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Discharged patients' attitudes towards their hospitalization experiences

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Discharged patients' attitudes towards their hospitalization experiences

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Content BISGHAHCÎEB PATIENTS' ATTITUDES TWAEDS THEIE
il
HOSPITALIZATION EXPEEIEHCES
by
Jacqueline Marie Bradley
A Thesis Presented to the
FACULTY OF THE SCHOOL OF SOCIAL WORK
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF SOCIAL WORK
June 1961
UMI Number: EP66765
All rights reserved
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a note will indicate the deletion.
Blssifrtaiiofi: PyblisM ng
UMI EP66765
Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author.
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This thesisj written under the direction of the
candidate's Faculty Committee and approved
by all its members, has been presented to and
accepted by the Faculty of the School of Social
Work in partial fulfilment of the requirements
for the degree of
MASTER OF SOCIAL WORK
Dean
Date...
\
Them
Faculty Committee
hairman
TABLE OP CONTENTS
Page
I. INTRODUCTION ........... 1
Purpose of the Study
Study Design
Plan of Presentation
II. PRESENTATION OP PINDINCS . . 9
Case Descriptions
Presentation and Summarization of
III. SUMMARY AND SOCIAL WORK IMPLICATIONS ... 27
Analysis
Conclusions
Implications
BIBLIOGRAPHY............................. 37
ii
CHAPTER I
i
INTRODUCTION |
I
I
Mental institutions throughout the world daily
face the challenge of providing restorative treatment to I
I
countless millions of mentally ill persons. There are
many schools of thought on this subject and each approach '
has its opposition. There is no recognized cure for the
I
illness which hospitalizes 350^000 annually in the United ,
States.1 I
While there is no panacea for mental illness, i
hospitalized patients do improve and return to their I
jobs, their families, and their communities. This '
research sought to discover if the discharged psychiatric
I patient was able to tell us what his hospitalization
I :
I experiences had meant to him. Specifically, what seemed |
I !
I to help him most and/or not at all. It was hypothesized
that the "helped" patient might, in telling how and what
I
' helped him, provide needed clues towards reaching the
"unhelped." Not all mentally ill patients improve. Not
^Kenneth E. Appel, "Mental Health and Mental
Illness," Social Work Year Book, 1957, ed. by Russell H.
Kurtz (New York: National Association of Social Workers,
1957), p.
2
all mentally ill patients return to the outside community.
The researcher reasoned that the improved, treated
patient might be an invaluable resource in improving our
knowledge of the treatment needs of the mentally ill.
The psychiatric hospital community is a complex
organization and one that has come under increasing
scrutiny by psychiatric administrators, sociologists,
psychologists, and anthropologists in the past two
decades. Maxwell Jones' research and innovations in
hospital life have led to patient government and patient
participation in hospital policy making in a growing
number of mental institutions.
In the past decade researchers^ have demonstrated
a recognizable, causal connection between role, status,
and communication conflict among professional personnel
' and the quality of treatment made available to the
i
I patient.
t
In an article entitled, "Social Processes in a
Collective Disturbance on a Psychiatric Ward,"
^William Caudill, The Psychiatric Hospital as a
Small Society (Harvard, Cambridge, Mass.: Commonwealth
Fund, 1958);Milton Greenblatt, Richard H. York, Esther
Lucille Brown in collaboration with Robert W. Hyde, From
Custodial to Therapeutic Patient Care in Mental Hospitals:
Explorât ions in Social Treatment (Hew York : Russell Sage
Foundation, 1955); Alfred H. Stanton and Morris S.
Schwartz, Tie Mental Hospital: A Study of Institutional
' Participation in Psychiatric Illness and Treatment(New
I York: Basic Books, Inc., 195^)*
3
Caudill3 traces the collective disturbance of patients
on a single ward to staff dissension and conflict which
preceded the ward outbreak by two months and which was
not resolved until one month after the collective ward
disturbance.
The ex-psychiatric patient has not heretofore
been chosen to be a prime research subject although
Caudill administered Thematic Apperception Tests to
patients as well as to staff in the course of his inves-
Social service agencies have pioneered in con
ducting research among the direct recipients of services.
Research of this nature indicates that persons who have
been helped are able to recognize and explain how they
have been helped.
In 1957, social workers employed by the Family
Centered Project of St. Paul interviewed their clients
in an effort to learn how they had helped their clients.
When by taking stock we began to see that a
goodly number of our families were beginning to move
3williara Caudill, "Social Processes in a
Collective Disturbance on a Psychiatric Ward," The
Patient and the Mental Hospital, ed. by Milton Greenblatt,
M.D., Daniel J. Levinson, Ph.D., and Richard H. Williams,
Ph.D. (Glencoe, Illinois: The Free Press, 1957)*
^William Caudill, Tie Psychiatric Hospital as a
Small Society (Harvard, Cambridge, Mass.: Commonwealth
Find; Ï958).
ahead, we shared our renewed confidence and optimism
with them. As time went on, we felt the need to
know what out of all we had tried to do had been use
ful to them. We wanted this knowledge to guide our
planning with them for future gains. Could the
families tell us? We decided to ask them. ... We
found that a number of those we asked were even
willing to write out for us their thoughts on the
questions we raised.
... In this effort we see an additional benefit
to the family. Any healthy relationship requires
that the participants carry a contributing, as well
as a taking role. Shrinkage in self-esteem and
resentment occur when people are only the recipients
of help.5
We speculated that the interviewees would identi
fy programs which facilitated improved social relations
with family and fellow patients. The most constant
characteristic lof the mentally ill person— regardless of
his diagnostic classification— is his inability to main
tain satisfying, personal relationships. We believed
the veterans would identify services and personnel which
they recognized as having helped them in the area of
socialization.
Tie Setting for This Study
The setting for this study was the Admissions
and Intensive Treatment Unit (Building 2) of the Veterans
Administration Hospital in Sepulveda, California. This
5Alice Overton, Katherine H. Tinker, et al.
Casework Notebook (St. Paul, Minnesota: Family Centered
Project, 1957), PP* 146-47, 162.
5
hospital was opened on April 17, 1955, and has 956 beds—
204 in general medical and surgical servicej 82 in
Tuberculosis-Psychiatric service; and 6J0 in neuropsychi
atrie service.
All psychiatric patients are admitted to the
third floor admissions ward in Building 2. Patients who
are expected to respond to short-term, intensive treat
ment (approximately three months) remain in Building 2.
Patients requiring a more prolonged period of hospitali
zation are transferred to other buildings known as the
Continued Treatment Service.
For each of 130 psychiatric patients. Building 2
is "the life space, the social group, and the institu
tional system in and through which he is going to inter
act"^ throughout his stay in the hospital. The fourth
floor of the building is comprised of an open and closed
ward for female, psychiatric patients. The remaining
five wards in Building 2 are reserved for male, psychi
atric patients. The third floor contains the closed
admission ward and a closed ward. The second floor is
comprised of one open and one closed ward. The ground
floor contains one open ward and professional offices.
^Edward Stainbrook, "The Community of the
Psychiatric Patient," American Handbook of Psychiatry,
Vol. 1 (New York: Basic Books, Inc., 1959), p. 153.
6
When a patient is transferred from admissions he is
first assigned to a closed ward. As he improves and is
able to assume greater responsibility for self, he is
transferred to the open ward on the side to which he has
previously been assigned. This arrangement facilitates
a relatively constant patient group wherein patients are
able to form lasting sub-groups throughout the period of
their hospitalization.
The two ward social workers were informed of the
nature of this research and were asked to refer patients
who had (l) entered the hospital voluntarily (not com
mitted by court action) and (2) who had been notified
that they would be given a Maximum Hospital Benefit
Six patients were referred to the researcher
after they had learned that they were scheduled to be
discharged in several days. Two patients were referred
by their physicians, four were referred by the two ward
social workers.
In the first hospital interview the researcher
explained the research topic, assured the patients that
the research interview was confidential and that ficti
tious names would be used in the report. The researcher
then explained that participation in the study was
entirely voluntary and research interviews would be held
7
following the patient's discharge from the hospital.
The six patients expressed a willingness to participate
in the study and an appointment was set for one to two
weeks after discharge from the hospital. The sample was
limited to patients who entered the hospital voluntarily
and who received Maximum Hospital Benefit discharges.
This type of discharge indicates that the patient has
realized the optimum period of hospitalization and will
not benefit by further hospitalization at this time.
This discharge serves to sever hospital-patient contact
and it is for this reason that discharged patients were
sought by the researcher. A voluntary patient is one who
enters the hospital of his own volition because he has
recognized a need for psychiatric help.
In preparation for the research interview, the
researcher reviewed each patient's record in order to
note the facts of his illness and the treatment programs
to which he had been assigned. At the time of initial
contact with the patients, it was explained that the
interview would not consist of a series of questions and
answers since we were looking for the participants' feel
ings and opinions most of all. The veterans were in
formed that we would have information on the programs
each participated in which would be introduced into the
8
research interview by the researcher if not mentioned by
the interviewees.
Because the interviewees stated that they
encountered helpful and unhelpful experiences in informal
situations as well as within specific treatment programs,
the topic evolved into discharged patients* attitudes
towards their overall hospitalization experiences. In
the loosely structured interview each patient recounted
his attitudes towards his illness, his total hospitaliza
tion experience and the programs he was involved in
throughout his stay in the hospital.
The following chapter. Presentation of Findings,
is presented in two sections. Section I contains
descriptive and background information on each discharged
patient and excerpts of statements each made in the
research interview. The names of the interviewees, pre
sented in Section I, are fictitious names which indicate
the ethnic origin of the participants. Section II con
tains a description of each of the services provided by
the hospital and the patients* attitudes towards them.
Also included are the patients* attitudes towards the
hospital environment, staff personnel and fellow patients.
Chapter III presents the analysis, conclusions,
and implications of this research.
CHAPTER II
! PRESENTATION OF FINDINGS
George Halloran is a fifty-four year old,
married, Caucasian Catholic who has a medium build,
thinning brown hair and blue eyes. After being laid off
from work a year ago, Mr. Halloran was hospitalized for
a duodenal ulcer. At that time he was informed that he
had a minor heart condition. Upon release from the
hospital, he developed shingles and increasing dependency
upon sleeping medication, pain medication, and tranquil
lizers. He entered Veterans Administration Hospital,
Sepulveda, on the advice of his private physician. A !
high school graduate, he has a steady employment history |
in a highly skilled occupation. ;
Tiis was Mr. Halloran*s first hospitalization for ;
a neuropsychiatrie condition and the admission diagnosis |
was Anxiety Reaction. "Just being admitted to the 1
i
hospital . . . being down sick like I was and knowing
and having everyone take such good care of me" was an |
i
especially meaningful experience for Mr. Halloran. He '
10
also placed considerable emphasis upon his orientation ;
to the hospital, "I was pretty confused for about a week ,
by what happens in a place like this and what was going
to happen to me, until some of the old hands— you know,
the ones who have been in and out several times— took me
I under their wing and showed me the ropes. They could
j pretty well tell what would happen all the way through.
It was really something! But that helped a lot-— to know
what would be happening to me and what all the initials^
and all stand for." Mr, Halloran commented favorably
upon the advice and counsel he received from fellow
patients, medical care and medication, and Industrial j
Therapy. He related several frustrating experiences he
encountered in his efforts to secure a discharge. ;
< 9 I
Mr. Halloran was hospitalized for twenty-six days.
James Garland is a single, twenty-eight year old,
Caucasian ex-Catholic who has attempted suicide several
times in the past several years. Mr. Garland is six feet j
tall, moderately obese, and has thinning brown hair and '
blue eyes. He has been hospitalized several times in the ■
past for a neuropsychiatrie condition and has made fre
quent, abortive attempts to secure private psychotherapy.
^Examples of initials in frequent usage are: IT
Industrial Therapy); OT (Occupational Therapy): CT
Correctional Therapy); ET (Educational Therapy); TV
Trial Visit); MHB (Maximum Hospital Benefit), etc.
11
An engineer, he tested in the superior range on a
Wonderlie test administered during this period of hospi-
■ ■ i
1
; talization. The admission diagnosis was Anxiety Reaction,j
! I
! chronic and acute, with depression features also present, j
Mr. Garland had the highest praise for his phy- *
sician, with whom he engaged in individual and group ;
psychotherapy. He felt he received constructive help in |
securing employment from Vocational Therapy group I
sessions. He said his social worker helped him with !
, out side problems. That helped, too, because I don* t i
I
think I could have concentrated on my inner problems if I |
had to worry about problems outside the hospital."
Mr. Garland was hospitalized for eighty-seven days.
Samuel Katz is a young looking, forty year old,
Caucasian married man of the Jewish faith. He has a
medium build, brown hair and blue eyes and displayed a
friendly engaging manner in the research interview. The
admission diagnosis: Schizophrenic Reaction, paranoid
type. He is a high school graduate and has been employed
as a salesman by the same firm for ten years.
This was Mr. Katz* first hospitalization for a
neuropsychiatrie condition and in a somewhat shy, yet
good natured fashion, he explained why he had sought
admission into the hospital. "I got some funny ideas
into my head. I thought that the people at work were
12
against me . . . that someone was trying to poison me.
I guess you call it paranoid. Well, it all seems kind
of silly now, but I really felt that way, then. My boss
at work suggested I see a psychiatrist. I did, and then
I came here."
Mr. Katz remarked, "I met a wonderful group of
fellows here in the hospital. It really helped to talk
things over with them and I got a lot of really good
advice from some of them." This interviewee felt his
Industrial Therapy assignment was most helpful, although
he found it somewhat upsetting to learn about the dif
ferent patients who were readmitted shortly after being
discharged. He said his Industrial Therapy assignment
gave him unavoidable access to réadmissions information.
Mr. Katz said that the social worker had been "very nice"
in explaining his condition to his wife and he thought
this had helped him, also. Mr. Katz was hospitalized
for thirty-two days.
Richard Lange is a thirty-five year old, single,
Caucasian Catholic. He has a slender physique, sallow
complexion, brown hair and blue eyes, Mr. Lange is
enrolled in the master*s program in a local college. He
has been employed in part-time, routine, clerical
positions for several years, while attending afternoon
13
college classes. The admission diagnosis was
Schizophrenic reaction, paranoid type.
Mr. Lange received considerable reassurance from
"the hospital regularity." He praised the hospital
dieticians and felt that good eating, recreation and
educational therapy had been instrumental in his recovery.
He believed the "solace and strength" he found in his
religion helped him most of all.
This interviewee especially appreciated being
able to compose music and play the piano whenever he
desired. Mr. Lange reported that he had confided in a
female patient who had musical talent and aspirations
similar to his own. Nursing Notes indicate that
Mr. Lange "spends most of his time reading quietly."
I
In the interview, he reported that he had worked out a j
seven piece orchestration for one of his compositions j
I
during his hospital stay. Throughout the Interview,
Mr. Lange made repetitive comments about warm weather,
warm clothing, warm food. In a rather circuitous fashion,
he explained that his illness was due to cold drinks or ■
i
cold weather and his conviction that he would remain well j
so long as he was able to keep things "moderate, instead
of hot or cold*" !
William Wright is a thirty-seven year old, I
I
divorced, Caucasian Catholic who has a steady employment
14
history as an engineering technician. He has a lean,
angular build, brown hair and blue eyes. Mr. Wright has
a grade school education and scored 109 (Wonderlic I.%. )
in hospital-administered testing. This was his third
hospitalization for a neuropsychiatrie condition and the j
admission diagnosis was Anxiety Reaction.
Mr. Wright said that group psychotherapy had
helped him immeasurably and that he had found it far
superior to Individual psychotherapy. He said this
experience had real, practical value because the thera
pist "kept everything on an everyday, living situation.
i
Most (therapists and patients) are too willing to go off '
on theoretical concepts. It * s a lot easier to do this
than face up to supporting a family, getting a job and i
all. . . . A lot of this business is being honest. It * s
easy to sit and talk . . . harder to face yourself in the ;
mirror. No one likes to admit failure, but it helps to i
I
bring things out in the group, in front of other people." |
Me*. Wright believed that Vocational Therapy
sessions had unduly minimized employment difficulties |
facing "an ex-mental patient." He said he felt personally!
!
threatened when he learned several of his ward friends I
I
were homosexuals. He thought it would be better to place ,
homosexual patients on separate wards. In addition to
evaluating the hospital programs he was involved in, this |
15
interviewee offered positive and negative evaluations of
his conception of the hospital’s treatment approach and
philosophy.
Arnold Kassner is a forty-four year old, twice
divorced, Caucasian, married man who rejected his Jewish
beliefs during his collegiate years. He is a close-
cropped, stoekily built consulting engineer who was
hospitalized following the collapse of his business. The I
admission diagnosis was Depressive Reaction; he was |
hospitalized for six and one-half months. Due to the j
length of his hospitalization, Mr. Kassner requested a !
two week interim in which to begin to readjust to society j
and thus "formulate a valid, retrospective appraisal of j
t
^ i ^ hospitalization experiences. " Upon entering the ;
1
research interview, he reported that he had given con- j
siderable thought to the research topic and that "as I
see it, two things helped me to recover, which I will j
I
outline for you." Mr. Kassner named group psychotherapy j
and confidential talks with fellow patients. He said he i
I
preferred group psychotherapy to individual therapy |
J
because of the opportunity it afforded one "to look at j
yourself through other peoples* eyes." He revealed that
his social worker had helped him with "family matters."
This interviewee viewed his Industrial Therapy assignment
I
as a neutral experience— "neither helpful nor unhelpful." :
16
He Is continuing in private psychotherapy although he
wished he could continue in out-patient group therapy.
He was convinced that group therapy would help him far
more than individual therapy.
Findings
There was a discernible change in the patients*
manner and appearance on the two occasions they were seen
by the researcher.
In the initial, preparatory interview the
veterans were polite and cooperative whereas they behaved
in an outgoing, confident manner in the research inter
view. All the participants voiced their interest in the
research; four interviewees requested that they be con- |
I
taeted in the event future, related research occurred. !
i
Interestingly, each patient underscored the fact that his '
comments were entirely subjective opinions. At the same
time, several of the patients expressed the opinion that
investigation into the patient*s view of his experiences
could certainly prove worthwhile. As Mr. Wright phrased
it, "After all, you people (staff) can*t know what it's
like for us because you're not in it like we are. You
can only try to imagine what it's like and try and put
yourselves in our place. But we're in it . . ."
The evaluative comments of the six, discharged
patients appear in the following three categories:
17
Hospital Environment, Hospital Programs and Personnel,
and Fellow Patients.
Hospital Environment
Three of the discharged patients expressed a
generalized, positive feeling towards the total arena of
the hospital. These three men had never before been
hospitalized for a neuropsychiatrie disorder. They
reported that the "whole hospital"— rest, good food,
daily routine— was helpful and reassuring to them from
the very beginning of their hospitalization. The remain
ing three men offered no comments on the overall hospital
environment. Two had prior hospitalizations; the third
had been hospitalized for six and one-half months.
The admissions ward in the hospital is a locked
ward. Five of the patients reacted to the locked admis
sions ward with fear and anxiety; the sixth said it made
him angry after a week had passed and he had begun to
feel better. Each explained how he managed to adapt him
self to the locked ward and indicated that he accepted
the rationale for a locked admissions ward.
Hospital Programs and Personnel
Group Psychotherapy
Three patients received group psychotherapy and
each identified group therapy as the most helpful
18
experience in his hospitalization. The group therapist
was the ward psychiatrist and group members saw their
therapist individually as well as in the group. Two of
the three patients had several previous hospitalizations
for neuropsychiatrie disorders. All three planned to
continue in psychotherapy after discharge. Each said he
!
would have preferred to continue in out-patient group '
therapy rather than in individual, private therapy. A ;
fourth patient revealed that talks with his ward physi
cian had helped him understand himself.
The patient who suffered from physical disorders
(heart, ulcer) singled out medication and medical care
as helpful. He recounted how his efforts to secure a
discharge were delayed because his physician had been
transferred to another ward. He did not find easy access j
to his ward physician.
One patient stated he found solace and strength
in his religion. Mr. Lange said that his doctor did not
seem to understand this and said that his personal,
religious articles were taken from him.
Social Service
Social workers are engaged in providing casework
I
services to patients and their relatives. Five of the |
fourteen caseworkers also conduct group sessions which
19
are focused (l) on preparing patients for foster care ;
i
placement and (2) meeting patients* relatives and |
explaining hospital policies and procedures. I
Three patients referred to help they had received |
from the ward social worker. One stated that the social |
worker helped him with his driver's license and other ,
problems "on the outside." He stated that the solution i
I
of outside problems allowed him to direct his efforts to i
I
the solution of inner conflicts. He felt he could not
have done this if he were worried about external problems.
Another said that the social worker interpreted his con- i
I
dit ion to his wife. He felt this had helped his wife and j
consequently had helped him also. The third patient |
!
revealed that the social worker had helped him with I
' I
"family matters." i
Industrial Therapy
Industrial Therapy is the therapeutic use of activi
ties incidental to the operation of the hospital for
the sole purpose of aiding the patient in his overall '
behavioral and economic adjustment. ... In this
therapeutic endeavor, the patient works with or in
close proximity to hospital personnel.^
Three patients participated in the Industrial
Therapy program. Mr. Lange's record states that he was
2"Physical Medicine and Rehabilitation in the
Veterans Administration" (Veterans Administration
Hospital, Sepulveda, May 29, 1959), p. 15. (Mimeo-
. /
20
referred and placed on an Industrial Therapy assignment.
This interviewee stated there had been a mix-up in the
referral and said he never received an Industrial Therapy
assignment. Mr. Katz was first given a clerical assign
ment in the Psychological Service department. He found
this too confining and several days later, by request,
t
he was assigned as a special messenger in the i
Communications and Records department. His Industrial j
Therapy supervisor's report states that "he is one of the j
best workers ever assigned to this service." Mr. Katz '
felt that his Industrial Therapy assignment was the most
helpful experience in his hospitalization. Mr. Halloran |
felt his Industrial Therapy assignment in Central j
I
Clothing was helpful in that "it helped to keep my mind
occupied." Mr. Kassner said his Industrial Therapy assign
ment in the electronics shop "didn't seem helpful or
unhelpful. It kept me busy and that was the general idea
I guess. It succeeded in doing that . . . "
Corrective Therapy
Corrective Therapy is the application of the princi
ples, techniques, and psychology of medically
oriented physical education to assist the physician
in the accomplishment of prescribed objectives. The
philosophy of treatment . . . stresses working with
as well as on the patient through cooperative rela
tionships in which the therapist teaches and directs
while the patient himself accomplishes the desired
objectives. . . . The relationships identified with
21
Informal exercise activities are used to develop
response, coordination, relief of frustration, and
socialization.3
All of the interviewees expressed the opinion
!
that physical activities had been, as Mr. Wright
expressed it, "a good way to let off steam." Each indi
cated that Corrective Therapy activities provided an
opportunity to enjoy physical exertion and forget prob
lems. They felt Corrective Therapy (swimming, basketball,
tennis, handball, bicycling) improved coordination and/or i
relaxed them. The respondents* remarks indicated that
they found enjoyment in Corrective Therapy activities.
Occupational Therapy
Occupational Therapy is medically prescribed treat
ment through the use of arts and crafts activities
such as woodworking, leathercraft, ceramics, textile-
eraft and other creative projects. . . . Treatment
objectives are usually classified under four major
types:
1. Kinetic: Restoration of improvement of physical
strength, control or coordination.
2. Psychiatric : The psychiatric type of treatment
is the scientific application of specifically
planned attitudes and activities prescribed to
(a) augment psychotherapy; (b) to develop con
structive habits as substitutes for undesirable
habits; (c) to provide outlets for tensions;
(d) to provide opportunities for therapeutic
work accomplishment and resocialization through
3"Physical Medicine and Rehabilitation in the
Veterans Administration" (Veterans Administration
Hospital. Sepulveda, May 29, 1959), P. l4. (Mimeo
graphed.)
22
inter-personal relationships in aiding the
patients to adjust to normal living; and (e) to
explore the patient's interests and aptitudes.
3. Metric : The metric type of treatment is the
utilization of specific activities through
planned individualized therapy programs to con
trol the patient's physical activity at a level
commensurate with the disability.
4. Tonic: The tonic type of treatment is the
utilization of specific activities through
planned individualized programs to improve or
maintain muscle and/or mental tone and to aid
the patient to adjust to disabilities and
hospitalization.^
Although Mr, Lange's file indicated he was
referred to Occupational Therapy, this interviewee said
that he was never accepted in this program. He explained
that, following his doctoradvice, he presented himself
to the Occupational Therapy department, only to be in
formed that they had not received a referral for him. He
said he was never re-referred to Occupational Therapy or
Industrial Therapy and pointed out, "I felt sort of
guilty to be the only one not working.” Mr, Wright
described his short-lived experience in Occupational
Therapy as "disjointed . . . not helpful.” He discon
tinued after three days.
^"Physical Medicine and Rehabilitation in the
Veterans Administration" (Veterans Administration
Hospital, Sepulveda, May 29, 1959), p. 13. (Mimeo
graphed. )
23
Vocational Therapy
The Psychology department is comprised of both
clinical and counseling psychologists who administer
psychological tests and/or provide vocational counseling
and group therapy. Ward government meetings are held
weekly and the psychologist serves as a group therapist.
Two of the patients who received group psycho
therapy also attended group sessions, headed by a
psychologist, concerning job opportunities. Mr. Garland
thought these meetings were quite helpful. Mr. Wright
felt this program was not handled in a realistic fashion.
He explained that there was considerable group discussion
j on whether or not employers discriminated against “ex-
i
I mental patients." He said that the group leader mini
mized the stigma employers attach to the ex-mental
patient. This interviewee stated that he has never had
i employment difficulties because he has never revealed his
i
I hospitalizations to his employers. He reported that in
I the group discussions he advised other patients to with
hold this information whereas the therapist encouraged
patients to share this information since certain
! employers did not discriminate. Mr. Wright felt his
I
i position was more realistic. He explained that he has
, had hiring responsibilities in the past and he felt it is
: "only realistic for an employer to prefer a
24
non-hospitalized person to an ex-mental patient with
equal qualifications." He did not think it was "real-
1 istic or practical” to reveal one's psychiatric hospital
!
I record to prospective employers.
Nurses' Aides
Five of the six interviewees commented on the
courtesy and help provided by the nurses' aides, "fhey
commented on the friendliness of the aides and mentioned
conversing and playing cards with them. Mr. Lange
resented the aide who was required to forcibly restrain
! him when he became hostile and hyperactive and was
placed in seclusion.
Fellow Patients
Every interviewee reported that he had received
help from fellow patients. The respondents stated that
they talked their problems over with a small group of
fellow patients with whom they spent a good deal of time.
The men reported that they received sound advice and
understanding from the patient-friends in whom they con
fided. Each patient indicated that he did not confide in
patients other than the small, psychic group members.
Each man commented to the effect that "This wasn't some
thing you could do with everyone. Certain ones were
good . . . others were not.”
25
Summary of Findings
All of the discharged patients expressed a desire
to return to the hospital for out-patient treatment if
this program were presently available. The ex-patients
indicated that they perceived the hospital— its staff and
its programs— as a helpful, patient-centered institution.
The two patients who had been hospitalized in other
Veterans Administration hospitals expressed the opinion
that the staff and programs at Veterans Administration
Hospital, Sepulveda, had helped them most of all. Both
of these men stated that the hospital atmosphere and per
sonnel of Sepulveda excelled in contrast to their pre
vious hospitalizations.
All of the respondents praised the staff person
who is with the patients most of all— the Nurses* Aide.
Mr. Lange resented one aide but said the other aides
were "nice" to him.
No program or professional group was greatly
criticized whereas several staff persons and programs
were seen as universally helpful. Overall, the inter
viewees reflected a feeling of trust and confidence in
the Veterans Administration Hospital, Sepulveda,
California. This research indicated that giving, as
well as receiving, is highly valued by the psychiatric
26
patient. For it is in giving that relationships are
fostered and maintained. As the findings report, the
patients identified programs which basically require
giving of one's self.
CHAPTER III
SUMMARY AND SOCIAL WORK IMPLICATIONS
I
I
This research was undertaken t© learn and eval
uate discharged patients* attitudes towards the
experiences they encountered in the course of their
treatment in the Veterans Administration Hospital in '
Sepulveda, California. The attitude, accuracy and sin
cerity which characterized the interviewees* comments
have strengthened the researcher's belief that the dis
charged psychiatric patient can be a reliable research |
!
subject. In five out of six cases the discharged !
patient's explanation of his illness corresponded with
the professional diagnosis contained in the clinical
files. We found that they were cognizant of the various '
programs they participated in and highly motivated to ,
I
share subjective evaluations of their experiences. With- i
out exception, the interviewees were voluntary patients
whose illnesses were non-service connected; none received i
federal pension or compensation. Five of the six ;
respondents traveled fifty or more miles in order to
participate in this research.
27
28
The ex-patients* interest and involvement in
this research can be observed by the manner in which they
participated in the research interview. At the outset of
the research interview the researcher repeated the
research question and the interviewees indicated that
they understood the area under investigation and had pre
pared for it. Each participant explained the problems
which had caused him to seek hospitalization, his reac
tions to hospitalization and his activities following
discharge from the hospital.
The interviewees understood that the researcher
was not inquiring into pre- and post-hospitalization
experiences. However, they expressed the opinion that
the researcher's understanding of their reaction and
responses to hospital programs needed to include the
range of experiences they had encountered from the time
they recognized they were mentally ill.
Analysis of Findings
Hospital Environment
The impact of the overall hospital environment on
the patient has come under increasing study in recent
years.^ Today, modern psychiatric hospitals provide an
^See, e.g., J. F. Bateman and H. W. Dunham, "The
State Mental Hospital as a Specialized Community
Experience," American Journal of Psychiatry, CV, 1948;
29
I
ever-increasing number of treatment services in an effort
to provide varied and individualized treatment opportuni
ties, The atmosphere of a psychiatric hospital cannot be ,
precisely defined. It is the culmination of past and
present human interaction throughout the hospital. It
reflects patient attitudes, staff attitudes, administra
tive policy and routine. When we speak of a hospital's
atmosphere, we refer to its people, its services and its
policies.
All six men expressed a positive feeling towards
"the hospital." Although the hospital does not provide
out-patient treatment at this time, each patient said he :
would participate in such a program if it were available.
Each man said he would prefer to return to Veterans
Administration Hospital, Sepulveda, for out-patient
treatment, rather than secure treatment in hospitals or
agencies in his own community. The ex-patient's confi
dence in the hospital and its personnel superseded the
inconvenience of time and distance.
William Gaudill, et al, "Social Structure and Interaction
Processes on a Psychiatric Ward," American Journal of
Orthopsychiatry, Vol. 22, April 1952; John Bartlow Martin,
The Pane of Glass (Harper and Brothers, New York, 1959);
Alfred H. Stanton and Morris S. Scwartz, The Mental
Hospital; A Study of Institutional Participation in
Psychiatric Illness and Treatment (New York: BasicBooks,
Inc., 1954j; Maxwell Jones, et al. The Therapeutic
Community: A New Treatment in Psychiatry (New Ÿork: Basie
Books, Inc., 1953).
30 I
Hospital Programs and Personnel |
The two patients who worked in Industrial Therapy !
assignments were men who had been successfully employed j
for many years. A regular Industrial Therapy assignment j
recreated the familiar daily routine which characterized i
their life prior to hospitalization. Mr. Katz remarked
that the hospital had helped him and he appreciated
being able to contribute his services to the hospital.
Both men indicated that they assumed the employee role
in their positions. They accepted personal responsi
bility for their work performance and took pride in the :
(
fact that they had executed their duties in a responsible |
manner* In this period of their hospitalization they saw I
themselves as responsible individuals who were contribu- ;
ting needed services to the hospital. |
Two interviewees said that the ward social worker
I
had been instrumental in improving their family rela- i
tions. Although all the interviewees voluntarily dis
cussed the dynamics of their illness and repeated
doctor-patient interchanges which occurred in therapy
sessions, they did not elaborate on interviews with the
social worker. Unlike their illness, they considered
family problems as personal, confidential material and
the researcher respected this attitude and did not
request specific information. They reported that the
31
social worker had discussed "family matters" with their
wives and interpreted their illness to their wives,
A third, single patient reported that the social
worker had helped him procure his driver * s license and
settle financial difficulties which occurred prior to
his admission to the hospital.
All six interviewees reported that they enjoyed
Corrective Therapy and believed that athletic activities
had contributed towards improved mental health. Their
comments revealed that they found in Corrective Therapy
rejuvenation, relaxation, camaraderie and welcome escape
from discussion of their problems. Corrective Therapy |
was equated with relaxation and enjoyment. !
Most of the men had not engaged in athletic ■
activity for a number of years, yet all found consider- j
able enjoyment in the athletic role. We have seen how
two patients responded favorably to the work role in
I
Industrial Therapy assignments. Similarly, in Corrective '
Therapy, the patient is socially and athletically in- ^
I
volved in a pre-patlent manner. He is able to relax and
perform in a role which is not peculiar to a psychiatric j
I hospital. He engages in sports which, for the most part, ‘
I were learned in childhood and developed in adolescence. ;
i
Educational Therapy constituted a pleasant
experience which offered interesting, educational
32
discussions of various topics. Only one patient
(Mr. Lange) viewed this as an experience which contrib
uted toward improved mental health. Nonetheless the
other patients perceived this experience as an enjoyable
feature of hospital life. Since they responded favorably
to lecture presentations and entered into group discus
sions of the material presented. Educational Therapy
sessions served to facilitate socialization.
The patients who received group psychotherapy
felt this program had been most instrumental in their
recovery. They commented favorably upon the therapist's
"down to earth" approach and the help they received from
fellow patients. Although each planned to continue in
individual psychotherapy, each said he was convinced that
group psychotherapy, if available, would be more bene
ficial. Two of the interviewees had received private
psychotherapy prior to and during hospitalization; the
third received private psychotherapy while he was
hospitalized.
Therapeutic Aspects of the
Patient Sub-Culture
While this research was not directly concerned
with investigating the patient sub-culture in Building 2,
the intensive treatment unit, significant material of
this nature was volunteered by the respondents.
33
Specifically, the ex-patients revealed their reactions
to locked wards, and how their discovery that other
patients had problems similar to their own caused them
to turn to fellow patients for help and guidance. Each
interviewee revealed that fellow patients* attitudes and
interest facilitated his adaptation to the hospital com
munity. The respondents also revealed that they had
initiated discharge plans with their physician. One of
the research participants recounted how he had learned
this procedure from his fellow patients.
Conclusions and Implications
Significantly, patients accented in a unique
fashion, the feeling that throughout their sojourn at
the hospital, the opportunity to achieve, in areas such
as Industrial and Corrective Therapy, were rewarding,
encouraging experiences. Mo less forcefully, each indi
cated an individual need to give--not merely of himself
but to others.
The ability to perceive the hospital through the
patient's eyes can be of far reaching importance to
hospital personnel. It can enhance our understanding not
only of the patients but how and why hospital services
must meet their need to give as well as to receive.
What sort of place is the mental hospital, as the
patient sees it? He enters the hospital not merely
34
to get treatment but to live his life for an indefi
nite period of time. . . . For him, the hospital is |
not an "organization" having a few specific func
tions. It is, rather, a "community"— a place to
live, a total life setting within which he pursues
his varied goals. ... He seeks a meaningful identi
ty and pattern of life here as he would elsewhere. ,
He may wish to change, but he strives as well to
achieve continuity with the past. He has a full !
repertory of human needs. He engages in relation
ships with authorities and peers, with persons of
his own and the other sex, with persons of various
dispositions and social backgrounds. He seeks free
dom and security, self-expression and self-control.
He wants to know what kind of world this is— what it
offers him, what it demands, what he can contribute
to it
Levinson believes that the psychiatric patient
wants to "contribute." In Industrial Therapy, Corrective
Therapy, Group Psychotherapy, etc., the patient gives of '
himself— either to the hospital or to his fellow patients.
Giving as well as receiving is an integral
characteristic of social functioning. If we are to help
patients return to a higher level of social functioning, '
we must indeed provide opportunities for patients to make
positive contributions during the course of their hospi-
I
talization.
Simmons and Wolff note: "Sometimes . . . patients
do create or devise original and effective ways of
^Daniel J. Levinson, "The Mental Hospital as a
Research Setting: A.Critical Appraisal," The Patient and
the Mental Hospital, ed. by Milton Greenblatt, M.B.,
Daniel J. Levinson, Ph.D., and Richard H. Williams, Ph.D.
(Glencoe, Illinois: The Free Press, 1947), p.
dealing with their problems in the hospital or they
become potential resources for help and healing in their
relationships with other patients.
This research clearly reveals that fellow
patients are recognized as "resources for help" for one
another. The patients* stated preferences for group,
rather than individual, psychotherapy may be due partly
to their need to help as well as to be helped. On the
basis of this limited research we can do no more than
speculate about the patients* preferences for group
psychotherapy and their universal practice of seeking
help from fellow patients.
The author believes that further research into
the patients* reactions and evaluations of their
experiences will most certainly lead to a greater under
standing of the hospitalized psychiatric patient.
Increased understanding of the patient * s needs cannot
fail to improve the selectivity and quality of treatment
made available to the patient.
In recent years research in psychiatric hospital
care and treatment has focused upon an examination of
hospital organization, structure, programs, etc.
3Leo W. Simmons and Harold G. Wolff, Social
Science in Medicine (Mew York: Russell Sage Foundation,
7 p. iBs:-----
Levinson notes that "the initial reference point in each
case is an influence external to the patient." Research
of this nature (notably Maxwell Jones, Stanton and
Schwartz, William Caudill) has hastened and directed the
movement from custodial care to therapeutic community.
There is, however, another type of question that
merits greater attention than it has yet received.
Its initial reference point is "the patient himself."
In its most general form, this question reads: What
are the varied needs and adaptive problems of per
sons who live as patients in a mental hospital? The
answers to this question will, I believe, provide a
more substantial basis than we now have for consider
ing what external influences will be of the greatest
value to the patient .... One of the most fruitful
areas for further research is the study of the indi
vidual patient; his varied experiences, personal
characteristics and adaptive problems, and the
implications of these for hospital policy.^
^Daniel J. Levinson, "The Mental Hospital as a
Research Setting: A Critical Appraisal," The Patient and
the Mental Hospital, ed. by Milton Greenblatt, M.D.,
Daniel J. Levinson, Ph.D., and Richard H. Williams, Ph.D.
(Glencoe, Illinois: The Free Press, 194?), P. 643.
BIBLIOGRAPHY
Books
Caudill, William. The Psychiatric Hospital as a Small
Society. Harvard, Cambridge, Massachusetts:
Commonwealth Fund, 1958.
Greenblatt, Milton, et al. From Custodial to Therapeutic
Patient Care in Mental Hospitals; Explorations in
Social Treatment. Mew Ÿork: Russell Sage Foundation,
1955.
Jone8, Maxwe11, et al. The Therapeutic Community: A Mew
Treatment in Psychiatry. New York: Basic Books,
Ino., 1953.
Martin, John Bart low. The Pane of Glass. Mew York:
Harper and Brothers, 1959.
Overton, Alice, et al. Casework Notebook. St. Paul,
Minnesota: Family Centered Project, 1957.
Simmons, Leo W., and Wolff, Harold G. Social Science in
Medicine. Mew York: Russell Sage Foundation, 1954.
Stanton, Alfred H., and Schwartz, Morris S. The Mental
Hospital: A Study of Institutional Participation in
Psychiatric Illness and Treatment. New Ÿork: Basic
Books, Inc., 195^.
Articles
Appell, Kenneth E. "Mental Health and Mental Illness,"
Social Work Year Book, 1957. Edited by Russell H.
Kurtz. New York: National Association of Social
Workers, 1957, 363-370.
Bateman, J. P., and Dunham, H. W. "The State Mental
Hospital as a Specialized Community Experience,"
American Journal of Psychiatry, CV, December 1948,
445-449.
38
39
Gatidill, William. "Social Processes in a Collective
Disturbance on a Psychiatric Ward," The Patient and
the Mental Hospital. Edited by Milton Greenblatt,
et al. Glencoe, Illinois: The Free Press, 1957,
W?71.
Caudill, William, et al. "Social Structure and
Interaction Processes On a Psychiatric Ward,"
American Journal of Orthopsychiatry, Vol. 22 (April
1952}, 314-333.
Levinson, Daniel J. "The Mental Hospital as a Research
Setting: A Critical Appraisal," The Patient and the
Mental Hospital. Edited by Milton Greenblatt, et al
Glencoe, Illinois: The Free Press, 1957, 633-649.
Stainbrook, Edward. "The Community of the Psychiatric
Patient," American Handbook of Psychiatry, Vol. 1.
Edited by Silvano Arieti. New York: Basic Books,
Inc., 1959, 150-160.
Unpublished Material
Veterans Administration Hospital, Sepulveda, California.
"Physical Medicine and Rehabilitation in the Veterans
Administration." May 29, 1959. (Mimeographed.)
U n i v e r s i t y of Southern California

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Creator Bradley, Jacqueline Marie (author)

Core Title Discharged patients' attitudes towards their hospitalization experiences

Degree Master of Social Work

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag health and environmental sciences,OAI-PMH Harvest

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