Custodialism Among Mental Hospital Personnel

Since the middle of the 1950's a succession of psychiatrists, psychologists and sociologists have done research on the attitudes of mental hospital personnel. Their interest in the attitudes of the personnel is a part of their conception of the hospital as a therapeutic milieu, where social relations are assumed to play an important role in the rehabilitation of the patients. Two American researchers, Doris C. Gilbert and Daniel J. Levinson, have introduced the concepts custodialism and humanism as designations for two ideologies or attitude-orientations which they believe are relevant for all those who have to do with the care of the mentally ill. The prototype for the custodial attitude is the traditional prison and mental hospital with the chronically sick. The main goal in such systems is to retain and maintain those who are interned. The custodial staff members regard the patients as irrational and insensitive to others and look upon their behavior as unpredictable and dangerous. Mental illness is said to spring from hereditary factors and organic damage. The custodians thus believe themselves unable to understand the patients, unable to have meaningful relations with them, and are pessimistic about their chances for improvement. The humanistically oriented staff members see the hospital as a terapeutic milieu. They stress the importance of interpersonal and intrapsychic factors as the sources of mental illness and often belittle possible hereditary and organic factors. They are optimistic, sometimes unrealistically, about the patients' chances to improve in a maximally therapeutic milieu. The humanistically oriented want to democratize the hospital and the relations between different staff members and between the staff and the patients, increase the therapeutic function of wardpersonnel and increase the patients' right to decide for themselves. (Gilbert & Levinson 1957, 22). Gilbert and Levinson intended these descriptions as prototypes, the opposite poles of an attitude-continuum along which most individuals would be distributed. In order to investigate whether or not it is meaningful to talk about such an attitude-continuum (among other things) Gilbert and Levinson constructed a scale

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