My PhD thesis related the growth of a large social system devoted to the treatment of personal problems; i.e. problems successively labelled as madness, mental illness and mental health problems, from the early fifties to the present days. That system involved heterogeneous networks of actors, including scientific experts, established professions, social movements, policy makers, services users and international organisations; instruments and knowledge ranging from psychoanalytical theories to biological knowledge and models of governance. It meant to explain how institutional change happened in that complex social system, by studying past and ongoing reforms, considered as interrelated steps towards complete paradigm shift, including shifting policy means, policy objectives and social organisation. By relying on in-depth analyses of five past reforms, it conceptualised the system as composed of interrelated ecologies, corresponding to different kinds of knowledge of personal problems, whose development was directed by protective and expansion strategies used by two coalitions of actors, holding different kinds of resources to influence the change process. The traditional coalition was embedded in the Belgian institutional system; it referred to medical knowledge of personal problems; and held many institutions delivering residential treatments. By contrast, the reformist coalition was connected to international professional and policy networks stimulating change in OECD-mental health systems; it referred to practical knowledge of social psychiatry and evidence produced by international organisations as the World Health Organisation; and it held non-profit associations delivering community treatments. Cross-regulations exerted through joint-participation of those coalitions in successive reforms caused rapid changes in the system’s structural configuration while hindering change in its social organisation. Thus, we suggested thinking of the issue of change in the system as consisting in setting conditions in ...