Paper short abstract:

Drawing on ethnographic fieldwork focused on extra-institutional care in the psychiatric hospital, the paper discusses the conditions of social reintegration of chronically mentally ill persons in Poland. The theoretical focus is the functioning of a total institution in a rural context.

Paper long abstract:

This paper discusses the processes of deinstitutionalization of healthcare of chronically mentally ill persons in Poland, focusing both on the psychiatric critique of total institutions and on the shifting economic and medical contexts. The paper is based on ethnographic and historic material collected during research on the extra-institutional care organized by the biggest psychiatric hospital in eastern Poland. Since 1930s there has been implemented a form of therapy called family care, which included patients diagnosed as chronically mentally ill and therefore unable to live outside the institution who did not have any relatives. The family care consisted in delegating patients under the care of families inhabiting villages in the vicinity of the hospital. This practice was justified by psychiatric critiques of hospitalization - the environment of psychiatric hospital was considered harmful and pathological and community care was viewed more favourably. Psychiatric literature and my ethnographic research indicate strong bonds between patients and their host families which, combined with the influence of rural environment and the possibility to help with everyday chores were believed to have positive therapeutic impact even on most seriously ill patients. Nonetheless, the practice of family care was abandoned in 2012, following changes in the state healthcare system.

This paper's theoretical focus is the functioning of a total institution in a rural context. Paradoxically, it was the multifold influence of the hospital that made social reintegration of chronically ill patients possible, especially by the lessening of social fears against mentally ill persons.