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From Asylum to Community: Mental Health Policy in Modern America

Carl C. Bell, MD
JAMA. 1991;266(22):3205. doi:10.1001/jama.1991.03470220121048.
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This book represents another effort at chronicling the process of deinstitutionalization that began after World War II. Unlike Out of Bedlam by Ann Braden Johnson (Basic Books, 1990), the text is neither cynical nor angry but, rather, matter-of-factly explains the role organized psychiatry and politics played in the process of moving patients from the asylum to the community. It is a well-documented historical perspective, drawing on organized psychiatric documents and governmental reports to describe what happened, rather than focusing on the external forces that shaped deinstitutionalization, as was done quite well in Madness in the Streets by Rael Jean Isaac and Virginia C. Armat (Free Press, 1990).

The book begins with the cogent observation that the Second World War taught psychiatry that environmental stressors could precipitate mental illness, and, by using psychotherapy along with environmental changes, neurotic and more extreme symptoms could be arrested. As a result, psychodynamic psychiatrists became


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