Geel Kolonie:  City of "Fools"?

        When did you last see an hallucinating psychotic served in a public restaurant with as much deference as the regular customers at the next table?  When did you last see a severely retarded woman with bells and bright ribbons pinned to her dress strolling through suburbia without causing consternation, ridicule or a 911 call? The fact is that such people are not free to roam our streets.  For the most part they are shut away in institutions - out of sight and out of mind.

        Although nearly half of the retarded and mentally ill in our institutions would probably not have to be there if there were some alternative, our society has decided that it is best for them (or better for us) that they be in asylums where they can no longer be a thorn in our conscience.  What does it matter that the death rate in such institutions is four to ten times higher than in the general population or that "prolonged custodial hospitalization often aggravates the patient's already pathological dependence, regression, apathy and social deteriorization trends"?

        Actually, there are alternatives to institutionalization for a vast number of patients who are not homicidal or suicidal and who do not pose a threat to the open community.  In short, there ought to be alternatives to low-risk chronic patients wasting away their lives in unnecessary confinement.  One alternative for those who do not need to be confined is a kind of community-based foster-family care as I shall describe below.

        There is a small town in Belgium where an hallucinating psychotic person can get served in a cafe without a raised eyebrow and where a woman with bells and ribbons on her dress can walk down the street without gathering a crowd of mocking children. The children of Geel, you see, are used to unusual behavior.  They, their parents, and grandparents for generations  now have grown up with retarded or mentally ill foster patients in their homes.

        For centuries, since the Middle Ages, they have known that most mental patients are not dangerous.  The gentle acceptance of mental disorders and retardation  has been part of the Geel way of life.  This Geel "lay milieu therapy,"  as it is sometimes called, although centuries old,  is considered unique, enlightened, and revolutionary by many in today's scientific community.

        How is it that centuries before the work of Pinel, Itard, Seguin and others  the citizens of Geel were treating the mentally ill and retarded not as devil-infected but as human beings who were sick?  By 1480 there was an infirmary or sieckenkammer at Geel.  The choice of the word sick is in itself significant. Where else in the 15 th century were mental disorders considered a sickness?  How is it that, while the rest of Europe was banishing, imprisoning or burning these spiritual lepers of society, documents dating from 1245 indicate that the  citizens of Geel were taking these people into their homes?

        Were you to travel 25 miles east of Antwerp to the town of Geel (population c. 30,000) you would find within the 16 th century church a sarcophagus from the Carolingian period. (The original church was built in 1349 and was destroyed by fire in 1489.)  This is the tomb of St. Dymphna and within are the relics of this patron saint of the mentally ill.  The Geel tradition of foster-family care begins with the legend of St. Dymphna.

        Clouded in legend,  the story of Dymphna briefly runs thus.  She is said to have been a 7 th century Celtic princess who fled to the continent to escape an incestuous father.  When her father caught up with her in Belgium he slew her with his own hand  because she still resisted his advances.  A cult soon arose to the virgin martyr who symbolized the triumph of wisdom and chastity over insanity and lust.  By the 13 th century Geel had become a place of pilgrimage.  Mental patients, often rejected by their own kin and driven from their homes, came to pray at the tomb of the saint and seek a cure.

        It soon developed that many of the pilgrims having nowhere else to go were taken in by the local townsfolk.  By the end of the 13 th century there were already some accomodations for the patients of Geel.  There was a gasthuis (hospice) built in1476 and the infirmary (sieckenkamer) already mentioned that was constructed in 1480.  Most of the patients, however, did not need medical care and eventually found their way into the local homes where they spent the remainder of their days.

        Thus was born an enlightened tradition centuries before Pinel.  It has remained an unbroken tradition to our own time.  In the mid -19 th century when Belgium became a modern nation the adminsitration of the Geel Kolonie passed from the Catholic church to the Belgian government. The 19th century also saw a sudden flurry of interest in the Geel system of family care.  No one until then had paid much attention to it and it had lived its serene lifestyle  unacknowledged.  Late in the century, however, a number of mental health reformers in several countries attempted to set up family care systems modeled after Geel.  Many of them still survive.  The first effort at family care in America came in Massachusetts in 1885.  Dr. Parigot, a former administrator of the Geel Kolonie came to America during this era and crusaded for foster-family care and against large asylums.  But he was generally laughed at and it is only in our own day that the validity of such an approach has been seriously considered as an option.

        Life in Geel has gone on in spite of post-war problems.  In 1959, for instance, one out of ten of the population of the town were mental patients (57 % were mentally deficient, 29 % were schizophrenic, etc.) When patients are referred to the Kolonie they first undergo an intensive physical and psychological examination to see if they are suited for foster care or not.  If it is decided that they would benefit from such care a home is carefully selected for them by professionals.

        There have always been plenty of foster homes in Geel.  It is a status symbol in the community.  Besides the traditional kindness of the populace there is the more recent incentive of a stipend from the government for caring for the patients.  The home may have no more than two patients of the same sex, each with his or her own room.  The patients are free to go about town as they wish.  They become members of the family, often staying over fifty  years in the same home.  Children grow up, marry, and inherit the patients they have known and loved since childhood.  Most patients at Geel change their legal residence to Geel no matter where they come from and chose to be buried in the local churchyard.  Geel has become their home.

        Acts of violence are extremely rare. Motivation is high. Why act out and be put back in the hospital - or worse, an asylum?  There are no signs of restraints in Geel, but many signs of love.

        In some ways modern times have threatened the Geel tradition. A Geel Research Project was therefore undertaken in 1966 in an effort to preserve,  improve, and perhaps adapt it to other cultures.  This broad-spectrum, international, and inter-university (Louvain and Columbia) multi-disciplinary investigation of every facet of the Geel Kolonie was launched in order to understand and preserve this unique human experiment.  Dr. Leo Srole, the American director of the Geel Research  Project, called the Geel tradition "a living monument of man's humanity to his suffering fellow man."  Will this endeavor lead to more enlightened treatment for the countless unfortunate people who might otherwise waste away their lives in endless and unnecessary confinement.?

Copyright 1998. Richard Cross