Outline of Issues in the Literature

Issues considered scandalous marked * ranging from perceived malpractices to neglect

I  issues of social policy, the role of the state

A. locus of care


responsibility for provision of care: 1.private/voluntary

or charity 2.state

C. responsibility to inspect, monitor, advise, license:

all under state

1.laymen including magistrates )

2.medical profession            ) hoc agent or agency       )

*D. legal regulation of process of confinement, preventing illegal or unnecessarily prolonged detention

11 issues of the manner of providing care A. management of the patient

1.custody and control

*a. use of restraint

i. mechanical (chains -19thC), tying, strait-jacket, locked wards, seclusion

ii. physical force: punching, kicking, whipping

sometimes resulting in death

iii. chemical: sedatives and tranquillisers iv. medically prescribed treatment: insulin shock(no longer used) ECT, neuro-surgery, electro-coagulation, brain implanted stim-oceivers.

*b. psychological techniques

i. induced fear: verbal threats, abuse, sarcasm, teasing

privileges, inc- to others. to better/worse

ii. constant surveillance iii. sanctions : withdrawal of luding meals, as example iv. classification: movement wards

2.Active treatment according to psychiatric ideologies a. somato-therapy

i. mechanical restraint (as above)

ii. chemotherapy by drugs (as above)

iii. medical treatments(l8th-19thC- emetics, purges, blistering of scalp, swinging, shock by water) 20thC- as l.a.iv above

*there may be irregularities in the prescribing, administering and recording of the use of the above

b. psycho- and sociotherapies

i. occupations to fill time, occupational and industrial therapy, domestic chores 19thC moral treatment for working class

ii. recreational and educational activities, re­habilitation, DT, PT, speech therapy, school, visits, dances, swimming, films 19thC moral treatment for middle class

iii. talk: one-to-one psychotherapy, psychoanalysis,

group therapeutic community, milieu therapy iv. assessment by clinical psychologist or OT, individualised progamme

*B. Standards of physical conditions

l. care of patients: standards of food, clothing, personal hygiene and health, sexual abuse and exploitation

2. environment: amenities, sanitation, overcrowding, clean­liness, furniture, decor, toys, personal possessions

3.staffing: a. staff/ patient ratio

b. nature of the nursing task

i, task-oriented

ii. patient-oriented

III issues of organisational management

A. fraud, corruption, irregularities with hospital or patient’s property, including money

B. administrative structure

1.leadership by medical superintendant or consultant

2.multi-disciplinary team

C. administrative structure of NHS

1.centralist/managerialist perspective

2.role of HFlCs, AHAs, RHAs/RHBs, central department

D. inspection and complaints procedures, advice

l.19th Century licensing, role of magistrates, Metropolitan Commissioners, Commission in Lunacy

2.20thC: HAS, Development Team, Nat’l Development Group CHCs, Health Service Commissioner, Davies Com.

IVissues which are a hidden agenda on official reports

the medicalisation of deviance: medical or ecological paradigm of causation/care B. social class differences in treatment of patients