Hospitalism – ‌why‌ is ‌dangerous‌ ‌deficit‌ ‌communication‌ ‌and‌ ‌attention‌

Have you ever had to stay in a hospital or other government facility for a long time, away from your family and friends? How did you feel? You probably missed heartfelt conversations, hugs, and warmth. Because of this, you were overcome with melancholy and depressed. These are mild manifestations of hospitalism. In more severe cases, hospitalism syndrome is manifested by a number of somatic and mental disorders. Hospitalism is especially dangerous for children from boarding schools and disadvantaged families. I propose to understand everything in order: what is the origin of the phenomenon of hospitalism and what does it mean, how it manifests itself and how it is treated.

What is hospitalism

The name is derived from the Latin word hospitalis, which means “hospitable”, “hospital”. Hospitalism is a syndrome in which a person experiences psychosomatic disorders due to a long stay in the hospital, away from home and friends. At the same time, this means a lag in mental and physical development in children who grew up in a boarding school from infancy or were deprived of parental attention and love. Close, warm communication with the mother and other significant adults is the leading need of infancy. Deprivation (non-satisfaction of needs) leads to psychophysical and intellectual disorders, developmental delays.

Let us consider in more detail the definitions of hospitalism in psychology and psychiatry.

In psychology

Hospitalism is, in psychology, psychosomatic changes in personality as a result of a lack of communication with loved ones. Psychologists consider hospitalism from two sides: in children and in adults. In the first case, this means the child’s psychophysical retardation due to a lack of communication in the first years of life. In the second case, we are talking about psychosomatic disorders caused by a long stay in the hospital. However, it is worth noting that hospitalism that occurs in childhood can haunt the child throughout his life. At the same time, children, like adults, are susceptible to hospitalization.

In psychiatry

This is a deterioration in psychophysical condition due to a long stay in the hospital. An alternative name is homelessness syndrome. It manifests itself as social maladaptation, loss of work skills, loss of interests, exacerbation of chronic diseases, weakening of the need for communication and a number of other changes.

What does it look like as an adult?

In adults, a similar syndrome usually occurs in old age, especially if a person is lonely and lacks care, attention and love from loved ones.

The characteristic symptoms in this case are:

• loss of appetite;
• development of apathy;
• personal regression;
• memory impairment;
• loss of the ability to adequately think and understand what is happening;
• emotional impoverishment;
• decreased sociability;
• deterioration of relationships with other people;
• loss of interest in work.

In adults, a similar phenomenon can cause personal devastation and loss of interest in life.

History of the discovery of the phenomenon

The phenomenon of hospitalism in psychology was discovered by psychoanalyst R. Spits (1945). He studied the phenomenon of hospitalism in children and infants forced to stay in the hospital for a long time, and in children living in a boarding school. The psychoanalyst found out that all the changes that are occurring are associated with the separation of the child from the mother. Spitz's teachings are based on Freud's psychoanalytic theory, in particular the position on the separation of the child from the mother.

Spits studied the condition of children who were in conditions favorable from a hygiene point of view (nutrition, care, cleanliness), but without proper maternal support. And this is what he noticed:

• in the third month of life, children experienced physical deterioration, weakened immunity, and increased mortality;
• a little later mental changes became noticeable, in particular depression, passivity, lethargy;
• in the second year of life, signs of deep psychophysical retardation in all areas (walking, speaking, ability to stand and sit) became noticeable.

As a result of his research, Spits (Spits, Spitz) concluded that children need the care and love of their mother. It is important for the life and development of the child.

The psychoanalyst identified two forms of the syndrome:

• hospitalism associated with complete deprivation of maternal care;
• anaclitic depression, which occurs if at first the child communicated normally with his mother, and then he was isolated.

Kreisler later revised Spitz's concept and came to the conclusion that any deprivation leads to hospitalism. Including inadequate child care in a family setting. Modern researchers adhere to the same point of view.

Diagnostics

The basis for diagnosis is a thorough history taking, medical examination data, pathopsychological examination and constant monitoring of the patient. The diagnosis of hospitalism in children is made based on the conclusion of a special commission, which includes a pediatrician, a child neurologist, a psychiatrist, and a clinical psychologist.

Differential diagnosis is carried out:

• in children after one year - with mental retardation, autism;
• in older people - with other mental disorders: neuroses, personality disorders, behavioral deviations.

The main difference between pathologies during hospitalization is the reasons that caused them.

Causes of hospitalism

The phenomenon of hospitalism occurs when a person is in a hospital for a long time, a child is living in a boarding school, or a child is in a dysfunctional family, including a family with a cold, unemotional mother.

In psychology there is such a concept: “mother-child dyad.” This means that up to a year, mother and child are inseparable; they are considered as a single organism. Early separation before one year of age (indifference and coldness of the mother or absence of the mother in the child’s life) leads to hospitalism.

The syndrome occurs in conditions where the mother’s care for the child is completely or partially absent (lack of love, inattention). Unfortunately, this happens even in families, and seemingly prosperous families at that. For example, where parents are busy building a career.

Thus, hospitalism in children and adults occurs for the following reasons:

• long-term isolation in a medical facility;
• lack of communication with family, relatives, friends;
• passivity of relatives (close relatives are not interested in the individual’s life).

Risk factors include the following:

• the presence of chronic diseases due to which a person often ends up in the hospital;
• elderly age;
• living alone (no family, friends);
• life in a boarding school, orphanage, orphanage;
• infancy and childhood;
• stay in a boarding house, health center.

Psychologists note that most modern families are at risk. Parents are forced to work a lot, mothers leave maternity leave early. Because of this, the child lacks attention, care, affection, and communication. In addition, psychologists note that more and more often mothers are cold and unwilling to communicate with their children. They do not know the needs and interests of the baby, do not want to develop his abilities, and do not take into account his capabilities. Many modern children lack closeness with their mother. Hence, late development, behavioral problems, late development of speech or speech disorders, and many other problems.

Classification of psychosomatic disorders

Psychosomatic medicine studies the relationship between a person’s psychological state and somatic disorders. This direction appeared in the 19th century. Psychosomatics includes reactions and disorders of a psychosomatic nature.

Psychosomatic reactions are conditions that are short-term in nature. They arise depending on the situation. Such phenomena include: increased heartbeat, blushing from shame, sweating under stress.

List of psychosomatic disorders:

• conversion symptom - psychological disorders appear as a result of a nervous experience, do not affect the tissues and functions of organs (psychogenic blindness or deafness, lump in the throat, numbness of the extremities);
• functional syndrome - a complex of symptoms that appears as a result of the physiological accompaniment of emotions, is characteristic of neuroses, leads to dysfunction of organs (VSD, migraine);
• psychosomatosis - the body’s primary reaction to worries and experiences, manifested by impaired functioning of organs and tissue pathologies (hypertension, ulcers, asthma, hyperthyroidism, neurodermatitis, rheumatism, ulcerative colitis);
• psychosomatic personality disorders - depend on the characteristics of the human psyche, behavior, moral attitudes (alcoholism, smoking, drug addiction).

Psychosomatoses, characterized by disturbances in the functioning of internal organs, were first described by the American psychoanalyst Franz Alexander. Diseases that appear as a result of psychosomatic disorders make up his famous Chicago Seven. However, scientists have supplemented this list with other diseases that appear against the background of neurotic disorders. These include the following diseases: heart attack, cancer, sleep disorders, sexual disorders, obesity, anorexia, bulimia, irritable bowel syndrome and others.

Symptoms and signs

Manifestations of hospitalism in children and adults are not the same. Let's consider both cases in more detail.

Hospitalism syndrome in children

In children, hospitalization manifests itself as follows:

• underdevelopment of reflexes and instincts in infants;
• urinary and fecal incontinence;
• delayed speech development;
• delayed motor development;
• emotional coldness, alexithymia (inability to express emotions);
• compulsive behavior such as rocking back and forth;
• rickets;
• retardation in physical development;
• low level of adaptation;
• lag in mastering one’s body and language;
• soreness;
• lethargy;
• apathy;
• pallor;
• passivity;
• exhaustion;
• poor appetite;
• sleep problems;
• fever;
• drowsiness;
• muscle hypotonicity;
• lack of reactions to signals from others (does not respond to affection, does not respond to voices, does not concentrate gaze).

Children who feel deeply about the lack of interaction with their mother appear unhappy. Their condition is difficult not to notice; the problem is visible to the naked eye. However, if the child is returned to the mother or another person who will fully replace her as soon as possible, then after 2-3 weeks all symptoms and signs of hospitalization will disappear.

Children deprived of interaction with adults begin to walk, talk, read, etc. late. If no one deals with them at all and in any way, then they grow up as Mowgli children (wild children).

Hospitalism syndrome in adults and the elderly

The following manifestations are characteristic:

• social maladjustment;
• loss of interest in work and work as such;
• weakening of professional skills;
• impoverishment of the social circle, decrease in the quality of contacts;
• exacerbation of chronic diseases and transformation of acute pathologies into chronic ones;
• loss of appetite;
• decreased immunity;
• decreased adaptive capabilities;
• phlegm;
• impoverishment of facial expressions;
• slow motor skills;
• cognitive impairment (memory, thinking, perception);
• carelessness;
• inactivity;
• monotone.

In older people, hospitalism manifests itself as degradation. It develops due to being in nursing homes, hospitals, or when an elderly person is abandoned in an apartment and lives alone.

At the same time, hospitalism in adults manifests itself as a chronic illness syndrome. A person gets so used to lying in a hospital bed that he cannot live in other conditions. After leaving the hospital, he does everything possible to get there again. The fact is that during long-term inpatient treatment, a person’s worldview is distorted. He does not perceive himself in a different environment, he gets used to the disease. This happens especially often among pensioners. This manifests itself during hospital treatment for 10–15 months (on average).

With such a long stay in the hospital, a person develops mental deformations. Several options are possible (subtypes of hospitalism):

1. Deprivatization desocialization. This is a loss of ability to adapt, a loss of social skills. Develops slowly.
2. Paternalistic subordination. This is the obsession with being sick. Occurs due to excessive care.
3. Pharmacogenic psychological, emotional and social personality regression. It develops very quickly due to improper treatment.
4. Mixed option.

How to recognize mental disorders in yourself or your family?

The diagnosis can only be made by a doctor. No self-diagnosis, advice from experienced relatives or colleagues will clarify this issue. But there are main signs that may indicate possible mental disorders:

• Bad mood or apathy for no apparent external reason.
• Lack of willpower when you can't even bring yourself to brush your teeth.
• Prolonged insomnia (more than two weeks), shallow light sleep.
• Constantly expecting “something terrible” to happen soon.
• Ordinary joys do not please you, familiar ones irritate you.
• Pain in the body, the cause of which cannot be found after tests and examination at the clinic.
• It seems that everyone suddenly changed their opinion about you and began to treat you badly.
• A sharp decrease in performance, absent-mindedness, inability to concentrate or solve ordinary problems.
• The desire to hit your interlocutor if he does not agree with your opinion.

But these symptoms do not necessarily indicate insanity. Trivial reasons for poor health can be constant workload, vitamin deficiency, and the inability to escape from solving problems. Therefore, before you suspect that you have a serious mental disorder, you should:

• Get enough sleep and have a good rest.
• Eliminate all possible somatic causes of illness.
• Review your daily routine.

But the main thing is not to self-medicate. The pills will only relieve some of the symptoms, and then only for a short time. The rest will have to be dealt with on your own or with the help of a therapist.

Treatment of hospitalism

Treatment of the syndrome in children and adults differs. Let's take a closer look at each of the categories.

In children

Treatment involves not only eliminating the negative factor, that is, restoring warm communication with the mother, but also systematic work with various specialists:

• pedagogical correction;
• psychological correction;
• expanding your social circle;
• increasing the intensity of communication.

At the same time, symptomatic therapy is carried out, that is, psychological and medical treatment to eliminate signs of exhaustion and retardation. The program of events is selected individually.

In adults

First of all, you need to eliminate the negative factor: cure the chronic disease, switch to outpatient treatment. But the most important thing is to return to the person the support of loved ones and communication with them. Comprehensive treatment by a therapist or psychotherapist (psychiatrist) is indicated. It is advisable to avoid consultations within the walls of a medical institution; it is recommended to invite a specialist to your home.

The main rule for preventing hospitalism is communication.

Why do they arise?

Unfortunately, the causes of many mental disorders are still unclear. True, depending on the type of disorder, there are certain factors that provoke the development of diseases. There are biological, psychological and social causes of mental disorders.

Mental health disorders are known to be caused by changes in the structure or function of the brain. It is generally accepted that the occurrence of mental disorders is influenced by exogenous or endogenous factors. Exogenous include poisonous drugs, alcohol, infections, psychological trauma, bruises, concussions, and cerebrovascular diseases. This kind of disorder is influenced by stressful situations provoked by family or social problems. Endogenous factors include chromosomal abnormalities, gene mutations or hereditary gene diseases.

Psychological deviations, regardless of the reasons for their occurrence, bring many problems. A sick person is characterized by inappropriate thinking, incorrect response to some life situations and often irrational behavior. Such individuals have an increased tendency to suicide, crime, and the formation of alcohol or drug addiction.

Why is hospitalism dangerous?

Each case requires individual consideration, but we can absolutely say that sometimes the effects of hospitalization are irreversible and even lead to death. Among people with hospitalism syndrome, there is a higher risk of developing mental disorders and antisocial tendencies.

Children's hospitalism is dangerous because the child will become wild and will never be able to return to a normal, human life. Victor Kaspar, Janie from California are vivid examples of Mowgli children from the past. But it’s scary that this is happening in our time. Not so long ago, all TV channels were full of shocking news: “A five-year-old Mowgli girl was found in a Moscow apartment.” There are a lot of such stories. Some people manage to become human, while others remain “wild animals”, living by instincts and reflexes. Unfortunately, even at the current level of development, pedagogy, psychology and other social sciences are not always able to help such children.

Psychopathological aspects of older people

At the end of the 20th century, the whole world was faced with the common problem of global population aging. This marked the beginning of a worsening health crisis. Social services have also entered a period of increased strain. All this was a consequence of the increased level of development of problems with brain activity in elderly and senile people.

Today, the global number of elderly people diagnosed with senile dementia is about 50 million. And if the human community does not rejuvenate on a planetary scale, then the number of such old people will increase to 100 million by 2025. At the same time, the Russian Federation has over 27 percent of people who have crossed the 60-year mark and are diagnosed with dementia in varying degrees of severity.

Proper training of social workers at all levels in psychopathology and gerontology is now urgently needed. This can significantly facilitate the task of providing palliative care to the elderly and elderly.

Prevention of hospitalism

As a preventive measure, psychologists recommend that parents or other close adults communicate with the child as much as possible, and start communication as early as possible. It should be a very warm, emotional interaction. Play and engage with your child. Try not to leave your child alone in the hospital, do not leave him with an emotionally cold person. Study developmental psychology to properly care for your baby.

Prevention of hospitalism among adults implies maximum preservation of contacts with the outside world: communication by phone, Skype, chat, personal visits. Don’t abandon your grandparents, don’t isolate yourself if you yourself find yourself in the hospital.

If in hospitals, boarding schools and other institutions there was always a person next to the patient (pupil) who would pay attention only to him 24 hours a day, 7 days a week, then the hospitalism syndrome would probably not manifest itself. But we understand that this is impossible, at least in government institutions. In everyday life, you can hire a nanny or a nurse.

Comparison of psychopathology with other sciences

Let's compare psychopathology with other related sciences. Popular psychology aims to study the normal mental state of a person and its phenomena. At its root, psychology is a social rather than a medical branch of science. Well, except for clinical psychology, which has certain medical aspects.

The question of comparing psychopathology with somatic medicine is different. Everyone knows the indivisibility of body and soul. At the same time, the science under discussion is engaged in research, analysis, and treatment of diseases of the soul, and somatic medicine does the same, but with diseases of the body. This can be seen in the similarities between the two concepts. Based on this statement, a parallel can be drawn between psychopathology and somatic specialties in medicine.

It is known that, for example, a person with a severe disability often suffers from depression. The emotional state of disabled people is reduced. Along with this, there is increased sensitivity and sensitivity to emotional stimuli.

The situation becomes more interesting when comparing two seemingly identical concepts - psychopathology and pathopsychology

It is important to grasp the line here. Psychiatry is one of the components of psychiatry, a science of exclusively medical orientation

But pathopsychology is already a component of medical psychology.

Methods of psychopathology are closely intertwined with diagnostics together with therapeutic methods in psychiatry. In many cases, severe neurological disorders of the central nervous system also bear signs of profound pathopsychological disorders.

Psychological disorders in children

In the process of growing up, a child undergoes a number of physiological and psychological changes. The formation of children's worldview is influenced by many factors, including the attitude of their parents towards them. If adults raise a child correctly, he grows up to be a mentally healthy person who knows how to behave correctly in society and in any situation.

Children who were exposed to daily violence at an early age perceive this parental behavior as the norm. As they mature, they will exhibit similar behavior to other people. All the negative aspects in raising young children make themselves felt in adulthood.

Famous psychiatrist D

McDonald identified the most dangerous signs in a child’s mental state, which need to be addressed as early as possible. If adults ignore these factors and do not take their children to a psychiatrist, they will have to face a number of serious problems in the future

Signs of psychological disorders in children:

• zoosadism - cruelty to animals (killing kittens, fish);
• inability to empathize with someone else's pain;
• coldness in expressing feelings;
• constant lies;
• enuresis;
• running away from home, love of wandering;
• stealing other people's things;
• early addiction to smoking, drugs, alcohol;
• desire to start arson;
• bullying of weak peers.

If a child demonstrates deviant behavior, it means that the parents made some mistake in raising him. Negative behaviors indicate symptoms of mental disorders only when they are repeated regularly. Parents need to take deviant behavior seriously and not let the situation take its course.

The source of the problem from a psychological point of view.

So, personality disorder in psychology is considered in two contexts - from the point of view of the social interaction of the individual with society, when the behavioral characteristics of a particular individual lead to psychological discomfort or social problems, or from the point of view of the properties and characteristics of the personality itself, when these characteristics again lead to to psychological discomfort and problems, only in this case the person himself suffers more.

Naturally, the concept of problem and discomfort can vary as widely as possible here. For an individual, this can be a state of mild anxiety or severe depression, and for society, problems can range from a real threat from the individual in the case of openly criminal behavior of the latter to small problems that are created, for example, by inappropriate appearance or behavior.

In any case, the signs of psychological deviations one way or another rest on the personal characteristics of the person himself and it is from this point of view that they are considered in psychology.

And in the context of a personality disorder (pathology), it is customary to talk specifically about the type of personality and its behavioral tendencies, which lead to the problems listed above.

It is believed that these problems are often associated with social disintegration of the individual, that is, his inability to form normal social relationships, where this inability is assessed precisely from the point of view of the very social stereotypes mentioned above.