[History of ideas and psychiatric reform: Italy, Great Britain and Germany].

Abstract

Ideas and societal structure interact. This paper focuses on relationships between the history of ideas and mental health reform in Italy, Great Britain and Germany. The Italian reform process is based on the ideas of Jean-Paul Sartre, Michel Foucault, phenomenology and Antonio Gramsci, with issues of human rights and social inclusion taking central stage; diagnostic concepts are (temporarily) put in brackets. In Great Britain, there is a strong tradition of empiricism coupled with Erving Goffman's institutional critique and analysis, evangelical (and Quaker) traditions of 'pauper and lunacy' politics, and high-quality evaluation of services. In (the Federal Republic of) Germany, Foucault, Goffman, anthropological-phenomenological psychiatry and international impulses are relevant. With its radical institutional critique and transformation towards comprehensive community care (in the face of tight finances), Italy's mental health reforms are impressive. In Great Britain there is a long-term orientation towards community mental health care, evidence-based services and a focus on patient rights (mixed with neoliberal elements in recent decades). In Germany, mental hospital reform was carried out based on the recommendations of a national Psychiatric Enquiry (White Paper, Psychiatrie-Enquête, 1975) but large psychiatric institutions are not closed, community psychiatric transformation is delayed. There is a recent surge of integrated care models with flexibility of care provision across the inpatient-community divide.