Social approaches to mental patient care / by Morris S. Schwartz, Charlotte Green Schwartz, and Mark G. Field [and others].

  • Schwartz, Morris S.
Date:
1964
Catalogue details

Licence: In copyright

Credit: Social approaches to mental patient care / by Morris S. Schwartz, Charlotte Green Schwartz, and Mark G. Field [and others]. Source: Wellcome Collection.

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    it is impossible for personnel to control their actions. Adminis- strative policies that require personnel to retain their traditional responsibility for patients’ behavior are incompatible with the realities of the open hospital and usher in problems that are usu- ally expressed as resistance to the innovation. Even though this sounds obvious enough, one important psy- chological residue of traditional hospital culture is the skepticism of personnel regarding the support they will receive from supe- riors in the event of incidents and crises. For this reason, a most important ingredient of change must be establishing trust. Per- sonnel in lower echelons must overcome their suspicion and skep- ticism and begin to believe the assurances of their superiors, and the development of this belief will rest on the actual performance of their superiors, as time goes on. We suspect that the time required to open a hospital and the difficulty encountered are functions of how long it takes to estab- lish this trust. Our impression is that one of the most important factors in the development of trust is the quality of leadership exercised both at the highest levels within the institution and in outside agencies with legal authority over its operation. Briefly, each person in the hospital can confidently accept the new defi- nitions of his responsibilities only insofar as his superior feels a similar confidence, and this depends on the exercise of effective leadership at all levels. Shifting responsibility for the patient’s behavior to higher ech- elons frees ward personnel in a legal or formal sense from their obligations as guards; however, they are not yet psychologically free. Moral and social identification with the community would not permit them, regardless of administrative edict or psychiatric theory, to open the doors and let the “mad” loose on the unsus- pecting community. Therefore, as the second most important pre- condition for an open door policy, the ward personnel must re- define the patient. ‘The patient must now be seen as less dangerous and more predictable, in short, as less “crazy.” Whereas a radical redefinition of the patient and of mental ill- ness would seem to require extraordinary efforts, an unrelated and fortuitous event in psychiatric treatment has permitted the