Reforming psychiatric institutions in the mid-twentieth century: a framework for analysis

This article develops an analytical framework of processes of institutional reform in psychiatry in Western countries during the last century. It discusses explanations of social change based on deinstitutionalization and proposes instead to put reform practices themselves at the centre of the analysis. Thus, central to this framework is the historicity of the idea of reform itself. Taking the case of France as an example, the article shows how the diffusion of a reformist ethos within psychiatry in the post-World War II period can be accounted for by a change in medical expertise during the first half of the century. It concludes with a discussion of the changing relationship between psychiatrists and the State in the twentieth century.