Hospitalism

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Classification according to ICD-10
F43 Reactions to severe stress and adjustment disorders
F94.1 Reactive attachment disorder of childhood
F94.2 Attachment disorder of childhood with disinhibition
ICD-10 online (WHO version 2019)

Under Hospitalism (causally also Deprivationssyndrom called) one understands all negative physical and psychological accompanying consequences of deprivation, d. H. especially the more or less massive withdrawal of social interactions.

The worst causes include insufficient care and loveless treatment of infants and children by their primary caregivers (parents), as the disorders caused by this last for a lifetime and can only be treated to a very limited extent. Apart from the pain, the consequential costs caused by the restricted ability to work are enormous for any society.

Even today, orphanages and hospitals do not usually offer adequate psychosocial support, e.g. B. by missing and changing, but also unqualified staff.

The torture of even completely healthy adults through solitary confinement can also have a serious effect, which in extreme cases beyond social isolation means the withdrawal of all stimuli - especially visual and acoustic - such as B. in a pitch dark padded cell, includes.

The term deprivation comes from the Latin word “deprivare” for “rob” and refers here to the withdrawal of stimuli and psychosocial attention.

Causal designations

Depending on the cause and severity, hospitalism is also referred to as psychological hospitalism ( deprivation syndrome , psychological deprivation ) or infectious hospitalism. If the neglect is mainly psychological / emotional , one speaks of psychological hospitalism (deprivation syndrome, emotional deprivation). If the neglect consists in withholding nursing and welfare measures or if the mental or psychological deprivation is so severe that it manifests itself both mentally and physically, one speaks of infectious hospitalism ( nosocomial infection ). A clear separation of the terms cannot be made, or only roughly, because the transitions are fluid and the individual circumstances must always be taken into account. It is assumed that severe emotional deprivation also has physical consequences and, conversely, that severe neglect of nursing care also results in psychological symptoms.

Psychiatric hospitalism

Hospitalism in the ICD-10-GM

Depending on the nature of the fault for the label are Hospitalism different in clinical practice ICD-10 - diagnostic codes used, namely the following:

Causal differential names are used internally and individually, but do not have their own ICD-10 diagnosis code.

Kaspar Hauser Syndrome

In medicine and psychology , the term " Kaspar Hauser syndrome" is often used for the most severe form of hospitalism, with total withdrawal of stimuli in combination with abuse, incorrect posture or cooping up. The name of the "Kaspar Hauser Syndrome" is derived from the person Kaspar Hauser , for whom the negative consequences of hospitalism were very pronounced. The term is used both for children (seldom) and for animals (more often) who have been exposed to complete deprivation of stimuli and abuse for a long time and have thus been disturbed in their development . In addition to physical and mental underdevelopment, it also manifests itself in extreme anxiety .

An example of the “Kaspar Hauser Syndrome” is the story of the dog “Michi”, who was kept in a cage in the official Hamburg-Harburg dog depository since he was six months old. When this dog came into a family, it showed clear signs of social deprivation. He was extremely anxious outside the kennel. At first he reacted anxiously even to dogs. All the stimuli of the animate and inanimate environment frightened him greatly. The Kaspar Hauser symptoms described can probably be traced back to the isolated kennel in Harburg. Another example of the “Kaspar Hauser Syndrome” are children from orphanages and children's homes in Romania , especially under the rule of Ceauşescu . Up until 1990, over 100 children lived in the “ Cighid ” home under conditions characterized by dirt, cold, insufficient clothing, malnutrition and a lack of human attention. Many of them could not crawl or walk, despite their physical abilities, because they had not received any support or because their leg muscles had atrophied from long, motionless squatting.

Mental hospitalism (deprivation syndrome)

Mental hospitalism is also known as hospitalism syndrome, hospital damage, deprivation syndrome, anaclitic depression, or emotional / mental deprivation. The term hospitalism goes back to the Austrian pediatrician Meinhard von Pfaundler , who was able to prove in 1901 that hospital damage in infants and children in clinics can be associated with a mother separated.

It manifests itself in developmental delays and developmental disorders in the case of longer hospital or home stays as a result of impersonal care and inadequate individual attention (lack of stimuli, lack of attention). Through the admission to a home, loveless care at home, the separation of parents or even child abuse , the child often becomes anxiously reluctant or anxiously avoiding attachment to the educator. The children's basic trust is destroyed again at an early stage. Mental hospitalism often occurs in hospitals , children's and youth homes and also in some families, when the children are “processed” “like on an assembly line” and under time pressure, that is, when they do not receive sufficient attention. Walter Züblin spoke in his book “The Difficult Child” in 1971 of “stupid autistic people ” and “unresponsive idiots ”.

The research of known René Spitz in the development of the relationship between mother and child in the first year of life. Investigations of the infant's disturbed maternal relationships in the event of contradicting maternal behavior: active and passive rejection of the child, overprotection, alternating hostility and pampering , rejection concealed with friendliness. Such threats to the relationship lead to various severe psychological and psychosomatic disorders in the child , depending on the type of disturbed object relationship .

The Czech Child Psychology School under Zdeněk Matějček has conducted important long-term studies to examine the developmental conditions of children and their consequences in various settings (homes, day nurseries, day-care centers, boarding schools, families) well into adulthood.

Harry Harlow showed with young rhesus monkeys and a dummy mother made of wire mesh as a milk dispenser and a second with a fabric cover as a cuddly toy that cuddling is very important when growing up. Monkeys that grew up without playmates often appeared more anxious later than their conspecifics who had grown up with their peers. Animals raised in complete isolation were later so behaviorally disturbed that they were often no longer able to raise their own young.

The neglect of children and adolescents is related to psychological hospitalism ; they are left to their own devices. In the past, hospitalism was also called early neglect . There was early research on this by August Aichhorn .

Similar phenomena also occur in adults in hospitals , retirement homes and in psychiatry when they are carelessly cared for and are cut off from the rest of the population.

Similar disorders also occur in animals. In an animal experiment , chicks were kept isolated in different cages and observed. After a while, they sat in a corner of the cage and stared at the wall. With horses in the stable, one can sometimes observe that they sway back and forth when they are left to their own devices for a long time and are without external stimuli (so-called weaving ; further psychological behavior disorder: Koppen ( lack of guarantee )). Some zoo animals that have lived in captivity for a long time tend to stereotypes that manifest themselves in motor restlessness (e.g. walking back and forth on the wall). Polar bears, for example , who need a lot of exercise in nature and are severely restricted in the zoo, can see that they rock their heads back and forth like in a trance .

causes

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Hospitalism can arise wherever people have too few ( neglect ) or negative (rejection) emotional relationships ( attachment disorder ). One possible cause is, for example, a lack of staff in old people's homes, nursing homes, children's homes and hospitals. It can also be found in families in which the parents are overwhelmed with the care of the children or refuse to take care of them for any reason.

The lack of optical and acoustic stimulation promotes hospitalism, as can be seen from the following observations:

  • if children in orphanages are only "kept" in cots and have no opportunity to move around independently and freely and B. to play in the garden or with other children (see René A. Spitz ; Harry Harlow )
  • Long-term restraint of old or mentally ill people in nursing homes or psychiatric hospitals
  • Lack of sensory stimulation in clinics: colors, images, music

The lack of stimulation as a result of severe deprivation can be used to deduce the cause of the presence of repetitive stereotypes and disorders of perception processing. Therefore, especially in small children who are in a hospitalized environment, no reliable differential diagnosis to autism is possible, because in a state of severe deprivation, non-autistic children show almost the same symptoms. A clear differentiation between hospitalism and autism can therefore only be made outside of a hospitalizing environment, if the symptoms of hospitalism subside, while the (same) symptoms in autism remain in undiminished intensity.

Symptoms and complaints of hospitalism

Depending on the individual situation of the person affected by neglect , not all symptoms occur or, depending on the cause, are more physical or more emotional in nature. Symptoms of neglect may include:

Consequences and complications

The consequences of psychological hospitalism (deprivation, deprivation syndromes, anaclitic depression) can only be recognized at second glance, but can be more serious and long-term than with physical hospitalism. Possible consequences are psycho-affective disorders, i.e. delays and changes in drive, in perception and in feeling and thinking, as well as emotional dullness. The children can retard and / or later possibly develop an attachment disorder (ICD-10 F94), a borderline personality disorder (ICD F60.3) or an adjustment disorder (ICD-10 F43). Long-term patients in hospitals, old people's homes and institutions can regress and, for example, be affected by depression (ICD-10 F32).

prevention

Skin contact is now made possible between mother and child in hospitals (so-called bonding and rooming-in ). Children, especially at a young age, who cannot live with their parents, are preferably placed in specially selected foster families. Even for physically, mentally or emotionally disabled people (in need of care) there is now a broad repertoire of prophylactic and therapeutic interventions such as basal stimulation , kinaesthetics , milieu therapy , animal-assisted therapy, regardless of the respective type of living . Many institutions (hospitals and homes) provide professional social work , social pedagogy or occupational therapy and organize voluntary visiting services that maintain regular contact with old and sick people.

Differential diagnosis

There are other disorders with similar symptoms, such as: For example, early childhood autism , Asperger's syndrome , some types of depression , schizoid personality disorder and certain forms of schizophrenia . Similar behavior can occur with constant child abuse . The mental retardation must be distinguished from nosocomial, but can occur in combination. The disorder that outwardly looks most similar to mental hospitalism is autism (ICD-10 F84.0). However, the fact that the symptoms of hospitalism disappear over time with significant improvement in living conditions is what distinguishes this disorder from autism and enables a differential diagnosis, because autism, unlike hospitalism, is incurable.

Treatment and prognosis

The symptoms of hospitalism can be treated with early therapy, depending on the severity of the physical and psychological symptoms, whereby hospitalism requires psychological and physical therapy in equal measure. The symptoms go when the external circumstances improve, e.g. B. through intensive care and / or the change to a loving and caring environment, clearly back and disappear over time. Has there been no other disorder due to mental deprivation such as If, for example, a reactive attachment disorder develops, the symptoms disappear as life conditions improve and with patient and loving attention. The following applies: the sooner a person comes out of the situation of neglect, the better the chances of the symptoms disappearing quickly and completely. Long-term, intensive psychotherapeutic treatment may be necessary in severe emotional deprivation , but here too the prognosis is good if the child comes out of the situation of neglect and into a loving and caring environment as quickly as possible.

Outlook for solutions

In the meantime, attempts are being made to place refugee or orphaned children in suitable foster families or in children's villages so that there are no symptoms of deprivation. In Hamburg there is the Evangelical Foundation Alsterdorf , where people with cognitive disabilities and those without disabilities live together in a village.

Quality-conscious homes are a bright spot in the care of old and sick people, especially homes with small residential groups (so-called house communities ) according to the recommendations of the "Kuratorium Deutsche Altershilfe", assisted living facilities , the hospice movement for people in need of care in the acute phase of dying, the outpatient Care and integrative therapy programs as in Geel , where mentally ill people are taken in with families.

See also

literature

Non-fiction
  • August Aichhorn : Neglected youth. Psychoanalysis in Welfare Education. Huber, Bern 2005, ISBN 3-456-84260-0 .
  • Norbert Kühne u. a. (Ed.): Pedagogy for technical schools. Stam, Cologne 1997, ISBN 3-8237-5959-0 .
  • Lauren Slater: Of Humans and Rats. The famous experiments of psychology. Beltz, Weinheim 2005, ISBN 3-407-85782-9 (see chapter on Harry F. Harlow Affenliebe , p. 174 ff).
  • René A. Spitz : From infant to toddler. Natural history of the mother-child relationship in the first year of life. Klett-Cotta, Stuttgart 2005, ISBN 3-608-91823-X .
  • Josef Langmeier, Zdeněk Matějček: Mental deprivation in childhood: children without love. Urban & Schwarzenberg, Munich, Vienna, Baltimore 1977, ISBN 3-541-07901-0 .
Essays
  • B. Bynum: Hospitalism. In: The Lancet. Volume 357, 2001, p. 1372.
  • Harry F. Harlow: The Nature of Love. In: Otto M. Ewert: Developmental Psychology I. Kiepenheuer & Witsch, Cologne 1972, ISBN 3-462-00865-X .
  • Jean Itard : Opinion and report on Victor von Aveyron. In: Lucien Malson u. a .: The wild children. Suhrkamp, ​​Frankfurt am Main 2001, ISBN 3-518-36555-X .
  • Werner Köhler : Hospitalism. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 627.
  • Alfred Nitschke: The picture of homesick reactions in young children. In: Günther Bittner, Edda Harms (ed.): Education in early childhood. Pedagogical, psychological and psychoanalytic texts. Piper Verlag, Munich 1985, ISBN 3-492-00726-0 .
  • René A. Spitz: The Anaclitic Depression. In: Günther Bittner, Edda Harms (ed.): Education in early childhood. Pedagogical, psychological and psychoanalytic texts. Piper Verlag, Munich 1985, ISBN 3-492-00726-0 .
  • René A. Spitz: Hospitalism I & II. In: Günther Bittner, Edda Harms (ed.): Education in early childhood. Pedagogical, psychological and psychoanalytic texts. Piper Verlag, Munich 1985, ISBN 3-492-00726-0 .

Web links

Wiktionary: Hospitalism  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ Article in the dog magazine WUFF, issue 10-2002
  2. ↑ Ariane Barth: Night of Civilization . In: Der Spiegel . No. 13 , 1990, pp. 194-212 ( online ).
  3. ↑ Norbert Kühne : Early Development and Upbringing - The Critical Period. In: Teaching Materials Pedagogy - Psychology. No. 694, Stark Verlag, Hallbergmoos, 2012
  4. ↑ KDA