Friday, October 10, 2014

Personal Note: A Visit to a Mental Institution

Something a little different for today’s post.  Recently while cleaning out my basement I found an old paper I had written for a college class in abnormal psychology—in 1979.  One of our assignments was to spend a morning at a large state hospital for the mentally ill, and then write about our impressions.  I was 21 years old at the time. 

The facility was known as “Arcadia”, for the town in central Florida where it was located—as if the town and the “mental hospital” were synonymous.  Most of the big state institutions were being shut down by the end of the 1970s, due to funding problems and overcrowding, but also because of terrible stories of abuse and neglect of patients.  Though I wrote this over thirty years ago, conditions for people with mental illness have not improved very much.  The big institutions are gone, but many who suffer from mental illness face an uncertain future living out on our streets.

This is a lengthy post, so I have added some headings to facilitate skimming.

Abnormal Psychology—Final Paper

It is difficult to describe the facility at Arcadia without being very critical of it at the same time.  Any sensible and compassionate person would find conditions quite appalling in most of the wards, to say nothing of the overcrowding and scarcity of professional therapists.  Even still, this bungling system of mental health care is perpetuated here and in at least four other places in Florida.  Why?

[Mental Illness and Society]
One reason why such deplorable conditions are tolerated at G. Peirce Woods and elsewhere is because of the prevailing attitude towards mental illness.  Mental illness is still not perceived as an illness at all, but rather, a weakness in character, or a manifestation of evil.  Mental institutions naturally reflect society’s view, and little will change at these places until the attitude of the community changes.  “Hospital” and “therapeutic community” are really misnomers for what are obviously places of incarceration.  Even if the Arcadia facility could raise the level of its services, the patients would benefit little in the long run.  Their chances of getting jobs or finding acceptance in their community are very slim.

Another reason why our mental health system is in such bad shape stems from the fact that we still know very little about the etiology and treatment of mental illness.  Definitions of what constitutes mental illness are still vague and questionable.  As attested to in nearly every chapter of the Coleman text, psychologists are able to describe maladaptive behavior, but are unable to give a comprehensive explanation of it or provide a reliable form of treatment.  Compounding the problem is the great disunity in the field of psychology, the diversity of approaches offered by the behavioral school, humanistic school, intrapsychic school, etcetera.  Few, if any, dependable and testable theories of mental illness have emerged from all of this debate.

Lacking solid guidelines, legislatures and other sources of funding are unwilling or unable to give adequate support to mental health care.  Facilities like the one we visited in Arcadia suffer gross overcrowding and inadequate treatment as a result.  All of this is traceable to our ignorance of the nature of mental illness.

[Some General Recommendations]
Although more qualified people than I have wrestled with these same problems, I will dispense with humility and offer what I consider to be possible solutions to the dilemma.

Obviously it will take a long time to change society’s view of mental illness.  There are a few things, however, which could be done to accelerate the process.  Mental institutions should be built smaller and located closer to the communities which they serve.  Greater contact between mental patients and the public at large could only be beneficial to both.  Much of the stigma and prejudice associated with mental illness could be removed if citizens were made aware of the difficulties of mental patients.  This could be done through special educational programs or through personal involvement, (such a volunteering or fund raising).  Patients might find encouragement in keeping closer ties with the world outside the institution.  This same argument could be applied to the treatment of retarded people, ex-convicts, and the handicapped.  Their chances of being successful in our society are also slight because of fear and ignorance.

[Criticism of Psychology]
As regards our dismal understanding of the etiology and treatment of mental illness, there is one humongous task which must be undertaken.  The entire field of psychology needs to be “cleaned up” and streamlined.  Research must be made subject to the same rigors as work in other scientific disciplines.  The emphasis should be placed on the behavioral and biomedical approaches. Other schools of psychology need to be redefined for what they are—exercises in philosophy and imagination, not science.  Support for any of these should depend on the clarity of their definitions and the rigorousness of their research.  A truly scientific and hence reliable psychology could be achieved through careful and perhaps ruthless redistribution of financial support.  Unless this is done, the field will lose even more credibility in the future.

[The Tour of Arcadia]
Having said all this I would now like to mention just a few of my observations of the G. Pierce Woods facility.  Aside from the overcrowding and less than mediocre treatment, it was especially depressing to see so little social interaction among the patients, or between the patients and members of the staff.  In nearly every ward we visited, patients stood around or sat quietly, submerged in their own thoughts.  Shameful enough that these unfortunate people receive little support from the staff; it’s worse still if they have little support from their peers.  I was also surprised at how quiet the place was.  Even the admissions ward, where “René” sat rambling on about the Mormons, was fairly quiet.  I suppose this was partly because of medication.

It must be difficult to give a tour of a mental institution.  The nurse who served as our guide was frequently addled about where she should take us next.  She wanted to show us something interesting, perhaps even entertaining, but we kept winding up in wards which were carbon copies of ones we had seen previously.  “I know!” said the nurse, “Let me take you to see the admissions ward.  I’m not supposed to take any tours there, but I’m in charge today, so why not?  I think you’ll get a kick out of it.  The other girl is there, the one who didn’t show up at the workshop—see if you can spot her!”

The admissions ward was no different from the other wards we had visited.  Patients stood around as if they were waiting for a bus.  There didn’t seem to be enough chairs for everyone to sit down in.  There was absolutely nothing for the patients to do with their time.  Someone could have at least thrown them a deck of cards or a bag of marbles.  Our nurse gave one of the patients a cigarette.  Later she explained that she did this because the woman had stomped a fellow patient to death several years ago.  The nurse hoped to stay in her favor by furnishing her with cigarettes.  Down a dark hallway I saw a shy, spectacled young woman hovering in the shadows.  I felt somewhat voyeuristic and intrusive, seeing these people in this place.

Nearly all of the wards were depressing to see, but there was one we saw early in the tour which could be called truly therapeutic.  It appeared to be some kind of an arts and crafts workshop.  The room was uncrowded, well lit and pleasantly furnished.  Radios played softly in the background.  Each patient was busy with ceramics, wood carving, or sewing.  The shop was run by a matronly woman who was not a nurse and who did not wear a uniform.  Everyone appeared calm and purposeful.  Our tour would have been more uplifting if this ward had been saved for last.

I am glad that I had the chance to see the inside of a mental institution, as depressing as it was.  I wish we could have spent more time there.  I confess I was rather more interested in seeing the staff than the patients.  I would like to know more about the people that work in such institutions, what they get out of it and how they relate to the people they care for.  All day they must be comforting and supportive of others, but who supports them?

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