Science in Christian Perspective

SOCIAL RELATIONS IN MENTAL THERAPY

From: JASA 15 (June 1963): 60

Frequently the reader views material in this journal with particular interest because of the strong convergence of thinking from various directions. Such interdisciplinarianism can be mutually helpful. One such pertinent item is the article by Dr. Lindquist in the June 1962 issue (pp. 52-53). In discussing therapeutic methods used in Geel, Belgium, for the rehabilitation of mental patients, he makes some observations which are useful for the sociologist. (cf. the notes on sociology in the Sept. 1961 issue.)

The basic proposition seems to be that "association with a healthy personality will have a healing effect on the mentally ill person." The reciprocity of social relationships has been at the core of sociological thinking for some time. The basic question raised by such a proposition is the nature of transference which provides for the healing effect. Is it the process of transference which is healing, or the object? Johnson has indicated that the rehabilitation institution should transfer norms to the inmates to provide for their acceptance in society (Social Forces, May 1960). In the case of mental patients, however, such a provision is inadequate.

Lindquist further states that the ratio of patients to other town inhabitants should be maintained at 1 to 10. If the number of healthy inhabitants were increased, the townspeople would be less aware of the patients and would not know what to do in the case of bizarre behavior. One of the earliest observations of the significance of group size was made by Georg Simmel. He asserts that "the number operates as a classificatory principle within the group" (Tbe Sociology of Georg Sim met, trans. Kurt Wolff, Free Press, 1950, p. 105). If this is so, perhaps the ratio of patients to medical personnel should be further studied for the direct therapeatic results which might be involved.

Another significant observation by Lindquist centers in the fact that each patient may give his viewpoint on possible changes in his status. The implication would be that the patient is capable of distinguishing a possible change in his status, very likely because he is aware that he no longer fits in with the inmate group. Belknap commented in Human Problems of a State Mental Hospital (McGraw-Hill Book Co., 1956) that prestige mental patients determined possible discharge for a fellow inmate since a patient could not be considered for discharge until he was a part of their group.

The theory behind such a view is based on peer group relationships. A patient is put into a mental hospital because he is "rejected" by his non-disturbed peers. In the future~ however, he may also be rejected by other inmates, indicating a possible improvement in his condition. The pattern of acceptance and rejection becomes in indicator of one's potential release from the hospital. In essence, then, Geel becomes a mental institution with an organizational structure far different from that which prevails in our society. Perhaps what is needed is a reevaluation of our hospital structure with the goal of providing an atmosphere which is similar to that of Geel.

Belknap makes several pertinent suggestions to this end. He maintains that modem concepts of psychiatry do not fit well in the hospital environment. They are most suitable for the welfare home where the less structured system provides the proper atmosphere for their use. He also states that mental hospitals should be separated from welfare functions and should be community sponsored with state aid. Such an approach would minimize the bureaucracy which categorizes the patient and treats him with impersonality.

Perhaps most important is the view that ward aides with low status should be given more responsibility. It is they who perform the most significant therapy for the patient. By spending the most time with them, they are most influential in resocializing them to society's values. Johnson would refer to them as "humane enthusiasts" and have them perform the function of bringing the patient into their culture. In essence, this is what is done by the inhabitants of Geel.

Such revised views of our mental institutions stress the need of reorganization. What is needed is a greater development of horizontal rather than vertical structures. The hierarchical bureaucracy of professional per-, sonnel is not as efficient as the person to person contact provided by the aides. The results manifested at Geel would seem to justify such a view. The problem is to develop such an organization which would be appropriate for our society.-Russell Heddendorf.