Boston University

OpenBU http://open.bu.edu

Theses & Dissertations Dissertations and Theses (pre-1964)

1962

Background survey of patients

discharged from an urban mental

institution

Yavner, Carol Frances

Boston University

https://hdl.handle.net/2144/25859

Boston University

~ ._..:. ..

~OS!OI UIIVIRSITY

SCHOOL ar BDU~ION

!heais

:BACKGROUliD SUB.VKY OJ' P.A!ID'l'S DISCHARGE)

Subll11 t ted b7

-carol Fraacee Ya'Ylll.er

(.A..~., ~oston t1:a1versit7, 1952)

Ia Partial J'alf1llaeat of Requirements for

tae Degree of Kaater of ~ducat1oa

First Reader: Julian s. Myers, Ph. D. Associate Professor of Education

Second Reader: Arthur J. Bindman, Ph. D. Assistant Professor of Education

ii

ACKNOOIDJMENTS

Acknowledgement is made of the support of Dr. Walter Barton and Dr.

Ralph Notman and the staff at the Boston State Hospital, without whose

aid and assistance the completion of this thesis would have been difficult.

iii

TABLE OF CON'lENTS

Page

LIST OF tABJFS••••••••••••••••••••••••••••••••••••••••••••••••••••••vi

LrST OF ILLUSTRATIONS •••••••••••••••••••••••••••••••••••••••••••••• vii

Chapter I. GENERAL STATEMENT OF THE PBOBLEM •••••••••••••••••••••••••••• l

Specific Problems Definition of Terms Delimitations Need for the Study

II. RELATED LJTERATUEE•••••••••••••••••••••••••••••••••••••••••l3

III. PROCEDUBE ••••••••••••••••••••••••••••••••••••••••.•••.••••• 20

IV.

TiJI!e and Place How Were the Members of the Group Studied Chosen Type of Follow-up

PRESENTATION AND INTERPRETATION OF DATA •••••••••••••••••••• 23

Ethnic Background ~ligious Background Education Marital Status Employment Intemperance Length of Hospitalization Age Legal Status Established Diagnosis Length of Hospitalization Previous Admissions Readmissions Mental Retardation Drug Addiction Readmission and Length of Hospitalization Intemperance and Readmission Mental Retardation and Readmission Readmission and Legal Status Readmission and Established Diagnosis Readmission and Age

iv

Chapter Page

V. SUMMARY AND CONCLUSIONS •••••••••••••••••••••••••••••••••••• 47

BIBLIOGRAPEY •••••••••••••••••••••••••••••••••••••••••••••••••••••••• 50

v

LIST OF UBJ.F.g

Table Page

1. Color of the Survey Poptilation •••••••••••••••••••••••••••••••• 23

2. Color of the Normal Population of Massachusetts (1960 Census)•••••••••••••••••••••••••••••••••••••••••••••••••••26

3. Beligious Preference of the Survey Group••••••••••••••••••••••27

4. :Religious Preference - Suffolk COunty (Boston, Chelsea, Revere, ~nthrop) 1950•••••••••••••••··~···••••••••••·•~··27

5. Education of the Survey Population••••••••••••••••••••••••••••28

6, Education - Normal Population of Boston (25 Years of Age or More) -:196o Census ••••••••••••••••••••••••••••••••••••••••• 28

1. Marital Status of the Survey Population ••••••••••••••••••••••• 29

8, Remunerated Employment Distribution Among Survey Population • •• 33

9. Remunerated Employment Distribution Among Comparative Boston Normal Population (196o Census) ••••••••••••••••••••••••••• 35

10. Length of Hospitalization ••••••••••••••••••••••••••••••••••••• 38

11. Types of Diagnoses in the Group Studied,, ••••••••••••••••••••• 39

12. Established Diagnosis ••••••••••••••.••.•••.••••••••••••••••••• 4o

13. Length of Hospitalization and Type of Mental Illness of Male Group Members•••••••••••••••••••••••••••••••••••••••••••••42

14. Length of Hospitalization and Type of Mental Illness of Female Group Members •••••••••••••••••••••••••••••••••••••• 43

15. Nunber of Mental Hospitalizations After That Recorded in the Survey •••••••••••••••••••••••••••••••••••••••••••••••••••• 44

16, Nunber of l!Badmissions of Patients and Type of Their Mental Illness ••••••••••••••••••••••••••••••••••••••••••••.•••••• 46

vi

LIST OF ILLUSTRATIONS

Figure Page

1. Eeligious Preference Survey Population ••••••••••••••.•••••• 24

2. Religious Preference Survey and Normal Populations ••••••••• 25

3. Marital Status -Survey Population ••••••••••••••••••••••••••• 31

4. Percentage Distribution of :&nploymEmt Within the S1lrvey Population.••••••••••••••••••••••••••••••••••••••••••••••32

5. Percentage Distribution of Remunerated Employment in the Normal and the Survey Population ••••••••••••••••••••••••• 34

6. Length of Hospitalization •••••••••••••••••••••••••••••••••••• 37

vii

CHAP!'ER I. GENERAL STA'.IEMENT OF THE PROBLEM

This survey had as its purpose the problem of examining the case

histories of patients discharged from a mental institution in an urban

commWlity in an effort to detemine whether &'IJ3' specific factors co11111on

to their backgrounds were consisten~ found among the more successful,

less successful or non-successful adaptations to canmuni ty life. The

factors examined were those canmon to all: age, color, education, employ'­

ment (or lack of employment), marital status, religion, and sex.

In addition to those factors, others common only to the subject group

were examined. These were: legal status on admission, legal status on

discharge, length of time in the hospital, n1111ber of times the patient

has previous:cy been admitted to a mental hospital, n1111ber of times after

this admission, and for a period of not more than two years after the

date of discharge, that the patient has been admitted to this hospital

or to another hospital of this type, and the type of illness.

In addition to both groups of factors, a third group was explored

which covered the areas of drug addiction, alcohol addiction (or excessive

alcoholic intake), and mental deterioration (or chronic bi'Iin damage).

These, than, were the factors which were examined to ascertain the

preponderance of aQ1 factor in the person's attempt to rehabilitate and

readapt himself to life in the canmunity •

. Specific problems.-The questions raised b,y this inquiry were varied:

(1) Did the factor of age place azv lim:l. tation on the individual's read­

jus'bnent to canmuni ty living?

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Because age is a known restricting !actor in the field of' employment

even !or the nomal population, the question arose as to whether it was

even more :!Jnportant to those who were once mentally ill.

(2) Did the age of' the indiVidual place aey restriction upon his ability

to recover fran his illness?

(3) Did the age of' the person place aey limitation on his ability to recover

fran the illness and not require rehospitalization at a later date?

Since the ability to readjust to living outside the hospital revolved

many times around the ability to find and hold an adequate remunerative

position, this survey was restricted to those of' working age. For this

reason, the population of the group studied was limited to those individuals

between the ages of twenty and sixty when they were discharged. It was

realized that there were maey in the normal population who were working

before they reached the age of twenty, and many so engaged beyond the age

of' s~. These artificial cut-o!f points were adopted both for their ease

of canparison, and for the reason that they covered the major portion of'

the productive years of' an individual in our society.

(4) Did, tbl previous work history have aey bearing on the person's ability

to recover fran his mental illness?

(5) Was an individual who had been mentally ill able to return to the

canmunity, find employment, and retain this remunerative position?

(6) Was aey factor more canmon to men than to wanen?

(7) Was any factor more canmon to wcmen than to men?

To ascertain this, the results of' this survey were detennined for men,

wcmen and the group as a whole.

(8) Did membership in a mi.nority race tend to cause more emotional problans

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''

in a society where the white race was overwhelming~ predaninant?

(9) Did the marital status of the individual play a part in his illness

and readjus'bnent?

(10) In what way did his education affect his emotional problem?

(11) To what extent did the religion of this person play a role in his

mental illness?

(12) Did his recognition of the fact that he was men~ ill (voluntary

or non-voluntary canmi ttment) reflect in any way upon his later ability'

to readjust to camnunity living?

(13) Did the length of his hospital confinement have any effect upon his

readjus'bnent to life outside the hospital?

(1.4) Did his specific illness have any effect upon his readjus'bnent?

(15) Was this the patient's first such illness?

(16) Were there any illnesses of a similar type following this confinement?

(17) Were aey of the complicating factors of mental retardation, alcohol

addiction, excessive alcoholic intake, or drug addiction present? To

what extent did they prove to be complicating?

Definition of terms.-Inasmuch as much of the terminology referring to the

men~ ill has cane fran the fields of medicine and law, and thus is

foreign to the ~an, sane of the basic tenns involved should be defined.

Acute brain syndrome -~se are the organic brain syndromes from which the patient recovers. They are the result of temporary, reversible, diffuse :Impairment of brain tissue function such as is present in acute alcoholic intoxication or •acute delirium' ••• (Also included are) acute reversible brain syndrames due to drugs generally used in medical practices, such as bromides, barbiturates, opiates, or

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hormonal and similar~ acting principles •••• •l

Addiction-· • ••• to give (oneself) up or over, as to versifying, as a constant practice; to habituate.•2 Alcohol addiction includes • ••• cases in which there is well established addiction to alcohol without recognisable under~g disorder.•3 Drug addiction• ••• is usually symptomatic or a personality disorder, and will be classified here while the individual is ac~ addicted; the proper personality classification is to be made as an additional diagnosis.•4

Anxiety reaction -•rn this kind of reaction the anxiety is diffuse and not restricted to definite situations or objects •••• It is not controlled by aey specific psychological defense mechanism as in other psychoneurotic reactions. This reaction is characterized by anxious expectatio~ and frequent~ associ­ated with sanatic symptanmatology.•5

Brain syndrane -8The organic brain disorders are separated into acute and chronic, because of the marked differences between these two groups in regard to prognosis, treatment, and general course of illness. The terms 'acute' and 'chronic' refer p~ to the reversibility or brain pathology and its accanpaeying organic brain syndrome; and not to the etiology, onset, or duration or the illness,tt6

Chronic brain syndrane -8 The chronic brain syndranes result from relative~ perman­ent, more or less irreversible, diffuse impairment of cerebral tissue function. While the under~ing pathological process may partial~ subside, or respond to specific treat• ment, ... (it) may become milder, vary in degree, or progress, • • • sane disturbance or memory, judgment, orientation,

1. American Psychiatric Association, Diagnostic and Statistical Manual Mental Disorders, Washington: 1952, p. 15.

2. lftltHiter's Collegiate DictiC, 5th ed.; Springfield, Massachusetts: a. & c. Merriam COIIIpaiiT, l9 • P• 12. . .1' . . ..

.3. American Psychiatric Association,~.· cit.p.,39. . -' --

4. Ibid, P• .39. -. 5. ~· P• .32.

6. ~· P• 14.

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comprehension and affect persists permanen~.·l

Degeneration --oeterioration in structure of a tissue or an organ.•2

Depressive reaction -"The anxiety in this reaction is allayed, and hence partially relieved, by depression and self-depreciation. The reaction is precipitated by a current situation, frequently by sane loss sustained by the patient, and is often associated with a feeling of guilt for past failures or deeds. The degree of the reaction in such cases is dependent upon the intensit,r of the patient's ambivalent feeling toward his loss (love, possession) as well as upon the realistic circumstances of the loss.•3

Emotionally unstable personality -• ••• the individual reacts with excitability and ineffec­tiveness when confronted by minor stress. His judgment may be undependable under stress, and his relationship to other people is continuously fraught with fluctuating emotional attitudes, because of strong and poorly controlled hostility, guilt, and anxiety.•4

Inadequate personality -• ••• characterized by inadequate response to intellectual, emotional, social, and peysical demands. They are neither physically nor mentally grossly deficient on examination, but they do show inadaptibility, ineptness, poor judgment, lack of pbys~cal and emotional stamina, and social incom­patibility. 11>

Involutional psychotic reaction -• ••• psychotic reactions characterized most commonly by depression occurring in the involutional period, without previous history of manic depressive reaction, and usually in individuals of compulsive personality t,rpe. The reaction

1. ~· p. 18.

2. Gould's Pocket Pronouncin~ Medical Dictionary, 11th ed.; Philadelphia: The Bi&klston Company, l9 9, p. 213.

3. American Psychiatric Association, 4.- cit. P• 33.

4. Ibid. P• 36.

5. ~· P• 35.

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tends to have a prolonged course and may be manifested by worry, intractable insomnia, guilt, anxiety, agitation, delusional ideas, and somatic concerns.•l

Manic depressive reactions -• ••• the psychotic reactions which fundamentally are marked by severe mood swings, and a tendency to remission and recurrence. Various accessory symptoms such as illusions, delusions, and hallucinations may be added to the fundamental affective alteration. Manic depressive reaction is synonymous with the term manic depressive psychosis.•2

Mental deficiency -• ••• those cases presenting primarily a defect of intelligence existing since birth, without demonstrated organic brain disease or known prenatal cause.•3

Mental illness or psychotic reaction -•A psychotic reaction may be defined as one in which the personality, in its struggle for adjustnent to internal and external stresses, utilizes severe affective disturbance, profound autism and withdrawal from reality, and/or formation of delusions or hallucinations ••• o'(It is) ••• characterized by a varying degree of personality disintegration and failure to test and evaluate correct4' external reality in various spheres. In addition, individuals with such disorders fail in their ability to relate the!nselves effective4' to other people or to their own work.•4

Passive aggressive personality -

l. ~·P• 24.

2. ~·P• 25.

3. Ib:i.d.p. 23. -.

8Reactions in this group are of three types: ••• (l) passive dependent type: this reaction is characterized by helpless­ness, indecisiveness, and a tendency to cling to others as a dependent child to a supporting parent. (2) passive aggressive type: the aggressiveness is expressed in these

4. ~·PP• 12, 24.

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l.

2.

3.

4.

reactions qy passive measures; such as pouting, stubbornness, procrastination, inefficiency, and passive obstructionism. (:3) aggressive type: a pers:t.stant reaction to .frustration With irritability, temper tantrums, and destructive behavior is the dominant manifestation. •l

... rsonali cy disorders -•These disorders are characterized b,y developmental defects or pathological trends in the personalit,y structure, with minimal subjective anxiety, and little or no sense of distress. In most instances, the disorder is manifested b,y a lifelong pattern of action o~ behavior, rather than b,y mental or emo­tional symptoms ••• • • ••• The personalicy, in its struggle for adjusiment to internal and external atr!lsses, utilizes primarily a pattern of action or behavior.•J

Psychoneurotic disorders -RGrouped as psychoneurotic disorders are those disturbances in which 1anxiety1 is a chief characteristic, directly felt and expressed, or automatically controlled b,y such defenses as depression, conversion, dissociation, displacement, phobia formation, or repetitive thoughts or acts ••• •4 • ••• 'Anxiet.Y' in psychoneurotic disorders is a danger signal felt and per­ceived b,y the conscious portion of the personality. It is produced ey a threat from Within the personalit,y (e.g. ey supercharged repressed emotions, including such aggressive impulses as hostillt.Y and resentment), with or without stimu­lation from such external situatio~s as loss of love, loss of prestige, or threat or injury.•!:>

Psychotic depressive reaction -•These patients are severe~ depressed and manifest evidence or gross misinterpretation of ieality, including, at times, delusions and hallucinations.•

Schizophrenia -• ••• is synon;ymous With the former~ used term dementia

~· pp. 36-37.

~· P• 34.

~· P• l3.

Ibid. P• 12. -5.~. P• 31.

6. ~· P• 25

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praecox. It represents a group of psychotic reactions charac­'terized by funaamental disturbances in reality relationships and concept formations, with affective, behavorial, and in­tellectual disturbances in varying degrees and mixtures. The disorders are marked by strong tendency to retreat from reality, by emotional disharmony, unpredictable disturbances in stream of thought, regressive behavior, and in some, by a tendency to 'deterioration•.•l

Under the laws of the Commonwealth of Massachusetts the admissions

to mental hospitals are controlled. These controls, or sections as they

are known, cover all types of admissions - voluntary, involuntary, and

court committed, as will be shown by the following references to the

Handbook of the Department of Mental Health.

Section 51 -A regular cammittment paper providing for prolonged judicial committment for an indefinite length of time of the person who is certified to be mentally ill. The court receives an application for committment from the ward physician. Written notice is served on the so named individual by the court officer. At the time of service of the notice, a notice of a right to a hearing is also delivered, The individual so named has forty-eight hours in which to request a hearing on the application for committment. If no request is made, the person is legally committed. 2

Section 77 Observation -A temporary care thirty day paper which penni ts the patient to remain i,n the hospital pending detennination of his mental condition.J

Section 77 Begular Committment -This section is essential~ the same as section 51 above. 4

l. ~- p. 26.

2. Handbook of the ~artment of Mental Health, Boston: Commonwealth of MassachUsetts, l95 , PP• 35-36.

3 • .lli.a• P• 43.

4. ~· P• 43.

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Section 79 -A temporary care ten day paper in which the patient is deemed to be in need of imnediate care and trea'bnent because of mental derangement other than drunkenness.l

Section 80-A voluntary temporary care fifteen day paper which is for menta~ ill due to alcoholism. 2

Section 86 -A voluntary canmit'bnent in which the superintendent of the hospital receiVing this type of case (mental illness) is empowered to receive for legal committment as a voluntary patient aey person who desires to subnit himself for trea'bnent, who makes written application for same, and who is mentally competent to make such application. The patient may request his own leave fran the hospital by subnitting such request in writing to the superintendent giving three days notice of same. If it is felt by the hospital personnel that the patient is still menta~ ill, is dangerous to himself or to others, or is liable to be a social nuisance from a safety factor at the time that he requests his dismissal from the hospital, the ward physician may initiate action to begin canmittment proceedings under section 51. 3

Section 100 -A fifteen day temporary care paper (an additional twenty days is possible on this paper) in which the patient, who is under complaint or indic'bnent for any crime, may be committed for a period not in excess of thirty days for observation.4

Section lOQ-105 -A regular committment paper in which a person who is under indictment or canplaint for aey crime may be canmi tted as mentally ill with no preliminary observation when there is no doubt as to the prisoner's mental illness. The prisoner is committed for an indefinite length of time. 5

1. ~· p. 44.

2. ~· PP• 44-45.

3. ~· P• 46.

4. ~· P• 53.

5. ~· PP• 56-57.

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Delimitations.-Due to the fact that I, as one person, found it impossible

to follow the individuals who were the subjects of this study, this survey

was of necessity limited to whatever information it was possible to garner

from the case folders.

Boston State Hospital is an urban mental institution which by law

may accept for commi ttment only those who have been residents of Boston

for not less than twelve years. Thus, the members of the group studied

had urban characteristics of living rather than rural.

The survty was limited to those officially discharged from the

hospital. This eliminated those who had been sent out uneuccessful:cy on

trial visits, and those who were on trial visits at the time of the survey.

Actual:cy then, this group contained three sub-groups:

(l) those who entered on temporary care papers and were discharged

while still on these papers

(2) those who were canmitted voluntari:cy, treated, improved and

released

(3) those canmitted involuntari:cy, treated, improved and then sent

into the community for a year's trial visit and discharged after

successful:cy completing this probationary period

The data obtained on readmissions was limited to a period not in

excess of two years after the date of discharge. This was done so that

the factor of re-instatement in the canmuni ty was constant as to the

length of time for all patients.

Need for the study.-Inasmuch as the factor of employment was so important

a part of the rehabilitation process of' the patient it was decided to

JJmi t the members of this group studied to those of employable age.

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Thus, it consisted of patients between the ages of twenty and sixty lihen

they were released fran the hospital • .Ul individuals discharged during

these two months were included, regardless of the type of admission, the

type of discharge, or the length of hospitalization. It was felt that this

method would assure an adequate sampling of those admitted to an urban

mental institution and later discharged, either cured or not in need of

this type of hospitalization at this time.

When it was attempted to ascertain comparative figures for the 1nonnal1

population, maey of these statistics were unavailable, inaccessible, and in

maey cases, unknown. Before it was possible to compare a mentally ill

population with a nonnal population, it was necessary to ascertain the

availability of statistics for the different factors to be compared. An

attempt was made to classify the survey factors, but it was found that in

different areas, studies, and parts of the same city, these definitions

and titles varied. When a question on a point such as this arose, Webster's

Collegiate Dictionary was used as the final and definitive source, e.g.

in classifying the remunerative positions of the survey population,

'supervisory' includes all those who were in aey wa:y responsible for

persons working under them. The City of Boston census of 1960 broke down

this classification into several sub-definitions, which were not felt to

be necessary to an adequate comparison. When comparative statistics for

the normal population were used, the figures were those which were avail­

able for the closest period of time to the time of the survey, e.g. in

comparing the religious backgrounds of the survey and the normal population,

the last possible period for which statistics for the State of Massachusetts

were available was the year 1950.

-ll-

For this reason, although comparisons were made, it was With the

understanding that these figures were not tru:cy reliable, inasmuch as the

survey population was based on the discharges fran the Boston State

Hospital during the months of January and February, 1958. It was felt that

although these comparisons were biased, due to the time differential, they

might have served as a guide point for further research.

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CHAP1ER II. m:LATED LiiERAWRE

Manf researchers have written of the problem of transition from hos­

pital to community". Much research and mazv exper:!ments have been performed

to determine the best means of discharge from the hospital for the patient.

Hadleyl found that work, in and of itself, was therapy for the patient.

Osarin2 in her paper discussed the various plans now in use to help the

patient return and readjust to life in the canmuni t,-. Some of the plans

now in use that she mentioned were the following: the patient on a trial

visit home (the patient's case was kept open even though he or she was

out in the cammunit,-. If, for any reason, the patient and/or the family

felt it necessary for the patient to return, he or she was immediately

admitted and placed once again on active status). In this way, incipient

problems were caught before they had a chance to cause irrevocable

damage. If the patient was able to handle himself and his affairs satis-

factorily, after an adequate testing period he was officially discharged

from the hospital.

Another arrangement was the member-employee plan in which the patient

was discharged from the hospital to became an employee of the hospital

with the full privileges of an employee. In this way, it was possible for

l. John M. Hadley, "'Work as Therapy,• American Archives of Rehabilitation Theran, VIII (1960), ll-16.

2. Lucy D. Ozarin, •The Patient's Preparation to Return to the Community,• Neuro-Psychiatry, IV (1958), 205-223.

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the hospital to help hi.nj gradualJ.¥ to adjust to life outside the institution.

There still was somebody nearby to whom he could talk and who could help

him with his problems of adjustnent during this period. This also might

serve as a transition to the community, since once the employee felt more

secure in his ability to care for himself, he left hospital employment to

live and work in the larger community.

Many have written (e.g. Lemkau, Frumkin, Stewart, and Hare) that the

basic factor in many mental illnesses is predicated on a 'breakdown of

social communications•.l Many concede that the area in which social customs

seem to be the dominating determinant is that in which the major portion

of new research is needed and must be done so that advancement in the

field of mental health can be realized.

Frumkin2noted that an inverse relationship seemed to be present

between education and rates of admission to a mental institution. An

individual's chances of being admitted to a mental hospital lessened as

he progressed higher on the educational ladder.

Adler3 reported that the greater the ethnic and racial homogeneit,r

of the population the lower the incidence of mental illness. This bore

out the urban versus rural theory - since the urban area is usually

highly diversified as to its background, with a multiplicity of races,

1. E. H. Hare, •The Ecology of Mental Disease, a Dissertation on the Incidence of Environnental Factors in Distribution, Development and Variation of Mental Disease,• Journal of Mental Science, IIC (1952), 579-594.

2. Robert M. "Frumkin, ~ducation and Mental Illness: A Preliminary Report,• Educational Research Bulletin, XIII (1953), 212-214.

3. Leta M. Adler, et al, Mental Illness in Washington County, Arkansas: Incidence, Becovery, ana Post-Hospital Adjustment, Research Service, Number 23, 1952, iv. 74 P•

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religions and creeds. There was a continuum of class categories which was

not as evident in rural areas.

Manr explorers in this field, such as Halperinl, gave greater emphasis

to the individual' particular environments rather than to their particular

heredity or intellectual traits. Many times the problem revolved around the

person 1 s ability to coalesce his needs, wishes, and desires With the demands

that a busy life in the city required of him. Freeman2 stated that in his

research no specific attitudes relating to a definite social class were

found relating to mental illness. The attitudes found were based on education,

age, and the ability of the particular individual to conmunicate with

others. Duchene3 reported important evidence which suggested that clashes

ol cultural values produced more mental disorders than did emotional

shocks. Rather than life on a person to person basis that was the under-

lying cause for these disturbances, it was life as a member of a large,

demanding, vastly superior whole which exacted its requirements in an im­

personal manner that was at fault. Not one incident or demand made by

society, but all the demands made by his culture over the individual's

life span might have been responsible for the formation of the nucleus of

the later mental abnormality.4

l. Sidney L. Halperin and Marcus Guensber~, •Heredity and Mental Traits,• American Journal of Psychiatry, CVIII (1951), 54-6o.

2. H. E. Freeman, •Atti tudes Towards Mental Illness Amon11 Relatives of l'ormer Patients,• American Sociological Review, XX:VI (1961), 59-66.

3. Duchene, ~ Societe VeC:ue (Society Experienced),• Evolutio!l!l7 Psychi­~. I (1956), 103-108.

4. Arun Kumar Raychaudhuri, 8 Are the First Born More Susceptible :jlo Functional Mental Diseases?,• Journal of Nervous and Mental Diseases, CIXIV (1956), 478-486.

- 15-

Little, or nothing, has been done With regard to the background of.

the mentally ill. Two research projects have been reported. One, reported

qy Eichlerl in 1956, discussed the religious backgrounds of the patient­

load of a mental hygiene clinic in New York. The mental hygiene clinic's

population reported its religious background as follows: JeWish: 50.7%,

Roman Catholic: 29.4%, Protestant: 12.6%. The religious background of the

normal population of the geographic area served qy this clinic was as fol­

lows: Boman Catholic: 45%, Protestant: 25%, JeWish: 25%, other religious

preferences: 5%. The other, reported qy Frumkin2 in 1957, discussed religi­

ous affiliation among the population of individuals who were admitted for

the first time to Ohio state mental hospitals in the year ending December

31st, 1950. That study indicated mentally ill admissions were highest among

the Protestants, while the JeWish had the lowest rates of admissions.

Norris3 found that the ratio of' single persons far excelled that of

the married. Liber4 reported that the adjustneats to every day life required

qy marriage 'can exacerbate an already latent men tal anomaly or produce a

mental abnormality in one or both spouses owing to the fact that marriage

itself is a severe test of a person's social ~tability 1 •

1. Robert M. Eichler and Sidney Lirtzman, "Religious Background of Patien ts in a Mental. Hygiene Setting,• Journal. of Nervous and HentaJ. Diseases, CXXIV (l$56), 514-517.

2. Robert M. Fr1.U11kin and Miriam z. Frmkin, "Religion, Occupation and Hajor Mental Disorders: A Research Note,• Journal of Human Relational VI (1957), 98-lOl.

3. Vera A. Norris, •A Statistical Study of the Influence of Marriage on the Hospital. Care of the Mentally Sick,• Journal of Hental Science, CII (1956), 467-486.

4. B. Liber, •Elusive Nental Cases: Marital. Conflicts,• New York State Jour­nal of Medicine, L (1950), 2287-2289.

- 16 -

Also noted was that single persons remained in the hospital for longer

periods of time than did married individuals.l Not specified was the ques-

tion of whether they remained longer because they were more ill or because

they had neither home nor family.

The possibility of acquiring a major mental illness is greatest among

those who are either widowed, separated, or divorced. The probable occur­

rence of this phenomena was the lowest among those individuals who were

married, while those who were single !ell between these two categories.2

There were apparently here two conflicting opinions concerning mar-

riage. It was possible to determine that the probable mental illness in

already latently affected would be precipitated whether or not they were

married.

Some validity was found by Frumkin3 in the qypethesis that income,

prestige, and socio-economic status bore an inverse relationship to the

number of first admissions of psychiatric patients. The high incidence of

mental illness came, he discovered, among the low income, prestige, and

socio-economic groups. Hollingshead4 speculated as a result of his studies

that the individual's position in the class structure might contribute to

l. Vera A. Norris, loc. cit.

2. Robert M. Frumkin, tiJ~arital Status as a Categoric 1!isk in Hajor Mental Disorders,• Ohio Journal of Science, LIV (1954), 274-276.

3. Robert M. Frumkin, •Occupation and Mental Illness,• Public Welfare Statistics, VII (1952), 4-13.

4. August B. Hollingshead, et al, -social Gratification and Psychiatric Disorders,• American Sociological Eeview, XVIII (1953), 163-169.

- 17 -

the type and severity of the mental illness in an inverse ratio. The lower

socio-economic groups contributed a higher number of persons to the psychi-

atric population, while the upper groups contributed a highly disproportion-

ate number to the neurotic population.

Franklin1 discovered that admission age and the severity of the mental

disorder held an inverse relationship to the discharge rates of these

patients.

In his study Hollingshead2 discovered that schizophrenia also displayed

an inverse relationship. In this case, however, the relationship was in

terms of social class. The higher that the social status of the person was,

the less the probability of the individual becoming schizophrenic.

Sammers3 indicated that the length of hospitalization of the person

was shown to correlate positively with the degree of deviation from social

norms.

Malzburg4 indicated in his study that migrants had a higher incidence

of mental disease than non-migrants. This indicated that the newly arrived -

those who had yet to learn the cultural mores of that particular segment

of society - were those who would be under the greatest pressure to con-

1. R. M. Franklin, •cohort Studies of First Admissions to Ohio State Mental Hospitals 1944-1951,• Public Welfare Statistics, VIII (1953), 26o-265; 302-319.

2. August B. Hollingshead, et al, lac. cit.

3. Robert Sommers and Robert Hall, •Alienation and Mental Illness," American Sociological Review, XXIII (1958), 418-420,

4.

- 18-

form to the not-yet understood social norms of their new home.

Thus, much has been done in the wide field of research. Much must be

done. The : immense field covering only those individuals of working age has

yet to be explored in specific detail.

- 19 -

CHAPER III. PIIOCZDURE

Time and place.-The population of this group were members of a larger popu­

lation consisting of all patients who were discharged fran the Boston

State Hospital in the months of January and February, 1958.

How were the members of the group studied chosen.-Included were all patients

discharged from sections 79, 77 observation, and 100, as well as those

whose legal status had been sec~on 51 or 77 regular committment (those on

section 5l or 77 regular committment had been in the community for a year

prior to their actual discharge on a trial visit. During this trial period

they must return to the hospital at least once a month, so that a constant

check may be kept on their progress. Medication, as needed, may be prescribed,

altered or el.mnatede Those finally discharged successfully adjusted to

life in the world outside the hospital; those who were unsuccessful were

active patients in the hospital again.) Those who signed voluntary commit­

ment papers(section 86), recovered, and returned to the community, were

also included.

This group studied, then, consisted of those discharged from tempor­

ary care papers, those brought in from court (section 100) for observation,

and discharged with a diagnosis of committment not necessary, and those

who successful:cy' readjusted to community living after a regular hospital

committment.

Since the employment factor was so important to the rehabilitation

process, the group was limited to those of employable age. The population

of this study consisted of persons between the ages of twenty and sixty

- 20 -

when they were discharged from the hospital.

TyPe of follow-up.-There were one hundred and fort,r (140) persons who met

the requirements noted above. All information regarding the backgrounds of

these people was gathered from their case histories at the hospital. In­

cluded also was any information regarding the readmission of the person to

a mental hospital. 1lthough given a new hospital number, the case histories

of the readmitted patients were combined with their old records, so that,

at any given time, it was possible to look at the individual's entire case

record, including where and when he had been admitted previously. This

also held true for any readmissions of the individual to another hospital.

Boston State Hospital, where this information was gathered, is one of

eighteen mental institutions and state schools in the Commonwealth of

Massachusetts. With the exception of one, all these hospitals and state

schools admit individuals on a geographic basis: i.e. Boston State Hospital

will accept for committment only those who have been Boston settled for a

period of not less than twelve years. The hospital makes no restrictions

on persons entering on temporary care papers. These people are admitted,

treated and/or helped, and then, if committment is warranted, transferred

to another mental institution.

Where possible statistics were accumulated for the •normal population•.

As mentioned above, data for the specific time of the study was not always

available. For this reason, statistics for the nearest possible time to

the dates under observation were used. Though 196o census figures were

used in the discussion of remuneration in the normal population, the year

of 1950 was the last period of time for which information regarding the

religious background of the population of Massachusetts was available.

1,. 21 -

Special attention was paid to those for whom it had been necessary to

return to the hospital, either Boston State Hospital, or another mental

institution. This was done in hopes of pinpointing some factor or sub­

factor constant in the backgrounds of these individuals that may have led,

or predisposed their readmission.

As the factors examined are camnon to all, this study was undertaken

with the hope that the presence or absence of a specific factor or sub­

factor might give an indication as to what might cause the ex-mental

patient to return to the hospital or, what mlllf help lrlln to readjust succese­

fully to life in the community once he has been discharged.

- 22 -

CHAP.l'ER IV. PRESENTATION .lliD IN:IERP.llETA.TION OF DATA

Presented here Will be both the raw statistics and the scaled data

(scaled in terms of percentage of the population). Where possible (all

survey statistics and sane normal statistics) the figures for male, female,

and the total population have been reported separately.

Ethnic background.-As shown by ~able 1, the white - nonwhite ratio in the

group studied was on the order of silt to one. The ratio of white to nonwhite

in the Commonwealth of Massachusetts, as shown in Table 2, was more than

nine to one. As a result, the nonwhite population had a ten percent higher

representation in this survey than it did in the total Massachusetts popu­

lation. This would tend to indicate that persons who are not members of the

predaninant white race have a greater chance of becaning mentally ill than

do the whites in Massachusetts.

TABLE 1

COLOR OF THE SU1lVEI POPULATION

Ma1e Percent Total Percent White 67 85.9 54 Ho.9 121 ljOeU

Nonwhite ll 14.1 8 13.1 19 13.6

Sample size 78 62 140

- 23 -

RKLIGIOOS PIUERENCE - 3JRVEY POPULATION 100

90

80

70

60

: :

' :

40

20

1.0

' ! I I

J

~

.3

• : ~- I

: . . ··- .... I :

-:_:~·· I

~--~f-, .•... -.•..•. -+. - r !

- . ~---

( ' .

-~-------·

-->----+ : , - ---y-- --......... 25

+--:

+ --t----1 r-~ ~ ·-: ;--H-+-~ --~-- .

I I ' ' ' I

-t-t-' ' -1-+ +LL[-+~­

rf+~

100

70

·+-

' I 6o

I ' '

so I '

4o

i

.30 j

i 20

10

0 j 1 . ;

'

T.A.BIZ 2

COLOR OF THE NOltill.o POPULATION OF MASSACBUSE'l'l'S (1960 CENSUS)

M"l" ~" t White 2,423,947 97.5 2,599,197 97.6 5,023,14ll 97.6

Nonwhite 62,288 2.5 63,146 2.4 125,434 2.4 .. Sample size 2,486,235 2,662,343 5,148,578

Religious background.-The relative number of Catholics in the group studied

(Table 3) and in the total population of Suffolk County in Massachusetts

(Table 4) differed only to a slight degree. Of the survey group 70 percent

were of this persuasion while the figure for Suffolk County was 67 percent.

Few Jewish people were hospitalized although they comprised 21 percent of

the Suffolk County population. ~ 6 percent of the group studied belonged

to this faith. Both Protestants and those of other religious faiths sbowed

a slight4' larger membership in the group studied than the frequency in

the normal group indicated. Frumkin1s1 study of Ohio state mental hospital

patients reached the same conclusion with regard to Jewish people, although

his findings indicated that Protestants had the highest number of admissions.

No mention is made of the religious background of the geographic area from

which Frumkin drew his statistics. In ll'igure 2 it is possible to see the

way in which the different religions stand regarding their relative rank­

ings in the survey and in the normal population.

Readmission statistics for this group indicated that over two-thirds

of this subgroup were Catholic, another one-fifth Protestant, while

l. Robert M. Frumkin and Miriam z. Frumkin, loc. cit.

- 26 -

Jewish and those of other religious faiths comprised the remainder. The

readmitted subgroup kept the same relative rankings in religious affili­

ation as did the total study group.

TABLE .3

m:LIGIOUS PREFIDIENCE OF THE SURVEY GRaJP

MAle Percent_ Female Percent Total Percent Catholic 57 7.3.2 42 o7.2 99 70oO

Protestant l6 20.5 lO 17.4 26 18.6

Jewish .3 .3.8 6 9.4 9 6.4

other 2 2.5 4 6.2 6 4.2

Sample 78 62 l4o size

UBLE 4

RELIGIOUS PREil'UENCE-SUFFOLK COUNI'Y (BOOTON, CHELSEA, REVEllE, WINTHROP) 1950

Catholic

Protestant

Jewish

other

50,.365

85 ,.31.3

l4o,ooo

470

66.8

12.6

20.8

Sample size-total church and synagogue membership 676,148

The catholics and the Protestants (Figure l) claimed more men than

women in their ranks, while the Jews and those of other religious faiths

had more women than men.

Education.-.Uthough almost half of the nol'lllal population (Table 6) had

sane schooling beyond the twelfth grade, only 7% of those in the survey

- 27-

group (Table 5) belonged to this category. When differentiated sexually,

this characteristic was very pronounced among the males. Over 61% of the

normal male group reported an education beyond high school. This was true

of but 9% of the hospital group. Frmikinl indicated that an inverse rela­

tionship existed between education and the rate of admission to mental

hospitals. This was further substantiated by the findings in this study.

TABLE 5

EDUCATION OF THE SURVEY POPULATION

Male--·~ Percent Female Percent Total Percent ~-tlth grades . ~0 - 12.1:1 .u <:.loU i::j .&.u.~

9-12th grades 38 48.7 32 51.6 70 5o.o

Post high 7 9.0 3 4.8 10 7.2 schoo~-co~lege inclusive

Not determined 23 29.5 14 22.6 37 26.4

TABLE 6

EDUCATION-NOffi:AL POPULATION OF BOSTON (25 YEARS OF AGE O.R MOllE) ~96o CENSUS

.~e Percent Fan ale Percent Total Percent 1-Bth grades ~97,184 15.4 214,54.3 26.~ 4ll, 1'C{ .L5'.2

9-12th grades 329,097 23.1 449,092 59.1 178,W9 36.3

Post high 807,823 61.6 school-co~legE

151,794 14.2 959,$~7 44.6

inc~usive

Total 1,334,104 815,429 2,149,533

Among the readmitted men and wanen, approximately one-half had some

1. Robert H. Frumkin, loc. cit.

- 28 -

high school training, yet less than 8% finished high school and continued

their education. One-quarter of the readmitted patients were unable to

indicate their educational training during their first admission and were

still unable to do so on recurring ac:bnissions. This was true more of men

(31%) than of women (21%). The ratio of normal to total hospital group

showed only a slight variation in this factor when, in place of the entire

survey group, the subgroup of readmitted patients was used.

Harital status.-Single individuals totaled just under three-quarters of the

survey population for both sexes. Harried persons were another one-fifth.

The balance were either widowed, separated, or divorced. The total popu­

lation exhibited a readmitted percentage of 41.2 (46.4% of the female

population and 31.9% of the male). A total number of 58 persons returned.

Of these 29 were male and 29 were female. Over half the patients reac:bnitted

were single. Another 22% were separated or divorced. Those separated or

divorced comprised but 1.4% of the original population study. During the

period between their discharge and readmission ll individuals (5 men and

6 women) became divorced or were separated.

TABLE 7

MAmTAL STATUS OF THE SURVEY POPULATION

Male Percent Female t Total Percent Single 57 73.0 46 74.2 103 n.o Harried 17 21.8 lO 16.2 27 19.3

Widowed 3 3.9 5 B.l 8 5.7

Separated or l 1.3 l 1.6 2 1.4 divorced

Sample size 78 62 140

- 29-

In Figures. 3 and 4 are represented both the percentage of population

who were single, married, widowed, separated or divorced, and the percentage

of the male and female populations which comprised these groups. As noted,

single people canposed a large section of the total which was true of both

sexes. More married men than wan en were members of the group, while the

opposite was true of widowed individuals. Persons separated or divorced

showed no outstanding differential. between male and femal.e.

Norrisl indicated that, in her study" as well, the nllJlber of single

persons was far higher than the n1lltlber of married persons. Frumkin2, how­

ever, found that the widowed, separated, and divorced had the highest rates

of mental. disease, single people were next, and the lowest rate of incidence

was held by" married individuals.

All three studies agreed that married persons had the lowest incidence

of mental. illness, although another researcher, Liber3, warned that marriage

many t:lmes can bring out into the open a problem already latent in either

or both members of the union. He noted that an abnormality might be pro­

duced where none had existed before, because of the social and emotional

adaptations required of the person entering into marriage.

Employment.-Observation of the range of emplo;yment within the survey group

as shown in Table 8 and illustrated in Figure 4 showed that almost half of

its members were either in domestic W'Ork or in unskilled labor, with

another 17% having no employment. Roughly one-fifth of the group were

1. Vera A. Norris, loc. cit.

2. Robert M. Frumkin, loc. cit.

3. B. Liber, loc. cit.

- 30-

' . FIGURE 3. MAmTAL S'llWS - SURVEY POPULATION

100

90

80

70

6o

50

40

.30

20

10

0

nat1JII 4. PERCENTAGE DISTRIBUTION OF !41PL

r I t • I !

. . i ' I • ! ___ .:_L .j I I

I r----··-····-----

j I I· ~~

---~- •~- -----;------~- ----1- .•

I ~le -----"---·-f.:_--'-------.fl' ~e-----t--:~

i !rotal popul&1

io~lll_ =+-~~!!! I ' . I : __ -- ___ L _________ . ----·- _____ II I

-~--1--i--;

< --+ -+ 1-~ .... -~

--~ ! - r -'

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: i f-----:-------~- --- --j

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----- ------~-.l-- --- -~---- ------! I

I ~~w:wr+--- -·----n-..-···--·- ·--~--

g H

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~ -~-··· __ J ~ I I

i I I I -+---- --r --

. '

. I .

T---~-

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[

bn-sk¥l:Ud+··--' I

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I

I

~0 ....2h __ I "T--1 1 .

RC8N~-- 32 -

+ - r ~- ·:· -·. . ' ' ' 1 • . • -~.:.:.t:r . ~-#~f-1~~- _·

- ~ : j - . : . I -- - - ; :

.,

'

(',_ skilled workmen, yet only 1% were managerial personnel. Three percent had

been employed in the field of sales. By way of contrast, the normal pop­

ulation (Table 9) rated 21% as professional people, while only 8% of the

hospital group were so classified. Seven percent of the total working

population in Massachusetts was made up of unskilled and domestic lil:lrkers,

although 44% of the group studied fell into this category. Over one-eighth

of the Massachusetts working population was in the. managerial field - onl;r

1% of the SUl"Ve;r members were in similar posi tiona. Bare:cy 5% of the hospital

population held jobs in the clerical f'ield, ;ret 27!% of the normal population

was lllllployed in this categor;r.

TABLE 8

RliMUNEI!J.TED l!MPLOIMENT DISmiBUTION AMONG SURVEY POPULATION

Type of Number Percent Nuaber Percent Percent lllllployment Males Males nmalel!l Females Total

Professional 7 9.0 5 8.1 8.5

Managerial 1 1.3 1 1.6 1.4

Clerical 4 5.1 3 4.8 5.0

Sales 4 5.1 .0 o.o 2.9

Danes tic 1 1.3 27 43.5 20.0

Skilled 21 26.9 8 12.9 20.7

Unskilled 28 35.9 6 9.7 24.3

No employment 12 J5.4 12 19.4 17.1

Figure 5 .!lhowS the percentage of both groups in dif£erent types of

empl~ent. Both the normal and the hospital groups have been differentiated

as to sex. Thus, it is illlnediately obvious llbat percentage of both popula-

- 33 -

PMP . -+ 'ft ~.·

. . .

i_ .

• •

. : -~c

. ~" '·• ; . I I ;-' '

. - · . .;, .

i .: .. : I"' . . I--~-·,' -! '-~.L · .. ' : ' H ' - ::t -L ' : -1_~ . . I ' ~ . . I . : ' ' ' . . ~~': ~ : L) •• _.L ·_, ' •• i·•·l~-1- . t· •. t!~. : I 7U i::t:.;_ I - tt...±i.:t ~. . ' . ' li_;_ I, -34-

: I ! __ ~

.·' ;

' ' '

' ' ' ' .

. '

·--. -.-A

. '

tiona in engaged in each specific type of 'WI:lrk experience, and, further,

what the sex distribution of population is in each respect,

TABLE 9

REMUNERATED »>PLOIMENr DIS'J.RLWTION AMONG CCMPARATIVE BOSTON NOBMAL POPULATION (196<> I:ENSUS)

Type of Number Percent Number Percent Percent ElnPloyment Males Males Females Females Total

Professional 96,880 21.5 52,881 21.7 21.5

Managerial 74,329 16.5 10,861 4.5 12.3

Clerical 59,315 13.2 131,920 54.3 27.5

Sales 55,o6o 12.3 27,o69 ll.2 ll,8

Skilled 129,843 28.7 4,634 1.9 18.3

Unskilled 33,527 7.4 1,139 o.5 5.0

Domestic 1,157 0.3 13,918 5.7 2.2

Total 450,lll 242,122 employed

Qver half of the normal females were engaged in clerical work while

an equal m111ber of females in the group studied were engaged in domestic

work, Normal males showed no preference for one type of work, yet just

over 40% of the males investigated were ,employed in unskilled labor. The

population in the group came overwhelming:cy fran the lower, non-professional

levels of 11111ployment. Without exception they outnumbered their normal

peers in the fields of domestic service and skilled and unskilled labor.

The normal population outranked them in each of the other fields of em-

ployment.

- 35 -

Frumkin'sl research indicated similar findings, i.e. those in the

lower socio-economic groups had the highest representation in this study

group. Hollingsheai felt that the lower the person's standing in the

class structure of his society, the more this standing might contribute

to both the type and the severity' of the ensuing mental illness. He reported

that the lower the standing was the higher the incidence and severity of

the illness would be.

Intemperance.-slightly over half of the male survey group were intemperate

(moderate to heavy drinking), while just over 40% of the females were so

classified. Men in their twenties and forties accounted for the largest

number; wanen between the ages of forty and sixty' accounted for the largest

portion of their sex.

McCart~ noted that the alcoholic was the person dissatisfied with

himself and/or his enviroment. The effects of alcohol on the individual

were threefold: (1) major changes in behavior, (2) indication of severe,

emotional illness, and (3) the possibility' of the developnent of bodily

and/or mental diseases.

Length of hospitalization.-Better than three-quarters of the male patients

had a hospital stay of less than six months (Figure 6, Table 10), although

this was true of only two-thirds of the female patients. Over half the male

patients were hospitalized for less than one month. However, it was necessary

1. llobert M. Frumkin, loc.cit.

2. August B. Hollingshead, ~. loc. cit.

3. Raymond G. McCartey, Facts About Alcoholism, Chicago, Science Research Associates, Inc., 1951, P• 33.

- 36 -

" H-h- ' I ; . '

FIGURE 6.

•~ " •. c . ~ ~---

-~ ' ' - '

. -'-f ; ~c , . ~---:-~ I I

~U JU !IU

- 37 -

· • .J:._, . , ' T- • .

' '

' .

. ~, -- '

-~--•~• .

' '

'LL. ''' , ;-T .

I

' ' '

40% of the entire survey population to remain in the hospital for longer than

one year.

TABLE 10

LENGTH OF HOSPITALIZATION

Male Percent Female Percent Total Percent 1-7 days 14 18.0 b 9.7 20 14~3

8-15 days 17 21.8 9 14.5 26 18.6

16-30 days 12 15.4 6 9.7 18 12.8

1-3 months 11 14.1 11 17.8 22 15.7

3-6 months 8 10.3 12 19.4 20 14.3

6 months- 1 1.3 4 6.5 5 3.6 1 year

1-2 years 8 10.3 6 9.7 14 10.0

2 years and up 7 9.0 8 12.9 15 10.7

There was no significant difference in the number of people readmitted

in correlation with their previous length of hospitalization. However, when

compared with the marital status it was noted that the overwhelming proper-

tion of the patients who were rehospitalized were single.

Norris1 reported the same facts in her studies in which those single

far outnumbered those married.

!s!·-Little variation was found among the different age groups as to the

number of persons admitted. Patients in their twenties comprised the

highest single age group in this stucy with 32.9% of the population. Those

between the ages of fifty and sixty had the smallest representation in the

1. Vera A. Norris, loc. cit.

- 38 -

survey. On discharge, although the same relative highs and lows persist,

the most active subgro1Jil, which also gained :l.n relative numbers, was popu-

lated by men in their thirties.

Legal status.-slightly over half of the patients entered the hospital for

observation involuntarily, and less than 20% were discharged with this

legal status. For the most part, the remainder either had signed voluntary

papers or were committed.

Established diagnosis.-OVer 35% of the group studied were given diagnoses

of personality disorders (Tables ll and 12), while just under 50% were

found to have psychotic disorders. Another 23% were diagnosed as having

brain syndranes, with but 5% classified as psychoneurotic disorders. The

one illness which cla:ilned the largest n1JIIber of patients was that of

schizophrenia with 33% of the entire population. Brain syndranes associated

With alcohol and character disorders accounted for another 17.5% of the

population, with 16% of the population diagnosed as passive-aggressive

personality. The diagnoses of character disorder and passive-aggressive

personality were predaninantly masculine illnesses. All other diagnoses

showed no more than random scatter characteristics.

TABLE ll

TYPES OF DIAGNOSES IN THE GRaJP S'lUDIED

Established dia1mosis Total Percent No mental illness 3 2.1

Personality disorders 50 35.0

Psychoneurotic disorders 8 5.6

Psychotic disorders 68 47.6

Brain syndranes 34 23.8

- 39 -

Diamosis Male No mental ill- 2 ness

:&notiona.J,4r l unstable personality

Character 23 disorder

Passive- 22 aggressive personality

Anxiety l reaction

Depressive 0 reaction

Neurotic 3 depressive reac~ion

Manic depres- 2 sive psychosis

Involutional 3 psychoses

Psychotic 3 depressive

Schizophrenia 23

Brain syn- l4 drane-alcohol

Brain syn- 0 drome-drug

,,

Brain syn- l drome-illness

Brain syn- 3 drane-injury

TABIZ 12

ESTABLISHED DIAGNOOIS

Percent Fenale Percent 1.4 l 0.7

0.7 l 0.7

16.1 2 1.4

1$.4 1 0.7

0.7 0 o.o

o.o 4 2.8

2.1 0 o.o

1.4 7 4.9

2.1 3 2.1

2.1 2 1.4

16.1 2$ 17.$

9.8 ll 7.7

o.o 2 1.4

0.7 3 2.1

2.1 0 o.o

- 40 -

Total Percent 3 2.1

2 1.4

2$ 17.5

23 16.1

l o. 7

4 2.8

3 2.1

9 6.3

6 4.2

s 3.5

48 33.6

2$ 17.$

2 1.4

4 2.8

3 2.1

Length of hospitalization.-As shown in Tables 13 and 14, it is evident

that the more severe the illness is, the longer the period of confinement

in the hospital will be. This observation has been reinforced by many re­

searchers including Frwnld.n, Hare, and Stewart. According to these writers,

the precipitating cause of mental illness was found to be a •breakdown of

social camnunications 1 • Duchenel indicated that clashes of cultural values

produced more mental disorders than did emotional shocks. Saumers2

reported

that the greater the deviation from the norms of society the longer the

length of hospitalization. I~ (Halperin, et al) felt that the problem

involved the person's ability or non-ability to come to terms with his

society.

Previous admissions.-For well over half the men and women, this was their

first hospitalization for mental disorder. Another one-third had had either

one or two previous admissions, and the remaining one-sixth had been admitted

a minimum of three times. No differential was noted between men and women

in this respect.

Beadmissions.-Over half the patients were able to return and readjust

successfully to life in the community (Table 15). Another quarter of the

population required but a single readmission, but for the others it was

necessary to return several times for treatment and hospitalization.

1. Duchene, loc. cit.

2. Robert Sommers and Robert Hall, loc. cit.

- 41-

TYPE OF ILLNESS 1-7 days

(j) (j) w No mental il !ness :z: ....J -.....1

Emotionally unstable persona I ity I

«: 1-:z: Character disorder 4 w ::;;: Passive-aggresive U..(J) On:: persona I i ty 3

w WCJ o_::;;: Anxiety reaction I

(') >-W 1-:2:

w Cl"-Depressive reaction

.....1 :Z:::::> CJ «:0 «: :z:?l5 1- 0

-w

Neurotic depressive I

Manic depressive I- .....I «:«: N::£ Involutional -....JU.. psychotic reaction «:0 1--"-

Psychotic depressive

s ::c Schizophrenia I

u.. 0 Brain syndrome-alcohol 5

::c 1-(!)

Brain syndrome-drugs :z: w ....J

Brain syndrome-injury

Brain syndrome-i I !ness - .

(

8-15 16-30 1-3 days days months

2

7 7 4

6 7 4

4

I

I

3 I

5 3 4

~

(

3-6 6-12 months months

2

I

4 I

I

1-2 years

I.

5

I

I

2 years and up

7

c

N

"""

TYPE OF ILLNESS !

(f) (f) w No menta I iII ness :z ...J ...J -

Emotionally unstable personality

...J <( I- (f)

Character disorder :za:: ww :::;:ro Passive-aggresive

:::;: i.J...W

personality 0::2:

wo.. Anxiety reaction 0..:::::> >-0

'<t 1-a:: - <!> Depressive reaction

0 w :zw ...J <t;...J

Neurotic depressive ro <( <( :Z:::E 1- ow

-i.J... Manic depressive

1-<(i.J... Involutional NO - ~sychotic reaction ...J <( 1- Psychotic depressive -0.. (f) 0

5chizophrenia :I:

i.J... Brain syndrome-alcohol 0

:I: Brain syndrome-drugs 1-<!> :z w

Srain syndrome-injury ...J

prain syndrome-il I ness -- ._

(

1-7 8-15 16-30 1-3 duys days days months

I

2

I

I I

I

I 2

I I

I I 2 6

I 5 2

I I

I I

(

3-6 6-12 months months

I

I I

3

6 2

I

1-2 years

I

6

I

I

2 years and up

2

2

I

c.

(')

'<t

TABLE 15

NllMBER OF MENTAL HOSPITALIZATIONS AF'lER THAT RECORDED IN THE SURVEY

Number Male Female Total Percent

0 49 33 82 57.6

1 20 19 39 27.3

2 3 5 8 5.8

3 2 3 5 3.5

4 3 1 4 2.9

5 0 1 1 0.9

6 0 1 1 0.9

Mental retardation.-About one-fifth of the population studied were given

the diagnosis of mental retardation in addition to their mental illness.

This was more prevalent among the females, with 23% being so designated

though only 15% of the males were thus categorized.

Drug addiction.-! very small group of 2.9% of the population studied were

diagnosed as drug addicts in addition to their mental disorder. There were

three women and one man.

Readmission and length of hospitalization.-When the number of readmissions

was correlated with the length of hospitalization of the patients, the

results of this study indicated that those who had been hospitalized for

the shortest periods of time were those least likely to need further hos­

pitalization.

Intemperance and readmission.-Of the readmitted subgroup, approximately

60% were not addicted to alcohol. This indicated a change of about 7% from

the original group studied, in which 53% were temperate and 47% were in-

-44-

temperate. Seven percent more of the temperate patients required rehospi­

talization than was true of the alcoholic patients.

Mental retardation and readmission.-One-quarter of the readmitted patients

were mentally retarded. This showed an increase in the rates of these

patients from. the one-fifth of the original survey population.

Readmission and legal status.-The highest rates of readmission were found

among those who had been committed -both voluntarily and involuntarily.

These comprised two-thirds of the readmitted population. These also were

the groups who had the longest periods of residence in the hospital. The

two largest subgroups, which were 41.4% of the group were men who had been

canmitted involuntarily and women who had signed voluntary papers.

Readmission and established diagnosis.-For both sexes the rate of readmission

was highest among those who had had schizophrenia (51%) as shown in Table

16. The percentage of men was higher than that of women in the diagnosis

which ranked second - brain syndrome associated with alcohol. Ranking third

for the women were the manic-depressive psychoses while character disorder

and passive-aggressive personalit,y were in this position for the men.

Readmission and age.-Men who, upon discharge, were in their forties had the

highest frequency of readmission. Conversely, men in their fifties had the

lowest frequency. For women, those in their twenties had the highest

readmission rates.

- 45 -

TABLE 16

NUMBER OF IIEADMISSIONS OF PATIENTS AND TYPE OF THEIR MENTAL ILLNESS

Established dia2nosis Male Percent Female Percent

No mental illness 0 o.o 0 o.o

Emotionally unstable l 3.5 l 3.5 personality

Character disorder 3 10.4 0 o.o Passive-aggressive 3 10.4 l 3.5 personality

Anxiety reaction 0 o.o 0 o.o Depressive reaction 0 o.o 0 o.o Neurotic depressive 0 o.o 0 o.o reaction

Manic depressive l 3.5 3 10.4

Involutional psychotic l 3.5 0 o.o reaction

Psychotic depressive 2 1·9 l 3.5

Schizophrenia 15 51.8 15 51.8

Brain syndrome-alcohol 5 17.5 4 13.8

Brain syndrome-drug 0 o.o 2 7.9

Brain syndrome-injury l 3.5 0 o.o Brain syndrome-illness 0 o.o 2 7.9

- 46 -

CHAPTER V, SUMMARY AND CONCLUSIONS

The minority non-white population showed a higher rate of mental

disease than did the predaninant white population,

The only differential evident in the religious statistics was that

Jewish persons comprised a much lower proportion of the population than

might have been expected when compared with the total Suffolk County popu­

lation. One explanation of this was found in Robert Eichler 1sl New York

research, in which he reported that the neurotic population held a high

number of Jewish persons when compared to their representation in the

entire New York population. The psychotic population contained few Jewish

people. Although their problems did not reach the extent of psychotic

illness, the rate of neurosis was excessive, according to Eichler, Here

was evident once again, the situation of a minority group experiencing

difficulty in its attempts to live according to the standards of the pre­

dominant cultural norms.

The completion of high school and some form of post-graduate education

has been the educational standard set by the normal population. Only 9% of

the group studied met these unwritten criteria, Over one-half of the hospi­

tal group did not complete twelve years of schooling. The survey group

achieved the status of a minority group in the field of education.

The largest number of admissions were of persons with psychotic dis­

orders. As persons with a psychotic disorder, they required the longest

1. Robert M. Eichler and Sidney Lirt:anan, loc. cit.

- 47 -

periods of hospitalization. Once discharged the 'improved' psychotic, whose

major problems had revolved around his adjustment to societ,r and acquiescence

to its demands, wss the one most likely to 'break contact• once again and

require hospitalization. His disobedience of the cultural mores of acqui­

escence to majorit,y standards resulted in mental and emotional problems

requiring hospitalization.

In both the total group studied and the readmitted subgroup, single

people were in the overwhelming majorit,y. Implicit was whether these persons

were single because of, or as a result of, their mental and emotional

problems. The pressures brought to bear upon marital relationships were

evidenced in that several separations and divorces occurred among the mem­

bers of the readmitted subgroup in the interval of time between hospitali­

zations.

For the normal population of the Commonwealth of Massachusetts, the

employment curve indicated a series of several small peaks with but two

lows. These lows, appearing at the lower end of the continuum, were the

fields of domestic and unskilled labor. For the group studied these same

two fields were the only two which showed peaks in the curve. People with

mental illnesses tended to come from the lower, less meaningful realms of

employment.

About one-half of the population studied had a history of moderate to

heavy drinking (this ratio held true for the readmitted subgroup as well).

Society accepts drinking when it is controlled, but drinking to excess is

frowned upon b,r our culture. The origin is the main question here - in-

. temperance because of, or as a result of, mental illness. A large segment

of this group, then, possessed characteristics frowned upon qy the culture

- 48 -

in which they lived.

In addition to their mental illness about 20% of the group studied were

diagnosed as being mentally retarded. That ratio, high for any population,

rose still higher for the subgroup which required rehospitalization for

mental illness. This, then, indicated that societ,y1s rejection of those

whose abilit,y to adjust had been hampered still more cr,r their lack of intel­

ligence or loss of intellectual ability was stronger than its rejection of

those mentally ill whose intelligence lay within normal limits.

Young wanen just entering maturit,y had the highest rates of admission.

For men, the years of late youth and early middle age were the highest in

this respect. Once men passed this period in their life and entered their

fifties, the rate dropped from the highest to the lowest in relative numbers

of admission~. Young persons of both sexes, at an age when the cultural mores

of their society demanded that they shoulder responsibility for themselves,

had the highest relative numbers of admissions. This also held true for the

readmitted subgroup.

In our culture variety is welcomed as a breath of fresh air. From the

limited sample upon which this study was based, however, the writer con­

cluded that those who differ from the predominant majorit,y - whether by

race, color, or creed - were those who had the greater propensit,y toward

mental diseases.

- 49 -

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-57 -