Measurement of improvement in "mental illness."

Abstract

The concept of mental illness as a disease process has resulted in the focusing of psychiatric attention on the symptoms which a "mentally ill" patient manifests. The extent to which a mentally ill person improves is traditionally based on the extent to which the original symptom picture becomes modified. As with most disease entities, the patient is judged as having recovered when the symptoms of the disease abate.Descriptive psychiatry, as practiced in most mental hospitals today, is based on the diagnostic classifications outlined by Kraepelin. His observation that the praecox progressed to a demented end-state led him to believe that this process was based on some degenerative "disease" process. Later evidence discredits the idea of the necessary demented end product, and, to a lesser extent, that this disease occurs only in young adults. The original evidence, then, for regarding dementia praecox as a disease process is no longer consistent with observations following those of Kraepelin. The hypothesis may still be true, but the evidence upon which the hypothesis was based is no longer accepted.The agreement of the American Psychiatric Association on a classification system in 1934 was a major step forward. Professional personnel had at last come to agree on a common system which facilitated communication and research. It is unfortunate, however, that many psychiatrists still regard the classifications as synonymous to disease entities, although the majority of the psychiatric group 1 In cooperation with Psychiatric and Nursing Services, particularly Anna Kontas, who supervised the collection of all admission behavioral data. This study was supported by the Psychiatric Evaluation Project, Richard L. Jenkins, Director.

Influence of Family Life on the Course of Schizophrenic Illness

“…number of previous admissions or length of time since onset), and those relating to clinical condition at discharge. The size of the associations, as in this study, has usually been small (Malamud and Render, 1939;Chase and Silverman, 1943;Schofield, Hathaway, Hastings, and Bell, 1954;Ellsworth and Clayton, 1959). For example, Schofield and others (1954) abstracted 200 items from case notes but found only seventeen related to their measures of outcome.…”

Psychometric instability of measures in novel settings: Use of psychiatric rating scales in nursing homes

“…Two raters were used by Lentz et al (1971) with the NOSIE-30 and ISMF, by Lorr and Vestre (1968) with the PIP, and by Ellsworth and Clayton (1959) and Anker and Walsh (1961) with the MACC. The present use of three raters, therefore, would increase the chances of obtaining a high reliability compared to that of the research just cited.…”

Individual Differences

“…and social interaction. Ells worth & Clayton (46) find that measures of behavioral adjustment, derived from the MACC Behavioral Adjustment Scale, and psychopathology are sig nificantly related. The four traits involved are motility, affect, co-operation, and communication.…”