Monday, October 15, 2007

Deinstitutionalisation, Institution, Psychiatric

Last night, at about 0-dark-30 hours, on a PBS station, I observed a show documenting the life of a mentally retarded 18 to 19 year old. Apparently, the mother knew somewhere in the middle of her pregnancy that her son in the womb was in all likelihood have extreme deficiencies. Rather than undergoing an abortive procedure, she kept the child, to term. With her husband, she raised this child to about 14 years or so. (To be clear, there seems to be a problem with this child in terms of perception of the signals from his sense organs. In other words, as an example, Wernicke's and Broca's do not function; however, the sensory pathways from skin and sight are firing, with the exception that they do not then communicate to the integrative areas. The boy cannot feed himself, speak, or really do anything productive.) At this point, caretakers were recruited to spend all their waking hours tending to this child, feeding, wiping, and cleaning up after. Gradually, the parents came to a consensus with the caretakers, wherein they would take the child and move him to a separate house to live permanently with the caretakers. The parents responded as if a mountain had been lifted from their shoulders.

Before the mid 1960's, most likely the child would have been brought to a psychiatric hospital. After the 60's, however, there was a movement to deinstitutionalise the hospitals. Most likely it was related to the advent of the phenothiazine class of antipsychotic drugs (e.g. thorazine). It is almost as if once they transitioned, they never looked back at the benefit of what the hospitals had to offer. As an example, Pennsylvania Hospital here in Philadelphia had a psychiatric hospital up on 48th and Haverford. What was interesting is that it was technologically interesting -- each patient room had huge windows, an individualized heating and cooling vent, and most importantly, there was custom treatment for individuals of all tiers of mental deficiency. This means that individuals who suffered from Down syndrome would have all the medical staff and psychiatric staff as necessary.

I'm not suggesting that progress has not been made in treating some individuals - in fact, we have come far with the atypical antipsychotics. However, not everybody is deserving of medication. Realistically, the boy being discussed will never be able to receive medication to palliate his symptoms. Rather, the fundamental wiring is incomplete. Would it be a bad idea to have a trained staff of professionals interacting with this child in a Hospital setting? Barring any corruption (which happened in a few hospitals (e.g. molestation of patients)) I think he may be able to benefit. Look at the situation he is in now, wherein he is removed from his home and has "caretakers". Would it not be more prudent to have trained professionals to deal with the child instead?

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