[Institutional care of severely handicapped - how does it happen? - or: can the patient's career be influenced?].
The project "Analysis of the placement of handicapped in institutions from a social point of view (example: multiple sclerosis); has the objectives to improve knowledge about the situation of institutionalized MS-patients and to analyse the patient's way towards institutionalization. As far as this way is concerned, numerous examples show that the evolution of social factors in a wider sense is at least as important as the evolution of the medical factors. With regard to these social factors, the problem solving processes both of the patients and of their aides, professionals or not, are of primary importance together with the problem of being in control of the situation. Repression of the illness and uncertainty about the future are both barriers towards the search for new aims of life. Often, help is asked for in a moment when a great number of possible solutions for the problem are not anymore feasible. Furthermore, the "unique" patient is confronted with the well-tested problem solving process of the aide and thus, his own initiative is reduced and his dependency increased. These mechanisms do also exist within an institution where they have a major impact upon quality of life and influence it much more than the visible structure of the institution, e.g. buildings and equipments.