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This chapter highlights the methodological challenges and potential benefits of examining archival psychiatric records to collect valuable information about the individual and family context of hospitalization, and to illuminate the processes that shape short- and long-term adaptation following psychiatric hospitalization. It presents the system used to evaluate the feasibility of employing archival psychiatric records to capture important differences among patients, describes the “life chart” technique used to distill the voluminous information, and demonstrates that a measure created for use with contemporaneous data can be reliably and validly used with archival materials to address important and substantive questions about the precursors and sequelae of adolescent psychiatric hospitalization.

This book introduces the lives of forty-three people who participated in a community treatment program intended as an alternative to their psychiatric hospitalization. It also aims to discover their worlds and individual lives to gain a human, sociocultural understanding of psychiatric de- and non-institutionalization as practiced and experienced in culture. The lure of cultural anthropology has been its lack of restriction in subject matter combined with its human focus shot through with curiosity, the pursuit of commonsense understanding, and enthusiasm for variety, diversity, creativity, and underlying pattern. It would appear that psychiatric anthropology, rather than being an exotic subspeciality of cultural anthropology, represents a deeply traditional anthropological exercise. Fieldwork and intimate inter- and intrapersonal experience in the process of inquiry and understanding seem powerfully present in the psychiatric arena.

If there has been any constant in modern mental disability law in its near-forty-year history, it is the near-universal reality that counsel assigned to represent individuals at involuntary civil commitment cases is likely to be ineffective. In many nations, there simply is no mental disability “law,” and, even where there is such a law “on the books,” the promise of counsel is often little more than an illusion. Moreover, the lack of meaningful judicial review makes the commitment hearing system little more than a meretricious pretext. Encouragingly, though, a variety of interrelated factors may shed some light on this scandal and lead to positive social change in this area: the new, robust case law from the European Court on Human Rights on virtually all aspects of mental disability law, the ratification of the CRPD, and the publication of the World Health Organization Resource Book on Mental Health; the work done by mental disability law–specific NGOs (e.g., Mental Disability Rights International; Mental Disability Advocacy Center) on institutional conditions in central and eastern Europe and in Central and South America, and greater interest globally in what can broadly be called “access to justice” issues. This chapter surveys an array of international jurisdictions (common law, civil law, and mixed) and considers the range of findings (from nations in which there is no counsel, to perfunctory-at-best counsel, to almost-adequate counsel). It considers other major legal, political, and social developments that might illuminate these issues, and the impact of sanism and pretextuality on these developments. It concludes that the legislative and judicial creation of rights—both positive and negative—is illusory unless there is a parallel mandate of counsel that is (1) free and (2) regularized and organized. Without the presence of such counsel, any rights articulated by a court, human rights commission, or legislature become, again, merely “paper victories.” The presence of sanism and the technical complexity of most mental disability law cases (involving, often, expert testimony by mental health professionals and subtle predictions about “future dangerousness” or about institutional conditions) further augments the necessity and importance of adequate representation in such cases.