Understanding Institutions

Abstract

Background: Since Goffman’s seminal work on psychiatric institutions, deinstitutionalization has become a leading term in the psychiatric debate. It described the process of closure or downsizing of large psychiatric hospitals and the establishment of alternative services in the community. Yet, there is a lack of clarity on what exactly the concept of institutionalization means in present-day psychiatry. This review aims to identify the meaning of psychiatric institutionalization since the early 1960s to present-day.

Method: A conceptual review of institutionalization in psychiatry was conducted. Thematic analysis was used to synthesize the findings.

Results: Four main themes were identified in conceptualizing institutionalization: bricks and mortar of care institutions; policy and legal frameworks regulating care; clinical responsibility and paternalism in clinician-patient relationships; and patients’ adaptive behavior to institutionalized care.

Conclusions: The concept of institutionalization in psychiatry reflects four distinct themes. All themes have some relevance for the contemporary debate on how ..