Shortly before the French Revolution, economic shifts led to it being dramatically more difficult for people to provide care to their friends and family. This lack of adequate care and supervision led to complaints about disruptive and alarming behavior. These complaints led to laws requiring a wide collection of people considered mentally ill or disabled to be locked away. The men responsible for incarceration saw that this was inappropriate and cruel. Asylums had previously only involved people who were wildly disruptive to the point of being a safety concern. These men of science and ethics began the process of reforming the penal institutions they oversaw and developing the asylum system.
PJ Triest was made responsible for the asylums in a district in what is now Belgium. He wanted to renovate the dungeons that housed the mentally ill in his district in order to provide more humane lodgings. He had been a student in Geel, lodged with a local family, and knew that the school had been shut down as a result of the revolution. He saw the opportunity to lodge his patients with families in Geel, who had previously housed students and relied on this income. This worked well and demonstrated an obvious truth – only a small portion of patients required restraints to avoid being disruptive. The majority of patients, who had lived peacefully in their communities until recently, thrived as part of a family and clearly did better in Geel than in a dungeon.
Had this not been a time of political chaos, Triest would have needed layers of approval to do this. In order to avoid getting in trouble, he claimed that patients had always been boarded out in Geel. The argument was that they hadn’t created a new system, they’d simply formalized an existing tradition. This wasn’t entirely false, as Geel was a regional center for being certified as a member of the deserving poor in order to legally beg. The boarding-out of those who needed care was practiced throughout Europe prior to laws requiring institutionalization. Since he was solving a problem, his superiors let it slide.
He and his collaborators then worked to establish a system of asylums throughout Belgium, providing various levels of care: acute care, chronic care for the docile incurable, and chronic care for the disruptive incurables. They publicized this system as a model for other countries to copy. This publicity sometimes included the claim that compassionate care can cure madness. While other colonies were established following the Geel model of foster care, it was significantly less popular than other, more restrictive, systems of custodial care. Most places instead housed chronic patients in small dormitories with a live-in staff on asylum grounds, rather than placing them with individual families in a community.
A lot of people with very different symptoms were and are classified as mentally ill. Some of these people will revert to the mean with time. Some are responding to circumstances at home and recover when they’re removed from them. Others will never be considered normal, but we don’t need to be normal to live meaningful lives, and they can thrive with support. A small portion of people cannot behave in ways that allow them to integrate into a community. This last group of patients was sent to Geel in the very beginning, because the prisons where they were being held were being renovated and they needed somewhere to go. These people were restrained and/or locked in rooms while in Geel and placed in closed asylums once renovations were completed. All patients placed in Geel were strictly supervised, required to follow numerous rules, and were required to remain in a specific geographic area.
Geel cured madness in that people do not do well when we lock them in dungeons. Incarceration in prisons was preventing people from recovering on their own or maintaining their usual level of functioning because incarceration actively harms people. People who needed time or a change of scenery recovered while living in Geel and were freed. People who continued to require care stayed on with their foster families in Geel. Just like any people whose economy relies on a sometimes troublesome population – students, tourists – the residents of Geel received this new group with a reasonable level of welcome. There were strict limits on acceptable behavior for patients and, likewise, there were strict limits on the amount of teasing or discrimination against patients permitted by residents.
As the asylum system throughout Belgium was built out, only “chronic incurables” were transferred to Geel. The patients placed there were expected to remain there for the rest of their lives. Because they were not considered curable, they were spared the regrettable “treatments” other patients were subjected to. Patients in Geel were and are provided with custodial care. The reason so many patients ended up being provided with custodial care in Geel, rather than in their home communities, was because of a wave of discriminatory laws preventing them from being able to remain at home. These laws were repealed in the 1990s and patients stopped being placed in foster care in Geel. Instead, people requiring custodial care in Belgium are largely provided with an easier to navigate version of the same menu of care options as people in the US and Canada.
When the fight for deinstitutionalization was gaining momentum, American doctors turned to Geel as a humane alternative to community care. Like their forebearers who argued that the mentally ill needed to be segregated from the wider world, they did not believe it was safe for them to receive acute or custodial care while living in their home communities. Some believed that the family of origin was the root of mental illness, so patients needed to be relocated in order to recover. They popularized the “compassionate community” of Geel as a way to make the segregation of the mentally ill more palatable. This was a resounding success in that even people who are deeply against institutionalization of the mentally ill fantasize about being able to be placed in the [penal] Colony of Geel.
While this Geel revival was a success in terms of generating media attention, it failed at getting anyone to actually copy the Geel model of family care. Mental hospitals required to release patients did not place them with foster families near the hospital, so they could easily be supported and supervised. Instead, patients were placed en masse in boarding homes with minimal supervision, often in areas where there was no access to ongoing support. This led to widespread neglect and abuse. Once again, a lack of care led to neighbors complaining and demanding patients be removed from communities.
The utter fiasco of the transition from the era of institutionalization to a “community care” system that was effectively never built makes it easy to understand why patients and caregivers can look longingly to Geel. Yes, Geel was a penal colony devised to isolate them from the wider world. It also largely accepted people as they were (incurable), provided them with their basic needs (food, shelter, clothing, medical care), and encouraged them to live meaningful lives as members of a family and a community.
After all this played out, what stuck in the popular imagination is a story about the young Saint Dymphna inspiring families throughout the world to abandon their mad in Geel, where the peasants provide endless love and compassion from the goodness of their saintly hearts.
Thank you - now you need to put these posts into a book, Cori! Fascinating. The only other model of community care that I know of is Shared Lives Plus in the UK. Alex Fox built this organization (he's moved on now) but you should read his excellent Escaping the Invisible Asylum https://www.amazon.ca/New-Health-Care-System-Invisible/dp/1447341678/ref=sr_1_1?crid=D8MRMM0NSHF7&dib=eyJ2IjoiMSJ9.WH3CJgEKJVIgNhmeAafoqZ6e3LgLlcpy_1520uSbZ6g.rzjq1e1ssdKh7kave3AD7b5_6KGrUUVWX-lbyxZk70I&dib_tag=se&keywords=asylum+alex+fox&qid=1725286130&sprefix=asylum+alex+fox%2Caps%2C92&sr=8-1. And this is the homeshare web page for Shared Lives Plus https://homeshareuk.org/. This is as close to the Geel ideal that I've seen.