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The Eastern State Penitentiary was one of the first prisons to emphasize reform rather than punishment.

Credit: Ajon Brodie

The word asylum often conjures up prison-like images of stark white walls and forgotten people institutionalized and removed from society — but one Penn professor wants to change that.

Medical ethics and health policy professor and director of the Scattergood Program for the Applied Ethics of Behavioral Healthcare Dominic Sistiwants to transform this connotation to one of healing.

In a recent paper titled "Improving Long-term Psychiatric Care: Bring Back the Asylum," published in the Journal of the American Medical Association, Sisti, along with medical ethics and health policy professor Andrea Segaland Vice Provost for Global Initiatives Ezekiel Emanuel, outlined the argument that asylums should return to the medical forefront as places where severely mentally ill people can heal.

“Our position is not all that radical,” Sisti said. Yet, the paper has generated media controversy, especially online, mainly centered around the team's choice of the word "asylum."

However, Sisti maintains that the true message of his work is not being acknowledged. "The goal was not to be intentionally provocative,” he said, adding that, "part of the issue is that the paper isn’t being read.”

Only two pages long and freely accessible on the web, the paper's declaration is less radical than its title.

Rather than proposing any radical shifts in psychiatric care, the paper suggests bringing back the asylum in the word’s original meaning, as a place of refuge and sanctuary. “We don't have to go back to the large monolithic institutions from the past — that’s not something we advocate," Sisti said. "But rather, a safe sanctuary where individuals can go to heal with dignity.“

Sisti emphasized that the newly-reformed asylums would not be for all patients with psychiatric problems, but only for those in danger or who are incapable of taking care of themselves, even with support.

He also highlighted the link between mental illness and incarceration, stating that imprisoning the mentally unwell is “as if someone had stage four cancer, and they were imprisoned because of the cancer.”

However, the ideas expressed in the paper may be just that — ideas. Sisti expressed doubts about the practical possibilities of restoring the asylum to today’s world and admitted that the vision presented in the paper is not reflective of the current trends in psychiatric care.

“I think that the future of mental health care is toward improving community treatment, which I completely support," he said. "We just have to fill some gaps.”

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