Creating an Environment for Health Communication
“Do unto others as you would have them do unto you.” That’s the “Golden Rule” that most people are taught from an early age. This rule is applicable in most areas of life: school, the workplace, and in personal relationships. There is one notable exception to this rule that I have observed in U.S. society, however, and that is the way “mentally ill” patients are treated. While the need for better care has been recognized and more funds have been allocated toward necessary programs (Feldman, New Funding, 2014), there has been little evolution in the system that is responsible for taking care of millions of people every year. In this paper I utilize the works of multiple contemporary authors to discuss and challenge existing research on the medical practices involved in the treatment of mentally ill patients and seek to work toward a communication-based approach to healthcare.
In the article, “The Devil’s in the details: Mental institutions and proper engagement,” the authors explain how institutions develop and extend the cognitive abilities and reasoning for those included (Tollefsen, Dale, and Olsen, 2013). For example, when a child is born, they become part of a familial institution. Everything they know is dependent on the environment their parents/caregivers provide. This is how children learn basic skills such as speaking and walking along with relational skills, for example, how to coexist with others and the part the individual plays in society. How people behave is entirely contingent on the environment they are put in. The hypothesis I have developed is quite simple: people behave how they are expected to and exhibit the behaviors that are constantly reinforced by external sources. If mental health patients are put in an institution where they are made to feel “othered” (Whalen, 2014) or “sick” (Kaysen, 1994) then that is how they will continue to act. Conversely, if the same patients are provided a safe and caring environment similar to, for lack of a better term, “the real world,” then it will be easier for them to behave in ways that our culture has deemed appropriate.
There is a village in Amsterdam called Hogewey that looks very much like the rest of the city; it has apartments, shops, and other places for people to visit. What sets this village apart is that it is a nursing home for over 100 people living with Alzheimer’s. Every employee in this village is trained to work with people with extra needs and is able to provide comfort and care to the residence without them being hospitalized. While still providing a safe environment, the doctors and other employees of the village are able to maintain a feeling of normalcy.
Moisse (2012) states, “The freedom to walk outside, shop, visit with friends or just relax can make patients happier and less agitated, meaning fewer mood-altering medications,” as a benefit for the type of living available at Hogewey. In Kaysen’s (1994) novel, Girl, Interrupted, and Whalen’s (2014) article, “Communicating to escape: A look at involuntary hospitalization,” the authors discuss their experiences with the required medications at the two different institutions where they stayed. Whalen stated that she had to fight to “act normal;” her medication made it almost impossible to behave the way it was required in order to be discharged from the hospital (55). There were several instances in Kaysen’s story where her medications also had startling side effects. One, in particular, was when she started to believe that there were no bones in her hand and she injured herself in order to find them. Yes, that seems like “crazy” behavior but would it have happened had she not been so heavily medicated?
“Normal” is a very subjective term. As the saying goes, “What is normal for a spider is chaos for a fly.” With that being said, I will take the liberty in this paper to outline two important concepts that I believe can be collectively agreed to be normal: agency and community. By agency I mean the ability to make your own choices, decide what you wear, what you eat, where you go, and your daily routine and schedule. Whalen (2014) talked about how she felt “childlike” (56) because her agency was taken away from her when she was admitted, involuntarily, to a psychiatric facility. She was ushered from place to place, forced to take part in activities that didn’t interest her, forced to take medication she didn’t like, and was told what to eat and when. Kaysen (1994) wrote about having similar experiences and she described it as living in a “parallel universe.” She stated in her book that an “odd feature of the parallel universe is that although it is invisible from this side, once you are in it you can easily see the world you came from” (6). People are living in these facilities that are completely different from the environments they had previously lived in and are extremely aware that they are being separated. This is how our society has decided is the best way to “help” the population of people considered “mentally ill.” In contrast, the people at Hogewey consider how they would want to be treated and act accordingly.
One of the most fascinating features of the human being is our desire and ability to form bonds with those around us. In Girl, Interrupted (1994) the females in Susanna’s ward became a family of sorts and in Whalen’s (2014) article, she became friends with several other patients in her short time admitted. If people seek to build relationships wherever they go, then there should always be environments that meet that need. At one point during her stay in the hospital, Whalen invited three other patients to a game of cards. “For awhile we feel like ‘normal’ people laughing over a card game. We joke aloud about how fun it would be to be sharing a case of beer over this social endeavor. It does not take long, though, before a staff member yells at us to keep it down” (p. 57). Whalen’s goal in doing this was to convince the staff that she was mentally healthy enough to be released: “The other patients I play with are curious about me, since this is a place where community is encouraged, but never realized, and somehow the card games helped us temporarily create that community” (p. 57). What she knew was that relationship building is a sign of health and stability, which is why it was encouraged. The reason it wasn’t realized was because the environment they were in was not one that fosters such behavior. Mental health institutions have a goal of producing well-adjusted people but do not allow them to live in the necessary conditions to do so, according to this research.
Furthermore, certain social skills are required to maneuver throughout our society. The communities we live in, like our familial institutions, help to develop these social skills. When Kaysen was allowed to leave her hospital on privileged outings with some of the other patients, it was very clear that these women either did not know how or didn’t care to behave themselves according to social guidelines. They communicated the same way in the outside world as they did in the confines of the hospital. This further illustrates the idea that your living environment shapes your behaviors. Therefore, if the institutions where we place our “mentally ill” more closely resemble the world outside then the transition between the two would be much easier.
Along with providing normal living situations under care and supervision, Hogewey gives its patients a priceless gift. This is the gift of being cared for without being treated like a “sick” person, being stigmatized, or being constantly reminded of their illness. The nurses at the hospital where Whalen stayed were no more susceptible to catching a mental illness from her as the caregivers in Hogewey are to “catching” Alzheimer’s yet those nurses maintained their distance from her and the other patients the majority of the time. She remarked how the nurses and attendants would reprimand the patients from a distance but come closer when they seemed “non-threatening… or, perhaps, ‘normal’” (57). White sterile walls, old furniture, and nurses in uniforms wandering around are typical images associated with psychiatric hospitals. These images also serve as a constant reminder that you are sick and in a hospital. Reminders that you have been separated from the rest of the world because you are not “well” enough to be a part of it. Whalen shared in her article how grateful she felt to encounter a nurse that was simply nice to her. All she did was sit down and talk with Jennifer like she was a human being and not just a patient.
The main criticism against Hogewey was the cost to build it. While it took $25 million to build, that amount is comparable to what is already spent in the U.S. for psychiatric facilities that are not as helpful. In 2014 an additional $50 million was allocated by the Affordable Care Act to community health centers for the specific purpose of establishing and expanding behavioral health services (Feldman, 2014). There has even been a town similar to Hogewey built in Michigan to help dementia patients on this side of the Atlantic Ocean. The reason the funding can only stretch so far is because the institution we put “mentally ill” people in is virtually inescapable. People are admitted into psychiatric hospitals for what they believe will be a short time but are unable to fulfill the requirements to leave for reasons already stated in this paper causing them to stay, sometimes, much longer than anticipated. Whalen never needed to be admitted, yet was in the hospital for several days; Kaysen expected to be in the hospital for a month and stayed years. With a village like this quality short-term care would be available as well as long-term care for those that require it. Not only would a similar living environment be feasible, it would be able to help many more people than the system we have now. What we lack, collectively as a society, is the compassion to care for people who require extra help.
I can confidently say that no one wants to be sick. People will, however, behave the way they are expected- the way their environment dictates. If you tell a person they are sick and isolate them from the rest of the world, they will behave sick and isolated. The opposite is also true, if you give people a safe environment similar to the world where they want to live, they will develop skills and behaviors necessary to perform in ways deemed desirable. When we change the system, then we can change the result. Girl, Interrupted can become Girl, Included and “Communicating to Escape” can become Communicating to Heal.
 It should be noted that this is not an argument in support of the way modern psychiatrists diagnose patients or the belief that the behavioral standards collectively decided by our society are correct. This just acknowledges that those are the two factors that make this discussion relevant.
Feldman, Stefanie. “New Funding to Increase Access to Mental Health Services and New Protections Under the Health Care Law.” The White House. The White House, 18 Feb. 2014. Web. 28 Mar. 2015.<https://www.whitehouse.gov/blog/2014/02/18/new-funding-increase-access-mental-health-services-and-new-protections-under-health->.
Kaysen, Susanna. Girl, Interrupted. New York: Vintage, 1994. Print.
Moisse, Katie. “Alzheimer’s Disease: Dutch Village Doubles as Nursing Home.” ABC
News. ABC News Network, 10 Apr. 2012. Web. 28 Mar. 2015.<http://abcnews.go.com/Health/AlzheimersCommunity/alzheimers-disease-dutch-village-dubbed-truman-show-dementia/story?id=16103780>.
Tollefsen, Deborah, Rick Dale, and Lucas Olsen. “The Devil’s in the Details: Mental Institutions and Proper Engagement.” Cognitive Systems Research 25–26 (2013):35–39. Science Direct. Web. 28 Mar. 2015.
Whalen, Jennifer (2014). “Communicating to Escape: A Look at Involuntary Hospitalization.” Journal of Medicine and the Person, 12(2).