Hospitalism syndrome in children psychology abstract

Hospitalism is a whole series of psychological and somatic disorders that are provoked by a person’s prolonged stay in a medical institution far from loved ones and his own home. This concept best defines hospitalism in adults, and in children the phenomenon of hospitalism manifests itself as psychopathic and physical underdevelopment, which begins in infancy and continues as the child grows up, under certain circumstances that arise - as a result of a lack of adequate communication between the child and the mother and a lack of elements education.

Hospitalism syndrome is manifested by a slowdown in development, difficulty in children mastering basic skills of self-care and control of their own body, underdevelopment of the speech apparatus, a reduced level of adaptation to the environment and society, loss of interest in work activity and work skills in general, low resistance to infectious agents and a tendency to chronicity pathological processes in the body. It is in childhood that the symptoms of hospitalism are long-lasting and often irreversible. In the most severe cases, with non-treatment and prolonged psychological oppression, hospitalism syndrome leads to the death of the individual.

Hospitalism is a phenomenon of lag in psychology ; the term was first introduced by the Austro-American psychologist Rene Spits. It was he who carried out research over a long period of time - observing children in a hospital setting, without the mother being nearby. Thanks to the origin of the research, the name itself arose - hospitalism. Much later, the concept gained expansion and began to include not only separation in terms of health, but also the general lack of interest of the mother in her child, and this can happen even if they are constantly in direct proximity to each other.

The essence of deviation

The phenomenon of hospitalism suggests the presence of a number of mental and somatic disorders that occur in children and adults for various reasons.
In the first case, the deviation is due to a lack of communication, attention and education; in infants, it is due to separation from the mother. Hospitalism syndrome in children is expressed in mental and physical underdevelopment and often leads to irreversible consequences, and in the absence of treatment, to death.

In adults, the disorder develops during a long stay in the hospital, in conditions of lack of communication and manifests itself in avoidance of existence in society, loss of interest in work and activity, loss of work skills, and interest in staying in a hospital setting for as long as possible. The longer a patient's stay in a hospital, the less chance of his preservation as a unit of the social environment.

Diagnosis and treatment

Diagnosis of hospitalism includes the following clinical methods:

1. Anamnesis collection - interviewing the patient’s parents and close relatives, staff and other persons who regularly contact him;
2. General examination of the patient by a pediatric neurologist, psychiatrist, clinical psychologist;
3. Neurological examination - determination of muscle strength and tone, response to external stimuli, complex targeted movements, identification of existing diseases of the nervous system;
4. A psychological examination makes it possible to assess the patient’s psychomotor development, ability to communicate and respond adequately, to care for oneself independently, as well as to detect lags in the mental and emotional sphere;
5. Dynamic observation of the patient is necessary to make a final diagnosis.

Ideal conditions for degradation

Hospitalization in children and adults occurs for the following reasons:

1. Prolonged hospitalization , the conditions of which isolate a person from communication with family and friends, while the circle of communication is limited to medical personnel. The risk factor in this case is chronic diseases that require frequent long courses of treatment in a hospital setting.
2. Separation of a child from his mother.
3. Lack of attention from the mother and those close to the small child , disinterest in him, his life and his development as a person.
4. Age . In infancy and childhood, children raised in orphanages, boarding schools and other places of a similar nature do not receive the necessary attention and care. This makes social adaptation difficult. Old age also contributes to the development of hospitalism, especially if old people stay in specialized institutions - nursing homes, boarding schools. Lack of attention and lack of love cannot but affect the psycho-emotional state of a person in his later years.
5. Long stays for both children and adults in health centers , where the environment and daily routine are similar to hospital conditions.

Factors that provoke the development of the syndrome also include the poverty of the psychological environment and lack of emotional contact.

Case in California

The fact that hospitalism occurs in the absence of normal upbringing and isolation from society is clearly demonstrated by a relatively recent case that occurred in the American town of Arcadia.

Social services found a thirteen-year-old girl in the closet of a city house. The savage grew up in a cramped room, without seeing sunlight, without normal nutrition, conditions for caring for the body and any communication.

The girl's mother turned out to be a mentally ill person. She was unable to give a single adequate answer about her treatment of the child. If the social service worker had not discovered the terrible discovery, the girl was in danger of imminent death, since her body was already in a catastrophic state.

The girl was given the name Jenny and placed in a clinic at the University of California

She was given first aid and nursed under the close attention and care of a team led by the famous psychologist D. Rigler

Doctors tried to return Jenny to her human form, but the results were disastrous: the girl never learned to express her thoughts and communicate. All her behavioral skills were reduced to only the most primitive reflexes.

By studying this case, which is directly related to the disease called “Hospitalism,” psychologists once again proved the vital need for a person to have harmonious communication and interaction with society.

Basic ideas of Spits theory and modern view

American psychologist Rene Spits (Spitz), studying the behavioral characteristics of residents of boarding schools, explained the phenomenon of hospitalism as follows: even in a favorable sanitary and hygienic environment, with conditions of satisfactory nutrition and care, children deprived of the opportunity to communicate with their parents experience developmental delays - slow development of thinking and speech.

At the same time, the psychologist previously believed that an important condition for the development of hospitalism syndrome is a lack of vitamins in the diet and the small number of personnel called upon to provide care for children.

Rene Spitz

Spitz's followers, further studying the phenomenon, somewhat expanded the concept of the term “hospitalism.” From the point of view of modern researchers, a similar syndrome occurs not only when a child is separated from his mother, but also if close people, being close to the child, do not show interest in him and do not take part in the process of his development and formation.

Hospitalization is especially dangerous for children, as it significantly inhibits their development. Some mental and physical disabilities can last a lifetime.

Hospitalization

Speaking about hospitalism syndrome, it is also necessary to mention the problem of hospitalization of children for medical reasons. The heads of children's hospitals have always had a negative attitude towards the hospitalization of children together with their mothers, citing the requirements of hospital asepsis. Of course, anxious mothers of sick children create additional burden on medical staff, and it is better to meet with them only during hospital visiting hours

But it is important for a small child to be close to his mother, especially during illness

Just one week of separation is enough for the development of anaclitic depression. But the problem of diagnosis is that it is difficult to distinguish from apathy and depression in a sick child. And when the mother came to the hospital to visit her child, she discovered that he was not at all happy with her, looking away, not reacting to her words (a typical sign of anaclitic depression). And if a mother went to the doctor with an alarming message that something was wrong with her child, she could receive a logical answer: “Well, what do you want? He’s sick!”

In my opinion, if a child aged 6 months to three and a half years is taken out of his usual environment even for 1 day, this will be enough to forever leave a scar in his soul. Of course, he will not remember the injury itself, but it is difficult to predict how this scar will respond in his subsequent life (I will write more about premature separation in.

Interestingly, the more care and attention a child receives at home, the more difficult he experiences hospitalization associated with separation from his mother. But this is natural, the more you have, the more painful it is to lose it.

But today, more and more children's hospitals allow the presence of mothers near sick children, understanding how traumatic separation from the mother can be for a child, causing a deterioration in well-being and delaying the recovery period (although they do not always create acceptable conditions for mothers to stay with their children).

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Hospitalism syndrome occurs as a result of the most severe deprivation, which, I hope, does not occur in civilized countries in our time. The next part of the article will describe the features of the occurrence of mental disorders during moderate but long-term deprivation. We will talk about the very common concept of introversion.

, which we do not even consider a manifestation of pathology.

these children can be found in another book by René Spitz, “ The First Year of Life

"
In it, he also talks about ninety-one babies separated from their mothers after three months. But here he points out that it happened in an orphanage outside the US. It turns out that, with long intervals, he could observe these children up to four years old. Spitz emphasizes: “The food, hygiene procedures, and medical care were no worse than in any other institution known to me, and in some ways they were superior
. But the children continued to experience deprivation in this orphanage, and its consequences were monstrous:

“By the age of 4, most children, with only a few exceptions, have not learned to sit, stand, walk or talk. The progressive deterioration of the general condition and increasing susceptibility to infection led to the death of children or to marasmus."

The phenomenon of hospitalism in infancy

In infancy, the general condition of children abandoned by their mothers or suffering from a lack of their care and attention is characterized by the following indicators:

• refusal to eat, rapid weight loss;
• the child is constantly in a sleepy state and shows no signs of activity;
• muscles lack tone, limbs are limp and flaccid;
• there is no backlash to contacts.

Babies with this syndrome later begin to hold their heads, crawl, sit up independently, and walk. Their movements are less coordinated, unstable and uncertain.

Symptoms

Infants in the first six months of life develop correctly and in a timely manner, if they do not have congenital pathologies. Starting from the age of six months, the formation slows down, and the phenomenon of extinction occurs. Since hospitalism affects physical and personal development, children experience manifestations of psychomotor disorders. Patients have psychophysical underdevelopment, which begins in infancy and progresses as the child grows older.

Symptoms of hospital syndrome in children:

1. Late formation of a complex reaction of revival - lack of smiling, screaming, humming, babbling when familiar faces appear, inability to fix the gaze on an object, tearfulness;
2. Impaired motor development - lack of sucking skills, underdeveloped reflexes, late holding the head and turning the body over, incoordination of movements, unstable and uncertain actions, inability to take a toy and transfer it from hand to hand;
3. Autonomic disorders - a rise in body temperature for no obvious reason, weakness, apathy, decreased muscle tone, drowsiness or insomnia, refusal to eat, short stature and low weight, underdevelopment of the musculoskeletal system, urinary and fecal incontinence, decreased overall body resistance to infections, chronic course of existing diseases;
4. Delayed speech development and progressive speech dysfunction – unintelligibility of speech, loss of intonation;
5. Emotional and personal disorders - crying and aggression in response to adults, indifference to everything that happens around, underdevelopment of higher emotions, lack of interest in communication, apathy, isolation or emotional irascibility with crying, screaming, fighting, disinhibition, antisocial behavior, lack of compassion, pity, shame, guilt, obedience, silence, indifference;
6. The appearance of stereotypical movements and obsessive actions - swaying the body, shaking the head, thumb sucking, chaotic movements of the arms and legs;
7. Intellectual disorders - inability to master basic skills, the predominance of inhibition processes over excitation, decreased adaptation in society, lack of role-playing games, severe mental retardation;
8. Changes in the central nervous system - neurasthenia, psychosis, signs reminiscent of autism, fear of toys, touches and looks, lack of self, uncertainty, stiffness of movements and slowness, constant anxiety, frequent conflicts, signs of depression, mood swings.

Clinical signs of pathology in adults:

• Lack of interest in professional activities and a desire to idle,
• Apathy, passivity, indifference,
• Fear of being discharged from the hospital,
• Reluctance to communicate with people, isolation,
• Constant conflicts with others,
• Meaningless and monotonous, often repeated, obsessive movements,
• Emotional impoverishment.

Elderly individuals with hospitalization suffer from progressive brain dysfunction. They experience mental disorders, manifested by memory lapses; thinking becomes inadequate - patients perceive real events distorted. General signs of pathology include: lethargy, apathy, weakness, cachexia, stiffness of movement, muscle rigidity, lack of initiative, carelessness. Patients lack plans and hopes, they become inhibited, lack of initiative, mannered, exhausted, and inactive. Most patients have a negative attitude towards returning to work after discharge. They don't read, don't watch TV, and rarely leave the house. Their gaze becomes frozen and distant, their limbs twitch slightly. Over time, signs of dysfunction of the vestibular apparatus appear, helplessness in matters of self-care and behavior in everyday life increases, personal regression and emotional emptiness develop.

Childhood deprivation

Children, in response to separation from their mother or lack of attention and love, develop hospitalism, which manifests itself in severe mental retardation, deficiency in body weight and height, and deviations in mental development.

Babies do not respond to sound or movement of an object and cry for a long time for no reason. Older children deliberately bang their heads against the wall and master neatness skills late - usually only after 3-5 years.

They often experience urinary incontinence - both nighttime and daytime, and stool loss. Such children's sleep is superficial. They do not have enough positive emotions, they refuse contacts, and are not drawn to people. Their process of personality formation is disrupted.

All these phenomena lead to severe mental disorders, for example, autism, mental retardation.

Sometimes hospitalization can cause the death of a child, especially when an infection is attached that the weakened body is not able to fight.

Causes of the disorder

Hospitalism provokes a lack of adequate sensory, emotional and intellectual contact with an adult in a young child. Newborn babies and children with poor health are at risk.

Children suffering from this pathology begin to lag behind in psycho-emotional and physical development. Complications include growth retardation, lack of body weight, and disruption of the gastrointestinal tract. Lack of medical care leads to the formation of complex psychiatric disorders. Including childhood autism, schizophrenia, infantile marasmus, which can cause disability.

Diagnosis is carried out based on consideration of the factor of mental deprivation. A child psychologist and psychotherapist, a defectologist, and a therapist take part in the examination. A family history is being studied. An additional risk is the presence of psychological illnesses in the family, smoking, drug and alcohol use by parents during pregnancy and by the mother during the months of gestation.

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.

The phenomenon of hospitalism in psychiatry

Separately, it should be noted that the conditions of stay in a psychiatric hospital create a risk of pharmacogenic personality regression, which is the most severe form of hospitalism.

This phenomenon develops very quickly, and the situation is aggravated by the fact that patients become accustomed to psychotropic drugs in a short time. Such people lose the desire to study or work, or to exist outside of hospital life at all.

After reducing the dosage of psychotropic drugs, the patient's interest in his surroundings is partially restored.

How to act

Treatment for hospitalism differs between children and adults. This syndrome is especially dangerous for children, which is why therapy takes much longer than recovery for adults.

To return a child to the social environment and restore his interest in life, it is necessary:

• work with a psychologist;
• pedagogical correction;
• expanding your social circle;
• intensifying the child’s communication with peers.

If the syndrome occurs when a child is placed in a hospital setting, it is necessary to return him to the family as quickly as possible, and while he is in the hospital, regularly visit him and show interest in him; the best option would be to organize the mother’s presence around the clock child.

When treating adult patients, the problem is treated as follows:

• if possible, eliminate the symptoms of the disease due to which the patient is forced to remain in hospital, as well as its root cause;
• carry out rehabilitation with a psychotherapist;
• provide the patient with attention and care from loved ones.

Notes

1. ↑ Ovcharenko V.I.
   [https://slovari.yandex.ru/~%D0%BA%D0%BD%D0%B8%D0%B3%D0%B8/%D0%9A%D0%BB%D0% B8%D0%BD%D0%B8%D1%87%D0%B5%D1%81%D0%BA%D0%B0%D1%8F%20%D0%BF%D1%81%D0%B8%D1% 85%D0%BE%D0%BB%D0%BE%D0%B3%D0%B8%D1%8F/%D0%93%D0%BE%D1%81%D0%BF%D0%B8%D1%82 %D0%B0%D0%BB%D0%B8%D0%B7%D0%BC/ Hospitalism] // Psychological Lexicon. Encyclopedic Dictionary: In 6 volumes / ed. N. D. Tvorogova, editor-compiler L. A. Karpenko; under general ed. A. V. Petrovsky. - M.: PER SE, 2007.
2. ↑ Konechny R., Bouhal M.
   Psychology in medicine. - Prague, 1974. - pp. 290-296.
3. ↑ Golovin S. Yu.
   [https://vocabulary.ru/dictionary/25/word/%C3%CE%D1%CF%C8%D2%C0%CB%C8%C7%CC Hospitalism] // Dictionary of a practical psychologist .
4. ↑ [https://vocabulary.ru/dictionary/30/word/%C3%CE%D1%CF%C8%D2%C0%CB%C8%C7%CC Hospitalism] // Big psychological dictionary / Comp. Meshcheryakov B., Zinchenko V. - Olma-press, 2004.
5. Wilson RS; Hebert LE; Scherr PA et al
   (March 21 2012).
   “[https://www.neurology.org/content/early/2012/03/21/WNL.0b013e31824d5894.abstract Cognitive decline after hospitalization in a community population of older persons].” Neurology
   . DOI:[//dx.doi.org/10.1212%2FWNL.0b013e31824d5894 10.1212/WNL.0b013e31824d5894].
6. Bleikher V. M., Kruk I. V.
   [https://vocabulary.ru/dictionary/28/word/%C3%CE%D1%CF%C8%D2%C0%CB%C8%C7%CC Hospitalism] // Explanatory dictionary of psychiatric terms. — 1995.
7. Kisker K.P., Freiberger G., Rose G.K., Wulf E.
   Psychiatry, psychosomatics, psychotherapy / Transl. with him. AND I. Sapozhnikova, E.L. Gushansky. - Moscow: Aletheia, 1999. - 504 p. — (Humanistic psychiatry). — 5000 copies. — ISBN 5-89321-029-8.
8. ↑ Putyatin G. G.
   [https://www.psychiatry.dsmu.edu.ua/1/3(20)2008.pdf#page=16 Diagnostic criteria and clinical characteristics of hospitalism syndrome in patients with schizophrenia] // Journal of Psychiatry and medical psychology. - 2008. - No. 3 (20).
9. Abramova I.V.
   [https://psychiatry.dsmu.edu.ua/1/2(6)1999.pdf#page=113 Personality regression in institutionalized psychiatric care] // Journal of Psychiatry and Medical Psychology. - 1999. - No. 2 (6).
10. Putyatin G. G.
    [https://www.psychiatry.dsmu.edu.ua/1/1(17)2007.pdf#page=53 Socio-psychological features of hospitalism in patients with paranoid schizophrenia] // Journal of Psychiatry and Medical Psychology . - 2007. - No. 1 (17).

Prevention of the syndrome

Prevention of dangerous hospitalism syndrome in children is to fill the child’s day as much as possible with interesting activities, games, and possibly work.
If possible, you should provide sufficient attention and care from loved ones, talk to the baby, discuss everything that interests him. In adult patients, it is possible to prevent the development of this phenomenon by providing them with a social circle, allowing them to place photographs of loved ones or objects reminiscent of home in the ward.

It is necessary to maintain the patient’s social activity - if the condition allows, to involve him in simple assistance in caring for other patients, to ensure independence and independence in meeting his needs.

Manifestations at an early age

Among the most important symptoms of pediatric hospitalism are the following:

• Improper physical development.
• Delayed ability to walk, speak, and impaired fine motor skills.
• Psychological, facial and emotional scarcity.
• Unnecessary, constantly repeated movements - snapping fingers, rocking in a chair, shaking your head, etc.
• Tendency to infectious diseases, mainly colds, and low immunity.

In babies under one year of age, the syndrome manifests itself in the fact that they slowly gain weight and refuse to eat, sleep a lot and are practically inactive, have weak muscle tone, and do not respond to voices and other stimuli.
Today it is no secret to anyone that a child can develop normally only if he feels parental love. We recommend: What is cognitive development?

In the case when the baby does not have parents, they rarely play with him, do not engage in physical education, and do not teach him to move correctly. Some psychologists believe that if every child who spends a long time in a hospital or lives in a boarding school had a personal nanny who could become at least temporarily a mother, hospitalism syndrome in children would be out of the question in the modern world.