CHAPTER IV

A SOCIAL SURVEY OF 786 ADMISSIONS TO STATE HOSPITALS

I. INTRODUCTION

In the preceding chapter the attempt was made to point out the shortcomings of the state hospital system insofar as care and treatment in the hospitals themselves are concerned. As has by now become evident, this study aims to consider the patients from all angles, including the care accorded in the place of temporary confinement, particularly in Bellevue Hospital; the care and treatment in the institutions to which they are committed, i. e., the state hospitals; the condition and progress of the patients discharged from the state hospitals; and the work of the after-care or parole agents of these hospitals. Before turning to a consideration of the main topics to be discussed in this chapter, it might be well to give thought to a number of social facts which this study has developed regarding the insane. In the second chapter a table of the marital condition of the patients admitted to Bellevue Hospital, psychopathic wards, was presented (Table 10). From this table it was seen that out of a total of 1,127 patients, 596 or 52.9 per cent were single, 435 or 39.6 per cent were married; and of the males, 25 patients were widowed and 8 divorced; whereas of the females, 53 patients were widowed and 10 divorced. These facts in themselves do not throw sufficient light upon the subject of social needs or upon the possibilities for service among the patients, discharged or otherwise, or among their families.

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II. THE FAMILY OF THE INSANE PATIENTS

In his volume on "The Family and Social Work," Dr. Edward T. Devine points out that the methods and policies of scientifically organized charitable relief have been adopted or rejected according to their profitable effect on family standards, and that it has become an axiom that each individual who is in need of assistance must be considered in his family setting if he is to be helped effectively.1 While this opinion emphasizes relief work, it is equally applicable to all phases of social work worthy the name. How true this is in cases of insanity is only too evident, for in but few other forms of social distress is the family more thoroughly upset and in need of proper advice and guidance. The question of the hereditary nature of insanity has a very disturbing effect on the relatives and immediate members of the family of an insane person when they learn that one of their own flesh and blood has been declared insane.

There were, as has been previously noted, 786 patients admitted to the Manhattan and Central Islip State Hospitals out of the total of 1,127 admissions to the psychopathic wards of Bellevue Hospital. In evaluating the services being rendered a community by its social agencies it is advisable, in justice to the institutions as well as to the public, that the efforts expended in ameliorating social conditions be given a fair trial. A prime factor in such procedure must necessarily be the question of the time permitted to elapse prior to the passing of judgment. It goes without saying that the problem must be very carefully followed out and studied during this time. In this connection, it has been deemed advisable to begin to survey the results of the work of the state hospitals in treating, and when possible curing patients, one year after the admission of a particular group

1 Devine, Edward T., The Family and Social Work, p. 32.

to the institutions. That is, patients admitted to a state hospital on a given date have not been considered subjects for study in the sense outlined in this chapter until twelve months later.

The movement of patients, including death rates, was discussed at length in the preceding chapter and in this connection only facts essential to a proper understanding of the problem as a whole in some of its other aspects will be considered in the major portion of the pages that follow. Since this part of the study concerns itself more particularly with the social phase of the subject, and the aim is to obtain facts and arrive at conclusions relative to the social conditions of the patients and their families, using the term "social conditions" in its broadest sense, the total or 786 patients have been divided into four categories. These are (a) those still in the hospitals at the end of one year—mostly single persons-who have no dependents and no family responsibilities; (b) those still in the state hospitals at the end of one year, who, prior to their admission, had family responsibilities; (c) those who died in the hospitals, whether or not they left minor children or other dependents; and (d) those discharged from the hospitals within a year after admission.

III. SINGLE PERSONS WITHOUT DEPENDENTS, IN STATE

HOSPITALS FOR ONE YEAR

Some consideration has already been given to the very large loss, economic and otherwise, sustained by society in the withdrawal from industry and gainful occupation of thousands of young persons whom it has been found necessary to commit and to detain in hospitals for the insane. Many of these patients are doomed to remain in the custody and under the supervision of the state for many years, if not for the remainder of their lives. Referring especially

to the group of 786 cases already spoken of, it is interesting to note that out of this number there remained in the institutions at the end of one year 244 single persons without dependents. These were mainly young persons with a history of irregularity of employment and with only intermittent periods of gainful occupation to their credit. This may be ascribed to the fact that of the 244 single persons, 151 or 62 per cent had been diagnosed as suffering from one of the forms of dementia praecox, which, as has previously been pointed out, is at the present time considered as being largely chronic in nature. Among the remaining number of cases only 61 or 25 per cent represented patients diagnosed as cases of manic depressive insanity, usually thought of as a recoverable form of insanity.

Little need or can be said pertaining to the social conditions of these patients and their relatives. The former will remain in the hospitals until the doctors feel that they have sufficiently improved mentally to render it safe and advisable to give them the opportunity of attempting to adjust themselves in what we call a normal environment. The state and society are at the present time doing little to aid them in the stressing process of readjustment to difficult living and working conditions.

Under ordinary circumstances it would be fair to assume that in nearly every case there would be relatives and friends ready and willing, as well as prepared, to give the paroled patient every help and chance to redeem himself mentally and physically, and even socially and economically. However, many of these young people came to this country with. the aim of bettering themselves, and in the attempt overworked and broke down after giving the best that was in them to the industries in which they were employed. Having arrived here alone, they usually had no one to turn to upon discharge from the hospitals. This resulted in the

retardation of their full recovery and in increased difficulties in readjusting themselves to alien conditions. This particular phase of the subject will be more fully discussed in the following pages, but it may be apropos to mention at this point that there are organizations in New York that provide positions and other requisites to discharged prisoners, persons who have violated the laws of the state; and yet, for those who have fallen by the wayside as a result of illness, little if anything is attempted in the way of real help and assistance.

(a) Value of Visits to Patients. The patients remaining in state hospitals and having relatives are somewhat better off because of the greater attention they receive through the agency of regular visits paid them and the delicacies and other things brought to them. These are seemingly small matters, but to sensitive individuals who still retain many of their faculties, though they may be in depressed or elated or even stuporous conditions for greater or lesser periods of time, the modicum of interest displayed by visiting relatives and friends helps in the improvement of their mental condition. Foster relatives in the guise of social workers assigned to the state hospitals for work on the wards would go a long way towards breaking the terrible monotony of life in a state hospital, and thus help in the earlier improvement of improvable and recoverable cases. A state hospital superintendent once remarked that if a small group of normal individuals were compelled to remain within a circumscribed area, as in a ward, for any length of time, several if not all these persons would in a relatively short time begin to feel and believe that one or more of the other persons within the confined limits of the four walls had developed an antagonism and even hatred towards the others. This would resolve itself eventually into ideas of persecution and actual psychoses. If such be