Origins of apathy ALEXANDER MITCHELL There has the

long

apathy and phrenics after

been debate about whether indifference shown

by

schizo-

many years in hospital is a result of the progress of the illness or of an institutional way of life. This new book the outcome of a scientific research programme provides the other side of the coin to the

?

writings

of Dr. R. D.

Laing.

Described as a monograph by the authors in their preface, this book seeks to study the relationship

between institutionalism and schizophrenia in the lives of patients at three psychiatric hospitals?Netherne

(Dr. Freudenberg), Mapperley (Dr. Barton).

(Dr. Macmillan)

and

Severalls

Questions have long been asked about the degree to which the so-called 'schizophrenic end state' is due to progress of the disorder or to living in an institution like a psychiatric hospital. This book records the result of a social psychiatry research programme designed to study the adverse effects on schizophrenic patients of a prolonged stay in the three selected hospitals, and ways in which these effects could be counteracted and prevented. Dr. J. K. Wing is professor of social psychiatry at the University of London and director of the Medical Research Council Social Psychiatry Unit at the Institute of Psychiatry. Dr. G. W. Brown is reader in sociology at Bedford College, London. This work is to be read in

conjunction with other books published by the authors in which they report their findings of the investigation

into the nature of the interaction between social and clinical events. It can be said that this book, and the others in the series, seek to find answers by means of the 'scientific method' rather than through the 'literary approach* adopted by others who have sought the same answers, such as Erving Goffman (1961) or Ivan Belknap (1956). The book is clearly laid out in convenient sections. The authors first give a comprehensive review of the literature and examine the hypothesis for the relationship of schizophrenia and the social environment. Then they outline the design of their study together with methods of assessment. There follow three personal descriptions by the physician superintendents of the

36

hospitals studied. These hospitals were chosen because they differed widely in their social conditions and administrative policies. The rest of the book is taken up with detailed reports of the various measures used and the findings obtained. I found it pleasing to see that the authors have balanced a somewhat dry statistical account of persons in the mass, with a descriptive account of three selected wards, one from each hospital, and six patients from each ward. This helps to bring the discussion to a very human level in the middle of a 'scientific' survey. I also liked the discussion and summary sections which come at the end of each important development of the main themes. One fifth of the book is taken up by very detailed tables and figures, so that other research workers in the field

(c) staff should have a good expectation of the patients.

of

graded

specific

but realistic morale and

their general summary the authors consider the implications of this study for the future of the psychiatric hospital and express a cautionary note. They feel that development of community based programmes of care for the chronic schizophrenic should not ignore what they describe as the 'rarely negligible, and in In

intolerable' burden on the families of out of hospital, have escaped the rigours of institutionalism but who may still have considerable

some

cases

patients who,

secondary handicaps. In my opinion, this

book takes an entirely stance from that of other well known works in of schizophrenia in particular that of Dr. R. and his colleagues (1964). I feel that each

different the field

D. Laing of these

Martin Weaver

can compare their own findings in depth and at the end there is a most comprehensive list of references to aid the student or the research worker.

(b) there should be provision facilities for specific individuals.

the authors mean 'long term exposure to social pressures which have brought about a change in the individual's behaviour and attitudes'. Their findings are clear cut and can be summarised as

By institutionalism

follows:

(a) social conditions are responsible for part of the Patients' symptoms, particularly the negative ones? social withdrawal, apathy, blunting of affect and poverty speech?the 'clinical poverty syndrome'.

(b) under-stimulating surroundings

lead to an increase

'the primary handicap resulting in an increase in clinical poverty syndrome'. (c) over-stimulating surroundings force a patient to interact and can lead to breakdown of psychic organisation characterised by an increase in florid symptoms? expressed delusions, hallucinatory experiences and

contrasted approaches illuminates the dark shadows of the other. Professor Wing's scientific statistical and operant approach cautions us against unsubstantiated about what makes or breaks a schizophrenic Laing's concern for the experience of the individual patient reminds us that people are what really matters in the end and that individuals can get

theorising and

Dr.

lost in the matrices of scientific hard data. For those of us who have been fascinated and stimulated by Dr. Laing I recommend Professor Wing and Dr. Brown as the much needed other side of the coin.

'n

impulsive behaviour. (d) clinical and social poverty, together with institutionalism, lead to a general apathy and indifference to discharge. The authors suggest practical steps which

would appear

to counteract the processes described above:

(a) patients should themselves as if they

handicapped.

encouraged to do things were not in hospital and were be

References

Goffman, E. (1961) Asylums: essays on the social situation of mental patients and other inmates. New York: Doubleday. Belknap, I. (1956) Human problems of a State Mental Hospital. New York: McGraw Hill. Laing, R. D. and Esteson, A. (1964) Sanity, madness and the family. London: Tavistock Publications.

Institutionalism and schizophrenia comparative study of 3 mental hospitals by J. K. Wing and G. W. Brown

A for not

1960-68

Cambridge University Press, 75s 37

Origins of Apathy.

A new book, reporting on a research programme, sheds more light on the vexed question of the adverse effects on schizophrenics of a prolonged stay in ...
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