Ideology and Practice of Deinstitutionalization

JOURNAL OF SOCIAL ISSUES VOLUME 37, NUMBER 3, 1981

Ideology and Practice of Deinstitutionalization

Barbara J. Felton and Marybeth Shinn

New York University

This article compares the history and current status of deinstitutionalization efforts for the mentally ill, criminal offenders, and the aged in need of long-term care. Evidence from other articles in this issue, and elsewhere, suggests that similar ideologies of deinstitutionalization have guided thinking for all three groups but that practices have diverged. Only the mentally ill have moved out of institutions in large numbers, and, for all three groups, many “alternatives” differ little from institutions. Society regards all three groups negatively, but with differences that are reflected in treatment goals. Effective technologies for community treatment are available for the mentally ill, and meth- ods for preventing institutionalization are available for the aged, but few members of even these groups receive such services. The diver- gence between ideology and practice for the three groups highlights both the constructive force of ideology in guiding policy and research, and its capacity to distort common perceptions of practice.

The call for deinstitutionalization has led to a multiplicity of policy initiatives, to the development of innovative treatment practices, and to shifts in the residential location of thousands of people. This article considers deinstitutionalization as an ideology and examines the role of ideology in service delivery and in the formulation of research questions. It explores both the constructive force of ideology, and its capacity to distort our perceptions of our practices and their consequences. It does so by considering the historical context of deinstitutionalization efforts; examining recent practices; and comparing societal attitudes and program effectiveness for each of the three populations treated in this volume: the mentally disabled, criminal offenders, and older people

The authors are grateful for the critical and creative comments of Wil- liam A. Brown, Robert B. Coates, David H. Krantz, M. Powell Lawton, Stan- ley Lehmann, and Mary Ann Test.

Correspondence regarding this article may be addressed to Dr. Barbara J. Felton, Department of Psychology, New York University, 6 Washington Place, Room 766, New York, NY 10003.

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IDEOLOGY AND PRACTICE 159

in need of long-term care. We conclude that ideology and practice are quite divergent. Practices toward the three groups have diverged increasingly since the close of the nineteenth century despite the similarity of ideologies about each.

HISTORY Before 1900

Prior to 1820, institutions were almost unknown. Americans rarely incarcerated deviant or dependent persons. Criminals in the Colonial period might be fined, whipped, put in the stocks, expelled from the community, or even hanged, but they were not imprisoned (Rothman, 197 1). Families cared for their insane members; the aged and the poor were supported at home or lived with neighbors or relatives. Local authorities provided financial support for these arrangements, but typically did not erect build- ings for public care (Rothman, 1971; Scull, 1977). The few institutions that did exist in larger cities had none of the features Scull ( 1 977) defines as characteristic of modern institutions: substantial involvement of the state, segregation from the surrounding community, categorization of different sorts of deviants, and consign- ment of each group to treatment by different experts,

Modern institutions, Rothman (1971) argues, were an invention of Jacksonian era reformers who saw crime and insanity as outgrowths of a diseased social order. Penitentiaries and asylums were intended both to eradicate deviance and to model regular and rational rules of social organization.

In the 1830’s, the new penitentiaries were the pride of the nation, and attracted numerous foreign visitors, among them Alexis de Tocqueville. Asylums claimed recovery rates of almost loo%, although the patients they supposedly cured frequently turned up later on their lists of new admissions (Caplan, 1969). At one asylum, “87 persons contributed 274 recoveries” (Roth- man, 1971, p. 131), in an early example of what would later be called the “revolving door.”

Almshouses were receptacles for the elderly poor and other paupers during this period. Conditions were purposely made less desirable than those of the lowest paid workers in the community to discourage malingering at public expense (Moroney & Kurtz, 1975).

By the middle of the nineteenth century, institutions of all types had lost much of their glamour. Utopian calls for institutions to serve as models for society faded as facilities grew more

160 FELTON AND SHINN

massive and overcrowded. Reform gave way to custody. Accord- ing to Rothman (1971), institutions for the first time became primarily a means for controlling deviant and dependent populations. Inmates in prisons, mental asylums, and almshouses were disproportionately poor and either foreign born or second-gen- eration Americans. Investigatory commissions in all three types of institutions found evidence of neglect and abusive punishment.

Some critics of mental institutions advocated community- based treatment in terms that sound remarkably modern, but they had little effect. Scull (1977) argues that they could not, for re- leasing patients who could not provide for their own subsistence would have required payments to maintain them in the community when such payments were not available to the unem- ployed more generally. In fact, before the Civil War, President Pierce vetoed a bill to use federal lands to support the indigent insane precisely because such charity might lead to federal support for all the poor (Caplan, 1969, p. 83).

After 1900 In the first years of this century, progressives emphasized

individualized treatment, based on a careful examination of the background of individual patients or offenders. However, according to Rothman (1980) the reforms instituted in the pursuit of individualized treatment expanded the role of the state in controlling deviant groups, in part by leading to increasing numbers of people in institutions.

In criminal justice, practices such as the indeterminate sentence, probation, parole, and plea bargaining were developed to tailor supervision to the individual criminal’s background and needs. However, indeterminate sentences did not shorten and may have increased prison terms; parole, at the end of these terms, certainly extended the duration of supervision. Examina- tion of sentencing patterns suggests that probation took the place of suspended sentences and brief jail terms more often than it substituted for incarceration (Rothman, 1980).

In the juvenile court, efforts to tailor justice to fit the child rather than the crime resulted in reforms that absolved the Ju- venile court of the requirements of due process. “Child savers” frequently “rescued” youths from their inadequate homes by re- moving them to training schools or placing them on probation (Platt, 1969).

In mental health, the ideology of individualized treatment led to calls for the development of psychopathic hospitals, out-


patient clinics, and community-based aftercare for those able to benefit from treatment. However, neither psychiatrists nor patients moved into the community in any appreciable numbers; rather, between 1880 and 1940 the mental hospital population increased 12.6 times, while the general population increased only 2.6 times (Rothman, 1980, p. 374).

Although population figures (Rothman, 1980) suggest that mental asylums retained some of the functions of almshouses for the aged, progressive reformers attempted to remove the stigma of pauperism from older people by moving them out of almshouses and into private boarding homes. The increased accessibil- ity to boarding homes afforded by the Social Security Act of 1935 led to increased use of these institutions as well. In 1939 the first national census of nursing homes (then indistinguishable from boarding homes) turned up 1,200 facilities with 25,000 beds; by 1954 the number of beds had increased sevenfold (Moroney & Kurtz, 1975).

RECENT TRENDS Rates of Deinstitutionalazation

The 1960’s and 1970’s saw calls for non-institutional placements for the mentally ill, criminal offenders, and older people in need of long-term care. But despite the continued use of a common ideology for the three groups, and common economic and social circumstances, actual practices have diverged. The population of mental hospitals has been reduced, but in part by shifting elderly mental patients to other forms of institutional care, and rates of incarceration in prisons have increased.

The mentally ill have been shifted out of mental institutions to a remarkable extent. The resident population of public mental hospitals declined from a peak of 559,000 in 1955 to 215,500 in 1974, or by 57 percent (General Accounting Office, 1977, p. 8).

For criminal offenders, there was a modest decline in rates of prison incarceration in the 1960’s, but Scull (this issue) notes that the downturn was short-lived, and that both institutions and community placements have been used with increasing frequency since then. Sarri (this issue) indicates that in early 1981 there were over 550,000 people in local, state and federal institutions of all kinds, an increase of almost 50% in the last five years; and an additional two million in probation, parole, and community-based diversion programs. The United States is now third in the world, behind the Soviet Union and South Africa, in its rate of impris-


onment (Doleschal & Newton, Note 1). Sarri’s (this issue) conclusion that rates of incarceration for juvenile offenders are unre- lated to crime rates suggests that the massive increase in the numbers of people controlled by the criminal justice system is not simply a response to increased crime.

The number of older people in nursing homes has also risen dramatically over the last two decades to a current estimate of one and a quarter million (Vladeck, 1980), in part due to the increasing numbers of older people, especially those over 75. Those aged in need of formal long-term care arrangements have gone primarily to institutions, although the number and type of residential alternatives to nursing homes have also increased (Sher- wood, 1975).

The same social welfare programs that have permitted the rapid shift of the mentally ill from state hospitals to the community have also paid for new nursing home beds, and for many elderly persons, “deinstitutionalization” has meant only relocation from one type of institution to another. The aged were the first to be affected by deinstitutionalization efforts in mental hospitals (Sherwood, 1975; Lerman, Note 2), and ex-mental patients have swelled the numbers of the aged in nursing homes and domicili- ary care (Gottesman & Brody, 1975).

Making Alternatives Community-Based Rates of deinstitutionalization, although lower than many

policy makers have advocated, may still overstate the extent to which members of the three population groups are actually in- tegrated into the community. Many so-called alternative programs have little to distinguish them from institutions.

In his article, Coates (this issue) differentiates community- based programs for delinquents from institutions in terms of the extent and quality of relationships between clients and the exter- nal community. He notes that small programs that are labeled group homes and physically located within the community but lacking in these relationships may be as “inhumane and institution-like as the largest training school located miles from urban settings.” In adult corrections, Greenberg (1975) argues that most halfway houses and group homes are, in fact, institutions in the sense that they exercise coercive control equal to that of prisons.

Coates’ continuum of community linkages can be applied to mental health and long-term care of the elderly as easily as to criminal justice. At one end of the continuum in mental health, Lamb and Goertzel describe boarding homes as “small long-term


state hospital wards isolated from the community” (1971, p. 31), and Estroff (this issue) documents in detail the social isolation of most of the mentally ill. At the other end of the continuum are many of the successful programs Test (this issue) describes, that serve to link psychiatric clients with community members and resources.

A survey of community integration among residents of sheltered care facilities for the aged (David, Moos, & Kahn, in press) showed that residents in congregate apartment facilities were far more likely to engage in a variety of community activities than were residents of skilled nursing homes. This variation was due to agency policies as well as residents’ functional ability.

In sum, deinstitutionalization, in the sense of reducing the numbers of people in traditional institutions, has occurred to a much greater extent for the mentally ill than for older people in need of long-term care. It has occurred only minimally for juvenile offenders and not at all for adult criminals. Even where deinstitutionalization has occurred, it has become obvious that many community-based programs have little to distinguish them from institutions.

SOCIETAL ATTITUDES AND TREATMENT GOALS Despite commonalities in the ideology of deinstitutionaliza-

tion for the three groups considered here, actual treatment practices have diverged. Variations in treatment of these groups reflect differences in assumptions about who these “deviant” people are, what the origins of their problems are, how threatening they are, and what’s needed to make them a place in, or alongside of, society. In this section, we will examine similarities and differences in societal attitudes toward the three groups by comparing the evaluation criteria used to assess the success of our treatment efforts with each, the community and family influences on place- ment decisions, and the relative weight placed on needs and rights for each group.

Treatment Goals and Evaluation Criteria For each of the three groups, controversies exist about the

appropriateness of treatment goals and the adequacy of the criteria used to measure treatment success. However, the goals and measures that have traditionally predominated provide telling information about societal attitudes toward the groups and begin to explain differences in patterns of deinstitutionalization.


The criminal justice system is seen as responsible for pro- tecting society and providing retribution for wrong-doing- responsibilities reflected in its traditional goals of isolating offenders, reforming or rehabilitating them, deterring others, and exacting retribution. The short-lived decline in incarceration rates in the 60’s reflected an increased emphasis on rehabilitation and the conclusion of national study commissions that imprisonment is incompatible with this goal (cf. Shinn & Felton, this issue). However, community correctional programs fail to isolate offenders, and also are perceived by many to be inconsistent with the goals of deterrence and punishment. Thus recent dramatic increases in incarceration rates may reflect increasing social concern with law and order.

Recidivism, which may be thought of as a measure of rehabilitation, has been the traditional outcome criterion for evaluating the success of correctional programs, perhaps because isolation and retribution are perceived as automatic concomitants of incarceration and because deterrence is difficult to assess. Other criteria reflecting a rehabilitation stance, such as employment rates or educational attainment, have been used occasionally and some authors (e.g., Lerman, 1968) have advocated community programs on humanitarian rather than utilitarian grounds. How- ever, most evaluations of success in criminal justice have focused upon rates of reincarceration, although these rates are influenced as much by police and court behavior as by offender behavior.

Recidivism, meaning rehospitalization, has also been used traditionally in mental health as the measure of treatment success. Recent conceptualizations of mental illness and its treatment, however, have broadened evaluation criteria to include psychological and skill-based benefits to the patient as well as financial and social benefits that society realizes through improved patient functioning. Thus, as Dellario and Anthony (this issue) suggest, appropriate criteria for evaluating treatment success in mental health include: 1) client skill gain, 2) benefits to the society and client as reflected in such data as employment rates and recidivism, 3) client quality of life, including remission of symptoms, and 4) client satisfaction. Within the treatment process, our ability to treat mental patients in the least restrictive setting has emerged recently as a measure of our capacity to respect the rights of mental patients. For the most part, however, evaluations rely more heavily on recidivism rates than on information about client quality of life and functioning.

Concern about “client” quality of life characterizes some cur-


rent thinking about treatment of the aged as well and is reflected in reliance upon measures of physical and emotional well-being as indices of treatment “success” with the aged. Well-being, usu- ally inferred from assessments of happiness and health, the latter evidenced in survivorship and functioning, coincides with the last two criteria listed by Dellario and Anthony for treatment success in mental health.

Cost, both fiscal and social, weighs heavily in selection and evaluation of treatment options, suggesting that “dependent” groups in our society, regardless of the nature and source of their “problems,” are evaluated according to their liability to society. Shifting the burden of cost away from states and localities has figured prominently in the shifting of both mentally ill and elderly clients out of state hospitals (Moroney & Kurtz, 1975). So- cial attitudes are also reflected in the amount of community resistance shown toward the groups and in our views of the proper roles of the family in decision-making about their members.

Community and Family Influences That most people dislike and avoid mental patients is evident

in documented attempts to block their entry into many communities and in Piasecki’s (cited in Rabkin, 1979) estimate that one community program for the mentally ill has been closed or pro- hibited for every one that survives. Accordingly, professionals have traditionally wielded more decision-making authority than family members over the disposition of the mentally ill, in part, perhaps, because families have been implicated as etiological agents in the onset of mental illness.

Decisions about the disposition of offenders have almost exclusively been seen as the proper domain of police and courts and family members have been seen as potentially responsible agents in criminal behavior as well as mental illness. Criminal offenders seem to be no more welcome than mentally ill in communities: attempts to exclude homes for delinquent and disturbed adolescents from local neighborhoods are not unusual (e.g., Wilgus & Epstein, 1978).

Society tends to accommodate the aged in its midst more readily than criminal offenders or the mentally ill. Norms obli- gating the family to care for the aged are strong, and nursing homes are resorted to only when efforts at sustaining family care have been exhausted (Tobin & Kulys, this issue). Community resistance to residential settings for older people is not as widely documented as resistance to residences for the mentally ill and


criminals: older people in social distance studies are evaluated less negatively than criminal offenders and the mentally ill; however, they are evaluated more negatively than people with a variety of specific physical impairments (see Tringo, 1970). “Ageism” is frequently cited as a factor in differential service delivery to older people (e.g., Butler, 1980). As a society, we do not take for granted the legitimacy of any of these groups’ claims on our time and resources.

Needs and Raghts Evaluation criteria, based on intervention goals, tend to focus

on needs for service or what Scull (this issue) has termed “positive rights.” Traditionally, however, rights have been defined negatively as freedom from intervention (Glasser, 1978). The lan- guage of rights is predominantly negative from the Bill of Rights (“Congress shall make no law . . .”) to the proposed Equal Rights Amendment (“Equality of rights under the law shall not be de- nied or abridged . . .”).

Rothman (1978) notes that attention to the needs of disad- vantaged groups to the neglect of their rights was a hallmark of the Progressive era. Recently, however, court decisions have emphasized the rights of the mentally iH to treatment in “the least restrictive setting” possible and the rights of criminal offenders to avoid compulsory “therapeutic” programs in prisons.

Rothman (1978) warns that the expansion of rights, while welcome, is only a partial solution to the problems of deviant and dependent members of society. Needs remain, and may be ex- acerbated by a focus on rights. Scull (this issue) concludes that we have failed to secure either rights or needs for our three target populations. Moving the mentally ill out of institutions may have saved some from potentially coercive “overhospitalization,” but Scull argues that the numbers of those thus saved are not large. Deinstitutionalization has also promoted a policy of neglect, rein- forced by desires to reduce costs. Despite the existence of a few exemplary programs, Estroff (this issue) shows that, for the vast majority of past and potential patients, needs have not been met.

A similar pattern is evident for older people in need of long- term care. Much of the literature Scull (this issue) cites as evidence for neglect of the mentally ill refers to the senile or oth- erwise impaired elderly. Older people’s rights are no more secure and their needs no better met in nursing homes than in mental hospitals. Nursing homes often violate fundamental rights such as freedom of speech, control of personal property, and freedom


to come and go at will (Glasser, 1978), and scandals involving poor quality of treatment have been frequent (Vladeck, 1980).

Scull suggests that most criminal offenders, in contrast to the mentally ill and elderly, are concerned exclusively with rights. He contends that community programs typically do not decrease coercion. The extension of control over additional individuals may increase it. Diversion programs may be a special danger to rights, since they frequently require the accused to admit guilt in order to qualify for diversion and thus avoid the risk of a more serious sentence if tried and found guilty.

For all three populations, Rothman’s question, “will we as a society be able to recognize and respect rights and yet not ignore needs?” (1978, p. 95) must remain a central concern of our deinstitutionalization policy.

THE EFFECTIVENESS OF COMMUNITY AND INSTITUTIONAL TREATMENT: WHAT WORKS?

Different goals for deinstitutionalization have been pursued with each of the three groups considered here. Drawing, in part, upon the other articles in this issue, this section describes the kinds and degrees of success experienced by community-based programs and highlights research and policy themes common to all three groups. Overall, the evidence in favor of community- based treatment is less compelling in the area of criminal justice than in the areas of mental health and aging, though solid evidence is sparse in most areas. For all three groups, where treatment takes place may be less important than what services are offered and how they are delivered.

Drawing from the best controlled of the voluminous evaluation studies in mental health, Dellario and Anthony (this issue) suggest that certain programs are able to effect the specific ends for which they have been targeted. Test (this issue) advocates a comprehensive range of supports, each of which may yield benefits for specific outcomes.

Scull (this issue) argues that the number of people in model programs is small, and Estroff (this issue) concludes that deinstitutionalization has failed because it has not upgraded the overall quality of life or fostered community integration for a majority of former patients. However, successful technologies have been demonstrated, and future policy might well be directed at making modal programs more like the exemplary ones.

In criminal justice, more research has been done on juvenile


offenders than on adults. Summing up the evidence from the National Assessment of Juvenile Corrections, Sarri (this issue) concludes that community-based treatment for juvenile offenders is at least as effective as traditional institutional treatment. Others have interpreted similar data to mean that community programs are no more ineffective than institutions (e.g., Martinson, 1974). Coates (this issue) notes that youths’ prior characteristics and the situations to which they return are more important than special features of the correctional program for their future criminal activity, self-image, and expectations. Like Test (this issue) in the field of mental health, Coates argues the necessity of working with youths’ families and social networks, although Mahoney (this issue) suggests that the research evidence on family interventions is mixed.

Studies of the relative effectiveness of community versus institutional treatment of the aged in need of long-term care are particularly scarce, and Gurland, Bennett, and Wilder (this issue) argue that these data demonstrate neither cost effectiveness nor increased enhancement of well-being or functioning in community settings. For the aged, deinstitutionalization efforts have focused on preventing rather than undoing institutional placements (Tobin & Kulys, this issue). Evidence is beginning to accumulate that independent and congregate housing can prevent institutionalization and promote overall well-being (Lawton, 1980; Sher- wood, Greer, & Morris, 1979).

Researchers in all three areas emphasize finding the right fit between the client and the treatment program. Person-environment fit is perhaps most salient in Lawton’s (this issue) model of matching support and challenge in the environment with the older individual’s needs and competencies. Deficiencies of either support or challenge, resulting in overly demanding or insuffi- ciently stimulating situations, can be detrimental to older people’s psychological and functional adjustment.

Estroff (this issue) echoes Lawton’s formulation in describing board and care homes for the mentally ill. Severely impaired persons may benefit from these low challenge environments, but less disturbed residents may stagnate. Test (this issue), similarly, finds individualized treatment, in which services are matched to the needs of each particular client, an essential part of successful treatment for the mentally ill. Coates (this issue) hints that person-environment fit may be important in programs for juvenile offenders as well, when he notes that geographic areas with a diversity of community-based treatment options yielded lower re-


cidivism rates than regions where only one or two types of programs were available.

Continuity of care seems to be another important ingredient of successful community programs for mentally ill individuals. Dellario and Anthony (this issue) conclude that initial differences favoring community programs over mental hospitals on rehospitalization, time spent in the hospital, and employment tend to wash out a year and a half after treatment termination. Test (this issue) notes that termination of treatment for chronic patients may have detrimental effects, and argues that services be asser- tively available, co-ordinated, and ongoing, perhaps for life.

Continuity is important for the aged as well. Several studies have shown that relocation has detrimental effects on older people’s health and well-being. This, and their documented wish (Lawton, this issue) to remain where they are, suggest the value of permitting older people to “age in place.”

The disabilities of elderly and chronically mentally ill persons seem to require long-term care. Criminal offenders do not suffer such disabilities, and, at least for youths, Sarri (this issue) suggests that longer and deeper penetration into the criminal justice system may actually be harmful.

The comparison of group-to-group differences in program effectiveness suggests that the “needy” groups, i.e., the elderly and the mentally ill, have benefited more from community treatment programs than have the “punished.” Differences in the effectiveness of our programs for different groups are, in part, a function of the criteria chosen for evaluation as well as a function of the treatment goals pursued. Perhaps if programs in criminal justice focused on more specific goals, such as employment, they would be better able to attain them.

Research on all three populations is plagued by methodolog- ical problems and a lack of theory. But answers to the complex question of what types of programs are successful in producing what sorts of outcomes for whom are beginning to be found. These preliminary answers should provide guidance for improv- ing treatment for each population.

IDEOLOGY AND KNOWLEDGE Criminal behavior, psychoses, and chronic physical impair-

ment are ubiquitous historically, and the task of defining how people who manifest or perpetrate these social problems ought to be treated has been a perennial societal concern. Assumptions


about what role institutions ought to play in treatment have shifted over time, along with conceptions of who these people are, what the causes of their “problems” are, and what possibilities exist for their participation in society.

Professional ideologies, that shape both treatment of these groups and theories about the causes and consequences of their problems, reflect in part the economic, social and political Zeit- geist. Consequently, the range of issues examined in research and put into practice tends to be constrained. The link between ideology and both treatment and research contains lessons for prac- titioners and researchers that help overcome these constraints.

First, it is important to recognize that ideologies frequently distort perceptions about what practices actually exist. Caplan (1969) concludes from her historical analysis of mental health policies and practices that ideologies tend to shift more rapidly than actual practices; in fact, many movements in the history of psychiatry took place only in people’s minds. Recent history suggests that the preoccupation with the proliferation of community alternatives to institutions in the past few years has obscured the fact that the numbers of people admitted to the criminal justice system and treated in nursing homes have actually increased dramatically. Calls for deinstitutionalization in criminal justice were still being voiced by official bodies (e.g., National Advisory Com- mission, 1973) after incarceration rates began their upturn in 1968 (Scull, 1977), and it is only recently that the rhetoric of law and order has caught up with the practice. Despite the ideology of deinstitutionalization, many of the “alternatives” to institutions for all three of the groups considered here provide little actual contact with the community. The lesson to be learned here is that the persistence of a belief system or preferred mode of treatment ought not to blur our understanding of the phenomenon as it is actually occurring.

Theory in social science is strongly affected by ideologies as well; the questions researchers ask and the criteria they use to evaluate the success of treatment efforts frequently reflect ideo- logically-based assumptions about what ought to be occurring. For example, the decision to evaluate the treatment of chronically mentally ill in terms of employment rates or other indicators of the individual’s contribution to society reflects a very different ideology from that which prompts the use of recidivism as an in- dicator of treatment success.

Ideology is frequently used as a substitute for theory, leading to overly simple categorization schemes. For example, several au-


thors in this issue point out that the question of the relative effectiveness of institutions and community treatment programs is a poor one. The lesson to be learned here is that the boundary between theory and ideology must be continually clarified.

Theories are beginning to emerge that allow us to test con- cepts whose value extends beyond the moment. Lawton’s support- challenge theory of person-environment fit, Dellario and An- thony’s multi-faceted conception of functioning among the chronically mentally ill, and Coates’ theoretical definition of “community-basedness” provide fine examples of the directions needed; all offer ways of using interventions as the raw material for understanding the fundamental processes involved in the relationships between the three populations, their environment, and the rest of society. More complex, theory-based questions will help guard against the easy acceptance of notions based on belief systems that operate independently of empirical knowledge. We must, at the very least, be continually wary of the sources of our assumptions about what is occurring and about what we know.

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Documents

Ideology and Practice of Deinstitutionalization