Counterpoints of care: two moments of struggle.
Big shifts in disability services (institutionalisation vs deinstitutionalisation) are driven by societal politics, not just clinical evidence—keep that lens when advocating for new models.
01Research in Context
What this study did
Gleeson (2010) tells a short history of disability care in Melbourne, Australia. The paper zooms in on two big shifts: the late 1800s rush to build large institutions and the late 1900s push to close them.
The author treats these swings as political battles, not medical discoveries. The story shows how wider social forces, not new data, moved people in and out of congregate settings.
What they found
The study finds that service change is driven by social upheaval, not by evidence reviews. When society feared poverty and disease, it built asylums. When it prized civil rights, it emptied them.
Each swing created winners and losers. The paper calls these moments "counterpoints of care" to stress the ongoing tug-of-war between safety and freedom.
How this fits with other research
Mansell et al. (2010) supply the evidence Gleeson (2010) says was missing. Their global position paper lists solid data favouring community living and urges states to close large facilities. Together the two 2010 papers show that policy can lag decades behind science.
Stancliffe et al. (2007) extend the story. They tracked one Australian state for ten years after it vowed to end congregate care. Despite the pledge, 43% of people still lived in some form of group setting. Their numbers prove that political declarations do not guarantee real change.
Macdonall (1998) gives a face to the risk. One man with severe ID moved to a less restrictive home and his health crashed. The case warns that freedom without support repeats the same cycle Gleeson (2010) describes.
Why it matters
When you fight for new service models, remember you are also fighting history. Use Gleeson (2010) to remind funders that past closures happened because of social pressure, not pilot data. Pair that story with Mansell et al. (2010) to show the science is now on your side. Expect push-back like Stancliffe et al. (2007) found, and plan extra supports so no one becomes the next Macdonall (1998) case.
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02At a glance
03Original abstract
This paper examines the history of care in modern society and seeks to expose how deep transformations in care arise from wider social relations. From historical survey we may discern a series of transitional points, where the practice and the experience of care was greatly, sometimes suddenly, redefined. Each betrayed deeper political and ethical struggles that went to the core of social relations, and which weren't merely therapeutic in nature. This paper explores two such 'moments'. I first examine the emergence of a new institutional landscape during the middle industrial era, in the wake of a series of legal and political reforms that sought to settle a social order uprooted and distressed by raw modernisation. I provide a composite, yet incomplete view, of how this transformation proceeded in one urban setting, colonial Melbourne. In the second instance, I review the ambitions and process of deinstitutionalisation in the late 20(th) century. Ostensibly, this reform sought, inter alia, to collapse the great division between 'fit' and 'unfit' established in 1834. Again, empirical reference is made to the reconstitution of care in Melbourne, Australia, this time during its late 20th experience of institutional reform. The focus in this case is the process of downscaling and closure for a major congregate facility, Kew Cottages. The major conclusion is that periods of intense transition in the ideology and mode of care are reflective of wider social transformations not merely of therapeutic or institutional shifts.
Journal of intellectual disability research : JIDR, 2010 · doi:10.1111/j.1365-2788.2009.01233.x