Journal of Youth and Adolescence, Vol. 4, No. 3, 19 75

Informing the Patient: What Social Science Research Can Tell the Adolescent Mental Patient D u n c a n Lindsey t

Received March 19, 19 75

The pioneer rasearch and theoretical formulations o f the psychiatric sociologists during the last decade have demonstrated the critical influence social processes have in the drift toward mental patient careers. In this article, I propose that several o f the important concepts and perspectives achieved by these research developments be incorporated into present institutional treatment programs by way o f a social science education program which reflectively examines the interpretations o f hospitalization fashioned by psychiatric sociologists.

INTRODUCTION Hospital patients, like heroes, are made, not born. Many people, including the patient himself, have spent much time and labor in training the patient for his difficult social role. Long before he ever sets foot in a hospital, the patient has heard things said and seen things done about hospitals and illness. By the time he enters the hospital he has been prepared for a certain kind of experience. -Earl Rubington In the last decade, several investigations c o n d u c t e d f r o m the "psychiatric s o c i o l o g y " perspective have suggested that the f o r e m o s t f u n c t i o n o f m e n t a l hospitalization is to provide c o m m u n i t i e s with relief from their t r o u b l e s o m e and a n n o y i n g members. These investigations have indicated (1) that " m e n t a l illness is a m y t h , " that there is n o substantial scientific evidence for the paradigm o f

1Assistant Professor, School of Social Work, West Virginia University, Morgantown, West Virginia. Has an interdisciplinary Ph.D. (1973) from Northwestern University with a focus in sociology and psychiatry. Current interests are in the development of practice and treatment models which enhance the subjectivity and self-competency of clients. Also has an interest in the sociology of knowledge construction in the social work field. 215 9 Plenum Publishing C o r p o r a t i o n , 2 2 7 West 1 7 t h Street, New Y o r k , N.M. 1 0 0 1 1 . No part o f this p u b l i c a t i o n m a y be r e p r o d u c e d , stored in a retrieval s y s t e m , or t r a n s m i t t e d , in a n y f o r m or by a n y means, e l e c t r o n i c , mechanical, p h o t o c o p y i n g , m i c r o f i l m i n g , recording, or o t h e r w i s e , w i t h o u t w r i t t e n permission o f the publisher.

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mental illness as an identifiable disease (Szasz, 1961; Scheff, 1966; Sarbin, 1972), (2) that societal reaction is instrumental in the referral process (Kitsuse, 1962; Mechanic, 1966), (3) that the social environment of the prepatient is characterized by conflict more than illness and disease (Miller and Kenney, 1966; Hammer, 1963; Wood et al., 1966; Greenley, 1972), and (4) that the distinctive features of mental illness are primarily the product of mental hospital processing and adjustment (Sarbin, 1968, 1969; Goffman, 1961; Braginsky e t aL, 1968; Lindsey, 1973; Scheff, 1966). These findings of the psychiatric sociologists have been questioned by several sociologists and psychiatrists (Gottesfeld, 1972; Mankoff, 1971). Young people interned at state mental hospitals are the subjects, and frequently discussants, of these controversies. Of course, most of the young patients rarely engage in dialogue concerning the merits of the various treatment programs; most never have the opportunity or requisite knowledge base. Nevertheless, virtually all of the adolescents discuss the hospital and what it is supposed to accomplish (Mayer and Rosenblatt, 1974). Stereotypes, prejudice, and narrow thinking prevail during these informal personal discussions. This is a highly volatile topic - it is a closed area. Rarely do these informal discussions among the patients lead to a fuller and more comprehensive understanding of the hospital's treatment program. Rather, the result is usually the development of a highly polemic viewpoint (Goffman, 1961). For adolescents interned in a state mental hospital, these controversial issues have profound implications. If mental illness is the paradoxical construction of mental hospital treatment (Becket, 1963; Matza, 1969), then these young people confront problematic issues which encompass more than their psychological difficulties (Levinson and Gallagher, 1964; Strauss et al., 1964). To cope effectively with these social issues, hospitalized adolescents must have the conceptual tools and knowledge necessary to an understanding of the social forces which impinge upon the course of their hospital careers. Thus those who desire not to become career mental patients would be better equipped to forge their actions in ways which lead away from the development of a mental hospital career. In this essay, I will propose a program designed to have young people examine the complex issues surrounding hospitalization and treatment in an atmosphere of democratic inquiry. The program should be in the nature of a social science course taught in a high school located within the residential facility (or the program might be conducted within the residential unit). The objective of the program would be to encourage adolescent inpatients to reflectively examine mental hospitalization. The abundance of research and theoretical formulations accumulated by the psychiatric sociologists necessitates careful selection (Rose, 1968). Therefore, my focus will center on three areas where the recent f'mdings especially

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underscore the relevance and importance of the educational recommendation set forth here. These areas are as follows: 1. The popular conceptions of mental illness are inaccurate. 2. Research indicates that annoying and disruptive behavior is the primary reason for hospital referral. The patient should examine the decision of the community. 3. Mental patient behaviors often develop as a result of mental hospital processing. The major theme of my proposal is that these three areas would all be most effectively examined by the adolescent patient in a reflective inquiry format. The specific structure of this format will be discussed in a later publication (Lindsey, 1975b). The objective of this essay is to outline the need for such a program.

POPULAR CONCEPTIONS OF MENTAL ILLNESS AMONG MENTAL PATIENTS In Popular Conceptions of Mental Health, Jum C. Nunnally (1961) produced convincing evidence of the prevalence of stereotypes and shallow understanding among the pubfic sector with regard to the issue of mental illness. However, since the publication of his research there have been no studies to determine the impact these stereotypes might have on the mental patient himself (Weinstein, 1972; Rotenberg, 1974). Since the mental patient is the subject of these stereotypes, it would be reasonable to assume that his acceptance of them would be especially detrimental (Phillips, 1963). The Mental Patient Stereotype and Patient Self-image

If the thinking of adolescent mental patients is influenced, as suggested, by the popular conceptions of mental illness, then one would expect to find a reflection of these conceptions in response to an open-ended survey concerned with these issues. To test this hypothesis, an open-ended survey was administered to adolescent patients at three state mental hospitals in theMidwest. The only requirement made of the three groups was that they be in a social science course in their respective hospital school which was using material at the fifthgrade reading level or above. Two questions were asked: 1. What are the causes of mental distress and breakdown? 2. What are the common characteristics of persons in mental hospitals? The answers to these questions were categorized according to mode responses. From these data, a nominal scale was developed along which the responses of the

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Lindsey Table I. Adolescent Inpatients' Attitudes Concerning Mental Distress and Hospitalized Mental Patients Causes of mental distress Craziness, disease, and/or bad thoughts Relations with family Social class or poverty Misbehavior No answer

26 15 2 7 7

Common characteristics of mental patients Look different Act different Crazy Need help Poor No difference Other No answer

7 11 20 8 0 5 1 7

adolescents were distributed (Siegal, 1956, pp. 21-25). The results of this procedure are reported in Table I. If those who did not respond are subtracted from the total population, the data indicate that 26 out o f 48 adolescents referred to craziness, disease, or bad thoughts as the cause o f mental distress and breakdown. This is greater than 54%. Only two adolescents referred to poverty, social class, or other social factors as having a bearing on the development of mental distress. In reply to the second question, there is a slightly reduced frequency o f stereotypical responses. Evidently the thinking of these adolescents is significantly influenced by the popular stereotypes. This sample o f adolescent patients were also administered the RosenbergGuttman scale of self-esteem (Rosenberg, 1965). The scores on the self-esteem scale were then divided into four groups ranging from lowest to highest. F r o m these data, a 2 • 4 contingency table was constructed of the scores on selfesteem and the frequency o f references to popular conceptions (Siegal, 1956, pp. 64-65). For experimental purposes, the following hypothesis was developed: reference to popular conceptions of mental illness has a negative pull on the selfesteem scale scores o f hospitalized adolescents. Translated into a null hypothesis, the two variables, self-esteem and reference to popular conceptions, are examined for independence. Since the c o m p u t e d X2 o f these two variables being independent is beyond 0.01 probability, the null hypothesis is rejected in favor o f the research hypothesis .2 Previous research on the self-concepts of hospitalized adolescents demonstrated a significant relationship between depression and self-concept ratings (Harrow et al., 1968). Since we did not have a diagnostic evaluation of all the adolescents in the sample, we were unable to control for the distortions this variable might introduce. Yet, the generalizability of the Harrow research is questioned by conflicting results reported by Karmel (1969).

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Table II. Contingency Table for Self-esteem Scale and Frequency of Popular Conceptions Self-esteem scale

References to popular conceptions

No such references

I (bottom 25%) II III IV (top 25%)

11

1

8

4

7 0

5 12

N = 48 x = 21.818 df = 3

p = 0.01 C = 0.559 (coefficient of contingency) f = 0.674 (association of attributes)

To retrace, adolescent inpatients are influenced by the popular conceptions of mental illness. This influence is particularly harmful for these adolescents as evidenced by the negative pull on scale scores o f self-esteem. Even though few adolescents arrive at a state mental hospital as a result o f crazy or hallucinatory behavior, they may begin to conceptualize their behavior and experience within the categories o f the popular conceptions of mental illness simply because they are in a mental hospital and the conceptual notions they have of this alien world consist o f the popular stereotypes. It is hoped that the recommendation proposed here might serve to counteract the propensity of adolescents toward adopting and confirming the popular stereotyped role.

CONFRONTING THE DECISION O F THE COMMUNITY Mental hospitals are found because there is a market for them. If all the mental hospitals in a given community were emptied and closed today, tomorrow relatives, police and judges would raise a clamor for new ones; and these true clients of the mental hospital would demand an institution to satisfy their needs. (Goffman, 1961, p. 382) The patient knows that he is deprived of his freedom because he has annoyed others, not because he is sick. And in the mental hospital he learns that until he alters his behavior he will be segregated from society. (Szasz, p. 84) Traditionally the mental health profession has defined its intervention in the community as diagnosing and treating mental illness and emotional disturbance. However, investigators from the psychiatric sociology viewpoint have accumulated sufficient evidence to demonstrate that most persons are referred to the mental health profession as a result o f being in personal conflict with others and only rarely as a result of exhibiting signs of mental illness (Greenley, 1972; Miller and Kenney, 1966; Lindsey, 1974; Laing and Esterson, 1970). This has been particularly true for those in the lower socioeconomic levels. Consequently, the psychiatric sociologists argue that rather than performing an illness-reduction service for the patient, the mental hospital, at the bedrock, offers an annoyance-reduction service to the community. It is not the intent o f this

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essay to engage the disputation of this issue but only to indicate that it is a controversial issue which has profound implications for the adolescent inpatient and therefore is an issue he should examine (Lindsey, 1975a); Mayer and Rosenblatt, 1974). If the analysis of the psychiatric sociologists is valid, then the problems confronting the mental patient become quite different than those traditionally sponsored by the mental hospital (Gruenberg, 1967). Rather than being concemed almost exclusively with his medical problem of disordered and disturbed thoughts and emotions, the adolescent is faced with coping with the moral judgment of his community and family: that he must change. Clearly something caused him to be overly troublesome for his family or community: some of the reasons documented by psychiatric sociologists include family conflict (Munichin et al., 1964; Wynne, 1961; Pollack, 1963; Sampson et aL, 1962), unpopular or annoying personality (Goffman, 1963; Benjamins, 1950; Schultz, 1961), socially unattractive physical features (Zilbach, 1962; Goffman, 1963), lack of academic success (Edgert6n and Sabagh, 1962; Freeman and Kasenbaum, 1956; Dexter, 1964), becoming target of family despair (Laing and Esterson, 1970; Vogel and Bell, 1961), being a member of a family that dissolved, running away from home (Robey et al., 1964), being uncontrollable (Clausen and Yarrow, 1955; Lindsey, 1974). Once admitted to the hospital, one of the major issues the patient has to decide is how he will cope with the judgment of his community that he be expelled or removed from community life (Ginsberg, 1973). One fundamental assumption of this educational proposal is that the adolescent patient is capable of coping with this judgment of his family and community. However, state mental hospitals with their mainstream therapeutic programs frequently avoid the community decision as one of the major issues confronting the patient. In the adolescent patient's search for the cause of his unhealthy emotions or reason for seclusion, the therapeutic modalities channel inquiry to a focus on inner problems and personal biography (Berger and Luckman, 1967, pp. 112-115). The purpose of the proposed educational program would be to extend the therapeutic perspective to the wider scope allowed by the educational perspective (Natanson, 1956). In a social science course, the patient would examine the social as well as the personal processes involved in mental hospital placement. 3

SOCIETAL INTERVENTION AND MENTAL PATIENT DRIFT

The movement into a mental patient career is influenced by a variety of psychological and social factors. The core of a young person's psychological 3Sociologists of deviance have constructed a powerful empiricallygrounded knowledgebase which should prove serviceable to deviant populations. The task for the serviceprofessions is to incorporate this knowledge into their practice and treatment models.

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disposition toward emotional disturbance or delinquency is essentially composed of both the history of his personality development and his attitudes toward authority. Clinical research has demonstrated that for a number of young people "pathological" personality development has established a disposition toward emotional disturbance and deviance (Weiner, 1970; Masterson, 1967). Within the hospital setting, the behavioral and medical technologies of the mental health profession can be brought to bear on this "unhealthy" psychological core to produce profound changes (Beckett, 1965; Easson, 1969). Before the young person arrives in a state mental hospital, important social events have occurred and been negotiated. This prior negotiation process is influenced by both the adolescent's behavior and the interpretation he and significant others have made of it (Rotenberg, 1974). 4 It is during this early prereferral negotiation period when social agencies must be particularly careful of their influence on an adolescent's drift into and away from a mental hospital career. Each case history of a disturbed or delinquent adolescent presents a unique picture with a unique combination of factors proving instrumental in the drift toward hospitalization. For a number of hospitalized young people, a "pathological core" was not the wellspring of disturbed or delinquent behavior. The underlying energy and drift propelling a large number of adolescents into disturbed and delinquent behavior issue from other sources not located within the individual. The size of this "non-pathological-core" population is highly contested. A conservative estimate would be in the 60-70% range (Scheff, 1966; Beckett, 1965; Miller and Kenney, 1966). For most of these "non-pathologicalcore" hospitalized adolescents, the social processes of signification (or labeling) were an important influence in their acquisition of a mental patient status. If a young person's exploratory deviant behavior becomes a focus of attention for important social audiences, then the reactions of these social audiences will immediately constrict the alternatives open to the developing adolescent. If the adolescent's predelinquent behavior is labeled, the signification will activate a series of social processes which will constrict his choice of friends and narrow his social opportunities (Kitsuse, 1962). Once the signification is set in motion, it attains a momentum of its own with a concomitant tendency to perpetuate and intensify the behavior it was instituted to prevent, s The issue for social agencies intervening in situations of early deviance is one of balancing their need to establish firm behavioral limits with their desire

4In another article, I have argued that the special characteristics of hospitalized mental patients (adolescent) most clearly derive from an analysis of the reasons prominent .social others instituted referral and subsequently requested admission (1974). See also Miller and Kenney (1966). s This paradoxical consequence of signification and institutional processing has been perceptively explored and outlined by sociologists of the naturalistic and symbolic interactionist perspective (Becker, 1963; Matza, 1969; Lindsey, 1975c).

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not to propel the spotlighted adolescent deviant's drift into an institutional career. Thus in their drive to establish and enforce behavioral boundaries these social agencies must be careful that their influence on exemplar individuals is not to shift deviant drift into deviant slide. 6 When the young person is taken into the custody of the social agency, the full force of the agency's influence on the young person's movement into or away from a mental patient career is unleashed. An adolescent who arrives at a state mental hospital is well on his way toward becoming a career mental patient. From the time of his admission, he will be treated by others as a mental patient. Significant others in his social world will view him as a mental patient (Sarbin, 1968; Goffman, 1961; Scheff, 1966). A young person who finds himself in a large state mental hospital begins to entertain notions about himself that he would entertain nowhere else. An adolescent who finds himself in this social situation should be encouraged to examine the source of his referral. In this manner, he may discover that his.present difficulties do not stem from mental illness. For the "non-pathological-core" population o f hospitalized adolescents, the educational program recommended here should be particularly useful. Moreover, if social agencies do not encourage this "non-pathological-core" population to explore their referral, then the social agency may, paradoxically enough, be participating in the social construction of what it officially strikes out against - mental illness.

THE EDUCATIONAL ISSUES The central theme of this proposal is that an adolescent patient can most effectively cope with the controversial issues surrounding hospitalization by examining them in a reflective inquiry format. Three educational issues which derive from the central theme remain to be discussed. Resolution of these issues has important implications for current psychiatric models of emotional and thought disorder. First, are adolescents cognitively capable of reflective thinking? Second, are diagnosed "emotionally disturbed" adolescents capable of reflective thinking into controversial areas? Finally, should educators be permitted to examine topics with adolescent inpatients which are currently restricted within the professional domain of therapeutic personnel?

6David Matza (1964) postulates that there is a universal need among young people to assert themselves, to become subjects in control of their lives instead of objects to be "pushed around" by authorities. This need exposes and expresses itself in the drift of many young people into delinquency. In this regard, he asserts that the delinquent subculture provides the young person with techniques whereby he can assert himself.

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Reflective Thinking

The empirical investigations of Inhelder and Piaget (1958) report that at the onset of adolescence the cognitive capacity of formal operations emerges. That is, the capability to think about things, oneself, and the relationships between them arises at about the age of 12. E. A. Peel (1971) has found through an extensive experimental research project that during the period between 13 and 15 years of age "there is a rapid acceleration in the power to offer explanations and make judgments." The ability to handle formal operations is the primary cognitive ingredient in the process of reflective thinking. In 1909, John Dewey proposed in his How We Think that everybody thinks in the sense that thoughts pass through everyone's head all during the day; it is the characteristic of reflective thinking that it is guided by a problem. Adolescents who find themselves in a state hospital clearly have problems which have the potential of fueling reflective thought. They abound in a natural concern which, if tapped carefully, could stimulate and exercise their newly emerging faculty. In this sense, adolescence is a particularly appropriate time to initiate reflective inquiry into "closed areas" (Hunt and Metcalf, 1968). Reflective Thinking and Emotional Disturbance

From the literature on adolescent psychiatry, as well as from the field experience of the author, it is clear that many professionals believe hospitalized adolescents categorized as "emotionally disturbed" are incapable of thinking clearly (Lindsey, 1973; Weiner, 1970, pp. 95-132; Spivak et al., 1967; Overall and Klett, 1972). Accordingly, emotionally disturbed adolescents are characterized as displaying rigid thought processes, being too emotionally distraught to confront difficult questions, and, for several patients, too enstrangled by their own pathology to use potent information in a constructive manner (Easson, 1969, pp. 183-198). The underlying assumption here is the proposition that one of the primary features of emotional disturbance is the presence of bizarre, disordered, and defensive thought processes. 7 It is beyond the scope of this essay to carefully examine the disordered thought component of the psychopathological model of emotional disturbance. There have been several significant research projects with adult patients which have challenged the soundness of the disordered thought processes proposition with empirical research. Braginsky et al. (1968) present a cogent treatise debunkhag the paradigm which views mental patients as bizzarre and hallucinatory 7Sigmund Freud contended that disordered and defensive thought processeswere a central feature of neurosis and psychosis(Gardner and Moriarity, 1968, pp. 36-60).

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individuals. Instead, they systematically demonstrate with several ingenious experiments that mental patients often manage their impressions to remain in the last resort - the mental hospital. Theodore Sarbin (1972) has explored the disordered thought model by reviewing the experimental literature which demonstrates that those in mental hospitals can be differentiated from the normal in their thought processes. His research review demonstrated the inconsistency and inadequacy of methodology and statistical analysis which permeate the experimental evidence. Sarbin concludes his review with the appeal that it is both misleading and futile to propose that the schizophrenic is significantly different from the normal in his thought processes (see also Sarbin, 1969). Finally, I am unaware of any experimental evidence which demonstrates either that adolescent mental patients are unable to think reflectively or that emotional illness disrupts the ability to think reflectively, s On the contrary, Peel reports that "investigations of the relationship between personality variables such as extroversion, introversion, and stable neuroticism and maturity of judgment have so far not revealed any consistent features" (Peel, 1971, p: 187). Peel believes that further research in this area is critically needed. If adolescent inpatients are found to be able to successfully examine the controversial issues proposed herein, then the proposition concerning disordered thought processes among this group should be reevaluated. Who Shall Guide Reflective Inquiry into Mental Health Care? Discussion of a student's personal life is not encompassed within role responsibilities of an educator. Diagnosis and treatment of a student's feelings and attitudes about his family, his friends, his problems, or himself are restricted within the professional purview of the therapist who has the requisite clinical skills. Nevertheless, behavioral scientists who have examined the relation between mental health and education argue that the teacher cannot ignore the ego development and emotional growth of his pupils (Bower and Hollister, 1967; Jones, 1968). Eli Bower urges the educator to take into consideration the emerging ego development of the child by building into the curricula experiences which will strengthen specific ego developments of the students, i.e., ego synthesis and ego differentiation.

8The task of psychotherapy is to engage the patient in reflective inquiry into his personal biography. The issues the patient discusses with the therapist are frequently quite personal and controversial. Consequently, the treatment paradigm of psychotherapy presupposes, in large measure, the ability of the patient to reflectively examine controversial areas. The primary difference between psychotherapy and education is thus the angle of focus for reflective inquiry.

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Richard Jones (1968) insists that the mission of the social science curriculum requires confronting issues even if those issues have strong emotional import. In this regard, Jones is disturbed about the way the current school curricula so often avoid topics which engage the student's emotions. In the classroom, the student's emotions are constantly involved. What concerns the educator is when the student's emotional energy becomes transformed into anxiety or uncomfortable emotions. To examine this process, Jones constructs the notion of anxiety as the level of emotional arousal which occurs when the student is alone and helpless and confronted by his imagination. The most appropriate environment in which the student can confront social issues that have strong emotional import, because they invoke the imagination, is the classroom. In the classroom the student is not alone, because the teacher and other students are there, nor is he helpless, for the teacher is there. In brief, the classroom provides a secure, supportive, and reflective environment for the exploration of important social issues. Controversial topics cannot be avoided by the educator primarily because they invoke the student's imagination and concern. The educator has a professional responsibility to assist the young person in exploring these issues. The social science project proposed here would arouse the imagination and interest of the enrolled student. Under the careful direction and support of his teacher and peers, the student would be encouraged to confront the difficult issues of hospitalization in a reflective inquiry format.

SUMMARY

To retrace, it has been illustrated how the research of psychiatric sociologists in the areas of (1) the stereotypes of mental illness, (2) the diverse services mental hospitals provide the patient and the community, and (3) the social processes influencing the drift into deviance all have direct bearing on the social circumstances of adolescent patients. Therefore, I have proposed that a social science education program be developed which would allow adolescent inpatients to reflectively examine these issues. To effectively cope with the problems of hospitalization, the adolescent must be able to examine the total picture of his hospitalization. This is a difficult process, for in so doing he will confront the humiliating stereotypes of which he is the subject, he will confront intrapersonal discrepancies between his many beliefs about the issue of mental illness, he will encounter the controversial issues surrounding the legitimacy of his hospitalization, he will confront whatever it was that set off his referral process, he will examine the possibilities (both negative and positive) of the treatment programs in the hospital. In this manner, it is imperative that the hospitalized adolescent acquire the conceptual

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tools and knowledge w h i c h w o u l d permit him to understand the social forces involved in the social c o n s t r u c t i o n o f a m e n t a l patient career so that if he selects n o t to b e c o m e a career mental patient he will be fully e q u i p p e d to forge his actions in ways which lead away f r o m a hospital career.

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Kitsuse, J. I. (1962). Societal reaction to deviant behavior: Problems of theory and method. Soc. Prob. 9: 247-256. Laing, R., and Esterson, A. (1970). Sanity, Madness and the Family, Penguin Books, Middlesex, England. Levinson, D. and Gallagher, E. (1964). Patienthood in the Mental Hospital, HoughtonMifflin, Boston. Lindsey, D. (1973). Reflective inquiry into the social construction of mental illness by hospitalized adolescents. Unpublished Ph.D. dissertation, Northwestern University. Lindsey, D. (1974). Adolescent pathways to residential treatment: The enforced expedition. Adolescence 9(33): 135-148. Lindsey, D. (1975a). Behaviorist versus sociologist in the mental health field. Correct. Soc. Psychiat. 21(3): 8-12. Lindsey, D. (1975b). Reflective inquiry into mental illness by hgspitalized adolescents. Theory and Research in Social Education (in print). Lindsey, D. (1975c). Mental hospitalization and the negotiation of self. Paper presented at the North Central Sociological Association Convention, Columbus, Ohio, May 4 to 6. Mankoff, M. (1971). Societal reaction and career deviance: a critical analysis. Sociol. Quart. 12: 204-218. Masterson, J. F. (1967). The Psychiatric Dilemma o f Adolescence, Little. Brown, Boston. Matza, D. (1964). Delinquency and Drift, Wiley, New York. Matza, D. (1969). Becoming Deviant, Prentice-Hall, Englewood Cliffs, N.J. Mayer, J., and Rosenblatt, A. (1974). Clash in perspective between mental patients and staff. Am. J. Orthopsychiat. 44(3): 432-441. Mechanic, D. (1966). Some factors in identifying and defining mental illness. Ment Hyg. 12(1): 33-48. Miller, R., and Kenney, E. (1966). Adolescent delinquency and the myth of hospital treatment. Crime Delinq. 12(1): 38-48. Munichin, S. (1964). The study and treatment of families that produce multiple acting-out boys. Am. J. Orthopsychiat. 34(1): 125-133. Natanson, M. (1956). The Social Dynamics o f George Herbart Mead, Public Affairs Press, Washington, D.C. Nunnally, J. C. ( 1961). Popular Conceptions of Mental Health, Holt Rinehart, New York. Overall, J., and Klett, C..1. (1972). Applied Multivariate Analysis. McGraw-Hill, New York. Peel, E. A. (1971). The Nature o f Adolescent Judgement. Wiley, New York. Phillips, D. (1963). Rejection: A possible consequence of seeking help for mental disorder. Am. Sociol. Rev. 28: 963-973. Pollack, O. (1964). The broken family. In Cohen, N. E. (ed.), Social Work and Social Problems, National Association for Social Workers, New York, pp. 321-339. Robey, A., Rosenwald, R. J., Snell, J. E., and Lee, R. (1964). The runaway girl: A reaction to family stress. Am. J. Orthopsychiat. 20(2): 762-767. Rose, A. (1968). Sociological studies on mental health and mental disorder. Int. Soc. Sci. J. 20(2): 273-285. Rosenberg, M. (1965). Society and Adolescent Self-Image, Princeton University Press, Princeton, N.J. Rotenberg, M. (1974). Self-labelling: A missing link in the "societal reaction" theory of deviance. Sociol. Rev. 23: 335-354. Rubington, E. (1969). Legal commitment and hospital behavior. Merit. Hyg. 5 3 : 4 1 . Sampson, H., Messinger, S., and Towne, R. (1962). Family process and becoming a mental patient. Am. Z Sociol. 68: 88-96. Sarbin, T. (1968). Notes on the transference of social identity. In Roberts, L., Greenfield, N. S., and Miller, M. H. (eds.), Comprehensive Mental Health, University of Wisconsin Press, Madison, pp. 97-115. Sarbin, T. (1969). Schizophrenic thinking: A role-theoretical analysis. J. Personal. 37: 190-206. Sarbin, T. (1972). Schizophrenia is a myth, born of metaphor, meaningless. Psychol. Today 6: 18-27.

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Informing the patient: What social science research can tell the adolescent mental patient.

The pioneer research and theoretical formulations of the psychiatric sociologists during the last decade have demonstrated the critical influence soci...
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