Howard Fischer
Uppsala, Sweden

Geel, Belgium is a city of about 40,000 inhabitants, in the Flemish province of Antwerp. It contains a university, and a branch of the esteemed Catholic University of Louvain, and a pharmaceutical plant. Geel may be best known for its centuries-long history of providing care for mentally disturbed individuals. The origin of this practice starts with the legend of Saint Dymphna. She was an Irish princess who fled to Flanders and was murdered near Geel by her incestuous father in around AD 600. Pilgrims who came to her tomb reported “miraculous cures” of “possessed” people. The inhabitants of Geel, nearly all farmers, offered accommodation to the pilgrims during their stay in Geel. Some of these pilgrims stayed in the town, and the foster family tradition began. An infirmary was also established in the thirteenth-century. Patients eventually came from Belgium, France, the Netherlands, England, Spain, and Russia. In the 1800s, there were 700 patients in Geel. In 1938, there were 3,700. Today there are about 500 mentally ill individuals living there with foster families.

The philosophy of Geel is “Not cure, but care.” The foster families understand that critical remarks, hostility, and even the labelling of individuals as “sick” is not permitted. The “patients” are integrated as much as possible into family life. They help with gardening, caring for farm animals, and shopping. One foster family may have a maximum of three “boarders.” The boarders may have been previously diagnosed with schizophrenia, psychosis, and mood disorders. The foster “parents” (who may be younger than their boarders) are neither told—nor ask—for diagnoses. Caseworkers are available around the clock. The police in Geel are familiar with the idea that there are some “different” people in town. They are rarely called for problems in the foster care population. The foster families are “certified” by ascertaining that there have been no legal or “moral” problems occurring in the family.

The majority of the boarders have been in foster care for more than twenty years. Some foster families have taken in boarders for several generations. A few boarders have been in foster care for seventy-five years.

The cost to the government is about €47 per patient per day. Half of this goes to the foster family. The cost of inpatient psychiatric care in Belgium would be six times greater.

Would the results be better? Since the mid-twentieth century, the trend in Western psychiatry has been toward deinstitutionalization of disturbed individuals. Unfortunately, there is no tradition of placing these people with host families that offer access to family life, as in Geel. A report from 2014 states that “Dozens of towns in Belgium, France, and Germany have their own versions of the ‘Geel system.’”

Sources

1. “Geel.” Wikipedia.
2. Mike Jay. “Geel’s ancient community cares for the mentally ill.” Aeon, January 9, 2014.
3. Henck van Bilsen. “Lessons to be learned from the oldest community psychiatric service in the world: Geel in Belgium.” BJPsych Bull, 40(4), 2016.
4. Matina Stevis-Gridneff and Koba Ryckewaert. “A radical experiment in mental health care, tested over centuries.” New York Times, April 23, 2023.