From Token Economy to Social Information System: The Emergence of Critical Variables

Abstract

The long-term wards of psychiatric hospitals are characterised by an extremely low level of social stimulation. In addition, a widespread mood of apathy may all too often be apparent both in the behaviour of the patients and in the behaviour of those who are responsible for their rehabilitation. This apathy on the part of the patients is seen to result from the debilitating effects that prevailing institutional practices have upon individuals. Wing and Brown (1970) have argued that a substantial proportion of the morbidity shown by long-term patients is a direct product of their environment. They have shown that an impoverished physical and social environment is very highly correlated with what they term a “clinical poverty syndrome”. That is to say, patients under such circumstances tend to exhibit social withdrawal, a lack of or inappropriateness of emotional responsiveness and poverty of speech. Basic self-care skills such as dressing, washing and feeding may be partially lost and there is usually a marked deterioration in former occupational skills. The apathy on the part of the caring staff in such situations may be due to the fact that traditional approaches such as milieu therapy and occupational therapy have made little headway in tackling these problems.

“That a high-level technology calls for a high level of humanism must not deter us from the task of developing both capabilities”.

Thomas S. Ball (1968, p. 232).