1 evolution of treatment procedures
1.1 custodial care
1.2 “patient-is-problem” phase
1.3 chemotherapy phase
1.4 community mental health movement
evolution of treatment procedures
the approach psychiatric care @ eastern state hospital has changed on time, reflecting changes in understanding of mental health in more 100 years since hospital’s founding. different approaches psychiatric care @ hospital can divided 4 distinct phases: custodial care phase, “patient-is-problem” phase, chemotherapy phase, , current “community mental health movement” phase.
custodial care
the custodial care phase represents first 5 decades of hospital’s operations. main emphasis of phase isolation or “asylum” of patients, separating them physically world simplify patient lives , protect in community. protected them community, mental illness heavily ostracized , stigmatized in days; though there still significant stigma today, less around start of 20th century. @ point in history there little no understanding of nature of mental illness; considered causes of illness @ time “age, tobacco, constipation, whiskey, , morphia[sic],” , person seen problematic (alcoholics, mentally retarded, suffering depression, criminals) placed in hospital.
this disrespect , lack of understanding of patients can seen in original name of hospital, 1891 opening until 1918 called “eastern state hospital insane.” treatments targeted @ symptoms, , many of treatments ineffective. such treatments included religious actions (prayer, exorcisms, forced religious study, etc.), physical restraint, , other punishments. hospital suffered severe overcrowding , understaffed in period, single attendant being responsible 40-50 patients, working in 12-hour shifts, total of 800 patients in original building. on time, 22 new buildings added hospital complex , population peaked @ 2,274 in 1954. many of these new buildings result of works project administration spending during depression, sought both create jobs , ease overcrowding.
a significant development in therapy came in 1930s. daisy lewis, attendant, gave insulin shot woman didn’t recognize husband nor daughter , “completely oblivious reality.” effects wore off shortly , treatment repeated, gave hope there done patients. despite positive results such treatments had some, had numerous negative effects on patient health. different kinds of convulsive therapies, or “shock therapies” (insulin shock, metrazol shock, electroshock), used manner of patients, these treatments consistent efficacy yet discovered (though effective on small number). overuse clear in hospital’s statement: “during 2 year period in 1950s, on 1,100 patients received 1 of convulsive therapies; altogether, 15,000 treatments administered.”
in world war ii, treatments turned “work therapy” not residing in locked wards, or 80% of total patient population. patients worked between 2 , 8 hours day on variety of tasks, including baking, farming, sewing, gardening, cobbling, landscaping, housekeeping, cooking, , many others. after day’s work, patients received either group or individual counseling; counseling focused on correcting perceived moral or religious deficiencies, seen cause of “demented” condition.
this period of hospital history (as in many other mental health facilities) regarded low point, , hospital officials have stated “must have been frightening place through [those] decades.” through first 5 decades of hospital’s history, number of patients rose steadily, , of them never left hospital. concerns raised when many patients being admitted, , few being reintegrated community; effectiveness of treatment cast severe doubt.
“patient-is-problem” phase
such concerns on hospital’s retention rates of patients led next phase of treatment styles @ hospital, “patient-is-problem” phase, 1941 1954. treatment began incorporate freudian theory of causes of mental illness, , focused on individual patient’s thought processes, formative experiences, , genetic factors. significant factor in approach came returning world war ii soldiers , medics, had front line experience of mental trauma caused war. on front lines, these groups developed methods first-response, short-term crisis therapy in distress allow them return battlefield. interest in understanding mental illnesses increased group therapies found effective, , research military medical personnel , social workers increased through both world war ii , korean war (1951–1954).
chemotherapy phase
the third reworking of hospital treatment policies began in mid-1950s, ushered in new availability of psychotropic drugs. while saw new use of pills treat mental illness little more “chemical strait jackets,” allowed large number of patients released , being reintegration community. hospital’s 12th superintendent dr. g. lee sandritter stated, “as long hang on patient, won’t well.” thus, new policy patients kept in hospital long medically necessary before being released , reintegrated. sandritter fired in 2nd year amidst controversy. spokesman review had run number of articles alleging misconduct @ hospital under supervision, including runaways , sexual misconduct between staff , patients. unclear how of these allegations based in fact, , how many generated hysteria on sandritter’s loosening of hospital policies confining patients; primary sources of accusations “disgruntled employees,” according official hospital literature.
these liberalizing policies continued sandritter’s successor, dr. harris bunnell. volunteer program started integrate hospital public, , in 1965 on 2400 visitors came hospital, helping lessen “asylum” stigma had plagued long. patient population falling dramatically; 1970, hospital @ quarter of peak 1950s numbers @ around 500 patients, number not seen hospital since 1907. treatment responsibilities released patients delegated community mental health centers, established locally under guidelines established federal legislation.
the community mental health movement
this phase, continues today, catalyzed new legislation in congress. mental health study act, passed congress in 1955, established joint commission on mental illness , mental health evaluate mental health treatment in united states. commission’s recommendations reforms incorporated, in large part 1963 community mental health act. act provided federal grants state , municipal governments establish community mental health centers deal outpatient treatment of mentally ill.
many not accepting of newly released mentally ill in communities, , discrimination common , institutional: released patients not vote nor hold driver’s licenses, despite having been declared “sane.” changed in 1974, when washington state legislature passed laws guaranteeing equal constitutional rights patients. treatment of mentally ill today increasingly done on outpatient basis, , esh focuses predominantly on more severe cases, providing space group therapy , workshops. hospital today has room 312 patients, , has 700 staff; 100 patients admitted on monthly basis.
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