As you may know I have been in the psych ward for some time now. I have to change my medication and to say it is highly unpleasant is a gross understatement. I live alone but now I am sharing with twenty people and a bunch of staff and have basically a lot less rights or privacy than I usually enjoy.
When I was studying for my Masters I wrote an essay on a philosopher called Michel Foucault and his theories around power. Monsieur Foucault saw structures of discipline across society which while they were different kinds of things doing different functions, they all shared the concept of institutionalisation. That is, making people behave and think in a uniform way. It is interesting stuff.
The structures of discipline that Foucault noted were the prison, the military the school and the hospital. Essentially prison turns people from criminals into functioning members of society – or is meant to, school socialises people for the world of work, the army teaches the discipline required to be a effective soldier. The hospital creates ‘healthy’ people with ‘healthy’ attitudes. Being in the psych ward I see Foucault and his theory in every interview room, medication run and every nurses’ clipboard.
The funny thing is that we live in a society which likes to think it is beyond this notion of discipline and power. We have inclusive services created in consultation with service users. There are public advocates and official visitors to ensure structures are inclusive and helpful. But the issue really is still there. If it wasn’t then all my current cohabitants and I would not get weighed every Tuesday morning!
Begin a psych patient involves being at the bottom of a highly developed power dynamic and structure. I am allowed to go for a walk outside the ward for half an hour. So I am not a prisoner but my movements are controlled. If I was on the locked ward my movements would be even more restricted. The attitudes of alienation and powerlessness you find in prisons are definitely found in psychiatric inpatient services. The other prison-like element I notice a lot is the waiting and how time is conceptualised. I know about prison dynamics as I spent over three years in prison in my early twenties. I see the parallels between the prison and the hospital to an immense degree. Waiting is a common element of both. In hospital you inhabit a sort of limbo time punctuated with nurses taking obs, giving medication, seeing the doctor, going for blood and other pathology tests, meal times and visits. In between those time stretches onwards into a sort of vague miasma. Being unwell makes it hard to organise your time and inertia can keep you from doing anything to fill the vast spaces of unproductive time.
I must note that this observation does not reflect on individuals within the hospital system. Many doctors, nurses and allied staff are amazing and do a great job with care and diligence. This post is more around systemic issues.
Another interesting notion of the hospital is that like all institutions, it self-perpetuates. Nurses always want you to go home and be ready for discharge but it is contradictory because everything about hospital trains you to do well not at home but in hospital! All institutions seem to work this way. In order to be able to function within the institution you became institutionalised. Then when you leave the institution is is even harder than it was before you went in! For me I feel lonely and struggle to fill all the unstructured time I find myself with. I am afraid of the world because it is too big. Hospital is a shocker for institutionalisation and all you need as evidence if the vast number of people who return over and over. In fact I have seen people get sicker the longer they stay in hospital.
It is like the structure which is meant to be helping in fact contributes to the illness.
I don’t have a proper answer to this. This is a big S social issue. I can’t fix the prison system either but I do think it is worth alerting people to these dynamics to help to understand and where possible avoid them. One of the things I do for myself to avoid being institutionalised is minor and harmless infractions. I will go for a walk without writing it in the leave book or I will sit outside the ward door without telling anyone. If nurses were concerned they could phone me so no harm done but it is me saying very gently ‘stick it to the system’ and it helps me remain independent and avoid becoming institutionalised. I also don’t do many of the group activities as any if them have ‘institution’ written on them in big magenta letters. I know the risk even if I recognise I need to be here,
I think some of the measures to remove some of the power element are laudable and often effective. But the hospital system is probably always going to involve a power structure to varying degrees of unhelpfulness. I think keep consulting, keep running inquiries and keep empowering those who use the services. If we have to have a power dynamic then let us make is as helpful a one as possible.
And in terms of my own current little dance with the system, I am not sure where I stand at the moment. I’m changing meds and feel like terrified death much of the time so I will have to submit my will to the system even if I don’t want to. But I shall be doing so in full knowledge of the risks and my need to maintain my independent self.