Politics of mental health: circles or spirals.

A brief reference to history suggests that there is a recurrent alternation of providing service to the indigent disturbed through asylum, general hospital and community. Despite modern knowledge about mental health, public attitudes remain seriously prejudiced against this group of mentally ill, and political decisions reflect these attitudes. Many developments for the emotionally disturbed deny the needs of the most disturbed. This paper considers the alienation of the severely mentally ill, the fear about the mentally ill, the guilt about their care, community education about the mentally ill, the development of advocacy on their own behalf by the mentally ill, and therapeutic advances in their care. The paper, although pessimistic about the future, concludes with the hope that the combination of modern humanism, modern communication technology and therapeutic advances may lead to an improvement in the lives of 'hard core' chronically ill psychiatric patients.