Constructing patient–psychiatrist relations in psychiatric hospitals: the role of space and personal action

Abstract

This essay investigates the role of space and personal action in the construction of patient–psychiatrist relations at psychiatric hospitals. In order to explore such a theme, the writings of R.D. Laing prove to be salutary. This is namely accredited to Laing's tenet that the staff and patients of a psychiatric hospital are institutionalised by both physical structures and personal action. A central approach taken in this essay is to explore Laing's theory through an inter-textual reading of Michel Foucault's Madness and Civilization (1967) and Erving Goffman's Asylums (1961).

Keywords:

• R.D. Laing
• Erving Goffman
• Michel Foucault
• psychiatric hospitals
• patient–psychiatrist relations

Notes

1. For the purposes of this essay, the term institutionalisation is used to refer solely to the factors of the physical environment and personal action in psychiatric hospitals. Thus, it excludes reference to additional factors usually associated with the term institutionalisation.

2. The only criterion for selection was the patient's social isolation on the ward. They were all patients with schizophrenia, aged from 22 to 63 years, who had been confined continuously for at least four years (Abrahamson 2007, 206).

3. There are a number of psychiatric hospitals that offer an alternative to the dominant formation of institutionalisation, for example, the Fulbourn Hospital. In terms of psychiatric hospital reform, Fulbourn is noted for having established social therapy, patient freedom, unlocked ward doors, and “therapeutic communities”. See Adams (2009), Clark (1974), Clark (1996).

4. The article is limited to the alternatives of the dominant formation of institutionalisation provided by Laing – solely in terms of psychiatric hospitals. As such, the article does not explore the positive aspects and outcomes of deinstitutionalisation as an alternative to the dominant expression of institutionalisation. Although this remains a limitation of the article, there is no doubt value in examining deinstitutionalisation as a response to the problems posed in institutionalisation. In particular, the ethos of deinstitutionalisation emphasises the following: patient participation in treatment (Hamilton and Manias 2008, 178); the acknowledgement of the experiences, values and personal goals of individual patients (Bachrach 1997, 31–32); the gaining of patient autonomy within a homely living environment (Trieman 1997, 57); privacy (Leff and Warner 2006, 75); and the importance of caregiver's establishing a permanent relationship with a patient (Bachrach 1997, 33).

5. Goffman (1973, 16) outlines five types of “total institutions”. Firstly, psychiatric hospitals and leprosaria are a category of places that are established to care for persons felt to be both incapable of looking after themselves and a threat to the community, albeit an unintended one. The second grouping refers to institutions established to care for persons felt to be both incapable and harmless; these are the homes for the blind, the aged and orphaned. Thirdly, institutions organised to protect the community against what are felt to be intentional dangers to it, with the welfare of the persons sequestered not the immediate issue: jails and penitentiaries. Fourthly, institutions established to better pursue some work-like task and justified in terms of instrumental grounds: army barracks, boarding schools and ships. Finally, institutions designed as retreats from the world while also serving as training stations for the religious: abbeys, monasteries and convents (Goffman 1973, 16).

6. See Janelli, Stamps and Delles (2006), Sturrock (2010), Taxis (2002).

7. See Gilburt, Rose and Slade (2008), Helmchen (1998).

8. See Borge and Hummelvoll (2008), Goss et al. (2008), Lezzoni, Ramanan, and Lee (2006).

9. In particular, the study by Kotzé, King, and Joubert (2008) reveals that there is considerable scope for improving patients' knowledge and understanding of their diagnoses and medication. The lack thereof can be seen as a plausible explanation for the non-compliance and consequent relapse rates of patients (Kotzé, King, and Joubert 2008, 90).