HLTHAGE 2G03 Lecture Notes - Lecture 8: Borderline Personality Disorder, Job Security, Simple Explanation

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19th century growth of institutions
Belief in isolation of hospitals, rigid scheduling, curative power of institutions
o Peoples days were planned from waking up until going to sleep
o Institutions were places of healing
Midway through the 20th century half a million US citizens in long term psychiatric care
Erving Goffman
Studied way psych institutions operate
o How do people within institutions understand what they are doing
o Published findings in famous book called Asylums
Proposed theory called
Total Institution
Closed off from outside world
Operate from their own logic and rules
Exist in their own world
You are at the whim who controls the institution
Individual scrubbed clean of previous identity called "Mortification of the
self"
To get out of an institution you have to convert. Follow their rules. "Conversion"
Criticism of Institutionalization
Costly
Ineffective: too many long term stays, too many failures after getting out
o Rosenhan on Being Sane in Inane Places
Grad students said they heard one word, and got diagnosed with schizophrenia
The mental health hospitals were incapable of seeing who's healthy or mentally ill.
Psych hospitals got upset
Inhumane: Boredom within institutions, anger written off as pathology, rigid division between
staff and patients, use of coercion.
Deinstitutionalization
Shift away from institutions
Fueled by both growing criticism and psychopharms
US: JFK launches Community Mental Health Act in 1963. Combined with laws making forced
confinement more difficult, patient population rapidly drops
1960-1980, Canada's inpatient population dropped 78% from 70,000 to 20,000 beds
Funds saved from closing hospitals earmarked for care in the community.. Yet community care has
grown slowly, patient pop , rapidly released from hospitals
One of the most well intended yet poorly executed social programmes ever undertaken
Homelessness and Shelters
If you close hospitals suddenly hundreds of thousands of people so you now see them on the
streets
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