The functions of asylum

Article Abstract:

The role of the large psychiatric hospital has diminished. Many functions of large institutions were originally intended to be those of asylum, including the provision of a calm, stable environment to serve as a base for repair, and the provision of protection from stress, competition, exploitation, social isolation and self-harm. A second function, reparation, includes diagnosis and identification of the causes of disability, followed by treatment, rehabilitation, resettlement, and emergency aid. Commonly cited disadvantages of large institutions include overprotection of patients, the need to conform to time-related routines, restrictions of individual choice, and stigma. It is argued that because there are many effective medical treatments available now, and because the view prevails that psychiatric institutions provide little more than protective custody, deinstitutionalization has not been accompanied by a compensatory effort to continue to provide patients with reparative functions. Refuge and recuperation aspects of asylum have been largely ignored and are no longer available to the majority of needy patients. In particular, there are many patients with a variety of mental disorders who wind up homeless or in charitable homes, Salvation Army shelters, or prison, who require the benefits provided by asylum. It is suggested that without a high priority being placed on traditions of asylum in future community service planning, psychiatric services for such needy populations may approach the drastic and miserable conditions of the lunatic asylums and madhouses of the 19th century, but with a new name, "community care". (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Evaluation, Psychiatric services, Mental health services, Mental illness, Mental disorders, Asylums, Psychiatric hospital care, Psychiatric hospitals

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Daughters of people with dementia: expressed emotion, strain and coping

Article Abstract:

Expressed emotion (EE) is a measure of the quality of relationships within families, assessed by ratings of emotional aspects of tone of voice and speech content; ratings are made while listening to one family member talk about another. Twenty-five daughters who were the primary home-based caretakers of an elderly demented parent were studied, in order to investigate relationships between EE ratings and measures of caretaker-related strain and coping strategies. The daughters' ages ranged from 36 to 62 years. The average age of the parents was 82.4 years, and most (21) were women. After being tested, the caretakers were placed in either a high EE or low EE group. The high EE group included daughters who were relatively more hostile and critical of the demented parent. Criticism tended to be evoked by behavior perceived as being deliberate and under the parent's control, such as repetition, messiness and being argumentative, rather than behavior recognized as being involuntary (such as loss of bladder control). The high EE group had significantly higher strain and distress scores than the low EE group, but no significant differences were found between groups in terms of coping strategies. Women who made one or more positive remarks while talking about their parent demonstrated significantly greater use of positive coping strategies than those who made no positive remarks. In general, results suggest that low EE levels are associated with lower levels of strain and distress and with more adaptive coping strategies. At the nine-month follow-up, no relationships were found between EE level and the continuation of home-care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Caregivers, Beliefs, opinions and attitudes, Dementia, Home nursing

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