253
PSYCHIATRIC PROBLEMS OF THE 1970’s RICHARD E. GORDON, M.D., PH.D. SHARON HAMILTON, M.ED. SUSAN WEBB, M.S.W. KATHERINE K. GORDON, M.A. MAX PLUTZKY, M.D. From the
Departments ofPsychiatry and Psychology and the Student Mental Health Services ofthe University ofFlorida
Gainsville, Florida 32610 The authors thank Winston Cheshire, Katherine L. Gordon and Stanley F. Reed
for
their assistance
ABSTRACT
This paper describes some of the social trends of the 1970’s that may be affecting patterns of psychiatric needs and presents data showing their impact. It suggests possible psychiatric and sociopolitical responses to meet these needs. Patients were studied in the outpatient and inpatient services of the Shands Teaching Hospital and Student Mental Health Services at the University of Florida. The main findings were that single youth, both females and especially males, were requiring less help since the winding down of American participation in the Vietnam War, perhaps indicating that youth are feeling less alienated from the national effort. Black women are seeking help more than ever before, probably because the black liberation movement has offered them hope that psychiatry can help them. Despite the women’s liberation movement, white women still remain the largest group of psychiatric outpatients, as they were in the 1950’s and 1960’s. back
the 1950’s and 1960’s, several social trends and the response these can be noted in the literature. An overview of these will then we shall examine some of the emerging trends and responses
Looking of psychiatry given here,
on
to
be of the 1970s. Studies of social mobility in America’s middle class suburbs during the 1950s and its impact on mental health have shown that during that period when America’s suburbs grew rapidly, male children and white married women were more likely than other groups to seek help for psychiatric or psychosomatic disorders. The fastest growing middle class communities showed the highest rates of emotional and psychosomatic illness for patients in this socialeconomic category. Rural communities on the other hand, where many elderly people were left isolated, produced the highest percentage of emotionally ill older persons (1,2,3). Improved techniques in social and family psychotherapy and in preventive psychiatry developed to handle these difficulties (4,5,6) These psychiatric responses were paralleled by sociopolitical changes such as the women’s liberation movement (7) the proliferation and growth of organised programs for boys (Little Leagues, Boy Scouts, Midget Football, and the like) and the Nursing Home Movement for the elderly. These developments may be outlined as follows :
,
Downloaded from isp.sagepub.com at OAKLAND UNIV on April 6, 2015
254 THE
A
Social Trends 1. Suburban mobility 2. Rural isolation
B
Groups with Psychiatric Problems l.
2. 3. C
D
Suburban male children Suburban middle-class white Rural elderly
1950s
_
_
women
Psychiatric Responses 1. Development of social and family therapy Sociopolitical Responses 1. Proliferation of organised programs for boys 2. Beginning of women’s liberation movement 3. Nursing home movement for the elderly During the 1960s, the post-sputnik educational
-
’
pressures on youth, coupled with their resentment about the draft and their alienation during the Vietnam War, resulted in a dramatic rise in percentages of young single psychiatric patients, especially among white middle class males (8,9,10). Increasing numbers of high school and college students became psychiatrically ill, drug dependent, or suicidal; on university campuses riots and demonstrations were commonplace; these were accompanied by a nation-wide establishment of campus mental health facilities (11), the community health movement, and by the successful demands of youth for greater power. The following summary describes this phenomena : ’
THE
A
1960s
Social Trends 1. Post-sputnik educational pressures on youth 2. Alienation of youth during Vietnam War z
with
Problems
B
Groups Psychiatric Young white patients, especially males
C
Psychiatric Responses Development of campus and community mental health centres Sociopolitical Responses 1. Youth obtained greater political influence; majority lowered
D
2.
to
age of
18 years. Militant phase of women’s liberation movement
The present study will evaluate patient data through the early 1970s. It will examine current trends in psychiatric services, and will relate these to present-day social developments. After considering the results of these studies we shall predict proactive sociopolitical responses for the present decade. Shown below are some important trends during the 1970s that may have had an impact on patterns of psychiatric needs and care : .
Downloaded from isp.sagepub.com at OAKLAND UNIV on April 6, 2015
-
255 THE 1970s Social Trends 1. The winding down and end of American participation in the Vietnam War 2. The continuing struggle by women for greater status 3. The improving social and economic status of blacks 4. The energy crisis 5. The great transcience in the nation along people of all ages
A.
In the 1950s middle class families migrated from inner cities and rural areas suburban residences in response to urban job opportunities. The present transcience contains both seasonal travelling to resorts and permanent migration to the South and Southwest. to
MIGRATION TO THE SOUTH AND THE ENERGY CRISIS
In the past two decades a wanderlust has hit the nation. Transients of all ages high schoolers to golden agers travel about the country. Emotionally healthy and financially independent transients, vacationers and retirees, and less stable ones-drifters, criminals, delinquents and emotionally ill persons-move seasonally to resort areas and permanently to the South and Southwest. In a separate paper we have reported on psychiatric aspects of this latter phenomenon, particularly as it occurs in Florida (12). The two striking features reported in that study were the great numbers of out-of-state admissions to psychiatric hospitals in Florida, and the large numbers of transient &dquo;orbiting&dquo; patients who have criminal charges against them.
from
CHARACTERISTIC OF THE ORBITING PSYCHIATRIC PATIENT
1. 2. 3. _
He is usually male He has no permanent job to keep him in one location Habitually he does not cope with problems but avoids and escapes from them by entering hospitals, getting divorced, abandoning jobs, leaving the
state, etc. He is able
5.
to travel freely because of an independent income, perhaps from insurance or a pension related to his illness, or from a private source such as a parent, an inheritance, or from investments, or because of his willingness to live on an income from casual jobs or crime. Usually he is not married, but if married he is generally having marital and
6.
family problems. He has been hospitalised previously
4.
disability
in other
states
for his
disorder. 7.
8.
He recovers quickly after being hospitalised for illness, but does from outpatient followup, despite his symptomatic similarity who do. He is likely to commit crimes.
I’__
psychiatric not to
benefit
patients
-
’
METHOD
’
In this study we have assumed that patterns of psychiatric patient demography useful indicators of social forces in a community. Persons feeling painful effects of stress need and seek out-patient help if they expect psychiatry can provide
provide
Downloaded from isp.sagepub.com at OAKLAND UNIV on April 6, 2015
256 relief. For decades Jews, for example, have believed in and utilised psychiatric services in clinics and private offices more than any other ethnic group; blacks have been underutilisers until recently (13). Unlike outpatients, those who require inpatient care in state hospitals, where admission is less likely to be voluntary, are distressed, but do not necessarily expect help. They may, however, be trying to escape problems at home. Thus, inpatients need psychiatry while outpatients both need and expect to benefit from psychiatric -
help. All the 1124 case records from 1968 through June of 1973 of patients seen in the Adult Psychiatric Outpatient Clinic of the Shands Teaching Hospital of the University of Florida were reviewed, and data on age, sex, marital status, financial condition, chief complaint, and precipitating events were compiled. For the same time period all 5,622 case records from the Student Mental Health Services of the University of Florida were studied and data analysed for all male psychiatric patients for whom anxiety about the draft was a major precipitating event. The inpatient and outpatient psychiatric units of the Shands Teaching Hospital and the Student Health Services of the University of Florida, at the affiliated Gainsville VA Hospital, at the Community Mental Health Clinic serving District VII in Florida, and at Northeast Florida and South Florida State Hospitals have provided examples of typical patients. The cases selected have all been disguised to preserve anonymity. Officials in the Florida Division of Mental Health and at other State Mental Hospitals have been consulted; they have supplied both data and descriptive information confirming the observations reported. _ _
RESULTS
DEMOGRAPHIC CHARACTERISTICS OF PATIENTS SEEKING OUTPATIENT PSYCHIATRIC CARE
Marital Status A striking drop occured in percentages of single white males seeking outpatient psychiatric care after the beginning of the draft lottery; comparing numbers in this group from the period 1968-70 with those from 1971-73, the percentages declined from 60 per cent of 119 total white male patients to 36.7 per cent of 161 ((X2= 18, p
PSYCHIATRIC PROBLEMS OF THE 1970’s RICHARD E. GORDON, M.D., PH.D. SHARON HAMILTON, M.ED. SUSAN WEBB, M.S.W. KATHERINE K. GORDON, M.A. MAX PLUTZKY, M.D. From the
Departments ofPsychiatry and Psychology and the Student Mental Health Services ofthe University ofFlorida
Gainsville, Florida 32610 The authors thank Winston Cheshire, Katherine L. Gordon and Stanley F. Reed
for
their assistance
ABSTRACT
This paper describes some of the social trends of the 1970’s that may be affecting patterns of psychiatric needs and presents data showing their impact. It suggests possible psychiatric and sociopolitical responses to meet these needs. Patients were studied in the outpatient and inpatient services of the Shands Teaching Hospital and Student Mental Health Services at the University of Florida. The main findings were that single youth, both females and especially males, were requiring less help since the winding down of American participation in the Vietnam War, perhaps indicating that youth are feeling less alienated from the national effort. Black women are seeking help more than ever before, probably because the black liberation movement has offered them hope that psychiatry can help them. Despite the women’s liberation movement, white women still remain the largest group of psychiatric outpatients, as they were in the 1950’s and 1960’s. back
the 1950’s and 1960’s, several social trends and the response these can be noted in the literature. An overview of these will then we shall examine some of the emerging trends and responses
Looking of psychiatry given here,
on
to
be of the 1970s. Studies of social mobility in America’s middle class suburbs during the 1950s and its impact on mental health have shown that during that period when America’s suburbs grew rapidly, male children and white married women were more likely than other groups to seek help for psychiatric or psychosomatic disorders. The fastest growing middle class communities showed the highest rates of emotional and psychosomatic illness for patients in this socialeconomic category. Rural communities on the other hand, where many elderly people were left isolated, produced the highest percentage of emotionally ill older persons (1,2,3). Improved techniques in social and family psychotherapy and in preventive psychiatry developed to handle these difficulties (4,5,6) These psychiatric responses were paralleled by sociopolitical changes such as the women’s liberation movement (7) the proliferation and growth of organised programs for boys (Little Leagues, Boy Scouts, Midget Football, and the like) and the Nursing Home Movement for the elderly. These developments may be outlined as follows :
,
Downloaded from isp.sagepub.com at OAKLAND UNIV on April 6, 2015
254 THE
A
Social Trends 1. Suburban mobility 2. Rural isolation
B
Groups with Psychiatric Problems l.
2. 3. C
D
Suburban male children Suburban middle-class white Rural elderly
1950s
_
_
women
Psychiatric Responses 1. Development of social and family therapy Sociopolitical Responses 1. Proliferation of organised programs for boys 2. Beginning of women’s liberation movement 3. Nursing home movement for the elderly During the 1960s, the post-sputnik educational
-
’
pressures on youth, coupled with their resentment about the draft and their alienation during the Vietnam War, resulted in a dramatic rise in percentages of young single psychiatric patients, especially among white middle class males (8,9,10). Increasing numbers of high school and college students became psychiatrically ill, drug dependent, or suicidal; on university campuses riots and demonstrations were commonplace; these were accompanied by a nation-wide establishment of campus mental health facilities (11), the community health movement, and by the successful demands of youth for greater power. The following summary describes this phenomena : ’
THE
A
1960s
Social Trends 1. Post-sputnik educational pressures on youth 2. Alienation of youth during Vietnam War z
with
Problems
B
Groups Psychiatric Young white patients, especially males
C
Psychiatric Responses Development of campus and community mental health centres Sociopolitical Responses 1. Youth obtained greater political influence; majority lowered
D
2.
to
age of
18 years. Militant phase of women’s liberation movement
The present study will evaluate patient data through the early 1970s. It will examine current trends in psychiatric services, and will relate these to present-day social developments. After considering the results of these studies we shall predict proactive sociopolitical responses for the present decade. Shown below are some important trends during the 1970s that may have had an impact on patterns of psychiatric needs and care : .
Downloaded from isp.sagepub.com at OAKLAND UNIV on April 6, 2015
-
255 THE 1970s Social Trends 1. The winding down and end of American participation in the Vietnam War 2. The continuing struggle by women for greater status 3. The improving social and economic status of blacks 4. The energy crisis 5. The great transcience in the nation along people of all ages
A.
In the 1950s middle class families migrated from inner cities and rural areas suburban residences in response to urban job opportunities. The present transcience contains both seasonal travelling to resorts and permanent migration to the South and Southwest. to
MIGRATION TO THE SOUTH AND THE ENERGY CRISIS
In the past two decades a wanderlust has hit the nation. Transients of all ages high schoolers to golden agers travel about the country. Emotionally healthy and financially independent transients, vacationers and retirees, and less stable ones-drifters, criminals, delinquents and emotionally ill persons-move seasonally to resort areas and permanently to the South and Southwest. In a separate paper we have reported on psychiatric aspects of this latter phenomenon, particularly as it occurs in Florida (12). The two striking features reported in that study were the great numbers of out-of-state admissions to psychiatric hospitals in Florida, and the large numbers of transient &dquo;orbiting&dquo; patients who have criminal charges against them.
from
CHARACTERISTIC OF THE ORBITING PSYCHIATRIC PATIENT
1. 2. 3. _
He is usually male He has no permanent job to keep him in one location Habitually he does not cope with problems but avoids and escapes from them by entering hospitals, getting divorced, abandoning jobs, leaving the
state, etc. He is able
5.
to travel freely because of an independent income, perhaps from insurance or a pension related to his illness, or from a private source such as a parent, an inheritance, or from investments, or because of his willingness to live on an income from casual jobs or crime. Usually he is not married, but if married he is generally having marital and
6.
family problems. He has been hospitalised previously
4.
disability
in other
states
for his
disorder. 7.
8.
He recovers quickly after being hospitalised for illness, but does from outpatient followup, despite his symptomatic similarity who do. He is likely to commit crimes.
I’__
psychiatric not to
benefit
patients
-
’
METHOD
’
In this study we have assumed that patterns of psychiatric patient demography useful indicators of social forces in a community. Persons feeling painful effects of stress need and seek out-patient help if they expect psychiatry can provide
provide
Downloaded from isp.sagepub.com at OAKLAND UNIV on April 6, 2015
256 relief. For decades Jews, for example, have believed in and utilised psychiatric services in clinics and private offices more than any other ethnic group; blacks have been underutilisers until recently (13). Unlike outpatients, those who require inpatient care in state hospitals, where admission is less likely to be voluntary, are distressed, but do not necessarily expect help. They may, however, be trying to escape problems at home. Thus, inpatients need psychiatry while outpatients both need and expect to benefit from psychiatric -
help. All the 1124 case records from 1968 through June of 1973 of patients seen in the Adult Psychiatric Outpatient Clinic of the Shands Teaching Hospital of the University of Florida were reviewed, and data on age, sex, marital status, financial condition, chief complaint, and precipitating events were compiled. For the same time period all 5,622 case records from the Student Mental Health Services of the University of Florida were studied and data analysed for all male psychiatric patients for whom anxiety about the draft was a major precipitating event. The inpatient and outpatient psychiatric units of the Shands Teaching Hospital and the Student Health Services of the University of Florida, at the affiliated Gainsville VA Hospital, at the Community Mental Health Clinic serving District VII in Florida, and at Northeast Florida and South Florida State Hospitals have provided examples of typical patients. The cases selected have all been disguised to preserve anonymity. Officials in the Florida Division of Mental Health and at other State Mental Hospitals have been consulted; they have supplied both data and descriptive information confirming the observations reported. _ _
RESULTS
DEMOGRAPHIC CHARACTERISTICS OF PATIENTS SEEKING OUTPATIENT PSYCHIATRIC CARE
Marital Status A striking drop occured in percentages of single white males seeking outpatient psychiatric care after the beginning of the draft lottery; comparing numbers in this group from the period 1968-70 with those from 1971-73, the percentages declined from 60 per cent of 119 total white male patients to 36.7 per cent of 161 ((X2= 18, p
