The British Journal of Psychiatry November 1975 [antikvár]

Brit. J- Psychiat. (1975), 127, The Assessment of Social Breakdown in Newly-Admitted Psychiatric Patients By RÓBERT CLEMMEY, DÁVID KENNARD and BERTRAM MANDELBROTE Summary. This paper presents a study of patients' social and domestic functioning preceding admission to a psychiatric hospitál. A method is described for the quantitative assessment of 'social breakdown' in the areas of work, domestic performance and social group activity, based on reports from the patient and from another household member. Complementary changes in the domestic tasks carried out by other family members are alsó investigated. The sample consisted of 28 women and 17 men. Their usual level of functioning and their degree of breakdown are related to psychiatric diagnosis on admission, to the patient's position within the family and to the social class of the household. Discrepancies between reports are alsó investigated in relation to these variables. 'The value of the person may be measured by his capacity to accomplish chores.' Pierre Janet Introduction Admission to a psychiatric hospitál can be seen as a particular stage in a process of progressive social breakdown. Gruenberg (1969) has described a 'Social Breakdown Syndrome': a sequence of stages beginning with the failure to fulfil social role expectations adequately and leading to increasingly disorganized attempts to meet such expectations. If unsuccessful, 'extrusion' from home and society into a psychiatric hospitál may follow, accompanied by the patient being labelled as 'mentally ill\ If the syndrome is unchecked progressive institutionalization will take place. Caplan and GoíTman have outlined similar processes, Caplan (1961) focusing on the earlier 'Crisis' phase, and Goffman (1961) on the 'Career' of the person who finds himself funnelled into a psychiatric hospitál. Explicit or implict in the writings of these authors are certain assumptions: 1. That a progressive failure to fulfil the normál roles expected of a person, both by himself and others, will be a frequent if not invanable precursor to admission to a psychiatric hospitál. 2.That the part played by others who are closely involved with the patient will be important, if not crucial, in bringing about admission. 3.That it is not always necessary to invoke the concept of 'illness' in order to understand the reasons for a person's admission to a psychiatric hospitál. Social breakdown-and reactions to it-may be sufficient reason in itself. These assumptions reflect a growing awareness of the importance of environmental and interpersonal factors in the causation and treatment of 'mentái illness'. Within psychiatric hospitals this awareness is often most in evidence in wards and units employing the Therapeutic Community approach (Clark, 1965). Staff working in such units usually place less emphasis on diagnosis than those working in more orthodox units; emphasis is placed instead on the patient's ability to function as a responsible member of the 'community', irrespective of his particular problem or symptoms. Frequently, attempts are made to involve the patient's relatives in the treatment setting. 4'7 t