Hostname: page-component-7c8c6479df-7qhmt Total loading time: 0 Render date: 2024-03-28T09:56:31.624Z Has data issue: false hasContentIssue false

Institutionalism and Schizophrenia 30 Years on

Clinical Poverty and the Social Environment in Three British Mental Hospitals in 1960 Compared with a Fourth in 1990

Published online by Cambridge University Press:  02 January 2018

David A. Curson*
Affiliation:
Charing Cross & Westminster Medical School, Academic Unit, Horton Hospital, Long Grove Road, Epsom, Surrey, and Department of Psychological Medicine, The Royal Masonic Hospital, Ravenscourt Park, London
Christos Pantelis
Affiliation:
Charing Cross & Westminter Medical School, Academic Unit, Horton Hospital, Epsom
Jan Ward
Affiliation:
Academic Unit, Horton Hospital, Epsom, Riverside Health Authority, London
Thomas R. E. Barnes
Affiliation:
Charing Cross & Westminster Medical School, Academic Unit, Horton Hospital, Epsom
*
Correspondence

Abstract

In their comparison of chronic schizophrenic patients in three British mental hospitals in 1960, Wing and Brown found a strong association between the poverty of the social environment and the severity of ‘clinical poverty’ (blunted affect, poverty of speech, and social withdrawal). Between 1960 and 1968 the social environments of all three hospitals improved and a weak causal relationship between social poverty and clinical poverty was reported in a proportion of patients. Using the same assessment instruments as Wing and Brown, the present study re-examined the relationship between social and clinical poverty in the long-stay schizophrenic population of a fourth British mental hospital in 1990. The association found between social and clinical poverty was much weaker than in 1960. Reluctance on the part of patients to be discharged from the institution was unrelated to length of stay. There was no significant difference in severity of illness between the patients in the present study and those in the earlier study. However, patients in the former group spent more time doing nothing than those in the hospital with the most understimulating environment three decades before, with four-fifths doing nothing for over five hours a day, despite a greatly increased ratio of nurses to patients.

Type
Papers
Copyright
Copyright © Royal College of Psychiatrists, 1992 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington, DC: APA.Google Scholar
Baldessarini, R. J. & Davis, J. M. (1980) What is the best maintenance dose of neuroleptics in schizophrenia? Psychiatry Research, 3, 115122.Google Scholar
Barnes, T. R. E., Curson, D. A., Liddle, P. F., et al (1989) The nature and prevalence of depression in chronic schizophrenic inpatients. British Journal of Psychiatry, 154, 486491.CrossRefGoogle Scholar
Barnes, T. R. E. & Liddle, P. F. (1990) The evidence for the validity of negative symptoms. In Modern Problems of Pharmacopsychiatry. Schizophrenia: Positive and Negative Symptoms and Syndromes (ed. Andreasen, N. C.), pp. 4372. Basel: Karger.Google Scholar
Barton, R. (1959) Institutional Neurosis. Bristol: Wright.Google Scholar
Birley, J. L. T. & Brown, G. W. (1970) Crises and life changes preceding the onset or relapse of acute schizophrenia: clinical aspects. British Journal of Psychiatry, 116, 327333.Google Scholar
Brown, G. W., Bone, M., Dalison, B., et al (1966) Schizophrenia and Social Care: A Comparative Follow-up of 339 Schizophrenic Patients. Maudsley Monograph No. 17. London: Oxford University Press.Google Scholar
Brown, G. W. & Birley, J. L. T. (1968) Crises and life changes and the onset of schizophrenia. Journal of Health and Social Behaviour, 9, 203214.Google Scholar
Curson, D. A., Patel, M., Liddle, P. F., et al (1988) Psychiatric morbidity of a long-stay hospital population with chronic schizophrenia and implications for future community care. British Medical Journal, 297, 819822.Google Scholar
Goffman, E. (1961) Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. New York: Doubleday.Google Scholar
Gruenberg, E. M. (1966) Evaluating the Effectiveness of Community Mental Health Services. New York: Millbank Memorial Fund.Google Scholar
Johnstone, E. C., Owens, D. G. C., Frith, C. D., et al (1985) Institutionalisation and the outcome of functional psychoses. British Journal of Psychiatry, 146, 3644.Google Scholar
Jones, K. (1982) Scull's dilemma. British Journal of Psychiatry, 141, 221226.Google Scholar
Jones, M. (1952) Social Psychiatry: A Study of Therapeutic Communities. London: Tavistock.Google Scholar
Nelson, H. E., Pantelis, C., Carruthers, K., et al (1990) Cognitive functioning and symptomatology in chronic schizophrenia. Psychological Medicine, 20, 357365.CrossRefGoogle ScholarPubMed
Scheff, T. J. (1966) Being Mentally Ill. Chicago: Aldine.Google Scholar
Shepherd, G. (1989) The value of work in the 1980's. Psychiatric Bulletin, 13, 231233.CrossRefGoogle Scholar
Smith, K., Pumphrey, M. & Hall, J. P. (1963) The “Last Straw”: the decisive incidents resulting in the request for hospitalisation in 100 schizophrenic patients. American Journal of Psychiatry, 120, 228233.Google Scholar
Stone, A. A. & Eldred, S. H. (1959) Delusion formation during the activation of chronic schizophrenic patients. Archives of General Psychiatry, 1, 177179.Google Scholar
Wing, J. K. (1961) A simple and reliable subclassification of chronic schizophrenia. Journal of Mental Science, 107, 862875.Google Scholar
Wing, J. K. (1978) The social context of schizophrenia. American Journal of Psychiatry, 135, 13331339.Google ScholarPubMed
Wing, J. K. & Brown, G. W. (1961) Social treatment of chronic schizophrenia: a comparative survey of three mental hospitals. Journal of Mental Science, 107, 847861.Google Scholar
Wing, J. K., Bennett, D. H. & Denham, J. (1964a) The Industrial Rehabilitation of Long-Stay Schizophrenic Patients. Medical Research Council Memo No. 42. London: HMSO.Google Scholar
Wing, J. K., Monck, E., Brown, G. W., et al (1964b) Morbidity in the community of schizophrenic patients discharged from London mental hospitals in 1959. British Journal of Psychiatry, 110, 1021.Google Scholar
Wing, J. K. & Brown, G. W. (1970) Institutionalism and Schizophrenia: A Comparative Study of Three Mental Hospitals 1960–1968. London: Cambridge University Press.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.