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At least 19 recordsLinked to original sources

Restraint versus treatment: seclusion as discussed in the Boston State Hospital case.

The recent Boston State Hospital case in Massachusetts produced, among other results, a decision that highlights areas of gross conceptual nonalignment between law and psychiatry on the subject of seclusion. The author presents a critique of aspects of the decision that have important implications for the psychiatric use of seclusion and explores related problem areas in the relationship between law and psychiatry.

Boston↗

The psychiatrist's double bind: the right to refuse medication.

The assertion of a patient's right to refuse medication places a psychiatrist in a double bind because he or she knows that medication will often greatly relieve mental disturbance. Delaying medication until the patient is formally judged incompetent and a guardian appointed causes discomfort for the patient, the physician, staff, and other patients. On the other hand, forcing medication on a patient undermines the latter's sense of autonomy and may interfere with his or her constitutional rights, as a federal judge has ruled in the famous Boston State Hospital case. The right to refuse medication presents a uniquely intriguing case study of a need for accommodation between abstract constitutional concepts and practical realities and has opened a profound legal and ethical debate about the nature of "true freedom."

Commitment of Persons with Psychiatric Disorders↗

'Mental' in 'Southie': individual, family, and community responses to psychosis in South Boston.

The deinstitutionalization of psychiatric patients is a deeply cultural as well as political task. It entails the sharing of responsibility for human distress with family and community. Consequently, the locus of social control has also shifted from psychiatric and medical expertise to community and legal institutions. Diagnosis and treatment models must be more compatible with lay explanatory models. This paper explores the various meanings of "going 'mental"' and "being 'mental"' in the white, working class, ethnic neighborhood of South Boston. The data are extracted from a study of the impact of deinstitutionalization on a cohort of middle-aged, psychiatric patients discharged from Boston State Hospital in the attempt to return them to community living. Individual, family, and community responses to, and interpretations of, the symptoms of mental distress are discussed. The study indicates that even seriously disturbed individuals are sensitive to cultural meanings and social cues regarding the perception, expression, and content of psychiatric episodes. While madness invariably disenfranchises, it does not necessarily deculturate the individual.

Alcoholism↗

Deprivation in the childhood of depressed women.

With recent developments in community psychiatric services, concern with prevention has become an urgent social, as well as medical challenge. Comprehensive investigation into causation must therefore be given systematic emphasis. This paper is an effort toward clarification of etiology, specifically of the depressive disorder, in terms of early childhood experiences. The work is based on social and psychiatric history data collected by experienced psychiatric social workers on two groups of subjects from the National Institute of Mental Health (NIMH) Collaborative Depression Studies under the direction of Allen Raskin, Ph.D, of the NIMH Psychology Research Branch, and a third group of subjects from Boston State Hospital. The hypothesis that childhood deprivation, defined as "the lack, loss or absence of an emotionally sustaining relationship prior to adolescence", has a meaningful association with the occurrence of adult depression was tested in a sample of 347 depressed inpatient women and 114 outpatient women in comparison to 198 normal women used as a control or reference population. The subjects were all Caucasian. Events occurring during childhood that could be considered within the definition of deprivation were documented. Further, subjects were assessed as to depriving childrearing experiences. The findings revealed no association of adult depression with overt childhood loss events, but did provide evidence to support an association of depriving childrearing processes with adult depression. The findings also revealed evidence of a relationship between the degree of the depriving childrearing experience with the severity of the adult illness as measured by hospital status. The results are discussed in relation to findings from other studies of childhood deprivation and psychiatric disorder.

Adolescent↗