1 - Disease and the social environment

Summary

The study reported in this book is concerned entirely with long-stay schizophrenic patients, but the ideas which inspired it, and which it was designed to test, have a much wider relevance. Institutionalism is a sociological concept which can be applied not only to schizophrenia and to mental hospitals, and not only to artificially segregated communities, but to familiar and everyday social events which affect all of us. A study of the relationships between institutionalism and schizophrenia may therefore illuminate problems which are of interest well beyond the confines of medicine, as well as throwing light on matters of contemporary concern or controversy in social psychiatry.

Such wide-ranging interests are a handicap in reviewing the literature because so much in the fields of anthropology, sociology, social psychology, psychology and psychiatry is relevant. We can attempt, in this chapter, only to give a personal (that is, a highly selective) impression of some of the ideas and studies which have influenced us. We are basically interested in the interaction between social and clinical events, so that social psychological and social psychiatric studies will be considered in most detail. The sociology of institutions (particularly of institutions without an ostensibly medical function) must be mainly left aside. This means that methods of structuring the staff environment so that patients are treated in an optimally therapeutic way are not discussed in detail. We are mainly concerned with the effect of techniques which could be used by staff to influence patients, rather than with attempts to ensure that these techniques are actually used. That is, we are not primarily interested here in staff organisation or with teaching.