Deinstitutionalization

Institutional Care as Housing Policy

Deinstitutionalization has been a long-evolving reaction to the dominant institutional solution for a variety of problems. Institutional care and control were appealing for a variety of reasons, but none was more important than the institution's ability to provide an alternative to a conventional home for those people who had no kin, were extremely burdensome to their families (often because of their disruptive behavior), or whose legal and social transgressions were deemed to warrant isolation in the service of social order. Many famous U.S. citizens were “institutionalized” in private or public facilities: As a boy, baseball great Babe Ruth spent several years before World War I in a Baltimore industrial home that was run by the Catholic church, because his parents couldn’t afford to raise him; during the 1960s, saxophone masters Art Pepper and Frank Morgan, both heroin addicts, played in the same jazz band at San Quentin State Prison near San Francisco, and bebop genius (and polypharmacist) Charlie Parker wrote the famous song “Relaxin’ at Camarillo” in reference to his sojourn of several months at a state mental hospital in southern California in 1947.

Most institutions were intended to be transitional settings. They were to subject their residents to a disciplined and beneficial regime of living that would prepare them to resume a place in the noninstitutional world. As it happened, however, a large percentage of institutional residents stayed for a long time or returned repeatedly when their lives outside unraveled. Young men and women grew up in orphanages because their families could never manage to support them or had brutalized them; adults with severe mental illness languished for years in mental hospitals for lack of another receptive home; alcoholics, addicts, and criminals returned repeatedly to hospitals and prisons when their “community adjustment” soured. Institutions of all sorts grew well beyond the population size for which they had been designed. Many, most notably mental hospitals and the “poorhouses” or “county farms” that evolved into public old-age homes, became internally differentiated to separate “chronic” from “acute” cases or, [Page 111]in less clinical language, those with some hope of getting out and those who would never leave. Inevitably, the “hopeful cases” got the most attention, and the others, the “custodial cases,” were left to spin out their lives in sordid conditions of neglect. The term back ward, used to describe those institutional regions inhabited by the hopeless cases, derives from the location of these areas in the rear parts of buildings hidden from public view.

...