“Eye contact and verbal contact reflect concern and individuation; their absence, avoidance and depersonalization. The data I have presented do not do justice to the rich daily depersonalization and avoidance:
I have records of patients who were beaten by staff for the sin of having initiated verbal contact. Tempers were often short and the morning attendants would often wake patients with, “Come on, you m—–f—–s, out of bed!”
Neither anecdotal nor “hard” data can convey the overwhelming sense of powerlessness which invades the individual as he is continually exposed to the depersonalization of the psychiatric hospital. The features that psychiatric hospitals had in common overwhelmed by far their apparent differences:
Powerlessness was evident everywhere.
The patient is deprived of many of his legal rights by dint of his psychiatric commitment. He is shorn of credibility by virtue of his psychiatric label. His freedom of movement is restricted.
Personal privacy is minimal. Patient quarters and possessions can be entered and examined by any staff member, for whatever reason. His personal history and anguish is available to any staff member who chooses to read his folder, regardless of their therapeutic relationship to him.
His personal hygiene and waste evacuation are often monitored. The water closets have no doors. At times, depersonalization reached such proportions that pseudopatients had the sense that they were invisible, or at least unworthy of account.
On the ward, attendants delivered verbal and occasionally serious physical abuse to patients in the presence of others (the pseudopatients). Abusive behavior, on the other hand, terminated quite abruptly when other staff members were known to be coming.
Staff are credible witnesses. Patients are not.
A group of staff persons might point to a patient in the dayroom and discuss him animatedly, as if he were not there. One illuminating instance of depersonalization and invisibility occurred with regard to medication.
All told, the pseudopatients were administered nearly 2,100 pills, including Elavil, Stelazine, Compazine, and Thorazine, to name but a few. Only two were swallowed. The rest were either pocketed or deposited in the toilet. The pseudopatients were not alone in this.
What are the origins of depersonalization? I have already mentioned two. First are attitudes held by all of us toward the mentally ill – including those who treat them – of fear, distrust, and horrible expectations on the one hand, and benevolent intentions on the other.
Our ambivalence leads, in this instance as in others, to avoidance. Second, the hierarchical structure of the psychiatric hospital facilitates depersonalization. Those who are at the top have least to do with patients, and their behavior inspires the rest of the staff.
Clearly, patients do not spend much time in interpersonal contact with doctoral staff. And doctoral staff serve as models for nurses and attendants. There are probably other sources. Psychiatric installations are presently in serious financial straits.
However, I have the impression that the psychological forces that result in depersonalization are much stronger and that the addition of more staff would not correspondingly improve patient care in this regard.
The incidence of staff meetings and the enormous amount of record-keeping on patients, for example, have not been as substantially reduced as has patient contact. Priorities exist, even during hard times.
Patient contact is not a significant priority in the traditional psychiatric hospital, and fiscal pressures do not account for this. Avoidance and depersonalization may. Heavy reliance upon psychotropic medication tacitly contributes to depersonalization.
If patients were powerful rather than powerless, if they were viewed as interesting individuals rather than diagnostic entities, if they were socially significant rather than social lepers, if their anguish truly and wholly compelled our concerns, would we not seek contact with them?
The facts of the matter are that we have known for a long time that diagnoses are often not useful or reliable, but we have nevertheless continued to use them. We now know that we cannot distinguish sanity from insanity. It is depressing to consider how that information will be used.
Not merely depressing, but frightening. How many people, one wonders, are sane but not recognized as such in our psychiatric institutions? How many have been needlessly stripped of their privileges of citizenship from the right to vote and drive?
How many have feigned insanity in order to avoid the criminal consequences? How many would rather stand trial and are wrongly thought to be mentally ill? How many have been stigmatized by well-intentioned, but nevertheless erroneous, diagnoses?
Finally, how many patients might be “sane” outside the psychiatric hospital but seem insane in it – not because craziness resides in them, as it were, but because they are responding to a bizarre setting, one that may be unique to institutions?”
Adapted from: On Being Sane in Insane Places by David L. Rosenhan. Originally published in Science, New Series, Vol. 179, No. 4070. (1973).
Now you know the power of Trauma Informed Care. Let’s turn this framework into a mindset for personal, social and political change. If you are unable to, you might need help first, to get safe or become ‘unstuck’ from trauma. Reach out for trauma informed care. #YouBelong
Dr Louise Hansen
PhD in Psychology
Human Rights Activist
#HealingTrauma #Justice4Australia #YouBelong
Trauma Informed World was inspired by Kopika and Tharnicaa; two faces that remind us everyday of Australia’s cruel refugee system. One of many systems in Australia that remind us of the negative operation of power. #HomeToBilo
You can listen my talk with Dr Cathy Kezelman AM, President of Blue Knot Foundation on my own healing journey, training and study and how it has informed my work and advocacy for a trauma informed world here:
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