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Mental illness among recent immigrants : a social work study of sample group of hospitalized patients… Rudnioki, Walter 1952

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MBBSAL  Hums mom mom  mamma  A sooial work; study of a sample group of hospitalized patients i n B r i t i s h Columbia.  WALTER RUDNIGKX  Thesis submitted i n Partial Fulfilment of tho Requirements for the Degree of MASTER QT SOQIAL WORK In tho School of Sooial Work  1952 The University of British Columbia Accepted as conforming to tho standard required for the degree of Master of Social Work  School of Sooial Korit,  11 fable of Contenta.  Copter 1  Entroduotlon. Seeing the imatgrantB as people, Treatment problems that disturbed newcomers might present. Ohoosing a eataple for study,. The rating used.  soale  Qhapter Z  Who are the Bgwogmere? Where do these people ooa© from? Bow well equipped are they to get along In thia country? What kind of mental disorders do they suffer?  Chapter J  Bewoomera i a trouble. Assessment of attitude to self and understanding of problems, attitude to illnoso, early childhood and fondly impressions, and the quality of relationships* by means of the rating soale, B&souselen of the two trends identified.  Chapter 4 Rehabilitation or Deportation? The newooxuars who are potentially good oltiaons, The newcomers who might have to be deported. The rating seal© as a prognostic tool, Plaoe for social work personnel, Reeozaaendations concerning Immigration legislation.  tAttBS* fable 1*  Distribution of Sample by Ago, ijaritol Statue and Sex  Peg© 14  fable 2» Distribution of Sample by Cultural i&okground, Social Glass of Parents, Rural or Urban Origin and Education ...... 16 fable 5. Retribution of Sample by Occupation before Migration, Occupation In Canada, and income prior to XUnafee*««*...«•*« 1$ table 4,  distribution of Sample by Command of English, Relatives In Canada, and Time In Canada before Committal..,,,,•»...,.. 20  fable 5. Distribution of Sample by Diagnostic Categories»,,»••*»...». 22  Figure l a . Average Distribution of Factors 2ieaaurod by Bating Scale for Gtroup 1 « . « . . • « . • • . . « . * • * * * * • • * . « « . • • * « • * » . » . * « « • 28 Figure l b . Average Distribution of Factors tioaaured by Sating Soalo for Group 2. **•••«.*#.••••••*•*••*»••«««**•*.*,*••• 80 Figure Sa, Psychiatric Categories •.••••••••«••••••..»•«..•••*•••»... ?8 Plguro 2b « History of Illness •••»#.«#•«*»**««••*««,*•«*«***#***••••* 38 Figure Sc. Predominant Symptoms ••  •««•••,.•»«*•,,.•.••....•.••*« 3S  Figure j5a, Social fork Services,•,•».•••••,•••.•••••««••.••»«••,..«•• 4 j Figure 3b,  Mspooitiea Under Immigration Act  .••••,.«•..••.•••••  4j  Bib1iogr&phy..«.•*..«.«••*.*...«.•»•••.••,•«,«..•«»•,.,...*•..•..,,••« 5^  Understanding the sooial, psychological, and physical dynamics involved i n mental illness i s d i f f i c u l t enough beeeuse of the many intangibles involved* However, when mental Illness ocoura among Ira/nisrents, the problem becomes even more complicated, Seoo of tho difficulty stoma from tho tendency to say that these people ore mentally 111 because they are newcomera, or that thoy are Immigrants bcopuse of their mental or emotional instability. This study i s intended aa a small contribution to bringing some order to the confusion union seems to distinguish present day approaches to mentally i l l newcomers* The material for this study was derived from a thorough perusal of new* comers hospital f i l e s . Because these f i l e s * i n most cases, included tho observations and impressions of psychiatrists, social workers, psychologists* nurses and others, together with a f u l l transcription of any Interviews hold with a patient, i t was possible to get a f a i r l y f u l l picture of any newcomer's personality, behaviour, and general olrcuaatanoes, On the basis of the information available In these f i l e s , a ratinj aoale was evolved, being designed to assess the newcomers* prevailing and potential adjustment* 1  In part, this study Is aa experiment i n scientific method, pointing the tray towards Identifying mentally i l l newcomers who could be rehabilitated, and those for whoa deportation appears to bo the only alternative. Such a method involves a differential approach to mentally disturbed immigrants, and tho assumption that deportation legislation should not apply to people who, with proper assistance, can become proper citizens* 'VltUout doubt, beoauae the sample of imrlgrants studied required hospitalization for mental and emotional disorders, thoy may be regarded as a special ^roup i n the total Immigrant population, nevertheless, the enquiry establishes the fact that some offer distinct rehabilitation possibilities whllo othore should not have boon permitted to migrate i n the f i r s t place* A verification of the existence of those two kinds of newcomers leads to appropriate recommendations concerning tho application of deportation legislation and the screening of potential citlaena* It suggests both tho employment of qualified soeial workers who are well equipped to assess a person's emotional or mental stability* end the use of methods on the lines of those developed In this study for evaluating and predicting the kind of adjustment newcomers are likely to experience i n this country.  MEHTAL ILLSES3 AMOHQ BJBOSMf I^MI^Am. A social work atudy of'a'sample group of hospitalized patients i n British Columbia,  Perhaps the faetor oosaoa to a l l migrations to Canada i n the past f i f t y years i s tho prevalent requirement that newcomers be of strong body and willing to work hard, St Is only necessary to consider the emphasis that legislation concerning immigration places on the a b i l i t y of the potential Immigrant to support himself and remain economically independent to find obvious support for this footer. This has meant that strong-armed labourers have often been accompanied to Canada by paunchy but wealthy immigrants* Section 4o of the Immigration Act insists that no immigrant become economically, physically, or mentally dependent for survival by saying i n part, "an inmate of a penitentiary, gaol, reformatory| prison* asylum* or hospital for the insane, or mentally deficient, or an Inmate of a public charitable institution", Is immediately deportable* The fact that a few Immigrants do become problems as defined i n the sot* and In many oases are deported, perhaps bears witness to nothing mors than a possible leek i n screening procedure, or else, excessive and unbearable environmental pressures upon tho newcomer concerned* & newcomer who ends up i n a Oanadian mental hospital, for example, has suffered this fate for two possible reasons* Slther he was mentally unstable before ho migrated or ho had to face and overcome more problems than ho oould possibly handle*. Whatever the case i n a particular instance, the foot nevertheless remains that when a prospective immigrant expresses his willingness to do s partloular job i n Canada for the allotted time, and appears to be i n excellent physical health* this does not constitute any guarantee whatsoever that he w i l l have the  «» 2 *» personality strengths and mental health to oope with the new circumstances l a whioh he finds himself after migrating* I t Is therefore important to consider the Immigrant not only as a member of a particular group* but also as a person, with a f a i r l y unique background* and equipped In his own individual way to oope with economlo social and psychological pressures he experiences In ids #  new land* the IgJEd-grant as an Individual, today* when one Is stopped by a person on a street who speaks with a marked foreign aooent, wears clothing that seems to have some slight deviation from prevailing styles* and Is perhaps seeking directions to hie destination* there i s a tendency to categorize him as a European immigrant* Depending on the person whose help i s being sought* the reaction may be one of suspicion and hostility* one of casual Indifference* or one of reassurance and helpfulness* f o the Immigrant* the reaction of the person of whom he i s seeking help* constitutes one of the many f i r s t impressions of his" homeland* and contributes In some measure to the sum total and quality of his adjustment*. Although I t i o easy for the native to generalise on the basis of accepted and preconceived ideas* the newly arrived person has no such easy recourse when i t comes to finding order and meaning i n his new surroundings*, fhe immigrant finds that oustome, values* and behavior patterns of former days which he took so much for granted* are completely alien i n his new environment, fie therefore feels different because he speaks* behaves* and appears differently* And* having such a strong desire to feel a part of his new environment! to feel wanted and accepted* any indifference or Intimation of rejection on the part of members of M a new community assumes enormous significance for him* Unlike earlier immigrants* the newcomer of today cannot look back for security to the country he l e f t beoause he often Is a person  without a homeland, fh® faot that tho contemporary immigrant has to accept his new environment unconditionally was indicated i n a study of recent immigrants who wore psychiatric and aodiool patients made hy Sr. h. lyhurot. Br. fyhurst concluded that the aowcoaor of today "cannot return physically} and, i n addition to this physical rootlesaaoss, there Is also the psychological root* leosness - the awareness that the social norms and values he believed i n at home have been destroyed, whether or not he actually witnessed the destruction," thue, without oh avenue of physical or psychological retreat, tho newcomer must make the best of the situation he finds himself i n l a his sew country. And* the Goraaa immigrant for example, who has had a mental breakdown i n his new country, and says that " a l l the people who worked l a tho I.H.G-.A. are Gterman", not only has lost contact with reality, but also i s trying to resolve the difference he fools to exist between himself and the rest of the oommunity, Ifeny immigrants do make a successful adjustment i n tho ©ease that they find a satisfying niche for themselves i n their new homeland. Others ore thrown into a state of mental confusion and anxiety which drives them to continually ©hang© jobs, to move from city to city, aad regard their sur- • rounding* with increasing suspicion and disillusionment, than there aro the few persons who suffer complete mental breakdowns and are oomaited to Canadian mental hospitals. She psychotic newoomer who remarks that "aqbno likes me. I want to hide a l l the time. People or© going to k i l l ms%  or the one who says,  "I want to die. tot me go. I have no place to go", are eaoh expressing l a their own way that they have no further resources or alternatives l o f t anywhere to make a continued attempt at l i v i n g . What the factors are which make ready adjustment possible Is d i f f i c u l t to say. Qa  e  can only speculate that i n cases of good adjuotment, the newcomers  I. fyhurst, Ljvbuoe, &.D,, Displacement and Migration*, fha yteorloan Journal of Psychiatry, vol. 107, No. S, February, 1951. 8  themselves had carefully planned their move* had acme knowledge of what they wanted to do after becoming citizens i n a new land* and either by means of their own Initiative or good fortune, encountered suitable resources In their new country to help them over the various obstacles they were sure to nest* A great deal remains to be learned i n this area. It Is equally d i f f i c u l t to say what contributes to a poor adjustment. Some Immigrants become dependent on social assistance* others cannot get along with fellow employees and employers* and a percentage suffer a sufficient degree of disorientation to require confinement In a mental hospital* Mother the new environment contributed primarily to a poor adjustment, or whether,the Immigrants i n these cases arrived as unstable people who could never make a successful living anywhere* i s a matter for conjecture* If* among the maladjusted* i t could be shown that the environ* ment preoipltated many of the d i f f i c u l t i e s , then i t would be f a i r l y certain that certain services and resources for immigrants are a dire necessity* On the other hand* i f among the maladjusted there aro some who evidently were suffering from severe personal maladjustment before coming to Canada* and perhaps* whose migration would appear to be one expression of their general instability* then one could wonder about the effectiveness of prevailing screening methods and the emphasis on physical health* In any case* this i e another matter about which a great deal more could be known* This knowledge Is particularly necessary because of Immigration laws whioh make the penalty for maladjustment virtually mandatory deportation. It i s indeed unfortunate i f Canada Is losing some potentially good oltieene who* because of oiroumstanoes beyond their control* have found I t impossible to manage their lives i n a way acceptable and desirable to a l l concerned* It l e equally unfortunate i f some persons* who may have been too unstable to make a successful adjustment before migration, had to be subjected to the  _  further stresses and strains off migrating and being deported i n turn* As the situation exists today* Canadian communities have both those reoent immigrants who are making a successful adjustment to their new way of l i f e , and those who are experiencing varying degrees of d i f f i c u l t y * However, this does not preclude that the latter group alone should be the recipients of services and suitable assistance to f a c i l i t a t e their adjustment. The task of successfully transferring one's nationality l a a great and d i f f i c u l t end, and i t would not be too much of a generalization to say that a l l newcomers could undoubtedly use te good advantage any help they could get  In f i t t i n g themselves t o a new way of l i f e * Without considering the many personal aspirations end needs which  distinguish the personality of each individual immigrant, they can be said to have a multitude of very basic needs t o f u l l f i l l before thef can be considered a part of the new community* today*s newcomer often has te over* come malnutrition of body and mind and the terrible experiences he lived through i n a war-torn Europe. He has to make a living* and eventually* t e find a suitable and satisfying vocation* Finally* he has to develop that personal stability which would reflect his acceptance of the new culture* Recognition of the fact that newcomers do need specialized services to f a c i l i t a t e their adjustment however* s t i l l leaves the problem concerning the  kind of services and the best manner they can be utilised In working  with recent immigrants* there i s also the problem of making known to new comers what services are available to them i n a particular community. Although i t i s the responsibility ef a l l agencies In a community concerned with the health, and welfare of individuals to gear some ef their services to meet the needs of newcomers* treatment through the media ef casework s k i l l s and techniques when necessary* must come within the Juris* diction of qualified social workers* Moreover*  a treatment approach by  sooial work agencies, i f i t i s to be successful, oust be based on a clear knowledge and understanding of the kind of problems tho immigrant has to cope with today, and the sort of person he ls» Some Treatment Problems,, A person who has just arrived from abroad i s , perhips for the f i r s t time since childhood, undergoing experience for which no precedents are available to him to suggest a suitable course of behaviour, thus, when a newcomer approaches a Canadian social agency for the f i r s t time i n his l i f e for assistance, he may be at a complete loss to comprehend tho agency's routine techniques and explanations. Words customarily used with clients may have no meaning to a newcomer even though he may be able to converse i n English. Be may consequently leave completely bewildered and without availing himself of the help he needed. Even i f the i n i t i a l problem of intake could be overcome, there arise further potential problems i n the kind of oeaework relationship which would arise between a worker and a client who each are differently oriented culturally, The social worker, i f he i s unfamiliar with the cultural back* ground of his client, could easily confuse a customary behavior pattern with a neurotiolsm. Horever, just as the social worker may not be able to evaluate properly the interplay between culturally influenced habits and neurotic needs in the newcomer, oo the recent arrival may completely misinterpret the social worker's efforts to help him with his problems. I t i s conceivable that a newcomer who, up to that time, had received help i n a very authoritarian setting, could easily see the social worker's interest and permissiveness as the behavior of a person who w i l l protect him from a harsh and unknown environment at any cost. There i s consequently the danger of a relationship building up where the newcomer becomes extremely dependent and demanding on  this one worker for a l l M s needs* A recent arrival  doss not know that  most  soeial workers i n Canadian agencies are permissive and understanding* Because the newcomer has so many great and immediate problems of adjustment* i t i s often very difficult to find out when the recent immigrant's problems really do stem from such things as language difficulty for example, and when language difficulty i s used as a rationalisation for deeper personality problems* As Joseph Klaga2 pointed out, "too often the Immigrant interprets his difficulties aa something outside himself*. fhua, hs may corns to a social agency blaming not only language difficulty for his problems, but also the landlord* his employer, or the store keeper* Such a focus on an adjustment problem can seriously obstruct a newcomer's a b i l i t y to oaks constructive us© of agenoy services, particularly i f the problem i s a personality one whioh would require casework service* Although these treatment problems confront family, child and assistance agencies primarily, similar problems face social workers In the medical and psychiatric f i e l d s . Br. L. Tyhurst?, referring to newcomers who have been to physicians for treatment of physical ailments, writes that, " a l l patients*,* f e l t that their illness had not been understood* Some of them accused dootors of not showing any interest or having made them worse by treatment* A l l patients who bad undergone surgery stated that their oomplaints had not Improved, had become worse, or that others had developed since the operation** On the other hand, i n a psychiatric setting, a soeial worker might not only witness a multitude of somatic complaints i n patients who are recent Immigrants, but have to handle extreme anxiety, depression, and feelings of hopelessness. Stefi Pederson* writing on refugee neuroses says that, "In those I'" Klaaa.• Joseph* 'ImmiRration and Social Service*". Canadian Welfare, feroh. 5 fyhur'St, oo» pit* 4 pederson, Stefi, "Psyohopathologlcal Reactions to Bxtraaa© Social Bis* placement , PaychoanaX. Rev.. October* l°^9* 8  194s  » 0 * oases to whioh the experience of flight i s essentially traumatic, i t seems as though acute dissociations of consciousness, hallucinations, deperaonal* lzatlon* and amnesia assume a central position among psyohopathologleal reactions'* Social workers therefore, In their various specialisations, have to help newoaroers who In many ways have similar problems and complaints to the general olientelle, the primary difference however, i s the fact that this particular group of people are immigrants. And, being an immigrant connotes an experience and a meaning to the person concerned whioh i s quite unique* therefore* not only the application of traditional social work principles to imrjigraKta Is indicated* but also the development of specific techniques to cope with the feelings and experiences which distinguish the Immigrants as a groups What these specific techniques should be Is something into which very l i t t l e research has been don© to date* Material and Sfethqd* . People who are Immigrants experience numerous problems In the course of attempting to adjust to their new land* Success or failure i n the new country not only affeote the future well-being of the newcomer himself* but also oan contribute to or detract from the welfare of the community as a whole* Since "casework has traditionally been concerned with the client and his social adjustment"5, i t i s a part of the social worker's responsibility to seek a batter understanding of the following* where the newcomers are concerned* .. (l)''.'3ho are these newcomers? (2) !*hat kind of personality and environmental problem© do they ^  Bollis, Florence* "the techniques of Oaee V»ork", .Journal qf Social Oasework. June, 194$>*  «. $  m  tend to manifest? i (5) What oan social workers do to alleviate some of these problems? The subsequent enquiry w i l l attempt to provide tentative answers to these questions for a sample group of severely maladjusted newcomersf namely* for those persons who immigrated from continental Europe and became patients at the Crease Clinic or the Provincial Mental Hospital i n British Columbia within four years of coming to Canada, Roughly half these patients had either been discharged or deported at the time of this enquiry and consequently* their f i l e s were used as the prime source of information. The f i l e s include the doctors ward notes i n which are recorded the 1  patient's tentative diagnosis, the kind of behavior, delsjalons, and halluoinations which were manifested, the patient's response to treatment* and other pertinent observations and impressions. In addition to these ward notes * the f i l e s often have a f u l l social history obtained by psychiatric social workers from relatives, friends, employers, and the patients themselves. Such a social history would contain as f u l l a picture of the newcomer's l i f e experiences and the onset of his illness as possible* A percentage of hospitalized immigrants also are given psychological tests which bring into further focus their personality, the content of their thinking, and the level of their intelligence. The patients are under continuous observation by nurses, occupational therapists, and other persons concerned with their supervision* care and treatment. These observations are reoorded regularly throughout a newcomer's stay In hospital and provide additional diagnostic and prognostic information for the psychiatrists. Finally* a l l of the no*•voluntary patients are committed under the medical certificates of two doctors. The doctors are required to record on these certificates the patient's own words and behavior at the point of committal, A verbatim report is therefore available concerning each patient's feelings about his  *  10  illness and his general circumstances, Fcr example, a patient who says, *I have headaches a l l the time. It i s because 1 work too long hours"* Obviously has a l i t t l e more insight into his condition than a person who states that, H  feel happy and well. People are after me and want to k i l l  me.  Information recorded on each newcomer's f i l e by doctors* social workers, psychologists* nurses* e t c * has served as a basis for devising a rating scale (used i n Chapter 5) as a method of organising and assessing the material, this rating scale i s so important to the subsequent analysis of the sample group* that It i s reproduced herewith.  P40IQB.  4  sto* S'oelo' he i s always a victim*  tsfflsasftussiiHl  a&ptm to  completely foreign to oolf wail© evidence points to contrary* Problems noltter accepted nor admitted* * % hcadaohoo ar© the e&aoo of this or thst**  ifenlal og IfiaeoQt • l aa-healthy and fcapf.y% denial of tensions* conflicts, ©to* a  5  en$»# | y » 3 i  Bo Spontaneous Station. •» patient avoids subject - ovidoneo that past experiences repressed.  Man*. Satisfying...Sslatloaohi^si patient admits having many friends, enjoying social activities, being with people»  .is om oousm. .Aotiootar Soe&inr; Bslationahigs - has had Oansdifln friends Bsc joined clubs, eto i n this.'aowitry.  6*  #J1  mtwm to 7  ••SOPH?.  a  8  Individual AMtsoAeoXi. patient feoogniases that aoslotsnso, advlco or eoapanioaship- possible froa some people, io able to rojeot others.  patient blames employer, for example* ... but feels ho oould have avoided difficulty by more appropriate behavior on his own port*  admits specific fears, conflicts, etc. Sees himself as having boon responsible for tho situation* X am not enough for the job , ote. a  0  Superficial... Uniers,t&ndio^t patiet own involvement i n problems but has no real insight, e,g, recognises that difficulty ro* relationships but does not kotow why.  good ItedersftaMiag » patient has clear understanding of his situation and wayo to remedy i t *  Doubt About Illness* patient Knows something -is wrong* llemos "nerves , etc. Illness' appeared "without reason .  Boca^aitlon of lllaasat patlo&t sees Illness as part of his own history, Snows $a& io sick ao& often has ooae understanding of w%,-  9  0  g^easivO^^gatlea t background d®» scribed as n©rmal , •happy", perfoot , etc, Nothing orltioal at o i l mentioned* Goapeaeatory'concern. 8  a  B  9  us Mention« a»|Uty to talh about unhappy childhood, fto need to paint idealised p i c t u r e % father drank a lot ,°u© were very poor , ©to* a  a  0  folly One hove 'Obfoofti patient refers to a specific sibling, lover, parent to the exclusion of other relatioaohipa* Oftea coapensatory* •  of friends, eto* Usually a history of isolation aad deprivation.  Psairlng Holatloaafolpsa©uprossos wish for fMonde - mioses companion* ship* * l want somooao to talk t o *  Rejection of, 8efetleaah^a,» exproosoe no desire for friends avoids contact with other people, prefers to bo aleno*  f  a  ft^lW. ,# #^ ,,f;^ilP.» i^tient mildly suspicious of people* relationship established only after seas blooding* A tendency to boeomo ever-dependent on specific people - doctor, eto. l  l  l  g^Mmail #§frmjte, patient  ^aro and dlotruoto a l l people - thinks that they w i l l feafBror punish hta*  - ll — After considerable experimenting, a set of seven factors were decided upon as the best mans whereby a mentally 111 newcomer could be rated for degree of maladjustment. Among the personality components rated were attitude to self, understanding of problems, attitude to Illness, and mention of childhood and family, (factors I to 4 on the rating scale)* Among the relationship components rated were relationships i n own country, relationships i n Canada, and attitude to people, (factors 5 to 7 on the rating scale). These factors were divided into three degrees of maladjustment, A, 8, and 0, The extracts used on the rating soale to Illustrate the three degrees of maladjustment do not relate to any one case but serve merely to exemplify the kinds of material read. Factors I to 4 under personality components have the following three degrees of maladjustment. Under "A", the psychosis i s usually of long stand* Ing, insight i s non-exietant, and the prognosis i s poor, Oader ®G% the psychosis i s usually acute and precipitant, the patients seem to respond to medical treatment and casework services,, and prospects f o r a successful rehabilitation are good. Under "B*, the patient Is intermediate between the two extremes, "A" and 0 , B  B  Factors 5 to 7 similarly are broken down into three degrees of maladjustment. Where relationship components are concerned, »A" offers hopeful prognosis, "0* represents poor prospeots for recovery and rehabilitation, and "8° is again the intermediate between the two extremes. The reason for this particular arrangement of degrees of maladjustment i s that any correlation between personality components and relationship components w i l l become clearer when graphically illustrated (see Chapter  page 2),  The subsequent discussion i s , i n essence, an essay In method, directed to testing the rating scale as a device for more systematic screening and analysis of newcomers. There is also some possibility that a rating scale  similar to tho one described  this study, might find application as a useful  prognostic tool to predict which persons arc li&aly to adjust, suocsssfulJly • to their new  srroundings, and which will likely continue to remain maiadjusted  and a burden to their eoaaiunitiea, •  WHO ARE THE KBtfCOMSRS?  Under the Canadian Immigration Act* every patient who becomes an inmate Of a mental hospital i s Immediately liable for deportation* To carry out this provision of the Act, the Provincial Mental Hospital and Crease Clinic i n British Columbia lay a formal complaint with the Minister of Mines and Hesources Immigration Branch, immediately an immigrant i s admitted* Consequent  t l y , there is available at the hospital a l i s t of names of those newcomers who became patients there* A l i s t of names of a l l patients was obtained who came from continental Europe, and who were i n Canada four years or less prior to hospitalization* From a l i s t of about f<pf-ty names, twenty-five were selected at random and their f i l e s studied* l a this chapter, various data w i l l be presented which will ssrv® primarily to identify these newcomers* A l l the immigrants chosen for this study had been admitted to the mental hospital for f a i r l y severe mental disorders* In a majority of eases* there had been attempts at suicide, and i n a l l instances, behaviour which had become so deviant that employees, relatives, or friends had seen the necessity of contacting a doctor and arranging for hospitalisation* These patients may therefore be said to represent the extremely disturbed and maladjusted members of the Immigration population* There are undoubtedly many more immigrants Whose disturbance or maladjustment i s largely unnoticed by others* or at least  •» i4 — not considered sever© enough to warrajat hospital care* Various data concerned with identifying the sample studied i s presented i n tables I to 5» This data suggests several factors which may have contributed to the poor mental health of these newcomers, TABLE I Distribution of Sample by Age, Marital Status and S©s,  :;  . . Men  Women  Total  20-30  7  6  13  30-40  6  Z  e  40-50  Z  2  4  ' 12  ?  19  ISarrled  3  3  Total •  15  10  Marital Status Single  •  2  5  The slight difference i n the distribution zcf asses In the sample studied, may perhaps reflect the proportion of men to women among newcomers coming to British Columbia* Since most male  immigraatB  coming to this province  would be employed i n primary Industries such as logging, farming and mining, and because there appears to be mors job openings for men than for women In these occupations, i t i s very likely that more men than women would come here* Proximity to hospital does not appear to have Influenced the distribution of sexes i n the sample studied, That i s , because the men tend to be employed i n the mere outlying districts while women would usually work as domestica i n urban areas, i t i s logical to assume that mors women than men  -15might find hospital f a c i l i t i e s aoeeaeable to them* In the group of patients studied, however* hospital care appeared to be equally available to both sexes* the immigrants studied can be desoribed as belonging to the younger ego group, with thirteen of the total patients being between SO and JO years old* The fact that most of these newcomers are young people perhaps indicates nothing more 'than a preference by the Canadian Government for youthful* healthy persons who could do the work required of thorn i n the various xndsBSXEus. industries. Because these people also are suffering from mental disorders* another reason l a suggested why this particular group are young i n years* Various types' of mental disorders seem to have m predilection f o r specific age groups* Or* Malaberg concluded after having devoted some research to the question of age and mental disorders that an Illness such as schizophrenia Is found predominantly In people between 15 and JO years old*^ 4 glance at the diagnoses of the sasqple studied reveals that  more than  half of the patients were suffer-  ing from various kinds of schizophrenia, i t i e to be expected therefore, that they be persons i n a younger age group* ;  Moat of the men and women i n the sample are unmsxried* This may be  indicative of the fact that unmarried persons are f a r more mobile than those who bear the responsibilities of providing a living end security for their families. However, this may not be the only reason why the hospitalised patients are predominantly single* I t i s an established fact that mental Illness tends to strike the single person more often than the married Individual, In a recent study ef ninety thousand admissions to mental hospitals In the United States* Or* Hell Dayton concluded that* "the single marital group admissions are 1^0 mimWiiiitiMiilH  § ?  ,i mil. hi  ..limn,  mi  per cent higher than those of the married .7 8  -  •••  i  •••"m  •  m >» Ur ui'W  mV'M.mwmmi^M?, • . niutfl  in nil ii».»in..m  Malzberg* Benjamin, social and Bfolo?loal Aaceots of Mental Disease. Hew York* State Hospital Freeo*.' Dayton, Neil, $£*D**35*G** Hew Facts on Mental Diaordars. Study of 89,190 eases, Charles 0 . Thomas, Publisher,  „  TABLE 2. Distribution ef Sample by Cultural Background, Social Class of Parents, Sural or Urban Origin, and Education. Cultural Background Czechoslovakia Estonia Germany Holland  Italy  Latvia ' Hungary Poland Ukraine Yugoslavia  Men  Women  Total  2 1  2 2  4 3 1  1  0  I  0 2  '•3  *  0  4 1  1 12 Z  6  4  9 9 2  0  I  0  9 3  1  I X I  1 1  1 6  Social Class of farente Middle Lower Unknown  2  2  7 J#  4  Rural or Urban O r i g i n Urban Rural Unknown  9 Z  9 12  '4  Education University Entered high school Elementary Total  1 2  & 3  a 19  X9  10  29  12  1  2  • 17 * fable 2 Indicates that the sample group esHnlgratett from countries which were directly involved .In the last. war. It i s therefore not too much of a generalization to oay that moat of these patients have, at one title, boon In a concentration cajsp, i n a displaced persons' camp, or caught i n some traumatic way In the confliot which recently had raged through Europe, The men l a the. samplO represent mostly the lower class, that i s , un~ skilled urban and rural labour* A majority of the women, on the other hand, come from the middle class which includes tho professional, business, sail white collar groups.*; This diBtrlbution can probably be related to tho fact that the men, on tho whole, have a lower educational lovel than the women* Similarly, most of tho men i n the group studied, origimted i n rural areas, while the women corns from a background of largo cities; and towns*.  It  might b© interesting, to note that this, group as a whole evidenced considerable mobility from rural to urban areas, Almost a l l of the male patients who wars bora and raised on farms i a their own countriea, subsequently worked as manual workers i a various European c i t i e s and often outside the borders of their own country, the fast that tho mobility these newocwisrs evidenced f i n a l l y included omigratioa from Suropo, might hear aomo'^sj^ion to their meats! health*. & study of thia problem In Horway by Ornulv Odegaard led to the conclusion that, "among those who emigrate one would expect to find a relative* ly large number of restless and socially maladjusted iMividuals*, fraits l i k e these hyo* very often signs of a predisposition toward i ^ t a l d i s e a s o a (particul a r l y toward achlsophrenlat the schizoid personality)''•^ < ill  $  ii.u.1  Mii'i|...i.i. . . .  ni.lmlin.n-1'i,.  i iii  i in,.!..!..,!.! • mill  inn  in,  .,• i i n I  .-.,.0,  i., r. , n.i.,. iV n  i n  i  „i  m.i..".,.,  Odegaard, Ornulv, "On tho Psychology of Soeial Groups as Illustrated by Their Incidence of Mental Eieorder , Poolings and JSaotloaa. edited by J&rtin L, Reyaert, Ph,D, McGraw-Hill Book Co, Inc., 1950, 8  9  .....ii.,..!,.,-,  TABLE J Distrlbutiott ef Sample by Occupation before Htgratioan Occupation i n Canada, and Income Prior to Illness*  Occupation before Migration Soldier leacns* Artist Stenographer Carpenter Farm. Labourer ' Chauffeur Unskilled'Labourer Photographer Hechanie ;  Hens  Women  1 i *• 0 • 0 I • t  0 o w 1 1 0 0  4 2 2  0 0 •0 I  *  0 I  7  1  fotal' 1.  i  *  1 . 1 1  m  1 • -4 2  •• • 'I-  Oooupation In Canada '• Farm Labourer Unokillod Labourer JSlnlng Logging • Bus Soy Stenographer Domestic Housewife  I  $ % 4 1  0 0 0  * 0  0  i 4 i  0 0 1  7  f  2  t •  Income Less than $100 $10© * §200 | 2 0 © * #00 •  Unemployed fc*al  1 12 2  6 2 0 2 10  J  14  .  The occupations i n which the persons In question were employed, before migrating to Canada, are given as the patients themselves described thorn* These occupations may not be completely accurate therefore, For example* although two men stated that they had been mechanics before coming to Oanada* there i o some evidence whioh suggests that they were merely employed by the American iooupatlon authorities to keep vehicles clean end presentable* Consequently* a l l the occupations given by these newcomers may not bo s t r i c t l y accurate and must serve only as a general indication of their preferences or aspirations* Eight persons In the sample are shown as being dependent before coming to Canada! that i s * they were not employed or self-supporting i n any way* These eight immigrants had been either at school* living with parents or relatives, or relying on marriage partners for support* Only one man f a l l s In the dependent category while seven women are indicated as not being self-supporting before coming to Canada* This seems to be consistent with the fact that most of the women i n the sample studied come from middle olase homes* have spent more years i n school* and on the whole* are younger than the men* The experience of seeking economic independence and security Is therefore A new one for most of these women, The occupations followed by these patients seem to reflect generally the fact that they entered primary industries as required by the regulations governing their migration to Canada* In a few oases* these people had attempted to return to the kinds of employment they had hold i n their own oountries after their Obligation to work In primary industries i n Oanada had been discharged. However* i n a l l these cases* the attempt was brief and unsuccessful* In a majority of Instances* the newoomere became mentally i l l before they had an opportunity to become established in the occupation of their preference* The income of these persons averaged between vlOO and §200 per month* A l l except one who made less than #100 per month were women employod as  domestics i n private homes* TABLE 4  Distribution of Sample by Command of Lagllsh* Relatives In Canada, and time i n Canada Before Committal to Mental Hospital*  Command of Sngllsh  Men  Women  total  Seed  1 14  4  9 20  1 2 12  4 1  5 9 17  3 2  9  0  7 9 12 1  10  29  FOOT  6  Relatives i n Canada Parents or Spouse unolec or Cousins Kbne  9  flme In Canada Before Committal Under 1-2 2-3 3 -4 total  one year years years years  4 3 7 1 19  table 4 offers a comparison between the patients who had some medium of contact with their new land, either through language ability or relatives* and those who did not have this advantage* I t i s significant that the majority of these people had l i t t l e or no command of the English language and no relatives of any description i n Oanada, Considering the fact that most basic avenues of becoming acquainted with a new way of l i f e did not exist for these nswoomers, and In most oases* they could not f a l l back upon their former countries for psychological support, the isolation and hope-  .** fil lessnesa experienced by them i n Canada must have been extreme* In any ease, suoh a situation would be very detrimental to good mental health* the fast that a l l except one of these newcomers had to be hospitalised for mental disorders between the time of arrival and three years of coming to Canada suggests two possibilities* (1)  Some patients were mentally i l l on arrival i n Canada, but managed  to get along i n a logging camp or with a disinterested employer for a few months before manifesting severs behaviour deviations* such as attempted suicide* which would be considered extreme enough to warrant committal to hospital* Also* a new arrival's "queer" behaviour could easily bo confused with unfamiliar cultural patterns, and consequently* psychotic symptoms might be overlooked for a long time* (3)  the other pesiblllty would be that some of these people were  f a i r l y well-integrated on arriving to Canada* but the social* economic* and psychological pressures which they encountered were so great that a mental disorder resulted, Whether the onset of mental Illness i s dated prior to migration to Canada or subsequent to i t no doubt determines to a great extent a newcomer*a capacity for a good adjustment In his new country* However* the mere dating of a patient*s Illness i s not sufficient to provide a completely valid Indeg of how good his general prognosis i s * Considerable supportive evidence i e necessary concerning his personality, the quality of his relationships with others, and the peculiar manifestations of his Illness, Tho whole question w i l l be dealt with i n a l l i t s ramifications In the subsequent chapter*  «* 22 — , TABLE 5 Distribution of Sample by Diagnostic Categories. Psyohoneuroses Reaction Depression and anxiety  Mm  Women  2  total  :  6  Psychoses Paranoid Schizophrenia Catatonic Schizophrenia Hebephrenic Schizophrenia Sohiso-affective Psychosis unclassified Schizophrenia  10 1 1  Total  15  e 0  5  1 0 2  I  10  2  * 2 1  25  the psychiatric diagnoses for the sample studied were based on a classification of mental disorders prepared i n 1947  by a committee of  experts set up by the Interim Commission of the World Health Organisation/ The particular ps^hiatric classification which each patient was given was derived largely from the predominant symptoms rather than the personality dynamics involved In each case. Such a compromise between classification based on symptomatology and Individual personality i s perhaps a necessary one since classification* as a method of generalizationj seems best suited for statistical, purposes* The point 'isf.howev'or ^.%haVtbO . diagnostic categories, themselves probably reflect l i t t l e If ahy of the particular kind of personality which distinguishes each patient»> for example* •hysteria* i s classified as a mental disorder i n which amnesia, anorexia, blidneso, and conversion, among other symptoms, are the main manifestations, i&" Manual, of the International Statistical Classification of Diseases:,' Injuries, and Causes of Dsathi Sixth Revision of the International Lists of Diseases and Causes of Death, Adopted In 1946, vol* 1, pp. 106-117.  l a most of the cases studied, a preliminary diagnosis was assigned by the doctor responsible for the patient* Subsequently, a case conference among tho doctors might modify or confirm the original tentative diagnosis* Also, the social worker's social diagnosis contributes to and supports tho findings of tho doctors* Although thero i s no method whereby tho r e l i a b i l i t y of a psychiatric diagnosis can bo measured, most Of the doctors would agree that thero i s sens unreliability* Hot only are diagnostic categories too broadly defined to make allowance for individual peculiarities, but also, symptoms can bo extremely variable, and, from day to day, oould suggest entirely different diagnoses, f o r example, i t i s oftea d i f f i c u l t - t o decide whether a case should bo described as "unclassified schizophrenia" or whether one symptom stands out enough to justify a diagnosis of "paranoid schisophrenia" or "simple schizophrenia . 8  Since psychiatric diagnoses tend to describe a patient only at a single point i n time, and also, because these diagnoses are sometimes i n f l u enced by subjective judgments, i t l a unlikely that there would bs aay valid relation between diagnoses as such and other variables* Consequently, for purposes of this enquiry, the patients can be described generally on the basis of the most outstanding and persistent symptomatology* In the sample studied, there appeared to be two such trends distinguishable! paranoid delusions and morbid suspicion} and, depression, anxiety, and some suspicion* Of the sample studied, thirteen immigrants were described by their doctors as evidencing distinct paranoldal delusions and were diagnosed as paranoid schizophrenia. Six other newcomers were diagnosed as different types of schizophrenia* However, this does not discount the fact that a large element of suspicion and paranoid delusions wore present i n these patients also* For example, a patient may have withdrawn completely into a catatonic state, but the responses that had been evoked from him at various times strongly  - 2* suggested paranoid content i n M a tMnking. Another six patients i n the sample were listed as being psychoneurotic* These persons manifested severe depression, great feelings of anxiety, and i n a l l cases, ono or more attempts at suicide. Xn spite of the fact that these patients did not appear to be psychotic at the point of committal, they a l l evidenced some paranoid trends. They either f e l t thoy would come to some harm, they wero convinced their employer intended to f i r e them without any basis for this fear i n reality, they had a desire to strike out at people, or thoy f e l t others wore not to bo trusted. These feelings seem to suggest that sue* ploion and paranoid thinking were not wholly confined to the other patients who wero designated as psychotic. Because of the aaaifest unreliability of diagnostic categories, and because i t i a evident that such symptoms as suspicion and paranoid ideas aro oomaon to both the groups diagnosed as psychotic and psychoneurotic, i t i s quits possible that the division between psychosis and psychoneurosls i t s e l f i s not too clear i n some of those cases. This may be particularly true f o r tbio sample because language barriers and different cultural orientations i n the newoomers would make i t more d i f f i c u l t to decide whether some border-line eases wore psychotic or psychoneurotic. with this consideration i n mind, i t would be valid to classify a case diagnosed as paranoid schizophrenia with a case diagnosed as reactive depression i f tho variables ueaourod by the rating scale followed a similar pattern i n each case. SUMMARYt The immigrants who constitute the case material i n this study aro a l l reoent arrivals from continental Europe who, on the average, wore i n Canada from two to three years before being committed to Grease Clinic or tho Provincial Mental Hospital i n British Oolumbia. There aro thro© men to every two women i n this group of patients, the women on the whole being somewhat  - «£> » younger than the men* The majority of these patients* however* may he desoribed as belonging to the younger age group* The men In this sample come primarily from the lower eoonomio olass and from a rural background* The women* on the other hand* oome from urban settings and represent the white collar occupations, This difference i n socio* •economic backgrounds appears to be verified i n the fact that the women are better educated than the men* have a better command of English* and* In most eases* did not have to work for a living t i l l coming to Oanada* Host of these newcomers were unmarried and had no relatives of any description In Canada. They therefore had no resources which could serve ae stepping-stones* so to speak* to beoomlng acquainted with their new surroundings. The immigrants In the sample came from occupations varying from professional to skilled and unskilled labour. A l l of the men worked i n Canada i n primary Industries such as farming* logging and mining* A majority of these people could not or did not wish to return to the occupations they were i n before emigrating. Most of the women were employed as domestics i n Canada* this being* i n many cases* their f i r s t experience with any employment* Unlike the men* the women appeared to have suffered a considerable lose i n social and economic status. Although a majority of the patients wore diagnosed ao suffering from paranoid schizophrenia* there seemed to be distinct paranoid features i n the thinking and behaviour of a l l these persons* Consequently* no significant correlations can bo sought between diagnostic categories per se* and such variables as personality and relationship components* Instead* i t seems more valid to seek contrasting trends between personality components and other variables such as quality of relationships with people, and then test the trends against the particular diagnosis of each patient*  She analysis Is pursued with special reference to the personality d i f f i c u l t i e s these men and women evidenced, the environmental problems they experienced, and the content and history of mental instability i n each esse*  CHAPTER  On the basis of the rating scale discussed i n Chapter I, the sample was assessed as to quality of relationships overseas and i n Canada, understanding of problems and Illness, attitude to self and others* and the prodominant symptoms end eeuteness of i l l n e s s i n each case. As two different groups became recognizable i n terms of these components, they are discussed for convenience under two headings* Group I and Group 2. ,*,°*P  Q  la  According to the rating scale, the eleven patients constituting Group i showed a distinctly different pattern of factors than the fourteen newcomers i n Group 2, Figure l a represents an average distribution of the factors measured by the rating scale, among the persons i n Group 1, i n individual cases, there were marked variations i n the pattern which the factors rated took. This suggests that i n this group there io considerable individuality i n personality, relationships, and i l l n e s s . Attitude to Self and Ifaderatandlng of Problems. The patient's attitude to himself i s significant because i t often suggests the extent to which he has distorted his limitations, capacities, and his role i n various relationships. For example, a patient who denies any psychological difficulty sad blames his employer, hia landlady, or the corner store keeper for a l l his problems, may be regarded as a person who Sees himself continually as a victim of his surroundings, l a other words, his attitude to himself la that he ie a person who i s sometimes rewarded by his environment  «* 26 and at other times punished. When problems become so externalized* there aeeme to be a tendency In such a person to minimize any feeling of personal respons i b i l i t y for what happens to him. On the other hand, a person may blame some aspect of his environment for his d i f f i c u l t i e s , but also concede the fact that he himself might play a v i t a l role In altering his circumstances. Then again* there might bo the extreme point of view held by a person that his problems stem from personal defects or limitations. Whatever a newcomer's attitude Is concerning himself* the extent to which i t i s realistic must be assessed i n relation to whether or not he has any real understanding of his circumstances* A person who i s convinced that a l l his woes represent a personal inadequacy can be quite unrealistic i f i t i s obvious that his external circumstances have made good adjustment d i f f i c u l t If not Impossible,  A  B  FieuAC  C  A  Id  8  ft CURE  C  lb  Average Distribution of Factors Measured by Bating Soale for Groups 1 and. 2*  - 29 * In the sample studied therefore, a patient's attitude to himself i s his own evaluation of his limitations, capacities, and his role i n various relationships* An assessment of a person's understanding of his problems, on the other hand, i s derived from the impressions whioh psychiatrists, social workers, psychologists, nurses, etc*, have formed of the patient* On the basis of these two ratings, i t 1B possible to measure a person's maladjustment in. terms of how much he has distorted his reality* In Group 1, six newcomers f e l t that their problems resulted both from external circumstances and from personal inadequacies* Of these six patients, four had a superficial understanding of their problems while two had no understanding* For example, one young g i r l f e l t herself to be very inadequate and feared that people were c r i t i o a l and judgmental of her* She also recognized the role a rigid and domineering uncle i n Oanada had played In creating these feelings i n her* This g i r l had only a superficial understanding of her problem however, because she could not establish the obvious connection between her prevailing circumstances and her feelings about even a more rigid and domineering person i n the form of her father whom she had l e f t behind overseas* In another case where more insight was present, a young man complained that he was 111 because bis employer made him work eighteen hours a day on the farm. This patient was able to recognise his own weaknesses and l i m i t ations and to speoify the area of endeavour i n which he could function beet* This person was consequently rated as having a good understanding of his circumstances and a f a i r l y r e a l i s t i c attitude about himself* The remaining five patients of this group of eleven tended to blame their environments as being the sole cause of their d i f f i c u l t i e s * Three of these five persons wore rated as having some understanding of their problems and therefore, a certain justification for their attitude* For example, one  - 30 woman had been an overt homosexual i n her own country and had boon apparently aooepted aa euoh by the community i n whioh she lived* Xn Canada, however, oho found that her sexual behaviour evoked only abuse* ridicule sad rejection. Consequently, although this women had* i n effect* adjusted herself to he? homosexuality i n her own country, shs became very disturbed when her behaviour oould aot be accepted by people i a Canadian communities. She therefore blamed her surroundings for her d i f f i c u l t i e s with a certain amouat of justification.  The immigrants * attitude to their illnesses was rated because i t was coaslderod accessary to discover what degree of laeight they had into their disorders. Thus* a person who denies his illness* or states that i t appeared very suddsnly at a spsoifio time and that before then he had boon "healthy and happy", very likely has very l i t t l e i f any insight into his a f f l i c t i o n . On the other hand*, when a newcomer seee his prevailing circumstances as being related to his l i f e history and can talk i n terns of conflicts* frustrations, and anxiety* there i s a possibility that insight i s good. Of the eleven patients i n Group 1 two recognised that they were i l l . Two other persons had doubts about their Illness* feeling that they might bo i l l but having some reservations shout t h i s , The remaining eevea newcomers denied their illness completely, they described their symptoms as belonging to their body rather than to the mindf they insisted that they had no oompiaiats whatsoeverj they maintained that a doctor*s oare was unnecessary} or they blamed the hospital for making them "nervous", A denial of illness by these seven patients might he construed ae a complete lack of insight into their condition. This conclusion, however, would contradict the fact that these seven patients* on the whole* had a f a i r l y good understanding of their problems and a realistic attitude about themselves. It i s therefore possible that these people were denying their illness i n a  - 31 * desperate effort to avoid being "sent back** Most of the patients In Group 1 wore painfully aware  that becoming  mentally i l l made them candidates for  deportation.' frffl^i,,^  ®$ipmfc  .y^/fwl^t  This factor was rated f o r the sample studied because i t might suggest an overall pattern  fitting  into the other assessments*. For example, a person  who i s defensive about his background might describe i t as being uniformly happy and be unable to think of a single deficiency i n i t * inch a person might also bo expected to deny his illness, show no understanding of his problems, ' and' tend to ©Ktoraalize a l l hia d i f f i c u l t i e s . £ patient who i s completely un« ablo t o talk about his childhood  and faMly  i n any terms has probably repres-  sed most of his earlier experiences. On the other hand, the immigrants who are able to talk spontaneously about their childhood and family, without showing a great need to present an idealised picture of their past, might be expected to have some Insight into their illness and problems and show some sense of responsibility for their future. Of the eleven persons i n group 1, three wore able to talk spontaneous* ly and realistically about their backgrounds. "Ehre© other newcomers tended to be defensive about their backgrounds, stressing their "breeding*, status, or maintaining that everything had  boon •wonderful* during  their cMldhood.  Five patients were unable to talk about their backgrounds at a l l , suggesting considerable repressed material in this area. In summary, the following may be said to bo personality components characteristic of Croup 1, (I) generally* the persons i n this group had a f a i r l y realistic attitude about themselves and some understanding of their problems, {2)  Group 1 included four persons who either recognized their illness  or had seme doubt about i t , Another seven newcomers denied the fact that they  were t i l * It l a unlikely that these two attitudes concerning mental illness represent two different patterns* these newcomers were* i n most oases*  . .  terribly fearful of being deported and would understandably enough deny their illness i f they f e l t this would keep them i n Canada* 0)  Here than half the patients i n this group were able to express  their feelings about their ohildhood and family experiences* Those that oould not talk about their background probably had repressed their earlier experleno es• W**y, ,o ,aela,tlonship,e i a f  famM  In addition to being rated for some personality components* Group I was also assessed for the quality of relationships i n their former country* i n Canada, and their attitude to people generally* Thus* i f a newcomer etated that he had many friends i n his own country and had enjoyed various social activities before migrating* while i n Canada he has not been able to make any friends* i t can be assumed that external circumstances such as place of employment, language handicap, or lack of relatives i n this country served to Isolate him* This eon be further confirmed i f the patient has been activel y seeking friendships i n Canada, and i f he exhibits positive feelings to people such as recognition that he can receive assistance, friendship* or understanding from some people i n this country. Cn the other hand* i f a patient has had no friends i n hie former country, has not sought or expressed interest i n friends i n Canada, and feels distrustful and suspicious of a l l persons, then i t can be assumed that ho has a very lengthy history of isolation from other people and of poor relationships* •• ' There were some newcomers who apparently did not have many' friende i n their former oouatry or a great deal of interest i n social a c t i v i t i e s . However, these persons are different from others i n the sample because they had  • 33 * oxperioaced a close attachment to some particular relative* lover* parent or friend. These patients may bo desoribed as Saving eomo capacity for relationship whioh i s perhaps undeveloped. Seven of the newcomers In Group 1 had enjoyed many olose friendships and relationships In their own oouatry* 411 of these seven patients desoribed themselves as having bad participated i n many social activities i n their own country* and maintained that they had enjoyed the company of others and mixed well with people. Five of these seven newoomers were either actively seeking or desiring relationships In Oanada, while two others expressed a preference to be alone In their new homeland* Those who preferred to bo alone considered their associates i n this country to be beneath the social status to which they were aocustomed, A l l of these seven newoomers tended to bo overly cautious about people i n this country, being suspicious of others' motives or being puzzled by the demands of others upon them* The remaining four patients i n Group 1 had no evident history of satisfying relationships. However* i n Oanada, one of these patients expressed a desire for "someone to talk t o , another two become greatly attached and 8  apparently over-dependent on a friend* and the fourth became very dependent on her doctor* Those patients evidenced some suspicion and distrust of people as did the other parsons i n Group 1* In summary* the relationships of the newoomers i n Group 1 seem to follow this pattern! (1)  The majority of the patients i n this group had enjoyed satisfying  relationships In their own countries* The four patients who showed no apparent history of satisfying relationships i n their own countries* nevertheless evidenced a certain oapaclty for relationship In Gonads* (2)  Moot of the patients i n Group 1 were either actively seeking  friendships i n Oanada* or expressing a great desire to meet people and make  - 34 friends* A reference to factor 6 i n Figure 1 confirms the fact that these people have experienced one of their greatest d i f f i c u l t i e s i n making friends i n this country and becoming involved i n sooial activities* One reason for this Io probably language barriers and the fact that most of those newcomers had no relatives whatsoever i n this country to bridge tho gap between two cultures* (5)  A l l of the persons i a Group 1 showed varying degrees of suspleioa  and distrust of people l a their surroundings*  The rating scale revealed a different pattern of factors for the new* comers i n Group 2 (see Figure lb)« The fourteen patients comprising Sroup 2 manifested an almost uniform consistency i n the distribution of factors for which they were rated* In the dlooussion of this group, the same headings are used as for Qroup 1,  since the factors rated are the same i n both groups*  Although there i s a l i t t l e overlapping* the differences appear to bo s i ^ o i f i * coat enough to warrant the distinction between the two groups. Attitude to 8fM, and,toderetandfrnfiof grobleas. Thirteen of the fourteen persons l a Group 2 were convinced that they had been victimised l a some way by others, and insisted that their problems belonged wholly to the environment. Also, i t was the opinion of the psychiatrists, social workers, and others, that these newcomers had no understanding whatsoever of their d i f f i c u l t i e s * Some patients i n Group 2 generalized by blaming "Canada for everything that had happened te them, 8  some blamed their doctors, and a few were convinced that everybody was "after them and was "planning to harm them * Thero was, l a other words, a 9  9  very marked distortion of reality l a this group of immigrants] much more so then was evident i n Croup 1.  - 25 The one individual who seemed to be the exception i n Group,2, was able to say that he might be somehow involved ta his problems and was able to describe speoifio incidents which were disturbing to him. However, there l a some suspicion that this patient was Intelieetuallzing, because, generally speaking, he had no insight into bis part i n the problem, he had a long history of mental instability and could not accept the fact that he was i l l . Attitude to Illness. A l l fourteen patients In Group 2 uniformly denied the fact that they were i l l or needed treatment. Since a few of these expressed a wish to bo deported, i t Is unlikely that their denial stemmed from fear. These patients either explained away their behaviour as something that had been provoked by enemies, or they insisted that they were well and happy. In a l l cases, I t can bo said that no degree of Insight was present, even i n those cases where psychosis had been alleviated by treatment* juration of Childhood and Family. Twelve of the fourteen patients i n Group 2 were not able to t a l k about their childhood or family experiences at a l l * The two remaining patients i n this group were able to refer to their backgrounds only after some persuasion, and then only very defensively and with considerable tendency to present an Idealized picture* in summary, the following may be said to be the personality components characteristic of Group 2i (1)  A l l the patients In this group assumed no personal responsibility  for their problems whatsoever, and showed no insight Into their circumstances* (2)  A l l patients denied the existence of their illness*  (3)  Koet patients could not talk about their childhood or family* The  two patients i n this group who did give some information about their background  did  ao.o^ly after persuasion and then painted an idealized picture of their  childhood aad fanlly experiences,  ^ f % o | ; , | e M l o n a M p 6 |n,,Gry»up f? lil  i  i  L  t  As far as could he judged from the records, seven of the fourteen patients i n Group 2 had experienced no satisfying relationships i n their own countries* Host of them had apparently been completely alone and friendless before migrating* The remaining seven patients claimed that they had either'a' lover, a sibling, a spouse, or some other person i n their former country to whom thoy claimed inordinate attachment* However, the idealised way i a whioh these relationships were described suggested that they wero #sen as satisfying to these patienta i n retrospect. Two of these patients idealized their former we#  of l i f e - on® war-time Germany, and the other Italy. Because  these l a s t two patients could not speak i n terms of specific relationships i t must be uoauscd that they were non-existent. M l of the fourteen, patients i n Group 2 rejected relationships completely i a Canada, and showed no desire or interest i n making friends or getting to know their new community. Also, a l l of the patients In this group evidenced excessive distrust and suspicion of their new environment. In summary, the relationships of the patients i n Group 2 seem to follow the following patterni (1)  Half of Group 2 had no satisfying relationships whatsoever i n  their own country. The remaining half referred i a a highly Idealised way to one love object or to a general way of l i f e . (2)  A l l patients l a Group 2 rejected relationships i a Canada*  (3) A l l patients i n group 2 showed excessive distrust and of their new surroundings.  suspicion  Further Comparisons Between Group X and Group 2 . The sample studied had been divided into two groups on -.the VbasisOf similarities and differences revealed by the rating scale. It i s interesting to note that* even though the i n i t i a l division into Group 1 and Group 2 had been done primarily on the basis of personality and relationship components* a subsequent comparison of mental illness factors seems to substantiate the Original division. Thus, a comparison of psychiatric categories,of aeuteness and persistency of illness, and of predominant symptoms In the two groups seems to confirm the differences originally noted*  In Group 1 (Fig, 2a) five out of eleven newcomers are described as being depressed and non-paychotic. The remaining s i s patients arc diagnosed as schizophrenic. However* unlike the psyohotlo patients i n Group 2* the six schizophrenic patients i n Group 1 either recovered completely or experienced oonsidersile improvement during hospitalization* A l l newoomers i n Group 2 (Figure 2a)  except one f a l l into various  categories of psychosis. Of the fourteen patients In this group* only two recovered, five were slightly improved after treatment, and seven showed no Improvement at a l l . Paranoid schizophrenia dominates a l l the other diagnostic categories i n Group 2 with eight out of fourteen patients receiving this diagnosis,  fiftrtq^ofl ,ft,bmai| Group 1 included seven cases whioh could bo described so acute; that i s , the illness had occurred suddenly after the person arrived i n Canada and the newcomer's background did not reveal any history of previous mental disorders* In another five cases, i t could not be definitely established how long the person had his illness, These wore designated as unknown. In Group I*  CROUP  I  GROUP  2  .......1,1.1  Xsysyj&s  >^ ^ PSYCHIATRIC  CATeCO***S  FtQune  ACwTt  CHRPMl C  UN/(NO***  HISTOK/  m  2 A  ACvTC  O f  CHRONIC  ILLNESS  l PfiEOOniNtltiT  SYMPTOMS  flGVRE 2 C  vNKNVWH  of the casee where the onset of the illness was established, there were no eases that could be described as chronic) that i s , where a patient revealed a long history of mental illness dating back prior to migration* In Group 2,  there were four cases which seemed to be suffering from  an acute mental disorder* Four other cases had to be designated as unknown* The remaining s i s caaee were definitely of a chronic nature, the patient himself or collaterals, having disclosed previous committals to hospitals i n other countries, or at least a long history of instability and psychotic  It was assumed that predominant symptoms whioh the patients manifested during their mental illness was aa area well worth consideration* The physical and psychological symptoms which distinguish a particular mental patient may be regarded ae attempts on his part to make his needs and desires known. In other words, many symptoms have a meaning, and can provide clues to the nature of physical and psychological disequilibrium i a a person* Or. M.J. HOraowski, writing on this subject, stated, "according to holistic theories, any communication i s indicative or symbolic of the sum total of a patient e disturbed equilibrium, and any symptom i s a communication about 1  this disturbance".^ The sample studied appeared to evidence five mala kinds of symptoms (Figure 2o) . Some revealed considerable physical anxiety, i.e., headaches, diaainese, and pains for whioh no physical cause was evident* Others tended to show conscious anxiety about such things ae "coming to some harm", not knowing what was expected of them, and being fearful generally without specific cause* & large number of these newcomers had either attempted to &  l  Hornoweki, M.D., "The jMeaaiag* of Symptoms" » Bulletin of tho Manninger Clinic, vol* 15, So* 2, Maroh, 1951,  -  ^0  -  commit suicide, or ©Is© showed a strong Inclination to do so, Some patients oppressed a morbid fear of people and went to great extremes to avoid contact with parsons* Other newcomers revealed very destructive behaviour, attacking people, breaking furniture, tearing clothes off their backs, and using abusive language, The differences which so far have set Group 1 apart from Group 2 seem to be further confirmed by looking at the predominant symptoms each manifests (Figure 2 c ) , In Group 1, there appears to bo no particular pattern of symptoms just as there i s no uniformity evident i n the personality and relationship components. In this group there are considerable dlfferenoee i n symptomatology. Considering the fact that i n this group the illness i s mostly of an acute nature, and the persons Involved seem to have some capacity for relationship and a relatively stable history, the predominant symptoms are probably more an expression of individual attempts to adjust or to communicate personal d i f f i c u l t i e s l a adjustment, than a sign of a deteriorating disease process, Vnlike Group 1, there Is a f a i r l y consistent pattern of symptoms In Group 2 , As Figure 2e illustrates, the persons In Group 2 manifest very similar symptoms, suggesting perhaps that the more sevoro and chronic disease processes i n this group produce a levelling effect i n personality and response to environmental stimuli,  foffiaary* Using a rating soale designed to provide a rough picture of each mental patient's personality, and the quality of his relationships, sufficiently significant differences and similarities wore noted to make a division for the sample into two groups possible. After this division was made, further comparisons wore observed i n psychiatric categories, aoutenese and persistency of illness, and i n the predominant symptoms i n each group.  these latter comparisons seemed to eorroborate the differences evidenced originally between Group 1 and Group 2* It should be noted that some relation was obtained between psychiatric diagnosis and the personality and relation* ship components for which the patients were rated* (Figure 2a)» Because psychiatric diagnosis sometimes has a tendency to be tentative and i s frequently governed by subjective elements such as the p s y c h i a t r i s t s s k i l l and orientation* the relation which was obtained assumes some significance* Generally speaking, Group I had a better appreciation of their problems, greater insight Into their illness, a history of f a i r l y satisfying relationships i n their own countries* and a desire to moot people and make friends In Oanada* this group was made up of patients diagnosed as depressed and also of schizophrenic patients who recovered rapidly under treatment* More* over, acute mental disorders and highly individualized symptoms distinguished Group 1 from Group 2* Group 2, on the other hand, appeared to be comprised of people who had no understanding of their problems, no insight into their illness, and a history of poor or non-existent relationships i n their own country and In Oanada. this group included persons who wore diagnosed as Various types of schizophrenics and whose illness was primarily of a chronic nature. In Group 2, a certain amount of stereotyping was reflected i n the symptoms of newcomers concerned, this suggests a levelling of personality i n these patients which comes with a chronic, deteriorating psychosis.  CHAPTER  4.  The differences i n personality factors, relationships* and mental illness components, whioh have served to set Group I apart from Group 2* suggest that the former newcomers have a greater potentiality for  rehabili-  tation than the latter* The high Indole of recovery In Group 1 alone would support this contention* However, a comparison of the casework services whioh these two groups received and their respective dispositions under the immigration Act, points to the fact that there seems to be no real selection from among these persons for rehabilitation services* Casework services with those patients may be considered i n terms of throe general areas* In some cases, a social worker would obtain a social history from relatives, friends and others for the psychiatrists to f a c i l i tate diagnosis and assessment of prognosis* In other cases, the social worker would compile a social history and remain with the case, providing casework services to patient and relatives* and implementing a suitable rehabilitation plan In cooperation with medical staff* In a very few cases, there would be no social work services given at a l l , mainly because there were no relativee or coiiatorais for the caseworker to interview* Figure Ja indicates that both Group I and Group 2 received similar proportions of social work services* Similarly, there was no apparent discrimination between Group I and Group 2 where discharge from hospital or deportation were ooncerned. Under the M i g r a t i o n Act, a l l persons who become patients i n a mental hospital are  -42-  CROUP  NuMf  HA6.  » « « M C a€  jocMc  MOTOR/  WORK  FlGu*£  pupasiTMV  u«*cff  JL  ye«v/|ce$ 3*  tNnexATto*  ACT.  44 -  -  deportable. In a l l cs.ee3, aa a matter of policy, deportation Is recommended by local immigration authorities and confirmed by the Immigration Department i n Ottawa, regardless of whether the patient concerned appeals his deportation or not,® However, an immigrant 0 doctor might recommend to the immi1  gration authorities that a patient i s suitable for probation. A patient may therefore be discharged into the community on probation for a period of six months* i f the newcomer concerned adjusts well, he may stay i n Canada indef i n i t e l y , although he must continue to remain on a probationary basis. That i s , the deportation order Is merely pigeon-holed and can be made effective any time i n the future i f i t i s deemed necessary*. Consequently, such a person may spend the rest of his l i f e i n Canada with a deportation order hanging over his head* As Figure- 5b illustrates, both  irons  I and Sroup 2 have received  very similar dispositions under the Immigration Act. The fact that there seems to be a slightly higher percentage of deportations i n Group 2 ae compared t o Croup I, suggests that the generally poor rehabilitation possibilities which the former shows might be influencing the doctors* recommendations to the immigration authorities* However, on tho whole, both groups seem to have received very similar treatment where deportation and discharge are concerned* There appeared to be no difference between Croup I and Croup 2 i n the social work services each received. This i s mostly because the Social Service Department at Crease Clinic and the Provincial Mental Hospital provided a one hundred percent coverage for a l l patients at the time of this study* An ammeadment to the Immigration Act i s presently being considered by the Canadian Government, which would permit certain classes of immigrants who become mentally or physically i l l after migration, to become citizens of this country.  — h*J m  the apparent tack df selection where disposition under the Emigration Act i s concerned, implies perhaps that the doctors are willing to give  |11  their patients an opportunity to become rehabilitated and recommend deport* atloa only for those they consider completely  hopeless*  the analysis i n this enquiry raises several pertinent questions* In the f i r s t place, there seems to be some evidence now i n favour of confirming the existence of immigrants, i n mental hospital at least, whose  mental  health  was very poor before they migrated to Oanada, Secondly, there appear to bo some persons who experienced a train Of circumstances In Canada which brought about poor mental health* patients whoso illness seems to be a condition of long standing, end whoso migration was likely an expression of that illness, obviously need a different sort of disposition than patients whoso illness has been precipitated by environmental stresses i n Canada, Such a different i a l approach to these patients has certain implications for screening,, deportation, and social services* ponclusions and Reoommendationa. It would not be valid to draw conclusions concerning the whole immigrant population i n Canada today from the relatively few who suffer mental disorders* the small percentage who become hospitalized oan be Studied and various Conclusions concerning the type of personality and environmental problems which distinguish them can be reached* About the majority* however, who never are hospitalized, these conclusions really reveal nothing. It i s perhaps possible, however, to draw some general and indirect inferences about the group of newcomers who never appear i n a mental hospital* It i s recognized by both the medical and social work professions today that personality as well as physical factors play an l a ^ r t e n t role i n the etiology of mental disorders, the personality components may be  46 ~ partly constitutional, determined by heredity and the person*e predisposition • In tomo ef bod? function? and partly e n v i r o M s n t a l , steraaiag from the. mental • stresses raM strains which were encountered during the person a lifetime. 1  Therefore,' tho statistical fact that within a certain group such as the toigrantsj,  a certain percentage become mentally 111^  may be taken as evidence  that they do so either because of an increased mental strain on the Immigrant group, or a decreased ability to cop© with mental strain. The former Implies that tho  nmawsatQ  "aay have led a f a i r l y Integrated and satisfying l i f e prior  to migration and ©ncotmtored insurmountable obstacles l a their now culture. The latter suggests that the newcomers may have been mentally unstable before migrating,--and the increased pressures they mot in' their new  surreuadiage  aooentuatetl-their ooat&l instability* • The tost of ouch a hypothesis i s the usual- one* namely* i t i s i n . keeping, with sooial work and psychiatric experience* i&et sooial workers would agree that persona 'who estgrats are subjected to greater stresses and strains this native Canadians or compatriots who remain at hefts*. One social worker-#he . Is Interested .to this subject* Sita 0. %auiain** |jut the point :  simply--'when she tfroto» *\% know that uncertainty and im^aeXi^  tend to  produce aaxioty i n tho individual* It io normal to react with-anxiety to aaxlety-produclag situations, and the process of laaigration i s such a situation**'**  i t would therefore seem quite plausible that some aeweomers,  who may .have been. reasonably stable and well-integrated in' their owa country* nevertheless find the pressures of inmigratioa and adapta^,'Oii''to a new eavirosGcnt too great to handle. •• '•' On the other hand, there has been some suggestion, particularly from psychiatrioto, that iss&gratioa might be i n many respects a selective process, That is,, thero might be periods whoa migration i s particularly attractive J i  %iauKiag, F4ta 3», 2ec<iaiquoo i a Oasework with 3i-placed r-eroons , Social Casework. February. 19^0. e  8  -47  *  to people who are essentially restless, mentally unstable, end socially maladjusted, Thus, Dr. Benjamin Malzberg, questioning whether immigrants In the United States represent random samples ef the populations from whioh they were derived, vjrites that "selective factors were clearly at work, some of which favoured emigration of hardy individuals! other factors may have encouraged a poor selection",*2 Such a selective process would also apply to Canadian immigration. In any case, there i s acme validity to the assumption that at least a small percentage of immigrants might have eaprossed their general instability through migration* unfortunately, i t has not been possible to conclude from the resources; available for the present study, whether the persons who have been heap!* talized i n a mental hospital belong to a group who wore reasonably well Integrated before migrating but who were subjected to great environmental pressures In Canada, or to a gran|j who had a long history of instability and maladjustment* If any generalisation i s possible from the twenty-five patients studied, i t i s likely that today*a Immigrant group i n Canada contain elements of both* The sample studied appeared to have included people whose illness could be traced to environmental pressures i n Canada, and some persons whose illness appeared to bo of a f a i r l y long duration* having i t 8 onset well before migration* Where deportation for this group of patients i s concerned* I t appears obvious that seme sort of differential application of the deportation clause In the Immigration Act i s warranted* A patient who i s found to havo had psychotic episodes i n Ms own country, who i s completely disinterested i n becoming established i n his own community, end whoso psychiatric prognosis i s not good* has not much to contribute or receive from his new homeland* On the other hand* a patient whose i l l n e s s was apparently precipitated i n 1 2  ISalsborg* Benjamin*.  QtoJ&fa,,  • 48 * taie country* who chows e f a i r l y ete.ble history up to his arrival i n Canada, and who continues to manifest a desire to become a pert of his new community, has something to offer as a potential citizen once ho can receive proper rehabilitative services. Clearly, the former type of patient would appear to bo more subject to deportation than the letter. '.."hat happens i n practice? The present study shows that patients from both Croup 1 and Croup 2 have been discharged into the community on a probationary basis, and have been given an opportunity to become established* even though* as this study has pointed out* most of the patients i n Croup 2 seem to have a decidedly poorer prognosis* It oan be anticipated that the patients discharged from hospital who belong to Group 2 w i l l sooner or later be returning to a mental, hospital* because their mental health seems such that they are loss capable of coping with personal conflicts and environ* mental pressures* & follow-up study would bo necessary to confirm this* and* obviously* It wouldbe worth makings Of the group of twenty-five patients studied* anyone who i s discharged into the eoamiunity has to bear the burden of possible deportation as long as he remains i n this country. The fear and anxiety which these people experience because of this throat of being *sent back cannot but be detrimental to their 0  ultimate recovery and adjustment, For example* one of the patients i n Group 1 was on the point of discharge when an immigration o f f i c i a l appeared to take a passport picture as a matter of routine* The person in question immediately suffered a relapse, and, undoubtedly* had to remain i n hospital longer than would have boon necessary otherwise. It would only bo a humane gesture to relieve some of the people of the added pressures whioh the provisions of the laiaigration Act create for them*.  <  One way of limiting deportation to those patients whose future i n this country doo| not look very promising* and of offering rehabilitation servioeo  to those who seem likely to become useful citizens, would be to screen a l l patients itt a way similar to this study, the decision as-to whether s person should be deported or not, more than any other decision, influences his whole future* Such a decision should net remain the sole responsibility of an Immigration official,,nor should i t be at the discretion of an individual doctor* A valid decision for, each case can come only from a case conference i n which the psychiatrists and social workers oan weigh a l l the evidence available i n the patient's personal and mental illness history* Moreover* disposition of such cases would probably bo much more i n keeping with enlightened welfare practices i f there was a provision i n the Immigration Act which would recognize the considered decision of a psychiatric team. Thus, i t would be possible for a patient a good prognosis to be recognized in more 1  constructive ways than by placing him indefinitely on probation i n the community* for example* i f a patient has made a successful adjustment after a six months probationary period, he should not be liable to deportation* Such an arrangement would do a great deal towards alleviating anxiety i n those cases where successful rehabilitation i s a distinct possibility. For axmapie, patients of the type which comprised Group 1 i n this study would undoubtedly find a good adjustment much easier i f the threat of deportation could be removed after a six month probationary period* By the same token* the classification inherent i n a careful screening of these oases would make i t possible f o r social workers to direot a l l their s k i l l s and resources towards those patients who would benefit the most. Perhaps the most effective steps which oan be taken to alleviate some of the suffering and disappointment experienced by many persons who are deported* would be to screen potential Immigrants more thoroughly for psychiatric disorders before migration i s permitted* In most of the cases i n Group 2, there was evidence that these patients had experienced psychotic  episodes i n their own country, and, generally speaking, were unstable enough to make their future adjustment i n Canada questionable indeed, Ae the situation seems to exist, a prospective immigrant i s merely asked by an immigration o f f l o i a l whether or not he himself or any member of his family had over had mental i l l n e s s . It i s understandable that many immigrants: would give a negative answer, regardless of the truth, i f their desire to eoae to Canada i s great enough, A more Intense screening for psychiatric disorders, possibly made by a qualified soeial worker, would provide a more valid index of a potential Immigrant's future value as a Canadian citizen than appears possible with existing methods. Screening of potential newcomers would also become mere effective i f a rating scale similar to the one utilised i n this study was developed. Outside of the many external factors which Influence a person s adjustment, 1  such as employment, housing and location, eaoh person i s equipped with a psychological combination of factors whioh would determine how he would get along i n his new country* For example, a person who evidences a long history of withdrawal from sooial contacts and of distortion of reality, i s , without a doubt, a poor risk as a potential immigrant, this i s particularly true because the very essence of besoming a part of one's new surroundings i s the willingness to make new friends and contacts and to see one's circumstances r e a l i s t i c a l l y , A rating scale along the same lines aa the one used i n this study, probably would be quite effective as a sort of prognostic tool whereby a person's adjustment potential could be measured* Although the particular rating scale developed i n this enquiry i s as yet tentative and i n need of considerable revision, i t can be regarded as a step i n tho right direction. A f i n a l implication made be drawn from the fact that the patients studied represent the extremely maladjusted group, among whom, as this  study hae indicated, some appear to be excellent candidates for rehabilitation i n Canada, while others seem to be deportable. I f stents! illness may be regarded as an extreme form of maladjustment, then i t oan be assumed, that .lessor degrees of maladjustment, suoh as an inability to hold employment, a withdrawal from sooial eoataota, or a tendency to become economically dependent, claim even a larger number of immigrants. Thus* the problem of besoming useful and happy Canadian citizens does not belong to the mentally i l l immigrants alone. Explanations for the reason that some Immigrants f a i l to l i v e up to tho requirements of their new homeland probably are similar to those suggested for the group of patients studied. That i s , some people must be regarded as being predisposed to a poor adjustment no matter what assistance they receive, while others probably succumb to excessive environmental pressures, and probably could use assistance from others to good advantage. Ih any case, Immigration to Canada i s Increasing i n scope and numbers yearly, end a research unit certainly seems warranted, A thorough study of the immigrant group as a whole would provide much needed information on what has happened to those already i n Canada, what soeial services aro available to thorn i n relation to their physical and pejrehelo|ieal needs* and what principles outside the economic should govern tho selection of prospective newcomers to Canada.  m&uxmww. Dayton, Hell* M,D„ M.0* Hew Facte on SSenta-j, Disorders. Study of 69*190 eases, Gharlee 0, Thomas* Publisher. y  E o l l l s , Florence, "the techniques of Social Casework , Journal of Social Oaseworfe. Juno, 19*9, 8  Bornowski* E*«f,, M.D** *fhe •Keening* of Symptom© * Bulletin of the ^nnla^er. 01jnle. vol, 15* JSo* 2, tbrtib* 1951* . 8  Klago, Joseph* t a i g r a t i o n and Social Service*, Canadian Welfare. llarek, 19^9+ 8  fclalaberg* Benjamin, M.D,, 3ooial and fllolorJLcal Aspects of tfental Disease* Um York* State Hospital Prose* 8  Manual of the International Statistical Classification of Disease©* Injuries* and Causes of Deatht Sixth Revision of the International Lists of Diseases and Causes of Death* Adopted In l$43* vol* 1* pp. 106-117* Odegaard* Ornulv* On the Psychology of Social Croupe as Illustrated by their Incidence of Mental Disorder * Feelings ..and .Emotions,. Edited by Ksrtla L* Reymert, Ph,D«* McGraw-Elll Book Oo*Ine* 1950* 8  8  Federeon, Stefi, Poychopathological Reaotlons to Extreme Social Displacement * f syphoanal*. Rev.. October* 19^9* 8  8  Spaulding, Rita Q,, "techniques i n Casework with Displaced Persons , Social Casework. February* 1950. 8  fQ***n^i  tyhurst* Lybuso, u*D** Displacement and Migration * the j5morican.n of gaychiatrv. vol* 107* So* 0* February 1951* 8  8  n  

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