To: American Spirit who wrote (532174 ) 1/29/2004 3:41:20 PM From: Neocon Respond to of 769667 Something on deinstitutionalization: Ideology, Not Science How have things gone so wrong? It is important to realize that the original underpinning for deinstitutionalization was ideology, not science. The idea had appeal across the political spectrum: Liberals found civil libertarian demands for mental patients' "freedom" persuasive, conservatives were happy to cut mental health budgets by shutting down state hospitals.When deinstitutionalization shifted into high gear In the early 1960s , only one study had been done on the effects of moving severely mentally ill individuals to community living. The 20 schizophrenics in that study, published in England in 1960, did relatively well when moved from a hospital to a supervised community facilities.Virtually every American advocate for deinstitutionalization in the 1960s and '70s cited this paper -- and did not mention that the 20 patients had been selected for the experiment because they were functioning at a high level and were able to work, unlike the vast majority of U.S. patients who would be sent packing. Advocates of deinstitutionalization based their argument mostly on such texts as Erving Goffman's "Asylums" (1961), which asserted that psychiatric patients' abnormal behavior was mostly a consequence not of mental illness but of hospitalization. Research in the past decade has proved this assumption false: Studies using such techniques as positron emission tomography scans have shown that schizophrenia and manic-depressive illness are physical disorders of the brain, just as Parkinson's disease and multiple sclerosis are. Patients with such illnesses need medications to control their symptoms, which usually get worse without treatment. Advocates assumed that mentally ill individuals would voluntarily seek psychiatric treatment if they needed it. As It turned out, about half of the patients discharged from psychiatric hospitals did not seek treatment once out of the hospital. Many of those who suffer from schizophrenia and manic-depressive disorder do not believe themselves to be ill. These untreated Individuals constitute most of the mentally ill population who are homeless or in jail, and who commit violent acts. States, meanwhile, shirked their responsibility, in part because the mentally Ill were newly eligible for a variety of federal programs. During the mass exodus of patients from psychiatric hospitals, nobody bothered to ask what was happening to them. Incredibly, despite the vast scale of deinstitutionalization, the federal and state governments never commissioned evaluations of this social experiment, which after all had been launched with virtually no empirical base.As late as 1981, when deinstitutionalization had been under way for over 15 years, an academic review of research on the subject found only five studies concerned with outcomes, three of which were methodologically flawed.psych-health.com