER & SOC.SC. (VIENNA), DIP.INDIV.PSYCH. D.ECON. M.D., F.R.C.PSYCH., of you may think it superfluous to discuss this problem denying that there any crisis. Some may think we are maybe approaching a crisis, while others may be convinced that we are already in it. In my opinion it is not important who is right. If we follow one of our beliefs, namely that prophylaxis is preferable to treatment, an early discussion of this existing or future problem is urgently needed. Over 50 years ago, when we pioneers of Social Psychiatry first began to dream of the revolution that has become known as Social and Community Psychiatry, what did we have in mind ? 1. We questioned that the long accepted method of locking people up because they were allegedly suffering from a &dquo;mental illness or disorder&dquo; had enough scientific proof to make it morally justifiable. 2. We, therefore, questioned the use of established diagnostics and in consequence the established approach to the whole problem. 3. We proved that mental illness in the established and generally accepted form does not exist and that there is no specific relationship between the individual treatments and the alleged pathological entities they are supposed to cure. 4. We proved that locking people up in so-called &dquo;snake pits&dquo; or even in so-called &dquo;country clubs&dquo; is not productive, but the opposite. They often re-create symptoms, which makes the patient worse-on the whole they are contrary to human logic. (When one starts with the assumption that, on the whole, mental illness is an escape from reality and responsibility, locking up patients away from a reality situation, with no responsibility, is obviously illogical.)
SOME
its
5. We proved that violent behaviour can be considerably reduced by opening the doors of mental hospitals. 6. We proved that in some countries the numbers of beds in mental hospitals could be considerably reduced and that in some hospitals all doors could be unlocked, without endangering the community. 6. We proved that in some countries the numbers of beds in mental hospitals could be considerably reduced and that in some hospitals all doors could be unlocked, without endangering the community. 7. We proved that the attitude of the staff and the relatives and that of the whole community towards the problem of mental illness could be changed. 8. We proved that full-timehospitals can be successfully replaced by different types of part-time institutions. 9. We proved that people who would otherwise be hospitalised could be kept in full-time work by attending night hospitals and weekend hospitals. 10. We proved that so-called &dquo;unapproachable&dquo; patients can be easily approached. 11. We proved thatnco-,op~rati and resentful patients can be won over to f@1
~°&dquo;°P~~4~P. i~ / ~-i .13U iT
k
JB ~ ~
.’
Lw
Downloaded from isp.sagepub.com at UCSF LIBRARY & CKM on March 16, 2015
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![[Antipsychiatry and identity crisis in psychiatry].](/assets/img/hold.png)
