The social learning model in contrast to the medical model deserves more trials in preparing schizophrenic patients for release from mental hospitals. Observations by the three disciplines (physicians, psychologists and social workers) on 465 male schizophrenic patients in a Veterans Administration hospital indicated that release readiness was correlated more closely with the degree of social efficiency than with the degree of psychopathology. Thus, in addition to the various treatments nsed to reduce symptoms, there is great need for resceializatlon programs.The increasing use of early release programs in mental hospitals opens a new frontier for research concerned with treatment, release readiness and post-hospital care. The present study, focusing on release readiness, was planned to ascertain how judgments of the patient's release readiness are related to: 1) certain of the patient's behavioral characteristics (social efficiency and psychopathology), and 2) variations in the evaluation of these characteristics on the part of professionals. Answers were sought to the following three questions: 1) Are the professional judgments on release readiness related to the patient's behavior? 2) Is the degree of social efficiency more predictive of release readiness than is the degree of psychopathology? 3) Do the judgments of release readiness by each of the three professional disciplines differ in their relationship to the behavior patterns of the patients?In reviewing the literature on schizophrenia, one is immediately impressed by the controversy over etiology that began with Pinel around 1800 and continues today. The following references are presented to illustrate how this controversy influences the treatment of schizophrenic patients.Schizophrenia traditionally has been defined as a functional mental illness. Fisher (1) defined "functional" as psychogenic with no organic basis. His definition contains the elements of two quite different concepts. One concept permits a theoretical formulation derived from the realm of interpersonal events-increasingly referred to as a social learning model. The other con-
Objectives o] this study were to determine whether judy, merits of release readiness are related to dischar~,e. Subjects i,cluded 4~,5 male schizophrenic patients continuously hospitalized in the Veterans Administration Hospital, Brecksvi]h', Ohio, h~r a minimum of 3 o days. Major findings are (1) over the 4-year period, the differences in percentayes discharged betu,een the "ready" and "not ready" groups are statistically significant; (2) judgmetlts of reh'ase readiness were found statistically significant in relationship to discharge or nondischarge of patients; amt (3) patient's previous hospitalization was proven to he siqnijicattt in relationship to release readiness judgments and discharge for those iudsed ready but not for others.
The organization and problems of a therapeutic team on a geriatric psychiatric ward are discussed. The growing recognition of mental hospitals as social systems has impressed upon the staffs the effect of the hospital itself on patients and families, quite apart from psychotherapy, drugs, occupational therapy and other specialized experiences. The mental hospital needs a profound social re-orientation. The sociotherapeutic model requires that all disciplines rally to the task and decide what social factors can really help the patients. At the medical and nursing levels, sociotherapeutic principles should be clearly formulated. This is the best way to dispense with status problems, to utilize all available resources, to provide for staff growth, and to offer the patients the best opportunity for improvement.For elderly psychiatric hospitalized patients, the rehabilitation process of adjusting to the hospital, leaving the hospital and becoming a useful member of society, presents great difficulty. A geriatric patient cannot be considered rehabilitated if he is only shifted from a hospital to a nursing home where he continues to be idle, with no interest in his environment and without any real goal. Such a patient is considered rehabilitated only if, when he leaves the hospital, the staff has fulfilled some of his emotional needs, planned a program for his personal growth and development, and helped him to strengthen his inhibited, scattered and/or undeveloped creative powers (1).Schizophrenic patients comprise almost 80 per cent of the population of some mental hospitals.' Schizophrenic patients hospitalized for long periods manifest a chronicity of symptoms that is extremely hard to reverse. These patients often are disturbed in their interpersonal relationships and are unusually seclusive or withdrawn. They also show a high degree of dependency on the hospital routine and the hospital personnel. Geriatric patients particularly lack drive, ambition and goal direction. They frequently have no hobbies or interests that can be utilized in a treatment program and show fear or even panic when release from the hospital is even considered. To motivate these patients to want to return to the community presents a difficult problem for the psychiatric team.
The prominence of chronic disabling diseases in present-day medical practice calls for an increase in social service work to help manage the associated psychosocial problems. The four stages of the social worker's in-hospital treatment for these patients are: 1) encouraging the patient to discuss his problems, 2) stimulating some understanding of how he may overcome these problems, 3) putting this perception into action, Administration Hospital, 10000 Brecksville Road, Brecksville, Ohio 44141.
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