Unless you work there, or have a family member or friend under a section, it’s unlikely you will have ever set foot in a psychiatric institution. For many, these environments — their conditions, routines, and prescriptive treatments — remain something of a mystery.
Yes, we have seen them dramatised in films such as Girl Interrupted and One Flew Over the Cuckoo’s Nest, but it’s 2021 — surely today’s reality must be vastly different, right?
Well, yes and no.
Firstly, there are countless factors that determine the quality of care these institutions can deliver — the funding they receive, how well-trained the staff are, the security level, the therapeutic consistency, and so on. However, key though these issues may be, the central catch-22 of psychiatric institutions is that they are charged with the dual-purpose of quarantining as well as healing their patients.
This begs the question, how would a healthy person fare if they were deprived of the freedoms they take for granted? Or no longer had recourse to the love and support of friends and family? How do you think you and I would hold up within these limiting environments?
In 2007, my mother was detained under a section and spent the next 13 years of her life in psychiatric institutions. During this difficult period I would visit her regularly, and bore witness to the steady decline of her mental health. Suffering from severe PTSD and depression, she had long since lost touch with all of her friends and, despite our consistent efforts to support her, my brother and I were close to giving up hope. Then something unexpected happened — she made a miraculous recovery.
But was it miraculous?
Love and Belongingness (the third tier of Maslow’s Hierarchy of Needs) does not easily lend itself to clinical research. Even today, there are few case studies on this pillar of psychological wellbeing. Furthermore, in respect to our often underfunded psychiatric institutions, it is exceedingly difficult to implement.
Sustaining meaningful relationships in such a constricting, turbulent environment is near impossible. After all, when the staff themselves aren’t adequately valued, have not been sufficiently trained in empathy, and constantly move through a revolving door, how can patients feel love and belonging?
My mother experienced this first hand — until one day it all changed. After befriending a certain care worker her mental health began to drastically improve. Before this person’s arrival my mother hadn’t had her core needs met. Suddenly, the care worker in question was treating her not as a patient to be condescended to, or as a daily problem to be solved, but as a fellow human being. They took regular trips to the local forest and, for my mother (whose environment was mainly limited to a small, spartan room), communing with nature beside her newfound companion was a significant step towards recovery.
No amount of Electroconvulsive therapy (ECT), or prescription medication (prescribed against her will) helped more than those excursions with her friend. Although such treatments can certainly be helpful, without Love and Belongingness as a foundation, their efficacy is undeniably limited. Her care-worker knew intuitively that authentic compassion is only possible when we are willing to be vulnerable ourselves, and truly engage with another’s suffering.
This begs the question, without Love and Belongingness how can we expect people to truly heal? No amount of psychiatric ingenuity can help the thousands, like my mother, who’s core human needs aren’t being met. In fact, with the absence of such a key component to health and wellbeing, treatments are often misprescribed in an attempt to plug a hole they simply cannot fill.
In a recent study on “The experience of long stay in high and medium secure psychiatric hospitals in England”, researchers concluded:
Negative perceptions arose from excessive restrictions, treatment repetition and changes in therapeutic relationships, leading some patients to exhibiting tokenistic engagement and low motivation to progress.
Given what we’ve discussed, is this really surprising?
Of course, every individual’s needs and requirements are different, and I do not mean to discredit the health professionals and care-workers who genuinely care for the wellbeing of their patients.
The issue isn’t the people.
The issue is the environment.
The issue is systemic.
Until these institutions are better funded, and the fundamental building-blocks of recovery are better understood, thousands less fortunate than my mother will continue to be swept under the rug.
While the pandemic has put a huge strain on our interpersonal life, it has also made us feel the importance of Love and Belongingness more acutely. Hopefully, this will enable it to be further integrated into our psychiatric institutions — then maybe others can be guided to their own ‘miraculous’ recoveries.