Abstract
Whilst the family home is the most important part of the social environment for the majority of the population, institutions constitute home for an unfortunate but large minority. This minority includes many of the psychiatrically ill, the mentally handicapped, the chronically sick and children (for instance, orphans). Although it is apparent that many of the disordered and abnormal behaviours found in these individuals are caused by internal pathology, it has also been demonstrated that significant aspects of their behaviour are maintained by the social environment within the institution. The previous chapter suggested that the outcome in schizophrenia is influenced by the patient’s family. Research on chronic schizophrenia, involving long-stay patients in hospital, has similarly demonstrated that behaviours such as social withdrawal and inactivity are determined as much by unstimulating ward environments as by any biological process. When ward environments are improved, many problematic behaviours subside in both number and severity. The key to change can therefore involve environmental alteration as much as individual treatment, and institutions become a natural focus for the clinician who is keen to improve the welfare of his patients.
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References
Barton, R. (1959; 3rd edn, 1976) Institutional Neurosis. Bristol: Wright.
Canter, D. and Canter, S. (eds) (1979) Designing for Therapeutic Environments: A review of research. Chichester: Wiley.
Fairweather, G.W. (ed.) (1964) Social Psychology in Treating Mental Illness. New York: Wiley.
Fairweather, G.W., Sanders, D.H., Cressler, D.L. and Maynard, H. (1969) Community Life for the Mentally Ill: An alternative to institutional care. Chicago: Aldine.
Fairweather, G.W., Sanders, D.H. and Tornatsky, L.G.(1974) Creating Change in Mental Health Organizations. New York: Pergamon.
Goffman, E. (1961) Asylums: Essays on the social situation of mental patients and other inmates. New York: Anchor Books, Doubleday.
Jones, Maxwell (1952) Social Psychiatry: A study of therapeutic communities. London: Tavistock (published as The Therapeutic Community, New York: Basic Books: 1953).
Jones, Maxwell (1976) Maturation of the Therapeutic Community: An organic approach to health and mental health. New York: Human Sciences Press.
Miller, E.J. and Gwynne, G.V. (1972) In Life Apart: A pilot study of residential institutions for the physically handicapped and the young chronic sick. London: Tavistock.
Moos, R.H. (1974) Evaluating Treatment Environments: A social ecological approach. New York: Wiley.
Rapoport, R.M. (1960) Community as Doctor: New perspectives on a therapeutic community. London: Tavistock.
Tizard, J., Sinclair, I. and Clarke, R.V.G. (eds) (1975) Varieties of Residential Experience. London: Routledge & Kegan Paul.
Towell, D. and Harries, C. (1979) Innovations in Patient Care. London: Croom Helm.
Annotated reading
Barton, R. (1959; 3rd edn, 1976) Institutional Neurosis. Bristol: Wright. This is now a classic, describing institutionalization as a state analogous to a disease. It is written from a medical perspective but is brief, easy to read, describes the effects of institutionalization within a hospital setting, but forcefully makes the point that the state can arise in any institutional setting.
Fairweather, G.W., Sanders, D.H., Cressler, D.L. and Maynard, H. (1969) Community Life for the Mentally Ill: An alternative to institutional care. Chicago: Aldine. The main part of this book describes the story of a group of mental hospital patients who left the hospital together and set up home in a ‘lodge’, living and working productively together. Elsewhere in the book research findings are reported. Those who enjoy reading about research findings may also wish to read Fairweather, G. W. (ed.) (1964), ‘Social Psychology in Treating Mental Illness’, New York: Wiley.
Goffman, E. (1961) Asylums: Essays on the social situation of mental patients and other inmates. New York: Anchor Books, Doubleday. Another classic, in which a sociologist describes the events and processes he saw in a large American mental hospital. The book is full of telling sociological insights, but it is important when reading ‘Asylums’ to have in one’s mind the knowledge that not all institutions, not even all mental hospitals, are alike and that there are important differences amongst them.
Jones, Maxwell (1952) Social Psychiatry: A study of therapeutic communities. London: Tavistock. (Published as The Therapeutic Community’, New York: Basic Books, 1953). Again a classic. The original description of the concept of the Therapeutic Community. Revolutionary in its time and still very well worth reading to understand the basic ideas behind the concept.
King, R.D., Raynes, N.V. and Tizard, J. (1971) Patterns of Residential Care: Sociological studies in institutions for handicapped children. London: Routledge & Kegan Paul. This book is detailed and has quite a high research content. It is especially useful for the definitions and criteria for assessing institutional practices. Because of this it has been an influential book upon which later research has been based.
King’s Fund (undated). Living in Hospital: The social needs of people in long-term care. London: Research Publications Limited. This is an easy to digest pamphlet designed to be read by people who work in institutions. It poses a number of very detailed questions which the reader should ask himself about the environment created in his own institution for those who reside there.
Miller, E.J. and Gwynne, G.V. (1972) A Life Apart: A pilot study of residential institutions for the physically handicapped and the young chronic sick. London: Tavistock. This is an account of a study of several homes and hospital units for a very disadvantaged group, most of whom would never leave the institutions in which they were resident. It describes several places in considerable detail and in the course of so doing raises many of the issues with which the present chapter on institutional climates is concerned.
Otto, S. and Orford, J. (1978) Not Quite Like Home: Small hostels for alcoholics and others. Chichester: Wiley. This book is in two parts. The first reviews work on institutions and on small hostels for the mentally ill, offenders, and people with drinking problems in particular. The second part describes in detail a research study of two particular hostels for problem drinkers. It covers a great deal of important ground but is probably not so easy to read as some of the other books suggested.
Tizard, J., Sinclair, I. and Clarke, R.V.G. (eds) (1975) Varieties of Residential Experience. London: Routledge & Kegan Paul. This book is an important collection of chapters written by different authors describing a variety of studies of residential institutions of one kind or another, mostly for children or adolescents. Particularly important are the first chapter in which the editors criticize the simplicity of Goffman’s approach in ‘Asylums’, and the chapter by Barbara Tizard in which she shows how residential nurseries can be run in very different ways.
Towell, D. and Harries, C. (1979) Innovations in Patient Care. London: Croom Helm. These authors describe how changes were brought about in the running of a mental hospital. Particularly inspiring in my view is chapter 2 which describes how significant change was brought about in an acute psychiatric ward and on a long-stay ward.
Rutter, M., Maughan, B., Mortimore, P. and Ouston, J. (1979) Fifteen Thousand Hours: Secondary schools and their effects on children. London: Open Books. Here is a recent account of a detailed research project concerning the organization of a number of London secondary schools and their effect on the pupils’ achievement and behaviour. The research is detailed and painstaking and the book is probably not easy to read, but for those who find statistics heavy going it contains some valuable passages about differences in school organization.
Walter, J.A. (1978) Sent Away: A study of young offenders in care. Farnborough, Hants.: Teakfield. Walter’s book describes his detailed observations and results of interviews at one Scottish List D school (the equivalent of the English Community Home or, as it used to be called, Approved School). It is a racy, easy to read account, concentrating particularly on the overall ideology or philosophy of the school and its effect upon staff and boys.
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© 1981 The British Psychological Society
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Orford, J. (1981). Institutional Climates. In: Psychology and Medicine. Psychology for Professional Groups. Palgrave, London. https://doi.org/10.1007/978-1-349-16594-0_10
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DOI: https://doi.org/10.1007/978-1-349-16594-0_10
Publisher Name: Palgrave, London
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