One-hundred husbands, diagnosed as suffering from alcoholism, and their wives, were followed up twelve months after initial consultation and assessment. Follow-up information was complete in 89 cases. On the basis of both husband and wife accounts of the husband's drinking behaviour during the follow-up period, and their assessment of the drinking problem at twelve-months follow-up, 28 were classified as having a 'good' outcome and 29 as having a 'bad' outcome. In the remaining 32 cases outcome was considered 'equivocal'. A composite measure of marital cohesion was predictive of twelve-month outcome classification, cohesive marriages being significantly more likely to have a good outcome. The measure of marital cohesion was based upon husband and wife reports of mutual affection and of husband involvement in family tasks, favourable spouse perceptions and meta-perceptions, and optimism about the future of the marriage. Composite measures of dominance balance within the marriage were not predictive of outcome. Husband's job status, husband's self-esteem, and wife's reported hardship were not independent of marital cohesion, and were themseleves predictive of twelve-months outcome. When these variables were partially controlled it was found that marital cohesion remained predictive for husbands with relatively low status jobs and husbands with relatively low levels of self-esteem. It is an over-simplification to state that either the marriage, the spouse, or the severity of the patient's condition is alone the cause of variation in outcome. It is possible to integrate these findings with those of other studies on the influence of family variables on the outcom of conditions other than alcoholism. Together these studies suggest a general hypothesis linking a breakdown in the cohesiveness, or mutual rewardingness, of family relationships and unfavourable outcomes following treatment or consultation for psychological disorder.
We present here some findings from a survey carried out in one (former) London borough, of the information known to one or more of a number of agencies such as courts, clergy, employers, doctors, etc. (we term these sources ‘reporting agencies', see Methodology Section 4), concerning those individuals who might have a drinking problem. The results will be interpreted in the light of a house-to-house sample survey which was conducted at the same time, and in part of that same area (Edwardset al., 1972a, b, c, d, 1973): the extent of overlap in case identification will be closely considered. The literature on epidemiology applied to alcoholism has been reviewed by one of us elsewhere (Edwards, 1973), and the relevance of epidemiology to planning the community's response to its drinking problems was discussed. In the present paper the application of those general arguments to the realities of a particular set of data will be tentatively explored.
In the second half of the fourteenth century, the whole problem of poverty became in England for the first time a matter of government concern. The contractual relationship between landlord and villein which had prevailed during the Middle Ages, was breaking down, and the Black Death hastened this process. Statutes dealing with vagrancy and poverty were promulgated in 1349, 1351 and 1388: the able-bodied beggar was punished in the stocks and generally repression was the keynote, but despite harsh laws vagrancy increased. In a series of statutes from 1531–1601 the Tudor sovereigns initiated a system of local relief based on the Parish unit. In 1576, Houses of Correction were established:“to the intent youth may be accustomed and brought up in labour and work, and then not likely to grow to be able rogues, and to the intent that such as be already grown up in idleness and so rogues at this present, may not have any just excuse in saying that they cannot get any service of work”.(De Schweinitz, 1943).
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