Wednesday, December 4, 2013

Hansels and Gretels

On my supervisors’ retirement about a year ago I was left with a large box of books, some of which long out of print and still others, with almost faded pencil lines marking sections that must have had some relevance to his work all those years ago. One of these was the 1971 Hansels and Gretels, Studies of Children in Institutions for the Mentally Retarded, by Dorothea & Benjamin Braginsky (New York: Holt, Rinehart and Winston). I finally got around to reading this book in the last week, more so out of interest for its historical context.

The book, as expected, is peppered with language that many of my younger colleagues would hardly believe is possible – I’m of course referring to clinical labels and accepted terminology of the time. Consider; for example “…as a psychologist in a large state school and colony,…”, “classified as high-grade mental defectives…”, “…I prepared myself through library research and clinical conferences to look for moronic behaviour…”.

Chapter 5, titled “Retardates and Their Keepers: Conflict of Interests” particularly caught my curiosity. Here the authors begin the chapter with an acknowledgment of an assumed covert ideological conflict between the retardates and the institutional staff. I think they were correct in seeing this to be crucial in interpretations concerning retardate behaviour. The authors’ show insight when are expounding questions such as “what is the nature of their affliction, who are they, how should they be treated, what are their needs, and why are they incarcerated,..” etc.

In order to ascertain the attitudes that the training school staff maintain about mental retardation, its treatment and prognosis, and the institution, the Braginskys provide the results of a 100-item adaptation of the Retardation Attitude Test (RAT). What's really fascinating here isn't so much the variance between "Upper Staff" and "Lower staff" attitudes, which by the way is in itself interesting, but the kind items in the RAT. For example, item 15 "Although Retardates may seem all right when they have left here, they shout not be allowed to marry." Something incidentally about 30% of both upper and lower staff agreed with.

As well as my interest in this book’s historical throwback – I had also read the more current paper by Dianne E. Green (et al) New Zealand Attitudes to Mental Health (New Zealand Journal Of Psychology, 1987, 16, 37-41) that also dealt with stereotyped attitudes towards the mentally ill. I’d wondered if attitudes have indeed changed and if so by how much.

The researchers examined propositions about stereotyped attitudes towards the mentally ill based on responses of a group of New Zealand university students and the results compared with those if similar New Zealand studies carried out by the authors some three and six years previously, and with a U.S.A study carried out nine years previously.

In a historical sense, the authors talk of a contemporary shift in the care and treatment for the mentally ill and that has been away from institutional care and towards greater involvement of the community. Also, an acknowledgment of proposals introduced by various countries for the community to be more deeply involved in the care and treatment of the mentally ill, for a diversity of fresh therapeutic treatment and management styles with different types of institution to be initiated, and for the adoption of safeguards to prevent the oppressive control of patients.

In order to throw some light on the validity of these assumptions the present authors examined attitudes of one section of New Zealand community (in this case university students) with a rationale that, subject to social and situational pressures, attitudes are generally a precursor to behaviour, and that attitudes to the mentally ill might indicate the readiness with which people could be expected to respond personally to the specific demands for community mental health care.

Three propositions were examined; two of which are described below.

Proposition one:

That people attach a stigma to the mentally ill, was confirmed. Ratings of the three relevant concepts (a) “mental patient”, “insane people”, and (c) “ex-mental patient” were examined.  When it came to the concept of “mental patient” the stereotype had a highly negative rating without bothering you with the statistical reliability. Interestingly, this did not differ significantly from the 1981 negative stereotype. 

Proposition one:

That the public holds moderately favourable attitudes toward mental health professional was tested via 2 concepts (a) “psychiatrist” and (b) “doctor”. The rating for this mental health professional was moderately positive as it was in 1981. However, the rating for the concept “doctor” was much more positive than for the psychiatrist, as it was in 1981, 1978, and 1971.

The authors conclude that social attitudes towards the mentally ill need to be changed before community-oriented mental health carte policies can have much hope of long-term success.