Backwardation Research Articles

Remedy for the Forgotten Back Ward

In a state mental hospital with five registered nurses for 2,800 patients and 300 patients per ward physician, patients vegetated and aides resented assignment in a custodial ward for men. Against these odds, self-respect was restored for patients and aides. The change came through a three-year project that began as an investigation of accidents.

Remedy for the Forgotten Back Ward

In a state mental hospital with five registered nurses for 2,800 patients and 300 patients per ward physician, patients vegetated and aides resented assignment in a custodial ward for men. Against these odds, self-respect was restored for patients and aides. The change came through a three-year project that began as an investigation of accidents.

Remedy for the Forgotten Back Ward

Remedy for the Forgotten Back Ward

Cause of the odor of a schizophrenic patient.

<h3>Introduction</h3> Smith and Sines¹reported the demonstration of an odor present in the sweat of chronic schizophrenic patients which was not present in the sweat of nonschizophrenic patients. They used rats conditioned to the odor as well as a panel of expert odor testers to determine the presence of this odor. The demonstration of the odor confirmed earlier reports, as mentioned by the authors, relating to the peculiar odor of back wards, sometimes said to emanate specifically from patients with catatonic schizophrenia. The authors postulated that—"if there is a unique ‘odor' in the apocrine sweat or in the sebaceous secretion of schizophrenic patients, the identification of this odoriferous substance may give a clue to an inborn error of metabolism and provide an approach to an etiological explanation for at least a segment of the schizophrenic syndrome." The purpose of this study was to determine

A further clinical study of anabolic steroids in incontinence.

Inability to restrain bodily discharges is a problem of both individual and social concern. In the mental institution the incontinent patient presents a severe nursing problem. After preliminary encouraging results obtained in a previous clinical trial, and confirmed by other authors, a further 33-week clinical study was conducted on 16 male patients with bladder and/or bowel incontinence with a new anabolic steroid (Dianabol). The dramatic results of continence in all 16 patients whose physical and mental resources were of the lowest, encourages us to recommend the anabolic androgensteroids in bladder and bowel incontinence for clinical trials on patients both in and outside the "back wards" of a mental institution. Further studies of the hypothesized pharmacodynamic effect of the anabolic male steroids on the incontinent patient are warranted. These should include physiological experiments, double-blind studies on patients with various physical and mental conditions and causes of incontinence, and studies in different environmental and cultural settings. There should be emphasis on possible psychosociological and placebo factors.

Trifluoperazine: a report of a clinical trial in back ward psychotic patients.

The double blind method would not have been useful in this study because of the frequency of extra-pyramidal side reactions, and the 10-22 year period of hospitalization of the patients with various therapy regimens. Therefore, the patients served as their own controls. It was found that the largest number of patients improved over approximately 6 weeks, and steady improvement was noticeable in the remainder of the patients when the drug was continued. This drug is useful in chronic psychotic patients. There were no noticeable urinary or hematological side effects, or variations in blood pressure. As compared to the other, tranquilizers, trifluoperazine exerted a more appropriate and definitive controlling effect on aberrant behavior. As reported elsewhere, it was found to be noticeably more beneficial in the chronic back ward patients than other phenothiazines and serpentina derivatives; it permitted the utilization of other therapeutic techniques and rehabilitation and re-socialization regimens(1, 2, 3). The Rauwolfias and phenothiazines, alone or in combinations, frequently produced indifference as contrasted to the freely outgoing and attentive behavior produced by trifluoperazine. The seclusion hours were appreciably reduced. The least amount of beneficial effect was in the lobotomized patient. Patients were noticeably motivated toward ward and ancillary therapies. The improvement in all cases described is purely symptomatic. Most of the patients who were actively hallucinated continued to experience these phenomena, although apparently seemed less motivated to act upon them(4). The drug is found to be worthwhile, and further study is warranted to avoid drawing definite and final conclusions from this simple clinical trial.

Specificity in the Psychotherapeutic Approach to the Psychotic Patient

Having followed for 10 years the suggestion of Boston’s Dr. E. V. Semrad to spend at least a little time during each week on the back wards of the state hospital, I should like to present from this experience observations concerning the effect of my various attitudes and behavior patterns on some of the denizens of these wards, directing attention particularly to the critical problem of how to get through to the chronic psychotic patient. Literature on the problem of making contact with the uncooperative, apathetic, and mute patient is not very extensive. Azima and Wittkower 1 attempted, with some success, to make contact with such patients, using a variety of media representing symbolic materials, such as mud, Plasticene, finger paints, baby bottles, balls, and bean bags. They found there was some object specificity; that is, not all patients responded to the same objects.

Demonstration of a Peculiar Odor in the Sweat of Schizophrenic Patients

Many have commented upon the strange odor that pervades the back wards of mental hospitals.^1-6A few have maintained that “there is an odour peculiar to the insane, which is not met with in ordinary hospitals for the sick, however dirty they may be.”⁷This unusual “odor” seems to be especially intense in the room where insulin therapy is given, and the odor appears to come from the skin of the patients, particularly those catatonic patients with greasiness of the skin. Among the symptoms of catatonia a recent textbook lists a “peculiar odour of the patient’s sweat which is difficult to describe.”⁸A recent article mentions “four patients, who for years had a skunk-like odor, which no amount of bathing changed,”⁹and these patients were all catatonic schizophrenics.¹⁰If there is a unique “odor” in the apocrine sweat or in the sebaceous

RESERPINE (SERPASIL) IN THE MANAGEMENT OF THE MENTALLY ILL

In our preliminary report,1we reported on 74 mentally ill and 15 mentally retarded patients who received reserpine for periods as long as seven months in duration. The oral dosage averaged 2 mg. daily, and the parenteral dose was 1 to 10 mg. Eighty per cent of the patients manifested improvement that was due to the alkaloid. Many regressed patients became alert and sociable, while the hyperactive, noisy, assaultive group became tranquil. The use of restraints, seclusion, and electroconvulsive therapy decreased by at least 80% after the inception of this treatment. Many patients no longer revealed psychotic symptoms, and it was possible to place on indefinite leave of absence or discharge status many patients whose prognosis had been regarded previously as hopeless. The patients selected for treatment in this project were only those who had a poor prognosis. They were the so-called back ward patients who had been mentally

Group Techniques in Rehabilitating "Back-Ward" Patients

IN large mental hospitals, patients on the so-called or chronic wards tend to lose their identity as individuals. Overcrowding, a staff that is inadequate in number, and the staff members' attitude of hopelessness toward the rehabilitation of these patients are the chief reasons for this unfortunate situation. If overcrowding could be reduced, if a reasonably adequate staff could be obtained, and if in some way an attitude of therapeutic optimism could be achieved, would the remaining spark of emotional life be rekindled in some of these patients and would some of them improve to the point of being able to leave the hospital? To answer this question was the main objective in the California Department of Mental Hygiene's attempt, in 1950, to evaluate the treatment problems of backward patients(1). For this project 400 men patients were selected from the back wards at Stockton State Hospital. Nearly all of them (97 percent) were diagnosed as schizophrenic. Their average age was 41, and their average length of hospitalization was 10 years. These patients were matched in pairs as nearly as possible according to age, diagnosis, education, marital status, accessibility, activity, and the like. One member of the pair was selected to be in the experimental group and was placed in one of two cottages set aside for an intensive treatment program; the other member was in the control group and remained on one of the overcrowded wards of the hospital. The cottages for the experimental group were staffed by 7 registered nurses and 73 psychiatric technicians. The control wards had no nurses. (Because so few nurses were available, all of them were needed on the wards where acutely ill patients were receiving intensive treatment.) It was recognized immediately that the two physicians in charge of the experimental wards would be unable to carry out the major portion of an intensified treatment program. Their role in the project necessarily became administrative and supervisory. The number of rehabilitation therapists was increased and a social worker and a psychologist were added to the treatment team. The nursing personnel, however, carried the brunt of conducting the intensified treatment program with the patient in the ward setting. There was no doubt that in their close daily contact with the patients, the registered nurses and psychiatric technicians could get to know and understand them, and that they could apply this understanding in a rehabilitative relationship.

NEW TRENDS IN HOSPITAL DESIGN

The one dominant note motivating our entire thinking on hospital design has been, "How does this or that feature improve the patient-doctor relationship?" We have not thought in terms of handling large numbers on a production line basis. This is best left to the automotive geniuses in Detroit. We have wanted to make our hospitals places where veterans can be treated not only with scientific skill but with human warmth and understanding attention. We have wanted our hospitals to instill a feeling of security and confidence in the patient and thus act as a silent, but ever active, force in therapy. We want our Hospital of the Future to be a "doctor's hospital" or, better still, a "patient's hospital"—not an "administrator's hospital." Psychiatry has made enormous strides in the last 50 years. It now occupies a respected position among the medical disciplines. Psychiatry is no longer relegated to the back wards of forbidding "asylums"—but makes its contribution felt on every ward of the modern hospital. Psychiatry has made great progress; we want its architecture to keep pace.