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

  • Schwartz, Morris S.
Date:
1964
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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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    considerably affected by characteristics of the institution itself: by whether it is a VA hospital, a state institution, or a private hos- pital; by whether it has many or few patients or the staff-patient ratio is high or low; by what kinds of patients are admitted; by whether the institution has a long history of a custodial orienta- tion or is a new one with a reformist base, and so on. Moreover, all these circumstances will affect the ease with which additional therapeutic milieu elements are introduced. Forms of the Therapeutic Milieu There is a wide variation among hospital personnel in the spe- cific concepts and objectives seen as pursuing the therapeutic mi- lieu approach. Measures introduced to implement the approach vary from those that serve to “humanize” the hospital situation, to those specifically used as treatment methods for a segment of the institution, to those that try to deal with the institution as a whole. The nature of therapeutic milieu varies from institution to inst1- tution, depending on where the emphasis is placed. In one, it might be on the therapeutic community (Jones, 1953; R. N. Rapo- port, et al., 1960), where, in addition to specific measures, a good community experience per se is thought to be directly therapeu- tic, and the process of adaptation, it is believed, will enable the patient to learn techniques that will be helpful in living on the outside. In another, it might be on developing one ward into a therapeutic milieu, in which patients are given more responsibil- ity for the conduct of their own and hospital affairs. PROVIDING A ‘“‘THERAPEUTIGC ATMOSPHERE’’ AND THERAPEUTIC ATTITUDES The referent of the term “therapeutic atmosphere” is vague and difficult to specify. ‘The atmosphere of a ward or a hospital seems to refer to the emotional climate or ethos, which is regarded as having an influence on patients. Attitudes, qualities of relation- ships, types of formal structures of wards and of hospitals, and physical settings—all are regarded as constituents of the therapeu-