Social. Recreational. Diagnosis. F. H. When patient was out of work, home found for her and board and incidentals paid for by agency. Suitable employment found for patient; sent to trade school; given English lessons at home by worker, as patient complained that lack of sufficient knowledge of language caused her much worry. Visited places of employment and interested employers in patient. Taken for walks to places of amusement; given tickets to concerts; interested in club work. Result Despite all attempts of physician and worker to help patient, she persisted in drinking, going to cabarets with chance acquaintances, painting, dressing in a vulgar way, etc. Worker could not obtain cooperation of brothers when it was seen that she was heading towards a life of immorality, as they persistently refused to sign commitment papers. During periods of depression, patient would come to office of agency in a drunken condition, create a disturbance, and threaten to kill several of the workers. Admitted she was leading an immoral life, but nothing could be done by worker to have her committed because of attitude of brothers and of physician in psychopathic ward. Was finally arrested for soliciting on the streets and sent to Bedford Reformatory for three years. CASE 24 Constitutional psychopathic inferiority with episodes of excitement. Father nervous and irritable. Male; age 18; born in U. S.; clerical worker. For six months prior to admission of patient to psychopathic ward, he showed an inability to get along with his parents and brothers, with spells of irritability; lacked efficiency at work. On ward was emotionally unstable, with some depression; had considerable insight into his condition which he ascribed to excessive masturbation. Mental. Physical. Recreational. Method Patient was committed to a state hospital, as his parents insisted they could not cope with him. Remained in hospital for eight months, was well-behaved and occupied as a messenger about the institution. After discharge referred to clinic; found to have improved while in hospital; advised regarding personal habits, etc. Within a few weeks parents returned patient to hospital, complaining he had again become irritable and unable to get along at home. Paroled within a few weeks; in about two months returned to hospital of own accord; sent to city on an errand and failed to return to hospital. Came to clinic and showed some signs of improvement, though unusually talkative. Returned to hospital of his own accord within a few months, as he felt better there than at home. Though hospital physicians were willing to discharge him within a few weeks after last admission and patient requested his discharge, parents refused to take him home until he was in a much better condition mentally. Prescribed at clinic for slight physical ailment. Obtained employment for patient when he was out on parole from hospital. Main effort was to educate parents to a proper understanding of the patient and how to care for and treat him when he was at home. Advised regarding suitable forms of recreation. Result Patient has had to return to and remain in the state hospital because of inability of parents to understand and care for him during periods when he was irritable. Lack of cooperation of parents largely responsible for hospital residence of patient. Poor, dirty home in a crowded tenement district contributing factor to irritability of patient. Could not induce parents to move to a better neighborhood for sake of patient, as father had business interests which he felt he could not sacrifice. Impossible to obtain cooperation of parents to have patient boarded in a better Diagnosis. P. H. Psychosis. Mental. Physical. Recreational. district and home. Necessary to wait until patient becomes older and his earning capacity will increase sufficient to render it possible for him to be entirely self-supporting when living away from home. CASE 25 Constitutional psychopathic inferiority. Female; age 20; born in U. S.; typist; unmarried mother with one child; seduced at 18 years by an Italian. Following death of father, sent to orphan asylum at age of ten years. Showed kleptomaniac tendencies at orphan asylum; after discharge at age of fifteen consorted with gang of thieves, acting as female accomplice. Finally arrested, sent to City Prison to await trial; actions and behavior caused transfer to psychopathic ward for observation and examination; found that she was not a committable case though subject to mild disturbances of short duration. Paroled by court and referred to mental hygiene agency. Method Examined at clinic regularly and advised. Given clerical work; board paid as long as was necessary; clothing provided; baby boarded with its father's relatives; worker saw patient regularly for two years and at intervals for several years thereafter; obtained a stenographic position. Advised very carefully. Result Patient has had a regular position for several years as stenographer in the government service, salary $1200 per year; pays board for child, of which she is very fond. Consistently refuses to marry father of the child; has had no difficulties for several years; thoroughly adjusted. The presentation of these twenty-five cases, even though in outline form only, should give to the reader a comparatively fair conception of the problems that are faced by physicians and social workers in the clinics of an organization specializing in the social service side of mental hygiene activities. The various combinations of circumstances, though numerous as far as these few cases are concerned, do not exhaust the wide range of possible problems that arise in dealing with mental hygiene patients. The attempt has been not to present selected and chosen cases, but rather to indicate as far as possible what amounts to a cross-section of the work in its various phases. Lack of space alone prohibits the presentation of one hundred or more cases, in each of which a particular set of problems need solution. Every mental patient and his family are the source of a new group of difficulties; and although certain of these can be pigeonholed as it were, still each patient must be studied separately, a plan for serving prepared and without hesitation modified as the exigencies of the developing situations demand. CHAPTER VI RecommendATIONS AND CONCLUSION I. SHORTCOMINGS OF SOCIAL SERVICE THE activities of most social service agencies depend for their efficacy and sphere of influence for good in a community upon the funds available from year to year, upon the personnel, the equipment with which they have to work, and the moral support of the socially minded persons whose interest is aroused in their work. This is as true of a mental hygiene as of any other agency. In a large community like New York City, there is never a dearth of patients; the problem is rather to obtain sufficient funds to maintain clinics in different parts of the greater city and to render both medical and social service of a high order. From the cases cited in the preceding chapter it was seen that, at least with some types of patients, such as those afflicted with manic depressive insanity, much can be accomplished and the patients saved from commitment to a state hospital for the insane. Social service has been less successful with cases of dementia praecox, general paralysis, paranoid conditions, psychoneuroses and others. This lack of success corresponds to the failure of the state hospitals to improve the mental condition of patients similarly diagnosed. From one point of view, however, this comparison is not altogether justified. Social service with mental cases aims to achieve just what state hospitals have thus far failed to accomplish; if, therefore, psychiatric social work is to develop upon a firm basis it must prove its utility as an important and distinct factor in increasing the ratio of re 228 [370 |