UBC Theses and Dissertations
Asylum, commitment, and psychiatric treatment in historical context Libbiter, Andrew Paul
This thesis was a sociological, historically informed, study of the interactions between three key variables over a two hundred year period. These variables were the changing nature of asylum- based care of the mentally ill, the epistemological and professional dominance of the psychiatric profession, and changing periods of mental health legislation. Specifically, the study examined how historical and contemporary tensions between the perspectives of psychiatry and law have been manifested in British Columbia, and with what consequences. Two qualitative methodological approaches were utilised. Data was obtained principally by historical analysis, A secondary component of the study was four exploratory-descriptive, in-depth interviews with mental health consumer-activists. These interviews were conducted to explore their beliefs regarding involuntary detention and treatment. The origins of the asylum were traced in the U.K., America, and Canada. Changes in nineteenth and twentieth century strategies concerning the management of the mentally disordered were examined in terms of the dialectical interaction between the identified variables. Using British Columbia as a case study, reasons for the discontinuous decline of the asylum in the twentieth century were analysed. In particular, the emergence and consequences of a contemporary dichotomy in the mental health discourse, summarised as "rights" vs "treatment", was examined. Findings showed that mental health legislative reform is initiated in order to facilitate major changes in the management of the mentally disordered. Such changes were shown to have centred around attempts to manage the enduring consequences of the asylum. The influence of the psychiatric profession was shown to be relative to the over-arching economic and social control objectives of the State. The dichotomy of treatment vs rights was suggested to be the latest manifestation of the historical tension between psychiatry and law. The contention was made that the dichotomy is essentially false. Implications for social work and social policy were discussed and suggestions for future research made.
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