State Mental Hospital Research Articles

The Progressive Past of Residential Treatment of Emotionally Disturbed Children

In January 1949, 9-year-old Betty stepped through the doors of the Cincinnati Child Guidance Home. For the next 2 years, the Home would attempt to treat her severe emotional and behavioral problems in an experimental approach called residential treatment. After 4 years of child welfare and child guidance interventions, the Home was a last resort. Betty's home life was a mess. When she was 3, her “promiscuous” mother had deserted the family, and her father, an alcoholic, was gone most of the time. The house was so messy that the family was evicted over and over.1 Two foster homes later, Betty arrived at a local child guidance clinic, where the staff noted her “extreme stubbornness, destructive behavior, vomiting, soiling, and diurnal and nocturnal enuresis.”1 Betty's third foster mother, Mrs F, resented having to care for this “defective” child. She regularly beat Betty, who had blank staring spells and skipped school. Fed up with this behavior, Mrs F begged the child guidance clinic to admit the girl to a psychiatric hospital.1 Looking back, we might imagine that Betty would have been sent away to a state mental hospital or a punitive custodial institution for delinquent girls. Twenty years earlier, this might have been the case,2 but, in fact, Betty had a very different experience than what we might expect. The Cincinnati Child Guidance Home, where … Address correspondence to Deborah Blythe Doroshow, MA, MPhil, Section of the History of Medicine, Yale University, 333 Cedar St, Sterling Hall of Medicine, L-132, New Haven, CT 06520. E-mail: deborah.doroshow{at}yale.edu

Antipsychotic Polypharmacy in Clozapine Resistant Schizophrenia: A Randomized Controlled Trial of Tapering Antipsychotic Co-treatment.

There is a considerable disparity between clinical practice and recommendations based on meta-analyses of antipsychotic polypharmacy in clozapine resistant schizophrenia. For this reason, we investigated the clinical response to reducing the use olanzapine that had been previously added on clozapine treatment among seriously ill hospitalized patients. In a randomized controlled trial with crossover design, we studied volunteer patients (N=15) who had olanzapine added on to clozapine in a state mental hospital. Clozapine monotherapy was just as effective as clozapine-olanzapine therapy, according to results from Clinical Global Impression Scale and Global Assessment of Functioning as primary outcome measures. Polypharmacy is widely used in treating schizophrenia, and usually, add-on medications are started because of worsening of the clinical state. A major confounding feature of these add-ons is whether observed improvements are caused by the medication or explained by the natural fluctuating course of the disorder. The present study, in spite of its small size, indicates the necessity of reconsidering the value of polypharmacy in treating schizophrenia.

P-1067 - Neurosyphilis presenting as psychosis

As we all know there has been a recent resurgence in the incidence of syphilis worldwide. Presented here is a case report of a 46 year old African- American male with no past psychiatric history, who presented with an acute onset of psychotic symptoms including delusions, hallucinations and aggressiveness. The patient was later diagnosed as having Neurosyphilis at a large community hospital and was started on benzathine penicillin G, 2.4 million units I/M every week for 3 weeks, and was later transferred to a state mental hospital to treat his psychosis. Patient was then tried on quetiapine with the target bid dose of 400 mg (am) and 600 mg (pm) along with benztropine 2 mg tid. After 3 weeks, the patient's hallucinations and aggressiveness improved, his EPS also became better. One of the objectives of this case report is to compare the patient's response to different trials of antipsychotics and to also emphasize the importance of routine screening for syphilis as part of the diagnostic work up of psychosis.

Contested Jurisdictions: Psychiatry, Psychoanalysis, and Clinical Psychology in the United States, 1940–2010

American psychiatry on the eve of Pearl Harbor was a small, stigmatised, and isolated specialty, for the most part confined as surely inside the high walls of its barrack-asylums as the patients over whom it exercised near-autocratic powers. The number of mentally ill patients incarcerated in state and county mental hospitals had grown sharply, from 150,000 at the turn of the century to 445,000 in 1940. The fiscal crisis of the states that accompanied the Great Depression had produced a steady deterioration of conditions in these institutions, a deterioration that would intensify as a result of the exigencies of total war. In the immediate aftermath of that prolonged conflict, conditions had degenerated to such a parlous state that a number of outside observers compared America's asylums to Nazi death camps.

Asylum: Inside the Closed World of State Mental Hospitals

Review of: Asylum: Inside the Closed World of State Mental Hospitals, photographs by Christopher Payne, with an essay by Oliver Sacks.

The discursive construction of care when there is no care to be found: Organizational life (re)framed by those on the socio‐economic margins facing job loss

At the same time that low‐wage workers in the changing US health care systems are facing under‐ and unemployment, organizational scholars are engaged in a healthy discussion of the impact of layoffs on various organizational stakeholders. Through a feminist ethics lens and an ethnographic in‐depth interviewing methodology, this case study expands that work by exploring how 55 low‐wage workers in a state mental health hospital facing closure make sense of their experiences of impending job loss. The collected narratives illuminate how the workers interpret the (un)ethical behaviors of the organizational decision makers and how the workers author a (re)framing of their experiences through an attention to care. Explicated from the workers’ descriptions is a perspective about standpoint and open communication that offers organizational scholars and practitioners a foundation from which to expand approaches to communicating with workers in an environment of organizational closure.

Asylum: Inside the Closed World of State Mental Hospitals

Back to table of contents Previous article Next article Book ReviewFull AccessAsylum: Inside the Closed World of State Mental HospitalsJeffrey L. Geller M.D., M.P.H.Jeffrey L. Geller M.D., M.P.H.Search for more papers by this authorPublished Online:1 Oct 2010https://doi.org/10.1176/ps.2010.61.10.1048aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The book Asylum, Christopher Payne's memorialization of America's disappearing 19th century state hospitals, is subtitled Inside the Closed World of the State Mental Hospital. An alternate subtitle might have been, "Inside the Disappearing World of the Closed State Mental Hospital." Using photographs, Payne makes the point that the state hospital was a "closed world," but I think he overstates his case. Pages 21–55 are exterior views of state hospitals. The photographs are stunning. Having seen many of the buildings myself, I can attest to the fact the views are selective (as well a photographer's portrayal should be) and yet true to life.Pages 57–117 are interior views. These photographs are also stunning, a mixture of color and black-and-white. But here, I was caught up short. The images are all so neat, with virtually no images of human detritus. What of the people who inhabited these spaces? I have been through scores upon scores of abandoned state hospital wards, and on many the reminders that patients were once part of the picture are everywhere—strewn clothing, cups and soda cans, cleaning fluid bottles and mops, newspapers from the last day the ward was occupied. … Virtually none of this is in Payne's pictures. I kept asking myself, looking at image after image, "Who swept the floor?" Payne comments, "In all hospitals, the wards were fundamentally the same. … On their own, they are just hallways, but taken together they are symbols of a closed and isolated ward." From my eye and my experience, Payne's selection of images (with added housekeeping) distorts the remains of the state hospital to highlight this viewpoint.Pages 118–201 contain striking photographs of interior and exterior shots, both black-and-white and color. This is the most successful section of the book, a moving portrayal of living at the state hospital, from daily activity through death. Without showing a single person—these are, after all, abandoned state hospitals—life pulsates in these pictures. This makes the second section, with its sterile corridors, all the more puzzling. In this third section, Payne refers to the state hospitals as "communities," a stark contrast to the prose that introduces the second section, quoted in part above. The photographs of Asylum are verbally framed by introductory essays by Oliver Sacks and Payne and by an afterword from Payne. These essays are easy-to-read, simplified histories that, unfortunately, contain some historical inaccuracies. The transition from prose to photographs is made through four pages containing 25 images of state hospitals from old postcards and an image of the Creedmoor State Hospital census board from a day in March 1953: total census of 6,440 patients, of which 5,795 were inpatients, exceeding the hospital capacity by 1,653 patients. Asylum is both a testimony to what we all lose as these state hospital buildings disappear from the American landscape and a reminder of what behemoth, self-contained institutions they were. The last photo before the afterword is of a poem written on a basement wall of Augusta State Hospital in Maine: "If my heart could speak, I'm sure it would say, I wish I were someplace else today.…" In perusing these photographs, one's thoughts can drift beyond the conditions of state hospital buildings to the conditions of the services that state hospitals once provided. The reader is actually set up to do this, in part, by the Sacks essay. Community and contemporary inpatient services might well be in sorrier shape than the state hospital edifices. How many residents of the jails of Cook County (Illinois), Los Angeles County, and Rikers Island (New York) would not, when comparing their current environs with those of the former state hospitals during their period of operation, agree with President Franklin Pierce's description of them in his 1854 Veto Message: "munificent establishments of local beneficence"?The reviewer reports no competing interests.Dr. Geller, who is the book review editor, is professor of psychiatry and director of public-sector psychiatry at the University of Massachusetts Medical School, Worcester. FiguresReferencesCited byDetailsCited ByNone Volume 61Issue 10 October, 2010Pages 1048-1049PSYCHIATRIC SERVICES October 2010 Volume 61 Number 10 Metrics PDF download History Published online 1 October 2010 Published in print 1 October 2010

Sanctuary or Prison?

Book Review| September 01 2010 Sanctuary or Prison? Asylum: Inside the Closed World of State Mental Hospitals Photographs by Christopher Payne, with an essay by Oliver Sacks MIT Press, 2009216 pp./$45.00 (hb) Colette Copeland Colette Copeland COLETTE COPELAND is a multimedia artist who teaches critical writing and visual studies at the University of Pennsylvania in Philadelphia. Search for other works by this author on: This Site PubMed Google Scholar Afterimage (2010) 38 (2): 37. https://doi.org/10.1525/aft.2010.38.2.37 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Colette Copeland; Sanctuary or Prison?. Afterimage 1 September 2010; 38 (2): 37. doi: https://doi.org/10.1525/aft.2010.38.2.37 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAfterimage Search This content is only available via PDF. © 2010 Afterimage/Visual Studies Workshop, unless otherwise noted. Reprints require written permission and acknowledgement of previous publication in Afterimage.2010 Article PDF first page preview Close Modal You do not currently have access to this content.

Carla Yanni. Review of "Asylum: Inside the Closed World of State Mental Hospitals" by Oliver Sacks and Christopher Payne.

Carla Yanni. Review of "Asylum: Inside the Closed World of State Mental Hospitals" by Oliver Sacks and Christopher Payne.

Family Therapy and Serious Mental Disorders: A Retrospective and Prospective View

This is a response to Malcolm MacFarlane's gracious and intriguing invitation to describe family therapy's role in the treatment of serious mental disorders at the start of my career and today. It is intriguing to look at things “then and now” from one's personal perspective and also challenging because of the necessity to be clear, comprehensive, and concise at the same time. My chosen point of departure for this saga is 1955–1956, a period in which I worked part-time as a psychiatric aide in the psychiatric unit of an upscale private hospital and subsequently worked with acute and chronic schizophrenic patients in a state mental hospital as part of a degree program. My account is necessarily illustrative, rather than comprehensive; therefore, discussion of important events is brief and the work of many pioneering and contemporary figures is not included.

Is the implementation of assertive community treatment in a low-income country feasible? The experience of Tbilisi, Georgia

In Georgia, difficult socioeconomic conditions have resulted in a drastic decrease in government financing for the health sector. State mental hospitals continue to be the main solution for the mentally ill, due to the severe lack of community-based services, and mental health services are inadequate to meet the needs of patients. An experimental intervention of assertive community care was implemented with the aim to engage socially isolated patients who lacked contact with outpatient services and to answer their different social and psychological needs. The intervention lasted 10 months and consisted of outpatient visits, visits at home, meetings outside and telephone calls to the services' facilities; all services were provided by a multidisciplinary team. The intervention was conducted in a psychiatric dispensary in the district of Tbilisi, Georgia. This pilot study showed the economic sustainability of community care and its effectiveness to facilitate continuity of care and to improve clinical and social outcomes. High-quality community care costs less than usual treatment and inpatient care and seems to be effective to improve clinical and social outcomes; for these reasons, policymakers should consider, in their future mental health reforms, allocating more resources to community-based care.

From Beauty to Despair: The Rise and Fall of the American State Mental Hospital

The American State Hospital has survived over 200 years. Society once viewed state hospitals as an absolute necessity and each state constructed numerous hospitals. Over time, the image of the state hospital as a means to cure the mentally ill changed drastically. The public perceived state hospitals as snake pits that warehoused the mentally ill and the state hospital was nearly destroyed. Nevertheless, the state hospital remains today with purposes similar to its ancestors and some that are very different. This paper examines the many influences that created the state hospital. Additionally, this paper addresses the Kirkbride Model, treatment methods and practices over time, and how the state hospital fell into disfavor as a means to treat the mentally ill. The paper concludes with comments on the mental health system today, in relation to the state hospital's role in treatment.

Overrepresentation of Black Americans in Psychiatric Inpatient Care

Overrepresentation of Black Americans in Psychiatric Inpatient Care

Overrepresentation of Black Americans in Psychiatric Inpatient Care

Numerous studies have documented overrepresentation of the black population in psychiatric inpatient settings, but none have included certain important covariates or examined heterogeneity within the black population. After controlling for key social, demographic, and clinical factors, the investigators sought to determine whether blacks are overrepresented in inpatient psychiatric settings; they examined differences within the black population by separately examining the prevalence of inpatient treatment of African Americans and U.S.- and foreign-born Caribbean blacks. Secondary analysis was performed on data from two population-based household surveys, the National Survey of American Life (NSAL) and the National Comorbidity Survey Replication (NCS-R), which provided a population-based sample of 9,371 community-dwelling adults, including 3,570 African Americans, 1,621 blacks of Caribbean descent, and 4,180 non-Hispanic whites. Using logistic regression, the investigators estimated self-reported lifetime psychiatric hospitalization as a function of racial-ethnic background after controlling for sociodemographic differences and differences in lifetime counseling or therapy and psychiatric diagnosis. With controls for demographic and clinical factors, both African Americans (odds ratio [OR]=2.52, 95% confidence interval [CI]=1.91-3.33) and Caribbean blacks (OR=2.74, CI=1.98-3.82) had higher odds than whites of having a psychiatric hospitalization in their lifetime. U.S.-born Caribbean blacks had much higher odds of hospitalization (OR=5.47, CI=3.60-8.32) than whites, whereas the likelihood of hospitalization of foreign-born Caribbean blacks did not differ from that of whites (OR=.96, CI=.51-1.82). Disparities between blacks and whites in the prevalence of psychiatric inpatient treatment appear to be persistent, but global comparisons mask important heterogeneity within the black population.

Does One Size Fit All? What We Can and Can't Learn From a Meta-analysis of Housing Models for Persons With Mental Illness

Numerous studies have evaluated the impacts of community housing models on outcomes of persons with severe mental illness. The authors conducted a meta-analysis of 44 unique housing alternatives described in 30 studies, which they categorized as residential care and treatment, residential continuum, permanent supported housing, and nonmodel housing. Outcomes examined included housing stability, symptoms, hospitalization, and satisfaction. Outcome scores were converted to effect size measures appropriate to the data. Effect sizes were combined to estimate random effects for housing models, which were then compared. All models achieved significantly greater housing stability than nonmodel housing. This effect was greatest for permanent supported housing (effect size=.63, p<.05). No differences between housing models were significant. For reduction of psychiatric symptoms, only residential care and treatment differed from nonmodel housing (effect size=.65, p<.05). For hospitalization reduction, both residential care and treatment and permanent supported housing differed from nonmodel housing (p<.05). Permanent supported housing achieved the highest effect size (.73) for satisfaction and differed from nonmodel housing and residential care and treatment (p<.001 and p<.05, respectively). The meta-analysis provides quantitative evidence that compared with nonmodel housing, housing models contribute to stable housing and other favorable outcomes. The findings also support the theory that different housing models achieve different outcomes for different subgroups. Data were not sufficient to fully answer questions designed to enable program planners and providers to better meet consumers' needs. It is important to answer these questions with research that uses common measures and adheres to scientific conventions.

State Hospital Admissions on Unexpected Upswing

State Hospital Admissions on Unexpected Upswing

Hildegard E. Peplau: leader, practitioner, academician, scholar and theorist. 1978.

Allow me to take some of you back in memory and for others to, perhaps, acquaint you with the psychiatric nursing scene in the late 1940s and early 1950s. The mentally ill were, by and large, hospitalized in huge mental hospitals. It seemed then that to be bigger in size was equated with better. I was proud then that my state hospital training school was in one of the largest hospitals of its kind in the world, albeit that this was the same hospital so devastatingly documented in a veiled work of fiction, Snake Pit, but in truth was largely fact. Recall with me that these were the days before the introduction of psychotropic drugs. These were the days of the Scotch douches, the wet packs, continuous tubs, full sheet restraints, B & C mixture, paraldehyde, and leather cuffs. The preoccupation of nursing staff often seemed largely to be with the prevention of suicide and, God forgive us, what indignities were visited on patients in the name of protecting them from their suicidal impulses. No eyeglasses, no shoelaces, no belts, no dentures, no toothbrushes, no combs, no mirrors, no silverware, or, at best, a spoon--with all spoons counted before the dining room could be emptied of its weary bodies that were then to be lined up to march back to the ward, back to the section where it surely would be time to pass the paraldehyde bottle and the tin cup. Recall the sweaty smell of deep coma insulin treatment and the slightly acrid odor accompanying fifty electric shock treatments given in the same room, with no anesthesia, and all over in an hour-and-a-half or less. Recall the ice-pick leucotomies, with thirty to fifty done in a single morning, and the nursing staff left in the wake of the visiting neurosurgeons to habilitate the now vegetable-like patient. Peplau: Leader and Practitioner If I have succeeded in evoking the feeling of that era of the state mental hospital, then you will know why, when I reread Mary Jane Ward's telling portrayal of life inside those walls, I was again reminded of the large debt I owe Hildegard E. Peplau for bringing me a new perspective, a new approach, a theoretically based foundation for nursing practice, for therapeutic work with patients in those problematic settings. Imagine the excitement of making sense out of a patient's hallucinatory experience through collaborative work! Imagine the joy that came from discovering that a delusion could be dealt with and satisfactorily eliminated through effective verbal work with patients. A new day had dawned! Theory was used to guide nursing practice. Theory was tested in the real world of practice. Remember, this was twenty years before there was an NLN accreditation standard that required some conceptual framework should frame the curriculum in schools of nursing. A quote from Kaplan seems appropriate here. ...What is needed more than ever before in human history is an understanding of man and his nature, an understanding of society, an understanding of our relationship to the world around us. In a word, what is needed is knowledge. (1973, p. 35) It was precisely that which Peplau brought to the real world of the state hospital and through the use of that knowledge helped give nursing's moral aspirations a concrete basis which narrowed the gap between the ideal and the real. While Hilda Peplau taught me not to speak for others, and in general I abide by that very valuable principle, I shall violate it now for I think I can speak for other nurses, thousands of them in large and small, urban and rural mental hospitals, who, through the 50s and 60s, were the participants in Peplau's summer workshops. So, on their behalf, I express what I am certain is their gratitude for the knowledge and clinical skills which Peplau so abundantly shared. While it is likely that Peplau had peers in the field of psychiatric nursing in those decades, none, I think, shared so freely or gave so much to the ordinary, everyday practitioner in those desolate wards of the state hospitals across the country. …

Hydrotherapy in State Mental Hospitals in the Mid-Twentieth Century

This research describes nurses' experiences in administering “the water cure,” hot or cold wet sheet packs, and continuous tub baths in state mental hospitals during the early twentieth century. Student and graduate nurses were required to demonstrate competence in hydrotherapy treatments used to calm agitated or manic patients in the era before neuroleptics. The nurses interviewed for this study indicated that, although labor intensive, hydrotherapy worked, at least temporarily. Although no longer used in state hospitals, hydrotherapy is regaining popularity with the general public and may serve as an adjunct to pharmacological treatments to calm hospitalized patients in the future.

Changing Trends in State Psychiatric Hospital Use From 2002 to 2005

Changing Trends in State Psychiatric Hospital Use From 2002 to 2005

Different Generations Review One Flew Over the Cuckoo's Nest Miloš Forman (Director)

Different Generations Review <i>One Flew Over the Cuckoo's Nest</i> Miloš Forman (Director)