Mental Illness: A Town for Outpatients
Friday, Mar. 14, 1969
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On the surface, Geel looks like any other country town in northern Belgium. Its cobbled marketplace is surrounded by 15th century homes and shops; its neat brick farmhouses look much the same as they did in Brueghel’s day. What makes Geel different is the fact that 1,800 of its 30,000 inhabitants are mental patients — and that most of them are not confined to an asylum but cared for by normal families in the town. While this kind of outpatient care is still relatively new to psychiatry, the good people of Geel have been sheltering the sick in their homes for more than 500 years.
In Geel, one in seven families is responsible for the care of one or two mental patients, and about 85% of the families who take in malades can truth fully say that their parents and grandparents did the same. “Here no one is afraid of mental patients,” says Psychiatrist Herman Matheussen, 38, director of the program. When a schizophrenic plowing a field suddenly stops and begins gesticulating in a hallucinatory argument with an imaginary persecutor, his foster father may say calmly, “Joseph, why don’t you finish that furrow?”
Beheaded Virgin. Geel’s enlightened approach to mental care is the product of a 1,300-year-old religious legend. According to the story, an Irish Christian princess named Dympna fled from her widowed pagan father when he ordered her to marry him. He pursued her across the sea to Geel, where, insane with incestuous lust, he beheaded her. He instantly recovered his sanity, thereby establishing Dympna’s reputation as a virgin martyr with powers to cure the mad. The date of her canonization is uncertain, but in the 13th century a chapel in Geel was named for her. Mentally afflicted pilgrims to the chapel soon overflowed the small lodge built to house them, and the Geeloise peasants, cannily combining religious devotion with thrift, began to take the pilgrims as boarders.
Those who were not cured often stayed on. They were treated as human beings by their foster families at a time when the mentally ill almost everywhere else were banished from society to asylums of appalling squalor and cruelty. Originally, Geel’s boarding system for the mentally ill was supervised by officials of the Roman Catholic Church; since 1860, the Belgian government has had the responsibility of screening the patients and administering the program.
Carefully Screened. Mental hospitals and clinics from all over Europe refer patients to Geel. Two general practitioners and four psychiatrists observe new arrivals for two to three weeks in a small hospital; about half the applicants are rejected. Those who remain —some 50 a year—are the ones found suitable to Geel’s way of life, mostly nonviolent psychotics and people with subnormal intelligence. The carefully screened families who take them in receive a practical compensation: extra hands for simple work, plus stipends of 80¢ to $2 per day. “The first time they take a patient they are doing it for economic reasons,” says Matheussen, “but after five or six years, it becomes an act of humanity.”
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