The Devious Path of Reform  

Oleh:

Dinerman, Miriam

Jenis: Article from Journal - e-Journal
Dalam koleksi: Affilia vol. 20 no. 1 (Feb. 2005), page 5-9.
Fulltext: 5.pdf (57.62KB)

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I worked in a state psychiatric hospital, training social work students,when psychotropic drugs were first introduced.Amovement for reform of mental health services swept mental health professionals and the public mental hospitals across the nation. I, too, was swept up in this revolution as a result ofmyexperiences in the state hospital. This is the story of that reform effort. At the state hospital, I saw patients who had been hospitalized for 10, 15, or 20 years—patients who were competent enough to run the institution’s kitchen or laundry or to be in charge of other complex tasks and those who were docile and seemed to pose no threat to the community but were never considered for discharge. In fact, when I and my students tried to prepare such patients for discharge to the community, we were often blocked, not because the staff thought that the patients posed any threat to the community but rather, because the patients’ discharge posed a threat to the smooth functioning of the institution. I saw also the prevalence of another disabling condition among these long-stay patients: institutionalitis. Patients were so habituated to the routines of institutional life that they lost the capacity for independent judgment or action in an enormous range of everyday activities. They did not believe they could turn on the lights, select which socks to wear, decide what to eat for breakfast, or manage the simplest task of everyday living. The vast bulk of the patients in this hospital were these chronic, long-stay patients, although a smaller number remained for a short time and were successfully treated and discharged.

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