13: The Geel Research Project

The people with actual academic qualifications who came before me

The fact that I have degrees from two universities in New York City does, in a way, make me an appropriate person to research Geel. It is Americans who idealize Geel, Americans who insist Geel could never be replicated in the US, and Americans who made Geel famous for being unique.

Aside from conversations and what I saw while in Geel, everything I read about Geel was written by outsiders for other outsiders. In addition to outdated language and concepts, they are full of othering and idealism. 

• They argue for moral therapy and the end to the physical restraint of patients, either showing that restraints aren’t necessary at Geel or showing that Geel is backward, cruel, and without treatment

• They argue for the social model of disability to be applied to care, showing that in Geel people are accepted and supported without labels or mandatory treatment

When the Geel Research Project began, the curate of Sint-Dimpnakerk said no Belgians came to the shrine. It was Americans who prayed to Dymphna, wrote desperate letters, and sent donations. 

In my entirely unscientific hobby of asking every Belgian person I come across about Geel, no one has heard of it. One example: I was taking a street art tour in Lisbon when I discovered our guide was Flemish, so I asked her about Geel. She’d been to Reggae Geel and had never heard of the Geel Family Care program, even though both of her parents worked with disabled people in Belgium.

How did this obscure project in a small Belgian city become the darling of psychiatric reformers in the US? How did I spend my whole adult life stumbling on wistful references to Geel? It all started with the VP of a chemical company I’d never heard of, who was in the area for a business trip and detoured to visit Geel.

The American obsession with Geel

John DJ Moore, future US Ambassador to Ireland, went to Geel in 1959. His interest is motivated by the mental illness of his daughter. He published an account of his visit in Look Magazine and established the Family Care Foundation for the Mentally Ill in 1960, creating a fellowship program in psychiatry. Moore fostered professional connections, which led to the Geel Research Project. He also served as the VP of the American Schizophrenia Foundation, now the Brain & Behavior Research Foundation, an organization founded by people with loved ones impacted by mental illness with the goal of providing funding to “increase the pace of research to find the causes, better treatments and cures for mental illnesses.”

Moore’s work leads to Matthew Dumont and Knight Aldrich spending two weeks in Geel and are alarmed to discover that the program is shrinking, as new foster care placements are not being made. They presented their work at the 117th annual meeting of the American Psychiatric Association in Chicago in 1961 and published it in the American Journal of Psychiatry the next year. 

Dumont was the Assistant Chief of NIMH Center for Studies of Metropolitan Mental Health Problems and was part of the radical psychiatry movement, inspired by socialist ideology. At the time, Aldrich was the first chair of psychiatry at the University of Chicago, where he sought to integrate psychiatry into general medical practice.  

Aldrich recruited Viola Bernard, the founder and director of Columbia University’s Division of Community and Social Psychiatry and future VP of the American Psychiatric Association. Bernard is remembered primarily for her work in adoption. 

Bernard connected them with Leo Srole, another Columbia University professor who had recently completed the Mental Health in the Metropolis: the Midtown Manhattan Study. This report resulted in a media storm in 1962, making Srole a sociology celebrity.

Lawrence Coleman Kolb soon joined. At the time, Kolb was chairman of the Department of Psychiatry at Columbia University Medical Center director of the New York State Psychiatric Institute. He went on to become the New York State Commissioner of Mental Hygiene in 1975. The New York Times described him as “the public face of psychiatry for a generation of New Yorkers”. The New York State Psychiatric Institute’s research facility is named in his honor. His father, Lawrence Kolb, was also a prominent psychiatrist. The National Library of Medicine houses both of their archives.

The project featured two Belgian researchers with strong ties to New York City. Jan Schrijvers, a Geel native, had begun a training program at Columbia’s School of Public Health before moving to a joint position with the Leuven School of Public Health and the Colony. Eugeen Roosens, then the chairman of the department of anthropology at the American Museum of Natural History, was a friend of Moore’s. Roosens went on to write Mental Patients in Town Life about the Geel Colony and Geel Revisited after Centuries of Rehabilitation.

Soon the researchers secured official connections with the Belgian Ministry of Health, the University of Leuven, and the Colony. The Geel Research Project was born in 1966. Srole agreed to direct the Geel Research Project from New York City, with Schrijvers as associate director, overseeing the work in Geel. 

In addition to funding from Moore, they soon secured a NIMH grant. Later, they received another 8 year grant from the NIMH and additional funding from the NY State Psychiatric Institute, Belgium Ministry of Health, and Leuven University. Nearly 100 part-time workers from the University of Leuven, Columbia University, the Colony, and “resident laymen” studied as part of the project Geel. The Belgian government included a special questionnaire in the 1971 National Census for the Geel Research Project.

The project documented the Geel system, with the primary goal of rescuing the system from “extinction”. Roosens described the project as being led by specialists in social psychiatry who viewed Geel as an alternative to psychiatric institutions.

Srole worried that because patients from outside of the immediate region were not being referred to the Colony, it would soon die out. He also found the Colony administration to be lukewarm about recruiting new boarders. 

In 1976 Sidney Malitz was named the investigator of record on grant paperwork, as Srole retired. He was the acting director of the New York State Psychiatric Institute. Malitz is remembered for his experiments seeking to determine if the response people had to LSD was similar to schizophrenia, including a controversial army experiment.

Irene Zola was brought into the project in 1987 to prepare Srole’s writing for publication, as he had a contract with Basic Books. Zola was an English professor at the John Jay College of Criminal Justice in New York City. She started a childcare coop in Morningside Heights and founded Lifeforce in Later Years (LiLY) in response to her experience supporting her mother as she aged in place. Her work in community care for the elderly resulted in a 2010 CNN Hero award and 2011 AARP Inspire award.

Srole remained involved in the project until his death in 1993. Moore continued to provide funding until at least 1988. 

Jackie Goldstein visited Geel in 1982, after reading about it in an abnormal psychology textbook. She went on to become professor of psychology at Samford University in Alabama. Golstein carried the torch as unofficial ambassador for the Geel family care system until her retirement in 2015. The next year she published Voices of Hope for Mental Illness: Not Against, With about community care programs in the US.

The Geel Research Project spanned from 1959 to 1993. It is not included in any of the obituaries of the people who ran the project. The archives ended up at Hobart and William Smith Colleges, one of the first schools Srole taught at, rather than any of the prestigious and easily accessible universities the project was affiliated with.

Photo by Chenwei Yao on Unsplash

The legacy of the Geel Research Project

There’s one thing the Geel Research Project can’t take credit for: community care in the US. The Community Mental Health Act was enacted in 1963, three years before the project began in earnest. It was a product of the push for community mental health care, not a cause. Deinstitutionalization in the US began in the mid-1950s. One Flew Over the Cuckoo’s Nest was released in 1962.

Kennedy signed the Community Mental Health Act as part of his battle against mental illness and retardation. In a message rife with military metaphors, the president told Congress: “we must seek out the causes of mental illness and of mental retardation and eradicate them.” 

Attention was paid to links between poverty, instability, class and diagnosis of mental illness. Johnson’s war on poverty was meant to prevent mental illness. Just as in the past, when those in charge strive to eliminate disease, the next crisis is what to do with those who are deemed incurable.

The most obvious impact of the Geel Research Project is that it changed the course of the Colony. Schrijvers, who oversaw the Geel Research Project, became director of the Colony in 1997. 

For such a massive undertaking, the other impacts are more difficult to quantify. The promised publications never materialized. Numerous conference presentations, journal articles, magazine articles, newspaper articles, and several doctoral dissertations did. The head of the anthropology team, Eugene Roosens, published Mental Patients in Town Life, promoted as the first book on Geel in English. Perhaps it’s the first book in English on Geel, without an “h.”

Perhaps more important than academic presentations and publications is the fact that renowned professors involved with the Geel Research Project taught their students about Geel for decades. Geel slid from obscurity into the public consciousness.

Thanks to the Geel Research Project, the Geel Colony had shifted from a place the great men of psychiatry viewed as a model program to a place caregivers longed to send their loved ones. The people of Belgium weren’t willing to banish people to Geel any longer, but Americans wished they could.

Goldstein wrote:

“Queries from parents, who have read my book or visited my website, may begin with a desire to move their children to Geel, a Belgium city (featured in my book, a city I have visited seven times) with a centuries’ old history of foster family care for the mentally ill – a city devoid of the stigma of mental illness, where "boarders" can live a meaningful life in an accepting integrated fostering community.

However, I must tell them that this option is not possible for those who are not citizens of Belgium.”

Goldstein has dedicated herself to popularizing programs in the US that are similar to the Geel Colony. Geel has also been championed by Oliver Sacks, who wrote the introduction to 2007’s Geel Revisited.

What about the origin myth?

While Goldstein notes that the ten year study struggled to obtain adequate funding and much of the data was never analyzed, it did lead to a revival of interest in Geel. This is when Geel moved from the niche of psychiatrists and public health officers and came to the attention of new generations of mental health care reformers. 

When I was reading Mental Patients in Town Life, which I had retrieved from Princeton University Library’s high density storage, I learned that this was not strictly true. Roosens reported that the history part of the project had been completed and reports had been prepared for publication. As I skimmed the sources cited in the 1970s and 1980s, I saw many references to unpublished manuscripts by Geel Research Project participants.

I began to wonder if the Geel Research Project was intentionally maintaining a myth that the family care system in Geel was ancient. They had a team of historians and anthropologists, yet they simply recited the Dymphna story as the origin of the system. Why did they conduct this research and then bury it?

In 1980, Renzo Villa wrote:

“Even if for about a decade it has been the subject of analysis by a team of psychiatrists, anthropologists, sociologists and historians, its tradition, the complexity and variety of elements that it highlights are still little studied and almost all of the writings dedicated to it do not cross the borders, even linguistic, of Flemish Belgium. This cannot help but be surprising: Gheel is in fact, in a certain respect, a “living fossil,” a still living fragment of a tradition of treating madness which for centuries was the only one, or almost the only one, in the West.” 

Villa notes that the Geel Research Project did not examine documents from before 1800. Everyone agrees that the system in Geel predates 1803 by hundreds of years and everyone agrees that foster families were paid by the family, church, or town of the boarder. Parigot references towns sending supervisors to Geel and “brokers' ' of insane persons exploiting peasant faster families. Yet there appear to be no documents and no one seems to have looked for these documents. Instead, academic journals, doctoral dissertations, and academic books all provide the same myth as Geel’s tourist office.

The most frequently cited article on Geel explains the admission procedure for boarding-out in Geel as “It was all quite informal” despite it consisting of a referral from another institution, several days of observation in the Geel infirmary, multiple conferences between members of the medical team until a consensus was reached on who the patient should be placed with, discussions with the selected foster family, the actual transfer of the patient to the family, frequent follow-ups, and potentially a return to the infirmary for placement with a different family. They credited the foster care system with making the mad docile, despite Geel’s policy of only accepting and keeping docile patients. 

A bit of history in Geel Revisited, had me double checking that I knew how centuries work:

“The sudden boom in the middle of the 17th century is principally due to financial considerations: officials in charge in Flemish villages, towns and cities sent their penniless mentally ill en masse to Geel. The Geel solution was a lot cheaper than locking them up in institutions.”

There is, as you recall, no record of boarders in Geel in the middle of the 17th century. Records only begin to show boarding-out in Geel after the French Revolution.

People make stuff up all the time. We teach children that tomatoes and peas are vegetables. Tons of people believe their ancestors' names were changed by careless or cruel agents at Ellis Island. Buffy Sainte-Marie claimed to be an Indigenous child stolen from her family and no one cared that her “adopted parents” could prove that they were her biological parents for decades until it suddenly became a scandal. Urban legends, fake news, and people accepting whatever they’re told as fact are not new parts of human nature.

The nobility paying for the art decorating churches gets to decide what that art will depict. The nobility whose donations fund the manuscript likewise decide what manuscripts are created, copied, and disseminated. The guy in charge of charitable funding and oversight can take the story made up by the Merodes and use it to justify his pet project when everyone is busy with more pressing matters.

The real question is what's wrong with me that I felt the need to transform into an investigative reporter to find the truth behind a fairy tale. No wonder the people in Geel treated me like I was a boarder – patiently humoring my delusion that this was something you could try to prove or disprove with historic documents.

Still, I couldn’t wrap my head around how so many prestigious researchers could do such shoddy work. Then again, there’s the whole replication crisis. This is especially problematic in psychology, which has more problems than just a questionable peer review system. 

It’s time to invoke a more charitable version of Hanlon’s razor: Never attribute to malice that which is adequately explained by motivated reasoning.

If you’re not paying attention to detail and you want it to be true, it’s very easy to conflate boarding-out with the exorcisms carried out in Geel. Voila! Now we have legal regulations for family care going back to 1676. Now we have a registry of boarders from 1687. And we have the gasthuis, founded in 1286, running it all. Easy-peasy, it’s all proven as true. We don’t need to verify “facts” that align with the story we already believe.

Not everything is the Stanford Prison Experiment.