Causes of institutionalism: patient and staff perspectives

Institutionalism is a pattern of passive, dependent behavior observed among psychiatric inpatients, characterized by hospital attachment and resistance to discharge. Survey research was conducted with 211 staff and 47 "institutionalized" patients in a public psychiatric hospital to determine their beliefs on the causes of institutionalism. Four explanatory models of institutionalism were investigated: the predisposition model, the total institution model, the asylum model, and the symptoms model. Patients and staff differed on all models. Responses indicated acceptance of multiple causes for the phenomenon, with patients and staff showing highest agreement on the need for hospitalization as asylum from the world. Patients and staff differed most on the role of the institution in promoting institutionalism. Job classification of staff also resulted in significant differences in beliefs on all models except the asylum model.