CORRESPON DENCE
Psychiatric care and politics
was "high emotional involvement" had a poor outlook. However, in 1 972. they found that it was not high emotional involvement itself, but "expressed critical emotion", especially when there was a lot of "face-to-face contact"; that is, the patient was around the house a lot. Rereading the editorial by Thompson one perceives that it is polemic, aimed perhaps mainly at politicians, which may explain the gaps in the scientific evidence.
To the editor: I found the article by Dr. George Voineskos and Sharon Denault (Can Med Assoc 1 118: 247, 1978) both interesting and heuristic in the sense that an audit of psychiatric recidivists now seems mandatory. What did surprise me were the omissions in the editorial by Dr. M.G.G. Thompson that accompanied their article (page 223). Thompson stated that "mental status factors at the time of discharge do A.D. FORREST, MD, FRC PSYcH, FRCP[C] not appear to have predictive value." Department of psychiatry Groups from the Medical Research University Hospital Council social psychiatry research Saskatoon, Sask. unit at the Institute of Psychiatry in London, England have studied the References factors affecting outcome in dis1. BROWN OW, CARSTAIRS GM, TOPPING charged patients with schizophrenia G: Post-hospital adjustment of chronic for more than 2 decades. Brown, mental patients. Lancet 2: 685, 1958 Carstairs and Topping1 pointed out 2. RENTON CA, AFFLECK JW, CARSTAIRS GM, et al: A follow-up of schizoin 1958 that it is essential to control phrenic patients in Edinburgh. Acta the clinical state of the patient at the Psychiatr Scand 39: 548, 1963 time of discharge, otherwise the sig- 3. BROWN GW, MONCK EM, CARSTAIRS nificance of social factors becomes GM, et al: Influence of family life on the course of schizophrenic illness. impossible to evaluate. Renton and I Prey Soc Med 16: 55, 1962 colleagues2 in 1963 again found that 4. Br BROWN GW, BIRLEY JLT, WING JK: the single most important factor reInfluence of family life on the course lated to the outcome at 12 months of schizophrenic disorders: a replicaafter discharge was the patient's mention. Br I Psychiatry 121: 241, 1972 tal status at the time of discharge. To the editor: Permit me to make There are two other points to some observations on what appears which Thompson gives inadequate atbe an oversight in the article by tention: (a) employment (patients to Dr. George Voineskos and Sharon who have jobs to go to after dis- Denault. The evidence they presented charge have a better prognosis1) and does not justify their conclusions, (b) residential setting. In 1962 Brown which has possibly misled Dr. and associates' studied the influence Thompson in his accompanying ediof family life on patients with schizo- torial to suggest that the high rate phrenia and found that those dis- of recidivism among hospitalized pacharged to family homes where there tients would perhaps be reduced by a "community adjustment rating contributions to the Correspondence section are welcomed and if considered suitable will be published as space permits. They should be typewritten double-spaced and, except for case reports, should be no longer than 1½ manuscript pages.
system." With some danger of oversimplifi-
cation I must point out the discre-
pancy between the data and the conclusions - or between the evidence and the belief, already alluded to by Bowen (ibid, page 236) and Hoffer (Can Med Assoc J 117: 733, 1977). A total of 78 patients (the recurring hospitalization [RH] group) had been admitted five times or more for psychiatric treatment within 2 years. Of the RH group 43 patients had schizophrenia, 11 had organic disorders and 11 had addictive disorders; only 13 of the 78 patients had other disorders. We are then given a profile of a typical recidivist - a man between 36 and 50 years of age who is receiving welfare and lives alone in a boarding house. Later we are told that the length of stay in hospital of the RH group was significantly longer than that of the group admitted for the first time. In the discussion we are given two conclusions to consider, only one of which is believable: "Traditional methods of treating hospitalized patients, including individual, group, work, pharmacologic therapy and token economy, do not affect differentially the rate of readmission of discharged patients."1'2 "Diagnosis seems to be relatively unimportant, whereas environmental supports are important." No matter how much the author tries to convince us otherwise, the diagnosis of chronic schizophrenia or chronic alcoholism will continue to suggest recurrent hospitalization and revolving doors. The only escape from this sticky situation seems to lie in better treatment rather than in better environmental supports. However, it is believed that a decrease in these environmental supports might favour an earlier state of
CMA JOURNAL/JUNE 24, 1978/VOL. 118 1485
Psychiatric care and politics
was "high emotional involvement" had a poor outlook. However, in 1 972. they found that it was not high emotional involvement itself, but "expressed critical emotion", especially when there was a lot of "face-to-face contact"; that is, the patient was around the house a lot. Rereading the editorial by Thompson one perceives that it is polemic, aimed perhaps mainly at politicians, which may explain the gaps in the scientific evidence.
To the editor: I found the article by Dr. George Voineskos and Sharon Denault (Can Med Assoc 1 118: 247, 1978) both interesting and heuristic in the sense that an audit of psychiatric recidivists now seems mandatory. What did surprise me were the omissions in the editorial by Dr. M.G.G. Thompson that accompanied their article (page 223). Thompson stated that "mental status factors at the time of discharge do A.D. FORREST, MD, FRC PSYcH, FRCP[C] not appear to have predictive value." Department of psychiatry Groups from the Medical Research University Hospital Council social psychiatry research Saskatoon, Sask. unit at the Institute of Psychiatry in London, England have studied the References factors affecting outcome in dis1. BROWN OW, CARSTAIRS GM, TOPPING charged patients with schizophrenia G: Post-hospital adjustment of chronic for more than 2 decades. Brown, mental patients. Lancet 2: 685, 1958 Carstairs and Topping1 pointed out 2. RENTON CA, AFFLECK JW, CARSTAIRS GM, et al: A follow-up of schizoin 1958 that it is essential to control phrenic patients in Edinburgh. Acta the clinical state of the patient at the Psychiatr Scand 39: 548, 1963 time of discharge, otherwise the sig- 3. BROWN GW, MONCK EM, CARSTAIRS nificance of social factors becomes GM, et al: Influence of family life on the course of schizophrenic illness. impossible to evaluate. Renton and I Prey Soc Med 16: 55, 1962 colleagues2 in 1963 again found that 4. Br BROWN GW, BIRLEY JLT, WING JK: the single most important factor reInfluence of family life on the course lated to the outcome at 12 months of schizophrenic disorders: a replicaafter discharge was the patient's mention. Br I Psychiatry 121: 241, 1972 tal status at the time of discharge. To the editor: Permit me to make There are two other points to some observations on what appears which Thompson gives inadequate atbe an oversight in the article by tention: (a) employment (patients to Dr. George Voineskos and Sharon who have jobs to go to after dis- Denault. The evidence they presented charge have a better prognosis1) and does not justify their conclusions, (b) residential setting. In 1962 Brown which has possibly misled Dr. and associates' studied the influence Thompson in his accompanying ediof family life on patients with schizo- torial to suggest that the high rate phrenia and found that those dis- of recidivism among hospitalized pacharged to family homes where there tients would perhaps be reduced by a "community adjustment rating contributions to the Correspondence section are welcomed and if considered suitable will be published as space permits. They should be typewritten double-spaced and, except for case reports, should be no longer than 1½ manuscript pages.
system." With some danger of oversimplifi-
cation I must point out the discre-
pancy between the data and the conclusions - or between the evidence and the belief, already alluded to by Bowen (ibid, page 236) and Hoffer (Can Med Assoc J 117: 733, 1977). A total of 78 patients (the recurring hospitalization [RH] group) had been admitted five times or more for psychiatric treatment within 2 years. Of the RH group 43 patients had schizophrenia, 11 had organic disorders and 11 had addictive disorders; only 13 of the 78 patients had other disorders. We are then given a profile of a typical recidivist - a man between 36 and 50 years of age who is receiving welfare and lives alone in a boarding house. Later we are told that the length of stay in hospital of the RH group was significantly longer than that of the group admitted for the first time. In the discussion we are given two conclusions to consider, only one of which is believable: "Traditional methods of treating hospitalized patients, including individual, group, work, pharmacologic therapy and token economy, do not affect differentially the rate of readmission of discharged patients."1'2 "Diagnosis seems to be relatively unimportant, whereas environmental supports are important." No matter how much the author tries to convince us otherwise, the diagnosis of chronic schizophrenia or chronic alcoholism will continue to suggest recurrent hospitalization and revolving doors. The only escape from this sticky situation seems to lie in better treatment rather than in better environmental supports. However, it is believed that a decrease in these environmental supports might favour an earlier state of
CMA JOURNAL/JUNE 24, 1978/VOL. 118 1485
