Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK.
Escuela de Enfermería, Pontificia Universidad Católica de Chile, Macul, Chile.
Cult Med Psychiatry. 2024 Dec;48(4):677-698. doi: 10.1007/s11013-024-09868-2. Epub 2024 Jul 1.
In Chile, a long and oppressive military regime (1973-1990) dismantled emergent initiatives for the deinstitutionalisation of psychiatric care, imposing a neoliberal constitution that opened public services to market forces and limited the state's role in health and social care. After being associated with communism and socialism, community-based mental health work was banned, and socialist psychiatrists were silenced through torture or exile. However, some therapeutic initiatives persisted, such as the "Protected Commune" (PC) initiative within the El Peral psychiatric asylum. The PC attempted to mimic a real town inside the asylum's gated perimeter. It featured an ecumenical chapel, a school, and various "council" departments like recreation, education, waste, economy, and health. Paths received names, wards became districts, and patients and workers were assigned new, democratic roles, all while the authoritarian regime entirely controlled the "outside" world. The initiative ceased with the return of democracy in 1990. Deemed an eccentric and negligible episode, the PC is often seen as an interruption to the radical community-based experiences of the pre-dictatorial era. Drawing on archival research and oral history interviews with participants, this paper examines how the PC harnessed the notion of community to navigate the complex socio-political landscape of the dictatorship. Differing from established accounts of the political uses of psychiatry under authoritarianism, the study positions the PC as a prism for understanding the contradictory ways in which the idea of 'community' has been able to transcend radically opposed social and political regimes, becoming a core feature in the vocabulary of mental health reform, despite its ambiguities.
在智利,一个长期而压抑的军事政权(1973-1990 年)瓦解了精神科护理去机构化的新兴举措,推行了新自由主义宪法,使公共服务向市场力量开放,并限制了国家在卫生和社会保健方面的作用。在与共产主义和社会主义联系在一起之后,以社区为基础的精神卫生工作被禁止,社会主义精神病学家要么被酷刑折磨,要么被流放。然而,一些治疗性的举措仍然存在,例如在 El Peral 精神病院的“保护公社”(PC)倡议。PC 试图在精神病院的封闭围场内模拟一个真实的城镇。它设有一个普世教堂、一所学校以及各种“理事会”部门,如娱乐、教育、废物、经济和健康。小路有了名字,病房变成了区,病人和工作人员被赋予了新的民主角色,而独裁政权完全控制着“外面”的世界。该倡议随着 1990 年民主的回归而停止。被认为是一个古怪而微不足道的插曲,PC 通常被视为前独裁时代激进的以社区为基础的经验的中断。本文通过档案研究和对参与者的口述历史访谈,考察了 PC 如何利用社区的概念来应对独裁政权下复杂的社会政治环境。与权威主义下精神病学的政治用途的既定说法不同,该研究将 PC 作为一个棱镜,以理解“社区”这个概念是如何以矛盾的方式超越了截然相反的社会和政治制度,并成为精神卫生改革词汇中的一个核心特征,尽管它存在模糊性。