'NERVIOS' OR PSYCHOSIS?: AN ETHNOGRAPHY OF PUERTO RICAN PSYCHIATRIC PATIENTS IN A NEW YORK CITY TREATMENT PROGRAM (DE-INSTITUTIONALIZATION, MEDICAL ANTHROPOLOGY)

The quality of life for long term psychiatric patients has become a major social concern. However, there has been a tendency to conceptualize this population as a singular group, with little attention given to the implications of ethnic, class, or community differences. Using an ethnographic perspective, based on participant observation, this dissertation addresses the differential impact of de-institutionalization by describing the daily lives of a group of Puerto Rican psychiatric patients involved in a New York City treatment program. The nature of the patient's community life, conception of mental illness, and support systems are described. Also, the mental health professional's own cultural constructions are compared with those of the patients'. Interestingly, the biomedical interpretation tends to emphasize disability and chronicity while the indigenous model does not reduce the patients' identity to only include a sick role. Because of the nature of the community supports (kin and non-kin) as well as their explanatory model, these patients interact regularly with their non-patient peers. This finding contrasts sharply with descriptions of other "chronic" psychiatric patients who are found to live in a high degree of isolation from their non-patient peers, and form what some have labeled a subculture. Based on findings, recommendations are offered concerning patients' families, insight oriented therapy, self-help groups, and staff training.