The formation of deinstitutionalization discourses in Italy and England: a cross-national archaeological study

This thesis offers new insights into deinstitutionalization and a fresh perspective on international differences in mental health care systems. Deinstitutionalization is a term used to describe a major transformation in the provision of psychiatric care (Bachrach, 1976), the move away from care delivery exclusively in long-stay psychiatric hospitals and towards the creation of community-based services. Although such shifts have been acknowledged as an international trend (Goldman et al., 1982), mental health care scenarios are characterized by high levels of differentiation. The rationale for this study was that these differences required more careful consideration.
The thesis challenges the widely held assumption that deinstitutionalization is an international trend. It presents a cross-national archaeology of the emergence of the deinstitutionalization discourses in Italy and in England. Legal and psychiatric documents produced in the two countries are analysed as evidence of the national conditions that allowed the acceptance of this shift in the two countries. The findings drawn from the analysis show multiple ruptures and different strategies at the core of the national discourses and practices. In summary, in the English case the emergence of deinstitutionalization was strictly related to a government driven process of rationalization, whilst in the Italian case deinstitutionalization was the result of a strategy aimed at the demolition of the system established during the Fascist period. The thesis illustrates how these differences led to the emergence of heterogeneous psychiatric and legal practices in the two countries. The most striking of these is the complete abolishment of the psychiatric hospitals in Italy. Through the comparison of, and the analysis of the differences between, how the English and Italian deinstitutionalization discourses and practices emerged, this study challenges what is often taken for granted, for instance the notion of the role of the introduction of drugs in the acceptance of treating psychiatric patients in the community or the idea of anti-psychiatry as an international movement.
Key words: deinstitutionalization; discourse; archaeology; Foucault; cross-national