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.

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.

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.

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.

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.

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 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.

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.

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.

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.

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.

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.

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.

Possible complications

In the absence of careful child care, medical supervision, psychological and pedagogical support, hospitalization can lead to the following complications:

• delayed physical development: lack of weight, height, underdevelopment of the musculoskeletal system;
• poor care, non-compliance with hygiene standards, reduced immunity lead to the development of infections;
• mental disorders: mental retardation, neuroses, pseudo-autistic symptoms, depression, psychopathy;
• psychological problems: communication difficulties, aggressiveness, increased anxiety, lack of self-confidence, conflict.

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.

How to act if the syndrome is diagnosed?

Hospitalism in psychology is a phenomenon that can be corrected, provided that assistance is provided in a timely manner, when the processes of regression and stagnation of personality have not become excessively deep. The ideal option for eliminating negative symptoms is to return the child to his native environment with his mother.

Such therapy, provided there is an adequate favorable climate in the family, is best able to heal childhood trauma resulting from forced separation.

However, such a positive scenario is often impossible in the realities of modern social orphanhood, when only a small percentage of children end up in orphanages due to the death of their parents, and the majority end up there as a result of the asocial lifestyle of their immediate environment.

That is why specialist psychologists, psychotherapists and teachers work with children in orphanages and try to correct these conditions through classes. Adults suffering from hospitalization in a hospital setting can also receive similar assistance.

Treatment for children is based on systemic psychological and pedagogical correction and social adaptation; in adults, psychological assistance is used to regain lost social skills.

Exercise games for children

When planning classes with children with symptoms of hospitalism, specialists include educational and training games:

• attention;
• thinking;
• memory.

These can be role-playing games in which you need to work in pairs, interact and compete. Through games, the child undergoes active socialization, learning to operate with skills, knowledge and abilities.

In the case of children in orphanages, play helps them better understand how the objective and social world works. An important point is the organization of such classes. To achieve better results, we work with children individually, as well as organizing them into small groups.

Treatment of nervous and depressive conditions

Often, the result of a long stay in institutional institutions is the development, both in children and adults, of borderline states - various neuroses, depression. Against the backdrop of grief (illness, separation from close relatives), all these conditions only intensify; a person’s anxiety, fears and tension increase.

To correct such conditions, psychotherapists work with children or older people, whose task is to create a positive emotional state. In cases of severe forms of depression, special medications may be prescribed to help patients overcome this condition.

Pedagogical support

Teachers working with children with hospitalism try to develop their social communication skills. They provide them with active support, helping them to join children's groups and carrying out rehabilitation activities. They help maintain the relationship between child and mother.

In addition to classes in institutions, children can be raised in family-type homes, where a female teacher acts as a mother for 5-8 children. Such forms of raising children without parental care are becoming increasingly popular and are more preferable to raising children in orphanages.

In family-type houses, married couples usually work, replacing mother and father for children. The positive dynamics of the development and upbringing of children in such families indicates the effectiveness of these forms of placing children and reducing the burden on their psyche in comparison with staying in orphanages and boarding schools.

Children placed in such families see the distribution of roles between husband and wife and the overall organization of family life, which contributes to their better subsequent adaptation in life and minimizing the consequences of hospitalization.

Drugs to correct emotional instability

Psychotropic medications can be prescribed by specialists when hospitalism is severe. Treatment is selected individually, taking into account the patient’s medical history and age.

The purpose of such drug support is:

• stop regression in development;
• correction of emotional instability;
• stimulation of cognitive functions.

  
  Tenoten

Medicines can be used to treat both adults and children. These can be mild drugs (Tenoten, Noofen) and more serious drugs prescribed for autism spectrum disorders and severe depression (Cortisone).

Means to stimulate the development of cognitive functions

One of the problems of hospitalization in children is a decrease in cognitive abilities, as a result of which their desire to learn new things and their learning ability decrease. The task of psychologists and teachers is to restore this mechanism.

Specialists sometimes have to re-teach children how to build communications and stimulate the emotional sphere. Classes are conducted individually, or, if there is positive dynamics, in small groups.

To motivate patients with hospitalization for cognitive activity, the following is used:

• activities that develop fine motor skills (finger games with young children);
• music therapy;
• art therapy;
• body-oriented psychotherapy (massage or contact exercises aimed at relaxing tensions that arise from neuroses and depression);
• trainings to help restore communication skills;
• family consultations for a sick person and his loved ones.