144

DEVELOPMENT OF STATUS WITHIN A GROUP OF

FEEBLEMINDED WOMEN

AGNES MILES* and R. MEIN

Harperbury Hospital, near St. Albans, Herts.

INTRODUCTION

The social system which develops within the ward may differ from that of thewider hospital community and of society at large. The ward's social structure mayinfluence a patient's conduct and contribute to treatment. One important aspectof this is the patient's status within the group.

A recent study in this hospital, using the method of participant observation,revealed that certain feebleminded women played dominant roles in the ward.Some were sought after as friends and received requests for help and advice;others, although not particularly liked by their fellows, nevertheless gave orderswhich were obeyed.

The purpose of the study described in this article was to devise a method,which would measure a patient's status as seen through the eyes of her fellowpatients, and to use it for examining associated features. Status was defined as "theplace in a particular system which a certain individual occupies at a particulartime . . ." (Linton, 1945).

Few articles were found in the literature which reported studies directly relevantto this question. However, Sutherland, Butler, Gibson and Graham (1954) reporteda sociometric study of female adult patients in which popularity was found to bedirectly related to intelligence. Hays (1951), in a sociometric analysis of defectivesusing "the one best friend" method, found that defectives of high mental agereceived a proportionately greater number of choices than those of low mental age.More recently Marden and Farber (1961) reported that work status, attendancefor occupational therapy and intelligence were important status determinants.

SAMPLE

The patients studied consisted of 29 females in a ward of 67. This sample wascomposed of 19 patients with LQ.'s of 50 and above and 10 patients of lower LQ.who were named by them in the course of the investigation. The patients wereclinically heterogeneous with a mean LQ. of 55.4 S.D. 14.9 range 77-20. (See Table 1.)

•Recipient of a grant from the National Society for Mentally Handicapped Children atthe time of this study.

[Received June 4th, 1964)

AGNE KS and R. ME

ble IDescrif if satnple (N =

Monetary reword

Mpan S.D. "

I.Q. 14.9

C.A. (years) 12.2

Length of stay (year 8.3

Status score 5.7

METHODIn order to elicit a measure of c^ntns a questionnaire A^,:^.,r,/i mintiiv

three categories of information cndix). Questi'sociometric-type, questions 2, ."i 2, 13 and 15within the ward, and questior id 14 concernEach question required mereK c of another |answer. One name only was i This restricticchances of valid responses from (^ .̂......o who had comnit. .iv.o. .questions (6, 9, 11 and 14) were designed to elicit respoins concerning negati^characteristics. Status score consisted of the number of tinn--; a patient was choseby other patients in the group. Tli latient receiving . '•was seen as occupying a position of h.. >tatus through the

RESULTSStatus scores ranged from 1-23 with a mean of 7.1, S.l {an- Table 1).

The following hypotheses were examined :

(a) Status was related to intelligenceSince Sutherland, et al. (1954), reported a relationshi] tween popularity an.

intelligence it might be argued that, among the subnormal Mien, status would 1conferred on the patient who most nearly approach( '• hospital staffintellectual level. However, the correlation coefficient r o (N = 29) for statscore and I.Q. does not achieve significance at a 5 per cei I of confidence.

(b) Status was related to C.A.As, in many communities, age carried position and rcspdii.sibility through th

effect of experience the possibility of a status/age relationship could not be excluded.However, the r of —0.13 between status score and C.A. was not significant.

(c) Status was related to length of stay in the hospitalIt seemed reasonable to postulate that patients who had spent a number of

years in the hospital had a greater knowledge of the formal rules and informal"feel" of the hospital. Over the years they would have become known intimately t"members of the hospital staff and, consequently, might occupy a special position

146 STATUS IN FEEBLEMINDED WOMEN

Table 2Preference score and monetary reward

Status score Below 4/11. Above 5/-

above 7 I 10

7 and below 14 4

within the ward group, recognised by the other patients and an influence in theirchoices. This hypothesis was not, however, sustained. The r of —0.14 between statusscore and length of stay was not significant.

(d) Status was related to patients' monetary rewards

The inclusion of monetary reward introduces a variable which is less objectivethan I.Q., C.A. and length of stay. Although the size of reward is to a certainextent related to the type of work the patient carries out in the hospital, it is subjectto fluctuations dictated by the patient's behaviour in the hospital. Anti-socialbehaviour within the hospital has traditionally been, and still is, dealt with bytemporary withdrawal of certain privileges. A temporary reduction in monetaryreward may be part of the sanction imposed. On the other hand an increase inreward within certain limits tends to reflect authority's recognition that therehabilitation of the patient is proceeding successfully. Since, in many societies,monetary reward influences the perception of the individual's status by others, itwould not be unreasonable to expect a similar influence among the patients. A2 x 2 contingency table (see Table 2) relating status score to earnings above andbelow 5s. per week showed a x' of 10.29 for one degree of freedom, significantbetween a .01 and .001 level.

DISCUSSION

The results of this preliminary study suggest that among the factors influencingstatus in the subnormal patients, intelligence played an insignificant role. It shouldbe noted, however, that this finding pertained only to the relatively small high-grade group studied. Prolonged observation of the total ward group suggested athree-tiered stratification among patients which appeared to be closely related tointelligence level (Miles, 1965). However, more recent findings with psychopathicmales in this hospital suggest that some patients of normal intelligence achieve littleor no status within a group of mixed intelligence. It should be borne in mind thatthe reports of Sutherland, et al. (1954), and Hayes (1951) which confirmed a relationbetween popularity and intelligence were concerned with a measure which may notbe synonymous with status as measured in the present study. Marden and Farber(1961) whose study was in many respects similar to the present study report a lowbut significant correlation between intelligence and "high-brow" status amongst

AGNES MILES and R. MEIN 147

mentally retarded boys. These authors used the specific question "Is . . . ahigh-brow or a low-grade?" The method of questioning used in the presentstudy did not, however, indicate in such specific terms the variable to bemeasured. On the other hand the two studies tend to confirm the relationshipbetween work status (and reward) and ward status. This may not be surprising sincea satisfactory work record in the hospital is considered by the staff to be a measureof social adjustment and social competence within the total hospital group. Agood work record reflects not only the patient's technical competence in her jobbut also her understanding of what is required of her. Additionally it reflects herability to make good social relationships with others. Monetary reward, therefore,represents an objective measure, the value of which lies in its "overlapping"(Wilkins, 1955) areas of information which do not lend themselves to measurement.It reflects, in fact, the resultant of the opinions of senior nursing staff and hospitalpsychiatrists about the patient.

Perhaps the most significant finding in this study is that the factors in thepatient's behaviour which influence status within the group appear to coincide, toa great extent, with those which are regarded by the staff as evidence of responseto treatment. In describing psychotherapeutic treatment of high-grade patients aparanoid social structure within the hospital was postulated (Shapiro, 1962). Thepresent results suggest that, on the contrary, in spite of the fact that individualpatients rebel against the hospital authority, patients' group values agree with thoseof the professional staff with whom they come in contact.

SUMMARY

In a group of subnormal women patients, status was found to be closelyrelated to size of patients' monetary reward. Intelligence, age and length of stayin hospital were not significantly correlated with status score. It is argued thatmonetary reward is an objective measure which "overlaps" other areas ofinformation which are not directly measurable. It is suggested that these flndingsdo not support the concept of paranoid culture within patients' groups.

ACKNOWLEDGEMENTS

The authors are indebted to Dr. A. Shapiro, Consultant Psychiatrist,Harperbury Hospital, for advice and encouragement during this study.

REFERENCES

HAYS, W. (1951) Mental level and friend selection among institutionalised defective girls.Amer. J. ment. Defic, 56, 198.

LiNTON, R. (1945) The Cultural Background of Personality. New York: Appleton-Century-Crofts.

MARDEN, P. W. and FARBER, B. (1961) High-brow versus lovif-grade status among institutional-ised mentally retarded boys. Soc. Probs., 8, 300.Sj A. (1965) Some aspects of culture amongst subnormal hospital patients. Brit. ]. med.

Psychol. (to appear).

148 STATUS IN FEEBLEMINDED WOMEN

SHAPIRO, A. (1962) Problems of Psychotherapy. Proceedings of the London Conference on theScientific Study of Mental Deficiency. Dagenham : May & Baker Ltd. 263.

SUTHERLAND, J. S., BUTLER, A. J., GIBSON, D . and GRAHAM, D . M. (1954) A sociometric studyof institutionalised mental defectives. Amer. J. ment. Defic, 59, 266.

WILKINS, L . T . (1955) Some developments in prediction methodology in applied social researchBrit. J. Soc, 6, 348.

APPENDIX

QUESTIONNAIRE

1. Who is your best friend ?

2. Who would be the best to look after the old patients on the Ward?3. Who is the best looking girl ?

4. If you had a secret with whom would you share it ?5. Whom would you turn to in trouble?6. Who tells tales to the Sister?

7. Who is the most popular girl ?8. Whom do you like to spend your free time with ?

9. Who is the most quarrelsome ?10. Who should be the first to take a job outside?11. Whom do you have the most trouble with ?

12. If the patients had a complaint to make to the Medical Superintendent whowould be the best to talk to him ?

13. Who would be the best to be put in charge of the others?14. Who has bad manners?15. Who is the most helpful ?