Mental Illness Careers in an Era of Change

The concept of illness career conceptualizes the illness experience as a dynamic pathway that takes shape over time as the person interacts with the treatment system. In this article we use data from 238 persons treated in Vermont State Hospital during the 1950s to evaluate several fundamental career assumptions and to illustrate how different predictors are contextualized by the career. We find that, among persons hospitalized for severe mental illness prior to deinstitutionalization, social status was more strongly associated with the length of the initial hospitalization than illness or community characteristics. We also find evidence of accumulation of hospital experience, with the pace of later hospitalizations shaped by earlier ones. Institutional reform was successful redirecting hospitalization careers and illness characteristics become more salient for the pace of hospitalization in this post-reform era. While mental health researchers have debated the relative influence of social and illness characteristics for predicting hospitalization, our findings suggest that the specific influence of any of these characteristics depends on where person is in their own illness career as well as where that career is located in historical time.