State mental hospitals' therapeutic processes and how they correlate with a therapeutic community : a case study of one ward
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Abstract
This dissertation is a descriptive case study of one ward at a state mental hospital in Massachusetts. The purpose of the study is to ascertain the ward's therapeutic processes and correlate them with the major characteristics of a therapeutic community. Chapter Two outlines the basic traits of a therapeutic community from the perspectives of three major theorists: Maxwell Jones, M.D., Richard Almond, M.D., and Robert N. Rapoport. Maxwell Jones discusses the differences between closed and open systems. He explains the social learning process. He focuses on such characteristics as open communication, sharing of power, sharing of decision-making, and the need for all members of the community to have a legitimate role. Richard Almond goes on to add his concepts of charisma and communitas. Robert Rapoport discusses his concepts of communalism, democratization, permissiveness, and confrontation.The methodology is phenomenological in nature; utilizing an open interview with an interview guide. Ten direct staff were interviewed which included the following roles: registered nurses, licensed practical nurses, psychiatrists, social workers, psychologists and mental health assistants. Ward G of Statesville Mental Hospital represents a custodial traditional, closed system; but when all the data is presented one can see that social learning and growth manage to emerge among the conglomerate of oppressions shared by the patients and staff. Woven amongst the traditional closed system are staff who hold humanistic ideals and feel social interactions are important, and these people keep a grass roots therapeutic community alive. It is pointed out in the conclusion that if the Department of Mental Health were to fulfill their obligations as outlined in Chapter 104 of the Code of Massachusetts Regulations a therapeutic community would emerge. The Department has a written ideology which closely resembl es a therapeutic community, but in practice it is several light years away.
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Dissertation (Ed.D.)--Boston University
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