32 Soc. Probs. 437 (1984-1985)
Therapeutic Innovations: Psychotropic Drugs and the Origins of Deinstitutionalization

handle is hein.journals/socprob32 and id is 449 raw text is: SOCIAL PROBLEMS, Vol. 32, No. 5, June 1985

Rutgers University
The deinstitutionalization of the mentally ill represents an important set of changes in the
provision of mental health services. These changes involved the movement of patients
out of state hospitals and the formulation of policies designed to promote community-
based treatment alternatives. This paper examines the impact of psychotropic drugs on
both population shifts and policy development. Using data on changes in discharge
rates before and after the drugs were introduced in the mid 1950s, I find that the drugs
did not affect movement out of the hospital significantly. I conclude that the introduction
of psychotropic drugs encouraged policy changes that hastened the process of dein-
stitutionalization in the 1960s.
The treatment of the seriously mentally ill in the United States has undergone a series of radical
transformations over the past 25 years. One of the principal changes was a marked reduction in
the importance of state and county mental hospitals. In 1955 these institutions contained approxi-
mately 560,000 patients and accounted for almost half of all mental health patient care episodes;
by 1977 they contained but 160,000 inmates and accounted for less than 10 percent of all mental
health patient care episodes (Goldman et al., 1983; Kramer, 1977).
These sharp decreases in inpatient populations are one element in the complex of policies,
philosophies, intentions, and facts which define the deinstitutionalization of the mentally ill. Dein-
stitutionalization has two goals. The first is the depopulation of state and county mental hospitals
and other traditional institutions charged with the care of the mentally ill, and the second is the
substitution of a network of community-based institutions to provide such care (Bachrach, 1978;
General Accounting Office, 1977; Goldman et al., 1983). Deinstitutionalization has been sharply
criticized for failing to implement its second goal, and much research has examined the problems
created for patients, families, and communities (e.g., Arnhoff, 1975; Aviram and Segal, 1973;
Aviram et al., 1976; Bachrach, 1976, 1978; Bassuk and Gerson, 1978; Becker and Schulberg, 1976;
Braun et al., 1981; Freedman and Moran, 1983; Kirk and Therrien, 1975; Lerman, 1982; Morrissey,
1982; Rose, 1979; Segal and Aviram, 1978; Segal et al., 1974).
Deinstitutionalization is also grist for mills more explicitly analytic and sociological in character
(e.g., Cohen, 1979; Estroff, 1981; Scull, 1977; Warren, 1981). The state hospital has been one of
the densest symbols of disorder, estrangement, and exclusion to trouble the popular imagination,
and has provided the central image for some of sociology's most influential treatments of social
control. Goffman's (1961) delineation of total institutions, for instance, is based in part on his field
work from 1955 to 1957 in St. Elizabeths, the public mental hospital serving the District of
Columbia. Erikson's (1966) discussion of the persistence of exclusionary and segregative deploy-
ment patterns in the treatment accorded deviants in the United States likewise draws on the
character of state hospitals prior to deinstitutionalization. The breakup of these models of social
control is clearly a matter of both theoretical and practical importance.
Both the abrupt decline in state hospital populations which began in 1955, and the administra-
* This research was supported in part by a grant from the Health Services Improvement Fund of Blue
Cross/Blue Shield, and in part by NIMH grant MH16242. I would like to express my appreciation to Ron
Angel, Yinon Cohen, Carol Selman, and three anonymous Social Problems reviewers for their helpful
comments on earlier drafts. Any remaining errors of style or substance are, of course, my responsibility.
Correspondence to: Rutgers-Princeton Program in Mental Health Research, Room 203-Murray Hall, Rutgers
University, New Brunswick, NJ 08903.

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