Institutionalisation and the Long-Term Course of Schizophrenia
It is ironic, in a field with many other ironies, that a number of studies (Johnstone et al, 1981; Mathai & Gopinath, 1985; Curson et al, 1992) have questioned what Mathai & Gopinath call “the hitherto inviolate (and ingenious) concept of institutionalisation”, at a time when massive deinstitutionalisation is casting into relief some of the practices to which it refers (Team for the Assessment of Psychiatric Services, 1990; Murphy, 1991; Abrahamson, 1993). However, the gap that this creates between theory and practice may be risky for the future. It would certainly be a major failure if the institutional era with which psychiatry's early professional identity was so intimately bound up were to end in unresolved contradictions. With this background, it will be argued here that re-examination of institutionalisation in the context of the longitudinal course of schizophrenic disorders both confirms the validity of the concept and sets a demanding agenda for alternative care in the community.