Geriatric Patients
Children and Adolescents

Guideposts, November 2002

A place to belong
(by Elizabeth Sherrill, Roving Editor)

It was market day as my husband, John, and I drove through the ancient town of Geel, Belgium. “Let’s stop and pick up lunch,” John suggested. The broad central square of Geel (pronounced “Hale”) was thronged with shoppers. John and I strolled among awning-shaded tables piled with cheeses, sausages, strawberries, great round loaves of bread. While I bought some fruit, John went off to look for olives. Passing a vegetable stand, I was stopped by a man handing out plastic bags. I shook my head but the neatly dressed salesman, as I took him to be, thrust one of the bags toward me anyhow, then gave some to a group of women coming toward me, all of whom, without a break in their conversation, reached across the stand and handed the bags to a man in a blue apron.
I watched as the bag-bestower handed out the last one, then lifted a fresh supply from a box beneath the stand. Now the aproned man gently pulled the bags away, murmuring something—I couldn’t understand the Flemish. The oddest thing about the little scene was that no one but me paid the slightest attention to it.
I went to tell John about it. “I just saw something very strange,” he said before I could speak. “A woman walking along with her hand to her ear, talking a mile a minute.”
“John, every other person here is talking on a cell phone!”
“She didn’t have a cell phone. She was talking into a black sandal. No one else even glanced her way.”

Intrigued, we visited the town’s information office and spoke to a young woman named Petra. Like many Belgians, Petra spoke excellent English. We told her we’d seen perhaps a dozen men and women with apparent psychiatric disorders mingling easily with the rest of the population. “Everyone seems so accepting of them,” I said.
“It’s the custom here,” Petra said, a phrase we were to hear again and again the next few days. In the Middle Ages when the mentally ill were caged and carted to fairs like animals, they’d been welcomed and cared for in Geel. “You should visit our museum. Hear about the princess and how she was murdered.”
A princess and a murder?
The next morning we entered the library of the local museum, housed on the ground floor of a once-bustling convent-hospital. The museum’s director, Dr. Frieda Van Ravensteyn, set cups of tea down next to two great volumes of illuminated manuscripts. “They must be five hundred years old!” I said.
“More like seven or eight hundred,” the director replied. “But not nearly as old as the story of Dymphna.”
Dr. Van Ravensteyn opened a dusty volume. “Here’s how Renaissance artists imagined her martyrdom.” A young woman knelt with bowed head while an older man raised a sword above her.
He, Dr. Van Ravensteyn explained, was an Irish king who around the year 600 had gone mad when his wife died. Mistaking his daughter, Dymphna, for her deceased mother, the king tried to force her into marrying him.
Horrified, Dymphna fled in a small ship, which eventually put in at Antwerp in what is now Belgium. Dymphna settled in the hamlet of Geel, but her father’s soldiers tracked her down. The king arrived, repeated his proposal, and when she again refused, cut off her head.
At the spot where villagers buried the young woman, healings, especially of the insane, were reported. Insanity during the seventh century—and for another thousand years—was regarded as devil-possession and sufferers were frequently cursed and attacked with stones. As the fame of Geel spread, despairing families brought sufferers from all over Europe, boarding temporarily with local families. A church dedicated to “St. Dymphna” was built.
“I don’t think it’s important whether her legend is true,” said Dr. Van Ravensteyn. “What’s important is that the story inspired hope, perhaps for the first time ever, that the mentally ill could get better. And here in Geel, you know, they always do get better.”
We didn’t understand right away what she meant. Many who came to St. Dymphna’s grave were not healed of the strange behaviors that made them outcasts. Disappointed families faced long journeys home with their afflicted son, sister, father, who would once again be ostracized. Only here in Geel there was a different attitude. Geelians had grown used to behavior that elsewhere aroused fear and loathing. Here, no one laughed. No one labeled it God’s punishment.
Many families, seeing their loved ones treated not as freaks or fiends, sought a way to let them remain. Might the troubled individual be able to stay on with the family who was boarding him? It was the beginning of a foster-family system of care still practiced in Geel today.
When the natural family could pay for their relative’s upkeep, Dr. Van Ravensteyn said, they did so, but before Napoleon’s 1797 invasion, the church provided most funds. “The nuns at the hospital also accepted mentally disturbed people who got sick. If you have time I’ll show you St. Dymphna’s church.”
A Gothic structure erected in 1349 on the site of a still earlier St. Dymphna’s, the church is down the street from the hospital-turned-museum. Dr. Van Ravensteyn led the way into the “sick room,” a small house built onto the side of the church, where patients once stayed for an initial period of prayer. Under Napoleon the church and the sick room were closed, the convent with its hospital dissolved. A centuries-old commitment to the mentally ill, however, could not so easily be ended; the foster-family system continued.
Later, the Nazis met this same community resolve, and left the mentally ill, exterminated elsewhere, untouched in Geel. “The town would have risen in outrage,” we were told. In fact, so inviolate was the tradition that Jews were often concealed here as mental patients.

The next morning we paid a visit to the public psychiatric hospital that oversees the family-care system today. The hospital is housed in a 100-year-old building flanked by half a dozen smaller houses. In a garden outside the entrance two men were talking animatedly as they unloaded pots of bright yellow flowers from a wheelbarrow. As we drew near, it became apparent that they were not conversing with each other but were absorbed, each one, in his own private world.
These men, we learned, were in the initial stage of possible placement with a Geel family. “This is their first exposure in many years to life outside hospital walls,” Wilfried Bogaerts, the hospital psychologist, explained.
Today, it isn’t families who bring the disturbed to Geel. “Ninety-eight percent of our patients come from institutions,” he said. “Most have had no contact with their natural families for years.”
When they come to Geel they are evaluated here at the hospital. Violent patients are not considered for family care. The next step is for the patient to live for a while in one of the small houses we’d seen on the grounds. After years of bells and bars and regimentation, how would the individual handle a more homelike setting? They are given small chores—washing dishes or watering the lawn—taken on brief excursions. Did the person know what money was? Could she ride a bicycle, as most Geelians do? Did he understand traffic lights?
If the patient is comfortable with the new freedom, he is placed with a foster family. At present over 600 “boarders” are living in homes in the community, and there is a waiting list of available homes. The motivation could hardly be money; the host receives the equivalent of $13 a day to maintain the boarder.
At any point, the family or boarder can end the relationship, yet breakups seldom happen. When the original foster parents die, one of their children usually takes on the responsibility of giving care to the mentally ill boarder.
“And do they always get better?” I asked, remembering what Dr. Van Ravensteyn had said.
“Yes,” Mr. Bogaerts answered. “When a patient is placed with a family, motor function improves, medication levels go down. But there’s a far more important kind of healing. Healing from a lifetime of rejection. Here the mentally ill are people of value—you can see it in the way they hold themselves.”

On a final stroll through Geel we observed again people whose differences are respected, even cherished, by their community. People who’ve at last found a place to belong. Outside a music store a woman was conducting an imaginary orchestra. Passersby nodded to her.
In Geel, the mentally ill are of value, above all, because they are children of God. And of course you can’t recognize his presence in someone else, without catching a glimpse of it in yourself. Perhaps this is the reason for the statistics we’d heard about Geel: low crime, low divorce rate, school dropouts rare. Here in a tiny Belgian town they’ve learned that being your brother’s keeper is the best way to make brothers of us all.