Historical and conceptual aspects

Abstract

‘Inpatient treatment’ in psychiatry names a cluster of therapeutic activities whose meaning and justification have changed throughout history. Currently, an emphasis on the success of neurobiological treatment tends to give the impression that the spaces of care themselves are little more than short-term containers. This would be wrong. Best considered as dynamic environments, spaces of care have always had a profound effect on the bodies and minds of their occupants. Whether such affects have been negative or positive has depended upon the sociopolitical, economic, and theoretical factors governing their organization. To understand and improve these spaces of care it is important to realize that they sit at the intersection of various dimensions: container versus dynamic, physical versus social, custodial versus interventionistic, intramural versus extramural, institutional versus rehabilitatory, and communitarian versus societal. Throughout the centuries, a variety of therapeutic interventions have been offered within these spaces. Because their nature, ethics, and rationale have repeatedly changed, it may be more sensible to consider the current state of inpatient psychiatry not as the final stage in the evolution of the ‘science of psychiatry’ but as a mere moment in the evolution of a never-ending interpretative process about the meaning of madness.