In 1964 the Senate Committee on Aging reported that "once
admitted to an institution ... the veteran begins ... to show signs
of social and physical degeneration," a phenomenon that has not
escapted the attention of clinicians, social scientists, veterans,
and other chronic-care patients.
Assuming that social withdrawal in the institutional setting was
avoidable ad that a strictly medical model of chronic care was
inappropriate, Lella and his collaborators established a
patient-government project designed to give thirty elderly men in a
large veterans' hospital, who suffered from various degrees of
social withdrawal, an opportunity to express their individuality
and independence and to shape institutional decisions.
"The Perils of Patient Government" goes well beyond a
description and analysis of the projects' successful side--a
general improvement in the lives of the veterans on Ward 23; it
also exposes and analyzes the project's failures, portraying
negotiation and conflict among change-oriented and conservative
staff of varying professional identities, ideologies, and career
strategies. While struggling over the idea and practice of patient
self-government, nurses, and other professionals did make progress
but also set severe limits on what patients could achieve for
themselves. As well, Lella's study tackles the larger question of
how change affects organizations and institutions.
Lively and well-written, this is an enlightening work for
students of gerontology and geriactics, for professionals and
para-professionals, administrators, and policy-makers involved in
chronic care, and for researchers probing the fields of medical
sociology and institutional organization.
General
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