Listen to thisThe foundations of my professional and academic life are rooted in the deinstitutionalization movement that closed the asylums in the mid to late twentieth century. My first job was in a day treatment program that was part of one of the new and innovative mental health centers set up in my community to work with patients being released from the asylums. The spirit of reform and socially radical approaches to care was strong. Working with what have come to be called psychiatric survivors was considered to be socially progressive and one of many movements of liberation at the time. The parameters of “madness” were being challenged for both those diagnosed and incarcerated, and those who worked with them. The notion of being freed from the confines of the institutions into the community was driven by a belief that care was best delivered in the context of friends, family, and peers.
This was the vision of the father of deinstitutionalization Franco Basaglia who saw institutional care as an extension of capitalism’s modes of discipline and control. He argued that asylums were warehouses for the poor and disenfranchised whose psychological and emotional struggles were the result of multiple levels of social trauma. Such trauma was rooted in the brutality of capitalistic appropriation and exploitation and that when the most egregious exemplars of suffering were hidden from view behind the walls of the institution, it diminished the community and filled it with a sensed of unresolved grief and loss.
Basaglia proposed that the asylums be closed, and missing community members be returned to their friends and family. He felt strongly that once returned to the community, former psychiatric inmates should be free of further psychiatric intrusions into their lives. The former patients should be supported by community members and form their own self-run homes and spaces of care.
The development of our current system of care run by mental health professionals with full engagement of psychiatric intervention was an anathema to Basaglia. He saw it as the new asylum without walls. The idea that community-based care would be delivered by professionals with little or no real connection to the community was a failure of deinstitutionalization. It was instead a new form of re-institutionalization that failed to address the primary force of capitalist society that he believed drove people mad in the first place.
At one point he was asked if he believed there was such a thing as schizophrenia. He responded that, as long as our current social system continued to produce conditions of life that were so traumatic and brutal that they could lead to madness as a response, it would be impossible to know. If we were to build a society that cared for its members with compassion and dignity and there were still instances of schizophrenia, then perhaps we could know if schizophrenia really existed.
I think of my roots in deinstitutionalization as a liberatory movement when I try to make sense of the current contestation between residential care and family-based care. The calls for the elimination of residential care in favor of returning young people to their families seems to me to be another instance of re-institutionalization. To argue that residential care is more institutionalized than family care and hence preferable, seems to me to start the conversation in the middle without anything close to adequate analysis or framing.
Don’t get me wrong, I am all in favor of deinstitutionalizing residential care, but I am equally in favor of deinstitutionalizing the family. I don’t believe that either one is structured in such a way as to promote human freedom and the capacity to live life at its fullest. I am reminded that Basaglia argued that psychiatry ought to have as its prime focus the liberation of human beings from all forms of bondage. However, he asserted that psychiatry most often finds itself as an agent of that very bondage.
I would make a similar argument for systems that claim to care for young people including Child and Youth Care. Do families and systems of care work to promote young people’s liberation from all forms of bondage that would bind them into the social norms of capitalist society? In what ways are families and institutional care simply proxies for the current regimes of exploitation and appropriation of every aspect of living creative capacity? Even when we deem them successful, do families and systems of institutional care increase or decrease the degrees to which young people can live truly full lives free of domination and discipline from the predations of the capitalist system of rule?
Of course, to even begin to answer these questions, we would have to believe that our own lives as providers could be lived with greater degrees of freedom. We would need to acknowledge that we are the products of the system that is designed to produce what Foucault called docile bodies. That is, bodies produced so that they unconsciously and seamlessly serve the prevailing system of rule. In the 20th century, it was literally the body that was to be trained to work in the factories of industrial capitalism, either as workers on the factory floor, or as managers, teachers, religious leaders, police, and the military that kept working bodies in line. In the 21st century what constitutes a docile body is more concerned with shaping and controlling our creative capacities.
In a sense, we have moved from docile bodies to docile subjectivities. Instead of training us to fit into the worksite of the factory, we are being trained to fit seamlessly into the workplace of cyber space. The role of the worker has changed, but the social apparatus designed to keep us on task and in line is largely composed of the same people and institutions. Certainly, we can count both the family and residential facilities as sites of social reproduction, where we train young people into the new world of cyber capitalism.
On the surface, that may seem a bit of an overreach. After all, very few families and perhaps even fewer residential facilities are training young people in the use of cyber technology. Often, it is the other way around with young people taking the lead in orienting parents, care givers and staff in the finer points of social media, gaming, AI, cell phones, and so on. The family and residential care are not generally sites of technical training in the world of 21st century technology. However, I would argue that the family and residential facilities are powerful sites that prepare young people to accept the domination of the existing system of domination and exploitation. And to a large degree, this is because a significant percentage of staff and parents have spent their lives as docile bodies themselves and find it difficult to see outside the system that has had a lifetime to shape them.
Parents and residential care workers quite often have very limited horizons of liberation for themselves. They often see their role as carrying out the mandates of the society in which they live. They believe in the kinds of rules and expectations that will shape young people to be good students, well behaved children, good employees, and good consumers. After all, the great majority of workers and parents believe that successfully following rules and meeting expectations is what allowed them to get as far as they have in life and to survive whatever it is they have had to survive.
For many parents and workers, their view is that you do what you have to, but the system always wins. For some, the system winning is not a bad thing. They have been inducted into the logic of the system as a reasonable and even laudatory way to run things. It may not be perfect, but it is the best society human beings have ever produced. If it is hard sometimes, that is the failure of the individual to work hard enough or make the kind of effort necessary to fit in. For others, it is more of a kind of fatalism. There is no hope of beating the system. It holds all the cards, and you must play the game or end up on the streets and on the permanent outside looking in. The system is bad and corrupt, but it will always win so it is better to play the game, even though it is rigged.
Both families and residential staff tend to fall into these perspectives and to shape their ideas and practices of care accordingly. This doesn’t mean that most families or residential facilities are intentionally cruel or abusive. Most are not, although enough are to raise ongoing concerns. Instead, both systems are methods of social induction into a system that is, to a greater or lesser degree, cruel, capricious, and more than anything indifferent to truly caring.
The philosopher Althusser referred to social structures such as families and institutional care as ideological state apparatuses. In other words, such social structures as the family and institutional care are designed to spread and replicate the ideology of the state or prevailing system of power. In the 21st century, this is less the state as government and more the state as international corporate empire. In either case, families and systems of institutional care operate to indoctrinate young people into the beliefs and habits of capitalist society and culture. Similarly, Foucault in a debate with Noam Chompsky warned against those social institutions that appeared most kind and benevolent. The kind that claims to be caring while actually exercising a very effective and pernicious form of social control and discipline.
It is this level of analysis that worries me when I see the arguments over deinstitutionalizing residential care by returning children to the family. The question of whether young people do well in residential care or in the family is so often measured according to standards of social acceptability rather than degrees of liberation from the system that put them in harm’s way to begin with. The question of the complicity of families and residential facilities in the very system that creates the conditions of brutality and neglect that puts children in harm’s way is crucial but often neglected aspect of the conversation about deinstitutionalization.
To return to Basaglia, it is the foundational structures of our contemporary society that have produced the conditions of harm and neglect that require institutional care to begin with. Basgalia argued that the asylum appeared to be an institution designed to ameliorate human suffering. However, it became an institution that both replicated the worst forms of brutality and obscured the social conditions that brought it into existence. If we are to seriously discuss the care of children in either the family or residential facility, we need to ask to what degree do these social structures act in ways that would significantly challenge the ways in which the dominant system of global capitalism is structurally designed to harm children in the first place. Does the family as it is currently configured provide a platform for resistance and revolt against the predations of our current social system of all of its members? Do residential facilities offer opportunities for children and youth to engage in their communities in ways that offer liberatory possibilities? If not, then both families and systems of residential care are at best band aids that patch over the wounds and traumas without ever addressing their root causes.
I don’t have a lot of faith in reforming either families or residential programs so that they become sites of social insurrection or collective healing. I think that, like the asylums, they probably just need to be shut down. Of course, the chances of that are marginal at best. So perhaps instead we could begin to restructure them from the inside out. Maybe we could quit seeing institutional care and family care as oppositional binaries and instead began to see both as part of community. If we began to shift our perspective in that way, we could start conversations between workers, parents, young people, and members of the community about how we could work together towards collectively organizing a different future for us all. To do that though we would need to begin deinstitutionalizing the whole system from beginning to end.
