Institutionalism and schizophrenia 30 years on. Clinical poverty and the social environment in three British mental hospitals in 1960 compared with a fourth in 1990.

In their comparison of chronic schizophrenic patients in three British mental hospitals in 1960, Wing and Brown found a strong association between the poverty of the social environment and the severity of 'clinical poverty' (blunted affect, poverty of speech, and social withdrawal). Between 1960 and 1968 the social environments of all three hospitals improved and a weak causal relationship between social poverty and clinical poverty was reported in a proportion of patients. Using the same assessment instruments as Wing and Brown, the present study re-examined the relationship between social and clinical poverty in the long-stay schizophrenic population of a fourth British mental hospital in 1990. The association found between social and clinical poverty was much weaker than in 1960. Reluctance on the part of patients to be discharged from the institution was unrelated to length of stay. There was no significant difference in severity of illness between the patients in the present study and those in the earlier study. However, patients in the former group spent more time doing nothing than those in the hospital with the most understimulating environment three decades before, with four-fifths doing nothing for over five hours a day, despite a greatly increased ratio of nurses to patients.