This is the twelfth part of a series. You can find part one here.
While there’s nothing written about family care in Geel prior to 1800, there is an avalanche of writing about it from then on. Asylum directors, social reformers, and bureaucrats dreaming of balanced budgets all had strong opinions on Geel. A few even based these opinions on having seen the place for themselves.1
The first Geel question
In the 1850s, reformers were already calling for new types of asylum care. Confining all of the mad to asylums was not feasible, as the cure rate was much lower than expected. The new asylums were not intended to provide long-term care, so the increasing numbers of “incurable” patients was a problem. Geel was repeatedly proposed as a solution for providing affordable and moral long-term care for incurables.
Those who looked at Geel debated two main points:
Was it safe to have the mad living among peasants?
Could the mad live in a community without needing to be restrained?
These debates suggest just how out of touch these men in charge of asylum care were. They largely ignored the reality that people with moderate mental illnesses and intellectual disabilities had long lived in communities, instead considering all of the “insane” and “feeble minded” to be like the “raving mad” who had been kept in restraints for safety reasons.
Several reformers promoted the idea that asylums could be emptied out and the healing effects of the countryside would render the “raving mad” docile and sociable. Attempts to do this in the early 1800s, when several asylums were closed2 and all patients were sent to Geel, resulted in foster families needing to restrain and confine them. This gave the impression that the care provided in Geel was medieval, backward, and cruel;3 and an alternative to asylum care.4 This reputation of Geel as providing medieval care as an alternative to an asylum has clung to it ever since.
There was much hand wringing about the potential for the mad to mix with the sane. There was nearly as much anxiety about the mixing of the sexes and the mixing of the classes at Geel. This concern was largely unfounded, as celibacy was carefully enforced in Geel and boarders were placed and cared for according to class.
Geel was held up as a model system, meant to be replicated.5 The debate was whether or not it was worth replicating.
The resulting (and remaining) boarding-out programs varied. Some isolated boarders to designated villages or restricted them to the vicinity of an asylum, while others, most notably in Scotland, retained boarders in their hometowns. In 1871 W. Lauder Lindsay bemoans how Scotland has refused to establish a national colony for the insane like Geel. Presumably Lindsay, who ran an asylum, was perfectly aware of the widespread practice of boarding-out in Scotland. What he wanted was a national place to sequester boarders.
Boarding-out6 remained incredibly common, even into the age of the asylum. An 1889 book says approximately ⅔ of the insane in Germany are boarded-out. There were also 29 open asylums for people with “lighter forms of mental disorder.” Open asylums could refer to the cottage system, farm colonies, and institutions providing various levels of freedom as a privilege. While Geel was different, in that it was not entirely built as a planned community for the mad, boarders were not permitted to leave the boundaries of the asylum. Boarders needed permission to do such things as own a bicycle into the 1980s.
Notably, even the most vocal advocates for closed asylums chose family care and boarding-out for themselves when it was necessary. Browne, superintendent of Crichton Royal Asylum in Dumfries and the first Scottish lunacy commissioner, suffered serious head injuries in 1870 when thrown from his carriage during the inspection of an asylum. He was cared for at home by his two unmarried daughters for the remaining 15 years of his life. Similarly, Dorothea Dix opted to stay with the Rathbone family and other friends during her periods of mental instability, rather than reside in the asylums she championed.
This remained the norm for the upper class in general, who responded by boarding-out their mad abroad to escape the new legislation.
The second Geel question
By 1945, boarding-out had become interchangeable with “family care.” The existence of and widespread nature of boarding-out prior to 1800 was largely ignored in favor of discussions of boarding-out organized through the asylum system.
The new Geel question was based on an old misunderstanding: could we abolish asylums and replace them with colonies like Geel?
Reluctant asylum directors became willing to test out family care and outpatient care in order to cut costs and reduce overcrowding. It certainly helped that family care cost half of traditional in-patient asylum care.
Still, while they were willing to experiment with elements of the system inspired by Geel, they unanimously viewed Geel as a unique and ancient system that could not be replicated. The residents of Geel were special and had been trained in care for the mad over countless generations, thus making them uniquely qualified. Geel was a compassionate city and other places, alas, lacked this compassion. Advocates like Conolly Norman had already argued with these points decades before:
“We are often told that family care is fraught with danger, fraught with difficulty, is practically unworkable, and so forth. I answer, solvitur ambulando – ”behold Gheel.” I am then told, or used to be told, nay, I have said myself, but it was a great many years ago, that Gheel is inimitable, having been founded in the piety of primitive ages, and being inhabited by a population among whom care for the insane had become something approaching to an hereditary tact. Again, however, solvitur ambulando ; Gheel has been equalled, in some respects surpassed, by the modern settlements at Lierneux and at Dun-sur-Auron, while family care has been established at numerous centres in Germany, in Russia, in Holland, and in Italy.”
Given the “fact” that the Geel system could not be reproduced, asylum reformers built modern retreats, modern farm colonies, modern cottage systems, and modern private asylums (now branded as group homes and halfway houses).
Boarding-out continued to be practiced in asylums everywhere, it was just so routine as to not merit attention. According to Horatio M. Pollock, assistant commissioner of the Department of Mental Hygiene in New York, it was only “family care” if the institution was paying. If someone could be placed in the community without payment, say with extended family or friends, it was simply business as normal.
The third Geel question
In the 1960s Geel received a flurry of attention and debate for a third time. Experts no longer argued about whether or not Geel provided appropriate care or whether it should be replicated. This time the question was how to save Geel.
I asked Gemini to rewrite my text to be more concise and this is what it came up with:
Crazy History You Won't Believe! (Seriously, it's wild)
Remember those creepy asylums from the movies? Turns out, back in the 1800s, things were even crazier (no pun intended). Buckle up for a mind-blowing historical tidbit!
So, asylums were overflowing with "incurable" patients. Some fancy folks thought a Belgian town called Geel had the answer: let the "mad" live with families!
Now, imagine the drama: "Is it safe?" "Can they control themselves?" Spoiler alert: these "experts" mostly ignored reality. Many mentally ill people already lived peacefully in communities!
Some even thought the countryside could magically cure everyone, which... didn't exactly work. But Geel kept chugging along, placing patients with families based on class and strictly enforcing celibacy (hey, different times!).
The real shocker? Geel wasn't some medieval torture chamber. It was actually seen as a model! But copying it wasn't so simple. Some programs isolated patients, while others, like Scotland, kept them in their hometowns. It was a mixed bag.
Even though asylums became the norm, boarding-out stuck around. In Germany, two-thirds of "insane" people lived with families! Open asylums with more freedom also popped up.
Here's the funny part: even asylum supporters chose family care for themselves! They just didn't want it for everyone else. Talk about double standards!
So, this historical saga shows how mental health care has always been complex and evolving. And hey, maybe next time you see a historical drama about asylums, you'll remember this crazy (but true!) story!
These asylums appear to have been closed temporarily, while they were renovated to provide care under the theory of moral treatment.
“A related but more intellectually effective critique of the Middle Ages developed during the 18th century Enlightenment, when philosophers such as Voltaire and Kant condemned medieval superstition and what they considered the infantile nature of medieval institutions, contrasting this with the development of modern reason, science, and civilised values. Such views were boosted by the noble, liberty-loving sentiments on display in the American and French revolutions. This pitching of ‘modernity’ against the medieval has remained at the core of our casual dismissal of the Middle Ages as a ‘dark age’ ever since, and of course it has much to recommend it. But when it comes to the history of prisons, post-Enlightenment societies could hardly be correct in boasting that imprisonment was more characteristic of the Middle Ages than their own.” https://issuu.com/marlborough_college/docs/mc_1122_reflections_revised_nov_2022_for_website
Geel is an asylum, not an alternative to one: “The official Report for 1895 gives the total number thus under official cognisance as 11,819, about 2,400 being in the colonies and the rest being in ordinary asylums. The asylums and the colonies are under the supervision of an Inspector-General, M. Lentz, appointed by the King, and he is assisted by three Commissioners appointed by the Minister of Justice.”
“When sending a patient to Gheel or Lierneux the same proceedings are required as when sending a patient to an ordinary asylum, and the authorities of these colonies have the same legal powers and responsibilities as to the detention of patients as are possessed by the authorities of ordinary asylums.”
“The superintendence of the insane and their guardians, and the general administration of the colony, is, like those of ordinary asylums in Belgium, in the hands of a local Board.” https://doi.org/10.1192/bjp.43.182.435
“After reading the endearing picture that M. Jules Duval draws of this colony so little known in France and so worthy of being so, we would like him to see institutions of this kind multiply and replace the hospices for the insane everywhere with this life in freedom and in family which brings the patient back to the habits of work and the society of reasonable men. We would easily find calm towns far from the tumult of the main roads and large centers like Gheel, solitary countries of a temperate climate in the middle of simple, gentle and religious populations as the Campine dedicates it itself would not fail the brothers of Saint John of God lock themselves up with the madmen and associate themselves in the asylums with their existence so sad and so agitated.” https://books.google.ch/books?id=M0wFAAAAQAAJ&newbks=1&newbks_redir=0&dq=sint%20Digne%20gheel&pg=PA549#v=onepage&q=sint%20Digne%20gheel&f=false
In some areas, this practice went by other names. In England, wills name a ‘keeper’ to function as the guardian of people who required care upon the death of their parents. If there was not a will which named a keeper, officials would assign one. Those who had property became wards of the crown.