Social structure and interaction processes on a psychiatric ward.

Abstract

HE individual who enters a mental hospital finds himself placed in a T number of new social situations, all of which influence his behavior and treatment. The patient's relationship to his therapist, both in its administrative and therapeutic aspects, has received the most study. This holds true where the course of treatment is through insight psychotherapy (13, 14), and also where it involves a structuring of the patient's social milieu by prescribing how hospital personnel shall react to him (1, 31, 40). More recently, the influence on the patient of the over-all social structure of the hospital has been investigated (2, 34, 3 9 , as well as the structure of certain types of wards (9, lo), and the social processes a t work in the split social field existing between patients and staff (21, 36, 37, 38, 39, 42).For information on a third social influence, the interpersonal relationships of patients with each other, we must, however, rely largely on patients' autobiographical accounts of their experiences (3, 7, 19, 23, 24, 33). Despite 14 This is, of course, part of the problem of parataxic distortion discussed by Sullivan (41). is The occurrence of such phenomena would seem to make it essential that a systematic understanding be gained of that behavior by patients on the ward which is attributable more to factors in the immediate social situation, and of that behavior which is attributable more to factors in their psychodynamic histories. Once such understanding is gained it would then be possible to investigate a second and very complex problem. This second problem concerns the effect of the patient group on the course of individual behavior that has its main inception in repetitive neurotic patterns. In the hospital the individual is pro-

Worker Perspectives on Contemporary Milieu Therapy: A Cross-Site Ethnographic Study

“…Jones observed that the social interaction of patients has "therapeutic possibilities" even when staff are not present. In the 1960s, the therapeutic community was proposed as a means of humanizing and improving the effectiveness of psychiatric institutions, even as critics argued that "total institutions" produced the very effects of serious mental illness and chronicity that they purported to treat ( Caudill, Redlich, Gilmore, & Brody, 1952;Goffman, 1961;Szasz, 1961). Gutheil (1985) has suggested that there is a strong family resemblance between the concepts of therapeutic community and MT.…”

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.…”

Covert research and adult protection and safeguarding: an ethical dilemma?

“…The dangers she experienced, however, were not those that might be expected, focusing rather on the harm that researchers could experience in settings where care was sub-standard and abusive Covert research in studying mental illness and the psychiatric system has involved researchers using deception, but has been justified by the understandings and social benefits accrued from it (see Caudill, 1952;Rosenhan, 1973). Rosenhan's study used a deliberate feigning of symptoms by eight people to gain entry different mental hospitals.…”