Institutionalisation

Institutionalization is a term used to describe both the treatment of, and damage caused to, vulnerable human beings by the oppressive or corrupt application of inflexible systems of social, medical, or legal controls by publicly owned or not-for-profit organisations originally created for beneficial purposes and intents.

Public and civic organisations acquired great authority and wealth during and in the century following the Industrial Revolution in the UK and other rapidly developing nation states. The growing demands of industry for high volume labour supplies in the nineteenth century also created an ethos in which the needs and rights of the unproductive or vulnerable individual were deemed less important than the needs of society as a whole. Large numbers of beggars and high rates of crime and disease were a consequence of the massive social and economic changes experienced in the period following the victory at the battle of Waterloo. Social unrest from the Peterloo riots onwards resulted in a significant Chartist challenge to established authority on the streets of major cities like Sheffield, Manchester, and Glasgow in the 1840s.

During the period from 1850 - 1930 many types of institutions were created by public subscription, parliament and local authorities to provide housing, healthcare, education, and financial support for individuals in need. At the upper end of the scale, public boarding schools such as Eton and Harrow were founded or greatly extended to meet the growing demand for the education of the children of those in colonial service overseas. These were seen as models of social improvement, and many inferior imitations followed for the lower social orders. Virtually every borough in the UK was required by legislation to make provision for impoverished paupers, criminals, orphans, disabled war veterans, older people with no means of support, deaf and blind schools, and lifelong asylums for those with learning disabilities or mental health problems.

Distinguishing features of such institutions were:

• communal dormitories
• communal kitchens and dining facilities
• rural, isolated locations
• restrictions on personal liberty and possessions
• uniforms
• oppressive, authoritarian regimes
• strict systems of rules and codes of conduct
• boards of visitors or trustees, usually drawn from the ranks of the upper middle classes, the so called "great and good"
• hierarchial systems of management
• compulsory religious attendance
• involvement of inmates as unpaid or poorly-rewarded labour in return for small privileges
• widespread abuse of human rights, dignity
• rigid separation of the sexes
• excessive reliance on medication and physical restraints

Many of these organisations, whilst originally expressing idealistic aspirations and aims, became "total" institutions within a generation or two of their foundation, providing in some cases cradle to grave housing, occupation and social control. Inmates were often trapped in a system that provided no obvious route of escape or promotion. As late as the 1950s, in Britain, several hundred thousand people lived in Victorian asylums and "colonies".

The dangers of institutions were chronicled and criticised by reformers almost since their foundation. Charles Dickens was an outspoken and high profile early critic, and several of his novels, in particular Oliver Twist and Hard Times demonstrate his insight into the damage that institutions can do to human beings.

Enoch Powell, when Minister for Health in the early 1960s, was a later opponent who was appalled by what he witnessed on his visits to the asylums, and his famous "water tower" speech in 1961 called for the closure of all NHS asylums and their replacement by wards in general hospitals.

"There they stand, isolated, majestic, imperious, brooded over by the gigantic water-tower and chimney combined, rising unmistakable and daunting out of the countryside - the asylums which our forefathers built with such immense solidity to express the notions of their day. Do not for a moment underestimate their powers of resistance to our assault. Let me describe some of the defences which we have to storm." [1] (http://www.mdx.ac.uk/www/study/xPowell.htm)

Scandal after scandal followed, with many high profile public inquiries. These involved the exposure of abuses such as unscientific surgical techniques such as lobotomy, the experimental use of powerful drugs such as LSD, and the widespread neglect and abuse of vulnerable patients in the USA and Europe. The gowing anti-psychiatry movement in the 1960s and 1970s led in Italy to the first successful legislative challenge to the authority of the mental institutions, culminating in their closure.

During the 1980s and 1990s the hospital population started to fall rapidly, mainly because of the deaths of long-term inmates. Significant efforts were made to re-house large numbers of former residents in a variety of suitable or otherwise alternative accommodation. The first 1,000+ bed hospital to close was Darenth Park in Kent, swiftly followed by many more across the UK. The haste of these closures, driven by the Conservative governments led by Margaret Thatcher and John Major, led to considerable criticism in the press, as some individuals slipped through the net into homelessness or were discharged to poor quality private sector mini-institutions.

The resistance of many institutions to change predicted by Enoch Powell has continued into the 21st century, and there are still several thousand people permanently resident in the dwindling asylums and long stay hospital replacement campuses scattered across the UK.

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