A Critical Approach to Abnormality 241A HISTORY OF DEINSTITUTIONALIZATION OF MENTAL
HEALTH PROFESSIONS
In Western societies, mental disorders have conventionally been
understood as individual psychopathologies, with clinical interventions
targeting the behaviors, brains, or even speech of those diagnosed. This
approach can be traced at least as far back as the psychoanalytic method of
Sigmund Freud (1964). Freud drew inspiration from ongoing interactions
with analysands to chart a topology, or map, of the psyche composed of
separate but interacting subsystems. In his early work, this included
conscious and preconscious thoughts as well as unconscious thoughts and
affects. This afforded a foundational interpretive structure for treatment
within the psychoanalytic relationship. Such a metapsychology has been
used by clinicians thereafter to relate thoughts expressed by clients to
systems of social affect and/or instinctual drives supposedly underlying
them.
Psychoanalysis operated as a dominant force within research and
practice in abnormal psychology in America until the latter half of the
twentieth century, when an array of other modalities emerged to challenge
its authority. This move away from psychoanalysis was punctuated by the
publication of the DSM-III. As Mayes and Horwitz (2005) note, it was
here that “mental illnesses were [first] transformed from broad,
etiologically defined entities that were continuous with normality to
symptom-based, categorical diseases” (pg. 249). Meanwhile, as public
awareness spread about problems with ethics and efficacy within
institutionalized psychiatric hospitals, attention turned towards opening
more locally organized, community-based centers. In the 1960s, anti-
psychiatrists such as Franco Basaglia, Ervin Goffman, and Thomas Szasz
cultivated deinstitutionalization as a sociopolitical movement while
President John F. Kennedy’s Community Mental Health Centers
Construction Act created some policy support for it in 1963. Psychiatric
hospitals and asylums quickly began closing across the country. And yet,
the overarching goals of Kennedy’s bill, and the deinstitutionalization