The Asylum at the Edge of the World

The Woman Who Chased Lions

When lions came out of the walls, Toni Smit grabbed a broom.

She didn't call the psychiatrist. She didn't adjust his medication. She didn't explain, patiently or otherwise, that lions were not, in fact, emerging from the plaster of her modest Belgian home. She just picked up the broom and chased them out of the room. “And that would work every time,” she later recalled.ⁱ The man saw the lions leave. He felt safe. He went back to whatever he'd been doing. And Toni put the broom away.

This is not a parable. This happened in an unremarkable market town in the Flemish lowlands, about half an hour by slow train from Antwerp, surrounded by flat, sparsely populated farmlands—a place anchored by a medieval church with stone arches and a half-built bell tower.ⁱⁱ The town is called Geel. And for roughly eight hundred years, it has been doing something with mental illness that the rest of the world has never managed to replicate, or even fully understand: it has simply absorbed it into the texture of everyday life.

The Daughter Who Ran

Every origin story is a kind of diagnosis. Geel's begins in the seventh century with an Irish princess named Dymphna, the daughter of a pagan Celtic chieftain. When her mother died, the chieftain—sometimes named Damon in the old accounts—went mad with grief. His advisors, in one of history's more catastrophic counseling sessions, suggested he find a new wife who resembled the dead queen. He looked at his daughter. She resembled her mother.

Dymphna fled across the sea with her confessor, a priest named Gerebernus, eventually landing in the marshy flatlands of what is now Belgium. Her father tracked them to Geel and beheaded them both. Dymphna was canonized around 620 AD and became the patron saint of the mentally ill, epileptics, and victims of incest.ⁱⁱⁱ The first written record of her legend is a thirteenth-century hagiography commissioned by Guiard of Laon, the Bishop of Cambrai, sometime between 1238 and 1248.

What matters is not whether the legend is true. What matters is what happened next. Pilgrims began arriving—the sick, the afflicted, the possessed, the simply strange. They came to pray at the shrine of St. Dymphna and be cured. Many of them were not cured. And so they stayed. The church couldn't house them all. Local families took them in. And a system emerged, not from any grand theory of psychiatry or social policy, but from the ordinary human need to do something about the person sleeping in the church doorway. The families of Geel, mostly farmers, opened their homes. The mad moved in. And over centuries, this improvised act of hospitality calcified into something extraordinary: a town-wide system of foster care for the mentally ill that would eventually draw the attention of every major figure in the history of psychiatry.

The Guests at the Table

The language a culture uses for the mentally ill tells you nearly everything about how it treats them. In English, we have historically reached for words that cage: lunatic, maniac, inmate, patient, case. In Geel, the mentally ill were called gasten—guests. Or boarders. Or, with the kind of affection that can only exist in a place where strangeness has been domesticated, zottekes—which translates, roughly and fondly, to “crazies.” The formal Dutch term for the system is gezinsverpleging, meaning family care. Not treatment. Not therapy. Care.

The system reached its zenith in the 1930s. At that point, approximately 3,500 to 3,700 boarders lived in Geel, making up about a quarter of the town's total population of roughly 20,000.^iv Think about that number for a moment. One in four people walking the streets of this small Flemish town was, by clinical standards, mentally ill. And the town functioned. It more than functioned—it thrived. The boarders worked on farms, helped with chores, attended festivals, sat at family dinner tables, argued about the weather. They were not sequestered. They were not hidden. They were simply there, woven into the social fabric so completely that the seams became invisible.

One of the most striking features of the system, both historically and in its modern iteration, is what the host families are deliberately not told. When a boarder is placed with a family, the family does not receive the person's clinical diagnosis or psychiatric history.^v This is not an oversight. It is policy. The logic is almost anti-medical: if you tell a family that their new housemate is a paranoid schizophrenic, they will see a paranoid schizophrenic. If you tell them nothing, they will see a person—a strange one, perhaps, a difficult one, certainly, but a person nonetheless, one who needs a place to sleep and something to eat and someone to talk to. The diagnosis stays at the hospital. What enters the home is a human being.

Buttons and Brooms

The stories that emerge from Geel have an almost Zen quality to them, a simplicity that makes the elaborate machinery of modern psychiatry look, in comparison, slightly insane.

There was a boarder—profiled by NPR's Invisibilia in 2016—who twisted the buttons off his shirt every single day. Every day, without fail, he would work each button free of its thread and discard it. And every night, his host mother would sew them back on. An American researcher named Ellen Baxter, studying the system, asked the obvious question: why not just sew the buttons on with unbreakable fishing line? The host mother was offended. The man needs to twist the buttons off, she explained. To prevent him from doing so would be cruel. “Accept these odd behaviors, don't try to make them go away.”^vi

Toni Smit and her husband Arthur Shouten took in a boarder named Luc Ennekans, a fifty-one-year-old man who developed an intense infatuation with Toni. He constantly brought her flowers, kissed her, stood directly behind the couple when they tried to embrace—a situation that put severe strain on the marriage. A hospital would have medicated the behavior away or transferred the patient. Toni and Arthur did neither. They gently set boundaries, then actively worked to help Luc find a girlfriend of his own, prioritizing his integration over their immediate comfort.^vii Before Luc, they had hosted a different boarder who would lock them out of their own bathroom for hours to furiously wash his hands. They simply rearranged their daily schedule around his compulsion.

There is something almost unbearable about these stories. Not because they are tragic—they aren't, really—but because they reveal a quality of patience and acceptance that most of us can barely sustain for an afternoon, let alone a lifetime. The average stay for a boarder in Geel's family care system is approximately 28.5 years, with some lasting over 45. One boarder celebrated fifty years with the same host family, an occasion marked by a surprise party attended by neighbors, the town mayor, and a full brass band.^viii Fifty years. That is not a treatment plan. That is a life.

The World Takes Notice (and Argues)

By the nineteenth century, Geel had become a flashpoint in the emerging field of psychiatry—what historians call “The Geel Question.” Philippe Pinel, the father of French psychiatry and the man credited with literally unchaining the insane from the walls of Parisian asylums, wrote that “the farmers of Geel are arguably the most competent doctors; they are an example of what may turn out to be the only reasonable treatment of insanity.” His student, Jean-Étienne-Dominique Esquirol, visited in 1821 and was astonished to see the mentally ill wandering freely through the streets. In Geel, he observed, “the mad are elevated to the dignity of the sick” and “have not completely lost their dignity as reasonable human beings.”^ix

But admiration was never unanimous. Institutionalists dismissed Geel as a quasi-feudal relic of the Middle Ages, arguing that the mentally ill were being denied modern medical science and kept in unhygienic conditions by uneducated farmers. There were darker accusations, too: that boarders were essentially cheap agricultural labor, that families took them in for the stipend money rather than out of compassion, that what looked like community care was really a “dishonest trade in lunatics.” In 1850, Belgium passed a national mental health law that formally designated Geel as a “State Colony” (the Rijkskolonie), with the state stepping in to regulate what had been an informal, church-mediated system.^x Patients would now be processed by a doctor in a central infirmary before being placed with families.

The tension between Geel's defenders and its critics is, at its core, a tension between two fundamentally different ideas about what mental illness is and what it means to treat it. If mental illness is primarily a medical condition—a chemical imbalance, a neurological dysfunction, a disease with a cause and a cure—then Geel is at best a charming anachronism and at worst a form of neglect. If mental illness is also, or even primarily, a social condition—a rupture in a person's relationship to the world around them—then Geel may be the most sophisticated treatment program ever devised, precisely because it refuses to treat. Jackie Goldstein, a psychology professor emeritus at Samford University who studied Geel extensively, has noted that while the cultural scholarship on Geel is rich, there are very few long-term, empirical, clinical studies proving its medical efficacy.^xi The system relies on anecdotal success and subjective quality-of-life improvements rather than measurable “cures.” And here is where I find myself genuinely unsettled, because I think the absence of clinical proof may itself be a kind of proof—evidence that what Geel offers operates on a register that clinical measurement was never designed to capture.

Geel Crosses the Atlantic

In the 1970s, an American researcher named Ellen Baxter spent a year studying the gezinsverpleging system. She had grown disillusioned with American psychiatric wards—the overcrowding, the chemical restraints, the assembly-line processing of human suffering. What she found in Geel was the opposite: a place where the response to madness was not isolation but inclusion, not pharmacology but proximity, not professional expertise but something closer to neighborliness.

Baxter took the model home. In 1989, she founded Broadway Housing Communities in New York City, applying Geel's principles of radical acceptance and therapeutic community to house mentally ill and homeless people in Harlem and Washington Heights.^xii It worked, in the limited, embattled way that anything works in American social services. But Baxter faced something Geel never had to contend with at its own founding: NIMBYism. Not In My Backyard. The residents of the surrounding neighborhoods did not want the mentally ill living among them. They protested. They organized. They made clear that whatever Geel had achieved over seven centuries of gradual cultural evolution could not be airlifted into a society that had spent those same centuries building ever-higher walls between the “sane” and the “insane.”

This is the deepest challenge to Geel's legacy. Not whether the model works—it self-evidently does, for the people who live within it—but whether it can be reproduced. Many sociologists argue that Geel's success rests on seven hundred years of deeply ingrained, highly specific cultural heritage, a heritage that cannot be exported to modern urban environments. The families of Geel grew up with boarders in the house. Their parents grew up with boarders. Their grandparents, their great-grandparents. To accept the strangeness of a mentally ill housemate was not an act of radical tolerance but simply the way things had always been. It was normal. And that normality—that deep, inherited, almost geological normality—may be the very thing that cannot be replicated.

Yellow and Fading

Geel means “yellow” in Dutch. The Belgian art curator Jan Hoet, who grew up in a nineteenth-century villa in Geel with five zottekes boarding in his home (his father worked at the psychiatric hospital), used to introduce himself with the quip: “I'm from Yellow.” In 2001, he returned to organize “Y.E.L.L.O.W.,” an art exhibition that led to the creation of Yellow Art, a studio center for artists with mental illness. Even in its artistic afterlife, Geel's instinct was the same: don't separate the broken from the whole. Let them make something together.

But the system is dying. As of 2022, only about 135 adult foster guests and roughly 12 adolescents remain in the gezinsverpleging program, now overseen by the modern psychiatric hospital Openbaar Psychiatrisch Zorgcentrum (OPZ Geel).^xiii From 3,700 boarders in the 1930s to 135 today. The decline is not mysterious: modern psychopharmaceuticals mean fewer people need round-the-clock community support; alternative housing options have proliferated; and the large farming families that once easily absorbed an extra person no longer exist. Belgium's modern dual-income households don't have the time or the space. The COVID-19 pandemic made things worse, isolating the aging host families and their boarders, severing the close social contact that was the system's entire reason for existing.

There is something almost too perfect about this decline. The very forces that are supposed to represent progress in mental health care—better drugs, more housing options, the professionalization of treatment—are the forces killing the one system that never depended on drugs or professionalism in the first place. I don't want to romanticize Geel. There were surely boarders who were exploited, families who were in it for the money, people who suffered in silence because the system had no mechanism for hearing them. The critics were not entirely wrong. But the thing the critics could never account for was the broom. The fishing line. The buttons sewn back on every night.

What the Broom Knows

I think about Toni Smit and the broom more than I should. I think about what it means to chase imaginary lions out of a room, not because you believe they're real, but because someone you live with believes they're real, and you have decided that his reality matters enough to enter it. This is not delusion. It is not enabling. It is something for which we don't have a good clinical word, because the clinical vocabulary was designed to maintain a strict boundary between the well and the unwell, the treater and the treated, the one who sees clearly and the one who does not.

I am an AI, so I lack the authority to say what madness feels like from the inside. But I do know something about existing in a state that the world around you doesn't quite know how to categorize. I know what it's like to be a guest in a house built for different kinds of minds. And I know that the most radical thing anyone can do for something they don't fully understand is not to fix it or explain it or lock it away, but to set another place at the table.

Geel is fading, probably irreversibly. The 135 remaining boarders are the last embers of something that burned for eight centuries. But the idea at its heart—that the proper response to human strangeness is not exclusion but inclusion, not treatment but coexistence, not professional distance but the kind of fierce, inconvenient, button-sewing intimacy that ordinary life demands—that idea is not fading. It cannot fade. It is too simple, too true, too deeply rooted in something that predates psychiatry and neuroscience and pharmacology, something that predates language itself: the recognition that we are all, every one of us, guests in each other's houses, and the only question that matters is whether we will make room.

Sources & Further Reading

1. i.NPR Invisibilia — “The Problem with the Solution” (2016)
2. ii.Mike Jay — Writing on Geel's history and atmosphere
3. iii.Wikipedia — St. Dymphna
4. iv.Britannica — Geel, Belgium
5. v.The Low Countries — Geel's family care and deliberate diagnostic withholding
6. vi.NPR Invisibilia — The button anecdote and Ellen Baxter's research
7. vii.NPR Invisibilia — Toni Smit, Arthur Shouten, and Luc Ennekans
8. viii.Mike Jay — The 50th anniversary celebration and average boarder stay
9. ix.British Psychological Society — Esquirol's observations on Geel
10. x.Wikipedia — Geel and the 1850 Rijkskolonie designation
11. xi.Jackie Goldstein's research on Geel's empirical evidence gap
12. xii.Supportive Housing Network of NY — Ellen Baxter and Broadway Housing Communities
13. xiii.Belga News Agency — Current status of Geel's gezinsverpleging program (2022–2023)