O istorie instituţională a psihiatriei în Basarabia: tratament spitalicesc şi abordare comunitară
An institutional history of psychiatry in Basarabia: hospital treatment and community approach

Summary/Abstract: This article examines the key elements of the history of psychiatry in Bessarabia (part of the present territory of the Republic of Moldova) from the perspective of two dominant approaches observed in the psychiatric system and practice: the intrainstitutional (within the hospital) and extrainstitutional (at the community level). The working hypothesis developed in this article is that starting with the end of the nineteenth century, the institutionalized psychiatric practice has been geared in the region towards institutional decentralization, community integration and diversification of mental health services. This trend has pursued the implementation of more efficient, socially integrated and more responsive services to the needs of the population. At the same time, it is important to critically assess the anachronistic and teleological approach according to which the psychiatric institution has evolved incessantly and inevitably from the hospital to community centres, towards a progressive “humanization” of therapeutic principles and practice. In the history of psychiatry and psychiatric practice in Bessarabia, there have been periods of rapid transformation, but also periods of relative stability, assured by a balance of power, in which some previous reforms were consolidated and other ones were revised, being considered too liberal. This sociohistorical study shows that some innovative elements of psychiatric practice implemented at the end of the 19th century, such as occupational therapy or patronage, have been later abandoned and recently recovered (in 2012‑2018) as part of the reform of the mental health system.

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