Psychopathic court experience of the relatives of patients committed to state mental hospitals

Citation preview

PSYCHOPATHIC COURT EXPERIENCE OP THE RELATIVES OP PATIENTS COMMITTED TO STATE MENTAL HOSPITALS

A Thesis Presented to the Faculty of the School of Social Work The University of Southern California

In Partial Fulfillment of the Requirements for the Degree Master of Social Work

W Emanuel H. Newman January 1950

UMI Number: EP66353

All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion.

Dissertation Publishing

UMI EP66353 Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code

ProQuest ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48 10 6 - 1346

T h i s thesis, w r i t t e n u n d e r th e d i r e c t i o n o f th e c a n d id a te }s F a c u l t y

C o m m itte e a n d a p p ro v e d

b y a l l its m e m b e rs , has been p r e s e n t e d to a n d a c c e p t e d b y th e F a c u l t y o f th e G r a d u a t e S c h o o l o f S o c i a l W o r k in p a r t i a l f u l f i l m e n t o f th e r e ­ q u ir e m e n t s f o r th e d e g re e o f

MASTER OF SOCIAL WORK

Dean

D a te .

F a c u lty Com m ittee

ifixx

C r.

t.p

...

Chairman

TABLE OP CONTENTS CHAPTER T.

PAGE

INTRODUCTION TO THE STUDY . . . . . . . . . . .

1

The p r o b l e m ................................

1

Statement of the problem

...............

Importance of the study

.............

Definition of terms

..............

Method and procedure

. . . . .

• • • •

5 8

Setting of the s t u d y .....................

8

.....................

10

Selection of c a s e s ...................

10

P r o c e d u r e ..................................

11

.Outline of c h a p t e r s .....................

•

THE COURT COMMITMENT P R O C E S S ................. Legal definition of mentally ill persons The petition

III.

2

.............

Source of data

II.

1

12 14

• •

. . .

15” 15

Apprehension and detention of the patient . .

16

Investigation and examination . . . . . . . .

18

The court h e a r i n g ...........................

20

Transportation of patient tostate hospital •

24

PRESENTATION OP THE D A T A ........... Description of c a s e s ..................... Interviews with the relatives . . . . • • • • Case I

....................................

26 •

26 29 29

iii

CHAPTER

PAGE Case I I ..................................

34

Case I I I ................................. .

37

Case I V ............

39

Case V

. ....................

43

. V .............................

47

Case VI

Case V I I .................................. Case VIII

50

• ................................... 53

Analysis of interviews with relatives

. . . .

57

Response to the offer of social casework help Emotional reactions to the commitment.

.

57

• .

59

Feelings and attitudes concerning state hospitalization

.............

. . . . .

The social caseworkerTs activity • • • • «

62 64

Indications of shift in feelings and attitudes that could mean some constructive

IV.

use of the social casework service . . .

69

CONCLUSION OF THE S T U D Y .......................

74

Conclusions • • • • • • • •

• • • •

Implications for the social w o r k e r .........

81

Recommendations for further

83

study ..........

B I B L I O G R A P H Y ........................................ TABLE I:

74

84

Statistical data for the eight cases studied

............. • • • • • • • • • •

28

CHAPTER I INTRODUCTION TO THE STUDY Commitment of the mentally ill In California still involves in over ninety-seven per cent of the cases a legal procedure similar to that used by society in dealing with the criminal offender.

Over nine thousand patients were

committed to California state mental hospitals through the Psychopathic Courts in 1948, while the only other plan of commitment, the Health Officer Certificate Plan, accounted for only two hundred fifty state mental hospital admissions The emotional impact and disabling effects of mental illness on the families of patients is generally accepted and recognized.

This study is an examination of these effects

at one particular point in the patient*s Illness —

his

court commitment to a state mental hospital. :I.

THE PROBLEM

Statement of the problem.

It was the purpose of

this study to explore, describe, and analyze the attitudes and emotional responses of relatives participating in the court commitment of the mentally 111 patient.

The study

iGardner Bullis, ’’Admission and Release Procedure,” (unpublished editorial statement presented to the discussion panel on Admission and Release Procedure, The Governor’s Conference on Mental Health, March 3-4, 1949, Sacramento, Calif.), p. 2.

2

further proposed to examine the social casework techniques utilized by the worker in meeting and dealing with these at­ titudes and emotional reactions, and the effectiveness of these techniques* Importance of the study.

In recent years there has

been an increasing interest and effort on the part of pro­ fessional and lay groups and official and voluntary social agencies to provide not only more and better care to the mentally ill person, but also to create a more enlightened and educated general public in relation to this problem. Patients and their families have great difficulty in the recognition and acceptance of the fact of mental illness, and of the need for hospitalization and psychiatric treatment.

The occurrence of mental illness creates a com­

plex of emotions which may include anxiety, fear, shame, and guilt.

Esther G o o d a l e ^ conducted a study at the Essex County

Hospital in New Jersey in which she interviewed relatives of psychotic patients immediately following the patients being brought to the hospital by them for admission.

She

found these relatives to be emotionally tense concerning? (1) their fears and anxieties about the hospital;

(2) anx­

ieties based upon imaginary and subjective dangers; ^Esther Goodale, nIntake Interviews with Relatives of Psychotic Patients,” Smith College Studies In Social Work, XV (September, 1944'), T5-50.

(3) guilt feelings based upon fear of disapproval. The attitudes and emotional reactions of the families of the mentally ill have m a n y of their roots in the his­ torical misconceptions about the causes of mental illness, and in the previous methods of treatment of the mentally ill.

Albert Deutsch in his recent book traces the develop­

ment of society*s thinking and attitude toward the mentally ill; and he points out very, vividly how these attitudes have contributed to the development and operation of the social institutions which serve these persons.

He says;

Por many centuries the insane were regarded as demoniacs and were consequently often handed over to the exorcist or even to the executioner, when they were not completely abandoned. In later times they Y/ere frequently treated as criminals and paupers and as such came under the supervision of penal and poor law authorities.3 Residuals of these primitive misconcex^tions are still prevalent in the operation of the social institutions of today.

The commitment of the mentally ill through a

court hearing is a vestige of the previous period in history when the mentally ill were considered criminals and came under the supervision of the law authorities.

If relatives

of patients react with anxiety, fear, and guilt to the di­ rect admission of the patients;to a mental hospital, as

Goodale showedj it might he expected they would react more strongly to a legal procedure which may conceivably repre­ sent to them an acting out of their worst fears and doubts about the treatment of the mentally ill.

The emotional im­

pact of a court commitment procedure on patients and their families prior to hospital admission has been recognized by many groups.

In the recent Governor!s Conference on Mental

Health in California, March 3-4, 1949, there was an entire discussion panel devoted to state mental hospital admission and release procedvires.

The Group for the Advancement of

Psychiatry has recommended the abolition of the court com­ mitment procedure and the adoption of a plan of commitment embodying the admission of patients to state mental hos­ pitals upon the certification of two qualified physicians with the safeguarding of the patient*s right to petition for release by court hearing.4

in 1947, California adopted

the Health Officer Certificate Plan which permits commit-, ment upon the certification of two qualified physicians and the local health officer; but the usefulness of this plan is limited in that It cannot be used if the patient ex­ presses resistance to it at any point in its operation. Changes In social institutions occur slowly.

The

realities of the present court commitment plan in use in 4 Group for the Advancement of Psychiatry, Report #4, Commitment Procedures,11 April, 1948, 4 pp.

5 California demand that its impact upon the individuals who participate in it he understood so that the social caseworker is better able to assist them to use it effectively with a minimum of trauma.

It is the hope that this study will

provide some of that understanding.

Perhaps the examination

of the experience of the relatives of patients in the court commitment procedure will lay bare some facts that may g i v e additional impetus to the consideration of changing the procedure of commitment of the mentally ill in California. II.

DEFINITION OF TERMS

The following terms will appear frequently in this study, and are briefly defined here for the purpose of clarification.

Many of these terms will be discussed in

greater detail in Chapter II. State hospital.

In this study the term 11state

hospital11 refers to state mental hospitals. Leave of absence.

This term applies to the status

of those patients not discharged, but released from a state hosioital to the supervision of a responsible person or agency for an indefinite period, usually one year.

These

patients are still under court commitment, and the -state hospital continues1 legal responsibility through the Bureau of Social Work of the California State Department of Mental

6 Hygiene. Court commitment. The term ffcourt commitment1* refers to that legal procedure by which mentally ill patients are committed to a state hospital after a Psychopathic Court hearing. Psychopathic Court.

This is the commonly used term

which designates that department of the superior court which hears cases to determine a person’s need for super­ vision and psychiatric care or treatment, and through which legal commitment to a state hospital or private sanitarium is accomplished.

A complete description of the physical

set-up of the court and its process will be discussed in Chapter II. County Mental Health’Department.

This refers to the

department of the County of Los Angeles which stands in . the same relation to the Psychopathic Court as does the County Probation Department to the criminal courts.

It was

formerly known as the Psychopathic Probation Department. Counselor in Mental Health.

This title designates

that employee of the Mental Health Department who prepares the social report on each case to be heard in the Psycho­ pathic Court, and who presents this report to the judge at the time of the hearing.

7 Civil service qualifications for the position re­ quire that the Counselor in Mental Health have completed one year’s graduate curriculum in an accredited school of social work, and has at least six months recent experience with cases under the supervision of a psychiatrist.

Six addition­

al months of the required experience may be substituted for the graduate year.5 Social Report.

The term "Social Report11 refers to

the report prepared by the Counselor in Mental Health for the judge of the Psychopathic Court. in more detail -in Chapter Court commissioner♦

It will be discussed

II. In this study the term "court

commissioner" designates that Los Angeles County employee with whom the petition requesting a Psychopathic Court hearing is filed. Pet it 1on.

The term "petition11 refers to the legal

document filed with the court commissioner by any interested member of the community, requesting a Psychopathic Court hearing to determine a person’s need for supervision and psychiatric care or treatment. 5The Los Angeles County Civil Service Commission, "Opportunities” (an announcement of the open competitive examination for the position Deputy Counselor in Mental Health, Los Angeles, Calif., April 2, 1948).

8 Affiant.

This term is used to designate that individ­

ual who files the petition requesting a Psychopathic Court hearing for a person he believes to be mentally ill. Ill.

METHOD AND PROCEDURE

Se11ing of the study.

This study was carried out in

the Jewish Committee for Personal Service, Los Angeles, *

California.

This is a non-profit voluntary social work

agency Y/hlch is a member of the Community Chest and the Wel­ fare Council of Metropolitan Los Angeles.

It is also af­

filiated Y/ith the Federation of Jewish Welfare Organizations. The Jev/ish Committee for Personal Service, hereafter referred to as the Agency, has a dual casework function. First, it offers social caseY/ork services to the JeYrish patients in state hospitals and on leave of absence from these institutions, and to the families of these patients with problems which arise out of the patients' hospitali­ zation and mental illness.

The second part of the Agency's

program offers casework services to the JeY/ish prisoner and parolee of state, county, and city penal institutions, and to his family. The provision of casework services to the families of mentally ill patients at the point' of court commitment was initiated by the Jewish Committee for Personal.Service on February 7, 1947, as an extension of Its casework program to

the mentally ill patient and his family.

The philosophy

"behind this decision was to provide casework services to the patient’s family at what was anticipated to be an anx­ iety producing and crucial point in the patient’s mental illness; and also, to provide a continuity of relationship between the agency and 'its clients, beginning with the court commitment, through hospitalization, and carrying on into the leave of absence-period. This extension of the Agency’s casework program was undertaken with the approval and cooperation of the County Mental Health Department within whose legal juris­ diction fall social services to the patient appearing in Psychopathic Court.

It in no way supplanted the work of

the Counselor in Mental Health, but rather supplemented It. At the time the material for this study was gathered January, 1948, through June, 1948, the casework at Psycho­ pathic Court was divided between two caseworkers at the Agency, one of whom was the writer.

In addition to this

service, both workers were carrying case loads of patients already in the state hospitals and on leave of absence from these Institutions, so that the writer had the benefit of the perspective, gained through work in every aspect of the services offered to patients.

The work at Psychopathic

Court was divided between the two workers according to the days of the week, the workers alternating days of court

10

visit.

This was not a rigid schedule and could he changed

at any time by direct consultation bet?^een the two workers with the approval of the casework supervisor.

In any in­

stance where an Individual worker had had contact with the patientfs family prior to the filing of the petition re­ questing a Psychopathic Court hearing, he would then follow through with that family in accordance with accepted casework practice, regardless of whether it was his court day. Source of data.

The primary source of information

for this study was from interviews with the relatives of the mentally ill patients conducted at the time of the Psychopathic Court hearing.

Additional information, partic­

ularly as it related to the patients1 mental Illness, was obtained from the petitions requesting Psychopathic Court hearing, and from the Counselors* In Mental Health Social Reports.

Occasionally, further background information came

from other social agencies. Selection of cases.

The cases used In this study

were selected according to the following criteria:

(1) The

Interviews with the relatives of the patients were conducted by the writer.

(2) The patients were committed through the

Psychopathic Court to a state hospital, and not to a private sanitarium.

(3) These were the patients* first commitments

11

to a state hospital and first appearances before the Psycho-: pathic Court. Only eight cases met these criteria and were selected for this study from among those cases interviewed by the writer in the six month period January, 1948, through June, 1948. Procedure.

Cases of Jewish patients to be heard in

the Psychopathic Court came to the worker*s attention in two ways:

(1) He received a copy of the mental petition filed

with the court commissioner.

(2) The clerk of the Mental

Health Department telephoned the Agency with information about a scheduled hearing. The first plan was the preferred one, agreed upon between the Executive Director of the Jewish Committee for • Personal Service, the Chief Counselor in Mental Health, and the Court Commissioner for the Psychopathic Court.

If, in

practice, this plan had operated successfully, it would have given the worker three to four days before a particular Psychopathic Court hearing during which time he might have been able to contact the family.

However, because of cer­

tain clerical routines this avenue of communication was un­ successful.

It meant, therefore, that the worker usually

learned of a hearing either on the same morning or the day before.

First contact with the relatives then took place

12

at the Psychopathic Court, both prior and subsequent to the actual hearing.

The relatives were either pointed out to

the worker by the Counselor in Mental Health assigned to the case, or olso were paged in the corridor outside the courtroom.

The actual interviews might be conducted v/hile

standing in a secluded part of the building, or outside the building.

Usually all relatives were interviewed together.

The interviews with the relatives followed no pre­ determined pattern or schedule.

They were conducted as a

part of the worker*s function, and prior to the contempla­ tion of this study. In general, the interviewer has attempted to answer the following questions in the analyses of these interviews: (1) How did the relatives respond to the offer of casework help at the point of court commitment?

(2) What were the

relatives* emotional reactions to the commitment?

(5) What

were the relatives* feelings and attitudes concerning state hospitalization?

(4) What was the worker*s activity in

dealing with the feelings engendered by this experience? (5) How effective was the worker*s activity? ' Qufclane of chapters. problem and plan of study.

This chapter has outlined the Chapter II will describe in de­

tail the court commitment process and the legal procedures Involved,

The presentation and analyses of the interviews

13 with the relatives appears in Chapter III.

Ghapter IV

will summarize the findings and draw conclusions from this study.

CHAPTER II THE COURT COMMITMENT PROCESS Since this 3tudy was concerned with the attitudes and emotional reactions of relatives of patients participat­ ing in the court commitment of the mentally ill in Los Angeles County, the relation of cause and effect will be made clearer by a description of the court commitment pro­ cess. jThere are several types of commitment defined in the Welfare and Institutions Code of California, related to kinds of psychiatric problems.

These commitment procedures

include, in addition to those for the mentally ill person, those for the mental defective, the alcoholic, and the narcotic addict.

However, this study was confined to those

patients and their families where the court commitment was accomplished in accordance with the definitions of the mentally ill person as laid down in- sections 5040 and 5041 of the Welfare and Institutions Code.

The description of

the process involved in court commitment is, therefore, also limited to this group,

it is further limited to how this

process unwinds itself in Los Angeles County.

Although the

Welfare and Institutions Code of California defines the legal procedure for the entire state, each county has some flexibility in setting up its own mechanics of operation within the legal framework*

15 I.

LEGAL DEFINITION OF MENTALLY ILL PERSONS

Mentally ill persons means persons who come within either or Doth of the following descriptions *

(l) Who are

of such mental condition that they are in need of super­ vision, .treatment, care or restraint.

(2) Who are of such

mental condition that they are dangerous to themselves or to the person or property of others, and are in need of supervision, treatment, care, or restraint .3* II.

THE PETITION

Any person may file in the superior court a veri­ fied petition alleging that there is in the county a person who is mentally ill and in need of supervision, care, or treatment, and asking that examination be made of the mental health of the person, and that provision be made for the 2 welfare of the person. In Los Angeles County these peti­ tions are filed in the downtown offices of the Court Com­ missioner with the Psychopathic Court.

The Court Commissioner

may accept or refuse the petition depending upon the evidence of mental -illness presented.

He may request that the

petitioner present a qualified physician1s written 3-State of California, Welfare and Institutions Code, 1947 (Sacramento, California,. California State Printing Office), Section 5040, p. 185. 2 Ibid., section 5047, p. 185.

16 recommendation that this action he taken. The Welfare and Institutions Code states that the petition shall contain the following:

(1) The name and ad­

dress of the petitioner and his interest therein.

(2) The

name of the person alleged to he mentally ill, and if known to the petitioner, the address, age, sex, marital status, and occupation of the person alleged to he mentally ill. (3) The facts upon which the allegation that the person is mentally 111 and in need of supervision, care or treatment is based.

(4) A statement whether in the opinion of the

petitioner, the alleged mental Illness of the person is such as to render him in need of supervision, care or treat­ ment, or to render him dangerous to health, person or prop­ erty.

(5) The name of, as a respondent thereto, every

person known or believed to he legally responsible for the care, support, and maintenance of the person alleged to he mentally ill, and the address of every such person, if known to the petitioner.

(6) Such other information as the court

may require III.

APPREHENSION AND DETENTION OF THE PATIENT

Subsequent to the filing of the petition, the patient is placed and detained in the psychopathic Ysrard of the Los 3lhid., section 5048, pp. 185-6.

17 Angeles County General Hospital for a period of observa­ tion, study, and diagnosis. The psychopathic ward of the Los Angeles County General Hospital is an old brick structure erected in 1915, with limited and crowded facilities.

The normal bed capacity

is ninety-two patients, but at the present time it is re­ quired to house between one hundred forty and one hundred seventy patients per day.

There are upstairs and down­

stairs wards, the former being used for milder and quieter mental patients.

Male and female patients are segregated.

There are a few private rooms for the very disturbed and agitated patients, but for the most part the other patients are housed in small siderooms accommodating three or more, or In open dormitories.

Ho outside facilities are available

to patients> and recreational outlets are very limited. Patients who are acutely disturbed may be placed under sedation or in physical restraint.

Because of the limited ,

space and transient nature of the hospitalization, patients do not appear to have as much freedom of movement as they later have in state hospitals. The patient may be brought to the psychopathic ward by friends or relatives, or may be apprehended by agents from the sherifffs office who are garbed In full police uniform.

In most cases the decision as to apprehension by

the sheriff rests v/ith the petitioner, but of course

13 depends., also, upon the patient !s mental condition.

At the

time of the patient*s apprehension he is served with a copy of the petition, and sorae explanation is given him as to the reasons for the action. Following admission to the psychopathic ward, patients are served with a copy of the arraignment papers by the court bailiff.

At that time they are again advised that they are

being detained on a mental petition.

They are also told

who has filed the petition, when and where the Psychopathic Court hearing will take place, and that they are entitled to legal counsel and witnesses. IV.

INVESTIGATION AND EXAMINATION

A patient is required to have his Psychopathic Court hearing within five days of his admission to the psycho­ pathic ward, except where there is good reason for the court to request a continuance.

The examination, study, and ob­

servation of the patient is accomplished during this time. Each patient on whom a mental petition is filed is examined prior to the court hearing by two reputable physi­ cians who have previously been certified by the superior court judge as medical examiners.

Certificates are granted

in accordance with the form prescribed by the State Depart­ m e n t of Mental Hygiene,- showing that.the persons.named are graduates of incorporated medical colleges, and have been

19 in active practice in their profession at least five years.^ In Los Angeles County these medical examiners are Doctors of Medicine with psychiatric specialization. In addition to the psychiatric examination of the patient during this observation and study period, an Inves­ tigation is conducted by the Counselor In Mental Health into the antecedents, character, family history, environment, and super-inducing cause of the mental disorder or mental illness of the person.

The information obtained from

this investigation is formulated in Los Angeles County into the Social Report which is submitted to the judge to aid him In his decision.

In actual practice this Social

Report contains the following:

(1) Identifying and factual

*

data about the patient such as age, birthplace, residence, names of relatives, citizenship, education, etc.

(2) A

brief statement about the onset of the patientfs mental Illness and symptoms.

(3) Some enumeration of the patientrs

previous mental and physical Illnesses, and present physical condition.

(4) An account of the Counselorrs interview

with the patient held in the psychopathic ward.

(5) The

relativesT statements about the patient*s mental condition, and their plans for the patient. "

(6) A brief statement of

~^~ I b l d section 5000, p. 183. 5Ibid., section 5029, p. 184.

20

the financial condition of the patient and his responsible relatives,

(7) The recommendations of the Counselor as

to an adequate plan for p a t i e n t s care and treatment based upon the findings of his investigation. The entire Social ReiDort is very brief.

Most of

the information is obtained from the petition, interested social' agencies, the patient, and the patientTs relatives. The Counselor in Mental Health is limited in time and number of investigations required of him.

For the most part his

interviews with the patientTs relatives must of necessity be limited to the accumulation of data which will assist the court in making a wise decision.

The family interviews

of the Counselor are conducted either on the telephone or in person. V.

THE COURT HEARING

The Psychopathic Court hearing is presided over by a duly elected judge of the superior court. full time responsibility.

This is a

The hearings may be held in

any one of three places, all places being within the psycho­ pathic ward building of the Los Angeles County General Hospital.

For those patients who are not too seriously

disturbed, who are ambulatory, and who do not require con­ stant supervision or restraint, the hearing is held in a small courtroom outside of the confines of the ward proper.

21

The hearing when held here is accessible to any interested party.

Inasmuch as there is more than one case on the

docket for any particular session of the court, the court­ room is usually filled with relatives and friends of pa­ tients •awaiting the hearing on the particular case In which they are interested. Hearings for the more seriously disturbed patients are held*within the confines of the psychopathic ward it­ self.

These hearings may be held in a special section of

the ward designated as the court, to which patients come; or they may be held at the patientfs bedside, when the patient is so emotionally disturbed that he or she requires re­ straint , When the hearing is held on the ward, but not at the patient’s bedside, there are present all of the friends, relatives, and witnesses of patients whose cases are to be heard in the same place.

However, this Is more private

than the hearings held outside the ward, since only persons who have a tfbona fide11 interest in a patient are admitted Into the ward. The hearings held at the patient’s bedside are the most private.

Present here are only those persons with an

official connection to the court, and those persons parti­ cipating in that particular court hearing.

In any of the three court settings described, the process and legal protocol is essentially the same, al­ though the physical arrangements differ.

Always present

at the hearing are' the judge, the patient, the affiant, the Counselor in Mental Health, and the two medical examiners who have previously examined the patient.

In addition,

there may be present friends and relatives of the patient, witnesses who have been subpoenaed by the court at the patient’s request, and legal counsel and an outside psychi­ atrist if they are also requested by the patient.

All

persons who testify except the medical examiners, the Coun­ selor in Mental Health, and the patient are sworn in by the court bailiff. The patient usually appears at the hearing in pajamas and bathrobe except where the hearing is held outside the ward proper.

In the latter case he may appear in his own

street clothing.

Throughout the testimony he is able, to

observe and face those who are testifying as to their be­ lief in his mental condition.

The actual hearing usually

begins with some initial remarks by the judge as to the purpose of the hearing, and an introduction by him of the Counselor in Mental Health and the medical examiners.

The

Counselor in Mental Health then reads the Social Report. The affiant and other witnesses may give additional testi­ mony, and the patient has the legal right to answer these

23 allegations and speak in his .own "behalf.' The. medical examiners report verbally the results of their psychiatric examination of the patient and make recommendations based on the3e examinations. This testimony does not always proceed step by step, but there is considerable interaction of all persons involved.

The hearing is held with as little formality as

possible without sacrificing the necessary legal procedure involved.

After all the testimony is heard, the judge must

evaluate it and decide upon what appears to be the best plan for the patient.

State hospital commitment is not

the only plan possible .

The patient may be committed at

the countyrs or family*s expense to a private sanitarium licensed to care for the mentally ill by the State Depart­ ment of Mental Hygiene, or placed anywhere in the community (including own home) under the supervision of a Counselor in Mental Health.

Where there is doubt of the existence

-of mental illness, the case is, of course, dismissed. Provision for jury trial is made available to the mentally ill patient, or to any friend acting in his behalf, if there is dissatisfaction with the results of the Psycho­ pathic Court hearing.

The request must be made within five

days of the court order of commitment. Relatives and/or friends of the committed patient may visit him in the psychopathic ward after the court hearing

24 subject to the approval of the supervising psychiatric nurse.

Contact is also made with the families of patients

committed to the state hospitals, immediately after the hearing, by a psychiatric social worker of the State Depart­ ment of Mental Hygiene.

This is done in order that some

brief orientation about the state hospital may be provided to the families; and also to make an appointment for the compilation of a psychiatric social history to aid the hospital staff in differential diagnosis and treatment, VI.

TRANSPORTATION OP PATIENT TO STATE HOSPITAL

The mentally ill person, together with certified copies of the petition, order for detention, report of the apprehending officer concerning the safeguarding and dis­ position of the mentally ill personfs property, the order for hearing and examination, order of commitment of the judge, and the certificate of the physicians shall be de­ livered to the sheriff of the county, and by him shall be delivered to the officer in charge of the designated state hospital or licensed hospital or sanitarium to which the mentally ill person is committed.® In Los Angeles County patients are usually trans­ ported to the state hospital within forty-eight hours after section 5105, p. 199,

25 the court hearing.

The means of transportation is either

by ambulance or chartered limousine depending upon the patient’s mental and physical condition.

CHAPTER III PRESENTATION OF THE DATA Relatives of eight mentally ill patients committed to state mental hospitals through the Psychopathic Court were interviewed at the time of the court hearing.

-This

chapter includes, a description of the patients and their relatives, the account of the interviews with the rela­ tives, and the analyses of these interviews. I.

DESCRIPTION OF CASES

All patients whose relatives were interviewed were diagnosed as suffering from some kind of psychosis. diagnoses were varied:

The

two were classified as schizophrenic

with no further delineation as to type; one was a schizo­ phrenic, catatonic type; one a schizophrenic, paranoid type; two patients were suffering from involutional psychosis one from senile psychosis; and one patient was diagnosed merely as psychotic with heart disease. psychotic patients, six were women.

Of the eight

Patients* ages ranged

from twenty years to eighty-one years old.

As indicated

in Chapter I this was each patient*s first commitment to a state mental hospital, although three patients had been previously institutionalized because of mental illness. forty-four year old woman patient described in Case I had

The

27

been in a private sanitarium, and the twenty-rtf ive year old World War II veteran in Case V had been previously hospital­ ized in a veterans1 administration neuro-psychiatric hos­ pital.

The eighty-une year old widower, Case II, had been

in various private mental sanitoria.

In no case had these

patients been committed to the respective Institutions through the Psychopathic Court. The relationship of the affiant to the patient varied, but with the exception of Case VII, where the affiant was the patient*s landlady, it was always one of close familial responsibility.

In two cases the relative who filed the

mental petition requesting Psychopathic Court hearing Y/as the patient*s son; two patients were filed on by their brothers; and one each by a husband, father, and daughter. In each case analyzed for the purposes of this study the affiant was one of the persons interviewed.

The most

relatives intervieY?ed on any particular case were three in Case VIII.

In five cases the worker interviewed two

relatives, and In the other two cases only one relative, the affiant, was present at the court hearing for Inter­ view.

Further description of the individual relatives ap­

pears in the account and description of the actual inter­ views presented later in this chapter. Table I presents-the statistical data-.on each patient, the afflant*s relationship to the patient, and the number

28 TABLE I STATISTICAL DATA FOR THE EIGHT CASES STUDIED

Case • number Sex

Age

Diagnosis

Affiant!s relationship to patient

Relatives interviewed

I

F

28

Schizophrenic, paranoid

Husband

Husband, sister

II

M

81

Senile psy­ chosis

Daughter

•Daughter, son

III

F

67

Involutional psychosis

Son

Son

IV

F

56

Schizophrenia

Brother

Brother

V

M

28 , Schizophrenia

Father

Father, mother

VI

F

65

Involut iona1 psychosis

Son

Two sons

VII

F

54

Psychosis with heart disease

Hone (landlady)

Two daughters

VIII

F

20

Schizophrenic, catatonic

Brother

Brother, father, mother

of relatives interviewed in each case at the time of the court hearing. II.

INTERVIEWS WITH THE RELATIVES

This section includes some social history and back­ ground information of each of the eight mentally ill pa­ tients who were briefly described in section I of this chapter, and the process record of the worker’s interviews with their relatives at the Psychopathic Court. CASE I. The patient.

M r s . G-., a twenty-eight year old

married Yeoman with tiro minor children, a daughter, age eight, and a son, age seven months, came to the attention of the Jewish Committee for Personal Service upon referral from a Jewish family agency subsequent to the husband’s filing of a petition requesting ing.

a Psychopathic Court hear­

The family agency’s case record and the Social Report

of the Counselor in Mental Health provided the following information about the patient and her mental illness.

The

patient and her family had been known to the family agency over a period of nine years, during which period they had been assisted with financial aid and -with placement plans for the two children.

The family agency had been called

into the situation again at this time when it became

30 necessary for the family

£0

plan in terms of state mental

hospital commitment because of their inability to afford further private mental sanitarium care and private psychia­ tric treatment.

The family agency 'was continuing its

activity in working out a placement plan for the patient*s two children after the commitment.

Arrangements had al­

ready been tentatively completed for the younger child to be placed in a child care institution; the daughter was ex­ pected to be placed in a foster home, but was temporarily living with an aunt. Mrs. G. had her first acute psychotic episode in June, 1947, after the birth of her second child.

Psychiatric

examination at this time diagnosed her mental illness as a post-partum psychosis.

Patient was depressed, had dis­

turbances in eating and sleeping.

She seemed to be acting

out hostile feelings toward the baby by force feeding him, and also at times by trying to suffocate him.

Arrangements

for* continued private psychiatric care and treatment were made and the patient was placed in a duly licensed mental sanitarium where she received several electric shock treat­ ments.

After a period of three weeks she was released from

the sanitarium to her own home.

A homemaker was placed in

the home to assist with the care of the children.

Contact

with the patlent*s mother at that time revealed that she played an active role in the family situation.

The mother

31 was described as a difficult, hypertensive, unstable person who expressed considerable hostility toward the patient’s husband for failing in his responsibility to his family. She characterised him as lasy. In September, 1947, the patient, had a relapse and was again placed in a private sanitarium.

Contact with the

psychiatrist .at this time elicited the information that Mrs. G. had a great 'deal of guilt about the death of another child*

This child had been exposed to the cold in an

eastern city for about six hours when the patient had for­ gotten about her while gossiping with a neighbor.

It was

also the psychiatrist’s opinion that the patient did not appear too bright.

She feared treatment.

During this

placement she again received electric shock treatment plus some insulin shock therapy.

After her release from the

sanitarium some of this treatment was continued on an ambulatory basis.

The prognosis was generally regarded as

good. The patient got along well after her release from the sanitarium the second time, until she moved in Y^rith her mother in a small three-room apartment.

She again'became

mentally ill, and exhibited the same symptom picture as before, wherein she neglected the younger child and tried to feed him peculiar foods.

The family again called in the

patient’s psychiatrist who recommended commitment in view

32 of the familyTs limited, finances. Interview with the relatives prior to the hearing. I introduced myself to the patientis hushand and sister in the corridor outside the psy­ chopathic ward prior to the court hearing. I in­ formed them of the functions and services of the Agency, and explained how I had come to know of the court hearing. Both expressed immediate interest and gratitude for the services offered, and were most eager to talk with me. At several points through­ out the interview they referred to my coming as a uG-odsend.ff The husband and sister were both very anxious and seemed to have a real need to talk about the situation. Mr. G-. seemed to be the more anxious of the two. He also impressed me as being a some­ what emotionally immature person with a kind of superficial insight into his wife's condition. The sister, although also quite anxious and emotional, seemed to have her feelings a little more under control, and seemed less confused. In the family!s great desire to talk about the patient, they many times talked at once and were quite apt to interrupt each other frequently. When I would try to talk with the sister, Mr. G-. would grab my arm or put his hand on my shoulder in order to attract my attention to his statements or ques­ tions. He told me about the situation leading up to the patient's illness, and it pretty much repeated the information given above. He asked rae a great many questions about the court procedure and the hospital care that the patient would receive, and I answered them as fully and completely as I could. He told me that the rest of the family wonders if he is doing the right thing. I wondered what else he could do, and he said he did not feel there was anything else inasmuch as he could no longer afford private care for his wife. He w a s ‘actually in debt for her previous care. I gave him a good- deal of reassurance that I did not feel he could do anything else at this point. I wondered what-Mr. G-. thought had brought on the patient's relapse. He told me that he felt that her condition had recurred because of the need for

55 the f a m i l y to move in with his mother-in-law. Housing conditions were very crowded. In addition, the patient1s mother is a cynical and bitter person. The patient became confused, exhibited speech block­ ing, and was very over-protective of her child. The husband requested that in the event I wished to reach him later, he be contacted through his aunt. He did not v/ish me to contact his mother-in-lav/. The sister asked me about visiting the patient immediately after her admission to the state hos­ pital. I explained that visiting was not permitted until after the patient had been in the hospital ten days in order that she could have a complete physical and psychiatric examination and be trans­ ferred. from admissions to a regular ward. The sister said that she had- postponed surgery for her own kidney condition until after the patientfs commit­ ment, and that she had also hoped to see the patient at the state hospital before her own operation. Both relatives then asked me questions about the manner in which the patient could secure her release from the hospital. I explained that the final de­ cision about the patient's release would rest with the hospital staff, that the family could submit plans for the patient's release, and that if the patient's condition warranted it and the plan was satisfactory, the patient would not be kept. I added that the hospital was anxious to release pa­ tients as quickly as they were well enough, and ade­ quate plans for their care were arranged. I assured them that this agency would be active in the situa­ tion, would visit the patient at the hospital, and would help in working through plans for Mrs. G.'s release. The hearing. The court hearing was held at the patient's bedside. Both examining psychiatrists recommended state hospitalization and agreed to the family's request for placement at Camarillo State Hospital. The diagnosis was schizophrenia, paranoid type. Interview with the relatives after the hearing. I sought out the husband and sister. The husband com­ mented that it was a load off his mind now that the final disposition had been made. The sister seemed

34 to b© much more upset. She needed to tell me a great deal about what conditions had been like prior to commitment. She also expressed some doubts as to whether it would have been better to ask for the patient1s release inasmuch as the patient had pleaded with' her to be allowed to go home. The sister commented that the patient had seemed almost rational. I pointed out that many times patients did appear this way at the point of commitment, but it did not really indicate that they were well. I attempted to explore some of the relatives* doubts about the commitment, and learned that the remainder of the family had refused to cooperate with the hus­ band and sister in this action. Mr. G. and his sister-in-law referred to their relatives as f,crepehangers.11 I said that naturally this kind of. atti­ tude would reinforce their own doubts about what they had done, but that under the circumstances I saw no other possibility. Mr. G. raised some questions about the adequacy of the child placement agency. I told him that I knew the children would be well taken care of and would be placed in foster homes ?/hich would best coincide with their needs. At the conclusion of the interview, I gave the relatives the card of our Camarillo worker to contact for future information and assistance. CASE II. The patient. "Mr. L., an eighty-one year old widower, came to the attention of the Agency upon routine telephone clearance with the clerk at the Psychopathic Court on the date of the hearing.

The mental petition had been filed by

the patient*s daughter. The Mental Health Counselor*s Social Report revealed that patient had had a cerebral .hemorrhage in July, 1947, and since that time had been acting queer and unusual.

He

55 was delusional, suicidal, and homicidal.

The daughter,

Mrs. K . , had stated that she was no longer able to care for the patient in the home, and on the recommendation of a pri­ vate physician had filed this petition.

There was no his­

tory of previous mental illness, use of drugs or alcohol, or venereal disease. The patient had-been interviewed on the psychopathic ward by the Mental Health Counselor. his daughter or anyone els e .

He denied threatening

He said he had thought of

suicide because he had been sick for a long period of time and the doctors had done nothing for him.

He appeared to

be disoriented for time and place, but not for person. Interview with the relatives prior to the hearing. I introduced myself to the patient rs family in the corridor outside the courtroom, and explained the services and functions of the Agency. P resent were the patient1s daughter, Mrs. K., a son, Mr. L., and a family friend, Hr. M., an attorney, who was attend­ ing the hearing in an unofficial capacity. In the beginning the relatives appeared to be somewhat sus­ picious of my interest in the situation. They wanted to know how I had learned of the hearing. The at­ torney knew a great deal about the Jewish social work agencies and was of invaluable assistance in the interpretation of the Agency!s services. Mrs. K. was the most active participant, in the interview. She is a rather heavy set person of middle age who wears thick lenses. She expressed some anxiety and guilt about the action she was tak­ ing, but not what appeared to be an excessive amount. The son appeared to be calm and very ac­ cepting of the need for this action. The relatives1 questions dealt chiefly with the technicalities and mechanics of the court procedure,

36 and of the subsequent state hospital care. I ex­ plained the court procedure to them, the kind of care patient would receive at the state hospital, the expenses involved, and how they could see to it that the patient had some personal comforts. This seemed to have a great deal of meaning to them, especially that they could leave patient money, cigarettes, etc. I initiated some discussion of the onset of the mental illness. I learned that the patient had operated his own service station until he ¥/as seventy-five years of age. For the past twenty-four, year 3 he had made his home with Mrs. K . , who is a widow. He only became ill after his cerebral hem.