Having carefully selected the staff for each clinic, it becomes necessary to determine upon the scope of work which the agency operating the clinics deems it can successfully carry through. The two clinics maintained by the social service department of the Free Synagogue at a cost of about $6,000 per year for each clinic, aim to render the following services to all those who are referred to them by various individuals and social agencies in the community: 1. To treat psychoneuroses and all so-called borderline cases of mental diseases in adults and children. 2. To inform the wage earners and others truthfully about conditions for the care of the insane in the state hospitals, to explain the significance of commitment to them and to assist them in committing proper cases to the state hospitals as well as to private sanatoria, suitable to the needs of the patients and the means of the family. 3. To make careful individual study of each case by keeping in close touch with the individual and his surroundings. 4. To arrange for the social care of both patient and family whenever social needs appear. 5. To facilitate the convalescent care of patients in need of this service, especially of those discharged from institutions. 6. To assist convalescents and others in obtaining suitable employment and to aid in readjusting them to their environment. To carry out the program as outlined above, it becomes necessary to call for the cooperation of various agencies in the community, such as orphan asylums, child-placing institutions, relief organizations, convalescent homes, general and special hospitals for the treatment of physical ailments, employment agencies, and a number of others, all of which have been found to be essentials in properly caring for mental hygiene cases. The Free Synagogue clinics and those associated in their work, do what they themselves can in providing for the mental, physical, social and recreational needs of the patient and the family of which he or she is a part. The cooperation and help of other agencies is sought whenever it is felt that the patient or the family is in need of such additional service as the mental hygiene agency is not as yet prepared to render, or as is altogether and properly the function of another type of agency. IV. TYPICAL CASES OF A MENTAL HYGIENE AGENCY The kind of cases that are referred to a mental hygiene agency are naturally of many sorts and include practically all varieties and classifications. In the activities of such an agency, decision must be made at an early period as to the kinds of patients that can be more or less successfully treated and served, and as to which categories must be referred to other agencies and institutions. Thus, it has been found in the clinics mentioned that all mental defectives must be referred to other organizations, as the attempt is to deal only with such cases as present definite psychoses or neuroses, or a borderline condition of either of these groups of ailments. In the pages that follow, typical cases that have been referred to and served by a mental hygiene agency over a period of years will be presented in outline form. Because of the fact that certain types of patients predominate not only in the psychopathic wards and in the state hospitals, but also in the mental hygiene clinics as well, several cases will be presented under certain headings and only one or two under such classifications as appear less frequently in the admissions to hospitals and clinics. A word should be said regarding the outline according to which the study of the cases was made. Following the usual order adhered to in state hospitals for the insane, the diagnosis is presented first; then follows as much of the family history regarding insanity in the family as has been ascertained; the personal history of the patient; and a statement regarding the onset of the psychosis. This ends the first divison of the outline. In the second part or division, is presented the method pursued by the mental hygiene agency in attempting to serve the patient and his family, and the work done to meet or help solve the mental, physical, social and recreational problems of the patient and his dependents. Finally, the result of the care bestowed upon the patient and his family by the mental hygiene agency and the other organizations and institutions whose services had to be called upon, is stated in a thoroughly unbiased way. Diagnosis. Family Onset of V. CASE STUDIES MANIC DEPRESSIVE INSANITY CASE 1 Manic depressive insanity, depressed type, with psychoneurotic symptoms. Sister of patient in a state hospital for five years with a diagnosis of dementia praecox. Male; age 35; born in Russia; came to United States 21 years ago; clothing operator; has wife and seven minor children. A few weeks before coming to the clinic, patient was riding in the subway and suddenly his head began to pain, he felt dizzy and could not go home alone. His whole body shook; could not sleep at night; felt sick and like crying all the time. His condition was worse in the morning than later in the day. Hands felt weak and became easily tired; was depressed; felt as if he had a wound on top of his head. Had feeling of inadequacy. Had been nervous and tormented by peculiar sexual ideas for several years. Method Mental. Physical. Social. Recreational. Patient came to clinic a number of times within a few months, but showed no improvement. Insisted he wanted to enter a state hospital as a voluntary patient as he could not remain at home with his wife and children, for they aggravated his condition. Did not merely want to stay away from home but also to be where his wife could not come to see him regularly and annoy him. Arranged for patient to enter a state hospital on a voluntary commitment. Remained there about nine months, leaving the institution in an improved condition. He returned home to his family and worked for a year as a newsstand attendant. Suddenly left his work and returned as a voluntary patient to the state hospital, where he has remained for about a year. He does not wish to go home as he fears to assume the responsibility of caring for his large family and to live with his wife. Mother of latter died in an insane asylum and daughter is nervous, high-strung, hyper-sexual, and makes unusual sexual demands upon her husband when he is at home. Patient prefers to remain in the state hospital until he has fully recovered; has shown marked improvement and expects to leave the institution within a few months. Little was necessary to be done for the patient, except to give him a thorough physical examination and assure him there was nothing wrong with him physically. Looked after the physical conditions of wife and children; provided set of teeth for wife. Wife of patient insisted that she could not care for seven small children when her husband was away from home, as they made her very nervous. To prevent a breakdown, two children were committed to an orphan asylum. This relieved mother greatly. Family provided with rent, living expenses, clothing, etc. during time that patient was and has been in state hospital. Children sent to vacation homes during summer. When out of hospital patient was advised and encouraged to take long walks, to pass spare time in parks, etc. Recreation provided for wife and children. Result Patient still in state hospital, and is expecting to return home within a few months in a much improved condition. Social service work has aimed properly to care for family while the patient was in hospital, to adjust the family preparatory to his homecoming, and to educate the wife as to what should be her proper attitude towards patient when he returns from the hospital. Frequent visits made to patient in hospital by worker to help him develop a greater sense of responsibility towards his family and a better understanding of his wife. CASE 2 Male; age 38; born in Austria; U. S. 18 years; clothing operator; married; wife and five minor children. For three years patient suffered cramps in abdomen and pains in upper and lower limbs. Following death of sister-in-law became very nervous and upset; could not sleep; imagined he saw the dead woman. Became depressed and quiet. Year and a half before coming to clinic had an attack of manic depressive insanity, lasting for a few days. While at work became excited and mixed up; did not sleep for a few nights. Later complained of pains on top of head, sleeplessness and inability to tolerate any noises. Had suicidal thoughts; occasionally things became dark before his eyes; noises in ears; while at work and away from home imagined some calamity had befallen family. Method Patient reported at clinic every two weeks for several months; later, as mental condition improved, these visits were made every month or two; patient visited regularly at home by mental hygiene worker. Wife of patient developed a sympathetic condition and also had to be treated at clinic. Family under care for three and a half years. |