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doi: 10.1176/appi.ajp.114.7.583pmid: 13487793
PAUL R. MILLER M. D. 1 1 Michael Reese Hospital, 29th and Ellis Sts., Chicago, Ill. It is clear that an inmate population which uses the prison code as a part of its social structure is not easily resocialized. To eliminate the code is possible only if the needs which the code satisfies are fulfilled by other means or replaced. All prison personnel should avoid participating in or condoning the prison code. Rather, they should attempt to show the inmate that he can best attain his goals by cooperating with the official program rather than living by the code; this could be initiated in an orientation unit. Each new inmate should be classified by a multidisciplinary team (representing each aspect of the professional and custodial staff) according to his resocialization potential. Our experience has shown the following criteria to be most valuable: age and recidivism (both negative correlations), basic personality pattern (neurotics are most treatable, psychotics and character disorders less so), and the drive toward mental health (using observed behavior rather than the inmate's verbalizations). Those who are "prison-wise" or "institutionalized" should be segregated in their housing and their work. Certain mental hospital practices can be incorporated into the management of prisons: 1. personality change should be directed toward resocialization, not just institutional conformity; 2. freedom of movement and choice should be allowed to the practical limit of custodial security; 3. a job commensurate with his level of ability and aspiration should be available to each inmate; 4. suitable living quarters should be available, using the criteria of age and treatability; 5. interpersonal relations between officials and inmates should be structured to decrease hostility, inspire a sense of personal confidence and mutual trust, and elevate self-esteem; 6. short term satisfactions and long term goals should be allowed and encouraged. To operate such a program it is necessary to enlist the help of all personnel. One group found that their staff "would do a better job in the interests of our new therapeutic approach if they felt a sense of involvement in our goals and if their statuses were not called into question by the reorganization(4). The prison code is the epitome of the destructive anti-rehabilitative elements of most prison societies. The roles of the custodian and the professional worker have been noted. Cooperation between these two groups is essential, because both control and treatment are necessary in the resocialization of inmates. In fact, a well-controlled prison setting may actually provide a milieu for the treatment of some deviant personalities which is potentially more effective than outpatient care or the minimal custody of a mental hospital(5).
ALEXANDER, LEO; MOORE, MERRILL
doi: 10.1176/appi.ajp.114.7.577pmid: 13487792
LEO ALEXANDER M. D. 1 , and MERRILL MOORE M. D. 2 1 Director, Neurobiologic Unit, Division of Psychiatric Research, Boston State Hospital, Boston, Mass. 2 Research Associate, Department of Social Relations, Harvard University. 1. Schizophrenia is a disease of unknown etiology. It appears to be multifactorial in origin, and may represent a group of diseases with similarity in clinical mental symptomatology, but with a wide range in prognosis. 2. The great variety of benign and malignant forms of schizophrenia require that we define as many objectively verifiable aspects of the disease as possible, and determine the spontaneous recovery potential for all of the resulting subgroups based on as many objectively measurable variables as are or may become available. 3. Variables affecting prognosis favorably are: recent onset, high intelligence, relatively unimpaired capacity for abstract categorical thinking, good educational background, better than average occupational status, stress-induced onset, and autonomic reaction pattern (adrenalin-mecholyl test pattern) similar to that of depressions. 4. Apparently schizophrenic illnesses in highly intelligent adolescents (pseudoschizophrenic neuroses) respond well to psychotherapy. 5. Schizophrenic patients showing an adrenalin-mecholyl test pattern similar to that of depressions respond well to electroshock therapy. 6. Patients with epinephrine-precipitable anxiety do better with insulin and the new drugs. 7. Response to all types of treatment declines with duration of illness, most markedly for the shock and coma therapies, somewhat less for the drug therapies and for psychotherapy, least for frontal lobotomy. 8. Recovery rates (complete and/or social recovery) obtained spontaneously as well as on various treatment regimens (intensive psychotherapy, electroshock therapy, insulin coma therapy, tranquilizing drug therapy and frontal lobotomy) at the various levels of duration of illness are given. 9. A practical treatment program is formulated based on the findings presented.
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