Vogel W
Department of Psychiatry, University of Massachusetts Medical Center, Worcester 01605.
Hosp Community Psychiatry. 1991 Jun;42(6):593-7. doi: 10.1176/ps.42.6.593.
The author recalls his experiences as an attendant at a state mental hospital in the early 1950s, before the introduction of psychotropic drugs. State hospitals of that era served not only as treatment centers for mentally ill patients but also as de facto nursing homes, retirement homes, orphanages, and shelters for chronic physically ill persons, medically ill poor people and wards of the state, adults and juveniles convicted of crimes, behaviorally disturbed retarded people, and alcoholics. The author argues that the deinstitutionalization movement removed an important, if unrecognized, source of palliative care for dispossessed individuals and recommends redesigning the state hospital to provide compassionate housing and treatment by trained persons for homeless and chronic physically and mentally ill individuals. Four patients typical of the heterogenous population of state hospitals in the 1950s are described.
作者回忆了自己在20世纪50年代初精神药物问世之前，在一家州立精神病院担任护理员的经历。那个时代的州立医院不仅是精神病患者的治疗中心，实际上还充当养老院、退休之家、孤儿院，以及慢性病患者、身患重病的穷人、国家监护人员、成年和少年罪犯、行为紊乱的智障者和酗酒者的收容所。作者认为，非机构化运动消除了一个重要的（即使未被认识到的）对无依无靠者的姑息治疗来源，并建议重新设计州立医院，以便由受过培训的人员为无家可归以及身患慢性身心疾病的人提供富有同情心的住房和治疗。文中描述了20世纪50年代州立医院中不同类型患者群体中的四位典型患者。
