Deinstitutionalization in Literature & Literary Theory

Deinstitutionalization: Etymology, Meanings and Concept

Etymology/Term:

The term “deinstitutionalization” originated in the mid-20th century, gaining prominence in the 1960s and 1970s. It is derived from the combination of “de,” meaning to reverse or remove, and “institutionalization,” referring to the placement of individuals in large institutions like mental hospitals or long-term care facilities. The concept emerged as a response to the critique of traditional institutional settings and the call for a shift toward community-based care.

Meanings and Concept:

Meaning/Concept	Description
Transition from Institutions to Community Care	Deinstitutionalization involves the movement of individuals from large, centralized institutions, such as mental hospitals or residential care facilities, to community-based settings. The aim is to provide more personalized and humane care, allowing individuals to integrate into society.
Focus on Mental Health Reform	Often associated with mental health reform, deinstitutionalization seeks to replace the confinement of individuals with mental illnesses in institutions with community-based mental health services. This transition aims to reduce stigma and promote inclusion.
Advocacy for Individual Rights and Autonomy	At its core, deinstitutionalization advocates for the rights and autonomy of individuals, emphasizing their right to live in the least restrictive environment possible. This approach promotes a more patient-centered and rights-oriented model of care.
Challenges and Controversies	Despite its noble goals, deinstitutionalization has faced challenges, including concerns about adequate community support, potential homelessness, and the strain on existing mental health services. There is ongoing debate about the balance between autonomy and the need for protective care.

Deinstitutionalization: Definition of a Theoretical Term

Deinstitutionalization refers to the process of shifting individuals from large, centralized institutions, such as mental hospitals or residential care facilities, to community-based settings. It is grounded in the belief that decentralized, community-oriented care fosters individual autonomy and societal integration. The concept gained prominence in the mid-20th century as a response to criticisms of traditional institutional settings and a push for more humane and personalized forms of care.

Deinstitutionalization: Theorists, Works and Argument

Theorist	Key Works	Central Argument
Erving Goffman	Asylums: Essays on the Social Situation of Mental Patients and Other Inmates	Goffman analyzed the dehumanizing effects of total institutions, influencing the call for deinstitutionalization by emphasizing the need for more humane and individualized care in community settings.
Thomas Szasz	The Myth of Mental Illness	Szasz challenged the medical model of mental illness, asserting that it is a social construct rather than a medical condition. His work contributed to the critique of institutionalization and paved the way for alternative community-based approaches to mental health.
Michel Foucault	Madness and Civilization	Foucault explored the historical development of mental institutions, arguing that they functioned as mechanisms of societal control. His ideas fueled the discourse on dismantling traditional institutions in favor of community-based care, promoting individual autonomy.
Dorothea Dix	Advocacy and lobbying for mental health reforms in the 19th century	Dix’s efforts led to the establishment of mental asylums but later became critical of their conditions. While not a formal theorist, her advocacy set the stage for discussions on the need for reform and deinstitutionalization in mental health care.
Franco Basaglia	The Destruction of the Psychiatric Asylum and the Birth of the Therapeutic Community	Basaglia pioneered the Italian psychiatric reform movement, advocating for the closure of psychiatric hospitals and the development of therapeutic communities. His work influenced the global deinstitutionalization movement.

Deinstitutionalization: Major Characteristics

Characteristics	Description	Literary Examples
Shift to Community-Based Care	Movement of individuals from large institutions to community settings, emphasizing personalized and humane care.	One Flew Over the Cuckoo’s Nest by Ken Kesey – Explores the dehumanizing effects of institutionalization and the desire for community-based care.
Emphasis on Individual Autonomy	Advocacy for the rights and autonomy of individuals, promoting their right to live in the least restrictive environment.	Girl, Interrupted by Susanna Kaysen – Chronicles the author’s experiences in mental institutions and the quest for personal autonomy in mental health care.
Mental Health Reform	Associated with reforms in mental health care, aiming to replace institutional confinement with community-based services.	The Bell Jar by Sylvia Plath – Reflects on the protagonist’s struggles with mental health and the evolving landscape of mental health care.
Critique of Traditional Settings	Evaluation of the dehumanizing aspects of institutionalization, leading to a call for more patient-centered approaches.	One Flew Over the Cuckoo’s Nest by Ken Kesey – Critiques the oppressive nature of mental institutions and the need for a more compassionate approach.
Challenges and Controversies	Recognition of difficulties such as concerns about community support, potential homelessness, and strains on mental health services.	I Never Promised You a Rose Garden by Joanne Greenberg – Explores the challenges and complexities of transitioning from institutional to community-based mental health care.

Deinstitutionalization: Relevance in Literary Theories

Literary Theory	Relevance to Deinstitutionalization
Feminist Literary Theory	Examines how deinstitutionalization impacts gender dynamics within narratives, considering the experiences of female characters in mental health settings.
Postcolonial Literary Theory	Analyzes the cultural implications of deinstitutionalization, exploring how it intersects with colonial legacies and influences portrayals of mental health.
Psychoanalytic Literary Theory	Investigates the psychological consequences of deinstitutionalization on characters, delving into the subconscious motivations and struggles portrayed.
Marxist Literary Theory	Explores the socio-economic dimensions of deinstitutionalization, questioning how class structures influence characters’ experiences with mental health care.
Queer Literary Theory	Considers the impact of deinstitutionalization on LGBTQ+ individuals, examining narratives that explore the intersection of queerness and mental health.
Postmodern Literary Theory	Analyzes the fragmentation and deconstruction of traditional narratives related to mental health, reflecting the broader societal shifts during deinstitutionalization.
Disability Studies Literary Theory	Focuses on the portrayal of mental health and disability in literature, critically examining how deinstitutionalization narratives contribute to the understanding of stigma.

Deinstitutionalization: Application in Critiques

1. One Flew Over the Cuckoo’s Nest by Ken Kesey:
   • Deinstitutionalization Critique: The novel critiques the dehumanizing nature of mental institutions, advocating for a shift towards community-based care. The oppressive environment of the mental hospital is portrayed as detrimental to the well-being and autonomy of the characters.
2. Girl, Interrupted by Susanna Kaysen:
   • Deinstitutionalization Critique: This memoir reflects on the author’s experiences in mental institutions, shedding light on the challenges within traditional settings. The narrative implicitly supports the idea of more personalized, community-based approaches to mental health care.
3. The Bell Jar by Sylvia Plath:
   • Deinstitutionalization Critique: Plath’s novel explores the evolving landscape of mental health care, criticizing the limitations and drawbacks of institutionalization. The protagonist’s journey reflects a broader societal need for reform and a move towards individualized, community-oriented mental health support.
4. I Never Promised You a Rose Garden by Joanne Greenberg:
   • Deinstitutionalization Critique: This novel provides a nuanced portrayal of the challenges and complexities associated with transitioning from institutional to community-based mental health care. It critiques the potential pitfalls and highlights the importance of adequate community support in the deinstitutionalization process.

Deinstitutionalization: Relevant Terms

erm	Description
Narrative Liberation	Liberation of storytelling structures to echo societal changes, as seen in deinstitutionalization critiques in literature.
Character Autonomy	Exploration of characters’ independence and self-governance, often tied to themes of deinstitutionalization.
Social Commentary	Use of literature to critique and comment on societal issues, including the consequences of deinstitutionalization.
Identity Dynamics	Examination of characters’ struggles with identity, particularly in the context of mental health and deinstitutionalization.
Power Shifts	Analysis of changing power dynamics within narratives, reflecting the post-deinstitutionalization landscape.
Genre Subversion	Deliberate deviation from genre norms to explore unconventional aspects of mental health and deinstitutionalization.
Psychological Portrayal	Realistic portrayal of characters’ mental states and experiences, capturing the effects of deinstitutionalization.
Cultural Critique	Evaluation of how literature mirrors and critiques cultural perspectives on mental health and deinstitutionalization.
Symbolic Spaces	Interpretation of literary settings as symbols representing the transition from institutional confinement to community-based care.
Metaphoric Liberation	Viewing deinstitutionalization in literature as a metaphor for liberation and breaking free from societal constraints.

Deinstitutionalization: Suggested Readings

1. Foucault, Michel. Madness and Civilization: A History of Insanity in the Age of Reason. Vintage Books, 1988.
2. Goffman, Erving. Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. Anchor Books, 1961.
3. Greenberg, Joanne. I Never Promised You a Rose Garden. Holt, Rinehart and Winston, 1964.
4. Kesey, Ken. One Flew Over the Cuckoo’s Nest. Penguin Books, 1962.
5. Kaysen, Susanna. Girl, Interrupted. Vintage Books, 1994.
6. Plath, Sylvia. The Bell Jar. Harper & Row, 1971.
7. Szasz, Thomas. The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. Harper & Row, 1961.
8. Basaglia, Franco. The Destruction of the Psychiatric Asylum and the Birth of the Therapeutic Community. Free Association Books, 1987.
9. Kesey, Ken. Sometimes a Great Notion. Viking Press, 1964.
10. Wacquant, Loïc. Punishing the Poor: The Neoliberal Government of Social Insecurity. Duke University Press, 2009.