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

Publication History

Received: 10 February 2025

Accepted: 12 March 2025

Article published online:
03 April 2025

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