雅思阅读真题+题目+答案：Care in the Community
'Bedlam' is a word that has become synonymous in the English language with chaos and disorder. The term itself derives from the shortened name for a former 16th century London institution for the mentally ill, known as St. Mary of Bethlehem. This institution was so notorious that its name was to become a byword for mayhem. Patient 'treatment' amounted to little more than legitimised abuse. Inmates were beaten and forced to live in unsanitary conditions, whilst others were placed on display to a curious public as a side-show. There is little indication to suggest that other institutions founded at around the same time in other European countries were much better.
Even up until the mid-twentieth century, institutions for the mentally ill were regarded as being more places of isolation and punishment than healing and solace. In popular literature of the Victorian era that reflected true-life events, individuals were frequently sent to the 'madhouse' as a legal means of permanently disposing of an unwanted heir or spouse. Later, in the mid-twentieth century, institutes for the mentally ill regularly carried out invasive brain surgery known as a 'lobotomy' on violent patients without their consent. The aim was to 'calm' the patient but ended up producing a patient that was little more than a zombie. Such a procedure is well documented to devastating effect in the film 'One Flew Over the Cuckoo's Nest'. Little wonder then that the appalling catalogue of treatment of the mentally ill led to a call for change from social activists and psychologists alike.
Improvements began to be seen in institutions from the mid-50s onwards, along with the introduction of care in the community for less severely ill patients. Community care was seen as a more humane and purposeful approach to dealing with the mentally ill. Whereas institutionalised patients lived out their existence in confinement, forced to obey institutional regulations, patients in the community were free to live a relatively independent life. The patient was never left purely to their own devices as a variety of services could theoretically be accessed by the individual. In its early stages, however, community care consisted primarily of help from the patient's extended family network. In more recent years, such care has extended to the provision of specialist community mental health teams (CMHTs) in the UK. Such teams cover a wide range of services from rehabilitation to home treatment and assessment. In addition, psychiatric nurses are on hand to administer prescription medication and give injections. The patient is therefore provided with the necessary help that they need to survive in the everyday world whilst maintaining a degree of autonomy.
Often, though, when a policy is put into practice, its failings become apparent. This is true for the policy of care in the community. Whilst back-up services may exist, an individual may not call upon them when needed, due to reluctance or inability to assess their own condition. As a result, such an individual may be alone during a critical phase of their illness, which could lead them to self-harm or even become a threat to other members of their community. Whilst this might be an extreme-case scenario, there is also the issue of social alienation that needs to be considered. Integration into the community may not be sufficient to allow the individual to find work, leading to poverty and isolation. Social exclusion could then cause a relapse as the individual is left to battle mental health problems alone. The solution, therefore, is to ensure that the patient is always in touch with professional helpers and not left alone to fend for themselves. It should always be remembered that whilst you can take the patient out of the institution, you can't take the institution out of the patient.
Choose the correct letter, A, B, C or D.
26.Which of the following statements is accurate?
A In the 20th century, illegal surgical procedures were carried out on the mentally ill.
B The Victorian era saw an increase in mental illness amongst married couples.
C Mental institutions of the past were better-equipped for dealing with the mentally ill.
D In the past, others often benefitted when a patient was sent to a mental asylum.
27.What does the writer mean by patient treatment being 'legitimised abuse'?
A There were proper guidelines for the punishment of mentally ill patients.
B Maltreatment of mentally ill patients was not illegal and so was tolerated.
C Only those who were legally entitled to do so could punish mentally ill patients.
D Physical abuse of mentally ill patients was a legal requirement of mental institutions.
28.What brought about changes in the treatment of mentally ill patients?
A A radio documentary exposed patient maltreatment.
B People rebelled against the consistent abuse of mentally ill patients.
C Previous treatments of mentally ill patients were proved to be ineffective.
D The maltreatment of mentally ill patients could never be revealed.
29.What was a feature of early care in the community schemes?
A Patient support was the responsibility more of relatives than professionals.
B Advanced professional help was available to patients.
C All mentally ill patients could benefit from the scheme.
D Patients were allowed to enjoy full independence.
30.What is true of care in the community schemes today?
A They permit greater patient autonomy.
B More professional services are available to patients.
C Family support networks have become unnecessary.
D All patients can now become part of these schemes.
31.What can be said of the writer's attitude towards care in the community?
A He believes that the scheme has proved to be a failure.
B He believes that it can only work under certain circumstances.
C He believes that it will never work as mentally ill patients will always be disadvantaged.
D He believes it has failed due to patient neglect by professional helpers.
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