Illness behaviour and children's hospitalization: A schema of parents' attitudes toward authority

Sot. Sci. & Med. 1972, Vol. 6, pp. 447-468. Pergamon Press. Printed in Great Britain

ILLNESS

BEHAVIOUR AND CHILDREN’S HOSPITALIZATION: A SCHEMA OF PARENTS’ ATTITUDES TOWARD AUTHORITY* DAVID ROBINSON

Addiction

Research Unit, Institute of Psychiatry,

101 Denmark Hill, London S.E.5

Abstract-This paper reports some of the findings of a project concerned psychiatric aspects of the welfare of children in hospital.

with social and

INTRODUCTION “The morbid episodes of life. . . symptoms, illnesses, disabilities as well as their attempted cures . . . cannot be regarded as purely physiological processes. Their full understanding requires a systematic consideration of the social and psychological context in which the episodes occur. . . . In fact, it requires that the changes of health and illness should be viewed against the total background of daily life . . . . .” Kosa, [l] p. 1.

IT HAS become

quite obvious from the large body of literature in the field of illness behaviour that physiological states are not the sole criteria for determining whether or not a person considers himself ill [2], is considered to be ill [3], presents himself to professional medical services [4], or is admitted to hospital [5]. By “illness behaviour” Mechanic [3] meant that “the ways in which given symptoms may be differentially perceived, evaluated, and acted (or not acted) upon by different kinds of persons”, for “whether we are concerned theories or those for bringing understand the influence of a ments on how a symptomatic

with the necessary conditions for building adequate etiological treatment to those in need of such help, it is necessary that we variety of norms, values, fears and expected rewards and punishperson behaves.” p. 189.

The concern with differential behaviour applies not only to the symptomatic person but also to all other people involved in the illness situation. This is particularly important, of course, in the case of children’s illnesses since most of the contact between child patients and professional medical services, and almost all other illness behaviour, is initiated by other people. Although much is known and written about child patients, their behaviour, their needs and their treatment, very little is known systematically about the attitudes and behaviour of their parents. Following Cartwright [9] and Freidson [lo] it was felt from the outset that attitudes about authority would be closely associated with mothers’ attitudes and behaviour in the hospital situation. With this in mind two authority dimensions were concentrated upon; “readiness to accept hospital authority” and “authoritarianism”. From the preliminary analysis of data it appeared that the two authority dimensions were unrelated to each other. This paper sets out details of the relationship between attitudes * The Social ham) Conf.

work was financed by the Ministry of Health (C/141/2) and carried out by members of the School of Studies, University College, Swansea. (Robinson, [6], Pill [7] and R. Dearden M. D. thesis (Birmingin preparation, Stacey et al. [8]). This is a revised version of a paper prepared for the First Znt. Sot. Sci. and Med., Aberdeen, 1968. 447

DAVID ROBINSON

448

toward authority and other attitudes and behaviour in the hospital situation, attempts to explain why the two authority dimensions are unrelated, constructs four authority categories, suggests how, by an extension of the role mastery theory of authoritarianism, such a schema could have more general relevance, and points to certain implications for the study of illness behaviour and the well-being of young children in hospital. METHODS

This discussion is based on material from the wide ranging structured interviews of a social survey. Two samples of mothers were interviewed. (i) 337 mothers whose under 5-year-old children had been hospitalized in one of seven South Wales hospitals during 1964 (the hospital sample) and (ii) 276 mothers, with under 5-year-old children, who had never had the experience of having a child hospitalized (the non-hospital sample). The mothers were differentiated, therefore, solely on the basis of their children’s hospitalization record. Since this was a survey using structured interviews, and since attitudes toward authority was only one of many factors which was of interest it was necessary to have short and easy methods for placing people on these two dimensions. Sanford’s [l l] shortened version of the Californian F Scale [12] was used to measure authoritarianism. The assumption had to be made that it differentiated people with respect to authoritarianism in the same way that the original version (Forms 45 and 40) would have done.* Acceptance of hospital authority was measured by the paired sentence technique developed by Ingham [13] from a procedure devised by Shapiro [14]. The four-sentence battery, arranged in order from statement 1, admitting greatest readiness to accept hospital authority to statement 4, admitting least readiness to accept hospital authority, was: 1. 2. 3. 4.

It It It It

is is is is

always best to accept without question what the hospital says, often best to accept without question what the hospital says, rarely a good thing to accept without question what the hospital says, and never a good thing to accept without question what the hospital says. THE

TWO

AUTHORITY

DIMENSIONS

In some instances there was an association between a high score on both of the authority factors and some other attitude or piece of reported or projected behaviour. On other occasions, however, there was no association. It was clearly necessary, therefore, to try to explain the relationship between authoritarianism and readiness to accept hospital authority. Table 1 sets out details of the basic distribution on these two factors and shows that there was no significant relationship between them. This is particularly true of the hospital sample.

* It was necessary to make this assumption since the following discussion is in part based upon Adorn0 et al.‘s system of variables which they saw as going to make up the authoritarianism syndrome. Thii shortened version has been assumed to measure authoritarianism in other places, and studies which have used it have been referred to elsewhere as measuring authoritarianism and using the F Scale. See, for example, Inkeles [15] p. 55.

Illness Behaviour and Children’s Hospitalization

449

TABLE 1. AUTHORITARIANISMANDREADINESSTOACCEPTHOSPITALAUTHO~

Readiness to accept

Most authoritarian No. %

Mid

Least

No.

%

No.

%

Total

A. Hospital sample Most ready Mid Least ready Total

65 16 68 149

43.6 10.7 45.6

33 11 35 79

41.8 13.9 44.3

32 16 43 91

35.2 17.6 47.3

130 43 146 319*

B. Non-hospital Most ready Mid Least ready Total

61 13 40 114

53.5 11.4 35.1

23 11 18 52

44.2 21.2 34.6

44 17 44 105

41.9 16.2 41.9

128 41 102 271t

Sample

* Eighteen of the hospital mothers either did not answer or gave inconsistent answers to the questions on acceptance of hospital authority. Two of them also did not answer the authoritarianism question. t Four of the non-hospital mothers did not answer or gave inconsistent answers to the questions on acceptance of hospital authority, while one other mother did not answer the authoritarianism questions. ACCEPTANCE

OF HOSPITAL

AUTHORITY

The series of paired sentences prepared specifically for this study did appear to measure what it was purporting to measure. It is seen in Table 2, how mothers who said that it is always best to accept without question what the hospital says had less complaints than other mothers about their children’s hospitalisation, were less likely to complain if they did have a complaint, and if they did complain were more likely to be satisfied. TABLET. COMPLAINTANDMOTHERS'READINESSTOACCEPTHOSPITALAUTHORITY

Accept

Mid

Not accept No. %

No.

%

No.

%

30 100 130

23.1 76.9

11 32 43

25.6 744

55 91 146

37.7 62.3

96 223 319

Complained Did not Total

14 16 30

46.7 53.3

7 4 11

77.8 222

32 23 55

58.2 41.8

53 43 96

Satisfied Not satisfied Total

7 7 14

Total

A. Had a complaint Did not Total B.

C.

2 5 7

8 24 32

17 36 53

In addition, these mothers were least critical of the ward visiting arrangements, their children’s treatment, the nurses, and the amount of in-hospital information they received.* * See Appendix A.

450

DAVID ROBINSON

Although the paired sentences dealt explicitly with “accepting without question what the hospital XZJLS” it is clear that it was not only the word of the hospital which was accepted. The accepters tended to accept the hospital regulations, the authority of the hospital personnel, and everything about the hospital. In short they tended toward the position of one of Coser’s [16] “primary orientated” patients who summed hospital up by saying that “everything is as it should be” (p. 107). AUTHORITARIANISM

Would authoritarians tend to believe of a hospital that “everything is as it should be?” If so, then there should surely have been a closer relationship between the two authority dimensions. If not, then what is an authoritarian’s attitude toward hospital authority? The basic content of the original Californian F Scale was made up of a number of variables.” These were thought of as going together to form a single authoritarianism syndrome. However, not all the nine variables were directly concerned with authority in the form of “an authority” such as “hospital authority”. The meaning of authoritarianism is more diffuse than that of the particular dimension “acceptance of hospital authority”. Nevertheless 19 of the 29 statements making up the final composition of the F Scale (Forms 45 and 40) are concerned with the three variables which seem to be most closely related to the acceptance of hospital authority dimension, namely; “authoritarian submission”, “authoritarian aggression”, and “power and toughness”. Why then is there no relationship between respondents’ position on these two authority scales ? The reason lies in the nature of authoritarianism where, as Adorn0 et al. [12] say“ambivalence is all-pervasive, being evidenced mainly by the simultaneity authority and readiness to dominate those who are deemed weak.”

of blind belief in p. 759.

These

two variables

go to make

up what is described as the “power complex”. This is

“a disposition to view all relations among people in terms of such categories as strong-weak, dominant-submissive, leader-follower . . . it is difficult to say with which of these roles the subject is the more fully identified. . . in short, the power complex contains elements that are essentially contradictory, and we would expect that sometimes one feature and sometimes another willpredominate at the surface 1evel.t We should expect that both leaders and followers will score high on this variable, for the reason that the actual role of the individual seems to be less important than his concern that leader-follower relations shall obtain.” A.P. 237.t * These variables are listed below with a brief definition of each, (see The Authoritarian Personality, p. 228). (a) Conventionalism: Rigid adherersive to conventional values. (b) Authoritarian submission: Submissive uncritical attitude. (c) Authoritarian aggression: Tendency to be on the lookout for, to condemn, reject, punish people who violate conventional values. (d) Anti-intraception: Opposition to the subjective, the imaginative, the tender minded. (e) Superstition and stereotypy: The belief in mystical determinants, the disposition to think in rigid categories. (f) Power and toughness: Preoccupation with the dominance-submission, strong-weak, leader-follower dimension. (g) Destruction and cyncism: Generalized hostility, vilification of the human. (h) Projectivity: The predisposition to believe that wide and dangerous things go on in the world, the projection of unconscious emotional impulses. (i) Sex: Exaggerated concern with sexual “goings on”. t My emphasis. t A.P. followed by a page number refers throughout this paper to Adorn0 et al. The Authoritarian Personality.

Illness Behaviour and Children’s Hospitalization THE

RELATIONSHIP

BETWEEN

THE

TWO

AUTHORITY

451 FACTORS

The “elements that are essentially contradictory” and the “all-pervasive” ambivalence of the authoritarian position account for the absence of any relationship between an individual’s position on this scale and their position on the “acceptance of hospital authority” dimension. The acceptance dimension represents something akin to the authoritarian submission variable of the authoritarianism syndrome, and, as we have seen, this is only one facet of the power complex. The hospitalization of a child is likely to place an authoritarian mother in a situation which contains these essentially contradictory elements; namely, the opportunity for (authoritarian) submission to the authority of the hospital and (authoritarian agression toward, or) dominance over, her child and things affecting her own position. As Adorn0 et al. pointed out “sometimes one feature and sometimes another will predominate

at the surface level.”

It is suggested in this paper that those authoritarians who score at the accepting end of the acceptance of hospital authority scale are predominantly submissive in the hospital situation whereas the non-accepters are predominantly aggressive. It is argued that there is no reason to expect there to be any association between the two dimensions since they are concerned with essentially different facets of the authority situation. On the one hand the F Scale differentiates between people with respect to their tendency to see human relationships and situations in terms of a power complex of leaders and followers, strong and weak, dominance and submission. On the other hand the acceptance of hospital authority scale identifies, in a particular situation, which feature of the essentially contradictory authoritarian position predominates at the surface level in terms of particular attitudes and behaviour. Turning to the low scorers on the F Scale, the anti-authoritarians, the authors report that “‘protesting’ and ‘easy-going’ low scorers apparently occur most frequently” (A.P. 771). The easy-going low scorer “is characterized by a marked tendency to ‘let things go’, a profound unwillingness to do violence to any object . . . and by an extreme reluctance to make decisions” A.P. 778.

It is suggested here that the Easy-going low scorer would willingly accept without question what the hospital says. The protesting low scorer, on the other hand, would tend to be a non-accepter of hospital authority for, say the authors, “the protesting low scorer has much in common with the Authoritarian high scorer, the main difference being . . . the conscientious rejection of heteronomous authority instead of its acceptance” A.P. 771. THE

FOUR

CATEGORIES

Returning to the authoritarianism by acceptance of hospital authority matrix it is now possible to identify the four authority categories discussed above. Table 3, which repeats section A. of Table 1, sets out the distribution for the hospital sample.

452

DAWD ROBIBSON TABLE3. AIJ~HO~UTARIANI~M ANDREADINESS TOACCEPTHOSPITAL AUTHORITY-HOSPITAL SAMPLE Readiness to accept hospital authority Most ready (1, 2) Mid (3,4) Least ready (5, 6) Total

Most authoritarian No. 65 16 65 149

Least authoritarian No.

Mid No. 33 11 35 19

32 16 43 91

Total 130 144: 319

Since the authoritarianism classifications were based on the scores from a six question battery there was not a very great spread of scores. The mid-authoritarian all had the same composite total. It is inevitable, therefore, that only the Most Authoritarian and Least Authoritarian groups can be dealt with at this stage. On the acceptance-of-hospital-authority dimension, however, there was enough end-clustering to allow the respondents, for purposes of analysis, to be divided into just two groups. * It is now possible to create the four categories discussed in the previous sub-section from the basic distributions on the two authority scales. These categories are displayed in Table 4.

TABLE4. AUTHOIZI~ CATEGORIES F Scale Most authoritarian Acceptance of hospital authority scale

More ready to accept (l-3) Less ready to accept (4-6)

Where Category I = Category II = Category III = Category IV = and

The The The The

Least authoritarian

I

III

II

IV

Submissive Authoritarians Authoritarian Rebels Easy Going Low Scorers Protesting Low Scorers

Table 5 shows the distribution of the hospital and non-hospital mothers among these four categories.?

7 The paired sentence technique results in six categories being created. For purposes of analysis these six were combined to form three larger groups in Table 3 (l-6). For the following discussion they are combined to form just two groups 1-3, and 4-6. * It is filly realized that, by leaving out the respondents who were classified as Mid Authoritarians, approximately a quarter of both the hospital and non-hospital samples are eliminated from the following discussion. However, it was felt that since a shorthand measure of authoritarianism was used, which discriminated rather weakly, it would be less useful for any further discussions along these lines to force the middle group into one or other category than to eliminate it and thus keep the categories to some extent “pure”.

Illness Behaviour and Children’s Hospitalization

453

TABLE 5. DISTRIBUTIONAMONGTHEAUTHORITYCATEGORIES

Hospital sample I 73 II 76 Non-hospital

III IV

37 54

III IV

53 52

Total 240

sample

I II

219

The following sections display the relationship between a mother’s position in one of the four authority categories and her other attitudes and behaviour in relation to the child-inhospital situation. CATEGORY

I “THE

SUBMISSIVE

“The subject achieves his own social adjustment subordination.”

AUTHORITARIAN”

only by taking pleasure in obedience and A.P. 759.

The mothers in Category I were seen to subordinate themselves to the authority of the hospital by both their attitudes and their actions. Firstly, they were least critical of the hospital regulations, treatment and personnel. They had least complaints* (i)’ were least critical of the nurses, (ii) were most ready to say that their children had been looked after properly in hospital (iii)’ and were most satisfied with the visiting time in operation (iv) (v) and the amount of in-hospital information which they received (vi)“. In addition to being least critical the mothers in this category were reluctant to take action if they did have any criticism to make. Apart from Category III they were least likely to ask for information when they felt that they did not have enough (vii) and, after Category III, were least likely to complain if they had a complaint (viii). Not only did this category avoid complaining to the hospital staff, but they tended to avoid the staff altogether. They were less likely than categories II and IV to speak to the doctor in charge of their children’s case (ix)’ and were least likely also to know the name of the surgeon who performed their children’s operation (x). In addition they had the highest proportion of mothers who actually said that it was not important to speak to the doctor in charge (xi).’ The general attitude of the mothers in this category was one of quiet satisfaction with the hospital and everything to do with it. They obviously felt that they were least likely to visit their children all the time that they were allowed to (xii), had the smallest proportion of mothers who said that it was necessary to visit children in hospital as much as possible (xiii), and were most likely to be satisfied if they did complain about something (viii). The great difference between the personal characteristics of this and the other three categories is that the “submissive authoritarians” score much higher on the fear of being hospitalized dimension (xiv).” The mothers in Category I were also much more likely than mothers in any other category to say that they would consult their doctor straight away in the event of their children’s minor ailments (xvi).’ * The Roman numbers in parentheses refer to tables in Appendix significance. 1 = p < 0.05; z = p -c 0.01.

B. Numerals refer to x2 test levels of

DAVDDROBINSON

454

Thus, the portrait of the ideal type submissive authoritarian four main features :

in the hospital situation has

Anxiety about their children and their own position in relation to the hospital. This is coupled with a tendency to be more concerned than any other group about the illness itself as opposed to anything else when their children were admitted to hospital (xvii). This tendency to be more aware of and concerned about illness and symptoms seems to lead to these mothers being more ready than other mothers, to consult a doctor about their children’s minor ailments. Although these mothers are most ready to consult a doctor outside hospital they have less contact with doctors in hospital than other mothers. This stems from their tendency to leave well alone in hospital and accept without question what the hospital does. Not only are these mothers least likely to have a complaint about anything to do with their children’s hospitalization, and are least likely to complain if they do have a complaint but they are also more likely than any other group to say that they saw changes for the good in their children after their return home (xviii). CATEGORY

II “THE

AUTHORITARIAN

REBEL”

“Instead of identification with parental authority ‘insurrection’ may take place. . . . This may lead to an irrational and blind hatred of all authority,. . . . It is exceedingly di&ult to distinguish such an attitude from a truly non-authoritarian one.” A.P. 162.

In contrast to the submissive authoritatians of Category I the “rebels” of Category II were reluctant to subordinate themselves to the authority of the hospital. Just as Category I said they were satisfied with hospital regulations treatment and staff, so Category II were critical. They were less satisfied with the visiting arrangements in operation at the time of their children’s hospitalization (iv) (v) than Categories I and III. They made direct criticism of the nurses, especially the non-hospital group who had never had a child of their own in hospital (ii), and also made most indirect criticism of the staff by having the smallest proportion of mothers who felt that children are always looked after properly in hospital (iii).’ This group contained the largest proportion of mothers who said that they received enough in-hospital information (vi) and the largest who reported seeing changes for the worse in their children after they were discharged (xviii).2 In addition they had four of the six mothers who said that their children had been treated worse than other children (xxii). The two categories which were most ready to criticize various aspects of the hospital were Categories II and IV. The difference between these two groups, however, was in their readiness to act as well as criticize. The authoritarian rebels were more ready to act. Even though more of category IV said that they had a complaint a higher proportion of category II actually complained to someone (viiia) and a smaller proportion of Category II reported that they received satisfaction when they did complain (viiib). The authoritarian rebels were also most likely to have asked for information about their children (vii)’ and were most likely to have known the surgeon’s name when their child had to have an operation (x). The general attitude of this category seemed to be one where nothing to do with hospital can be taken on trust. Their belief that it is necessary for mothers to visit as much as possible (xiii) was probably due to them wanting to be there to “keep an eye” on how the hospital is treating their children rather than specifically to mitigate any ill effects of separation.

455

Illness Behaviour and Children’s Hospitalization

This is supported by that fact that when mothers were asked to say what they were most concerned about when they knew their children were going into hospital the authoritarian rebels were less concerned than Categories III and IV about their child grieving or being frightened (xvii). The personal characteristics of this category were similar to those of the other authoritarian mothers. The authoritarian rebels had second largest proportion of mother who were afraid of being hospitalized themselves (xiv). This again was coupled with a higher proportion of mothers in the non-hospital sample with a high level of worry about their children (xv),’ and also with a tendency to be more ready, in both samples, than categories III and IV to consult the doctor straight away in the case of their children’s minor ailments (xvi). The picture of the ideal type authoritarian rebel in the hospital situation is one of: 1. personal fear coupled with 2. a high level of readiness to consult a doctor straight away about their children. However, although these mothers are ready to consult they are not prepared, like the submissive authoritarians, to surrender up their children to the hospital and accept without question that whatever the hospital does is best. On the contrary, 3. the authoritarian rebels are not only the most critical of the four categories but also, more likely than the other critical group, Category IV to make their criticisms known to the hospital staff. CATEGORY

III

“THE

EASY-GOING

LOW

SCORER”

“These subjects sometimes come close to neurotic indecision. One of their main features is the fear of ‘hurting’ anyone or anything by action.” A.P. 771.

The mothers’ in Category III tended to be more unlikely than any other mothers to comment, act, or commit themselves personally to anything to do with the hospital situation. Like the submissive authoritarians they were less ready to criticize than groups II and IV. These mothers made less criticism of the visiting arrangements (iv) (v), than groups II and IV (i) and, in the non-hospital sample especially, were least critical of nurses (ii) and the way children are looked after in hospital (iii). Absence of criticism was not, however, the distinctive feature of these mothers. What really distinguished them was firstly their lack of action if they had a complaint, and secondly a general lack of concern with the whole process of having a child hospitalized. The lack of action shows itself by the fact that less of the “Easy-Going” mothers who had a complaint actually complained to anyone about it (viii), while less of this group than any other asked for in-hospital information when they felt that they had not received enough (vii).’ The general lack of concern with the whole child-in-hospital process is shown in the answers to several questions. There were more mothers in this category than any other who either said that they were not concerned about anything when they knew that their children were going into hospital, or were concerned about things other than their child’s grieving or illness (xvii).l The lack of concern is also suggested by their professed lack of desire to take advantage of the unrestricted visiting system (xx),~ and by being less likely than categories II and IV to say that they would definitely like to live-in with their children (xxi). S&M.6/4-c

DAVID ROBINSON

456

The attitude of this category is essentially one of quiet acceptance that things are neither particularly good nor bad but just as they are. This group have the highest proportion of mothers who felt that the treatment given to their children was the same as to other children, neither better nor worse (xxii), and the highest proportion of mothers who noticed no change in their children’s behaviour after they were discharged (xviii). The picture of the ideal type “Easy-Going Low Scorer” in the hospital situation is one of general absence of involvement. This has shown itself in: 1. an unwillingness to comment on various aspects of the hospitalization of their young children 2. a lack of action if there was anything which they considered unsatisfactory 3. a suggested lack of awareness of their children’s position in hospital, their treatment and their behaviour after discharge; or if not a lack of awareness then a belief that things are best left well alone. This is supported by the greater reluctance of this group to visit or live in with their children. In addition there is 4. a lack of what might be called emotional involvement in the hospital situation. This is suggested by the fact that the Easy-Going Low Scorers worry least about their children (xv)’ and have least personal fear of being hospitalized (xiv).” CATEGORY

IV “THE

PROTESTING

“They are thoroughly guided by ‘conscience’ against social repression.”

LOW

SCORER”

. . . . They ‘protest’ out of purely moral reasons A.P. 774.

The mothers in Category IV exhibited a general reluctance to subordinate themselves to the authority of the hospital. They tended to be more critical than other mothers about the hospital regulations. After Category II this group contained fewer mothers who thought that their children had been looked after properly (iii) and more mothers who were critical of the nurses (ii). This group had the highest proportion of mothers who had a complaint to make about some aspect of their children’s hospitalization (i)’ but a higher percentage of Category II actually complained (viii). It was suggested earlier that the critical attitude of the mothers in Category II was to some extent symptomatic of opposition to “authority” per se. The criticism of the mothers in Category IV, on the other hand, appears to be based on an opposition to anything which threatens the well being of their children and particularly the close contact between their children and themselves. This is suggested by the amount of concern with separation which, particularly in the non-hospital sample, these mothers had (xvii),’ and also by their concern with visiting arrangements. The protesting low scorers had most criticism of visiting arrangements (iv) (v), were most in favour of living in (xxi)’ and were more ready than the other groups to say that they would take advantage of an unrestricted visiting system (xx). Like the easy-going low scorers the mothers in category IV had a low level of fear of being hospitalized themselves (xiv). This was coupled with a tendency in both samples to be least ready to consult a doctor straight away about their children’s minor ailments (xvi).l The ideal type “protesting low scorers” appear 1. not to be unduly concerned about illness and hospitals, not afraid of being hospitalized themselves, not likely to over-estimate the effects of illness, and thus not likely to consult professional medical services straight away in the case of children’s minor ailments. After their children have been admitted to hospital

Illness Behaviour and Children’s Hospitalization

457

2. their main concern is clearly centred upon their own relationship with their children and especially with regulations which enable mothers to be with their children as much as possible. The preceding pages have set out the characteristics of four ideal types of response to the hospital situation. It is not suggested, of course, that all the mothers in these four authority

categories exhibited all the facets of their particular ideal type. DISCUSSION “It is neither necessary nor feasible to postulate that we are concerned

with authoritarian ‘personality’. To talk of personality implies a comprehensive understanding of the life development of an individual’s emotions. Instead, authoritarianism can be seen as a characteristic reaction pattern to a wide variety of social situations.” Janowitz and Marvick [17] p. 197.

By combining the authoritarianism and acceptance-of-hospital-authority dimensions an attempt has been made to produce a schema of attitudes toward authority which would help us to identify characteristic reaction patterns in the hospital situation. It is suggested, in this brief conclusion, that such a schema could have more general relevance. Four characteristic reaction patterns were identified. There was no discussion, however, about causes. This was partly because such discussion was well outside the terms of reference of the survey based study, but also due to difficulties over the notion of an authoritarian “personality”.* The Authoritarian Personality” approaches the problem: (of social discrimination) with the means of socio-psychological research”, A.P. ix,t and its “findings are strictly limited to the psychological aspects of the more general problem of prejudice” (A.P. 972). The authors stress “the importance of the parent-child relationship in the establishment of prejudice or tolerance” and admit that a study of “the social and economic processes that in turn determine the development of characteristic family patterns” was beyond the scope of their investigation. Hoult and Stewart [18] after reviewing many of the studies which have used the F Scale offer “a social psychological theory of the authoritarian personality”. They conclude that these studies “considered as a whole indicate that all authoritarians identified to date manifest inadequacies in role-taking and role-playing”, This is based upon the long established notion that prejudice is largely a function of ignorance, and is related, to quote Sarbin [ 191 to “the widely accepted postulate ‘better’ his social adjustment”

that the more roles in a person’s behaviour

repertoire

the

p. 233.

One of the attractions of this role-mastery theory of authoritarianism is that it helps to meet the deficiencies of the original psychoanalytic theories which stressed a family environment common to only certain (mainly right wing) authoritarians. Lipsitz [20] also after reanalysing data from several surveys, implicitly supports this role-mastery thesis. He suggests that the phenomenon termed by Lipset [21] “working class authoritarianism” would be better explained in terms of level of education rather than class. In the present study when * See the quotation t My insertion.

at the beginning of the Discussion.

DAVID ROBINSON

458

occupational status was held constant there was, in spite of the small number involved, a consistent relationship between an increase in level of education and a decrease in authoritarianism. This, as Table 6 shows, applied to both the hospital and non-hospital samples. TABLE

6.

AUTHORITARL~NISM AND TERMINAL EDUCATION AGE

Terminal education age

Under 15 No. %

authoritarian Mid authoritarian Least authoritarian Total

3 1 :

Most authoritarian Mid authoritarian Least authoritarian Total

46

Most authoritarian Mid authoritarian Least authoritarian Total

8 2

Most authoritarian Mid authoritarian Least authoritarian Total

49 23 21 93

Most

g 86

Hospital sample (non-manual) Further education* 15 or 16 16+ No. % No. % No. 11 9” 26

53.5 23.3 23.3

28.6

52.7 24.7 22.6

2 2 d

0 1 3 4

Hospital sample (manual) 74 45.1 39 24.1 : Z 30.2 1; 33.0

8

Non-hospital sample (non-manual) 11 4 5 2 19 54.3 1: 57.1 35

0 1 3 4

Non-hospital sample (manual) 37.0 30 5 13.6 2 ti 49.4 8 53.3 81 15

0 0 1 1

0

*Because of an undetected mistake on the questionnaires the “level of education” dimension did not discriminate as well as it was meant to. The precedingof the terminaleducationage was printed as: (i) under 15;

(ii) 15 or 16; (iii) 16+ without Further Education; (iv) Further Education. It should, of course, have read: (i) under 15; (ii) 15; (iii) 16; (iv) 16+ without Further Education; (v) Further Education. The only other point which can be made about the causes of authoritarianism concerns the relationship between anxiety and the mothers’ scores on the shortened Californian F Scale. There was a clear association between authoritarianism and an increase in fear of being hospitalized. This lends support to the notion of “anxieties about a generally threatening environment or a lack of support being typical of high scorers” (p. 143). A high level of fear was as Table 7 shows, significantly more apparent among authoritarians in both the hospital and non-hospital samples. By introducing the acceptance-of-hospital-authority dimension an attempt has been made to overcome the difficulty of the essential ambivalence of the submissive and aggressive elements of the authoritarian position. It is not possible, of course, to say whether this method of identifying surface traits would enable us to predict characteristic reaction patterns in other situations. The predominantly submissive authoritarian in the hospital situation may very well be a rebel authoritarian in some other type of setting. The Hoult-Stewart thesis postulates that it is inadequacies in role-taking and role-playing, stemming from being brought up in an environment which limits perspective and presents few opportunities for developing role-taking abilities, which leads to the development of an authoritarian response.

Illness Behaviour and Children’s Hospitalization

459

TABLE7. AUTHORIT~WANLYM AND FEAROF BEINQ HOSPITALIZED* A. Hospital sample Most authoritarian No. % More fear Less fear Total

55 98 153

B. Non-hospital More fear Less fear Total

Mid authoritarian No. %

Least authoritarian No. %

35.9 64.1

16 63 79

2@3 79.7

18

19.6 80.4

28.1 71.9

8 44 52

15.4 84.6

7 99 106

6.6 93.4

sample 32

A. x2 = 10.3, d. off. = 2;~ < 0.01. B. x2 = 17.9, d. off. = 2; p < O-01. *Fear of being hospitalized technique which was used

was measured

by the paired sentence

to measure readiness to accept hospital

authority. By extending this thesis it is possible to suggest that opportunities forparticular role learning determine whether a high scorer on the F Scale will be a submissive authoritarian or an authoritarian rebel in any particular situation. It could be hypothesized that the more opportunity an authoritarian has had for role mastery in any particular situation the more likely it is that the person will be a rebel rather than a submissive authoritarian in that situation. This is supported by the figures in Table 8 which show how the non-hospital mothers who, by definition, have had no opportunity to learn the mother-of-hospitalchild role, and the mothers in the hospital sample who have only had a child in hospital once, were significantly more likely than those mothers in the hospital sample who had been “mothers-of-children-in-hospital” more than once to be submissive authoritarians rather than authoritarian rebels. TABLE 8. AUTHOR~TYCATEGORYANDEXPERIENCEOFBEINGMOTHEROFHOSPITALIZED

I Non-hospital sample No. % A. Submissive authoritarians Authoritarian rebels B. Easy going

low scorers Protesting low scorers

CHILD

Hospital sample II III Mother-of-childMother-of-child-in in-hospital (once) hospital (more than once) No. No. % %

66

57.9

33

56.9

40

44.0

48

42.1

25

43.1

51

56.0

53

50.5

19

50.0

18

34.0

52

49.5

19

50.0

35

66.0

A. x2 = 4.31 d. off. = 1 (I and II collapsed)p B. x2 = 428 d. off. = 1 (I and II collapsed)p

< 0.05. < 0.05.

460

DAVID ROBINSON

In the same way the figures in Table 8 lead us to hypothesize that among the low scorers unfamiliarity with the role demanded in a particular situation will tend to result in a person adopting the “easy going” rather than the “protesting” position. Unfortunately, because of the specialized nature of the data collected in this survey, there was no opportunity to test any of these notions in any other than the hospital setting. IMPLICATIONS “It becomes a matter of both theoretical and practical concern to discover the sources and consequences of different illness behaviours.” Mechanic [3] p. 189.

The sociologist or social psychologist must understand, and take account of, such systems of “characteristic reaction patterns” if he is to construct adequate theories of illness behaviour. Norms of attitudes toward authority differentially affect the behaviour not only of the symptomatic person but all those involved throughout the illness process. As far as the well being of young children is concerned it has been seen that a mother’s readiness to take advantage of facilities (e.g. living-in and unrestricted-visiting) designed to preserve the continuity between the child’s home and hospital life is closely associated with her attitude toward authority. The mother’s position in one of the authority categories was also seen to be associated with the degree of readiness with which she consults a doctor about her child. Since almost all contact between child patients and professional medical services is initiated by the child’s parents this has implications for the well being of some children in that they may be kept away from a doctor when, by any kind of objective medical assessment, they should be given some sort of treatment for what might be considered to be their own, or perhaps other people’s, benefit. REFERENCES 1. KOSA, J. et al. The place of morbid episodes in the social interaction

2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17.

pattern. Paper presented to the Session on Sociology of Illness at the 6th Congress of the Z.S.A. Evian, France, 1966. KESSEL,N. and SHEPHERD,M. The health and attitudes of people who seldom consult the doctor. Medical Care, Jan. March, 1965. MECHANIC,D. The concept of illness behaviour. J. Chron. Dis. 15, 189-194, 1961. KELLNER,R. Family Ill Health. Tavistock, London, 1963. GILLIS,L. S. and KEET,M. M. Factors underlying the retention in the community of chronic unhospitalized schizophrenics. Brit. J. Psych. iii, 1057-1067, 1965. ROBINSON,D. A. Some Aspects of Parents Attitudes and Behaviour in Relation to the Hospitalization of their Young Children. Unpublished Ph.D. thesis (Wales), 1967. PILL, R. M. Social Aspects of the Hospitalization of Young Children. Unpublished M.Sc. (Econ.) thesis (Wales). 1967. STACEY.M.. DEARDEN.R.. PILL, R. and ROBINSON,D. Hospitals Children and their Families, Routledge & Kegan Paul, London, I970. CARTWRIGHT.A. Human Relations and Hosoital Care. Routledge & Kegan Paul. London, 1964. FREDSON, E.Patients’ View of Medical Practice. Russel Sage Foundation, N.Y, 1961. SANFORD,F. S. Authoritarianism and Leadership. Stevenson Bros., Philadelphia, 1950. Aooa~o, T. W. et al. The Authoritarian Personality. Harper & Row, N.Y., 1950. INGHAM,J. G. A method for observing symptoms and attitudes. Brit. J. Sot. C&t. Psychol. 4, 131-140, 1965. SHAPIRO,M. B. A method of measuring psychological changes specific to the individual psychiatric patient. Brit. J. Med. Psychol. 34, 151-155, 1961. INKELES,A. What is Sociology, an Introduction to the Discipline and Profession. Prentice-Hall, N.J., 1964. COSER,R. L. Life in the Ward. Michigan State Univ. Press, 1961. JANOWITZ,M. and MARVICK, D. Authoritarianism and political behaviour. Public Opinion Quarterly XVII, 185-201, 1953.

Illness Behaviour and Children’s Hospitalization

461

18. HOULT, D. and STEWART,D. Social psychological theory of the authoritarian personality. Amer. J. Social. 65, 174-279, 1959. 19. SARBIN, T. R. Role Theory in Handbook of SocialPsychology. Addison-Welsey, Cambridge, Mass., 1954. 20. LIPSITZ, L. Working class authoritarianism-a re-evaluation. Amer. Social. Rev. XX, 103-109, 1964. 21. LIPSET,S. M. Political Man. Heinemann, London, 1960.

APPENDIX

A

MOTHERS’CRITKISMANDTHEIR READINESS TO ACCE~THOSPITALAUTHORITY Mid ready No. %

Most ready No. % i. Visiting arrangements: Criticism Not Total ii. Child: Not looked after properly Looked after properly Total

15-5 84.5

7 36 43

16.3 83.7

31 112 143

21.7 78.3

58 257 315

12;

3.1 9@9

2 41 43

4.7 95.3

25 120 145

17.2 82.8

31 286 317

2 1 40 43

4.7

5

3.4

0 12: 130

iv. Nurses: Criticism Good good Very Total v. Information: Not enough Enough Total

Total

20 109 129

129

iii. Treated : Worse than others Better than others Same as others Total

Least ready No. %

;1 96.9

*

1; 299 318

9z 145

18

14.0

9

21.4

29

20.0

56

18

72.1 140

;; 42

26.2 52.4

31

21.4 58.6

2: 316

38 92 130

29.2 708

13 30 43

30.2 69.8

60 86 146

41.1 58.9

111 208 319

APPENDIX B The tables set out here are referred to in the text by reman numbers in the parentheses. The categories are: I Submissive Authoritarians; II Authoritarian Rebels; III Easy Going Low Scorers; and IV Protesting Low Scorers. TABLE(i). COMPLAINTa Hospital sample Had a complaint Did not Total *x2 = 6.25, d. off. **x2 = 4.93, d. off.

1*

II

No.

%

14 59 73

19.2 80.8

No. 22 54 76

III

Iv**

%

No.

%

No.

%

28.9 71.1

14 23 37

37.8 62.2

23 z:

42.6 574

= 1, p < @05 (II, III and IV collapsed). = 1, p < 0.05 (I, II and III collapsed).

462

DAVID ROBINSON TABLE (ii). ATITIVDE TOWARD NURSES

Hospital sample

I

Very good Alright Criticism Total DK/NA Non-hospital sample Very good Alright Criticism Total Did not know

No.

%

No.

55 8 10 73

15.3 11.0 13.7

18 9 6 33 33

54.5 27.3 18.2

II

%

No.

48 11 16 75 1

64.0 14.7 21.3

9 6 6 21 27

42.9 28.6 28.6

III

IV

%

No.

24 6 6 36 1

66.6 16.7 16.7

32 12 10 54

59.3 22.2 18.5

8 11

36.4 50.0 13.6

11 10 5 26 26

42.3 38.5 19.2

2; 31

%

TABLE (iii). WHETHER CHILDREN ARE UX~KED AFTER PROPERLY IN HOSPITAL

1*

Hospital sample

Properly Mid Not Total DK/NA *x2 = 3.85 d. off. Non-hospital Properly Mid Not Total DK/NA

11**

III

IV

No.

%

No.

%

No.

%

No.

%

56 14 2 12 1

71.8 19.4 2.8

46 17 12 75 1

61.3 227 16.0

28 8 3:

15.7 21.6 2.7

34 12 8 54

63.0 22.2 14.8

= 1p

< 0.05 (Mid and Not collapsed), (II, III and IV collapsed).

sample

*x2 = 582 d. off. **x2 = 406 d. off.

58 5 2 65 1 = 1p = 1p

89.2 7.7 3.1

33 11 4 48

68.8 22.9 8.3

43 7 0 50 3

860 14.0 -

36 15 1 52

69.2 28.8 1.9

c @05 (Mid and Not collapsed), (II, III and IV collapsed). -c 0.05 (Mid and Not collapsed), (I, III and IV collapsed).

TABLE (iv). WHETHER OR NOT VISITING TIMES SHOULD BE CHANGED

Change Not Total DK/NA

II

I

Hospital sample

IV

III

No.

%

No.

%

12 60 72 1

16.7 83.3

18 57 75 1

24.0 76.0

No. 7 30 37

18.9 81.1

13 41 54

% 24.1 75.9

Illness Behaviour and Children’s Hospitalization

A~TWDE TOWARD Hospital sample

Very good Allriaht Criticism Tota 1 DK/NA

TABLE (v). EXISTINGVISITINGARRANGEMENTS

I No.

II % 52.8 30.6 16.7

12 72 1

463

No.

13 76

III

IV

%

No.

%

No.

46.1 36.8 17.1

21 10

56.8 27-o 16.2

376

% 42.6 37.0 20.4

11 54

TABLE@& WHE~RMOTHERSFELTTHATTHEYRECEM3DENOUGHIN-HOSPITALINFORMATION

Hospital sample

Enough information Not enough Total * x2 = 6-89 d. off.

1*

II

III

IV

No.

%

No.

%

No.

%

No.

%

54 19 73

74-o 26.0

45 31 76

59.2 40.8

21 16 37

56.8 43.2

31 23 54

57.4 42.6

= 1p

< OGOl (II, III and IV collapsed).

TABLE (vii). WHETHERORNOTMOTHERSASKEDWHENTHEYFELTTHEYWANTEDMOREINFORMATION

Hospital sample

Asked Did not Total * x2 = 4.32 d. off. ** x2 = 9-29 d. off.

I

11*

111**

IV

No.

%

No.

%

No.

%

No.

%

16 3 19

84.2 15.8

30 1 31

96.8 3-2

10 6 16

62-5 37-5

21

92.3 8-7

= 1p = 1p

< O-05 (I, III and IV collapsed). < 0.01 (I, II and IV collapsed).

TABLE (viii). (a) WHETHERORNOTMOTHERSWHOHADACOMPLAINTCOMPLAINEDAND

(b) WHETHER,IFTHEY

DID,THEYWERESATJSFIED

Hospital sample

(a) Complained Did not Total (b) Satisfied Not Total

I

II

III

IV

No.

%

No.

%

No.

%

No.

%

6 8 14

42-9 57-l

15 9 24

62.5 37.5

6 9 15

40.0 60.0

13 10 23

56.5 43.5

3 3 6

50-o 50-o

1:

15.4 84.6

2 4 6

33.3 66.7

4 9 13

30.8 69.2

13

DAVID ROBIN%JN

464

TABLE(ix). WHETHERMOTHERS SPOKETO THE DOCTORIN CHARGE OF THEIRCHILDREN’S CASE Hospital sample

1*

Spoke to the doctor Did not Total + x2 = 4.00 d. off.

III

II

No.

%

No.

%

32 41 73

43.8 56.2

42 34 76

55.3 44.7

= 1p

IV

No.

:zj 37

%

No.

43.2 56.8

34 20 54

% 63.0 37.0

< 0.05 (II, III and IV collapsed).

TABLE(x). WHET%RMOTHERSOFCHlLDRENWHO HADANOPERATIONKNEWTHESURGEON'SNAME Hospital sample

I

II

III

No.

%

No.

%

8 11 19

42.1 57.9

17 13 30

56.7 43.3

IV

No.

%

No.

%

50.0 50.0

7 8 15

46.7 53.3

Knew the surgeon’s name Did not Total

4 4 8

TABLE (xi). WHETHERORNOTMOTHERSTHINKTHATITISIMPORTANTTOSPEAKTOTHEDOCTORIN Hospital sample

1*

Important Not If the illness is serious Total * x2 = 4.83 d. off.

IV

%

No.

%

No.

%

No.

%

58 12

79.5 16.4

68 8

89.5 10.5

36 1

97.3 2.7

49 3

90.7 5.6

3 73

4.1

76

2 54

3.7

49 2

94.2 3.8

1 52

2.0

63 2

955 3-o

48 -

1 66

1.5

48

100.0

51 2

96.2 3.8

53

TABLE (xii). ALLTHETIMETHATTHEYWEREALLOWEDTOVJSIT II

I

Hospital sample

37

< O-05 (II, III and IV collapsed).

WHETHERMOTHERSVISITED

All Not Total

III

No.

= 1p

Non-hospital sample Important Not If the illness is serious Total

II

CHARGE

III

IV

No.

%

No.

%

No.

%

No.

%

31 42 73

42.5 57.5

40 36 76

52.6 474

21 16 37

56.8 43.2

23 31 54

42.6 57.4

Illness Behaviour and Children’s Hospitalization

WHETHER

TABLE (xiii). MOTHERS THINK IT IS NECESSARY TO VJSITYOUNG(UNDER POSSIBLE

Hospital sample As much as possible Not Total Non-hospital As much as possible Not Total

I

II

465

~)CHILDREN AS MUCH

III

IV

No.

%

No.

%

No.

%

No.

%

51 22 73

69.9 30.1

62 14 76

81.6 18.4

26 11 37

70.3 29.7

42 12 54

77.8 22.2

49

74.2 25.8

39 9 48

81.3 18.7

43 10 53

81.1 18.9

42 10 52

80.8 19.2

sample

TABLE (xiv). MOTHERS'FEAROFBEING HOSPITALIZED

1*

Hospital sample I-east Mid Most Total DK/NA * x2 = 436 d. off. ** x2 = 510 d. off. Non-hospital Least Mid Most Total DK/NA

III**

II

IV

No.

%

No.

%

No.

%

No.

%

36 16 19 71 2

50.7 22.5 26.8

45 15

60.8 10.8 18.4

29 4

78.4 10.8 10.8

32 13

61.5 25.0 13.5

:t 2

3::

527 2

= 1 p < O-05 (Least and mid collapsed), (II, III and IV collapsed). = 1 p < 0.05 (Mid and most collapsed), (I, II and IV collapsed).

sample 26 23 16 65 1

40.0 35.4 246

31 12 5 48

64.6 25.0 10.4

48 4 1 53

90.6 7.5 l-9

44 6 2 52

84.6 11.6 3.8

* x2 = 17.79 d. off. = 1 p < O-01 (Least and mid collapsed), (II, III and IV collapsed). ** x2 = 16.12 d. off. = 1 p < 0.01 (Mid and most collapsed), (I, II and IV collapsed). TABLE (xv). MOTHERS'WORRYABOUTTHEIRCHILDREN

Hospital sample

Least Mid Most Total DK/NA

I

II

IV

%

No.

%

No.

%

No.

%

26 22 25 73

35.6 30.2 34.2

21 27 27 75 1

28-O 36.0 36-O

21 7 9 37

56.8 18.9 24,3

17 13 21 51 3

33.3 25.5 41.2

* x2 = 8.26 d. of f. = 1 p < 0.01 Non-hospital Least Mid Most Total DK/NA

III*

No.

(Mid and most collapsed),

(I, II and IV collapsed).

sample

* x2 = 4.15 d. off.

32 14 19 65 1

49.2 21.5 29.2

25 12 10 47 1

53.2 25.5 21.3

36 15 2 53

= 1 p c 0.05 (Mid and most collapsed),

67.9 28.3 3.8

28 17 7 52

(I, II and IV collapsed).

53.8 32.7 13.5

AS

D~vro ROBINSON TABLE(xvi). MOTHERS RBADINESSTOCONSULTADOCTOR Hospital sample More ready Less ready Total

I*

II

No.

%

32 41 73

43.8 56.2

No. 5”: 76

III

IV**

%

No.

%

No.

%

32.9 67.1

11 26 37

29.7 70.3

12 42 54

22.2 77.8

24.5 75.5

8

15.4 84.6

* x2 = 5.52 d. off. = 1 p i 0.05 (II, III and IV collapsed). ** x2 = 3.87 d. off. = 1 p -z 0.05 (I, II and III collapsed). Non-hospital More ready Less ready Total

sample 37.9 62.1 66

15 33 48

31.3 68.7

13 40 53

* x2 = 4.70 d. off. = 1 p c 0.05 (II, III and IV collapsed). ** x2 = 5.31 d. off. = 1 p < 0.05 (I, II and III collapsed). TABLE (xvii). (a) HOSPITAL MOTHERS' CONCERN WHEN THEIR CHILDREN WERE HOSPITALIZED AND (b) NONHOSPITALMOTHERS'IMAGINED CONCBRNIFTHEIRCHLLDRBNwERETOHAVEBEENHOSPlTALIzED THEFOLLO‘WINGDAY

(a) Hospital sample

I No.

a. No concern b. Concern about illness c. Concern about separation d. “Other” concern Total (b) Non-hospital sample a. No concern b. Concern about illness c. Concern about separation d. “Other” concern Total

II %

10

No.

Iv**

111* %

5

No.

%

No.

4

%

9

34

54.0

37

52.1

14

424

15

33.3

22 7 63

34.9 11.1

25 9 71

352 12.7

12 7 33

364 21.2

23 4:

51.1 15.6

3

8

6

3

24

38.1

13

32.5

11

23.4

9

17.3

39

61.9

25 2 40

62.5 5.0

30 6 47

63.8 12.8

40

82.7

63

49

* X* = 6.01 d. off. = 1 p -c 0.05 (a and d collapsed, b and c collapsed), (I, II and IV collapsed). ** x2 = 6.33 d. off. = 1 p < 0.05 (a,b and d collapsed), (I, II and III collapsed). TABLE (xviii). CHANGESINCHILDREN'SBEHAVIOURAFIXRDISCHARGERBPORTBDBYMOTHER~~ Hospitalsample

a. No change b. Change for the worse c. Change for the better Total * x2 = 6.66 d. off.

I

IV

111*

II

No.

%

No.

%

No.

%

No.

%

30

41.1

25

32.9

20

54.1

24

44.4

33

45.2

47

61.8

15

40.5

24

44.4

10 73

13.7

4 76

5.3

2 37

5.4

6 54

11.1

= 1 p c 0.01 (a and c collapsed), (I, II and IV collapsed).

Illness Behaviour and Children’s Hospitalization

467

TABLE(xix). MOTHERS

WHETHER

Hospital sample

No.

Had unrestricted visiting Did not Total

I

40 33 73

HAD

%

No.

54.8 452

39 37 76

II

TABLE WHBTHBR

Hospital sample Would like it Would not Total DK/NA

MOTI-IBRS WOULD

I

No. 22 10 32 1

Non-hospital sample Would like it 58 Would not 7 Total 65 DK/NA 1

No.

Hospital sample Definitely yes Not Total

OR NOT

No.

68.8 31.2

25 11 36 1

MOTHERS

28 45 73

Non-hospital sample DefinitelyYes 26 Not 40 Total 66

No.

51.3 48.7

8 29 37

III

%

No.

21.6 78.4

26 28 54

IV

% 48.1 51.9

(xx). HAD

UNRESTRICTBD

%

No.

69.4 30.6

III+

VISITING

IV

%

No.

%

11 16 27 2

40.7 59.3

21 6 27 1

77.8 22.2

45 7 52 1

86.5 13.5

49

96.1 3.9

(I, II and IV collapsed).

89.2 10.8

I

%

II

42 5 47 1

89.4 10.6

TABLE WHBTHBR

VISITING

LIKE TO HAVB

%

* x2 = 8.82 d. off. = 1 p < O-01

m(;TED

WOULD

%

No.

38.4 61.6

45.5 54.5

5; 1

(xxi).

LIVE-IN

II

IF THE FACILITY

%

No.

38 38 76

50.0 50.0

26 22 48

54.2 45.8

III

WAS

AVAILABLE

%

No.

15 22 37

40.5 59.5

30 24 54

27 26 53

50.9 49.1

Iv*

% 55.6 44.4

63.5 36.5

52

* x2 = 4.13 d. off. = 1 p c 0.05 (I, II and III collapsed).

TABLE MOTHERS’

Hospital sample The same as other children Better Worse Total 73

A Tl-ITUDE

No. 69 3 1

TOWARD

I

(xxii).

THE TREATMENT

%

No.

94.5 41 1.4 76

71 1 4

II

OF THEIR

%

No.

93.4 1.3 5.3 37

36 1 0

CHILDRBN

III

IN I-IGSPITti

%

No.

97.3 2.7 54

48 5 1

IV

% 88.9 9.3 1.8

468

DAVID

ROBINSON

TABLE WHETHER

OR NOT

MOTHERS

(xxiii).

THEIR

CHILDREN

FOR GOING

%

No.

%

No.

%

14 I 21

66.7 33.3

13 6 19

68.4 31.6

9 3 12

75.0 25-o

57

HOSPITAL

IV

No.

52

INTO

III

II

I

Hospital sample Prepared Did not Total Child was too young to be prepared

PREPARED

25

No. 8 1: 40

% 57.1 42.9