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Change in attitudes toward mental hospital ward aides and beliefs about mental illness over time of hospitalized… McDonald, James Timothy 1969

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CHANGE IN ATTITUDES TOWARD MENTAL HOSPITAL WARD AIDES AND BELIEFS ABOUT MENTAL ILLNESS OVER TIME OF HOSPITALIZED MENTAL PATIENTS by James Timothy McDonald B.S., Washington State U n i v e r s i t y , 1967 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF Master of A r t s i n the Department of Psychology We accept t h i s t h e s i s as conforming to the requ i r e d standard THE UNIVERSITY OF BRITISH COLUMBIA September, 1969 In p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f the r e q u i r e m e n t s f o r an advanced degree a t the U n i v e r s i t y o f B r i t i s h C olumbia, I ag r e e t h a t the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and Study. I f u r t h e r a g r e e t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g o f t h i s t h e s i s f o r s c h o l a r l y p u rposes may be g r a n t e d by the Head o f my Department o r by h i s r e p r e s e n t a t i v e s . I t i s u n d e r s t o o d t h a t c o p y i n g or p u b l i c a t i o n of t h i s thes,is f o r f i n a n c i a l g a i n s h a l l not be a l l o w e d w i t h o u t my w r i t t e n p e r m i s s i o n . Department of Psychology The U n i v e r s i t y o f B r i t i s h Columbia Vancouver 8, Canada ABSTRACT In recent years there have been s e v e r a l s t u d i e s concerning themselves w i t h such t o p i c s as mental p a t i e n t s ' a t t i t u d e s toward h o s p i t a l personnel and mental p a t i e n t s ' b e l i e f s about mental i l l n e s s . However, these s t u d i e s are not without f a u l t . They have been s t r i c t l y e m p i r i c a l i n approach, w i t h no t h e o r e t i c a l framework from which to p r e d i c t and/or e x p l a i n the r e s u l t s they have obtained. These s t u d i e s a l s o have f a i l e d to c o n t r o l f o r p o t e n t i a l l y important v a r i a b l e s such as whether a patient, has had previous admissions to a mental h o s p i t a l . The present study attempted to surmount these shortcomings. Drawing upon Heider's (1946) balance theory, i t was p r e d i c t e d that i f the p a t i e n t s ' a t t i t u d e s toward the s t a f f changed i n a p o s i t i v e d i r e c t i o n (as a study by R e z n i k o f f , e_t j j l . [I960] suggests i s the case), those b e l i e f s about mental i l l n e s s held by the p a t i e n t s which were d i s s i m i l a r to the s t a f f ' s b e l i e f s would converge toward those b e l i e f s h e l d by the s t a f f . This study a l s o c o n t r o l l e d f o r the no p r i o r admissions p r i o r admissions v a r i a b l e , a v a r i a b l e Wolfensberger's (1956) study suggests may be important. The Semantic D i f f e r e n t i a l was used to measure the p a t i e n t s ' a t t i t u d e s toward the s t a f f w h i l e the Information Questionnaire (Nunnally, 1957, 1961) was used to measure t h e i r b e l i e f s about mental i l l n e s s . These two questionnaires were administered twice: the f i r s t time being no longer than four days a f t e r admission to the h o s p i t a l ; the second time being approximately three weeks a f t e r the f i r s t a d m i n i s t r a t i o n . The r e s u l t s of t h i s study i n d i c a t e d that p a t i e n t s ' a t t i t u d e s toward the s t a f f (aides i n t h i s p a r t i c u l a r study) do i n c rease i n a favorable d i r e c t i o n , but t h i s had no i n f l u e n c e on the p a t i e n t s ' b e l i e f s about mental i l l n e s s as had been p r e d i c t e d . The p a t i e n t s ' b e l i e f s about mental i l l n e s s d i d not change i i toward the s t a f f s ' (aides) b e l i e f s but r a t h e r remained the same over the two t e s t i n g s . P o s s i b l e reasons f o r the f a i l u r e of t h i s study to support the p r e d i c t i o n were discussed. A l s o , the v a l i d i t y of the Information Questionnaire was s e r i o u s l y questioned. i i i TABLE OF CONTENTS Fa_e A b s t r a c t 1 Table of Contents i i i Table of Tables i v Table of Figures v ;Chapter One - Background of the Problem 1 Chapter Two - Review and C r i t i q u e of E a r l i e r Research 3 Theory and Ra t i o n a l e f o r the Present Study 8 Chapter Three - Method 14 Subjects 14 M a t e r i a l s 15 Procedure 17 Chapter Four - Results . 21 P a t i e n t s ' A t t i t u d e s Toward Aides 21 P a t i e n t s ' B e l i e f s about Mental I l l n e s s 23 R e l a t i o n s h i p Between P a t i e n t s ' A t t i t u d e s Toward Aides and B e l i e f s About Mental I l l n e s s 25 Chapter F i v e - D i s c u s s i o n 28 Chapter S i x - Summary and Future D i r e c t i o n s . 33 Footnotes 37 References • 39 Appendix A - Mean Scores f o r each Scale of the Semantic D i f f e r e n t i a l 41 Appendix 15 - Mean Scores f o r each Item of the Information Questionnaire.. f o r both A d m i n i s t r a t i o n s 43 Appendix C - D-Scores f o r each Factor f o r both the No P r i o r and P r i o r Admissions Groups 48 Appendix D - Questionnaires Used i n Present Research . . . . . . . 50 i v TABLE OF TABLES Table 1 . Summary of Procedure Used i n t h i s Experiment Table 2 . Means and C o r r e l a t e d t s f o r the E v a l u a t i v e Factor of the Semantic D i f f e r e n t i a l Table 3. Means and C o r r e l a t e d _ts f o r the Potency Factor of the Semantic D i f f e r e n t i a l Table 4 . Two-Way A n a l y s i s of Variance Comparing No P r i o r Admissions and P r i o r Admissions Groups Page 20 21 22 24 V TABLE OF FIGURES Page Figure 1. States of p a t i e n t s ' b e l i e f s about mental i l l n e s s as contrasted to those of the s t a f f upon e n t e r i n g the h o s p i t a l and a f t e r the p a t i e n t s have spent a period of time i n the h o s p i t a l (given p o s i t i v e change i n a t t i t u d e c f p a t i e n t s toward s t a f f ) . 9 Figure 2. States of p a t i e n t s ' b e l i e f s about mental i l l n e s s as contrasted to those of the s t a f f upon e n t e r i n g the h o s p i t a l and a f t e r the p a t i e n t s have spent a p e r i o d of time i n the h o s p i t a l (given negative change i n a t t i t u d e of p a t i e n t s toward s t a f f ) . 11 Figure 3. P a t i e n t - s t a f f d i s c r e p a n c i e s i n b e l i e f as a f u n c t i o n of time of h o s p i t a l i z a t i o n (repeated measurements). 26 CHAPTER ONE BACKGROUND OF THE PROBLEM The e f f e c t s of h o s p i t a l i z a t i o n upon the mentally d i s t u r b e d p a t i e n t have been the concern of mental h e a l t h p r o f e s s i o n a l s f o r s e v e r a l years. Goffman (1961) devotes a s u b s t a n t i a l part of a book to t h i s t o p i c . He se v e r e l y c r i t i c i z e s the mental h o s p i t a l and i t s personnel f o r what he considers to be t h e i r adverse e f f e c t s on the p a t i e n t s ' behaviors and a t t i t u d e s . He mentions, f o r i n s t a n c e , the " d e p e r s o n a l i z a t i o n " that a p a t i e n t experiences when h i s clo t h e s and other personal e f f e c t s are taken away from him. F o l l o w i n g d e p e r s o n a l i z a t i o n , i t i s e a s i e r f o r the s t a f f of the h o s p i t a l to "remake" the p a t i e n t i n t o a conforming h o s p i t a l p a t i e n t . Ullmann and Krasner (1969) spend s e v e r a l pages throughout t h e i r book d i s c u s s i n g the e f f e c t s of h o s p i t a l i z a t i o n upon the mental p a t i e n t . L i k e Goffman (1961), they are h i g h l y c r i t i c a l of h o s p i t a l i z a t i o n , emphasizing the seemingly adverse e f f e c t s h o s p i t a l i z a t i o n has upon p a t i e n t s . They mention, f o r example, a study by Mahrer and Mason (1965) which suggests t h a t , compared to p a t i e n t s t e s t e d immediately p r i o r to admission, p a t i e n t s who had been h o s p i t a l i z e d f o r even a b r i e f period of time reported more symptoms. As Ullmann and Krasner (1969) s t a t e , i t i s hard to t e l l whether t h i s e f f e c t i s due to the "degradation ceremonies" (Goffman., 1961) or to modeling of those behaviors that cause concern and lead to s t a f f a t t e n t i o n . While these mental h e a l t h p r o f e s s i o n a l s and others (e.g., Szasz, 1961) are h i g h l y c r i t i c a l of the e f f e c t s of h o s p i t a l i z a t i o n upon p a t i e n t s , others are not. For example, Cumming and Gumming (1962) mention what they b e l i e v e are b e n e f i c i a l e f f e c t s of h o s p i t a l i z a t i o n upon the p a t i e n t , e s p e c i a l l y i f the h o s p i t a l o r i e n t a t e s i t s e l f toward m i l i e u therapy. One b e n e f i c i a l e f f e c t , 2 they f e e l 5 i s that w i t h i n the p r o t e c t i v e m i l i e u of the h o s p i t a l ; a p a t i e n t can more e a s i l y e s t a b l i s h i n t e r p e r s o n a l r e l a t i o n s h i p s than he could on the ou t s i d e . Furthermore, i t has been the experience of t h i s w r i t e r t h a t , when asked, many p r o f e s s i o n a l and nonprofessional personnel of l a r g e mental h o s p i t a l s mention what they b e l i e v e are the b e n e f i c i a l r a t h e r than the harmful e f f e c t s of h o s p i t a l i z a t i o n . The major p o i n t to n o t i c e i n both the proponents and the opponents of h o s p i t a l i z a t i o n i s that they tend to have t h e i r arguments on r a t i o n a l grounds, case h i s t o r i e s , and/or anecdotal s t o r i e s . They present l i t t l e , i f any, research evidence., p o s s i b l y because l i t t l e evidence of t h i s type e x i s t s . Although research i s sparse, there has been some research along the l i n e s of p a t i e n t s ' a t t i t u d e s toward the h o s p i t a l , treatment, and s t a f f as w e l l as p a t i e n t s ' b e l i e f s about mental i l l n e s s . Some of these s t u d i e s have als o been concerned w i t h how these a t t i t u d e s and b e l i e f s might change as length of h o s p i t a l i z a t i o n i n c r e a s e s . This research i s reviewed i n the next chapter. As the reader w i l l d i s c o v e r , while a s t a r t , t h i s research i s n e i t h e r too p l e n t i f u l nor without s e r i o u s f a u l t s of method. With s u b s t a n t i a l p o r t i o n s of books (e.g., Goffman, 1961? Cumming and Gumming, 1962) being w r i t t e n on the advantages and disadvantages of h o s p i t a l i z a t i o n f o r mentally d i s t u r b e d persons, i t was f e l t by t h i s researcher that, more, and b e t t e r , research i n t o the e f f e c t s of h o s p i t a l i z a t i o n ( i f any) should be undertaken. I t was with t h i s aim i n mind that the research reported below was conducted. CHAPTER TOO REVIEW AND CRITIQUE OF EARLIER RESEARCH In recent years s e v e r a l l i n e s of research have y i e l d e d i n f o r m a t i o n con-cerning mental p a t i e n t s ' a t t i t u d e s toward such t o p i c s as p s y c h i a t r i c h o s p i t a l s , mentally d i s t u r b e d persons, and mental h o s p i t a l personnel. Souelem (1955) was the f i r s t i n v e s t i g a t o r to construct a s c a l e s u i t a b l e f o r the q u a n t i t a t i v e measurement of these a t t i t u d e s . This s c a l e i s an equal-appearing i n t e r v a l s c a l e and was constructed f o l l o w i n g the procedures o u t l i n e d by Thurstone and Chave (1929). I t deals s p e c i f i c a l l y w i t h a t t i t u d e s toward the mental h o s p i t a l . Souelem administered her s c a l e to two samples of p a t i e n t s : 95 men from fou r wards at a Veteran's A d m i n i s t r a t i o n h o s p i t a l , and 103 men from four wards at a s t a t e h o s p i t a l . Results i n d i c a t e d that the m a j o r i t y of p a t i e n t s i n both i n s t i t u t i o n s expressed favorable a t t i t u d e s toward the h o s p i t a l . The a n a l y s i s a l s o revealed no s i g n i f i c a n t c o r r e l a t i o n between a t t i t u d e s toward mental h o s p i t a l s and d i a g n o s t i c c a t e g o r i e s , length of h o s p i t a l i z a t i o n , and age of p a t i e n t . However ; more favorable a t t i t u d e s were found among p a t i e n t s on admission wards and more a c t i v e convalescent wards than among those of the chronic and semiconvalescent wards. Seve r a l other researchers have used Souelem*s s c a l e to measure a t t i t u d e s of p a t i e n t s toward the mental h o s p i t a l . K l o p f e r , H i l l s o n , and Wylie (1962) administered t h i s s c a l e to s i x d i f f e r e n t groups, i n c l u d i n g members of a s e r v i c e o r g a n i z a t i o n (Rotary Club)., c l e r i c a l and a d m i n i s t r a t i v e employees of a h o s p i t a l , aides on the i n t e n s i v e treatment s e r v i c e } and a mixed group of 33 chronic and acute i n p a t i e n t s . Somewhat contrary to Souelem's (1955) f i n d i n g s , the data showed that p a t i e n t s have g e n e r a l l y unfavorable a t t i t u d e s toward the h o s p i t a l , e s p e c i a l l y i n comparison to the other groups. The p a t i e n t s considered mental 4 h o s p i t a l s f r i g h t e n i n g and anxiety provoking as w e l l as r e s t r i c t i v e . Imre and Wolf (1962) administered the Souelem questionnaire to four groups: 1) 55 p r o f e s s i o n a l and n o n p r o f e s s i o n a l employees of a s t a t e mental hospital.: 2) 53 h o s p i t a l i s e d a l c o h o l i c s ? 3) 61 student nurses; and 4) 72 n o n a l c o h o l i c s t a t e mental h o s p i t a l p a t i e n t s . The r e s u l t s showed that a l c o h o l i c p a t i e n t s expressed s i g n i f i c a n t l y more favorable a t t i t u d e s toward the mental h o s p i t a l than n o n a l c o h o l i c p a t i e n t s . A l s o , h o s p i t a l employees were more fa v o r -able toward the h o s p i t a l than the nonalcoholic, p a t i e n t s , a f i n d i n g s i m i l a r to that of K l o p f e r , H i l l s o n , and Wylie (1962). Imre and Wolf suggest that these r e s u l t s may be due to the f a c t that the employees and most a l c o h o l i c p a t i e n t s are at the h o s p i t a l v o l u n t a r i l y and t h e r e f o r e may be expected to be r a t h e r u niformly f a v o r a b l y disposed i n t h e i r a t t i t u d e s toward such an i n s t i t u t i o n . However, committed p s y c h i a t r i c patients,, many of whom are on locked wards, could be expected to be more unfavorably disposed toward the mental h o s p i t a l . In another study> Imre (1962) included female volunteer h o s p i t a l workers and found that these volu n t e e r s a l s o expressed more fav o r a b l e a t t i t u d e s toward the h o s p i t a l than d i d the i n p a t i e n t s . Wolfensberger (1956) administered the Souelem questionnaire to 95 newly admitted p a t i e n t s at a s t a t e h o s p i t a l . The p a t i e n t s represented a wide range of d i a g n o s t i c c l a s s i f i c a t i o n , age, and s o c i a l , economic, and educational background. T h i r t y - s i x of these p a t i e n t s were a l c o h o l i c s . The p a t i e n t s were d i v i d e d i n t o groups according to the kind of previous h o s p i t a l i z a t i o n they had experienced: Type I had had no previous p s y c h i a t r i c i n p a t i e n t care; Type I I had r e c e i v e d p s y c h i a t r i c care at a general h o s p i t a l ; and Type I I I had been confined at a mental h o s p i t a l . The r e s u l t s revealed that n e i t h e r age nor education f o r e i t h e r a l c o h o l i c 5 or n o n a l c o h o l i c p a t i e n t s made any d i f f e r e n c e as f a r as a t t i t u d e s toward the mental h o s p i t a l were concerned (the age f i n d i n g r e p l i c a t i n g Souelem's [1955] r e s u l t s ) . The data a l s o i n d i c a t e d , as Imre and Wolfe (1962) had found, that a l c o h o l i c p a t i e n t s were s i g n i f i c a n t l y more fav o r a b l y disposed toward the h o s p i t a l than were n o n a l c o h o l i c p a t i e n t s . F i n a l l y , the n o n a l c o h o l i c p a t i e n t s who had experienced p r i o r h o s p i t a l i z a t i o n s i n a mental h o s p i t a l showed a s i g n i f i c a n t l y l e s s c r i t i c a l a t t i t u d e than those who were f i r s t admissions. This suggests that previous h o s p i t a l i z a t i o n experiences have an e f f e c t upon the a t t i t u d e s of mental p a t i e n t s . Kahn, Jones, MacDonald, Conners s and Burchard (1963) conducted a f a c t o r i a l study of p a t i e n t a t t i t u d e s . They used a questionnaire c o n t a i n i n g one hundred items presumed r e l e v a n t to a t t i t u d e s of p a t i e n t s about p s y c h i a t r i s t s , p s y c h i a t r i c i l l n e s s , and h o s p i t a l i z a t i o n . The s c a l e was administered on two consecutive days to the e n t i r e p a t i e n t p o p u l a t i o n (N=64) of a u n i v e r s i t y p s y c h i a t r i c h o s p i t a l . Seventeen f a c t o r s emerged, one of the most prominent being Negative H o s p i t a l O r i e n t a t i o n . This f a c t o r appears to measure the tendency of p a t i e n t s to view the h o s p i t a l as r e s t r i c t i v e and p u n i t i v e . This f i n d i n g agrees w i t h s e v e r a l of the s t u d i e s mentioned above that had used the Souelem s c a l e . A l l of the above s t u d i e s may b e c r i t i c i z e d f o r one or more of the f o l l o w i n g reasons. F i r s t , the samples used i n these s t u d i e s were very heterogeneous (both i n t r a - and i n t e r - s t u d y ) concerning such p o t e n t i a l l y important v a r i a b l e s as length of stay i n the h o s p i t a l and whether the p a t i e n t s had previous admissions to a mental h o s p i t a l . Wolfensberger's (1956) r e s u l t s i n d i c a t e t h a t t h i s l a t t e r v a r i a b l e i s important and, i n f a c t , may e x p l a i n the c o n t r a d i c t o r y f i n d i n g s of Souelem (1955) on the one hand, and K l o p f e r , H i l l s o n and Wylie (1962), Imre and Wolf (1962), Wolfensbergef (1956), and Kahn, Jones, MacDonald, Conners, and Burchard (1963) on the other. I f Souelem's sample contained many p r i o r admissions, then from Wolfensberg&r's (1956) r e s u l t s one would expect Souelem's sample to view the h o s p i t a l i n a f a v o r a b l e l i g h t and the other i n v e s t i g a t o r s ' samples to view the mental h o s p i t a l i n a more negative l i g h t . Second, none of the s t u d i e s measured the change i n a t t i t u d e s which may occur over time a f t e r a p a t i e n t enters the h o s p i t a l . Again, the d i f f e r e n c e s i n a t t i t u d e that Wolfensberger (1956) found between p a t i e n t s who had p r i o r admissions as compared to those who had no p r i o r admissions to a mental h o s p i t a l suggest that some change may occur. T h i r d , a l l of these s t u d i e s were s t r i c t l y e m p i r i c a l , w i t h no t h e o r e t i c a l s t r u c t u r e w i t h which to organize and/or e x p l a i n the r e s u l t s . Other s t u d i e s have e l i m i n a t e d one or more of these shortcomings. Reznikoff., Brady, and Z e l l e r (1959) developed and then used (Re z n i k o f f , Brady, Z e l l e r , and Toomey, 1960) the P s y c h i a t r i c A t t i t u d e s B a t t e r y . This B a t t e r y c o n s i s t s of a P i c t u r e A t t i t u d e s Test (modeled a f t e r the Thematic Apperception T e s t ) , a Sentence Completion A t t i t u d e s Test, a M u l t i p l e Choice A t t i t u d e s Test, and the Souelem A t t i t u d e Scale. I t measures p a t i e n t s ' a t t i t u d e s toward the h o s p i t a l , p s y c h i a t r i s t s , treatment, and t h e r a p e u t i c outcome. Reznikoff, et a l . (I960) -administered, t h e i r P s y c h i a t r i c A t t i t u d e s B a t t e r y over a s i x month p e r i o d to an unselected group of 142 p a t i e n t s from one to two weeks a f t e r t h e i r admission to a h o s p i t a l . Of the pool of p a t i e n t s s t i l l i n the h o s p i t a l at the end of s i x months, the. B a t t e r y was readministered to three groups of ten. For the f i r s t of these groups, the i n t e r v a l between a t t i t u d e assessments was two months, f o r the second four months, and f o r the t h i r d , s i x months. The r e s u l t s i n d i c a t e d that general a t t i t u d e s became more f a v o r a b l e during the course of h o s p i t a l i z a t i o n . This was true f o r a t t i t u d e s toward p s y c h i a t r i s t s , treatment, and t h e r a p e u t i c outcome, but not true f o r a t t i t u d e s toward p s y c h i a t r i c h o s p i t a l s . The changes seemed to be more conspicuous i n the l e s s obvious measuring devices (e.g. s P i c t u r e A t t i t u d e Test) A l s o , when changes i n the three groups were contrasted, i t appeared that the most s i g n i f i c a n t d i f f e r e n c e s occurred between the two and s i x t h month groups with p r o g r e s s i v e l y more p o s i t i v e a t t i t u d e s a s s o c i a t e d w i t h greater l e n g t h of h o s p i t a l i z a t i o n . Manis, Houts,- and Blake (1963) assessed b e l i e f s about mental i l l n e s s among p s y c h i a t r i c i n p a t i e n t s at a Veteran's A d m i n i s t r a t i o n h o s p i t a l , the mental h e a l t h s t a f f r e s p o n s i b l e f o r t h e i r treatment, and a group of medical and s u r g i c a l c o n t r o l p a t i e n t s . The major mental p a t i e n t sample co n s i s t e d of 45 i n p a t i e n t male p s y c h i a t r i c p a t i e n t s , 13 from a clo s e d ward and 32 from an open ward, These p a t i e n t s were test e d e i t h e r i n d i v i d u a l l y or i n small groups of two or three. They were t e s t e d twice; at admission and one month l a t e r . A subgroup of 9 open ward p a t i e n t s was t e s t e d f o r a t h i r d time, j u s t p r i o r to discharge. The q u e s t i o n n a i r e used i n t h i s study was l a r g e l y based upon Nunnally's (1957, 196.1) work." i t c o n s i s t s of ten b e l i e f c l u s t e r s , each composed of f o u r items. The r e s u l t s showed t h a t : (1) P s y c h i a t r i c and n o n p s y c h i a t r i c p a t i e n t s g e n e r a l l y h o l d s i m i l a r opinions regarding mental i l l n e s s . Severely d i s t u r b e d p s y c h i a t r i c p a t i e n t s , however, view mental i l l n e s s i n more m o r a l i s t i c terms than do "normals.1'' ;(2) P s y c h i a t r i c h o s p i t a l i z a t i o n i s g e n e r a l l y accompanied by a change i n p a t i e n t s ' b e l i e f s concerning mental i l l n e s s , t h i s change being i n the same d i r e c t i o n as the b e l i e f s already held by the s t a f f ( i n t h i s case, 8 s t a f f members i n p s y c h i a t r y , psychology, and p s y c h i a t r i c s o c i a l work). (3) U n l i k e the change R e z n i k o f f , Brady, Z e l l e r , and Toomey (1960) observed i n p a t i e n t s ' a t t i t u d e s toward p s y c h i a t r i s t s and treatment (which was that the greate s t amount of change occurred betwoen two and s i x months of h o s p i t a l i z a t i o n ) , the change i n b e l i e f s occurred w i t h i n one month a f t e r h o s p i t a l i z a t i o n , w i t h no f u r t h e r systematic change o c c u r r i n g a f t e r t h i s . Although these l a t t e r two stu d i e s have overcome some of the c r i t i c i s m s p r e v i o u s l y mentioned (e.g., they have test e d f o r change i n a t t i t u d e s i n p a t i e n t s as a f u n c t i o n of time spent i n the h o s p i t a l ) , they s t i l l have not surmounted other c r i t i c i s m s . For example, these s t u d i e s d i d not consider the no p r i o r a d m i s s i o n — p r i o r admission v a r i a b l e Wolfertsberger (3.956) found important .con-cerning p a t i e n t s ' a t t i t u d e s ( i n Wolfensberger's case, a t t i t u d e s toward mental h o s p i t a l s ) . Nor d i d these s t u d i e s overcome the shortcoming concerning t h e o r e t i c a l s t r u c t u r e . They are s t i l l s t r i c t l y e m p i r i c a l s t u d i e s and do not answer questions such as: "Why are there changes over time i n a t t i t u d e s and b e l i e f s of h o s p i t a l i z e d p a t i e n t s ? " Haider's balance theory (Heider, 1946) may o f f e r an e x p l a n a t i o n , Theory and R a t i o n a l e f o r the Present Study: When p a t i e n t s f i r s t enter a mental h o s p i t a l , t h e i r a t t i t u d e s toward the s t a f f cay be. f a i r l y n e u t r a l r e l a t i v e to the p a t i e n t s ' a t t i t u d e s a f t e r they have been i n the h o s p i t a l f o r a w h i l e . As time passes, through i n t e r a c t i n g w i t h the s t a f f , the p a t i e n t s may come to l i k e the staff.''' I f they do, t h e i r a t t i t u d e s toward the s t a f f w i l l s h i f t i n a p o s i t i v e d i r e c t i o n . Given t h i s s h i f t , the p a t i e n t s are i n an unbalanced s t a t e w i t h respect to those b e l i e f s about mental i l l n e s s they hold that are d i f f e r e n t from those they know are he l d by the h o s p i t a l personnel. According to balance theory, pressure w i l l tend to b r i n g 9 the unbalanced c o g n i t i o n s i n t o balance. One way t h i s may happen i s f o r the p a t i e n t s to change t h e i r b e l i e f s toward the b e l i e f s held by the s t a f f . Of course, those b e l i e f s held by the p a t i e n t s that xvere s i m i l a r to the s t a f f s ' to begin w i t h w i l l remain unchanged. The diagrams below w i l l help c l a r i f y t h i s . There are four s t c t e s that may e x i s t concerning p a t i e n t s ' b e l i e f s toward mental i l l n e s s as contrasted to those of the s t a f f when the p a t i e n t s f i r s t enter the h o s p i t a l . These s t a t e s , and the change (or non-change) of these s t a t e s as time i n the h o s p i t a l increases are represented i n Figure 1. FIGURE 1 . States of p a t i e n t s ' b e l i e f s about mental i l l n e s s as contrasted to those of the s t a f f upon e n t e r i n g the h o s p i t a l and a f t e r the p a t i e n t s have spent a pe r i o d of time i n the h o s p i t a l (given p o s i t i v e change i n a t t i t u d e of p a t i e n t s toward s t a f f ) . C o n d i t i o n I When f i r s t admitted A f t e r p e r i o d of time + C o n d i t i o n I I When f i r s t admitted B "'V F ' S 0 A f t e r p e r i o d of time B " A " C o n d i t i o n I I I When f i r s t admitted B + A f t e r perioc of time + P : B Condition IV When f i r s t admitted . 3 A f t e r p e r i o d of time B " A -+ KEY P = P a t i e n t S = S t a f f B = B e l i e f 0 - n e u t r a l a t t i t u d e + = p o s i t i v e a t t i t u d e or agreement w i t h a b e l i e f - = negative a t t i t u d e or disagreement w i t h a b e l i e f 10 In Conditions I and I I , the p a t i e n t s have entered the h o s p i t a l w i t h n e u t r a l a t t i t u d e s toward the s t a f f and b e l i e f s about mental i l l n e s s s i m i l a r • to the s t a f f s b e l i e f s ( a l b e i t i n Cond i t i o n I both p a t i e n t s and s t a f f agree w i t h the b e l i e f s and i n Co n d i t i o n I I both disagree w i t h the b e l i e f s ) . In both Coi"iditions, the p a t i e n t s ' a t t i t u d e s toward the s t a f f change i n a p o s i t i v e d i r e c t i o n a f t e r being i n the h o s p i t a l f o r a pe r i o d of time. Their b e l i e f s about mental i l l n e s s do not change ( i . e . , remain s i m i l a r to. the s t a f f ' s b e l i e f s ) however, s i n c e the change i n a t t i t u d e does not produce any unbalanced c o g n i t i o n s . C o n d i t i o n I I I i s a d i f f e r e n t s t a t e of a f f a i r s from e i t h e r C o n d i t i o n I or I I . When f i r s t admitted to the h o s p i t a l , the p a t i e n t s i n Condi t i o n I I I have n e u t r a l a t t i t u d e s toward the s t a f f and they hold c e r t a i n b e l i e f s about mental i l l n e s s . However, the s t a f f disagree w i t h these b e l i e f s . As i n Conditions I and I I , a f t e r a pe r i o d of time i n the h o s p i t a l , the p a t i e n t s ' a t t i t u d e s toward the s t a f f change i n a f a v o r a b l e d i r e c t i o n . This change i n a t t i t u d e toward the s t a f f leaves the p a t i e n t s i n an unbalanced c o g n i t i v e s t a t e , s i n c e t h e i r b e l i e f s about mental i l l n e s s are divergent from the s t a f f ' s b e l i e f s . In order to r e s o l v e t h i s unbalanced s i t u a t i o n , the p a t i e n t s change t h e i r b e l i e f s to be more consonant w i t h those of the s t a f f . That i s , the p a t i e n t s change toward agreement w i t h the s t a f f ' s b e l i e f s about mental i l l n e s s . Of course, f o r the above a n a l y s i s to be accurate, i t i s necessary that the s t a f f communicate to the p a t i e n t s , i n one form or another, i t s b e l i e f s about mental i l l n e s s . This a n a l y s i s would e x p l a i n the change i n p a t i e n t s ' a t t i t u d e s toward p s y c h i a t r i s t s that R e z n i k o f f , Brady, Z e l l e r , and Toomey (1960) found and the change i n b e l i e f s about mental i l l n e s s that Manis, Houts, and Blake (1963) found. However, at best these s t u d i e s only o f f e r i n d i r e c t evidence f o r t h i s 11 a n a l y s i s as R e z n i k o f f , et a l . (1960) d i d not measure the p a t i e n t s ' b e l i e f s about mental i l l n e s s and Manis, et a l . (1963) d i d not measure the a t t i t u d e s of p a t i e n t s toward the personnel. There i s a p o s s i b i l i t y that as the p a t i e n t s i n t e r a c t w i t h the s t a f f , 2 they w i l l come to d i s l i k e ( r a t h e r than l i k e ) the s t a f f . Given t h i s , one would p r e d i c t from balance theory the changes i n p a t i e n t s ' b e l i e f s about mental i l l n e s s shown i n Figure 2. FIGURE 2. States of p a t i e n t s ' b e l i e f s about mental i l l n e s s as contrasted to those of the s t a f f upon en t e r i n g the h o s p i t a l and a f t e r the p a t i e n t s have spent a pe r i o d of time i n the h o s p i t a l (given negative change i n a t t i t u d e of p a t i e n t s toward s t a f f ) . C o n d i t i o n I Condition I I When f i r s t admitted P • v s 0 A f t e r p e r i o d of time P L — i s When f i r s t admitted B A" A f t e r period of time , B T A _ ?l is C o n d i t i o n I I I When f i r s t admitted -A * p L s s 0 KEY A f t e r p e r i o d of time B + i -i > S Same as above Condi t i o n IV When f i r s t admit ted + A \ p •-- ^ s 0 A f t e r p e r i o d of time B The same type of a n a l y s i s , only i n reverse order, can be a p p l i e d to these four c o n d i t i o n s as was ap p l i e d to those four conditions f o r which the p a t i e n t s ' a t t i t u d e s toward the aides changed i n a p o s i t i v e d i r e c t i o n . The reader i s r e f e r r e d to the f i r s t a n a l y s i s f o r the d e s c r i p t i o n of these four 12 c o n d i t i o n s , remembering to j u s t reverse the order f o r the present f o u r c o n d i t i o n s . The r e s u l t s of R e z n i k o f f , Brady, Z e l l e r , and Toomey (1960) and Manis, Houts, and Blake (1963) are mora i n l i n e w i t h the former a n a l y s i s than the l a t t e r , and consequently t h i s i n v e s t i g a t o r f e e l s that the f i r s t a n a l y s i s i s the more a p p l i c a b l e one. The purpose of the present study i s to t e s t whether t h i s i s the case or not. The s p e c i f i c hypotheses tested are as f o l l o w s : 3 1. When p a t i e n t s ' a t t i t u d e s toxjard mental h o s p i t a l ward aides are measured upon t h e i r (the p a t i e n t s ) e n t e r i n g the h o s p i t a l , these a t t i t u d e s w i l l be d i f f e r e n t (more n e u t r a l ) than when they are measured l a t e r on i n t h e i r (the p a t i e n t s ' ) h o s p i t a l i z a t i o n . The change i n a t t i t u d e w i l l be i n a p o s i t i v e d i r e c t i o n . 2. Upon e n t e r i n g the h o s p i t a l some of the p a t i e n t s ' b e l i e f s about mental i l l n e s s (as measured by the Information Questionnaire) w i l l be divergent from the aides' b e l i e f s . However, i n order to solve the unbalanced s i t u a t i o n created by the p a t i e n t s becoming more fav o r a b l y disposed toward the a i d e s , the p a t i e n t s w i l l change t h e i r divergent b e l i e f s to correspond more c l o s e l y to those of the aide s . Of course, as mentioned p r e v i o u s l y , i t could be that the p a t i e n t s ' a t t i t u d e s w i l l change i n a negative d i r e c t i o n , although t h i s i s not expected. I f t h i s does occur, the f o l l o w i n g i s p r e d i c t e d concerning changes i n the p a t i e n t s ' b e l i e f s about mental i l l n e s s . 1. I f the b e l i e f s about mental i l l n e s s held by p a t i e n t s when they f i r s t enter the h o s p i t a l are s i m i l a r to the aides' b e l i e f s , they w i l l diverge s i g n i f i c a n t l y from the aides' b e l i e f s as time passes. 2. I f the b e l i e f s are divergent from the aides' at the beginning, they w i l l remain divergent as time passes. The research reported here, then, i s an improvement over p r i o r research i n that i t o f f e r s a t h e o r e t i c a l framework from which p r e d i c t i o n s can be made. A l s o , t h i s research takes i n t o account the v a r i a b l e of p r i o r admissions to a 13 mental h o s p i t a l : a v a r i a b l e which may be important and which has been over-looked f o r the most p a r t i n p r i o r research. CHAPTER THREE METHOD 4 Subjects: The subjects were 40 newly admitted p a t i e n t s from two acute t r e a t -ment wards of a p r o v i n c i a l mental h o s p i t a l . Both wards were open wards, one s t r i c t l y female and the second both male and female. The subjects represented a l l admissions to these two wards during a period of two months, excepting those p a t i e n t s who were e n t i r e l y uncommunicative or not s u f f i c i e n t l y i n contact to be able to understand the questionnaires (17 p a t i e n t s ) or who were discharged p r i o r to the second a d m i n i s t r a t i o n of the questionnaires (17 p a t i e n t s ) . Tho p a t i e n t s represented a wide range of d i a g n o s t i c c l a s s i f i c a t i o n s ; however, there were no chronic b r a i n syndromes or a l c o h o l i c s among them. The length of stay at the h o s p i t a l v a r i e d , but many were released w i t h i n one to two months a f t e r admission. For the t o t a l group of 40 subjects the median age was 32.5 years. The range was 18-58, There were 28 females and 12 males. Twenty subjects were s i n g l e and 17 subjects were married. The mean education was 9.6 year s , ranging from f i v e years to a u n i v e r s i t y degree. There was a wide range of occupational backgrounds. The median age of those subjects w i t h no previous h i s t o r y of admission to a p s y c h i a t r i c ward or mental h o s p i t a l (N=20) was 29 years. There were 12 females and 8 males i n the group. There was a preponderance of s i n g l e subjects (12) as compared to married subjects (6). The mean education was 11 years. Those su b j e c t s w i t h p r i o r admissions (N=20) were approximately the same i n demographic c h a r a c t e r i s t i c s as those w i t h no p r i o r admissions except f o r age (median, 36 years) and m a r i t a l status (a preponderance of married subjects [13] as opposed to s i n g l e [ 6 ] ) . The aides on the two wards a l s o served as s u b j e c t s . There was a t o t a l of nine aides on the two wards. S i x completed the q u e s t i o n n a i r e s . ^ M a t e r i a l s ; Two measuring instruments were used: The Semantic D i f f e r e n t i a l (Osgood, S u c i , and Tannenbaum, 1957) and the Information Questionnaire (Nunnally, 1957, 1961). The Semantic D i f f e r e n t i a l used c o n s i s t e d of two concepts; Lawyer ( f o r p r a c t i c e and/or demonstration) and Mental H o s p i t a l Aide. Ten s c a l e s ( f i v e belonging to the E v a l u a t i v e Factor and f i v e to the Potency Factor) were pre-sented w i t h the two concepts. These sc a l e s ware; E v a l u a t i v e Potency 1. F o o l i s h Wise 6. Severe Lenient 2. I n s i n c e r e Sincere 7. Weak Strong 3. U s e f u l Useless 8. P r o h i b i t i v e Permissive 4. Kind C r u e l , 9. Serious Humorous 5. Worthless Valuable 10. Masculine Feminine The s c a l e s were randomly placed on the sheet f o l l o w i n g each concept. Each s c a l e had seven d i v i s i o n s . For example: Good: : : : : : : : Bad. The concept "Lax^er 1' was always presented f i r s t to give the subject p r a c t i c e i n completing t h i s q u e s t i o n n a i r e . The second q u e s t i o n n a i r e used was the Information Questionnaire. This q u e s t i o n n a i r e was developed by Nunnally (1957, 1961) and was used by Manis, Houts, and Blake (1963). The questionnaire was developed by f a c t o r a n a l y s i s and c o n s i s t e d of ten b e l i e f c l u s t e r s , each composed of four items. Following Nunnally, each c l u s t e r i s named and described below: I . Look and Act D i f f e r e n t (Subhuman). The mentally i l l are r e c o g n i z a b l y d i f f e r e n t i n manner and appearance from normal persons. They have glassy eyes and small b r a i n s , laugh more than normal 16 people, and pay l i t t l e a t t e n t i o n to t h e i r personal appearance. I I . W i l l Power. W i l l power i s the b a s i s of personal adjustment. Once adjustment i s l o s t , the p s y c h i a t r i s t e x e r c i s e s h i s own w i l l power to b o l s t e r the p a t i e n t s f a i l i n g w i l l . Persons who remain mentally i l l do not " t r y " to get b e t t e r . Most of the people who seek treatment do not need i t , and those who do are not very worth-w h i l e people. III. Sex D i s t i n c t i o n . Women are more prone to mental d i s o r d e r than men are. Women worry more than men and more often have ''nervous breakdowns." IV. Avoidance of Morbid Thoughts. Preoccupation w i t h pleasant thoughts i s the b a s i s of mental h e a l t h . Mental disturbances can be avoided by keeping busy reading books on "peace of mind," and aot d i s c u s s i n g troublesome t o p i c s . P s y c h i a t r i s t s must have a good sense of humor. The p s y c h a t r i s t recommends hobbies and other ways f o r p a t i e n t s to occupy themselves. V. Guidance and Support. Mental h e a l t h can be maintained by depending on strong persons i n the environment. The t h e r a p i s t e x p l a i n s to the p a t i e n t the o r i g i n of h i s t r o u b l e s and t e l l s the p a t i e n t where h i s ideas are i n c o r r e c t . The mentally i l l are those who lacked a f f e c t i o n i n childhood. VI. Hopelessness. There i s l i t t l e that can be done to cure a mental d i s o r d e r . Few of the inmates of mental h o s p i t a l s r e t u r n to work i n s o c i e t y . P s y c h i a t r i s t s cannot t e l l whether a c o n d i t i o n i s curable. V I I . Immediate E x t e r n a l Environment versus P e r s o n a l i t y Dynamics. The i n d i v i d u a l ' s s t a t e of mental h e a l t h i s dependent on the pressures of h i s immediate environment. Mental tr o u b l e s are caused by p h y s i c a l exhaustion, f i n a n c i a l and s o c i a l problems. A cure can be e f f e c t e d by a v a c a t i o n or change of scenery. V I I I . Nonseriousness. Emotional problems are r e l a t i v e l y unimportant problems that cause l i t t l e damage to the i n d i v i d u a l . IX. Age Function. Persons become more s u s c e p t i b l e tc emotional d i s o r d e r 17 as they grow o l d e r — a n apparent analogy w i t h the increased s u s c e p t i b i l i t y of " p h y s i c a l " d i s o r d e r s . C h i l d r e n are l e s s a f f e c t e d by f r i g h t e n i n g exper-iences . X. Organic Causes. Mental d i s o r d e r s are brought on by organic f a c t o r s l i k e poor d i e t and diseases of the nervous system. They are a s s o c i a t e d w i t h p h y s i c a l d i s o r d e r s such as b r a i n damage and can be cured by " p h y s i c a l " means. (Nunnally, 1961, pp. 17-18.) A l l items on t h i s q u estionnaire were i n d e c l a r a t i v e form. The respondents i n d i c a t e d t h e i r agreement w i t h each statement on a four p o i n t L i k e r t - t y p e s c a l e , ranging from STRONGLY DISAGREE (1) to STRONGLY AGREE (4 ) . The items w i t h i n each of Nunnally's c l u s t e r s were reworded where necessary to f a c i l i t a t e comprehension. A sample item i s shown below: DISAGREE AGREE _ J 2 3 Ji _ Women have more emotional problems than : j j ' j , ' I I  men do. Procedure: The two questionnaires were administered to the p a t i e n t s on an i n d i v i d u a l b a s i s . Each p a t i e n t came to the Psychology Department of the h o s p i t a l . The experimenter explained that t h i s was a research p r o j e c t , that i t had nothing to do w i t h the p a t i e n t ' s h o s p i t a l e v a l u a t i o n , and that the p a t i e n t could f e e l f r e e to refuse to f i l l out the q u e s t i o n n a i r e s . The experimenter a l s o explained to the p a t i e n t that i n order f o r him to use h i s (the p a t i e n t ' s ) q u e s t i o n n a i r e i n the research a l l statements would have to be answered. I f , however, w h i l e completing them, the p a t i e n t f e l t that he d i d not want to answer a statement, he should inform the experimenter. The experimenter would then terminate the experimental s e s s i o n and r e t u r n the p a t i e n t to the ward. 18 When the p a t i e n t acknowledged that he understood these i n s t r u c t i o n s , he was asked to read the d i r e c t i o n s f o r the f i r s t q u e s t i o n n a i r e . Half the p a t i e n t s r e c e i v e d the Semantic D i f f e r e n t i a l f i r s t ; the other h a l f the Informa-t i o n Questionnaire f i r s t . A copy of both the. Semantic D i f f e r e n t i a l and Information Questionnaire w i t h complete i n s t r u c t i o n s f o r each can be found i n Appendix D. B r i e f l y , concerning the Semantic D i f f e r e n t i a l , f o r each p a i r of a d j e c t i v e s , the subject was asked to make one check mark at the i n t e r v a l along a seven-point continuum which he thought best described the h o s p i t a l aides. For the Information Questionnaire, the subject was asked to place one check mark f o r each statement along a 4 p o i n t continuum ranging from STRONGLY DISAGREE (1) to STRONGLY AGREE (4) . I f the p a t i e n t understood the d i r e c t i o n s , he was asked to f i l l out the q u e s t i o n n a i r e . I f not, the experimenter x<rent over the d i r e c t i o n s w i t h him answering any questions that the p a t i e n t had about completing the q u e s t i o n n a i r e . I f the p a t i e n t understood the second time, the experimenter l e f t the room and the p a t i e n t f i l l e d out the q u e s t i o n n a i r e . I f the subject could understand E n g l i s h but had d i f f i c u l t y reading, the experimenter read the statements aloud and the p a t i e n t marked h i s answers on a d i f f e r e n t sheet. This occurred w i t h 10 s u b j e c t s . At no time would the experimenter look at the p a t i e n t ' s answers w h i l e the l a t t e r was marking them. E s s e n t i a l l y the same procedures were c a r r i e d out on the second a d m i n i s t r a -t i o n . The mean number of days between a d m i n i s t r a t i o n s was 19.7. The same questionnaires were used except that the order of the s c a l e s on the Semantic D i f f e r e n t i a l and of the statements on the Information Questionnaire were changed i n order to have a p l a u s i b l e reason f o r asking the p a t i e n t s to f i l l the 19 questionnaires out f o r the second t i n e . On the second a d m i n i s t r a t i o n , the p a t i e n t s were t c l d t hat the research i n v o l v e d the p o s s i b l e e f f e c t of placement of items on q u e s t i o n n a i r e s . The experimenter obtained responses from the aides a f t e r approaching each one i n d i v i d u a l l y (which was not done at f i r s t and was the cause of much concern on the. p a r t of the a i d e s ) . He t o l d each aide that he was conducting research on the p o s s i b l e e f f e c t s of s t a f f upon p a t i e n t s ' a t t i t u d e s toward s t a f f and b e l i e f s about mental i l l n e s s . I t was explained that t h e i r answers would be kept completely c o n f i d e n t i a l . They were then given the questionnaires and asked to r e t u r n them as soon as p o s s i b l e i n a sealed envelope w i t h only a number of t h e i r own choice on i t . H a l f the aides completed the Semantic D i f f e r e n t i a l f i r s t , and the other h a l f the Information Questionnaire f i r s t . These instruments were i d e n t i c a l to those f i l l e d out by the p a t i e n t s . Three weeks l a t e r , the aides completed the questionnaires f o r the second time. The experimenter r e c e i v e d f i v e r e t urns on t h i s a d m i n i s t r a t i o n . The aides were t o l d before the f i r s t a d m i n i s t r a t i o n that they would be asked to f i l l out the questionnaires a second time. A l l semantic d i f f e r e n t i a l s c a l e s were scored so that the most "unfavor-a b l e " r e a c t i o n was scored one. (1) w h i l e the most " f a v o r a b l e " r e a c t i o n was scored seven (7). For example, Bad.* : ; / : : : ; : Good was scored as three (3) w h i l e Bad: ; : s : : __/_ : : Good was scored as s i x (6). Scoring f o r the Information Questionnaire was more complicated. To o f f s e t the p o s s i b l e response set tendency of e i t h e r l a r g e l y agreeing or d i s -agreeing w i t i r q u e stionnaire items r e g a r d l e s s of t h e i r content, c e r t a i n items on the que s t i o n n a i r e were presented i n a reversed d i r e c t i o n . For example, 20 the item "A v a c a t i o n w i l l help a nervous breakdown" could be reversed to "A v a c a t i o n w i l l not help a nervous breakdown." Thus each of the four items composing any one of the ten f a c t o r s was scored such that a score of one (1) was assigned to STRONGLY DISAGREE with the Factor and a score of four (4) was assigned to STRONGLY AGREE w i t h the Factor. The procedure i s summarized i n Table 1. Table 1. Summary of Procedure Used i n t h i s Experiment. No. of Measures F i r s t Second Group Subjects Used . Admin. Admin. No P r i o r 20 1. Semantic D i f f e r - Semantic D i f f e r - Same two Admissions e n t i a l . 10 s c a l e s : e n t i a l a d m i n i s t e r - questionnaires Ward East 3 10 F i v e E v a l u a t i v e ed f i r s t to h a l f administered a Ward East 4 10 f a c t o r ; f i v e the p a t i e n t s ; mean of 19.75 Potency f a c t o r Information days a f t e r f i r s t 2. Information Questionnaire ad- a d m i n i s t r a t i o n . Ou est i o n n a i r e m i n i s t e r e d to Information other h a l f f i r s t . q u estionnaire No mere than 4 administered to days elapsed be- h a l f the sub-tween admission j e c t s f i r s t ; and a d m i n i s t r a t i o n Semantic D i f f -of q u e s t i o n n a i r e s . e r e n t i a l to Both questionnaires other h a l f administered i n f i r s t . same s e s s i o n . P r i o r Ad- 20 Same as f o r No Same as f o r No Same as f o r No missions P r i o r Admissions P r i o r Admissions P r i o r Admissions Ward East 3 7 Group Group Group Ward East 4 13 T o t a l 40 CHAPTER FOUR RESULTS P a t i e n t s ' A t t i t u d e s Toward Aides The f i r s t hypothesis of t h i s study was supported by the data. The p a t i e n t s changed t h e i r a t t i t u d e s toward the aides a f t e r 3 weeks of h o s p i t a l i -z a t i o n , and t h i s change was i n a fav o r a b l e d i r e c t i o n . Table 2. Means and Co r r e l a t e d t s f o r the E v a l u a t i v e f a c t o r of the Semantic D i f f e r e n t i a l . Mean F i r s t Mean Second Ward Group A d m i n i s t r a t i o n A d m i n i s t r a t i o n t P E„ + E. 1 J> 4 No F + P 2 • 5.72 j 6.14 i 2.24 <.05 E 3 4- E 4 No P 5.60 6.10 1.81 NS E 3 + E4 P —- ——————————————— 5.83 6.18 2.38 <.05 E 3 Wo P 5.60 6.38 2.51 <.05 \ No P 5.56 5.82 0.53 NS E 3 P 6 . 3 8 6.56 0.88 NS E/ 4 ? 5.45 5.93 2.26 <.05 E = East 2 No P = No p r i o r admissions P = P r i o r admissions Table 2 presents the mrians and c o r r e l a t e d t s f o r the E v a l u a t i v e Factor of the Semantic D i f f e r e n t i a l f o r the t o t a l p a t i e n t sample, the No P r i o r Admissions Group, the P r i o r Admissions Group, and the d i f f e r e n t wards. With a l l p a t i e n t s considered together (N=40), the mean score f o r the E v a l u a t i v e Factor was 5.72 f o r the f i r s t a d m i n i s t r a t i o n . The mean score 22 f o r the second a d m i n i s t r a t i o n was 6.14. While t h i s was a s n a i l increase i n absolute t e r n s , i t was s t a t i s t i c a l l y s i g n i f i c a n t (P<.05). For the P r i o r Admissions Group only (N=20), the mean f o r the Ev a l u a t i v e F a c t o r , f i r s t a d m i n i s t r a t i o n , was 5.83, while f o r the second a d m i n i s t r a t i o n the mean was 6.18. Again, t h i s was a small absolute increase that was s t a t i s t i c a l l y s i g n i f i c a n t (F<.05). The mean f o r the E v a l u a t i v e Factor, f i r s t a d m i n i s t r a t i o n , No P r i o r Admissions Group (N=20), was 5.60 and the mean f o r the second admini-s t r a t i o n was 6.10. While t h i s increase was not s t a t i s t i c a l l y s i g n i f i c a n t , a d e f i n i t e trend was shown (t = 1.81, P<.10). Since there were two wards i n v o l v e d , c o r r e l a t e d t s were computed to determine I f there were any c o n s i s t e n t d i f f e r e n c e s between wards. Table 2 i n d i c a t e s that no such d i f f e r e n c e s e x i s t e d . That i s , no p a t t e r n v/as d i s c e r n i b l e such t h a t , f o r example, the p a t i e n t s of E^ changed t h e i r a t t i t u d e s toward the aides i n a favorable d i r e c t i o n and the p a t i e n t s of E. d i d not. 4 Table 3: Means and C o r r e l a t e d _ts f o r the Potency.Factor of the Semantic D i f f e r e n t i a l . Mean F i r s t Mean Second Ward Group A d m i n i s t r a t i o n A d m i n i s t r a t i o n t P 1 E 3 + E 4 2 No p + r 4.04 3.99 0.49 NS L E 3 + E4 No P 4.10 4.19 0.65 NS E 3 + E4 P 3.97 3.79 0.77 NS E 3 - • No P 4.34 4.33 0.14 NS E4 No P 3.86 4.06 0.87 NS E 3 P 3.80 3.80 0.00 NS •' •  — • r — 1 E. | F i 4.16 •4 , ; 3.78 1.92 NS E - East No P - No p r i o r admissions F = F r i o r admissions 23 The means and c o r r e l a t e d t s f o r the Potency Factor of the Semantic D i f f e r e n t i a l f o r the t o t a l p a t i e n t sample, the No P r i o r and.Prior Admissions Groups, and the d i f f e r e n t wards f o r the two a d m i n i s t r a t i o n s are presented i n Table 3. A review of t h i s Table i n d i c a t e s that the p a t i e n t sample, whether considered as a whole or i n i t s subgroupings, changed i t s Potency r a t i n g s of the h o s p i t a l ward aides very l i t t l e between the f i r s t and second a d m i n i s t r a t i o n s of the Semantic D i f f e r e n t i a l . With a l l p a t i e n t s combined, the mean Potency score f o r the f i r s t a d m i n i s t r a t i o n was 4.04, while f o r the second a d m i n i s t r a t i o n i t was 3.99. This was a small change which was not s t a t i s t i c a l l y s i g n i f i c a n t . The reader i s r e f e r r e d to Appendix A f o r the mean score f o r each s c a l e and each a d m i n i s t r a t i o n of the Semantic D i f f e r e n t i a l . In reviewing t h i s Appendix, the reader w i l l note the r a t h e r c o n s i s t e n t changes that occurred w i t h the E v a l u a t i v e s c a l e s between the f i r s t and second a d m i n i s t r a t i o n s and the r e l a t i v e l a c k of change or consistency that occurred w i t h the Potency s c a l e s . Thus, as p r e d i c t e d , the p a t i e n t s changed t h e i r a t t i t u d e s toward the a i d e s , and t h i s change was i n a p o s i t i v e d i r e c t i o n . However, t h i s change was l i m i t e d to the E v a l u a t i v e Factor of the Semantic D i f f e r e n t i a l . There was no s t a t i s t i c a l l y s i g n i f i c a n t change i n the Potency Factor. P a t i e n t s ' B e l i e f s about Mental I l l n e s s U n l i k e the p a t i e n t s ' a t t i t u d e s toward the a i d e s , t h e i r b e l i e f s about mental i l l n e s s d i d not change a f t e r three weeks of h o s p i t a l i z a t i o n . C o l l a p s i n g over a l l f a c t o r s , the mean b e l i e f score f o r the t o t a l p a t i e n t sample, f i r s t a d m i n i s t r a t i o n was 2.375 f o r the second a d m i n i s t r a t i o n , the mean b e l i e f score was 2.32, Dichotomizing the p a t i e n t s i n t o those with or without p r i o r admissions, the mean b e l i e f score f o r the No P r i o r Admission Group, f i r s t a d m i n i s t r a t i o n , was 2.33 and f o r the second a d m i n i s t r a t i o n , the mean 24 score was 2.24. For the P r i o r Admissions Group, there was no d i f f e r e n c e i n mean b e l i e f score f o r the two a d m i n i s t r a t i o n s , both being 2.41. A two-way a n a l y s i s of v a r i a n c e (Meyer, 1966) was computed to determine i f there x^ere any d i f f e r e n c e s between the b e l i e f s about mental i l l n e s s of the No P r i o r and P r i o r Admissions Groups and whether the current h o s p i t a l i z a t i o n had any e f f e c t upon the p a t i e n t s ' b e l i e f s . This a n a l y s i s i s summarized i n Table 4. Table 4. Two-Way A n a l y s i s of Variance Comparing No P r i o r _ Admissions and_Prior Admissions Groups.  df MS F Prob. Between Group 1 485.113 3.204 NS E r r o r 38 151.401 W i t h i n Ho s p i t a l i zat i o n 1 66.613 1.206 NS Group X H o s p i t a l i z a t i o n 1 J. 74.112 1.342 NS E r r o r 38 55.204 As shown by t h i s a n a l y s i s , there was no s i g n i f i c a n t d i f f e r e n c e between the txTO groups (F = 3.20, P<.10) s nor d i d the current h o s p i t a l i z a t i o n seem to have any e f f e c t upon the p a t i e n t s ' b e l i e f s about mental i l l n e s s ( i . e . , no H o s p i t a l i z a t i o n main e f f e c t ; F = 1.21, n.s.). This a n a l y s i s a l s o i n d i c a t e d that there was no i n t e r a c t i o n e f f e c t between group and current h o s p i t a l i z a t i o n (F = 1.34, n . s . ) . The means f o r each item on both a d m i n i s t r a t i o n s of the Information Questionnaire f o r the t o t a l p a t i e n t sample, the No P r i o r and P r i o r Admissions Groups, and the aides are presented i n Appendix B. An overview of t h i s Appendix r e v e a l s extreme i n c o n s i s t e n c i e s . For example, on no Factor d i d the p a t i e n t s e i t h e r i n c r e a s e (agree more) or decrease (disagree more) t h e i r scores 25 on the mean of a l l four items composing the Factor when the f i r s t and second a d m i n i s t r a t i o n s were compared. S i m i l a r l y , there was no p a r t i c u l a r item(s) which seemed to change appreciably from f i r s t to second a d m i n i s t r a t i o n or to d i s t i n g u i s h between the No P r i o r and P r i o r Admissions Groups. R e l a t i o n s h i p Between P a t i e n t s ' A t t i t u d e s Toward Aides and B e l i e f s About Mental  I l l n e s s In order to determine whether the second hypothesis of t h i s study was supported by the data, the o v e r a l l b e l i e f p r o f i l e s of the No. P r i o r Admissions and P r i o r Admissions Groups were compared i n terns of t h e i r r e s p e c t i v e d i s c r e p a n c i e s from the b e l i e f s of the aide s . This comparison was done by c a l c u l a t i n g the D - s t a t i s t i c (Crcnbach and C l o s e r , 1953) between each p a t i e n t ' s b e l i e f s and the b e l i e f s of the average s t a f f member. Figure 3 shews the average, discrepancy between the p a t i e n t s ' views and those of the s t a f f ? as a f u n c t i o n of length of h o s p i t a l i z a t i o n . Results are p l o t t e d s e p a r a t e l y f o r the No P r i o r Admissions Group and the P r i o r Admissions Group. The mean discrepancy i n b e l i e f s about mental i l l n e s s between those p a t i e n t s w i t h no previous admissions and the s t a f f decreased between the f i r s t and second a d m i n i s t r a t i o n s of the Information Questionnaire (9.975 to 8.724). For those p a t i e n t s w i t h previous admissions, the mean discrepancy from the s t a f f increased between the f i r s t and second a d m i n i s t r a t i o n s (10.225 to 10.475). Neither the decrease f o r the No P r i o r Admissions Group nor the increase f o r the P r i o r Admissions Group was s t a t i s t i c a l l y s i g n i f i c a n t , however, s i n c e the two-way a n a l y s i s of vari a n c e computed on the Information Questionnaire showed no s i g n i f i c a n t treatment ( h o s p i t a l i z a t i o n ) e f f e c t or i n t e r a c t i o n (group x h o s p i t a l i z a t i o n ) . Thus, the second hypothesis of t h i s study was not supported. There was no s i g n i f i c a n t change i n the p a t i e n t s ' b e l i e f s about 26 P r i o r Admissions (N=20) No P r i o r Admissions (N=20) 5 10 15 20 Days between t e s t s P a t i e n t - s t a f f d i s c r e p a n c i e s i n b e l i e f as a f u n c t i o n of time of h o s p i t a l i z a t i o n (repeated measurements). 27 mental i l l n e s s i n the d i r e c t i o n of those h e l d by the aides even though the p a t i e n t s ' a t t i t u d e s toward the aides increased i n a f a v o r a b l e d i r e c t i o n . CHAPTER FIVE DISCUSSION The f i r s t hypothesis of t h i s study was supported by the data. The p a t i e n t s d i d s i g n i f i c a n t l y change t h e i r expressed a t t i t u d e ^ toward the aides (as measured by the Semantic D i f f e r e n t i a l ) a f t e r three weeks of h o s p i t a l i z a t i o n , and t h i s change was i n a favorable d i r e c t i o n . This change by the p a t i e n t s i n expressed a t t i t u d e toward, the aides occurred both i n the P r i o r Admissions Group and the No P r i o r Admissions Group. This f i n d i n g i s i n l i n e w i t h t h a t of R e z n i k o f f , Brady, Z e l l e r , and Toomey (1960) who found that p a t i e n t s ' a t t i t u d e s toward p s y c h i a t r i s t s , treatment and t h e r a p e u t i c outcome changed i n a favorable d i r e c t i o n as length of h o s p i t a l i z a t i o n increased. One d i f f e r e n c e between the R e z n i k o f f , et al_. (1960) study and the present one i s that i n the former study, the pe r i o d of time between the two a t t i t u d e measurements ranged up to s i x months f o r some p a t i e n t s , w h i l e i n the present study t h i s p e r i o d of time was approximately three weeks. Furthermore, the R e z n i k o f f , _et a l . (1960) r e s u l t s i n d i c a t e d that the most s i g n i f i c a n t change i n a t t i t u d e s of the p a t i e n t s occurred between two and s i x months, w i t h p r o g r e s s i v e l y more p o s i t i v e a t t i t u d e s a s s o c i a t e d w i t h greater length of h o s p i t a l i z a t i o n . This f i n d i n g suggests that i f the p a t i e n t s ' a t t i t u d e s toward the aides i n the present study bad been measured beyond the three weeks used, even more change i n a p o s i t i v e d i r e c t i o n may have been observed, though, i n p r a c t i c a l terms, the expressed a t t i t u d e s , both at the outset of h o s p i t a l i z a t i o n and three weeks l a t e r , were already h i g h l y p o s i t i v e . I t i s i n t e r e s t i n g to note that not only i s there a s i g n i f i c a n t f a vorable change i n the p a t i e n t s ' expressed a t t i t u d e s toward the aides w i t h i n the f i r s t three weeks of h o s p i t a l i z a t i o n , but a l s o that t h e i r i n i t i a l r a t i n g of the 29 aides (no more than four days a f t e r e n t e r i n g the h o s p i t a l ) was q u i t e high. In f a c t , the p a t i e n t s * mean i n i t i a l r a t i n g s on the E v a l u a t i v e Scales ( f o r both the No P r i o r and P r i o r Admissions Groups) were approximately the same as those found by Nunnally (1961) f o r the general population w i t h approximately the same ed u c a t i o n a l background as the p a t i e n t s . I t may be conjectured from these data that upon e n t e r i n g a mental h o s p i t a l , a p a t i e n t has approximately the same expressed f a v o r a b l e a t t i t u d e toward mental h o s p i t a l aides as the general p o p u l a t i o n w i t h the same ed u c a t i o n a l background. This expressed a t t i t u d e changes to an even more fav o r a b l e p o s i t i o n as the p a t i e n t remains i n the h o s p i t a l , p o s s i b l y as a r e s u l t of i n t e r a c t i o n w i t h the aides. The second hypothesis was not supported by the data. The su b j e c t s ' expressed b e l i e f s about mental i l l n e s s as measured by the Information Questionnaire d i d not s i g n i f i c a n t l y converge toward the aid e s ' expressed b e l i e f s . In f a c t , Figure 3 and Appendix C i n d i c a t e that the P r i o r Admissions Group, who s i g n i f i c a n t l y changed t h e i r expressed a t t i t u d e s toward the aides i n a favorable d i r e c t i o n , moved s l i g h t l y (but n o n s i g n i f i c a n t l y ) away from the aides' expressed b e l i e f s about mental i l l n e s s a f t e r three weeks of h o s p i t a l i z a t i o n . Furthermore, even though the No P r i o r Admission Group showed some movement toward the aides' expressed b e l i e f s about mental i l l n e s s , t h i s change was not s t a t i s t i c a l l y s i g n i -f i c a n t . Thus, from these data i t appears that r a t h e r than there being a r e l a t i o n s h i p between increased expressed l i k a b i l i t y of the aides by p a t i e n t s and a convergence c f p a t i e n t s ' b e l i e f s about mental i l l n e s s toward those of the aid e s ' , these two v a r i a b l e s are independent of each other. Why d i d t h i s study f i n d no change i n p a t i e n t s ' b e l i e f s about mental i l l n e s s toward those of the s t a f f s ' w h i l e the Manis, Houts, and Blake (1963) study d i d f i n d such a change? One explanation f o r t h i s discrepancy may be that 30 there was too short a time span between the f i r s t and second a d m i n i s t r a t i o n s of the q u e s t i o n n a i r e s i n the present study to p i c k up any s i g n i f i c a n t changes i n the p a t i e n t s ' b e l i e f s about mental i l l n e s s . S i g n i f i c a n t changes may have been observed i f the questionnaires had been readministered f i v e or s i x weeks a f t e r the f i r s t a d m i n i s t r a t i o n r a t h e r than the three week i n t e r v a l that was used. This e x p l a n a t i o n i s a p l a u s i b l e one. On the other hand, the data of Manis, et a l , (1963) argue against i t . T heir data showed that the p a t i e n t s ' change i n b e l i e f s about mental i l l n e s s occurred w i t h i n one month (four weeks) a f t e r h o s p i t a l i z a t i o n , w i t h no f u r t h e r systematic change o c c u r r i n g a f t e r t h i s . With the data c f the present experiment showing so l i t t l e change i n p a t i e n t s ' b e l i e f s about mental i l l n e s s a f t e r three weeks of h o s p i t a l i z a t i o n , i t i s d o u b t f u l that one more week would have made any d i f f e r e n c e . In a d d i t i o n , according to Manis, et a l . (1963), there i s no systematic change i n p a t i e n t s ' b e l i e f s about mental i l l n e s s a f t e r the f o u r t h week of h o s p i t a l i z a t i o n . Another e x p l a n a t i o n f o r the discrepancy may be that i t i s not increased l i k a b i l i t y of a person which causes the mental p a t i e n t to change h i s b e l i e f s about mental i l l n e s s toward the person's own b e l i e f s , but r a t h e r whether the p a t i e n t views the person as an expert concerning mental h e a l t h and i l l n e s s . The present research used mental h o s p i t a l aides as the s t a f f comparison group w h i l e Manis, e_t a l . used p r o f e s s i o n a l workers ( p s y c h i a t r i s t s , p s y c h o l o g i s t s , and s o c i a l workers). Furthermore, i t appears that the p r o f e s s i o n a l s i n the Manis, ejt a l . study spent much more time w i t h t h e i r p a t i e n t s than the p r o f e s s i o n a l s t a f f members at the h o s p i t a l where the current research was conducted. Manis, et a l . s t a t e that "they [ s t a f f members] a l s o spent considerable hours i n t e r -a c t i n g w i t h t h e i r p a t i e n t s on the wards, as p a r t of a m i l i e u approach which had been p r a c t i c e d i n the h o s p i t a l f o r a period of years." (1963, p. 227) 31 While the wards where the current research was conducted i n v o l v e d a " m i l i e u approach," i t i s probably i n c o r r e c t to assume that the degree of contact w i t h the p a t i e n t s was es high i n the present s e t t i n g . I f i t i s the e x p e r t i s e of the s t a f f member r a t h e r than l i k a b i l i t y of the s t a f f member by the p a t i e n t which i n f l u e n c e s him to change h i s b e l i e f s about, mental i l l n e s s (at l e a s t be-l i e f s as measured by the Information Questionnaire) toward the s t a f f members' b e l i e f s , then the discrepancy between the f i n d i n g s of Manis, et: al_. (1963) and the present study are understandable. With r e l a t i v e l y l i t t l e contact w i t h mental h e a l t h experts, one would not expect the p a t i e n t s i n the present study to change t h e i r b e l i e f s whereas i n the Manis, e t a l . (1963) study, one would expect such change because of the "considerable hours" of i n t e r a c t i o n that occurred between p r o f e s s i o n a l s t a f f and p a t i e n t s . Another e x p l a n a t i o n (and a more tenable one from t h i s researcher's p o i n t of view) f o r the d i f f e r e n c e observed between the Manis, elt al_. (1963) r e s u l t s and the r e s u l t s of the present study i s that the Information Questionnaire that was used to measure expressed b e l i e f s about mental i l l n e s s i n these two stu d i e s i s not a v a l i d measure of such b e l i e f s . Manis, ejt a l . (1963) had to c o l l a p s e over a l l f a c t o r s i n order to o b t a i n a s i g n i f i c a n t d i f f e r e n c e , s t a t i n g i n a footnote that "When the eleven item c l u s t e r s ["they used s i x items from Basse! (1955) f o r the eleventh c l u s t e r ] were considered one at a_ time, none of them showed s i g n i f i c a n t changes during the f i r s t month of h o s p i t a l i z a t i o n . " (p. 230) In the present study, even c o l l a p s i n g b e l i e f scores over a l l f a c t o r s f a i l e d to r e s u l t i n s i g n i f i c a n t b e l i e f change. And even i f s i g n i f i c a n t r e s u l t s had been obtained by c o l l a p s i n g over a l l items on the Questionnaire, the meaning of such a r e s u l t would be d i f f i c u l t to assess. Furthermore, Appendix 6 shows that the items i n any given f a c t o r 32 are i n c o n s i s t e n t with each other and thus the v a l i d i t y of the f a c t o r s i s i n s e r i o u s question. For example;, on two items c f Factor One (Mental P a t i e n t s g are Subhuman), the p a t i e n t s answered so that they disagreed more w i t h the » —————— f a c t o r on the second a d m i n i s t r a t i o n (three weeks a f t e r h o s p i t a l i z a t i o n ) as compared to the f i r s t a d m i n i s t r a t i o n (no more than four days a f t e r h o s p i t a l i -z a t i o n ) ; on the other two items of t h i s f a c t o r the p a t i e n t s answered i n such a manner as to say they agreed more w i t h Factor One on the second a d m i n i s t r a t i o n as compared to the f i r s t a d m i n i s t r a t i o n . S i m i l a r i n c o n s i s t e n c i e s were found w i t h a l l ten f a c t o r s . This should not have occurred i f the f a c t o r s were v a l i d ( i . e . , i f the items of a p a r t i c u l a r f a c t o r had reasonable loadings on that f a c t o r ) . F i n a l l y , the v a r i a b l e of no p r i o r a d m i s s i o n s — p r i o r admissions d i d not seem to a f f e c t a t t i t u d e s or b e l i e f s of mental p a t i e n t s . There were no d i f f e r -ences between these two groups of p a t i e n t s on e i t h e r the expressed a t t i t u d e s as measured by the Semantic D i f f e r e n t i a l or on t h e i r b e l i e f s about mental i l l n e s s as measured by the Information Questionnaire. This i s u n l i k e Wolfensberger' s (1956) study which shox<red that p r i o r admissions had an e f f e c t on how the p a t i e n t s viewed the h o s p i t a l . Perhaps expressed a t t i t u d e s toward the h o s p i t a l as a whole (as measured by the Souelem s c a l e ) d i f f e r from those a t t i t u d e s and b e l i e f s measured by the questionnaires used i n t h i s study. There i s some evidence f o r t h i s reasoning as most stu d i e s (Wolfensberger, 1956; K l o p f e r , H i l l s o n , and Wylie, 1962; Imre and Wolf, 1962) found that p a t i e n t s ' a t t i t u d e s toward the mental h o s p i t a l are negative, whereas the present study as w e l l as other s t u d i e s (e.g., R e z n i k o f f , Brady, Z e l l e r , and Toomey, 1960) found that p a t i e n t s ' expressed a t t i t u d e s toward the s t a f f are f a v o r a b l e . A l s o , R e z n i k o f f , e t a l . (1960) found that w h i l e p a t i e n t s ' a t t i t u d e s toward p s y c h i a t r i s t s , treatment, and outcome changed, the p a t i e n t s ' a t t i t u d e s toward the h o s p i t a l i n general d i d not change. CHAPTER SIX SUMMARY AND'FUTURE DIRECTIONS This study attempted to r e l a t e p o s s i b l e changes i n mental h o s p i t a l p a t i e n t s ' b e l i e f s about mental i l l n e s s to p o s s i b l e changes i n t h e i r a t t i t u d e s toward the s t a f f . Using Heider's (1946) balance theory, i t was p r e d i c t e d that i f the p a t i e n t s ' a t t i t u d e s toward the s t a f f changed i n a p o s i t i v e d i r e c t i o n , those b e l i e f s h e l d by the p a t i e n t s which were d i s s i m i l a r to the s t a f f ' s b e l i e f s would change i n the d i r e c t i o n of the s t a f f ' s b e l i e f s . On the other hand, i f the p a t i e n t s ' a t t i t u d e s toward the s t a f f changed i n a negative d i r e c t i o n , those b e l i e f s about mental i l l n e s s held by the p a t i e n t s which were s i m i l a r to the b e l i e f s of the s t a f f to begin w i t h would diverge from the s t a f f ' s b e l i e f s . This p r e d i c t i o n hinged, of course, upon the s t a f f communicating to the p a t i e n t s , i n one form or another, i t s b e l i e f s about mental i l l n e s s . There have been previous s t u d i e s which have concerned themselves w i t h the general t o p i c s of a t t i t u d e s of p a t i e n t s toward s t a f f or p a t i e n t s ' b e l i e f s about mental i l l n e s s . However, no study has combined these two t o p i c s nor has any study suggested how they might be r e l a t e d . A l s o , these previous s t u d i e s were not s u f f i c i e n t l y c o n t r o l l e d f o r p o s s i b l e i n f l u e n c i n g v a r i a b l e s such as whether a p a t i e n t had had previous admissions to a mental h o s p i t a l . For reasons mentioned i n the Procedure s e c t i o n of t h i s r e p o r t , aides were chosen as the group of s t a f f most s u i t e d to represent the s t a f f i n the current study. The Semantic D i f f e r e n t i a l was used to measure the p a t i e n t s ' a t t i t u d e s toward the aides and the Information Questionnaire (Nunnally, 1957, 1961) was used to measure the p a t i e n t s ' and the aides' b e l i e f s about mental i l l n e s s . These two questionnaires were administered twice: the f i r s t time being no longer than four days a f t e r admission to the h o s p i t a l ; the second time approxi-34 mately three weeks a f t e r the f i r s t a d m i n i s t r a t i o n . I t may be concluded from the r e s u l t s of t h i s study that compared to t h e i r a t t i t u d e s toward the aides when they f i r s t entered the h o s p i t a l , the p a t i e n t s ' a t t i t u d e s toward the aides changed i n a favorable d i r e c t i o n a f t e r three weeks of h o s p i t a l i z a t i o n . However, these changes i n a t t i t u d e were not accompanied by changes i n b e l i e f s about mental i l l n e s s by the p a t i e n t s i n the d i r e c t i o n of greater agreement w i t h the aides' b e l i e f s . In f a c t , the p a t i e n t s d i d not change t h e i r b e l i e f s about mental i l l n e s s at a l l from the time they were admitted to the time they were r e t e s t e d three weeks l a t e r . Thus, r a t h e r than being r e l a t e d i n some manner w i t h each other as p r e d i c t e d , the p a t i e n t s ' a t t i t u d e s toward the aides as measured by the Semantic D i f f e r e n t i a l and t h e i r b e l i e f s about mental i l l n e s s as measured by the Information Questionnaire, appear to be independent of each other. Many p o s s i b l e reasons f o r the f a i l u r e of t h i s study to confirm the pre-d i c t i o n s were discussed i n the D i s c u s s i o n s e c t i o n of t h i s paper. One hypothesis suggested was that i t i s not increase l i k a b i l i t y of a person which causes the mental p a t i e n t to change h i s b e l i e f s about mental i l l n e s s toward that person's own b e l i e f s . Rather i t i s whether the p a t i e n t views the person as an expert i n the f i e l d of mental h e a l t h . To check t h i s hypothesis, a study s i m i l a r to the one reported i n t h i s paper could be conducted. However, i n s t e a d of measuring only aides' b e l i e f s about mental i l l n e s s , one could measure b e l i e f s of both p r o f e s s i o n a l and non-p r o f e s s i o n a l s t a f f . As f o r the p a t i e n t s , one would measure t h e i r a t t i t u d e s toward the p r o f e s s i o n a l s t a f f (e.g., p s y c h i a t r i s t s and nurses) i n a d d i t i o n to t h e i r a t t i t u d e s toward nonprofessional s t a f f (e.g. aides) and t h e i r b e l i e f s about mental i l l n e s s . 35 The r e s u l t s of t h i s study would show whether the n o n p r o f e s s i o n a l or the p r o f e s s i o n a l s t a f f i n f l u e n c e d the p a t i e n t s ' b e l i e f s . I t may be that the p a t i e n t s ' a t t i t u d e s change i n a favorable d i r e c t i o n f o r both p r o f e s s i o n a l and non-p r o f e s s i o n a l s t a f f , but only p r o f e s s i o n a l s t a f f i n f l u e n c e the p a t i e n t s ' b e l i e f s . This would lend support to the above hypothesis that i t i s the e x p e r t i s e r a t h e r than the increased l i k a b i l i t y of a s t a f f member which produces a change i n mental p a t i e n t s ' b e l i e f s about mental i l l n e s s . For t h i s proposed study, i t i s recommended that a d i f f e r e n t questionnaire than the Information Questionnaire be used to measure p a t i e n t and s t a f f b e l i e f s about mental i l l n e s s . There i s evidence from the present study to s e r i o u s l y question i t s v a l i d i t y . A l s o , i n seme i n s t a n c e s , the wording of t h i s q u estionnaire i s o b s o l e t e . For i n s t a n c e , the word "insane 5' i s used. In 1957, when the q u e s t i o n n a i r e was f i r s t used, t h i s word may have been i n common usage. However, today such terms as "mentally d i s t u r b e d " or "mentally i l l " are more appropriate. Furthermore,, i n such research i t may be wise to s e l e c t the sample i n terms of d i a g n o s t i c c a t e g o r i e s . I t could be that c e r t a i n types of p a t i e n t s are more l i k e l y to change t h e i r b e l i e f s about mental i l l n e s s than are others. To combine a l l d i a g n o s t i c categories as was done i n the present study may have the e f f e c t of "dampening" any s i g n i f i c a n t change. Thus, i t may be best to i n c l u d e only one or two c l a s s i f i c a t i o n categories i n the study (e.g., only d e p r e s s i v e s ) . For a long-term research p r o j e c t i t would be worthwhile to c o l l e c t data of t h i s type from p a t i e n t s of many d i f f e r e n t c l a s s i f i c a t i o n s and compare the commonality and d i f f e r e n c e s i n t h e i r a t t i t u d e s toward s t a f f and b e l i e f s about mental i l l n e s s and how each type of p a t i e n t might change these a t t i t u d e s and b e l i e f s through h o s p i t a l i z a t i o n . One f i n a l note. Although the major hypothesis was not supported by the 36 data, t h i s study d i d c o n t r i b u t e c e r t a i n f i n d i n g s . C e r t a i n data lend support to previous s t u d i e s (e.g., R a z n i k o f f , et a l . , 1960) which found that p a t i e n t s ' a t t i t u d e s toward 3 t a f f change i n a f a v o r a b l e d i r e c t i o n as a f u n c t i o n of h o s p i t a l i z a t i o n . Evidence from t h i s study a l s o places i n serious doubt the v a l i d i t y of a questionnaire which has been used r a t h e r e x t e n s i v e l y i n past research (e.g., Nunnally, 1957, 1961). F i n a l l y the r e s u l t s of t h i s experiment suggest that at l e a s t i n the realm of b e l i e f s about mental i l l n e s s , aides may not have any short-term i n f l u e n c e over mental p a t i e n t s . This l a s t c o n c l u s i o n however, i s only t e n t a t i v e and needs to be supported by f u r t h e r research. 37 FOOTNOTES 1. There could be s e v e r a l reasons f o r t h i s . For example, the s t a f f may be kind and h e l p f u l to the p a t i e n t s . Furthermore, they may be l e n i e n t toward the p a t i e n t s and a l l o w them considerable freedom. 2. This, again, could be f o r s e v e r a l reasons. For example, the s t a f f may be r e s t r i c t i v e and ra t h e r c r u e l to the p a t i e n t s . They may be l e s s than h e l p f u l to the p a t i e n t s . 3. Mental h o s p i t a l ward aides were chosen f o r t h i s study from a l l the d i f f e r e n t groups of personnel at the h o s p i t a l where t h i s research was conducted f o r the f o l l o w i n g reasons. At t h i s h o s p i t a l , the aides are one group of personnel that has day to day contact w i t h the p a t i e n t s . Thus, the p a t i e n t s are l i k e l y to get to know them f a i r l y w e l l . A l s o , the p a t i e n t s may have come i n t o contact w i t h such personnel as p s y c h i a t r i s t s and nurses p r i o r to admission, but unless they have been p r e v i o u s l y admitted to a mental h o s p i t a l i t i s very d o u b t f u l that they have come i n t o contact w i t h mental h o s p i t a l aides. 4. The author would l i k e to express h i s g r a t i t u d e and thanks to the s t a f f at Riverview H o s p i t a l , Essondale, B r i t i s h Columbia f o r t h e i r a s s i s t a n c e concerning t h i s p r o j e c t . The author i s e s p e c i a l l y g r a t e f u l to Dr. G. Kontaxopoulos, D i r e c t o r of Crease U n i t , f o r a l l o w i n g him to use two wards of h i s Unit f o r the present research. The author i s a l s o g r a t e f u l to the nurses and aides on wards East, and East, of Crease U n i t 3 H who p a r t i c i p a t e d i n t h i s study and without whose help the present research would not have been p o s s i b l e . The author's s p e c i a l g r a t i t u d e i s a l s o extended to Dr. A. C l a r k , Chief P s y c h o l o g i s t , Riverview H o s p i t a l , who gave the author v a l u a b l e a s s i s t a n c e i n developing the study and who was k i n d enough to extend the use of two of h i s o f f i c e s to the author f o r h i s research. The author i s also indebted to h i s a d v i s o r , Dr. D. Papageorgis, without whose constant guidance and c o n s t r u c t i v e c r i t i c i s m t h i s research p r o j e c t could not have been completed. 5. There were a t o t a l of nine aides on the two wards but because of c e r t a i n misunderstandings between the experimenter and the a i d e s , only s i x completed the q u e s t i o n n a i r e s . 6. The model assumed here i s that of conceiving the t e s t s as coordinates, and each subject's score set as a p o i n t i n the t e s t space. Then distances between p o i n t s , computed by the D measure, are an i n d i c a t i o n of s i m i l a r i t y between sets of scores. The D s t a t i s t i c i s a measure of s i m i l a r i t y between sets of scores but does not i n d i c a t e s t a t i s t i c a l s i g n i f i c a n c e . As a p p l i e d to the present study, the D measure i n d i c a t e s whether the p a t i e n t s ' responses on the second a d m i n i s t r a t i o n of the Informaion Questionnaire were more or l e s s s i m i l a r to the ai d e s ' responses on t h i s questionnaire than were t h e i r (the p a t i e n t s ' ) responses on the f i r s t a d m i n i s t r a t i o n . However, only a t e s t of s i g n i f i c a n c e 38 between the twc a d m i n i s t r a t i o n s can i n d i c a t e whether t h i s change i n s i m i l a r i t y i s s t a t i s t i c a l l y s i g n i f i c a n t or not. The D s t a t i s t i c was chosen f o r the present study s i n c e the number of aides per ward (3) was too small to permit an a n a l y s i s of variance between the aide and p a t i e n t scores. 7. There are many p o s s i b l e reasons why t h i s change occurred. For example, i f the aides were h e l p f u l and k i n d to the p a t i e n t s , the p a t i e n t s could come to l i k e the aides and thus change t h e i r a t t i t u d e s toward the aides i n a fav o r a b l e d i r e c t i o n . On the other hand, the p a t i e n t s may have f e l t that responding f a v o r a b l y toward the aides would help them o b t a i n a d e s i r e d goal (e.g., e a r l y r e l e a s e ) . Thus, the use of the cautious word "expressed." 8. The d i f f e r e n c e s i n "disagreement" and "agreement" discussed here are based ori raw scores and i n many instances may not be s t a t i s t i c a l l y s i g n i f i c a n t . 39 REFERENCES Cronbach, L. J . , & G l e s e r , G. C. Asessing s i m i l a r i t y between p r o f i l e s . P s y c h o l o g i c a l B u l l e t i n , 1953, 50, 456-473. Cumming, J . , & Gumming, E. Ego and m i l i e u : Theory and p r a c t i c e of environment therapy. New York: Atherton P r e s s , 1962. Goffman, E. Asylums. Garden C i t y : Doubleday and Company, Inc., 1961. Heider, F. A t t i t u d e s and c o g n i t i v e o r g a n i z a t i o n . J o u r n a l of Psychology, 1946, 21, 107-112. Imre, P. D. A t t i t u d e s of volunteers toward mental h o s p i t a l s compared to p a t i e n t s and personnel. J o u r n a l of C l i n i c a l Psychology, 1962, 1_8, 516-518. Imre, P. D., & Wolf, F. A t t i t u d e s of p a t i e n t s and personnel toward mental h o s p i t a l s . J o u r n a l of C l i n i c a l Psychology, 1962, 18, 232-234. Kahn, M. W., Jones, N. F., MacDonald, J . M., Conners, C. K., & Burchard, J . A f a c t o r i a l study of p a t i e n t a t t i t u d e s toward mental i l l n e s s and p s y c h i a t r i c h o s p i t a l i z a t i o n . J o u r n a l of C l i n i c a l Psychology, 1963, 19, 235-241. K l o p f e r , W. 0., Wylie, A . A., & H i l l s o n , J . S. A t t i t u d e s toward mental h o s p i t a l s . J o u r n a l c f C l i n i c a l Psychology, 1956, 1_2, 361-365. Mahrer, A. R., & Mason, D. J . Changes i n number of s e l f - r e p o r t e d symptoms during p s y c h i a t r i c h o s p i t a l i z a t i o n . J o u r n a l of Consulting Psychology, 1965. 29, 285. Manis, M., Houts, P . S.s & Blake, J . B. B e l i e f s about mental i l l n e s s as a f u n c t i o n of p s y c h i a t r i c s t a t u s and p s y c h i a t r i c h o s p i t a l i z a t i o n . J o u r n a l of Abnormal and S o c i a l Psychology, 1963, 6_7, 226-233. Meyers, J . L. Fundamentals of Experimental Design. Boston: A l l y n and Bacon, Inc., 1966. Nunnally, J . C , J r . The communication of mental h e a l t h i n f o r m a t i o n : A comparison of the opinions c f experts and p u b l i c w i t h mass media p r e s e n t a t i o n . B e h a v i o r a l Science, 1957, _2, 222-230. Nunnally, J . C , J r . Popular Conceptions of Mental Health. New York: H o l t , Rinehart and Winston, Inc., 1961. Osgood, C. E., S u c i , G. J . , & Tannenbaum, P. H. The measurement of meaning. Urbana, 111.: U n i v e r s i t y of I l l i n o i s P r e ss, 1957. Reznikoff,, M., Brady, J . P., Z e l l e r . W. W., & Toomey, L. C. A t t i t u d e change i n h o s p i t a l i z e d p s y c h i a t r i c p a t i e n t s . J o u r n a l of C l i n i c a l and Experimental  Psychology, 1959, 15, 309-314. 40 R e z n i k o f f , M., Brady, J . P., & Z e l l e r , W. W. The P s y c h i a t r i c A t t i t u d e s B a t t e r y : A t t i t u d e s toward p s y c h i a t r i c treatment and h o s p i t a l s J o u r n a l of C l i n i c a l Psychology, 1S59, 1_5, 260-266. Souelem, 0. Mental p a t i e n t s ' a t t i t u d e s toward mental h o s p i t a l s . J o u r n a l of  C l i n i c a l Psychology, 1955, 11, 181-185. Szasz, T. S. The Myth of Mental I l l n e s s . New York: Harper and Row, Inc., 1961. Thurstone, L. L., & Chave, E„ J . The measurement of a t t i t u d e . Chicago: U n i v e r s i t y of Chicago Press, 1929. Ullmann, L. P., & Krasner, L. A p s y c h o l o g i c a l approach to abnormal behavior. Englewood C l i f f s , New Jersey: P r e n t i c e - H a l l , Inc., 1969^ Wolfensberger, W. P. A t t i t u d e s of a l c o h o l i c s toward mental h o s p i t a l s . Q u a r t e r l y J o u r n a l of Studies of Alcoholism, 1958, 19, 447-451. APPENDIX A MEAN SCORES FOR EACH SCALE OF THE SEMANTIC DIFFERENTIAL 42 1. F o o l i s h — W i s e 2. U s e f u l — U s e l e s s 3 . C r u e l — K i n d 4. V a l u a b l e — W o r t h l e s s 5. I n s i n c e r e — S i n c e r e 6. Weak--Strong 7. Humorous—Serious 8. S e v e r e — L e n i e n t 9. Feminine—Masculine 10. P r o h i b i t i v e — P e r m i s s i v e No P r i o r Bef. A f t . 5.00 5.65 5.65 6.20 5.60 6.25 6.30 6.20 5.45 6.20 5.60 6.10 2.80 2.70 5.00 4.30 4.50 5.04 4.10 4.15 4.10 4.75 4.10 4.19 P r i o r Bef. A f t . 5.10 5.95 6.10 6.40 5.85 6.05 6.20 6.25 5.80 6.25 5.83 6.18 2.35 1.90 4.05 4.10 5.15 4.50 4.35 3.85 3.95 .60 3.97 3.79 T o t a l Pat. Aide Bef. A f t . Once 5;05 5.78 5.67 5.93 6;30 5.00 5.73 6.15 5.83 6.25 6.23 6.00 5.63 6.23 5.83 5.72 6.14 5.67 2.58 2.30 3.00 4.53 4.20 3.50 4.83 4.78 4.77 4.23 4.00 4.83 4.03 4.68 4.83 4.04 3.99 4 .18 APPENDIX B MEAN SCORES FOR EACH ITEM OF THE INFORMATION QUESTIONNAIRE FOR BOTH ADMINISTRATIONS 44 No P r i o r P r i o r T o t a l Pat. Bef. A f t . Bef. A f t . Bef. A f t . LOOK AND ACT DIFFERENT (SUBMAN) 1. The mentally i l l pay l i t t l e a t t e n t i o n to t h e i r personal appearance. 2.85 1.95 1.60 2.30 2.23 2.13 2. The insane laugh more than normal people. 1.45 2.40 2.05 1.80 1.75 2.10 3. Most of the people i n mental h o s p i t a l s speak i n words that can be understood.(R) 2.30 1.90 2.70 2.20 2.50 2.05 4. You can t e l l a person who i s mentally i l l by h i s l o o k s . 1.75 1.65 1.85 2.20 1.80 1.93 WILL POWER 1. W i l l power alone w i l l not cure mental disorders.(R) 2.60 1.85 2.95 3.15 2.78 2.50 2. P s y c h i a t r i s t s t r y to teach mental p a t i e n t s to hold i n t h e i r strong emotions. 2.30 2.10 2.90 2.05 2.60 2.08 3. Mental h e a l t h i s l a r g e l y a matter of t r y i n g to c o n t r o l the emotions. 3.15 3.25 2.20 3.00 2.68 3.13 4. People who become mentally i l l w i l l have l i t t l e w i l l power. 2.00 2.10 2.80 2.60 2.40 2.35 SEX DISTINCTION 1. Women have no more emotional problems than men do.(R) 2.75 2.15 2.35 2.95 2.55 2.55 2. I t i s e a s i e r f o r women to get over emotional problems than i t i s f o r men. " 2.15 2.40 2.40 2.10 2.28 2.25 3. Women are as emotionally healthy as men. (R) 2.20 2.10 2.15 2.00 2.18 2.05 4. Women are more l i k e l y to develop mental d i s o r d e r s than men. 1.85 1.95 2.30 2.30 2.08 2.13 45 No P r i o r P r i o r T o t a l Pat. Aide Bef. A f t . Bef. A f t . Bef. A f t . Once AVOIDANCE OF MORBID THOUGHTS 1. People who t h i n k pleasant thoughts most of the time seldom become mentally i l l . 2.70 2.60 3.10 3.00 2.90 2.80 1.50 2. The main job of a p s y c h i a t r i s t i s to suggest hobbies and other ways f o r the mental p a t i e n t to occupy h i s mind. 2.70 2.15 3.05 2.90 2.88 2.53 1.67 3. The best way to mental h e a l t h i s by avoiding morbid thoughts. 2.85 2.65 2.95 3.00 2.90 2.83 1.17 4. I f a person t h i n k s about happy memories, he w i l l not be bothered by unpleasant things i n the present. 2.60 2.65 2.85 3.00 2.78 2.83 1.67 GUIDANCE AND SUPPORT 1. People cannot maintain good mental h e a l t h without the help of strong persons i n t h e i r environment. 2.90 2.60 2.85 2.70 2.88 2.80 2.17 2. P s y c h i a t r i s t s t r y to show the mental p a t i e n t where h i s ideas are wrong. 3.20 2.05 2.85 2.75 3.03 2.40 2.83 3. The mentally i l l have not r e c e i v e d enough d i r e c t i o n from the important people i n t h e i r l i v e s . 3.15 2.95 2.85 2.65 3.00 2.55 1.83 4. The good p s y c h i a t r i s t acts l i k e a f a t h e r to h i s p a t i e n t s . 2.55 2.50 3.50 2.65 3.03 2.58 2.50 HOPELESSNESS 1. Few people who enter mental h o s p i t a l s ever leave. 1.20 2.05 1.90 1.80 1.55 1.93 2.17 2. Mental d i s o r d e r i s not a hopeless case. (R) 1.30 1.40 1.50 1.80 1.40 1.60 1.17 3. There i s not much that can be done f o r a person who develops a mental d i s o r d e r . 2.05 1.20 1.90 1.90 1.98 1.55 1.17 46 No P r i o r P r i o r T o t a l Pat. Bef. A f t . Bef. A f t . Bef. A f t . 4. Mental p a t i e n t s u s u a l l y make a good adjustment to s o c i e t y when they are rel e a s e d . (R) 2.00 1.45 1.70 2.30 1.85 1.88 IMMEDIATE EXTERNAL ENVIRONMENT VERSUS PERSONALITY DYNAMICS 1. Mental i l l n e s s can u s u a l l y be helped by a v a c a t i o n or change of scene. 2. A change of cli m a t e seldom helps an emotional d i s o r d e r . (R) 3. Helping the mentally i l l person w i t h h i s money and s o c i a l problems o f t e n improves h i s c o n d i t i o n . 4. Most disturbances i n ad u l t s can be traced to emotional experiences i n childhood. NONSERIOUSNESS 1. Emotional problems do l i t t l e damage to the i n d i v i d u a l . 2. Mental h e a l t h i s one of the most important n a t i o n a l problems. (R) 3. Mental d i s o r d e r i s one of the most damaging i l l n e s s e s that a person can have. (R) 4. The seriousness of the mental h e a l t h problem i n t h i s country has been ov e r s t a t e d . 2.55 2.40 3.10 2.20 2.83 2.30 2.30 2.85 2.50 2.10 2.40 2.48 3.25 2.65 2.90 2.60 3.08 2.63 3.00 3.20 2.60 2.10 2.80 2.65 1.65 2.15 2.20 2.00 1.93 2.08 1.85 2.10 2.30 2.25 2.08 2.18 2.10 1.30 2.10 2.10 2.10 1.95 2.05 1.45 2.60 2.10 2.33 1.78 AGE FUNCTION 1. Older people have fewer emotional problems than younger people. " 2.15 1.65 2.45 2.05 2.30 1.85 47 No P r i o r P r i o r T o t a l Pat. Aide Bef. A f t . Bef. A f t . Bef. A f t . Once 2. Disappointments a f f e c t c h i l d r e n as much as they do a d u l t s . (PO 1.05 2.05 1.70 2.00 1.78 2.03 1.17 3. C h i l d r e n sometimes have mental breakdowns as severe as those of a d u l t s . (R) 2.05 2.40 2.15 1.80 2.10 2.10 1.67 4. E a r l y adulthood i s more of a danger pe r i o d f o r mental i l l n e s s than l a t e r years. 2.55 2.00 1.95 2.45 2.25 2.23 2.33 ORGANIC CAUSES I. X-rays of the head w i l l not t e l l whether a person i s l i k e l y to become insane. ( R ) 2.45 2.60 2.45 1.80 2.45 2.20 2.00 2. Mental d i s o r d e r i s u s u a l l y brought on by p h y s i c a l causes. 1.85 2.05 2.45 2.60 2.15 2.33 2.17 3. Nervous breakdowns seldom have a p h y s i c a l o r i g i n . ( R ) 2.45 1.80 1.80 2.20 2.13 2.00 2.67 4. Almost any disease that attacks the nervous system i s l i k e l y to b r i n g on i n s a n i t y . 1 . 8 0 2.20 1.85 2.05 1.83 2.13 1.83 APPENDIX C D-SCORES FOR EACH FACTOR FOR BOTH THE NO PRIOR AND PRIOR ADMISSIONS GROUPS NO PRIOR D ADMISSION _ D 2 PRIOR D ADMISSION D. 1 2 12.670 13.774 7.823 9.069 10.002 15,511 12.431 16.958 3 4 14.189 28.864 12.088 26.731 10.826 27.114 14.464 28.693 FACTORS 5 6 15.784 8.075 13.133 5.182 16.249 12.119 14.306 16.428 7 8 10.577 9.509 10.220 10.603 13.516 10.224 14.765 8.739 49 9 10 13.662 8.075 10.964 9.744 13.445 10.338 13.161 15.606 APPENDIX D TIONNAIRES USED T.N PRESENT RESEARCH PATIENT 51 INSTRUCTIONS THE HOSPITAL IS TRYING TO FIND OUT WHAT YOU THINK ABOUT THE HOSPITAL AIDES (ATTENDANTS) THAT WORK AT THIS HOSPITAL. THERE ARE NO RIGHT OR WRONG ANSWERS TO THIS QUBSTIONAIRB. PEOPLE ANSWER IN DIFFERENT WAXgo PLEASE ANSWER HONESTLY. IOC ANSWERS WILL BE KEPT CONFIDENTIAL.. IOU MAX ANSWER THIS QUESTIONAIRE IN THE FOLLOWING MANNER. PLACE A CHECK MARK AT THE POINT ON THE SCALE WHICH YOU THINK BEST DESCRIBES THE AIDES. FOR EXAMPLE, IF YOU FEEL THAT AIDES ARE HIGHLY RELATED WITH ONE END OF THE SCALE „ YOU WOULD PLEACE A CHECK MARK AS FOLLOWS? FAIR? . . . . . . j / s UNFAIR OR FAIR? . . . . . s UNFAIR IF YOU FEEL THAT THE AIDES ARE MODERATELY RELATED TO ONE OR THE OTHER END OF THE SCALE„ YOU WOULD PLACE YOUR CHECK MARK AS FOLLOWS: WEAK: ".STRONG OR WEAK? . _ . w S _ . _ . _ ; J ^ _ STRONG IF YOU FEEL THE AIDES ARE ONLY SLIGHTLY RELATED TO ONE SIDE AS OPPOSED TO THE OTHER. YOU WOULD CHECK AS FOLLOWS: WARM: _ . _ . J ^ _ . _ . _ ? _ „ sCOLD OR WARM: _ . _ s _ . _ ^ _ s _ iCOIfl PLEASE CHECK ALL SCALES. IF YOJ FEEL A PAIR OF ADJECTIVES DOES NOT APPLY, PLACE A CHECK IN THE CENTER. THE FIRST PAGE CONTAINS THE WORKr. "LAWYER" „ AT THE TOP, THIS IS A PRACTICE PAGE,. PLEASE COMPLETE IT BEFORE YOU DO "MENTAL HOSPITAL AIDE." 52 AIDE INSTRUCTIONS THE HOSPITAL IS TRYING TO FIND OUT WHAT IOU THINK ABOUT YOUR FELLOW AIDES (ATTENDANTS) THAT WORK AT THIS HOSPITAL. THERE ARE NO RIGHT OR WRONG ANS1ERS TO THIS QUBSTIOHAIRE. PEOPLE ANSWER IN DIFFERENT WAYS. PLEASE ANSWER HONESTLY. YOUR ANSWERS WILL BE KEPT CONFIDENTIAL9 YOU MY ANSWER THIS QUESTIONAIRE IN THE FOLLOWING MANNER« PLACE A CHECK MARK AT THE POINT ON THE SCALE WHICH YOU THINK BEST DESCRIBES YOUR FELLOW AIDESo FOR EXAMPLE„ IF YOU FEEL YOUR FELLOW AIDES ARE HIGHLY RELATED TO ONE END OF THE SCALE,, YOU WOULD PLACE A CHECK MARK AS FOLLOWS; FAlRs „ . . . . . . . j / s UNFAIR OR FAXRs V. ~. . . . . s UNFAIR IF YOU FEEL YOUR FELLOW AIDES ARE MODERATELY RELATED TO ONE OR THE OTHER END OF THE SCALE, YOU WOULD PLACE YOUR CHECK.MARK AS FOLLOWSg WEAKs . . . . % STRONG OR WEAK? . . . . „ j / _ s STRONG IF YOU FEEL THAT YOUR FELLOW AIDES ARE ONLY SLIGHTLY REklTED. TO ONE SIDE AS OPPOSED TO THE OTHER„ YOU WOULD CHECK AS FOLLOWS s WARMs ^ j j / . w . . . , sCOLD OR WARMs ^ ^ ^ ^ j £ - ^ ^ ^OLD PLEASE CHECK ALL SCALES„ IF YOU FEEL A PAIR OF ADJECTIVES DOES NOT APPLY„ PLACE A CHECK IN THE CENTER. THE FIRST PASE CONTAINS THE WORK, "LAWYER™„ AT THE TOP, THIS IS A PRACTICE PAGE,, PLEASE COMPLETE IT BEFORE YOU DO 58MENTAL HOSPITAL PJDno 53 PROHIBITIVE? USEFULs SEVEREs CRUELs FOOLISHs HUMOROUSi INSINCERE.* WEAKs FEMININE? VALUABLES -.PERMISSIVE ;USELESS jLBHSEHT tKIND •WISE sSERIOUS sSINCERE jSTRONG sMASCULINE -WORTHLESS MENTAL HOSPITAL AIDE 54 PROHIBITIVE: USEFUL? SEVERS: GRUEL 2 FOQ&ISHs HUMOROUS: INSINCERE: WEAK: FEMININE: VALUABLE: :PERMISSIVE iUSELESS % LENIENT s KIND 2 WISE 5SERIOUS % SINCERE sSTRONG sMASCULINE sWORTHLESS 55 PATIENT AND AIDE INSTRUCTIONS ON THE FOLLOWING PAGES IOU WILL FIND kt STATEMENTS ABOUT HEALTH PROBLEMS. WE WANT TO KNOW HOW MUCH VOU AGT-'EE OR DIS-AGREE WITH EACH OF THE STATEMENTS« TO THE R7.JHT OF EACH STATE-MENT YOU WILL FIND A RATING SCALE AS FOLLOWS: 1ISAGREE MRSE 1 2 3 THE POINTS ALONG THE SCALE (1 e 2a3,4) CA? BE THO'JGI'f OF AS FOLLOWS: H. STRONGLY DISAGREE 2 0 MODERATELY DISAGREE 3. MODERATELY AI3REE ^ 0 STRONGLY BGRES THE USE OF THE SCALE CAN BE SHOWN WITH THE FOLLOWING STATE-MENT! "SMOKING CAUSES LUNG CANCER,," IF IOU AGREED STRONGLY WITH fHE STATE dEHT„ IOU WOULD 'LACE A MARK Hi COLUMN IF YOU MODERATELY AGRKsD WITH THE STA',3MENT0 IOU WOULD PLACE A MARK IN COXUMN % IF IOU MODERATELY DIS. j REED WITH THE STATEMENT, YOU WOULD PLi(S YOUR MARK IN 2„ IF YOU VTRQKGLX DISAGREED WITH THE STATEMENT. 107/' WOULD MARK COLUMN 1 „ IN 1.V.S MANNER IOU CAN INDICATE HOW MUCB YOU AGREE OR "JI3AGREE WITH A .TOIS-MENT.. LTsKE EVERYONE ELSE. YOU ."OXL PROBABLY FEE! TEAT IOU DO NOI OOW THE ANSWERS TO MANY OF THE STATEMENTS„ WHEN THIL OCCURS. PLEASE MAKE THE BEST GUS5; IOU CAS. Mk ££H 222 M l k 1S&RK £2&. m ™ STATEMENT a \EAVB 3I0Mi OF THE STATEMENTS BLA7.v AND MAKE OMLY ONE MARK FOR EACH, 1. §HE MENTALLY ILL PAX LITTLE ATTENTION TO THEIR PERSONAL APPBARAKCB. 2. PEOPLE WHO THINK PLEASANT THOUGHTS MOST OF THE TIME SELDOM BECOME MENTALLY ILL, 3o FEW PEOPLE WHO ENTER MENTAL HOSPITALS EVER LEAVE0 4 0 OLDER PEOPLE HAVE FEWER EMOTIONAL PRO-BLEMS THAN YOUNGER PEOPLE, 5o PEOPLE CANNOT MAINTAIN GOOD MENTAL HEALTH WITHOUT THE HELP OF STRONG PERSONS IN THEIR ENVIRONMENT„ 6„ WILL POWER ALONE WILL NOT CURE MENTAL DISORDERS Q 7o WOMEN HAVE NO MORE MOTIONAL PROBLEMS THAN MEN DQ„ 80 X6RAYS OF THE HEAD WILL NOT TELL WHETHER A PERSON IS LIKELY TO BBS COME INSANEo 9o EMOTIONAL PROBLEMS DO LITTLE DAMAGE TO THE INDIVIDUAL, 10o PSYCHIATRISTS TRY TO TEACH MENTAL PA© TIENTS TO HOLD IN THEIR STRONS EMOTIONS0 111 o MENTAL ILLNESS CAN USUALLY BE HELPED BY A VACATION OR CHANGE OF SCENE. H2o DISAPPOINTMENTS AFFECT CHILDREN AS MUCH AS THEY DO ADULTS» 13. THE MAIN JOB OF THE PSYCHIATRIST IS TO SUGGEST HOBBIES AND OTHER WAYS FOR THE MENTAL PATIENT TO OCCUPY HIS MIND, 14, THE INSANE LAUGH MORE THAN NORMAL PEOPLE, H5o PSYCHIATRISTS TRY TO SHOW THE MENTAL PAS TIENT WHERE HIS IDEAS ARE WRONG, I I 6 0 MENTAL DISORDER IS NOT A HOPELESS CON* DITlONo 57 l ?., MENTAL HEALTH IS ONE OF THE MOST BljBQP.TAMT NATIONAL .PROBLEMS. . i MENTAL DISORDER IS USUALLY BROUGHT ON BY PHYSICAL CAUSES. 19» IT IS EASIER FOR WOMEN TO GET OVER EMOS TIONAL PROBLEMS THAN IT 13 FOR MENo i i 20 „ A CHANGE OF CLIMATE SELDOM HELPS AN MO® , TIONAL DISORDERp 211, THE BEST WAY TO MENTAL HEALTH IS BY AVOID* im MORBID THOUGHTSo 22* THERE IS HOT MUCH THAT CAN BE DONE FOR A PERSON WHO DEVELOPS A MENTAL DISORDER. 23o MENTAL DISORDER IS ONE OF THE MOST DAMAGE im ILLNESSES THAT A PERSON CAN HAVE, 2^ o CHILDREN SOMETIMES HAVE MENTAL .BREAKDOWNS AS SEVERE AS THOSE OF ADULTS 025 o NERVOUS BREAKDOWNS SELDCM HAVE A PHYSICAL ORIGIN c. 26„ MOST OF THE PEOPLE IN MENTAL HOSPITALS SPEAK IN WORDS THAT CAN BE UNDERSTOOD. 2? 0 MENTAL HEALTH IS MSG-ELY A MATTER OF TRY-ING HARD TO CONTROL THE EMOTIONS., 28, IF A PERSON THINKS ABOUT HAPPY MEMORIES„ HE WILL NOT BE BOTHERED I I UNPLEASANT THINGS IN THE PRESENT. Z9, THE MENTALLY ILL HAVE NOT RECEIVED ENOUGH DIRECTION FROM THE IMPORTANT PEOPLE IN THEIR LIVESo 30, WOMEN ARE AS EMOTIONALLY HEALTHY AS MEN, 3«o THE SERIOUSNESS OF THE MEHTAL»I85ALTH•PRO-BLEM IN THIS' COUNTRY HAS BEEN OVERSTATED. 32= HELPING THE MENTALLY ILL PEftSOR -WITH HIS MOiffiY AND SOCIAL PROBLEMS OFTEN IMPROVES HIS CONDITIONc j% mma, PATIENTS USUALLY MAXS A GOOD AD* JPS5KBNT TO SOCIETY WHEN THEY ARS RJB* J L . i IZIZ J zrzi rzrzxzi: —I izizrzrz] T. QC<5;.; : jnrC5:^'mJiT A7TS &CKS A FATHER '.'X) HIS PA'C£KNX'3„ 35. FJARLI ADULTHOOD IS MORE OF A DANGER PER-IOD 70R MENTAL J2LNESS THAN LATER YEARS*. 3 6 0 ALMOST ANT DISEASE THAT ATTACKS THE N3R» TOGS SYSTEM IS L7J05LY TO ERIKS OI IB™ SANITY* 37 o IOU mi TELL A PERSON WHO IS JJENTALLi' ILL FROM HIS LOOKS. 38„ PEOPLE WHO BECOME MENTALLY ILL HAVE LITTLE WILL POWER. 39. WOMEN ARE MORE M 2 E U TO DEVELOP MENTAL DISORDERS THAU KEN. feOo MOST MENTAL DISTURBANCES IN ADULTS CM BE TRACED TO EMOTIONAL EXPERIENCES IN CHILDHOOD. 

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