- Email: [email protected]
State mental hospitals: Problems and potentials
SK Sc,. Mud Vol.16.pp 33710348.IV82 Pergamon Press Ltd
Prmed
,n Great Brna~n
BOOK Social Work in Health Services: An Academic
REVIEWS
Partnership,
book is to present a curriculum development, the process focus nevertheless reflects a problem endemic to much of social work education. The field as a whole needs to know whether the education of its students results in more effective services to clients. The kinds of outcomes reported here-field instruction more integrated with the academic process, enhanced course offerings, varied teaching contexts in the practice settings, a sense of satisfaction in both faculty and students-are worthwhile steps and not to be depreciated at all, but the field generally and particularly those engaged in an engrossing and exciting development as the one reported here, need to keep an eye on the most meaningful objective of improved client services. The issue of stereotyped language is another shared by the field. The authors’ decision to use the masculine form throughout is stated as an editorial concern. However, to the extent that the decision reflects a lack of awareness of the importance of gender in all of the issues discussed in the book, the decision is a substantive one. Documentation is increasing steadily about the effects of gender and sexrole stereotyping on all aspects of health care delivery-in the diagnosis and treatment of illness, in power relationships among health care personnel, in the encounters between instructor and student. In a few places the authors comment on the impact of the variable of sex on particular educational questions. The stereotyped language tends to negate that stated concern and leaves one wondering about the degree of awareness of gender related issues. Caroff, Mailick and their associates have taken on a gnawing problem of articulation of class and field instruction. Educational planners ready to tackle that issue will find here sources of encouragement and ideas about process, both of potential utility.
edited by PHILLIS CAROFF and MILDREDMAILICK.Prodist, New York, 1980. 205 pp. $19.95. $9.95 (paper) Social work education, and other professional disciplines using concurrent internships, struggle continually with the issue of articulating in-class learning with that of practicum experience. This volume describes one school’s effort to bridge this gap, and curriculum planners, especially in social work, will find that their description of the process of educational developments is a useful contribution to resolving this academic problem. Through this book, in addition, professional colleagues of social work in the health care system, particularly medicine and nursing can gain a better understanding of the substantive issues addressed in the education of social work for health care practice. The editors use two guiding principles in organizing the book: (1) the collaborative nature of their efforts, and (2) the description of the process by which curriculum was developed. The format clearly reflects these principles. The seventeen authors of the ten chapters represent academic faculty, field instructors, agency staff and administrators, and s&dents. Most of the chapiers describe the process of collaboration between class and field, as the Hunter College School of Social Work and a number of hospitals and other health care settings worked together to improve student education. In the social work education literature, one does not often see such a fully elaborated model. The reader views alternately the perspectives of the academics, the practitioners and the students and the kaleidoscopic effect enriches the discussion. The reader will find limited specific course content, since the primary emphasis is on the collaborative process and overall principles of instructional development. Issues presented include the instructional tensions in field instruction between teaching from case to case, on the one hand, and a planned didactic progression, on the other, the principles used in the planning of courses, and the varied teaching roles assumed by field instructors with different responsibilities I%-&uis the student. At times, however, the emphasis on process leads to an excessively general discussion and over-use of social work educational jargon. The inclusion of a few specifics, e.g. teaching tools, evaluation forms and case review protocols indicate that more such illustrations would have usefully fleshed out the general treatment of the issues. Implicit throughout and specified at several points are the necessary conditions for such a collaborative effort. Resources are needed-in this instance, a federal grant underwrote many of the activities. Both the academic and service institutions need to be open to collaboration and ready to give the necessary time. Here, the School of the Social Work faculty and many health care personnel made a commitment to an improved model of education and acted seriously on that commitment. Readers interested in adopting the curriculum development model described here would be well cautioned to see to these necessary pre-conditions. The authors clearly state that concensus was not reached on all issues, and identified a number of unresolved questions, including reciprocal power, renumeration of both agency and school personnel, and staff development. The progress reported in this volume would seem to be the beginning of a continuing effort. With a clear acknowledgement that the purpose of the
1.5~16 3--H
School of Social Work Clniversiry of Washington Seattle, WA, U.S.A.
State Mental Hospitals: TALBOTT. Human
NAOMIGOTTLIEB
Problems and Potentials,
Sciences,
New
York,
by JOHN 1980. 219 pp.
$16.95 That large hospitals run by state governments have for 150 years been a disaster for patients, for the people who staff them and for the communities they were intended to serve is plain to anyone who bothers to study their history and their contemporary state. That there still are reputable groups which staunchly support their continuation is a tribute to the capacity of anxiety to generate denial. Private sector psychiatrists and those who work in psychiatric units in general hospitals who need backup facilities for difficult patients, members of communities and their elected representatives who fear the proximity of deinstitutionalized patients, the membership of public employee associations and community caretakers reacting to the problems with poorly implemented community care plans, are beginning to create a myth which retrospectively idealizes the state hospital as a place of asylum, run by a heroically beleagured staff which provided humane care despite the acknowledged budgetary constraints. State Mental Hospirals: Problems and Potentials, edited by John Talbott, is another in a series of publications whose aim is to keep squarely in the forefront of public attention the impossibility of the state hospital as a viable 337
338
Book reviews
institution. Made up of a series of papers by persons who are highly knowledgeable about state hospitals and public mental health systems, Spate Mental Hospitals provides both further documentations of their deficiencies and some suggestions for. new and diRerent roles for these institutions within community-based programs. The section on “The Problems of State Hospitals” allocates the responsibility to society with its attitudes toward the mentally ill, to the bureaucratic systems Of representative government which are set up to prevent things from happening rather than to facilitate their being done, to the government/university interaction which is characteristically shot through with misunderstanding based on apparently conflicting agendas and the lackluster characteristics of many of the professionals in state hospitals whose indifferent performance is both elicited and sheltered by the system. “The Potential Role of State Hospitals” covers important and often neglected functions for state hospitals in the future-as tertiary prevention facilities, to provide domiciliary care and as possible loci for community mental health centers. In all cases these future roles presuppose such vast changes in administrative relationships, physical facilities and staff quality that one might properly argue that what is envisioned is not a potential role for the state hospital but rather the development of new institutions to carry on certain of the functions of the state hospital. The last section of the book “The Future of State Psychiatric Services” deals with problems one step above the state hospital in the management of state mental health systems in these precarious times. Although concerned with important matters, its main points are not directly germane to the rest of the book. Expanded, that section could make another book, but not this one. Even more than most collections of papers Srare Mental Hospitals suffers from unevenness both of style and quality of contribution. Certain of the papers seem idiosyncratic and the range of concerns is overly broad. Finally, it shows a surprising degree of inattention to copy editing so that some of the papers read very badly. This is unfortunate since the vital issues which are addressed by Sture Menrul Hospitals deserve better-a more focused set of papers and considerably more attention to the craft of presentation. Nonetheless, this book has its place as an addition to the literature on one of the major human service issues of our time. Massachusetts Mentul Heulth Center Department of Psychiutry Hurvurd Medicul School Boston. MA. U.S.A.
MILES F. SHORE
Aging in Culture and Society, edited by CHRISTINEL. FRY, Foreward by PAUL BOHANNAN. Praeger, New York. 1980. 280 pp. $18.95
Aging in Culture and Society is a collection of essays focused around anthropologists’ explorations of age organization and values in a number of cultural settings including the U.S. Fry. as editor. weaves the disparate articles together by prefixing each with a synthesis and overview of how each piece contributes to the collection as a whole. There are primarily three factors that keep the volume from being as widely useful as it might have been although most of the articles are useful in various settings. First, the quality of the articles is uneven, leaving the reader with a sense of unfulfilled expectation. Secondly, the technical nature of the articles varies to such a degree that the text would be useful in graduate courses, but use with undergraduates would be somewhat limited. Thirdly, while the scope of anthropology and social gerontology is broad, the
least interesting efforts in this volume are unfortunately typical of the general gerontological literature: while the value of combining quantitative and qualitative data is mentioned in introductions, some of the resultant articles are quantitative discussions which lack the richness of ethnographic analysis and reduce people. values and interaction to numerical abstraction. Fry begins with a cogent, stimulating review of the anthropology of aging in Chapter I which covers a range of topics and outlines the problem areas which are addressed by other authors in the volume. It would have been helpful to have mentioned in this introduction that she, as editor. prefaced each article with a short synopsis because it is not clear until several articles that these synopses are not written by the authors. Chapter 2 sets off with a discussion of biological factors in aging. This chapter is good as far as it goes, although Beaubier neglects any discussion of diet and nutrition except in an anecdotal fashion. The article becomes disjointed and off balance as he shifts without transition from technical biological discussion to ancedotal description. The technical data in Chapter 2 is followed in Chapter 3 by a technical methodological discussion of multidimensional scaling in analysis of the cultural dimensions of age. Fry ties her discussion to her introduction by assessing in different form the cultural meaning of age in a rigorous methodological discussion. This article would be excellent for an upper division or graduate course in research methods, but is too technical in this volume if one wanted to use it in general undergraduate teaching. Chapters 4, 5 and 6 were disappointing because the topics of discussion were potentially interesting but the articles themselves were loose, fragmented and not well pulled together. Kagan. in discussing activity and aging in a Colombian peasant village, begins development of a model which is unfulfilling since it has lots of interesting ideas which are not drawn together into a coherent analysis or conclusion around her own data. She herself notes in the summary that the data is vague and abstract. Chapter 5 contains interesting ethnographic data about the Chinese population in Hong Kong. The discussion initially develops along the lines of interdependence versus dependent and independent values and behavior patterns in relation to filial piety, but this theme is dropped and not integrated into the concluding remarks. This as well as a comparative but relatively non-productive use of Rosow’s index leave this article disjointed and a bit too long; the reader finishes wishing the article had been tighter, more succinct, and clearer in its conclusions. In Chapter 6. Williams presents an unsatisfying discussion of American Indian elderly in which alcoholism is a term used rather loosely and never documented with specific data. In discussing population increase and age statistics, Williams neglects to mention or integrate the rather compelling fact that the average life expectancy for American Indians is much lower than for the population in general. Chapters 7-10 represent the best of the articles in this collection. As a group they are well written, well edited and contain thoughtful analysis which is substantiated by varieties of methodological techniques. Kerns in her discussion of support relationships among Black Carib gives a concise, well developed picture of the individual variability in responses to old age and offers good clues for how to analyze this variability in her concluding remarks. Likewise, Vatuk’s discussion of disengagement and real versus ideal responses to aging in India provides a tight analysis which ties history and Hindu religious belief to the very real people and adaptive changes she documents for contemporary Indian communities. Vatuk uses quantitative data to complement and solidify her analysis and the
Prmed
,n Great Brna~n
BOOK Social Work in Health Services: An Academic
REVIEWS
Partnership,
book is to present a curriculum development, the process focus nevertheless reflects a problem endemic to much of social work education. The field as a whole needs to know whether the education of its students results in more effective services to clients. The kinds of outcomes reported here-field instruction more integrated with the academic process, enhanced course offerings, varied teaching contexts in the practice settings, a sense of satisfaction in both faculty and students-are worthwhile steps and not to be depreciated at all, but the field generally and particularly those engaged in an engrossing and exciting development as the one reported here, need to keep an eye on the most meaningful objective of improved client services. The issue of stereotyped language is another shared by the field. The authors’ decision to use the masculine form throughout is stated as an editorial concern. However, to the extent that the decision reflects a lack of awareness of the importance of gender in all of the issues discussed in the book, the decision is a substantive one. Documentation is increasing steadily about the effects of gender and sexrole stereotyping on all aspects of health care delivery-in the diagnosis and treatment of illness, in power relationships among health care personnel, in the encounters between instructor and student. In a few places the authors comment on the impact of the variable of sex on particular educational questions. The stereotyped language tends to negate that stated concern and leaves one wondering about the degree of awareness of gender related issues. Caroff, Mailick and their associates have taken on a gnawing problem of articulation of class and field instruction. Educational planners ready to tackle that issue will find here sources of encouragement and ideas about process, both of potential utility.
edited by PHILLIS CAROFF and MILDREDMAILICK.Prodist, New York, 1980. 205 pp. $19.95. $9.95 (paper) Social work education, and other professional disciplines using concurrent internships, struggle continually with the issue of articulating in-class learning with that of practicum experience. This volume describes one school’s effort to bridge this gap, and curriculum planners, especially in social work, will find that their description of the process of educational developments is a useful contribution to resolving this academic problem. Through this book, in addition, professional colleagues of social work in the health care system, particularly medicine and nursing can gain a better understanding of the substantive issues addressed in the education of social work for health care practice. The editors use two guiding principles in organizing the book: (1) the collaborative nature of their efforts, and (2) the description of the process by which curriculum was developed. The format clearly reflects these principles. The seventeen authors of the ten chapters represent academic faculty, field instructors, agency staff and administrators, and s&dents. Most of the chapiers describe the process of collaboration between class and field, as the Hunter College School of Social Work and a number of hospitals and other health care settings worked together to improve student education. In the social work education literature, one does not often see such a fully elaborated model. The reader views alternately the perspectives of the academics, the practitioners and the students and the kaleidoscopic effect enriches the discussion. The reader will find limited specific course content, since the primary emphasis is on the collaborative process and overall principles of instructional development. Issues presented include the instructional tensions in field instruction between teaching from case to case, on the one hand, and a planned didactic progression, on the other, the principles used in the planning of courses, and the varied teaching roles assumed by field instructors with different responsibilities I%-&uis the student. At times, however, the emphasis on process leads to an excessively general discussion and over-use of social work educational jargon. The inclusion of a few specifics, e.g. teaching tools, evaluation forms and case review protocols indicate that more such illustrations would have usefully fleshed out the general treatment of the issues. Implicit throughout and specified at several points are the necessary conditions for such a collaborative effort. Resources are needed-in this instance, a federal grant underwrote many of the activities. Both the academic and service institutions need to be open to collaboration and ready to give the necessary time. Here, the School of the Social Work faculty and many health care personnel made a commitment to an improved model of education and acted seriously on that commitment. Readers interested in adopting the curriculum development model described here would be well cautioned to see to these necessary pre-conditions. The authors clearly state that concensus was not reached on all issues, and identified a number of unresolved questions, including reciprocal power, renumeration of both agency and school personnel, and staff development. The progress reported in this volume would seem to be the beginning of a continuing effort. With a clear acknowledgement that the purpose of the
1.5~16 3--H
School of Social Work Clniversiry of Washington Seattle, WA, U.S.A.
State Mental Hospitals: TALBOTT. Human
NAOMIGOTTLIEB
Problems and Potentials,
Sciences,
New
York,
by JOHN 1980. 219 pp.
$16.95 That large hospitals run by state governments have for 150 years been a disaster for patients, for the people who staff them and for the communities they were intended to serve is plain to anyone who bothers to study their history and their contemporary state. That there still are reputable groups which staunchly support their continuation is a tribute to the capacity of anxiety to generate denial. Private sector psychiatrists and those who work in psychiatric units in general hospitals who need backup facilities for difficult patients, members of communities and their elected representatives who fear the proximity of deinstitutionalized patients, the membership of public employee associations and community caretakers reacting to the problems with poorly implemented community care plans, are beginning to create a myth which retrospectively idealizes the state hospital as a place of asylum, run by a heroically beleagured staff which provided humane care despite the acknowledged budgetary constraints. State Mental Hospirals: Problems and Potentials, edited by John Talbott, is another in a series of publications whose aim is to keep squarely in the forefront of public attention the impossibility of the state hospital as a viable 337
338
Book reviews
institution. Made up of a series of papers by persons who are highly knowledgeable about state hospitals and public mental health systems, Spate Mental Hospitals provides both further documentations of their deficiencies and some suggestions for. new and diRerent roles for these institutions within community-based programs. The section on “The Problems of State Hospitals” allocates the responsibility to society with its attitudes toward the mentally ill, to the bureaucratic systems Of representative government which are set up to prevent things from happening rather than to facilitate their being done, to the government/university interaction which is characteristically shot through with misunderstanding based on apparently conflicting agendas and the lackluster characteristics of many of the professionals in state hospitals whose indifferent performance is both elicited and sheltered by the system. “The Potential Role of State Hospitals” covers important and often neglected functions for state hospitals in the future-as tertiary prevention facilities, to provide domiciliary care and as possible loci for community mental health centers. In all cases these future roles presuppose such vast changes in administrative relationships, physical facilities and staff quality that one might properly argue that what is envisioned is not a potential role for the state hospital but rather the development of new institutions to carry on certain of the functions of the state hospital. The last section of the book “The Future of State Psychiatric Services” deals with problems one step above the state hospital in the management of state mental health systems in these precarious times. Although concerned with important matters, its main points are not directly germane to the rest of the book. Expanded, that section could make another book, but not this one. Even more than most collections of papers Srare Mental Hospitals suffers from unevenness both of style and quality of contribution. Certain of the papers seem idiosyncratic and the range of concerns is overly broad. Finally, it shows a surprising degree of inattention to copy editing so that some of the papers read very badly. This is unfortunate since the vital issues which are addressed by Sture Menrul Hospitals deserve better-a more focused set of papers and considerably more attention to the craft of presentation. Nonetheless, this book has its place as an addition to the literature on one of the major human service issues of our time. Massachusetts Mentul Heulth Center Department of Psychiutry Hurvurd Medicul School Boston. MA. U.S.A.
MILES F. SHORE
Aging in Culture and Society, edited by CHRISTINEL. FRY, Foreward by PAUL BOHANNAN. Praeger, New York. 1980. 280 pp. $18.95
Aging in Culture and Society is a collection of essays focused around anthropologists’ explorations of age organization and values in a number of cultural settings including the U.S. Fry. as editor. weaves the disparate articles together by prefixing each with a synthesis and overview of how each piece contributes to the collection as a whole. There are primarily three factors that keep the volume from being as widely useful as it might have been although most of the articles are useful in various settings. First, the quality of the articles is uneven, leaving the reader with a sense of unfulfilled expectation. Secondly, the technical nature of the articles varies to such a degree that the text would be useful in graduate courses, but use with undergraduates would be somewhat limited. Thirdly, while the scope of anthropology and social gerontology is broad, the
least interesting efforts in this volume are unfortunately typical of the general gerontological literature: while the value of combining quantitative and qualitative data is mentioned in introductions, some of the resultant articles are quantitative discussions which lack the richness of ethnographic analysis and reduce people. values and interaction to numerical abstraction. Fry begins with a cogent, stimulating review of the anthropology of aging in Chapter I which covers a range of topics and outlines the problem areas which are addressed by other authors in the volume. It would have been helpful to have mentioned in this introduction that she, as editor. prefaced each article with a short synopsis because it is not clear until several articles that these synopses are not written by the authors. Chapter 2 sets off with a discussion of biological factors in aging. This chapter is good as far as it goes, although Beaubier neglects any discussion of diet and nutrition except in an anecdotal fashion. The article becomes disjointed and off balance as he shifts without transition from technical biological discussion to ancedotal description. The technical data in Chapter 2 is followed in Chapter 3 by a technical methodological discussion of multidimensional scaling in analysis of the cultural dimensions of age. Fry ties her discussion to her introduction by assessing in different form the cultural meaning of age in a rigorous methodological discussion. This article would be excellent for an upper division or graduate course in research methods, but is too technical in this volume if one wanted to use it in general undergraduate teaching. Chapters 4, 5 and 6 were disappointing because the topics of discussion were potentially interesting but the articles themselves were loose, fragmented and not well pulled together. Kagan. in discussing activity and aging in a Colombian peasant village, begins development of a model which is unfulfilling since it has lots of interesting ideas which are not drawn together into a coherent analysis or conclusion around her own data. She herself notes in the summary that the data is vague and abstract. Chapter 5 contains interesting ethnographic data about the Chinese population in Hong Kong. The discussion initially develops along the lines of interdependence versus dependent and independent values and behavior patterns in relation to filial piety, but this theme is dropped and not integrated into the concluding remarks. This as well as a comparative but relatively non-productive use of Rosow’s index leave this article disjointed and a bit too long; the reader finishes wishing the article had been tighter, more succinct, and clearer in its conclusions. In Chapter 6. Williams presents an unsatisfying discussion of American Indian elderly in which alcoholism is a term used rather loosely and never documented with specific data. In discussing population increase and age statistics, Williams neglects to mention or integrate the rather compelling fact that the average life expectancy for American Indians is much lower than for the population in general. Chapters 7-10 represent the best of the articles in this collection. As a group they are well written, well edited and contain thoughtful analysis which is substantiated by varieties of methodological techniques. Kerns in her discussion of support relationships among Black Carib gives a concise, well developed picture of the individual variability in responses to old age and offers good clues for how to analyze this variability in her concluding remarks. Likewise, Vatuk’s discussion of disengagement and real versus ideal responses to aging in India provides a tight analysis which ties history and Hindu religious belief to the very real people and adaptive changes she documents for contemporary Indian communities. Vatuk uses quantitative data to complement and solidify her analysis and the