- Sasha Durakov Warren
Gheel, the Past or Future’s ‘Colony for the Mad’?
This is a part of a series on the treatment of madness before psychiatry. You can read my introduction here. I have added an ongoing list of the posts to that page. This series will be sub-divided into parts dedicated to a specific place, model, or theme. This post is the first on family-boarding systems, beginning with Gheel.
“[The] peasants of a Belgian village, moved by their simple good sense and kindness of heart, showed the way towards a new departure which learned students of mental disease did not perceive. They set the lunatics quite free. They took them into their families, offered them a bed in their poor houses, a chair at their plain tables, a place in their ranks to cultivate the soil, a place in their dancing-parties. And the fame spread wide of ‘miraculous cures’ effected by the saint to whose name the church of Gheel was consecrated. The remedy applied by the peasants was so plain, so old it was liberty that the learned people preferred to trace the result to Divine influences instead of taking things as they were [...] Liberty and fraternal care have proved the best cure on our side of the above-mentioned wide borderland ‘between insanity and crime.’ They will prove also the best cure on the other boundary of the same borderland. Progress is in that direction.” – Pyotr Kropotkin, “In Russian and French Prisons.”
“The world moves; progress has been made and acknowledged. Gheel has served a good purpose for many centuries; but the world will not witness the establishment of another commune patterned after that of Saint Dympna” –A.M. Shew, “The Insane Colony at Gheel.”
The Belgian town Gheel took its first steps to becoming a “colony for the mad,” where the mad walk freely and board with families in the heart of the community, in the 13th century.[1] About 600 years after its founding, the Russian anarchist Kropotkin would find himself joining in a chorus with a small group of prison abolitionists, mostly East Coast psychiatrist contributors to the American Journal of Insanity, Catholics, pastoral-romantics, and urban social welfare reformers proclaiming the Gheel system the future of mental health care, or, even more broadly, of the social response to deviancy. Gheel was the way forward. Some of these 19th and early 20th century reformers took this notion seriously and tried to reproduce Gheel’s (or the oft-compared Scottish open door) model on the scale of a town in Massachusetts [2], Argentina [3], and in more limited experiments in New York and elsewhere [4]. Others, like the psychiatrist Pliny Earl or the above-quoted A.M. Shew, were convinced that the Gheel system belonged to the past. Progress went forward, leaving Gheel behind as a distant medieval memory belonging essentially to the age of pilgrimage and tight bonds of agricultural familial networks now lost to most towns.
Even among these commentators who saw or see no hope of carrying the Gheel model into the future, nearly all admit that it was or is a model system, if not one of the best. Earle, long before his studies on recovery rates deflated the euphoric exuberance of asylum keepers, was something of an American Tocqueville for madhouses taking extensive trips from Europe to Turkey visiting asylums and publishing his observations [5]. He claims he was the first American to visit Gheel when he stopped there in 1849.
Mirroring his own reluctant conversion to the love of Gheel, he describes his carriage ride into town as passing through a “sterile plain” dotted sparsely with meager patches of vegetation and trees [6]. As the horses trudged slowly through sand, he noted that “this desolation of nature comported well with the mental desolation which I was about to witness: [...] the change in the face of the earth, during this short journey, was typical of the alteration in a vigorous mind when, by disease, it is transformed into a dreary intellectual waste.” But as he approached the town, “the landscape again assumed a more cheerful aspect, and rich fields, laden with grass and grain, stretched far and wide around us. Nature resumed her smiles, and the strong mind which had been made a desert was again restored to reason.” He’d gone prepared to find a system rife with exploitation and neglect; instead he found himself struggling to come up with more than a handful of observations of forced confinement, some anecdotes around poor living conditions, and records of a very small number of violent encounters between sane and mad townsfolk he read about or translated from a French travel diary. In each case, he was forced to admit that comparable offenses occur in asylums, that living conditions are generally good and in some cases excellent, and that “as at every other place where there is a large congregation of the insane, there is liability to serious accidents, and that these have not always been avoided.” All we are left with is Earle’s strong belief that the asylum system could theoretically be more responsible, distribute according to need more rationally, and produce better results.
Whether it’s positioned as the past or future of mental health care, no one can deny Gheel’s importance as a symbol of non-institutional care. It is indisputably a real, functioning example of a system actually deserving of the title “community-based care.” So much so that conservative skeptics and the partisans of institutional provisions who saw it as a threat and set out to expose it as a sham by catching Gheelians in the act of chaining the mad outside during rain storms or beating them viciously were left with the comparably weak alternatives of “we could provide care better” or “this only works here because of ______.” If they adopted the first, they were forced to explain how their institutional plan would eradicate the perennial problem of violence and neglect better than Gheel or why a Gheel-like system would be better administered exclusively by psychiatrists. Why the debate about whether or not the Gheel model was exportable appeared so frequently in the 19th century and continues to today will be a question left for a future entry dedicated to it. The second alternative explanation will be the question underlying the whole series on Gheel, and I’ll address it continuously. For now, I would like to sketch a basic picture of what the “Gheel system” is that has attracted such sustained admiration.
The Gheel System in Outline
Before it became associated with the cult of Saint Dymphna in the 13h century, Gheel was a hamlet in the Kempen woods near Antwerp. With the novel cultivation technology of the time [7], Gheel proved to be a promising location for an agricultural colony just as the cult gained increasing recognition around 1230. The region was then under the tutelage of the Berthout family headed by Hendrik I, who seized upon the cult to establish a local identity and grab for increased autonomy, building a church in her name (consecrated in 1247), leading to a commission for an official vita, supervised by the parish priest of Gheel [8].
Saint Dymphna attracted early supplicants and pilgrims to Gheel before the end of the century on account of her exceptional gift for expelling demons. For reasons we will explore at a later time, Saint Dymphna’s power of exorcism morphed into a capacity to heal the mad of their afflictions between the 13th and 15th centuries. By the early 16th century, her image as depicted in altars regularly showed her curing the insane of their fury, at which point Gheel began attracting more and more mad supplicants. The cult’s fame spread far and wide during the Counter-Reformation around the turn of the 17th century, when the Church published biographies and miracle books attesting to Dymphna’s great power.
Upon arrival, the mad underwent a nine-day ritual healing process at the end of which they either left—cured of their affliction (or greatly improved)— or were put up in an infirmary erected for stubborn cases. As this space quickly reached capacity, the Church began asking local families to temporarily house these mad travelers until they were ready to try other methods at a later date. It is widely believed that the combination of an increasingly high volume of mad visitors and the necessity of lodging them as they waited for their turn birthed the “Gheel system,” which names the gradual rationalization of this ad-hoc boarding tradition. This process of rationalization arguably began somewhat paradoxically in the 18th century as religious enthusiasm declined, and, with it, the mass of pilgrims tapered off. At this point, the mad were placed directly with families in Gheel or one of the surrounding villages and hamlets without the expectation of ritual healing. But the founding of the Rijkskolonie voor Gezinsverpleging (National Colony for Care in the Community) in 1852 officially recognized the practice as centrally a matter of local administration rather than a particularly successful appendage to Catholic veneration.
Despite the weakening of the cult, yearly processions still made their way through the streets and supplicants still arrived seeking traditional faith healing, but continued religious interest likely does not account for why Gheel’s famed system grew so rapidly and ultimately reached its apogee only after these administrative rationalizations. According to Daniel Hack Tuke (the great-grandson of the famed William Tuke) who visited in 1856, there were 1,653 mad people living in Gheel or the immediate surrounding area that year in a population roughly totaling 11,000. Only around 50 of those were living in the nearby asylum, meaning more than 1 in 7 of the general population was mad. To accommodate this, around a third of households were putting up one or more of these boarders [9]. Gheel experienced yet another boon in the late 1930s when a baffling 4,000 boarders lived in a town of 16,000 [10]. Since this peak, the proportion has continually dwindled such that now there are fewer than 250 boarders [11]. What happened?
Elements of the Gheel Question
The 19th century debates around the meaning of Gheel and the possibilities for instituting some version of it outside of Belgium were referred to as the “Gheel question.” This question has never been adequately resolved and contemporary visitors to the town find themselves wondering why we can’t just replicate or adapt it in Boston or London or in a smaller town on the periphery. It’s an obvious question: if family boarding is so successful there, why are there scant examples of it around the world in comparison to other models of residential care? And why did the number steadily dwindle through the second half of the twentieth century?
As I see it, in order to answer those questions, we have to take the following into account: the history of the religious cult of Dymphna and its associated forms of faith healing and pilgrimage practices; the agrarian local economy and the place of the mad boarders within it; the changes to that economic activity through the twentieth century; the process of secularization and increasing municipal administrative control; the changing function of psychiatric services; and the relationship of medical organizations and the state to the boarding system. At each point, we must also stop to ask: what manner of madness did Gheel make a place for and did it stay the same through all these changes?
These then, are the basic parameters of this little case study. My method for each piece of writing will be as linear and thematically sound as I can make it for the sake of timeliness and readability. To that end, I will try hard to impose limits on these posts and keep them as short and simple as possible, but history is messy and does not often conform to thematic or analytic categories, so there will undoubtedly be a good deal of crossover and last minute changes. The current plan is for my next post to be on the cult of Dymphna and the specific practices of faith healing that attracted so many pilgrims in the Middle Ages.
Notes
Note that Gheel is today more often spelled “Geel.” I chose "Gheel" simply because most of the sources I’ve found use this spelling. Note however that "Gheel” was used more often in the 19th and early 20th century and “Geel” is the more common contemporary spelling.
Copp, Owen. "Some Results and Possibilities in Family Care of the Insane in Massachusetts." American Journal of Insanity 59, no 2 (October 1902): 299–312.
Iacoponi, Lucía. "El Hospital Interzonal Colonia Dr. Domingo Cabred y el método Open Door." Alcmeon 7, no 4 (1999) https://alcmeon.com.ar/7/28/alc28_03.htm
For a roundup and history of family boarding projects in the US circa 1945, see Pollock, H. M. (1945). "A Brief History of Family Care of Mental Patents in America." American Journal of Psychiatry 102, no 3 (1945): 351–361.
His statistical studies in the 1870s exposed the extremely high rates of recovery claimed by model institutions in the US to be highly exaggerated and based on false premises. The most inflated were William Awl’s (“Dr. Cure Awl”) who claimed to be able to cure close to 100% of his patients at the Ohio Lunatic Asylum in the 1840s. Earle demonstrated that some rates had been artificially inflated by counting all discharges as recoveries, including those who had been released and recommitted, and, even worse, some who died. Earle’s own accuracy and pessimistic bias has come under question by Richard Warner in Recovery From Schizophrenia and others.
Earle, Pliny. "Gheel." American Journal of Psychiatry 151, no 6, (June 1994 [originally published July 1851]): 16.
Namely the three-field crop rotation and the moldboard plow. Later posts will explore the centrality of agriculture to the Gheel system.
My account of early Gheel history here is a synthesis of all of the sources above plus especially Schalley, Niels “The Cult of Saint Dymphna in Image and Prayer.” In Crazy About Dymphna: The Story of a Girl who Drove a Medieval City Mad (Lanham: Cannibal Publishing, 2021).
Hack Tuke, Daniel. "On a Recent Visit to Gheel." Journal of Mental Science 31, no 136 (January 1886): 481–482.
Thériault, Anne. "Geel, Belgium has a radical approach to mental illness." Broadview, September 5, 2019. https://broadview.org/geel-belgium-mental-health/
Chen, Angus. "For Centuries, A Small Town Has Embraced Strangers With Mental Illness." NPR, July 1, 2016. https://www.npr.org/sections/health-shots/2016/07/01/484083305/for-centuries-a-small-town-has-embraced-strangers-with-mental-illness