Deinstitutionalising Women: An Ethnographic Study of Institutional Closure (review)

Kelley Johnson, Deinstitutionalising Women: An Ethnographic Study of Institutional Closure. Cambridge: Cambridge University Press, 1998. 216 pp. $64.95 cloth; $23.95 paper.

Over the past thirty years, much has been written about the personal and social outcomes associated with the closure of public long-term care institutions, which is more commonly referred to as "deinstitutionalization." Much of that literature describes the ways in which these relocation policies have failed disabled individuals and their communities. Problems of substance abuse, homelessness, criminalization, victimization, and other social ills are frequently placed squarely on the shoulders of shortsighted policy makers and hospital staff. It is argued that, in the rush to close the doors of institutions, decision makers failed to adequately assess patients' needs and abilities and measure them against the resources available in the community. "Dumping" of patients by these institutions has raised the ire of community residents, creating tensions between the disabled and the nondisabled, as well as between policy makers and community residents.

How these failures emerged and whether the future might hold a more rational and enlightened process are questions explored in Kelley Johnson's book on the deinstitutionalization of twenty-one women who had been labeled profoundly intellectually disabled and who have been institutionalized for an average of thirty years. Using an ethnographic approach fashioned on a postmodern feminist perspective, Johnson both observes and participates in the life and fate of these women over a twenty-month period.

Chapter 1 develops the dual purpose of the book, as well as the author's approach and biases. In part 1 (chapters 2-4), Johnson develops the first purpose of the book, which is to explore "the personal, subjective experiences of people with developmental (intellectual) disabilities and those around them in order to understand better the meaning their lives had for them" (8). Using participant-observation methods, the author reveals the circumstances of the women's lives and the environment in which they live. The purpose and focus of the book change in part 2 (chapters 5-8). The author explains the process of deinstitutionalization at one institution and her role as a participant-advocate for the women there. It is through this role and process that the author pursues the book's second purpose: to actively improve the well being of the women. Johnson unabashedly reveals in chapter 1 (and throughout the book) her enmeshment with the women, her "strong interest in ensuring . . . they were treated fairly" (2), and her desire to improve the "quality of their lives." In the last chapter (part 3), Johnson orchestrates the polyphonic voices of the earlier chapters into a symphony that resonates with her own subjectivity.

Johnson's story is set in Australia. Australian policy makers in the 1990s implemented policies to close institutions for the intellectually disabled. One such institution was a 440-bed Victorian facility named Hilltop, which as its name suggests, was located on top of an isolated hill miles away from urban life. Nested within Hilltop was the infamous Unit N, the locked unit, where women were sent to be punished for unspecified "bad" behavior. Women who were sent there rarely ever left, as they were forever dogged by the label of being challenging or difficult. For this reason, the women of Unit N, aged twenty-five to seventy-two, had spent roughly 40 percent of their time at Hilltop on that unit.

With the closure of Hilltop, these women were to be transferred to another institution or placed in community "houses." Much of Johnson's story focuses on the process of deinstitutionalization at Hilltop, a process that spanned twelve months, and involved clients of the institution, their family members, advocates, and institutional staff in a team approach. The goals of relocation were explicitly stated by policy makers: each placement was required to "provide accommodation and services equal to or better than those offered at Hilltop" (152). The closure project teams...