‘943]
JAYL.HOFFMAN
573viouslybeenhospitalizedformentaldisease.Therewascommonlyahistoryofunsettleddomicileandpooroccupationaladjustmentformonthsoryearspriortohospitalization,andthismaybepresumedtobeevidencealsooftheexistenceofmentalillnessintheseindividualsduringthisperiod.Only3ofthepatientswerenativesoftheDistrictofColumbia.Thelastextendeddomicileofthemembersofthegroupin-cluded
22
differentstates.AlthoughCali-forniaisthemostdistant,thenumberofpatientsfromthatstatewasexceededonlybythenumberfromNewYork.Mostofthepatientshadnevermadea
very
goodoccupationaladjustment.Whileafewhadatonetimehadfairlygoodand
regular
employment,practicallyallwereir-regularlyemployedornotemployedatallforaconsiderableperiodimmediatelypriortohospitalization.Theoccupationslistedwerealmostinvariablyintheunskilledtrades-laborers,clerks,domestics,janitors,min-ers,porters,farmers,apants-presser,achambermaid,ashoemaker,aweaver,apeddler.Overhalfthegrouphadlessthananeighthgradeeducation.Two-thirdsofthegrouphadnotbeenself-supportingformonthsoryearspriortotheirhospitalization.Itisofsomeinteresttonotethat,withref-erencetotheirexpressedreligiousaffiliation,therewasonlyonepatientwhoexpressedadherencetoasect.Possiblyadherencetoareligioussect-initselfevidenceofmental
instability-.-obviatestheneedforthis
par-ticularmethodofsolvingone’sconflicts.Twenty-ninepatientsweremembersof
variousProtestantdenominations,19were
Catholics,
2
wereJewish.Oneclaimedtohavenoreligion,andthereligionofanotherwasnotrecorded.Therearefewtypesofpatientssocom-pletelyandsopermanentlylackinginin-sightasthemembersof
this
group.Yetinspiteoftheirverbalinsistenceupontheva-lidityoftheirbizarreandfantasticdelusionalideas,fewareaggressiveinexpoundingthem.Itistherulethatthesepatientsare,withcertainnotableexceptions,quiet,pleas-ant,congenial,
cooperative
andwellbehaved.Theyaccepttheirenforcedhospitalizationwitharemarkabledegreeofpassivityandfrequentlywithoutevenverbalcomplaint.Theyrarelyattempttoleavethehospitalwithoutpermission.Only3oftheentiregroupwererecordedasbeingfrequentlycombativewhilepatientsatSaintElizabeths
Hospital.Nevertheless,becauseoftheir
completelackofinsightcoupledwiththeirbizarredelusionalideas,theseindividuals
must
beconsideredandtreatedaspotentiallythemostdangerouspatientswehavetocare
for.
Asmightbeanticipated,thediagnosisin
themajorityofthesepatientswithaso-calledfunctionalpsychosiswaseitherde-
mentiaprecox,
paranoidtype,orparanoiaandparanoidconditions,paranoidcondition.Theformerdiagnosis
was
madein
23
pa-tientsandthelatterin6.Twelvemoreweredesignatedassufferingfromtypesofde-mentiaprcoxotherthantheparanoidtype.Manic-depressivepsychosis,manictype,wasthediagnosisof3more.Fourreceivedthediagnosisofpsychosiswithcerebralarterio-
sclerosis,
andoneeachthediagnosisofepi-lepticpsychosis,alcoholicpsychosis,psycho-siswithmentaldeficiency,psychosiswithpsychopathicpersonality,andpsychosiswith
organic
changesofthenervoussystem(pa-ralysisagitans).Thegenerallyunfavorableoutcomeinthesecasesmightalsobeanticipated,bothfromthediagnosesrecorded
and
fromthe
other
datamentioned.Onlyoneofthe53recovered(apatientwithmanic-depressive
psychosis,
manic
type).Fourmoremadesomeimprovement,buttheremainder-48
in
number-wereunimproved.Only
10
of
thegroupwereconsideredeligible
fordis-chargefromthehospitalandtherest-43-
eitherremainedat
SaintElizabethsHospitalorweretransferredtootherhospitals.TheattractionthatWashingtonholdsforthesepatientsisnotfullyexplainedbythefactthatitcontainstheofficesofthehigh-estrankinggovernmentofficials.Forsome
thereisamorepersonalrelationshipcreated
andthisiswellverbalizedbyoneofourrecentWhiteHousevisitors.ThisisM.M.,
a29-year-oldbusboy,
bornintheUnitedStatesofHungarianparentsandhimselfresidentinHungarybetweentheagesof9and
20.
Hehadworkedinthis
countryat
variousoddjobssuchasdish-washerandhotelporter,hadbeenarrestedfiveyears
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