From Custodial to Therapeutic Care in Mental Hospitals

The Relevance of Medical Sociology to Psychiatry

“…Within the colloquia discussion, the lines of collaborative research during the next half century were clearly foreshadowed: the epidemiology of social factors like class and culture as they influenced mental illness, the social organization of hospitals, the basic concepts of therapeutic communities, the interactive effects of mental disorder and families, and a variety of other subjects. A direct product of these meetings were the studies of a mental hospital by Howard Rowland (1938Rowland ( , 1939, establishing a model for combining the theories of Sullivan with the methods of field research developed by Sapir and Park, and their application for the study of mental hospitals over the period of the next 30 years (Belknap, 1956;Caudill et al, 1954;Greenblatt et al, 1955;Goffman, 1961;Stanton and Schwartz, 1954). It can be argued that these were the underpinnings of the therapeutic community movement, later associated with the British psychiatrist Maxwell Jones, and also the community mental health movement in the United States.…”

Life-Style Performance: From Profile to Conceptual Model

“…The era of Moral Treatment, for example, demonstrated the importance of the environment in shaping the behavior of persons with mental illness (e.g., Stanton & Schwartz, 1934). During the period of renewed interest in this philosophy, numerous studies were undertaken to define and create a treatment environment that would maximize the therapeutic potential of the mental hospital (Greenblatt, York, & Brown, 1955;Jones, 1953;Stanton & Schwartz, 1934). Moos's (I 974) evaluation of treatment environments further influenced the design of institutions; Goffman's (I963) work contributed considerably to understanding the influence of institutions on behavior; Searles' (1960) offered impressive evidence of the role of the nonhuman environment both in health and in mental illness; and Wolfensberger's (I972) initiatives in describing the normalizing aspects of an environment transformed institutions and homes for persons with developmental disabilities.…”

The Descent of Milieu Therapy

“…More attention was given to the organization of the total institution, and David Clark elaborated a theory of administrative therapy (18). The clinical development of these ideas has been described by Greenblatt, York and Brown in their unique biography of an institution (35).…”