CAN A PSYCHIATRIC institution exist for ‘really’ psychotic people where there is communication within solidarity, community and communion, instead of the It-district, the no-man’s-land between staff and patients?
This rift or rent in solidarity may be healed in a professional therapeutic relationship. A ‘relationship’, professional or otherwise, which does not heal this rent can hardly be called therapeutic since it seems to me that what is professionally called a ‘therapeutic relationship’ cannot exist without a primary human camaraderie being present and manifest. If it is not there to start with, therapy will have been successful if it is there before it ends.
There can be no solidarity if a basic, primary, fellow human feeling of being together has been lost or is absent. It is not easy to retain this feeling when you press the button. Very seldom, when I pressed the button, could I feel I was doing for this chap in terrible mental agony what I hoped he would do for me if I had his mind and brains and he had mine.
This issue of solidarity and camaraderie between me as a doctor and those patients did not arise for me, it did not occur to me until I was in the British Army, a psychiatrist and a lieutenant, sitting in padded cells in my own ward with completely psychotic patients, doomed to deep insulin and electric shocks in the middle of the night. For the first time it dawned on me that it was almost impossible for a patient to be a pal or for a patient to have a snowball’s chance in hell of finding a comrade in me.
It would be a mistake to suppose that ‘mental’ institutions are It-districts. There may be a lot of camaraderie between staff and staff, and patients and patients. But there tends to be an It-district between staff and patients. Why this should be so may not be immediately apparent. But when one looks into it one sees that it can hardly be otherwise, under the circumstances.
All communication occurs on the basis either of strife, camaraderie or confusion. There can be communication without communion. This is the norm. There is very little communion in many human transactions. The greatest danger facing us, the human species, is ourselves. We are not at peace with one another. We are at strife, not in communion.
The New Year is the biggest celebration in Scotland. It is marked by prolonged carousing on the part of the alcoholic fraternity, but many teetotallers celebrate the spirit of the New Year contentedly sober. There is no ‘religion’ about it. There is a special spirit abroad - ‘Auld Lang Syne’, ‘A man’s a man for a’ that.’ In Gartnavel, in the so-called ‘back wards’, I have seen catatonic patients who hardly make a move, or utter a word, or seem to notice or care about anyone or anything around them year in and year out, smile, laugh, shake hands, wish someone ‘A guid New Year’ and even dance...and then by the afternoon or evening or next morning revert to their listless apathy. The change, however fleeting, in some of the most chronically withdrawn, ‘backward’ patients is amazing. If any drug had this effect, for a few hours, even minutes, it would be world famous, and would deserve to be celebrated as much as the Scottish New Year. The intoxicant here however is not a drug, not even alcoholic spirits, but the celebration of a spirit of fellowship.
There are interfaces in the socio-economic-political structure of our society where communion is impossible or almost impossible. We are ranged on opposite sides. We are enemies, we are against each other before we meet. We are so far apart as not to recognise the other even as a human being or, if we do, only as one to be abolished immediately.
This rift or rent occurs between master and slave, the wealthy and the poor, on the basis of such differences as class, race, sex, age.
It crops up also across the sane-mad line. It occurred to me that it might be a relevant factor in some of the misery and disorder of certain psychotic processes; even sometimes, possibly, a salient factor in aetiology, care, treatment, recovery or deterioration.
This rift or rent is healed through a relationship with anybody, but it has to be somebody. Any ‘relationship’ through which this fracture heals is ‘therapeutic’, whether it is what is called, professionally, a ‘therapeutic relationship’ or not. The loss of a sense of human solidarity and camaraderie and communion affects people in different ways. Some people never seem to miss it. Others can’t get on without it. It was not easy to retain this feeling when I pressed the button to give someone an electric shock if I could not feel I was doing to him what I hoped he would do for me if I had his brains and he mine. I gave up ‘pressing the button’.