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8 Soc. Probs. 254 (1960-1961)
Symptoms of Institutional Care

handle is hein.journals/socprob8 and id is 264 raw text is: SYMPTOMS OF INSTITUTIONAL CARE
The Saskatchewan Hospital, IWeyburn, Canada

During the last decade social scien-
tists have begun to concern themselves
with the effects of what Goffman (14)
calls the total institutions. We are
becoming familiar with people who
have become so adjusted to hospital,
jail, army, or concentration camp, that
they cannot live outside. Labels have
been given to these people such as
institutional cure, prisonized con-
vict, or passive patient. The under-
lying process has been called institu-
tionitis, hospitalitis, depersonaliza-
tion, prisonization, and desocializa-
tion. Under one or another of these
headings it has received some sporadic
attention but not much systematic in-
vestigation. In this paper we shall show
that several diverse phenomena are in-
volved. We hope that this clarification
will lead to a better understanding of
life in institutions and so to effective
means for making them less harmful.
Our interest stems from our studies
of mental patients who have been in
hospital a long time. As Johnson ( 21 )
and his colleagues have shown, by far
the greatest part of the mental hospital
population is a residual one which
consists of psychiatric failures, pa-
tients who have not responded to treat-
ment enough to leave a hospital and
who give no promise of responding
in the foreseeable future. Using only
figures from a patient's last admission,
Johnson found that patients at Warren
State Hospital averaged eleven years
in the hospital. At our own hospital
we summed each admission of every
patient studied and came up with an
average figure of sixteen years. Al-
though appalling from a public health
standpoint, here is a rich lode of in-
formation about people who have been
separated from their homes and fain-
This study was supported by funds from
the Rockefeller Foundation and the De-
partment of Health and Welfare (Ottawa).

ilies for long periods of time. Prob-
ably in no other type of institution can
one find so many people who have
been isolated from their communities
for such long periods. In England, for
example, the prisoners who are sen-
tenced to life imprisonment serve an
average of about eight years. It is true
that mental defectives sometimes have
even longer periods of continual resi-
dence, but a large proportion of them
have never lived outside institutions
and so have no other social values.
Schizophrenics not only enter hospitals
quite young, but those who remain
there live a long time. In all except
recently opened hospitals, one can
find people who have been patients
continually for thirty, forty, and even
fifty years.
The effects of living in institutions
can be studied both longitudinally and
in cross-section, but because of the dif-
ficulties of longitudinal studies most
authors have avoided them, particular-
ly if they continue for 10-15 years or
more. John Wing (36) states bluntly
No one has yet been foolhardy enough
to undertake this type of study and
the opportunity is fortunately rapidly
passing. The cohort method of Malz-
berg (20), Johnson (21), and Kramer
(17), comes closest to this sort of
study. So far these authors have been
more concerned with questions of the
likelihood of release from hospitals,
rather than enquiry into the effects of
prolonged institutional living on a
particular cohort for a period of 5 to
10 years. This has meant that most
research into the effects of institutional
living has involved a total population
of inmates and compared them accord-
ing to length of stay. A disadvantage
of this procedure is that if discharge
from an institution is selective, the
long-staying fraction, although making
up a large proportion of the current

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