A Town for Outpatients

On the surface, Geel looks like any other country town in northern Belgium. Its cobbled marketplace is surrounded by 15th century homes and shops; its neat brick farmhouses look much the same as they did in Brueghel's day. What makes Geel different is the fact that 1,800 of its 30,000 inhabitants are mental patients -- and that most of them are not confined to an asylum but cared for by normal families in the town. While this kind of outpatient care is still relatively new to psychiatry, the good people of Geel have been shel tering the sick in their homes for more than 500 years.

In Geel, one in seven families is responsible for the care of one or two men tal patients, and about 85% of the families who take in malades can truth fully say that their parents and grandparents did the same. "Here no one is afraid of mental patients," says Psychiatrist Herman Matheussen, 38, director of the program. When a schizophrenic plowing a field suddenly stops and begins gesticulating in a hallucinatory argument with an imaginary persecutor, his foster father may say calmly, "Joseph, why don't you finish that furrow?"

Beheaded Virgin. Geel's enlightened approach to mental care is the product of a 1,300-year-old religious legend. Ac cording to the story, an Irish Christian princess named Dympna fled from her widowed pagan father when he ordered her to marry him. He pursued her across the sea to Geel, where, insane with incestuous lust, he beheaded her. He instantly recovered his sanity, thereby es tablishing Dympna's reputation as a virgin martyr with powers to cure the mad. The date of her canonization is uncertain, but in the 13th century a chapel in Geel was named for her. Mentally afflicted pilgrims to the chapel soon overflowed the small lodge built to house them, and the Geeloise peasants, cannily combining religious devotion with thrift, began to take the pilgrims as boarders.

Those who were not cured often stayed on. They were treated as human beings by their foster families at a time when the mentally ill almost everywhere else were banished from society to asylums of appalling squalor and cruelty. Originally, Geel's boarding system for the mentally ill was supervised by officials of the Roman Catholic Church; since 1860, the Belgian government has had the responsibility of screening the patients and administering the program.

Carefully Screened. Mental hospitals and clinics from all over Europe refer patients to Geel. Two general practitioners and four psychiatrists observe new arrivals for two to three weeks in a small hospital; about half the applicants are rejected. Those who remain --some 50 a year--are the ones found suitable to Geel's way of life, mostly nonviolent psychotics and people with subnormal intelligence. The carefully screened families who take them in receive a practical compensation: extra hands for simple work, plus stipends of 80-c- to $2 per day. "The first time they take a patient they are doing it for economic reasons," says Matheussen, "but after five or six years, it becomes an act of humanity."

A doctor visits each patient monthly, a nurse every other week. Though the program is geared to the long-term patient, about half of the patients newly placed in foster homes are able to go home after about 16 months. Those who remain in Geel, some for as long as 50 years, may make little if any progress, but at least they are exposed to normal human conversation and society and have the simple dignity of honest work. Patients are treated like members of their foster families, eating with them, sleeping in their own rooms, helping with household and farm chores (or working outside the house in bakeries, dairies or shops), sharing in the upbringing of the children or going out to movies and clubhouses. Families learn to tolerate a certain amount of odd behavior, and Geel has been remarkably free of mishaps. Thanks in part to the use of modern tranquilizers, there has been no serious outburst of violence by a patient for at least 15 years.

Gentle Rhythm. Patience, understanding and the gentle rhythm of life have been almost the only real treatment at Geel. Now Matheussen is planning to set up several neighborhood treatment centers where patients will meet regularly for group therapy, schooling and vocational training. This additional therapy may be crucial to Geel's survival because modern life is at last changing the town's stable, close-knit medieval patterns. Factory jobs are replacing the farm work that is suitable for many patients. Trucks and cars thunder through the square, their drivers not accustomed to watching for dazed people who forget to look both ways at corners.

The use of these intensive-treatment neighborhood centers may mean that more patients will recover, so that families will be required to surrender their charges. That will present Matheussen with a special problem of diplomacy, since many do not want to let their boarders go. "Families adjust," he sighs. "They get attached to their patients."

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