Geistesgeschichte und Psychiatriereform: ein Blick auf Italien, Großbritannien und Deutschland

Zusammenfassung

Ideen und Gesellschaftsgestaltung stehen in Wechselwirkung. In diesem Artikel werden Beziehungen zwischen Ideengeschichte und Psychiatriereform in Italien, Großbritannien und Deutschland untersucht. Die italienische Reform bezieht sich auf Jean-Paul Sartre, Michel Foucault, die Phänomenologie und Antonio Gramsci, im Zentrum stehen die Themen Person-Rechte und Teilhabe. Diagnostische Konzepte werden im Reformprozess (zunächst) hintangestellt. In Großbritannien imponieren Traditionen des Empirismus, evangelikale Traditionen der Armen- und Psychisch-Kranken-Hilfe und die Institutionskritik (Erving Goffman) neben hochwertiger Versorgungsforschung. In Deutschland waren Foucault, Goffman, die anthropologisch-phänomenologische Psychiatrie und internationale Impulse wesentlich. In den Psychiatriereformen imponieren in Italien die Radikalität der Institutionskritik und die Transformation zur Gemeindepsychiatrie (bei knappen Ressourcen), in Großbritannien eine über die politischen Lager reichende Orientierung auf Gemeindepsychiatrie, Evidenz- und Rechte-Orientierung mit neoliberalen Elementen, in (der Bundesrepublik) Deutschland die Psychiatrie-Enquête mit der Reform psychiatrischer Fachkrankenhäuser, dem Erhalt großer psychiatrischer Institutionen, einer relativ späten gemeindepsychiatrischen Transformation und einem in jüngerer Zeit starken Schub für integrierte Versorgungsformen.

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.

Schlüsselwörter

Psychiatriereform - Ideengeschichte - Italien - Großbritannien - Deutschland - Gesundheitsversorgung

Keywords

Psychiatric reform - History of ideas - Italy - Great Britain - Germany - Health care

• Literatur

• 1 Thornicroft G, Tansella M. The Mental Health Matrix. A manual to improve services. Cambridge: Cambridge University Press; 1999
• 2 Kibria AA, Metcalfe NH. A biography of William Tuke (1732-1822): Founder of the modern mental asylum. Journal of medical biography 2016; 24: 384-388
• 3 Raynor MJ. The work of Antony Ashley Cooper, the Seventh Earl of Shaftesbury, for social reform an environmental hygiene in the nineteenth century. The Journal of the Royal Institute of Public Health and Hygiene 1963; 26: 216-223
• 4 Porter R. Two Cheers for Psychiatry! The Social History of Mental Disorder in Twentieth Century Britain. In: Berrios GE, Freeman H, Hrsg. 150 Years of British Psychiatry 1841–1991. London: Gaskell/Royal College of Psychiatrists; 1991
• 5 Scambler G. Liberty’s Command: Liberal Ideology, the Mixed Economy and the Briish Welfare State. In: Ikkos G, Bouras N, Hrsg. Mind, State and Society: Social History of Psychiatry and Mental Health in Britain 1960-2010. Cambridge, New York: Cambridge University Press; 2021: 23-31
• 6 Steinberg H. [25 Years After Re-Unification of Germany: An Overview on Eastern German Psychiatry. Part 1: Post-War Era, Pavlovization, Psychopharmacological Era and Social Psychiatric Reform Movement]. Fortschritte der Neurologie-Psychiatrie 2016; 84: 196-210
• 7 Brink C. Grenzen der Anstalt: Psychiatrie und Gesellschaft in Deutschland 1860 – 1980. Göttingen: Wallstein; 2010
• 8 Söhner F. Psychiatrie-Enquete: mit Zeitzeugen verstehen. Eine Oral History der Psychiatriereform in der BRD. Köln: Psychiatrie Verlag; 2020
• 9 Martinelli A, Killaspy H, Zarbo C. et al. Quality of residential facilities in Italy: satisfaction and quality of life of residents with schizophrenia spectrum disorders. BMC psychiatry 2022; 22: 717
• 10 Polin K, Hjortland M, Maresso A. et al. "Top-Three" health reforms in 31 high-income countries in 2018 and 2019: an expert informed overview. Health policy (Amsterdam, Netherlands) 2021; 125: 815-832
• 11 Fioritti A. Is freedom (still) therapy? The 40th anniversary of the Italian mental health care reform. Epidemiology and Psychiatric Sciences 2018; 27: 319-323
• 12 Wing JK, Brown GW. Institutionalism and Schizophrenia. A Comparative Study of Three Mental Hospitals 1960-1968. Cambridge: Cambridge University Press; 2009
• 13 Goldberg D. The future pattern of psychiatric provision in England. European archives of psychiatry and clinical neuroscience 1999; 249: 123-127
• 14 Burns T. Community-Based Mental Health Care in Britain. Consortium psychiatricum 2020; 1: 14-20
• 15 Anderson M, Pitchforth E, Edwards N. et al. United Kingdom: health system review 2022. Health Systems in Transition. 2022. 24. i-192
• 16 Bauer M, Kunze H, von Cranach M. et al. Psychiatric reform in Germany. Acta Psychiatrica Scandinavica 2001; 104: 27-34
• 17 Deister A, Willms B. Am Anfang war das Regionalbudget. Zur konzeptuellen Vorgeschichte der Modellprojekte nach § 64b SGB V. Nervenheilkunde 2023; 42: 759-761
• 18 Bechdolf A, Nikolaidis K, von Peter S. et al. Utilization of Psychiatric Hospital Services Following Intensive Home Treatment: A Nonrandomized Clinical Trial. JAMA Netw Open 2024; 7: e2445042
• 19 Priebe S, Badesconyi A, Fioritti A. et al. Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries. BMJ (Clinical research ed.) 2005; 330: 123-126
• 20 Chow WS, Priebe S. How has the extent of institutional mental healthcare changed in Western Europe? Analysis of data since 1990. BMJ open 2016; 6: e010188
• 21 Bührmann AD, Schneider W. Vom Diskurs zum Dispositiv. Eine Einführung in die Dispositivanalyse. Bielefeld: transcript. 2008