Worcester State Hospital Research Articles

Book Review: Madeline Kearin Ryan, A Refuge of Cure or Care: The Sensory Dimensions of Confinement at the Worcester State Hospital for the Insane

Book Review: Madeline Kearin Ryan, <i>A Refuge of Cure or Care: The Sensory Dimensions of Confinement at the Worcester State Hospital for the Insane</i>

'As syllable from sound': the sonic dimensions of confinement at the State Hospital for the Insane at Worcester, Massachusetts.

As the first state hospital in the USA, the Worcester State Hospital for the Insane at Worcester, Massachusetts (est. 1833), set a precedent for asylum design and administration that would be replicated across the country. Because the senses were believed to provide a direct conduit into a person's mental state, the intended therapeutic force of the Worcester State Hospital resided in its particular command over sensory experience. In this paper, I examine how aurality was used as an instrument in the moral architecture of the asylum; how the sonic design of the asylum collided with the day-to-day logistics of institutional management; and the way that patients experienced and engaged with the resultant patterns of sound and silence.

“A State of Conscious and Permanent Visibility”: Sight as an Instrument of Cure and Control at the Worcester State Hospital for the Insane, 1833–1900

The nineteenth-century lunatic hospital was intended to function as a curative instrument, targeting the mind through the senses. This paper compares the way in which visibility was mobilized in the design of the asylum, drawing upon ideals of nature and domesticity, against its imperfect realization in practice, with a focus on the lived experiences of patients.

The Rise and Demise of America’s Psychiatric Hospitals: a Tale of Dollars Trumping Sense

The Rise and Demise of America’s Psychiatric Hospitals: a Tale of Dollars Trumping Sense

Re-Introducing Bunky at 125: E. M. Jellinek's Life and Contributions to Alcohol Studies.

Elvin Morton Jellinek (1890-1963) was one of the founders of modern addiction science. This overview is a brief survey of his life and achievements, intended to re-introduce alcohol scholars to his contributions (and possible failings) as well as stimulate interest and historical research in the field. The article draws largely from the archival collection of the Rutgers Center of Alcohol Studies (CAS) Library and the Jellinek memorial issue of the CAS Information Services Newsletter. Scholarly works and personal and institutional records by or about E. M. Jellinek were assembled and, when necessary, translated into English. Born in 1890 in New York and raised in Hungary, Jellinek studied at several European universities and worked for various institutions and organizations in Budapest (1914-1920), Sierra Leone, Honduras, and at the Worcester State Hospital, in Massachusetts. In 1941 he became an associate professor of applied physiology at Yale University, where he directed the Yale Summer School of Alcohol Studies from 1941 to 1950. After more than a decade of work with the World Health Organization and several Canadian institutions, he taught and conducted research at the Institute for the Study of Human Problems at Stanford University until his death in 1963. Jellinek was a pioneer in research on the nature and causes of alcoholism and was an early proponent of the disease theory of alcoholism. With the help of E. M. Jellinek, the modern era of addiction science was launched with an international outlook that included critical attention to the physical infrastructure and intellectual capital needed to form an interdisciplinary field of basic research, applied science, and clinical practice.

Gerald N. Grob, 1931–2015

Gerald N. Grob, 1931–2015

Madness: American Protestant Reponses to Mental Illness by Heather H. Vacek

Reviewed by: Madness: American Protestant Reponses to Mental Illness by Heather H. Vacek Lawrence B. Goodheart Heather H. Vacek. Madness: American Protestant Reponses to Mental Illness. Waco, Tex.: Baylor University Press, 2015. 283pp. $39.95 (978-1-4813-0057-5). In order to understand the perspective of the author, it is important to know that she is assistant professor of Church History at Pittsburgh Theological Seminary. Vacek has written a scholarly jeremiad in which she has weighed her co-religionists’ responses to mental illness in the moral balance and found them wanting. The organization of the book highlights what she persuasively argues is a perennial gap between belief and practice in her faith community. There are five chapters that profile exceptional Protestants—Cotton Mather, Benjamin Rush, Dorothea Dix, Anton Boisen, and Karl Menninger—who acted to do good in the field of mental health over several centuries. The conclusion is the piece de resistance in which Vacek offers compelling pastoral guidance on Christian duty to the afflicted. The prose is clear, the documentation thorough, and her stance heartfelt. Boston-born Mather, a prodigy of Puritan erudition, wrote The Angel of Bethesda in 1624, the only comprehensive medical tome of the colonial era. He famously declaimed in post lapsarian metaphysics, “What is the Whole World, but an Entire Mad-house?” (p. 12). He identified sin, natural causes, and the supernatural in the inexplicable etiology of mental disease. He found no contradiction in mixing the theological with the scientific. In the face of medical resistance, he advocated inoculations during a smallpox epidemic of the early 1720s. He coped with a third wife who suffered psychic distress, and he ministered to the sick of his congregation. For future reference, note should be made of Gershom Buckeley, Mather’s contemporary in Connecticut. Unlike Mather during the Salem hysteria of 1692–93, Buckeley—a minister, physician, and attorney—played a critical role in ending executions for witchcraft during the same time in Connecticut. The Philadelphian polymath Benjamin Rush combined devout Presbyterianism with his medical humanitarianism. Widely known as the “father of psychiatry” in the United States, he was also a signer of the Declaration of Independence, a foe of slavery, and an opponent of the death penalty. Whereas the Puritan Mather linked sin with mental abnormality, the Enlightenment-era Rush saw organic causes, particularly the excessive blood flow to the brain. His practice of copious bleeding and other heroic measures, however, soon fell out of favor with subsequent physicians. Nonetheless, his religious and medical commitment made him the American counterpart in “moral” (humane) treatment of the insane to Phillipe Pinel in France and the English Quaker William Tuke. The antebellum crusader Dorothea Dix launched and expanded thirty mental asylums. With initial success in the famous Memorial to the Massachusetts Legislature (1843) on behalf of the neglected insane, she enthused that she “was now an instrument of divine grace” (p. 81). Vacek includes a brief obligatory comment on Michel Foucault and the well-worn social control thesis. The paradigm of the book relies, however, heavily on the judicious assessments of scholar Gerald N. Grob. The work of Mary Ann Jimenez, Norman Dain, David Gollaher, and Lawrence J. Friedman is also brought to bear in relevant chapters. [End Page 334] The two last figures are the little known minister Anton Boisen and the well-known psychiatrist Karl Menninger. A Presbyterian cleric, Boisen suffered five severe psychotic episodes. His personal odyssey with schizophrenia led to what Vacek terms his “call for physicians of the soul” (p. 113) that included a chaplaincy at Worcester State Hospital in Massachusetts, clinical training for seminarians, and a reflection on his own hospitalization, The Exploration of the Inner World: A Study of Mental Disorder and Religious Experience (1936). Directly influenced by the religious commitment of his mother, Karl was a member of a remarkable family of physicians who established the renowned Menninger Foundation and the Menninger Clinic in Topeka, Kansas. This most famous American psychiatrist of the twentieth century was inspired to good works in a perceived unity of religion and medicine. In his own words of 1964, “The basis of all religion is the duty to love God and offer our help...

Ben Behind His Voices: One Family’s Journey From the Chaos of Schizophrenia to Hope

Back to table of contents Previous article Next article Book ReviewsFull AccessBen Behind His Voices: One Family’s Journey From the Chaos of Schizophrenia to HopeKathryn Y. Raymond, M.S., A.P.R.N., and Jeffrey L. Geller, M.D., M.P.H., Kathryn Y. RaymondSearch for more papers by this author, M.S., A.P.R.N., and Jeffrey L. GellerSearch for more papers by this author, M.D., M.P.H., EditorPublished Online:1 May 2013https://doi.org/10.1176/appi.ps.640506AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail by KayeRandye; New York, Rowman & Littlefield Publishers, Inc., 2011, 320 pages, $26.95Serious mental illness disrupts the lives of people with the illness and their families. Ben Behind His Voices, by Randye Kaye, presents a view of a family’s odyssey while dealing with schizophrenia.Ms. Kaye, author and mother, shares her family’s experiences with her son’s mental illness and their arduous journey toward recovery. Ben, a gifted and loving young man full of promise, began exhibiting symptoms of schizophrenia during high school. As Kaye describes, obtaining the diagnosis of a serious mental illness such as schizophrenia can be a long and confusing process. The personality changes that Ben experienced were gradual and, at times, seemed to mimic the chaotic hormonal and behavioral changes that come with adolescence. Kaye brings us into her world of emotional turmoil as she tries to manage her day-to-day life as a single parent in the midst of uncertainty about when another crisis would develop and create havoc within the family. In their search for help, Ben and his family found that navigating the mental health system can be a trying process of receiving different psychiatric opinions and treatment recommendations before a definitive diagnosis can be made. Unfortunately, Ben’s symptoms erupted into a crisis that led to hospitalization and commitment for treatment. This was necessary in order for him to be correctly diagnosed and treated with antipsychotic medication.Dealing with serious mental illness is emotionally turbulent. Kaye explains that the process of accepting Ben’s mental illness has been a road of denial, confusion, anger, loneliness, sadness, and grief. The loss of a child’s potential and previous level of functioning must be grieved in order to move toward recovery and to redefine life’s goals. Another painful struggle for parents is their children’s denial of mental illness and refusal to take prescribed medications, which can lead to the relapse of symptoms and rehospitalization. Through education and the support of the National Alliance on Mental Illness (NAMI), Kaye was able to gain strength and wisdom about how to best manage Ben’s illness and to help herself and her family cope with its burden.This book is a well written and compelling story of a mother’s unwavering love and hopefulness for her son and her belief in his ability to create a meaningful and fulfilling life by managing his schizophrenia. Kaye, bravely and insightfully, uses her experiences to assist other families in caring for their family members with mental illness by promoting education, support, and early intervention for diagnosis and treatment of psychiatric disorders. Obtaining support from advocacy groups, such as NAMI, that are run by families who know and understand the experience of living with mental illness can become a lifeline to others on the road to recovery.Ms. Raymond is a psychiatric nurse clinical specialist in the Department of Nursing and Psychiatry, Worcester State Hospital, Worcester, Massachusetts.The reviewer reports no competing interests. FiguresReferencesCited byDetailsCited ByNone Volume 64Issue 5 May 2013Pages e03-e03 Metrics The reviewer reports no competing interests.PDF download History Published online 1 May 2013 Published in print 1 May 2013

Measuring Abuse Sequelae: Validating and Extending the Trauma Symptom Checklist–40

This study used the Trauma Symptom Checklist–40 (TSC–40) to index both childhood sexual abuse (CSA) and childhood physical abuse (CPA) in a college student sample of both men and women (N = 441). Although the TSC–40 was designed as a measure of CSA trauma, this study concludes the measure is appropriately reliable for indexing the traumatic sequelae of CPA as well as CSA in nonclinical samples. This study also explored the effects of gender and abuse severity on resulting symptomatology, finding that women and severely abused individuals report the most negative sequelae. Both CSA and CPA emerged as significant explanatory variables in TSC–40 scale scores beyond gender, supporting its validity for indexing traumatic sequelae in nonclinical samples. Tess M. S. Neal is now at the Department of Psychiatry, University of Massachusetts Medical School and Department of Psychology, Worcester State Hospital.

Psychiatric–Mental Health Nursing: An Interpersonal Approachedited by JonesJeffrey S., FitzpatrickJoyce J., and RogersVickie L.; New York, Springer Publishing, 2012, 696 pages, $65

Back to table of contents Previous article Next article Book ReviewsFull AccessPsychiatric–Mental Health Nursing: An Interpersonal ApproachJeffrey L. Geller, M.D., M.P.H., , and Kathryn Y. Raymond, M.S., A.P.R.N.Jeffrey L. GellerSearch for more papers by this author, M.D., M.P.H., Editor, and Kathryn Y. RaymondSearch for more papers by this author, M.S., A.P.R.N.Published Online:1 Oct 2012https://doi.org/10.1176/appi.ps.631006AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail edited by JonesJeffrey S., FitzpatrickJoyce J., and RogersVickie L.; New York, Springer Publishing, 2012, 696 pages, $65Preparing future psychiatric–mental health nurses is a challenging and complex task. Advances in neuroscience and genetics, global travel and cultural diversity, health care disparities, and legal and ethical issues are just a few topics complicating psychiatric–mental health education. Jones, Fitzpatrick, and Rogers are skilled educators and clinicians who have compiled a superb textbook based on the expertise of multiple contributors from the field.The text has many strengths. Most important, it emphasizes practice based on theoretical frameworks. This is reflected in the title focusing on the interpersonal approach. Hildegard E. Peplau, the founder of psychiatric–mental health nursing theory and practice, developed the theory of interpersonal relations, which views the interpersonal process between nurse and patient as the essential vehicle for recovery. Joyce Travelbee, a contemporary of Peplau, gives further credence to the importance of the interpersonal process, as explicated in her human-to-human relationship theory. Interpersonal relationship theories are thoughtfully woven throughout the text. The volume also addresses mental health concerns across the lifespan, giving insights into issues specific to children, adolescents, families, and the elderly population. Topics include dealing with abuse and victimization, working with vulnerable populations, and addressing the effects of substance abuse and general medical illness on mental health. The final chapters on cultural, ethical, legal, and health policy issues discuss additional complexities affecting mental health practice today.The text pays adequate attention to the basics of psychiatric–mental health nursing practice, including psychiatric disorders, treatment modalities, and various roles of the psychiatric–mental health nurse. Another strength of the text is the use of embedded text boxes that elaborate on content within each chapter. These boxes provide opportunities for further learning by focusing on evidence-based practices related to various disorders and treatment modalities, offering clinical vignettes for practicing skills, highlighting summary points, and suggesting Web links for further exploration. The chapters on the therapeutic use of self, therapeutic communication, and boundary management impress upon novice practitioners the intricacies of practice by pointing out the importance of self-awareness and self-reflection in developing and maintaining an effective therapeutic relationship.The text lacks discussion of the importance of informed consent for treatment, especially when working with patients who have difficulty accepting their psychiatric diagnoses. Helping patients accept their illness and their need for treatment can be challenging. Although the responsibility for informed consent has traditionally been placed on the psychiatrist, the role of the psychiatric–mental health nurse is critical in providing ongoing education about treatment, lifestyle adjustment, and symptom management. Informing patients, involving them in treatment decision making, and using an interpersonal approach to do so are important aspects of nursing practice.The editors accomplished a difficult task in developing this well-written, comprehensive psychiatric–mental health nursing text. It is an excellent resource for both the novice nursing student and the practitioner.Ms. Raymond is a psychiatric nurse clinical specialist with the Department of Nursing and Psychiatry, Worcester State Hospital, Worcester, Massachusetts.The reviewer reports no competing interests. FiguresReferencesCited byDetailsCited byNone Volume 63Issue 10 October 2012Pages e2-e2 Metrics The reviewer reports no competing interests.PDF download History Published online 1 October 2012 Published in print 1 October 2012

David Shakow and schizophrenia research at Worcester State Hospital: The roots of the scientist‐practitioner model

As Chief Psychologist and Director of Psychological Research at Worcester State Hospital (WSH), David Shakow (1901-1981) made substantial contributions to the scientific study of schizophrenia and by extension to the study of psychopathology in general. His methodological innovations--particularly on issues of diagnosis and conditions of testing-set a new standard for experimental rigor in the field. Shakow helped to establish many of what are considered basic facts about schizophrenia. His empirical work at WSH-specifically on the crossover effect--provided the scientific foundation for his theory of schizophrenic cognition, known as segmental set. Moreover, Shakow's schizophrenia work informed his developing ideas on the synergy between clinical practice and research.

Evidence-Based Outcome Research: A Practical Guide to Conducting Randomized Controlled Trials for Psychosocial Interventions

Back to table of contents Previous article Next article Book ReviewFull AccessEvidence-Based Outcome Research: A Practical Guide to Conducting Randomized Controlled Trials for Psychosocial InterventionsWilliam H. Fisher Ph.D.William H. Fisher Ph.D.Search for more papers by this authorPublished Online:1 May 2008https://doi.org/10.1176/ps.2008.59.5.579AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Research methods for assessing the effectiveness of behavioral health interventions are complicated, and these methods become ever more sophisticated as more factors are identified that can undermine the validity of research studies. For many clinicians with little research training—or for those whose graduate training took place when Ronald Reagan was president—reading the contemporary research literature or participating in research projects may prove daunting.For those who have wanted to update their familiarity with how contemporary research is conducted, how data are analyzed, and how the ethical concerns posed by research are addressed, there have been few readable texts and certainly few convenient ways to access this knowledge. Enter this excellent book by Nezu and Nezu. As one who has been an ardent consumer of methodological works over the years, I must say this one strikes me as unique. Indeed, use of the word practical in the title immediately suggests that this book offers something different.The volume begins with two chapters discussing conceptual issues related to threats to validity in randomized control trials. This is followed by the second section, which includes three papers loosely grouped under the heading of "Assessment Issues." These discuss clinical interviews, behavioral assessment, and issues with self-report. The third section, "Methodological Issues," includes eight chapters, each of which addresses a critical topic in the design of randomized controlled trials, including sample size, recruitment, research designs, efficacy and effectiveness, and treatment and integrity in research designs. The highly readable papers in this section also address concepts, such as fidelity to treatment and other issues, which were beginning to be the focus of concern a decade or so ago but have become major concerns in contemporary research design.The fourth section, titled "Data Analysis," covers some of the statistical issues that are currently receiving attention from researchers and are part of the routine discourse around research projects, including a discussion of some of the newer approaches to data analysis, such as growth curves and the estimation and presentation of effect sizes. Finally, under the heading of "Special Topics," three papers address a set of interesting, if not directly interrelated topics, such as ethical issues and multisite intervention studies.Evidence-Based Outcome Research is designed primarily for those interested in research on new approaches to psychotherapy and other behavioral interventions. Its readership should not be limited to those working in these areas, however. Indeed, mental health services researchers could find an extraordinary amount of useful information in this volume. The papers are all clearly written. The data analysis papers present some statistical formulas, but nothing in the discussion of these concepts is daunting. This volume is strongly recommended for persons who will be a part of any research endeavor, those wishing to be more knowledgeable consumers of published research, and persons who want to update their knowledge of research methods. Dr. Fisher is affiliated with the Department of Psychiatry, Worcester State Hospital, Worcester, Massachusetts. FiguresReferencesCited byDetailsCited ByMotivational design for web-based instruction in health professions education: Protocol for a systematic review and directed content analysis (Preprint)26 September 2022 | JMIR Research Protocols Volume 59Issue 5 May, 2008Pages 579-580PSYCHIATRIC SERVICES May 2008 Volume 59 Number 5 Metrics PDF download History Published online 1 May 2008 Published in print 1 May 2008

Mood and Anxiety Disorders in Women

Back to table of contents Previous article Next article Book ReviewFull AccessMood and Anxiety Disorders in WomenKathleen P. Whitley M.D.Kathleen P. Whitley M.D.Search for more papers by this authorPublished Online:1 Sep 2007https://doi.org/10.1176/ps.2007.58.9.1234AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Physicians and medical researchers have long known that certain psychiatric disorders are diagnosed with greater frequency among women than among men. Major depression, dysthymia, seasonal affective disorder, panic disorder, social phobia, and generalized anxiety disorders are diagnosed for women at rates that range from 1.6 to six times those for men. An increasing amount of research has been published over the past 20 years focusing on gender differences in the etiology, symptom patterns, and effective treatment of these disorders.David Castle of the University of Melbourne, Jayashri Kulkarni of Monash University, and Kathryn Abel of the University of Manchester have brought together experts from Australia, the United Kingdom, Canada, and the United States to write a series of thorough yet concise reviews on the subject of mood and anxiety disorders among women. Each chapter of their valuable book focuses on one aspect of the general topic, from the initial emergence of the "gender gap" in mood disorders during adolescence to the clinical aspects of anxiety and depression during women's senior years.The writing is clear and succinct, and the discussions are broad based and well supported with references to recent research. Developmental, social, cultural, biological, and psychological factors are all considered. Some of the specific areas addressed include hormonal influences on depression during childbearing years and during menopause, domestic violence and its impact on mental health, posttraumatic stress disorder, and special issues for women with bipolar disease. The chapter on pharmacological treatment of anxiety and depression during pregnancy and lactation provides extremely helpful recommendations on a clinical management challenge that constantly confronts physicians. However, I find it difficult to praise one chapter over another because every one was filled with useful data for researchers, clinicians, educators, and health care administrators.Mood and Anxiety Disorders in Women is an excellent overview of selected mental disorders that disproportionately affect women. Clinicians in both inpatient and outpatient mental health practice will find it a valuable guide to understanding these disorders and to current treatment practices. Although written primarily from the perspective of psychiatry, clinicians working in family practice, adolescent medicine, gynecology, and public health will also find it useful in treating the women under their care. Training programs will also want to purchase this book as a reference for psychiatric residents and trainees who have few other texts that provide such a complete review of important diagnostic and treatment issues in women's mental health. Dr. Whitley is director of clinical and professional services, Worcester State Hospital, and assistant professor at University of Massachusetts Medical School, Worcester. FiguresReferencesCited byDetailsCited ByNone Volume 58Issue 9 September, 2007Pages 1234-1234PSYCHIATRIC SERVICES September 2007 Volume 58 Number 9 Metrics PDF download History Published online 1 September 2007 Published in print 1 September 2007

Suicide by Cop: Committing Suicide by Provoking Police to Shoot You

Back to table of contents Previous article Next article Book ReviewsFull AccessSuicide by Cop: Committing Suicide by Provoking Police to Shoot YouDebra A. Pinals, M.D.Debra A. PinalsSearch for more papers by this author, M.D.Published Online:1 Nov 2005https://doi.org/10.1176/appi.ps.56.11.1470AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Who would have thought Suicide by Cop: Committing Suicide by Provoking Police to Shoot You, by Mark Lindsay and David Lester, would include mention of Antigone and Socrates? These ancient Greek figures seem far removed from what the reader would expect from the book's title. Nevertheless, the book's authors, who have law enforcement and social and political scientific backgrounds, include these figures as part of vignettes of persons who are seeking death at the hands of the state through execution. Also included is a review of the life and death of Gary Gilmore, the first person to be executed in the United States after a hiatus in state executions of approximately one decade. State executions would not meet any formal definition of suicide by cop, a situation wherein a suicidal individual intentionally engages in specific behavior to provoke a law enforcement officer to use lethal force so that the individual will be killed.In fact, the authors of this compact text cover a variety of areas not commonly seen in existing literature on suicide by cop, including suicide following the murder of police officers or other individuals. A broader title for this book might have helped me understand the direction the book would take. Nevertheless, reading the book in its entirety provides a spectrum of situations that, through extrapolation, share related themes.Within this context, the authors do a decent job of describing the phenomenon of suicide by cop, looking at its epidemiology as well as providing suggested directions for reducing its incidence. They describe situations in which suicide by cop may take place, including those involving barricades or hostages. Although the book does not fully address the rigor of the existing research on these topics—which is often a major critique of papers on this topic—it does reference many important articles. Also, the section about helping police officers provides a balanced commentary on the issues of critical incident debriefing, which has generated some controversy among clinicians as to its effectiveness in preventing anxiety disorders. The bibliography at the end of the book will be useful for anyone who is interested in pursuing further reading in this area.Probably one of the more unique chapters is Chapter 5, which addresses victim-precipitated homicide in other cultures. For example, the authors describe "crazy dog wishing to die," a phenomenon of the Plains Indians, such as the Crow, wherein a man who is tired of living deliberately seeks death in battle and is accorded special status if he persists in his plan. According to the authors, rituals before the battle include singing special songs and using a special rattle. In addition, the book devotes an entire chapter to suicide by cop among African Americans. However, in this chapter, the authors come close to using racial stereotypes. They tell the stories of the Black Panthers and the MOVE confrontations in the 1970s, which, again, seem somewhat removed from the book's topic.Given the growing interest in encounters between law enforcement officers and persons with mental disorders, Suicide by Cop is a useful reference. The book's casual, unscientific style in many ways makes it more geared toward law enforcement than mental health professionals. However, the book's contents provide some interesting perspectives for anyone who is interested in the phenomenon of suicide by cop and of seeking suicide by proxy.Dr. Pinals is affiliated with the department of psychiatry of Worcester State Hospital in Massachusetts.by Mark Lindsay and David Lester; Amityville, New York, Baywood Publishing, 2004, 128 pages, $32.95 FiguresReferencesCited byDetailsCited byNone Volume 56Issue 11 November 2005Pages 1470-1470 Metrics History Published online 1 November 2005 Published in print 1 November 2005

Ethical Issues in Surreptitious Prescribing

Back to table of contents Previous article Next article LettersFull AccessEthical Issues in Surreptitious PrescribingPaul Noroian, M.D.Paul NoroianSearch for more papers by this author, M.D.Published Online:1 Aug 2005https://doi.org/10.1176/appi.ps.56.8.1023AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: I was pleased to see the topic of surreptitious prescribing addressed in the April issue of Psychiatric Services (1). In the course of my work in state hospitals in Massachusetts, I have had to make decisions about whether to prescribe medications concealed in food or fluids. In most of these cases, guardians and other nonclinicians were the main advocates of this type of prescribing. I agree with the authors that there may be a role for this type of prescribing in work with patients with dementia and severe retardation, when the patient is not aware of the medications prescribed and a guardian has given consent for them. However, it is less clear whether any role exists for this type of prescribing for patients with psychotic illness, who are aware of the medications that they take.One ethical issue in this population is whether an adult with the capacity to understand the implications of having a medication prescribed has the right to know what is being given. The finding of incompetence does not preclude an individual's having the capacity to recognize that he or she is being given a medication that has the potential to cause adverse effects—which creates a dilemma if the patient develops side effects. Does the patient have a right to know about these side effects and the fact that they are caused by a medication? A physician has an ethical obligation to explain side effects to patients, even to patients deemed incompetent. A patient's discovery of the fact that medication is being given surreptitiously could have devastating effects on the treatment relationship and the patient's ability to trust the psychiatrist and the treatment team, an issue raised by Ahern and Van Tosh in their Taking Issue commentary in the April issue (2). I would also be concerned that a psychotic patient who learns accidentally that he or she is being medicated surreptitiously might stop accepting all treatments and potentially all food and nourishment. For inpatients deemed incompetent who have a high level of awareness, it could be quite difficult to shield this information, given the number of staff on different shifts who might accidentally disclose information about the concealed medication. For these reasons, the practicality of this practice is far from certain. Further reports on the application of this practice would be welcome.Dr. Noroian is assistant professor of psychiatry at the University of Massachusetts Medical School and director of psychiatry at Worcester State Hospital in Worcester, Massachusetts.Reference1. Whitty P, Devitt P: Surreptitious prescribing in psychiatric practice. Psychiatric Services 56:481–483,2005Link, Google Scholar2. Ahern L, Van Tosh L: The irreversible damage caused by surreptitious prescribing. Psychiatric Services 56:383,2005Link, Google Scholar FiguresReferencesCited byDetailsCited ByProof in the Pudding: The Value of a Rights Based Approach to Understanding the Covert Administration of Psychotropic Medication to Adult Inpatients Determined to Be Decisionally-Incapable in Ontario's Psychiatric Settings1 January 2021 | Journal of Law, Medicine & Ethics, Vol. 45, No. 2 Volume 56Issue 8 August 2005Pages 1023-1023 Metrics History Published online 1 August 2005 Published in print 1 August 2005

Hope: The Elusive Element in Healing

Click to increase image sizeClick to decrease image size Additional informationNotes on contributorsMary Eileen FoleyMary Eileen Foley, RGS, M.Ed., C.A.E.S., C.A.PS., is an NACC certified chaplain. She currently serves at Worcester (MA) State Hospital. In addition, she conducts a spiritual concerns group in the psychiatric unit of the University of Massachusetts Memorial-Marlborough Hospital.

American “community” psychiatry

' w e n t to my local library search of definition of .community because I wanted to understand what we mean these days when we refer to services the for individuals ~vith chronic mental illnesses. The best I came up with was, a social group sharing common characteristics, circumstances, and/or interests, perceived or perceiving itself as distinct some respect from the larger society which it exists. Considering this definition, it is extraordinary that the modem thrust of publicsector psychiatry the USA has been the movement of patients from large, public, state hospitals to any setting that is an alternative to those literal or figurative historic edifices, and proclaiming that patients are now in the The state hospitals, such as Worcester State Hospital, which is the prototypic American state hospital, were built throughout the 19th century the USA to create for those deemed at the time to be insane. Under the heading of moral treatment, small number of paid employees attempted to create locus, far removed from the strains and stresses of the life one community, where, through instruction, modelling, teaching and guidance, individuals could learn better self control and respect for themselves and others. Thus, they would come to lead more orderly and reasonable lives the state hospital community. Those who wished could then move from the which they had learned these capabilities to another of their choice--usually the one which they had lived before. These state hospital communities grew to the size of small towns, far beyond the scale envisioned by their originators. Much like more modern urban housing projects, the population over-ran the resources, and the deteriorated to point at which the lack Of habitability and safety mimicked the inhumane conditions that existed the jails, almshouses, and stockades that had housed the insane prior to the building of these state hospital communities. The modern remedy for these intolerable conditions became the tearing down of the state hospitals. Under the same banner as the one under which they had been constructed--ie, doing what is right and saving money-these state hospital communities were destroyed. Although we were actually moving disenfranchised, mentally ill individuals from one to another, we proclaimed we were deinstitutionalising them by moving them from institutions to non-institutional settings. In many cases we accomplished this task; many others we did not. Depending upon the state, the USA has range of settings--with regard to both housing and t reatment-that can provide for the wide range of needs of those with serious and persistent mental illness. And American community psychiatry

From Clinic to Classroom: Power of Experiential Learning

In 1993, after working twenty years as a clinical pastoral counselor and edu cator, I became a full-time teacher in Department of Religious Studies of a small liberal arts college. My academic responsibilities involved teaching both traditional and nontraditional students, in graduate and undergraduate courses. As I prepared to teach, my intuitive sense was that strongest asset I brought to this work was my experience in clinical setting, as student, educator, and practi tioner. The challenge that emerged in my new role was how best to use that experi ence?without turning teaching into ther apy or classroom into clinic. As a third-year seminary student at University of Chicago in 1971,1 took my first unit of clinical pastoral education (CPE), a program that began in 1920s, under direction of Anton Boisen. Boisen, a Presbyterian minister then serv ing as chaplain at Worcester State Hospi tal in Massachusetts, together with Richard Cabot, a cardiologist at Harvard Medical School, founded Council for Clinical Training of Theological Stu dents, organization that ultimately became American Association for Clinical Pastoral Education (Stokes 1985; Thornton 1970). Drawing heavily on the methods of

Witnessing Insanity: Madness and Mad-Doctors in the English Court.

Assistant Professor of Psychiatry; University of Massachusetts Medical School, Worcester; Co-Director, Forensic Service; Worcester State Hospital; Worcester, Massachusetts

Dr. Richard Clarke Cabot: An American Pioneer in Wholistic Healthcare

An anniversary is an important time. It is a time to celebrate and a time to reflect. It is a time to give honor and a time to evaluate. An anniversary is a time to survey how far we have come and to make some projections for the future.Important anniversaries for the Clinical Pastoral Education movement are presently occurring. They are the 70th anniversary of the beginning of the Rev. Anton Boisen's work in Worcester State Hospital and the 125th anniversary of Dr. Richard Clarke Cabot's birth.The significance of Boisen's work has been noted throughout CPE literature and he has been given his rightful place in our history. It is the purpose of this paper to review the work of Dr. Cabot and to portray a fuller picture of his contributions than is generally presented.