[Social control, social support and therapy. The tension field of (social-)psychiatric treatment].

As generally in psychiatry the treatment concepts in social psychiatry base to a great extend on disease- and deficit models. These models, however, have their limits and run the risk to promote exactly that, what social psychiatry is fighting against: chronification. The question shall be discussed, if the systemic approach could be helpful to reduce (social) psychiatry's contribution on the process of chronification. Since ever psychiatric institutions have the mandate of social control and exclusion of social disturbing people from society. On the other hand, social support has become a cornerstone of rehabilitation in psychiatry. There the therapist becomes the manager of the disability. The (case-)manager subsequently takes over the responsibility for the future course. So he also gets power over the system to be treated. He decides, how much of social support and control is necessary. But then he gives up the aim of profoundly changing something in the sense that the patient can give up his symptoms and take more self-responsibility for his acting. The consequence is that the patient and psychiatry keep up each other: a coevolution develops. This leads to rigidity and makes changes difficult. By taking over responsibility the therapist becomes part of the system to be treated. So he looses his neutrality and also the possibility of therapeutical influence and change. The whole system quickly moves into a vicious circle of helplessness. Finally it will be reflected how someone, working in an institution, still can do therapy in this field of tension of (social) psychiatry.