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（1）The Geel question
For centuries, a little Belgian town has treated the mentally ill. Why are its medieval methods so successful?
Half an hour on the slow train from Antwerp, surrounded by flat, sparsely populated farmlands, Geel (pronounced, roughly, ‘Hyale’) strikes the visitor as a quiet, tidy but otherwise unremarkable Belgian market town. Yet its story is unique. For more than 700 years its inhabitants have taken the mentally ill and disabled into their homes as guests or ‘boarders’. At times, these guests have numbered in the thousands, and arrived from all over Europe. There are several hundred in residence today, sharing their lives with their host families for years, decades or even a lifetime. One boarder recently celebrated 50 years in the Flemish town, arranging a surprise party at the family home. Friends and neighbours were joined by the mayor and a full brass band.
（2）Among the people of Geel, the term ‘mentally ill’ is never heard: even words such as ‘psychiatric’ and ‘patient’ are carefully hedged with finger-waggling and scare quotes. The family care system, as it’s known, is resolutely non-medical. When boarders meet their new families, they do so, as they always have, without a backstory or clinical diagnosis. If a word is needed to describe them, it’s often a positive one such as ‘special’, or at worst, ‘different’. This might in fact be more accurate than ‘mentally ill’, since the boarders have always included some who would today be diagnosed with learning difficulties or special needs. But the most common collective term is simply ‘boarders’, which defines them at the most pragmatic level by their social, not mental, condition. These are people who, whatever their diagnosis, have come here because they’re unable to cope on their own, and because they have no family or friends who can look after them.
（3）The origins of the Geel story lie in the 13th century, in the martyrdom of Saint Dymphna, a legendary seventh-century Irish princess whose pagan father went mad with grief after the death of his Christian wife and demanded that Dymphna marry him. To escape the king’s incestuous passion, Dymphna fled to Europe and holed up in the marshy flatlands of Flanders. Her father finally tracked her down in Geel, and when she refused him once more, he beheaded her. Over time, she became revered as a saint with powers of intercession for the mentally afflicted, and her shrine attracted pilgrims and tales of miraculous cures.
（4）In 1349, a church was built on the outskirts of the town around Saint Dymphna’s memorial, and in 1480 a dormitory annex was added to accommodate the growing number of pilgrims. When the stream of visitors overflowed the allotted space, townspeople started to house them in their homes, farms and stables. During the Renaissance, Geel became famous as a place of sanctuary for the mad, who arrived and stayed for reasons both spiritual and opportunistic. Some pilgrims came in hope of a cure. In other cases, it seems that families from local villages took the chance to abandon troublesome relatives whom they couldn’t afford to keep. The people of Geel absorbed them all as an act of charity and Christian piety, but also put them to work as free labour on their farms.
（5）Today, the system continues along much the same lines. A boarder is treated as a member of the family: involved in everything, and particularly encouraged to form a strong bond with the children, a relationship that is seen as beneficial to both parties. The boarder’s conduct is expected to meet the same basic standards as everybody else’s, though it’s also understood that he or she might not have the same coping resources as others. Odd behaviour is ignored where possible, and when necessary dealt with discreetly. Those who meet these standards are ‘good’; others can be described as ‘difficult’, but never ‘bad’, ‘dumb’ or ‘crazy’. Boarders who are unable to cope on this basis will be readmitted to the hospital: this is inevitably seen as a punishment, and everyone hopes the stay ‘inside’ will be as brief as possible.
（6）The people of Geel don’t regard any of this as therapy: it’s simply ‘family care’. But throughout the town’s long history, many both inside and outside the psychiatric profession have wondered whether this is not only a form of therapy in itself, but perhaps the best form there is. However we might categorise or diagnose their conditions, and whatever we believe their cause to be — whether genetics or childhood trauma or brain chemistry or modern society — the ‘mentally ill’ are in practice those who have fallen through the net, who have broken the ties that bind the rest of us in our social contract, who are no longer able to connect. If these ties can be remade so that the individual is reintegrated with the collective, doesn’t ‘family care’ amount to therapy? Even, perhaps, the closest we can approach to an actual cure?
（7）Modern psychiatry was born in the 19th century, and for the first generation of psychiatrists, ‘the Geel question’ was central to the revolution they were attempting to bring about. For many, the system was a dismal relic of the Middle Ages, where the mad were condemned to a life of drudgery and neglect under the lax oversight of the Church. Shut away from the modern world in quasi-feudal isolation, they were denied the benefits of new medical expertise, and with it, any chance of proper treatment.
（8）For others, however, Geel was a beacon of the progressive ideas that came to be known as ‘moral management’. Freeing the insane from their chains and madhouses, providing them with fresh air, occupational therapies and the chance to patch themselves back into normal life — this was treatment in itself. Philippe Pinel, the founding father of French psychiatry who was legendary for ‘striking the chains off the mad’ at the Salpetrière asylum in Paris, declared that ‘the farmers of Geel are arguably the most competent doctors; they are an example of what may turn out to be the only reasonable treatment of insanity and what doctors from the outset should regard as ideal’. His student Jean-Étienne Esquirol, who became the next generation’s leading reformer of mental hospitals, visited Geel in 1821 and was astonished by the sight of hundreds of lunatics wandering freely and calmly around the town and countryside. He praised the tolerance of a system where ‘the mad are elevated to the dignity of the sick’.
（9）The ‘Geel question’ has remained at the heart of psychiatry, and the pendulum continues to swing between these polarised views. In 1850, Belgium integrated Geel into a new state dispensation that combined elements of both perspectives. Oversight of the family care system was transferred from church to government. Families got a modest state payment, in return for which they had to submit to inspection and regulation by the medical authorities. Under the church system, any crimes committed by a boarder had been the responsibility of families, who sometimes resorted to chaining and beating boarders who were violent or difficult to control. Under the new rules, however, restraint and corporal punishment were banned. And in 1861, a hospital appeared on the outskirts of town: a two-storey building with an elegant portico and large arched windows, designed in every detail to resemble a country mansion rather than a prison. Boarders, arriving now as wards of state, came here to be assessed before taking up their lodgings in town.
（10）Medical supervision brought great improvements, but the directors of the new hospital insisted that it should supplement rather than replace the unique regime of family care. In the terminology still used by boarders and townspeople today, ‘inside’ — the world of the hospital — was a resource to use sparingly, and ‘outside’ — the wider community — was preferred wherever possible. For routine supervision, boarders were required to attend one of three bathhouses at least once a week: ostensibly for hygiene but also for more general health checks, as well as a chance for a conversation with someone outside the family sphere. The fact that these checks could be performed ‘outside’ rather than ‘inside’ meant that, for most boarders, the smell of the hospital and the sight of asylum wards vanished from their lives.
（11）The reformed system became a source of great professional and local pride. Doctors and psychiatrists from across Europe and America came on fact-finding missions. Dozens of towns in Belgium, France and Germany established their own versions of the ‘Geel system’, some of which still survive. In 1902, the International Congress of Psychiatry officially settled the ‘Geel question’, declaring it an example of best practice to be emulated wherever possible.
（12）Throughout the 20th century, the family care system prospered and expanded, and the town’s fame spread. With the growth of state asylums, families across Belgium faced the choice of having their relatives ‘put away’ for life in grim institutions or sending them to Geel, where handsome promotional photographs and brochures showed them working the fields, attending harvest festivals and church services, and sleeping in regularly inspected private bedrooms with cots and linen sheets. As a result, so many boarders arrived from the Netherlands that their hosts built a Protestant church in town for them. One wealthy family even took in a Polish prince, who came with his own butler and carriage.
（13）By the late 1930s, there were almost 4,000 boarders among a native population of 16,000. Across Belgium, the town became famous for its eccentricity and was often the butt of coarse humour (‘Half of Geel is crazy, and the rest is half crazy!’), but in the town itself, normal life was little affected. Local jokes tended to revolve around how frequently locals and boarders were confused, and how hard it was to tell the difference. Boarders were well aware that disruptive public behaviour might result in being sent back ‘inside’; the problem was more commonly the opposite, that they became overly timid for fear of drawing attention to themselves.
（14）In recent decades, the ‘two-layered system’ — family care supported by a medical safety net — has been constantly recalibrated to reflect developments in psychiatry, but its most abrupt shift came in the 1970s. As the asylums emptied, mental healthcare was reconceived to become more flexible and extend further into the community. Antipsychotic and antidepressant medications, central to the new treatment model, were initially resisted by many families who felt they would turn boarders into medical outpatients, but they rapidly proved indispensable in helping to manage the worst of the depressions, crises and public incidents.
（15）These all appear to have been changes for the better. Yet they coincided with a precipitous and perhaps terminal decline in the centuries-old system. Today, there are around 300 boarders in Geel: less than a tenth of its pre-war peak and falling fast. While many locals believe family care will endure, it has become a markedly smaller part of town life, and others suspect that this generation will be the last to maintain it. Why is this deeply rooted and universally praised system suddenly on the point of disappearing?

（16）The limiting factor is not demand but supply. Few families are now able or willing to take on a boarder. Few now work the land or need help with manual labour; these days most are employed in the thriving business parks outside town, working for multinationals such as Estée Lauder and BP. Dual-income households and apartment-living mean that most families can no longer offer care in the old-fashioned way. People remain proud of the tradition, and credit it with giving Geel a broad-minded and tolerant ethos, one that has made it attractive to international businesses and visitors (these days it is probably best known for its annual reggae festival). But the town is no exception to the march of modernity and the irreversibly loosening social ties that come in its wake.
（17）Modern aspirations — the increasing desire for mobility and privacy, timeshifted work schedules, and the freedom to travel — disrupt the patterns on which daily care depends. Increasing wealth is also a disincentive: most of the burden of care always fell on the poorer families, who counted on the supply of free labour and state payments to lift them above subsistence. The state now pays around 40 ($55) per day for boarders, of which only half is passed on to the families: hardly a financial incentive for most, these days.
（18）More optimistically, the decline of the system can be seen as a reflection of modern improvements. Psychiatry has met the town halfway: the choice is no longer limited to the stark alternative of Geel or the horrors of the asylum. Care in the community, of which the town was once the leading example, has become the norm. For most mental health service users, the combination of medication and community mental health teams has made the line between ‘inside’ and ‘outside’ more porous, with ‘outside’ the preferred option for doctors and patients alike, on grounds both of cost and quality of life.
（19）The boundaries have blurred in Geel too, and the old system is hard to maintain within the institutional logic of modern mental health care. More than half of the boarders now receive some form of service, such as day care, therapy or supervised work programmes. Families come under pressure to be trained in therapy or psychiatric nursing as part of their duty of care to their boarders, but many insist that they aren’t clinicians and don’t want responsibility for medical issues such as their boarders’ drug regimes. In accordance with their patient rights, boarders are now given their own diagnoses and they are free to share them with families or not, as they choose; either way, the inevitable effect is to medicalise their situation. Within the family home they might still be boarders, but outside it they are now ‘patients’ or ‘clients’.
（20）When the anti-psychiatry movement emerged in the 1960s and ’70s, many of its proponents — like the 19th-century moral and religious reformers before them — used the story of Geel to argue that psychiatry and its institutions should have no place in the treatment of the mentally unwell, and indeed that psychiatry created many of the problems it purported to solve. But there are many clear examples in its long history of medicine’s benefits: in eliminating the use of restraints and physical punishment, in stepping into chaotic situations where families are no longer able to cope, in medication regimes that have the power to transform lives of suffering. At the same time, Geel’s story does suggest that psychiatry’s role could be limited, perhaps dramatically so: not at the centre of mental healthcare but on its periphery, as a backstop to the community. In an ideal world, might not the modern psychiatric clinic shrink back towards the size of the 19th-century hospital: a discreet ‘inside’, as remote from the majority of patients’ lives as possible?
（21）Yet this would demand a reform not simply of medicine but of society itself. It’s ironic but probably not coincidental that the need for a community response to mental illness is becoming obvious just as the structures that might provide it are failing. The boarder who celebrated 50 years in residence is by no means exceptional: another, recently deceased at the age of 100, had spent 80 years with the same family, in the care of successive generations to whom she had been first like a daughter, then a sister and finally an aunt. Who would not wish to live in a community where such extraordinary resources of time, attention and love were available to those who needed them — but who these days can imagine being in a position to offer them?
（22）This is, in yet another form, the tragedy of the commons: our liberation as individuals to create lives of our own choosing places unsustainable pressures on the type of society that most of us would choose to live in. We might define mental ill-health in medical terms, but this is not enough to confine its treatment within the medical frame. If it is in practice a condition that has exhausted the capacity of the individual and the social support available, it’s bound to manifest more intensely in an atomised society where insoluble problems devolve onto the sufferer alone. To take up these problems on behalf of others demands, all too often, more than their own loved ones can give or the state can provide. As mental illness proliferates and outpaces the psychiatric resources available to manage it, Geel’s story offers a vision, in equal parts sobering and inspiring, of what the alternative might look like.

（8）For others, however, Geel was a beacon of the progressive ideas that came to be known as ‘moral management’. Freeing the insane from their chains and madhouses, providing them with fresh air, occupational therapies and the chance to patch themselves back into normal life — this was treatment in itself. Philippe Pinel, the founding father of French psychiatry who was legendary for ‘striking the chains off the mad’ at the Salpetrière asylum in Paris, declared that ‘the farmers of Geel are arguably the most competent doctors; they are an example of what may turn out to be the only reasonable treatment of insanity and what doctors from the outset should regard as ideal’. His student Jean-Étienne Esquirol, who became the next generation’s leading reformer of mental hospitals, visited Geel in 1821 and was astonished by the sight of hundreds of lunatics wandering freely and calmly around the town and countryside. He praised the tolerance of a system where ‘the mad are elevated to the dignity of the sick’.（紫烟雨）
然而，对另一些人来说，吉尔进步思想的指明灯被称为“道德管理”。将精神失常者从束缚中和疯人院里释放出来，为他们提供新鲜空气，职业治疗，以及让自己回到正常生活的机会——这就是治疗本身。菲利普·皮内尔，法国精神病学之父，他在巴黎萨博特救济所是‘摆脱精神病释放束缚’的传说，声称‘吉尔镇农民可能是最有能力的医生；他们可能证明是精神病唯一合理的治疗榜样，医生从一开始就应该视为理想’。他的学生珍·埃蒂安·埃斯基罗尔成为下一代精神病院的领先改良者，于1821年访问吉尔，看到数以百计的精神病人自由而平静地在城镇乡村周围闲逛，感到震惊。他盛赞这个地方‘精神病人提升了病人的尊严’这一系统的宽容大度。

（10）Medical supervision brought great improvements, but the directors of the new hospital insisted that it should supplement rather than replace the unique regime of family care. In the terminology still used by boarders and townspeople today, ‘inside’ — the world of the hospital — was a resource to use sparingly, and ‘outside’ — the wider community — was preferred wherever possible. For routine supervision, boarders were required to attend one of three bathhouses at least once a week: ostensibly for hygiene but also for more general health checks, as well as a chance for a conversation with someone outside the family sphere. The fact that these checks could be performed ‘outside’ rather than ‘inside’ meant that, for most boarders, the smell of the hospital and the sight of asylum wards vanished from their lives.（紫烟雨）
医疗监督带来巨大改善，但新医院的主管坚持认为，它可以是家庭护理独特管理体制的补充，而不是替代品。寄宿者和市民仍使用相关术语，‘内部’（医院的世界）是资源使用节俭的地方，而‘外部’（更广泛的社区）尽可能的是首选。对于日常监管，寄宿者被要求至少一周一次要照料三分之一的澡堂：表面上是卫生，也为了更普遍的健康检查，而且有一个机会与家庭范围之外的人交流。这些检查实际上可以在‘外部’完成，而非‘内部’所意味的，对大多数寄宿者来说，医院的味道和收容所病房的景象从他们生活中消失了。

（11）The reformed system became a source of great professional and local pride. Doctors and psychiatrists from across Europe and America came on fact-finding missions. Dozens of towns in Belgium, France and Germany established their own versions of the ‘Geel system’, some of which still survive. In 1902, the International Congress of Psychiatry officially settled the ‘Geel question’, declaring it an example of best practice to be emulated wherever possible.（紫烟雨）
改革系统成为伟大职业的根源和当地的骄傲，来自横跨欧美的医生和精神病学家来此进行实况考察。比利时、法国、德国的几十个城镇建立了自己的版本的‘吉尔系统’，其中一些仍然存在。1902年，国际精神病学大会正式解决了‘吉尔问题’，宣布它是在任何可能情况下能被模仿的最佳实践案例。

（12）Throughout the 20th century, the family care system prospered and expanded, and the town’s fame spread. With the growth of state asylums, families across Belgium faced the choice of having their relatives ‘put away’ for life in grim institutions or sending them to Geel, where handsome promotional photographs and brochures showed them working the fields, attending harvest festivals and church services, and sleeping in regularly inspected private bedrooms with cots and linen sheets. As a result, so many boarders arrived from the Netherlands that their hosts built a Protestant church in town for them. One wealthy family even took in a Polish prince, who came with his own butler and carriage.（瓷杯）
在20世纪期间，家庭保健体制的健全和扩大，镇的名声已在外。随着国家政治避难者的增长，比利时的家庭面对让他们的亲戚远离残酷的机构或送他们到吉尔的选择。其中精美的宣传图片和宣传册展示了他们劳动的场景，出席丰年祭和教会礼拜活动，私人卧室有人定期检查，床上铺有亚麻床单。结果，很多寄宿者（住院者）来自荷兰，以至于他们的房主为他们在镇上筹建了新的教堂。富裕的家庭带领有随从和马车陪伴的波兰王子来此地。
（13）By the late 1930s, there were almost 4,000 boarders among a native population of 16,000. Across Belgium, the town became famous for its eccentricity and was often the butt of coarse humour (‘Half of Geel is crazy, and the rest is half crazy!’), but in the town itself, normal life was little affected. Local jokes tended to revolve around how frequently locals and boarders were confused, and how hard it was to tell the difference. Boarders were well aware that disruptive public behaviour might result in being sent back ‘inside’; the problem was more commonly the opposite, that they became overly timid for fear of drawing attention to themselves.（瓷杯）
到了19世纪晚期，1万6千的本地人口中几乎有4千人是寄宿者(住院者），比利时境内，镇上以怪癖和经常受到低俗幽默的嘲弄而闻名（吉尔的一半是疯子，其他的是半个疯子），但就镇自身来说，日常的生活受到的影响较小。本地的笑话往往围绕当地人和寄宿者（住院者)经常多久才会糊涂，这是很难说清楚的。寄宿者（住院者）都清楚地知道，违反公共行为准则可能会导致被送回“精神病院” ，这就容易出现极左的一面，他们过度胆小，时刻提醒注意自己的行为。

（14）In recent decades, the ‘two-layered system’ — family care supported by a medical safety net — has been constantly recalibrated to reflect developments in psychiatry, but its most abrupt shift came in the 1970s. As the asylums emptied, mental healthcare was reconceived to become more flexible and extend further into the community. Antipsychotic and antidepressant medications, central to the new treatment model, were initially resisted by many families who felt they would turn boarders into medical outpatients, but they rapidly proved indispensable in helping to manage the worst of the depressions, crises and public incidents.（紫烟雨）
近几十年来，‘双层体制’——由医疗安全网支持的家庭护理——已不断重新调整，体现出精神病学的发展，但最急剧的转变发生在20世纪70年代。随着收容所被清空，精神医疗保健被重新接受，变得更灵活，且进一步扩展到社区。抗精神病药和抗忧郁药本是新治疗模式的中心，遭到许多家庭的抵制，尤其是那些认为他们会将寄宿者送进医疗门诊的人，但他们很快被证明，在帮助管理抑郁、危机和公共事件的最坏情况中是不可缺少的。
（15）These all appear to have been changes for the better. Yet they coincided with a precipitous and perhaps terminal decline in the centuries-old system. Today, there are around 300 boarders in Geel: less than a tenth of its pre-war peak and falling fast. While many locals believe family care will endure, it has become a markedly smaller part of town life, and others suspect that this generation will be the last to maintain it. Why is this deeply rooted and universally praised system suddenly on the point of disappearing?（紫烟雨）
所有这些似乎都在往更好的方面改变。然而他们与悠久的体制急剧的可能是晚期的衰落相一致。今天，吉尔镇大约有300名寄宿者：比战前高峰期的十分之一还少，并且还在迅速下降。然而很多当地人认为家庭护理可以持续，这已成为小镇生活明显较小的一部分，其他人怀疑，这一代将是最后一代来维护的人。为什么这个根深蒂固、被举世赞扬的体制即将要消失了呢？

（16）The limiting factor is not demand but supply. Few families are now able or willing to take on a boarder. Few now work the land or need help with manual labour; these days most are employed in the thriving business parks outside town, working for multinationals such as Estée Lauder and BP. Dual-income households and apartment-living mean that most families can no longer offer care in the old-fashioned way. People remain proud of the tradition, and credit it with giving Geel a broad-minded and tolerant ethos, one that has made it attractive to international businesses and visitors (these days it is probably best known for its annual reggae festival). But the town is no exception to the march of modernity and the irreversibly loosening social ties that come in its wake.（瓷杯）
限制因素不是需求而是供应。目前，少数家庭会或愿意接纳一名寄宿者。耕种的家庭或需要手工劳动者的家庭是少数，这些日子以来，多数人在镇外兴隆的商业界就业。并就业于多家跨国公司，如，雅诗兰黛、英国石油公司。双收入的家庭和居住在公寓的家庭意味着多数家庭不再以古老的方式提供服务。人们仍以传统引为自豪，为吉尔赢得了开明和宽容的口碑，
其一：吸引了国际企业和游客（这些日子，可能是一年一度的音乐节最为出名）的到来。但现代城市的行进脚步对这所镇来说也不例外，随之而来的是不可逆松动的社会关系。
（17）Modern aspirations — the increasing desire for mobility and privacy, timeshifted work schedules, and the freedom to travel — disrupt the patterns on which daily care depends. Increasing wealth is also a disincentive: most of the burden of care always fell on the poorer families, who counted on the supply of free labour and state payments to lift them above subsistence. The state now pays around 40 ($55) per day for boarders, of which only half is passed on to the families: hardly a financial incentive for most, these days. （瓷杯）
对现代的渴望--- 流动性和隐私欲望的增长，轮班工作的日程安排，及无拘无束的旅游---打破了依靠日常保健的模式的生存方式。日益增长的财富也起着抑制作用：贫困家庭的医疗保健的负担很重，他们生存的收入主要依靠自由劳动和国家的支付费用。目前，国家按一天约40（55美元）支付给住宿者，其中只有一半支付费用是交给家庭使用的：这些日子，对多数家庭来说，几乎经济刺激。
（18）More optimistically, the decline of the system can be seen as a reflection of modern improvements. Psychiatry has met the town halfway: the choice is no longer limited to the stark alternative of Geel or the horrors of the asylum. Care in the community, of which the town was once the leading example, has become the norm. For most mental health service users, the combination of medication and community mental health teams has made the line between ‘inside’ and ‘outside’ more porous, with ‘outside’ the preferred option for doctors and patients alike, on grounds both of cost and quality of life. （瓷杯）
更为乐观的是，体制的衰退见证了现代的进步。精神病学和镇相遇在现代的半道上，选择不再局限吉尔的完全替代或庇护恐怖。曾是镇上先进事例的社区的健康保健已成为普遍现象。多数心理健康服务用户，药物治疗和社区心理健康队伍的结合，能让“心理”和“非心理”形成统一。以成本和生活质量为基础，“非心理”治疗的医患者有优先选择权。

（19）The boundaries have blurred in Geel too, and the old system is hard to maintain within the institutional logic of modern mental health care. More than half of the boarders now receive some form of service, such as day care, therapy or supervised work programmes. Families come under pressure to be trained in therapy or psychiatric nursing as part of their duty of care to their boarders, but many insist that they aren’t clinicians and don’t want responsibility for medical issues such as their boarders’ drug regimes. In accordance with their patient rights, boarders are now given their own diagnoses and they are free to share them with families or not, as they choose; either way, the inevitable effect is to medicalise their situation. Within the family home they might still be boarders, but outside it they are now ‘patients’ or ‘clients’. （瓷杯）
吉尔界限也已经模糊，在现代精神健康保健的陈旧的体制的机构内维持陈旧的体制是很难的。当前，一半以上的寄宿者接受某种形式的服务，如，日间护理、治疗、或监督工作项目。对寄宿者健康保健责任方面，家庭在治疗或精神科护理方面进行培训。可是许多家庭坚持家庭不是诊所，不想承担医疗责任，如，寄宿者的药物监督等。依照病人的权力，允许寄宿者可以给自己诊断病症，他们可以免费与家庭共享或不共享诊断的结果，由病人选择；无论哪种方式，不可避免的结果让他们进行医学体检。在家庭，他们仍是寄宿者，出了家庭他们是“病人”或“客户”。

备注：（18）是瓷杯重新改正的。用蓝色标注。
（18）More optimistically, the decline of the system can be seen as a reflection of modern improvements. Psychiatry has met the town halfway: the choice is no longer limited to the stark alternative of Geel or the horrors of the asylum. Care in the community, of which the town was once the leading example, has become the norm. For most mental health service users, the combination of medication and community mental health teams has made the line between ‘inside’ and ‘outside’ more porous, with ‘outside’ the preferred option for doctors and patients alike, on grounds both of cost and quality of life. （瓷杯）
更为乐观的是，体制的衰退见证了现代的进步。精神病学和镇相遇在现代的半道上，选择不再局限吉尔的完全替代或庇护恐怖。曾是镇上先进事例的社区的健康保健已成为普遍现象。多数心理健康服务用户，药物治疗和社区心理健康队伍的结合，能让“家庭内”和“家庭外”形成统一。以成本和生活质量为基础，“家庭外”治疗的医患者有优先选择权。

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