Understanding psychiatric institutionalization: a conceptual review

Abstract

Background: Since Goffman’s seminal work on psychiatric institutions, deinstitutionalization has become a leading term in the psychiatric debate. It described the process of closure or downsizing of large psychiatric hospitals and the establishment of alternative services in the community. Yet, there is a lack of clarity on what exactly the concept of institutionalization means in present-day psychiatry. This review aims to identify the meaning of psychiatric institutionalization since the early 1960s to present-day.

Method: A conceptual review of institutionalization in psychiatry was conducted. Thematic analysis was used to synthesize the findings.

Results: Four main themes were identified in conceptualizing institutionalization: bricks and mortar of care institutions; policy and legal frameworks regulating care; clinical responsibility and paternalism in clinician-patient relationships; and patients’ adaptive behavior to institutionalized care.

Conclusions: The concept of institutionalization in psychiatry reflects four distinct themes. All themes have some relevance for the contemporary debate on how ..

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The Tort Liability of the Psychiatrist

Psychiatry is defined as "a branch of medicine that deals with mental, emotional, or behavioral disorders."Due to its very nature, psychiatric practice differs from that of other medical specialties, which minister primarily to bodily ills and discomforts. Consequently, the tort liability of the psychiatrist, as might be expected, is in many ways different from that of other practitioners.The psychiatrist must deal not only with psychiatric disorders of an organic nature, but also with the emotions and feelings of his patients. To a great degree, success in treatment is dependent upon the effective interaction between practitioner and patient. Psychiatric patients often institute litigation against their doctors during periods of temporary setback, when the relationship with the physician is far from optimaL. This paper will survey the areas of tort liability encountered by the psychiatrist, examining past and present trends, and suggesting guidelines to be followed which may minimize the risks involved. ..

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Law & Psychiatry: Responsibility for Torts: Should the Courts Continue to Ignore Mental Illness?

Abstract

Although courts routinely consider whether a criminal defendant's mental illness makes punishment unfair, the rules are very different for civil liability. When people with mental illness harm others, courts refuse to consider their mental states in determining civil liability. The justifications offered for this rule range from the difficulty of assessing the impact of mental illness on behavior to the desire to place the burden of loss on the person who caused the injury. Undeniably, though, mental disabilities are treated differently from physical impairments, and the law's resistance to change seems largely based on misunderstanding and prejudice against mental illness....

(Psychiatric Services 63:308–310, 2012; doi: 10.1176/appi.ps.20120p308)

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A review of tort liability in involuntary civil commitment.

Abstract

The grounds for liability in cases of involuntary civil commitment have been broadened in recent years. Psychiatrists and other mental health professionals have been found liable for infringement of civil rights under Section 1983 of the Civil Rights Act and for failure to commit an individual who is subsequently involved in a tragedy. This article reviews recent developments in tort liability in involuntary civil commitment as well as the traditional areas of tort liability, including malpractice, malicious prosecution, false imprisonment, and abuse of process. The authors believe that even in this climate of expanded liability, mental health professionals who follow the letter and spirit of civil commitment laws will continue to enjoy the broad protections from liability afforded them in the past...

PMID: 3596501

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Weakness and Fatigue

Definition

Weakness refers to a decrease in muscle strength . Fatigue is tiredness that may be either independent of, or associated with, exertion. The complaints of weakness and fatigue are among the most common and challenging problems encountered by clinicians . Because patients may use these terms to describe a variety of symptoms, the physician should attempt to obtain a precise understanding of the problem . Technique

Weakness and fatigue are nonspecific symptoms that may be encountered in a bewildering number of medical and psychiatric disorders ; they also may be the expected physiologic consequence of normal human activities. Most patients with weakness or fatigue have self-limited conditions and do not seek medical care . Among those who visit a physician, weakness and fatigue are often part of an easily identified symptom complex . The patient who presents with chronic weakness or fatigue as the sole or major complaint may represent a more difficult diagnostic and therapeutic problem ..

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Study of the Relationship Between Intelligence and Crime, A

The question of delinquency, which has ever constituted a grave social problem, is arousing a constantly increasing interest as a result of the recent application of scientific methods to the study of crime in all its varied phases. Indeed, before a truly scientific interest could be developed, it was necessary that there be a development of those sciences which throw light on human conduct and behavior such as biology, psychology, sociology, and psychiatry, and particularly so this last-named science. However, the great significance of the problem is scarcely appreciated as yet, and the field of study, so wide and fertile, is relatively untouched, although significant progress has been made in some directions. Possibly, the most notable of advances made has been the beginning recognition of delinquency as a problem belonging almost entirely to the field of psychiatry rather than to the legal realm or to sociology, that field of normal human relationships.......

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The Homicidal Narcissist

ABSTRACT

Personality type and murder have been linked via several studies on Sadistic personality disorder, Antisocial personality disorder, and psychopathy. The present study focused on the relationship between Narcissistic personality disorder and homicidal propensity. The relationship was examined using a sample of 490 inmates of the Colorado Department of Corrections. The subjects specific to this study were 215 inmates convicted of homicidal crimes including manslaughter, first degree murder, second degree murder, and second degree murder-crime of passion. A control group of approximately 275 inmates was included. The control group consisted of a random sample of crimes with the exception of homicide. Elevations on the Narcissistic, Sadistic, and Antisocial indices of the Millon Clinical Multiaxial Inventory-III were expected from the homicidal subjects. Results showed small but significant differences were found between minorities and whites on years of education and IQ. Significant...

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