Giant yellow wooden letters spell out GEEL in the city center of Geel, Belgium
In the summer of 2023 I visited the Belgian city of Geel, excited to discover how it’s been home to an adult foster care program for generations. In the US and Canada, adult foster care is all but unheard of, with adults instead relegated to institutional care. I wanted to know how they did it and how we could better support caregivers in the US.

Instead, things got weird and kept getting weirder. I learned much more than I bargained for about faith, classic literature, medieval social hierarchies, settler colonialism, and expanded my knowledge of French with quite a collection of words I would never say aloud.

I came up with a plausible explanation for how Geel’s family care system began and thrived from the asylum age through the end of the Cold War. I also found myself reinterpreting my childhood and the small town my family’s lived in on the Jersey Shore for generations.

In the end, I did come to understand how Geel was able to develop and maintain an adult foster care system. I came to understand why family care thrived in Geel and vanished in other placed in Europe and North America. The origins and history of this darling of the anti-psychiatry movement and psychiatric survivors turns out to be something none of us would ever wish to replicate or preserve.

This wild adventure led me to understand why adults who require care are pushed to rely on unpaid care from family members, home care from exploited minorities, and confinement to institutions. Despite the incredibly troubling history, the experience led me to discover the opportunities presented by current systems of grassroots care. We can tap into this potential to both work with existing legislation and advocate for new legislation to enable people to receive the truly compassionate, non-coercive, non-carceral care they deserve.

Contents

Chapters

Part One: Belgium

Part Two: the USA & Canada

Appendix

Population of Geel

Timeline of Geel Family Care System

Making sense of the stories and myths of Geel

1: Going to Geel

A trip to Vancouver Island rouses my curiosity about the famous city of Geel, renowned for its adult foster care program. I discover how the mental health care facility that oversees Geel’s “family care” program works today. I provide an overview of the utopian reputation of Geel’s program.

2: The place and the fantasy

I arrive in Geel and discover something profoundly troubling about the city of Geel. The “compassionate city” which as taken in the unwanted since time immemorial turns out to be famous for exorcisms.

3: Pilgrimage as acute care

Seeking to understand the myths connected to Geel, I research the history of pilgrimages by the mentally ill and visit the modern pilgrimage site of Fatima in Portugal.

4: Saints and symbols

Confused as to how Dymphna became the patron saint of the mentally ill, I research other saints connected to care work and mental health. I discover several saints and shrines with exorcism rituals similar to those in Geel, as well as towns known for providing foster care for adults with mental illness.

5: The Cinderella Saints

Realizing the story of Saint Dymphna is a variation of the Cinderella story, I find other Cinderella saints and discover how widespread these stories were in Europe. I uncover their ties to ancient sacred sites and settler colonies in present-day Belgium. 

Geel’s population

YearBoardersResidentsNotes
1374 2000 
1435 872 taxable houses and 254 houses free of taxes, with an estimated population of 8,078 
1496 506 taxable housesWar and plagues, economic ruin
154904,000 registered at Sint-Amands 
1593 1,450 registered at Sint-AmandsMore war, more plagues, more ruin
1684 1,000 registered at Sint-AmandsGeel run by absentee nobility with no interest in Dymphna
1784 4,829Moral asylums built in the US, Austria, and France
1800200 Under French control, law authorizes sending of all insane to institutional care
18036005,933 (1806) 
18125006,202 (1816)Family care in Geel is abolished by the French Minister of Justice
1820400  
1821400  
18426997,000 (1841) 
1850900 Major crop failures
185580010,713 (1856)Family care transferred to federal authorities under legislation created by Triest and Guislain, confining boarding-out to Geel
1860600-1000 due to frequent intake and discharge11,206 
18911,800 (200 foreign, 40 from France)11,000Rail line reaches Geel
18952,400 in Geel and Lierneux11,40011,819 insane persons in other (non-colony) asylums
19001,90013,070 
19202,277 (in 1923 421 were Dutch)16,692 
19292,69418,638Means-tested disability payments introduced
19373,000  
19383,73620,000 (1936) 
19442,600  
19502,45922,296 (1947)Chlorpromazine and lithium introduced
19601,93427,007 (1961) 
19701,386 (plus 350 in the closed institution)29,346 / 1,000 host families (1975) 
19791,600  
199099232,367The 1850 Belgian law requiring confinement of the mad and vagrants is overturned
199954933,677 (2000) / 455 host families 
2001571  
2003516423 host families 
2006460  
200739936,990 (2010) / 343 host families with 38 additional rooms available 
202312541,828 

 

 

Timeline

5th century – The area of Geel was part of Gallia Belgica. The Romans left behind burial mounds, a villa, a coin hoard, a watchtower, and a statue of Diana in the Kempen. During Roman times the Kempen resisted romanization. During Julius Caesar’s occupation the area was inhabited by Celtic-Germanic tribes. The Gauls had a reputation for beheading people and for worshiping at natural site, known as nemetons. The area was colonized by the Franks in the 5th century. The Gaulish language is thought to have died out during the 6th century.

6th to 8th century – Dymphna was born in the 620s. Or maybe the 750s. Or the 800s. According to P. D. Kuyl in 1863, when Saint Dymphna arrived in Geel, “a little before the year 600, this place was a villa of fifteen houses, subjects whose huts were clustered around that of their lord, and who did all kinds of work for him.” Regardless of when she actually got there, at the time Geel was near the edge of the Merovingian dynasty.

In the 600s, Saint Amand, to whom the church in the center of Geel is dedicated to, was traveling around what is now Belgium converting the pagans to Christianity. 

Saint Clemens Willibrord travels around the area, destroying pagan sacred sites and replacing them with Christian shrines. He was ordained as a priest in 688 and died in 739. The wells and springs where he converted pagans to Christianity become pilgrimage sites, especially to cure nervous disorders. Today there is a 727 km pilgrimage route linking various sites connected to Saint Willibrord that’s popular with cyclists. There is a chapel near Geel, Sint-Willibrorduskapel van Meren.

10th century – The sarcophagi of Dymphna and Gerebernus were taken and brought to Sonsbeck by pilgrims from Xanten. This is despite the fact that they hadn’t yet been discovered, since the earliest chapel on the site in Sonsbeck dates to 900 and we are told the chapel was built at the spot where oxen refused to carry the remains of Gerebemus any farther. 

Under the patronage system, the nobility owned churches, used monasteries as land trusts for their families, and sold church roles. While the clergy had specific rights, the property of the nobility included any altars, shrines, and relics. Devout believers feared that churches led by the nobility could not truly convey the sacraments. In 1122 a compromise was reached, making the power of the nobility to choose bishops, abbots, and popes unofficial.

The beguine movement began in Liege in 1170.

The population of Western Europe doubled and the population of France tripled between 1000 and 1340 thanks to agricultural developments. Around 1100 farmers in Flanders began draining wetlands and converting it to agriculture.

1235 – Six hundred years after she dies, so either 1235 or 1365, Dymphna’s body is dug up for some reason. Kuyl says that this happened in the 12th century. Or maybe it was rediscovered in the cave. Or maybe two ancient sarcophagi are unearthed from the peat. Supposedly one of the sarcophagi has a plaque saying it holds the body of Saint Dymphna. Clearly, the sarcophagi were made by angels because they are so beautiful they couldn’t possibly be made by men. The miracles begin! Or resume, if we’re talking about the version of the story where viewing her murder cured five madmen.

Saint Elizabeth of Hungary, future mother-in-law of Henry II, died young in 1231 and was canonized formally by Pope Gregory IX in 1235. Her heart is sent to Cambrai. Petrus Cameracencis, Augustinian canon of Saint-Aubert in Cambrai, composed songs celebrating her life.

Petrus Cameracencis, Augustinian canon of Saint-Aubert in Cambrai, is said to have written the vita of Saint Dymphna. This is believed to have happened sometime between 1238 and 1248, during the reign of Bishop Guy I of Laon. The vita notes that her story is based on oral tradition, despite her body having been exhumed either 13 years ago or 117 years in the future. In 1247, Geel was granted some of the privileges of a city.

Henry II’s daughter, Maria of Brabant, happened to have been beheaded by her husband in 1256 due to a misunderstanding involving her confessor.

Henry II founded a chapel in 1270 and Henry III founded the gasthuis (hospital) in 1286, under Bishop Willem van Henegouw. The gasthuis was run by a co-ed order of Augustinians, which sent two master managers, three brothers, and five sisters to run the hospital. The founding letter mentions Dymphna. 

In the 13th century the harvesting of peat began in the Kempen. Canals were constructed to transport peat to the cities for sale. This, along with the grazing of sheep and the use of deep pit manure techniques damaged the soil and began the process of turning the wetlands of the Kempen to sand dunes. This coincided with the gradual temperature shift from the Medieval Warm Period to the Little Ice Age. The last crusades fizzled out in 1272.

The Great Famine began in 1315. It continued to 1317 and recovery finally came in 1322. Crop failures and livestock plagues led to starvation, disease, and unrest. As famine was viewed as divine retribution, this undermined the power of the Catholic church.

1317 – Pope John XXII issued anti-beguine decrees.

The cult of Dymphna

1349 – Sint-Dimpnakerk was constructed in 1349. Villages could expel beggars, so all pilgrims arrived with cash in hand for treatment. 

The years between 1346 and 1353 were particularly brutal years for the bubonic plague. Life expectancy at birth dropped from 40 to 18 years. New cults arose, along with the popularity of self mortification. Jews were expelled from England, France, and Spain, with many settling in Antwerp and Amsterdam. 

1411 – A letter refers to “all pilgrims existing and arriving in the aforesaid chapel” of Sint-Dimpnakerk. An 1412 letter granting indulgences to participants in the procession of the relics from Sint-Dimpnakerk to Sint-Laurentiuskerk refers to general charity, not insanity.

1431 – An indulgence letter refers to Dymphna healing those “who were tormented by evil spirits were wont to be brought by them to be dreed” and the nine day healing ritual.

1448 – The earliest depiction of Dymphna is a votive stone in Sint-Dimpnakerk. The municipal register began in 1449 and accounts from church administrators began in 1513.

1480 – The hostel attached to Sint-Dimpnakerk was built. According to Kuyl, the hostel was built by Jan Van Roye and it was under his leadership “that some arrangements were made regarding the senseless for the first time. They were no longer allowed to stay in Gheel without prior permission…Before the 17th century, no insane people lived except around Ste-Dimphnakerk or as far as its territory extended.”

1451 – Sint-Dimpnakerk changed hands several times, ending up passing to Aleidis, who married into the Merode family in 1451. From 1484 to 1601 “the de Merode family owned and effectively ran St Dympna’s church…when the cult grew most speedily and became associated with the cure of lunatics…St Margaret was a patron saint of the family, and about 40 per cent of all the de Merode daughters between the fourteenth and seventeenth centuries were named after her. It appears, therefore, that the de Merodes were deliberately coining their own private version of St Margaret in the cult of St Dympna.” This coincided with humanism, a time when it became popular to study ancient languages, including texts by pagan and Christian authors.

In 1485 three marble tombs were unearthed on the Appian Way outside of Rome. One of the tombs contained a well-preserved body of a young woman. This celebrated event is among the best document events of the 15th century. 

1489 – Sint-Dimpnakerk was damaged during the Brabant rebellion. Numerous homes in Geel and other religious buildings were also burnt. The destruction of the church and its artifacts gained attention for the cult and provided an opportunity to rewrite the story. Under the patronage of the Merode family:

“Her father’s name was supplied as Damon, or Damen, he was reported to have returned to his senses the moment he smote his daughter’s head off; a group of lunatics, wandering through the woods near Geel years – if not centuries – later, allegedly fell asleep on the very spot where the saint was martyred, which was covered by overgrowth, and woke up the next day with their mental health restored. Finally, the saint herself became endowed with the unexpected attributes: apart from a sword – the instrument of her martyrdom – she is usually depicted (from the late fifteenth century onwards) with a fettered imp, either sitting at her feet or being trampled down by her.”

1496 – The earliest written record of Dymphna’s life, a woodcarving printed in Amsterdam in 1517, dates from 1496. The author of the story is said to be Peter of Cambrai.

1505Goossen Van der Weyden painted the Dymphna story on an altarpiece for Tongerlo Abbey in Westerlo in 1505, likely at the request of Antonius Tsgrooten.

Shortly after knowledge of the existence of the Americas became widespread, the Renaissance reached France and Belgium. Geel’s population had shrunk by half in the past century, due to war and plague. The cloth industry, the center of the local economy, had collapsed. 

1515 – The altarpiece currently in the center of Sint-Dimpnakerk, depicting an exorcism, is created by Jan van Wavere. A document from 1517 refers to a church dedicated to Saint Douceline de Digne in Geel. Geel gained expanded rights as a city. Martin Luther ignited the Protestant Reformation in 1517, with two Augustinian monks in Antwerp being the first to be burnt at the stake in 1523. Martin Luther had been an Augustinian monk and had taught some of the monks in Antwerp, who were then spreading his ideas. After breaking with the Catholic church, Luther and his wife supported themselves by farming and taking in boarders. The inquisition ebbed and flowed between its establishment in 12th century France and when it was abolished by Napoleon in 1806, but this was a particularly rough time for heretics and anyone who seemed unusual.

1532 – Sint-Dimpnakerk burnt down and was replaced with the current Sint-Dimpnakerk. In 1541 the tower collapsed and the attached pilgrim hostel was destroyed. This was the golden age of the saintly procession. The Ommegang of Brussels was also hitting its peak.

1546 – Church leaders and nobility met at the castle of Westerlo and came to an agreement over how to manage the plague, including:

“The director or his deputy may administer the holy Sacraments of the dying to his fellow brothers, to the headmaster of the Latin school, to the sexton and to others currently in the service of the Ste-Dimphna Church, as well as to all who live in the house of these persons. This also included the pilgrims and the senseless who stayed in Gheel; but at their funeral services the pastor of St-Amands could be present, and then he stood, in what is rightly connected, with the canons.”

Kuyl clarifies that “When this settlement was written, there were no senseless people living in the vicinity (district) of Ste-Dimphnakerk. When they later resided in the parish of St- Amands and died there, difficulties arose again in deciding in which church their funeral services should be held.”

This is one of very few references to the family care program in Kuyl’s exhaustive account of historic documents.

1549 – The Netherlands formed and left the Holy Roman Empire. By the 1550s Geel had begun to recover its population when the Eighty Years War led to further population decline. The parish at Saint Amands dropped from 4,000 to 1,500 between 1500 and 1593. Over one hundred houses had been burnt down and 17 homes were vacant. The wealthy were the first to leave. The area was subject to near constant warfare and epidemics. The Merode family generously provided the peastry of Geel with a loan in order to pay tribute in order to avoid their homes being burned and looted on at least one occasion. The churches were repeatedly desecrated.

1552 – The gasthuis in Geel became a convent in 1552, when it was issued an Augusitinian charter. Sint-Elisabethgasthuis in Antwerp was reorganized and expanded in 1553. Some accounts claim the family care system began when locals took in pilgrims at the request of Augustinian nuns, which would place the start of the system after 1552. Other sources say that this is when pilgrims began coming from outside Brabante.

1556 – Sint-Dimpnakerk was damaged during the iconoclasm. Most of the works of art in Sint-Amandskerk were destroyed by the Beggars in 1567, with the exception of statues of Saint Dymphna and Saint Gerebernus. The church crucifix fell and crushed a man to death during the attack. Church buildings in Geel were damaged again during the Eighty Years’ War, most notably in 1581.

1576 – Antwerp was burned and looted by Spanish soldiers in 1576, turning the Dutch Rebellion from a religious thing to an anti-Spanish thing. After a year-long siege, the city of Antwerp surrendered to Spain in 1585 and all Protestants were forced to leave. The area suffered economically for two centuries due to a loss of Protestant merchants and blockades that cut this trading center off from international trade, with businesses moving to Amsterdam. Geel’s economy shifted from the production of cloth to farming rye, oat, barley, and buckwheat. The war, heavy taxes, and imperial control made life challenging.

In 1579 the area became part of the Spanish Netherlands. In 1583 the castle of Westerlo was captured by the Spanish. Almost half of Geel was burnt, with the region being plundered. In 1586 Jan van Merode reconciled with the king of Spain and his possessions, including the castle, were returned. He then made sure his subjects had remained faithful Catholics during the occupation. With Spanish Catholic rule came the return of support for beguines.

1585 – Construction on the Sint-Dimpnakerk tower stopped, without it being completed. Kuyl says the population of Geel was reduced by ⅔ by 1587. The church canons pleaded to have their tribute charges reduced. At the end of the 16th century Geel had seven years without being burnt and looted, although they still had to pay assessment charges to both the Spanish and the Dutch. Then in 1602 the plague struck again, continuing until 1605. In 1602 mercenary Italian soldiers serving in the Spanish army mutinied. They regularly demanded money, food, and supplies from Geel, Turnhout, Herenthals, and Santhoven. They were overthrown in 1604.

1604 – With a break from constant warfare, pilgrims to Sint-Dimpnakerk resumed. Many miracles of Saint Dymphna were reported by the Bollandists between 1604 and 1668. This included a “miraculous healing of a mute, deaf and lame youth from Maeseyck”.

1632 – War returned in 1624. The area was captured by the Dutch in 1629. Because the Catholics supported the Spanish, they were considered the enemy, leading to suppression of the church. The Calvinists took power and suppressed Catholicism. A letter from 1632 debates whether or not to have the Dymphna procession and what route to take.

From 1636 to 1642 the Retortion Placard forbade Roman Catholic clergy from Meierij van ‘s-Hertogenbosch, a region of eastern North Brabant which included Westerlo. Tongerlo Abbey and all local churches were shut down in 1637. Priests who didn’t flee disguised themselves as peasants and conducted mass in secret. A 1635 letter from Pope Urban VIII makes no mention of the family care system, only of care for the poor. There is no record of income from exorcisms from 1637-39, with records of payments resuming in 1640. A 1641 letter grants the power “to exorcise the besieged or the evil-doers, when with the power to substitute another suitable exorcist, in case of necessity” to a new church leader. By 1644 the relics in the shrine of Dymphna had dwindled to four large bones.

1658 – Udolphus van Craywinckel published the life of Saint Dymphna. A graduate of Geel’s Latin school, he resided at Tongerlo Abbey in Westerlo since 1631 and was writing at the request of the abbot, A. Wichmans.

1774Leopold II, Holy Roman Emperor, passed the law allowing for hospitalization of the insane in 1774 and began construction of an asylum. While ostensibly meant to remove the mad from workhouses and prisons in order to provide moral treatment, people behaving oddly in public could now be examined and sent to institutions on the basis of their madness alone.

The first American institution for the insane was founded in 1773 in Williamsburg, Virginia. The Enlightenment touched off a wave of reforms in mental health treatment. Instead of viewing madness as an affliction best handled by locking its sufferers away, a new school of doctors asserted that things like rest, fresh air and a generally humane approach could vastly improve the prognoses of the mentally ill. The madhouse model fell out of favour, and progressive doctors began to promote the idea of “asylums,” huge, sun-filled buildings where patients could escape the pressures of society and access various therapies.”

The Kempen, among other areas, lived in fear of the goat riders, between 1743 and 1794. People were robbed at night by devil worshipers traveling by flying through the air on goats. There were several trials where confessions were obtained through torture, resulting in the death penalty.

1790 – The law required the insane be locked away. Austrian authority returned to Geel in December. The French invaded in 1792. The Austrian regime regained power in 1793. The French invaded again in 1794.

The French Revolution

1795 – Geel became part of France. It appears that prior to this the lordship of Geel had passed through a quick succession of hands and was in dispute at the time. This officially ended the medieval system of land ownership, although little appears to have changed. Napoleon was not a fan of the Catholic church. France had already dissolved all ecclesiastical orders and congregations, although orders nursing the sick were allowed to remain at first. When the hospital was secularized the nuns remained in their positions and were made civil employees. In Sint-Elisabethgasthuis in Antwerp the sisters were disbanded in 1803 and weren’t hired again until 1824, without regaining management of the hospital. Church relics were placed in hiding during the Reign of Terror. The treasures of Sint-Dimpnakerk were hidden for 24 years.

1797 – Sint-Dimpnakerk was shut down. Priests who refused to take an oath of loyalty to the civil authority had to go into hiding and conduct sacraments in secret or go into exile. All power over the program at Geel transferred from the church to the state. It’s in the 18th century that treatment at the hospital in Geel officially came to be overseen by doctors, rather than nuns. However, supposedly due to a lack of qualified workers, the nuns were simply made state employees.

1798 – Peasants revolted and were crushed during the Boer War, also known as the Peasants’ War. The uprising protested the loss of customs, rights, and privileges, especially the new anti-religious and conscription policies. They wanted to restore Austrian rule. Antwerp was the northernmost naval port of France and there were a lot of military conflicts, so conscription was a huge issue and people in the Kempen led the rebellion.

1799 – Sint-Dimpnakerk was auctioned off by the French government. It was purchased by Amandus de Vos, along with the chapels of Osterlo and Zammel.

1801 – Bonaparte officially ended the hunt for priests who refused to swear loyalty oaths in 1800, although in practice persecution continued. In 1801 the Catholic church regained possession of Sint-Dimpnakerk. That year the diocese of Antwerp was abolished and Geel was moved back to Mechelen. The archdiocese of Mechelen was in disarray. The Archbishop of Mechelen, Cardinal Frankenberg was exiled in 1797, resigned in 1801, and died in 1804.

1803 – A new law required all “maniacs” kept in Brussels to be taken to Geel. This legislation requires regular inspections, over the objection of the people of Geel. An 1808 account by Dr. Andree mentions being told that madness is endemic in Geel.

1811 – The French Minister of Justice officially abolished family care in Geel. This legislation was never acted on. Sint-Dimpnakerk was desecrated by the French a final time, despite being privately owned.

1815 – Geel ceased to be part of France and instead became part of the United Kingdom of Netherlands. The former borders are not restored and instead new provinces are created. The basement of Geeraard de Duivelsteen in Gent was modified to hold mentally ill men in 1815. It had already hosted the mentally ill when it served as a prison, possibly from when it became city property in the 14th century until 1775, when the new prison opened at Rasphuis. Duivelsteen also served as an arsenal, a monastery, a school, an episcopal seminary, and an orphanage for boys.

1818 – The first of what would become seven Colonies of Benevolence was set up as an experiment by the United Kingdom of the Netherlands. The seventh colony was completed in 1825. The two colonies that are located in what is today Belgium are located near Geel, in the Campine

1821Jean-Étienne Dominique Esquirol, a student of Philippe Pinel, published an account based on a two day visit to Geel made in 1811. This was part of a tour he’d been conducting of asylums in France since 1810, which was later made into a book. This appears to be the account that plucked Geel out of obscurity and shone a spotlight on it as a unique program. He explains that the village of Geel was founded after the martyrdom of “Saint Nymphna,” whose bones were miraculously discovered in the 7th century and who could cure maniacal distempers. The elderly rector of Sint-Dimpnakerk reports that while he’s seen many cured by the saint, they have become rare. The account claims boarders are not permitted to attend the parish church and cannot be out after dark, but they are allowed beer. It’s also noted that in the previous ten years, five pregnant boarders have been sent to Brussels.

The creation of Belgium

1830 – The Belgian Uprising took place in 1830, for which Geel was awarded a medal of honor by King Leopold I. The province of Antwerp became part of the nation of Belgium later that year. French was the only official language. In Flanders only the aristocracy spoke French. Despite the mix of cultures, nation building brought an interest in Belgian traditions and culture, including celebrating the beguines. 

Belgium became a country just as the era of institutionalization and eugenics was dawning. There were at least 18 asylums in Belgium operated by Christian orders at this point. “In the 19th century, medical treatment of the mentally ill trumped religious devotion. Belgian  law required “mad people” to live under lock and key in an asylum. But Geel, with its history of community care of psychiatric patients, was exempted for economic as much as humanitarian reasons.”

1838 – When the family care system was transferred to the control of the local government, Geel had 700 patients placed with families. This year, law mandated at least one asylum in each department. In 1840 Felix Bogaerts wrote a novel about the Dymphna story. In 1841 a law in the Netherlands required all “insane” persons, which included the intellectually disabled, receive treatment in an asylum. Those who were deemed incurable were placed in custodial care. 

In 1845 those in charge of housing the insane in Saint-Dizier-l’Évêque were charged with practicing medicine without a license.

1847 – Belgian towns were required to develop or sell wasteland. This included the common heathland the Kempen/Campine is known for. Major crop failures between 1845 and 1849 left a third of the population of Flanders reliant on poor relief. People living in Flanders moved to Wallonia for work.

1852 – Family care was transferred to state authority and renamed the Rijkskolonie. The 1850 legislation that created this change included the legal recognition of family care, making it equal to admission in an asylum, suggesting it previously was operating under a quasi-legal status. Essentially, the entire district of Geel was designated as an asylum without walls and boarding-out was no longer permitted elsewhere.

“Geel still functioned as a “normal” community, as it always has, but, on paper, the whole area was somewhat of a “hospital without walls,” with each boarder’s room in the family home considered, on paper, as a hospital room.”

The creation of a national framework to address lunacy was inspired by the French 1838 Loi Esquirol. The French law ended the practice of housing mental patients in prisons, even temporarily.

1857 – The Guislain Hospice opened in 1857, as the first insane asylum in Belgium. This was followed by the creation of the infirmary building at Geel, which opened in 1862. Formally known as the Infirmary of the National Colony for Family Nursing, it was designed by Gent architect Adolphe Pauli along the guidelines of Dr. Jozef Guislain. It has space for 50 patients. Entry examinations, temporary rehospitalization, and detainment prior to transfer to an asylum were moved from the Gasthuis to the infirmary. This is when it becomes policy to screen patients for suitability and send inappropriate patients to the asylum in Gent. 

1867 – A model house for family treatment was displayed at the Universal Exhibition in Paris by Baron Jaromir von Mundy of Moravia. He had written his dissertation on the colony of Geel and continued to travel internationally, giving lectures on the Geel system in French, German, and English.

1873 – Public secondary schools were permitted to use Dutch for the first time.

1874 – Sint-Dimpnakerk became a parish church for the first time and boarders are expected (not required) to attend services there. In 1875 legislation was passed making it illegal to house patients in the church sick rooms. The last patient was removed from the church in 1881.

1879 – A railway line between Antwerp and Mönchen-Gladbach, Germany, opened, connecting Geel by rail. There was an agricultural crisis in 1880, leading to major economic shifts in the region.

1885 – A psychiatric hospital with a family care system was created in Lierneux and Geel’s French speaking boarders were transferred there. An 1889 book reports that French and Belgian asylum inmates had the right to go before a judge and ask be released. 

At the turn of the century, Belgium began to establish the modern social safety net. First there was sickness insurance in 1894, then a voluntary old-age insurance program in 1900, followed by unemployment insurance in 1907. Various self funded insurance and savings programs were slowly subsidized by the state. This came along with human rights advances, like the outlawing of payment in kind in 1887, the right for all men to vote in 1893, and abolishing of slavery in 1890. In 1898 the Dutch language was given equal status with French.

1902 – The 1902 Congres International de l’Assistance des Alienes et specialement de leur Assistance Familiale, in Antwerp, announces the “wish that family care would be applied in all its forms as widely as possible.” A 1905 account by a visitor to Geel mentions visiting a museum at the Geel asylum. In 1908 the Congo Free State was transferred from the personal property of King Leopold II to a Belgian colony, becoming the Belgian Congo. Indiana introduced a law to forcibly sterilize people in 1907, but California was the first to actually pass it in 1909. In due time, ⅔ of US states followed suit.  In 1912 Switzerland made it illegal for the “mentally deficient” or “legally irresponsible” to get married.

1912 – Subsidized disability funds were established, followed by general medical care in 1920 and piecemeal expansion in the next two decades.

1914 – Belgium’s neutrality during WW1 did not prevent it from being invaded in 1914. Flanders was a war zone under control of the German army. Germany constructed the Wire of Death, an electric fence along the border, to slow the flood of refugees into the Netherlands. The Germans encouraged the Flemish Movement, something they would also do during their WW2 occupation. The Germans stripped the country of industrial materials and equipment, creating massive unemployment. Herbert Hoover organized the Commission for Relief in Belgium to provide food aid to millions of Belgians. 

1918 – A new hospital was built in Geel to replace the gasthuis. That year Belgium passed a law allowing all men to vote equally. In 1920 Antwerp hosted the Summer Olympics.  In 1928 Belgium introduced means-tested financial support for people who could not earn an income due to disability. In 1928, Switzerland was the first European country to require the forced sterilization of people with intellectual disability. Germany didn’t get started until 1933. In 1934, the Journal of the American Medical Association published a report praising the German legislation.

1922 – A division for mentally handicapped children at Geel was established. 

1930 – Historians came together to revive the Ommegang of Brussels with the hope that it would attract tourists. UNESCO named the festival an intangible cultural heritage site in 2019.

World War 2

1939 – The Albert Canal, which connects Antwerp to Liège, passing through the south of Geel, opened in 1939. This later formed a major defensive line during WW2 and all bridges over the canal were preemptively blown up. Bridge replacement was completed in 1946. In May 1940, the Germans crossed the Albert Canal. Belgium surrendered 18 days after the Germans invaded. In Geel, the boarding-out system continued throughout WW2, including with the placement of new boarders. This is, however, the beginning of a long decline.

1944 – Geel was liberated on September 23, 1944 in the Battle of Geel. Around 130 civilians were killed. Sint-Dimpnakerk suffered extensive damage. From 1945 to 1951, the Flemish and Walloon communities debated whether or not to allow King Leopold III to return. These debates ultimately led to Belgium becoming a federal state with language areas and a Flemish Parliament. The Marshall Plan provided funds for Belgium to rebuild after WW2. Antwerp’s port was once again expanded and upgraded in hopes of expanding industry in the region. By 1948 both men and women could vote equally.

1948 – Responsibility for mental health care in Belgium was transferred from the Ministry of Justice to the Ministry of Public Health in 1948. This emphasis on public health shaped the way care was provided and funded in other countries as well. In 20th century Canada: “Framing feeblemindedness as a public health concern legitimized the use of institutions and their funding through the auspices of the Ministry of Health…Accordingly, families who admitted their child to an Ontario institution had their child’s care fully covered from ‘cradle to grave.’…Those families who chose to keep their child at home, on the other hand…received nothing in compensation from the government.”
In 1949 Antonio Egas Moniz was granted the Nobel Prize for inventing the lobotomy.

1952 – Ninety-six hectares of the Geels Gebroekt, a low peat swamp in Geel and Olen, was purchased for preservation. In 1959 the King Baudouin Motorway opened, running alongside the Albert Canal.
The number of patients in psychiatric hospitals in Britain peaked in 1954 and in 1955 in the US. This coincided with the discovery of chlorpromazine, the first effective antipsychotic medication.

1960 – Researchers from Chicago visiting Geel were alarmed to discover a dwindling number of boarders. They resolved to save Geel, or at least document the system. That year the Colongy of Geel ended the practice of providing different services based on the social class of the boarder.

1962 – The boarding school at Sint-Luciakerk, in the Oosterlo section of Geel, closed in 1962. It was then turned into the Medical Pedagogical Institute Maria Hulp der Kristenen, which provides care to people with intellectual disabilities.

1965 – The division for mentally handicapped children at Geel was closed.

1966 – The Geel Research Project began, directed by Leo Srole, a sociologist from Columbia University. It was done in partnership with the University of Louvain. This unleashes a new wave of international research attention and advocacy arguing for increased support of the Geel program.
The first official translation of the Belgian constitution in Dutch was published in 1967.

1971 – The Geel gasthuis became a museum.

1975 – Geel hosted the International Symposium on Foster Family Care. As part of this, the Saint Dimphna Folk Festival, which had been abandoned in the 1960s, was revived with support from American researchers.

1988 – The Geel Research Project concluded. It resulted in many reports, articles, and conference presentations. It also resulted in at least seven doctoral dissertations and two books in English. It was predicted that the Geel family care system would end by 1980 without additional support.

Modern Geel

1991 – Geel became a city in the 1980s. The Rijkscolonie in Geel and Lierneux become Flemish Public Institutes in 1991, following changes to Belgian laws. They are renamed the Openbaar Psychiztrisch Ziekenhuis Geel, which translates to the public psychiatric hospital at Geel and is referred to as the OPZ. This transferred decision making power from Brussels to the hospital itself.

1993 – Belgian laws forbidding vagrancy were repealed. One Colony of Benevolence was closed and turned into a park, while the other was officially converted into a prison.

1997 – The archive of the Geel Research Project was moved to Hobart and William Smith Colleges in Geneva, NY in 1997 after the death of Leo Srole. This was also the year Jackie Goldstein of Samford University visited Geel for the first time. Additional archives from the Geel Research Project were transferred to Columbia University in 1998. The planned book on the Geel Research Project was never published.

1999 – A second major study began, Geel Revisited, led by Harvard Medical School. This led to the publication of a book of the same name. In 2000, there was an international congress attended by over 300 professionals from around the world to celebrate the 700th anniversary of the family care system. A 2001 WHO report, Mental Health, New Understanding, New Hope mentioned Geel. CBS featured Geel on 60 Minutes, with 11 million viewers. In 2003 an episode of BBC World Service’s Travels of the Mind shared the story of Geel. In 2003 the Sisters of Charity handed over their 67 institutions in Belgium to lay people due to a decline in their numbers.

2004 – The OPZ hospital took its modern form. There are four hospitals: adult care, adolescence, geriatrics, and rehabilitation. The OPZ continues to run the foster family care program. In 2007, OPZ Geel became an externally independent agency of the Flemish Government, under the policy domain of Welfare, Public Health and Family.

2013 – Belgium made it illegal to sterilize someone against their will because of an intellectual disability. This practice remains legal in other European countries, including Bulgaria, Croatia, Cyprus, Czechia, Denmark, Estonia, Finland, Hungary, Latvia, Lithuania, Malta, Portugal and Slovakia. 

Written by Cori Carl
As Director, Cori is an active member of the community and regularly creates resources for people providing care.

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