Tindaro Bellinvia

Therapeutic Communities or Small Total Institutions? Psychiatric Rehabilitation and Its Contradictions

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In this paper - on the basis of a recent ethnographic experience - I have tried to distinguish the shades of meaning in the social world of therapeutic communities for psychiatric rehabilitation, the interpretation of which can be complex. I underline the renewed presence in treatment activity of eighteenth century approaches such as moral management. I highlight the greater and lesser resistances that are practiced daily in post-asylum residential structures by patients for self-protection to affirm their individuality and perception of liberty. Measures to punish and reward, constant surveillance, pharmacological coercion, limited autonomy of movement, as well as collocation in isolation, often distant from urban centres, reinforce the idea that these therapeutic communities are no more than small total institutions.

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