The "Last Straw": The Decisive Incident Resulting in the Request for Hospitalization in 100 Schizophrenic Patients

Insanity Ascriptions: A Formal Pragmatic Analysis

“…However, the interpretative work that has already been done by relatives of the presenting patient (cf. Mechanic 1962, Schwartz 1957, Smith et al 1963, is different in important respects to that undertaken by the mental health professional in terms of the implications of the disruption of communicative action. For those immediately involved with the alleged patient, interpretive efforts have been linked with the attempted repair of everyday and routine action plans15.…”

The complaint process in protective services for children

“…A study of decisive incidents that become the "last straw" in the proce s s of seeking hospitalization of schizophrenic patients may have implications for the reporting of child abuse and neglect (Smith, Pumphrey, and Hall 1963). The family and community tolerated the patient even though they understood that he was mentally ill.…”

Stereotypes of mental illness: A comparison with ethnic stereotypes

“…Similarly, parents of schizophrenic children repeatedly provide 'normalizing' definitions for aberrant behavior (Silver 1955;Bakwin 1963). In an analysis of 100 cases, Smith et al (1963) found that repeated norm violations Were committed before the 'last straw' was reached, i.e., the incident which resulted in the family's decision to hospitalize. Apparently the threshold for crossing the sanity-insanity boundary is high for in-group members.…”

“…Smith et al (1963) found that the incidents preceding re-hospitalization increased in apparent dangerousness and disruptiveness. This suggested a raised threshold for re-hospitalization, but it is not clear from the study whether this difference was actually conative or the result of a lowered cognitive threshold, i.e., the second 'last straw' was perceived as being more disruptive than the first even though it was not.…”

“…This high threshold becomes particularly significant when one considers that initial recognition does occur in the community. Representatives of the mental health system usually see the prepatient only after lay persons in the community have brought the prepatient to their attention (Bittner 1967;Yarrow et al 1955;Mechanic 1962;Smith et al 1963). This means that the mechanisms of social control are set in motion before the professional sees the offender, and the public's high recognition threshold acts as a sort of conservative 'falter,' repeatedly normalizing deviant acts until the 'last straw' is reached.…”