OUT OF BEDLAM: The Truth About Deinstitutionalization by Ann Braden Johnson

OUT OF BEDLAM: The Truth About Deinstitutionalization

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A scrupulous and well-modulated study of the discharge of mental patients to community care. Johnson is a social worker whose professional experience (Mental Health Unit Chief/Montefiore & Rikers Island) informs her perspective as it enriches her account. For Johnson, deinstitutionalization is the unreasoned product of a coincidence of developments (though nowhere among them is the ""anti-psychiatric"" legal climate that Isaac and Armat, reviewed above, identify as pivotal). Among the casual elements Johnson pinpoints are the discovery of Thorazine, the deterioration of the state hospital system, Thomas Szasz and R.D. Laing's ""refraining"" of the phenomenon of mental illness, and the demonstration in Erving Goffman's Asylums of the therapeutic bankruptcy of a patently custodial system. But even while understanding these causes to be in the background, Johnson sees deinstitutionalization and its often assumed by-product, homelessness, as parallel legacies of public shortsightedness. Addressing the gross inadequacy of treatments and services, she cites the importance of access to hospitalization and the ""dire need"" for the transmission of mainstream living skills. Community Mental Health Centers, Johnson finds, are the haphazard result of ""policy completely divorced from clinical reality,"" with the schism between planners and practitioners at the root of the incoherence of today's mental health system. The author compares the fragmentation of contemporary funding to a con game as she negotiates the maze of entitlement programs to isolate systemic flaws: patient needs are never a factor; programs are designed to fit the funding, not to do the work, etc. A balanced and caring observer, and a felicitous writer, Johnson offers an authoritative report on the magnitude and intractability of the problem.

Pub Date: Sept. 10th, 1990
Publisher: Basic Books