Also a psychiatric patient makes decisions
In my study I also had to do an internship in some organization. There was an offer for a possibility to do an internship in a psychiatric hospital close to Utrecht. The staff there explained me that a problem of these organizations was that very few patients go back to the real world. This is called “hospitalization”. In order to see if they could reduce this effect they had organized one center where no staff members were available who would tell them what to do but they had to organize all by themselves. Given that the staff denied themselves access to this center, they did not know what happened there. So they wanted a student to participate there to get more information. I became the student who did this participating observation.
The psychiatric hospital in Den Dolder in the Netherlands
My first days in the hospital
I was rather tense when I went there because I did not know how the patients would react. When I entered the room I saw a bar and a barman who served drinks, there were several tables where people were sitting together in silence or talking a bit. There was a place free at a table with middle aged men. I asked them if it was okay if I would sit down there. That was okay. Then the barman came to me and asked if I wanted a drink. I asked for a cup of tea. I got that and we spoke a few words about the different drinks they were offering, no alcohol. Nobody asked why I was there.
The room had a big window with a view on a meadow where a horse was standing with a foal. One of the men at the table said: “The foal is livelier today then yesterday.” “Yes,” another said “it is nice to see that it is much more active”. It turned out that this was one of the most frequently occurring conversations in the center. I also saw that all persons were always sitting on the same places with the same people. Only the barman was walking around and was the manager there.
Besides I observed that nobody was reading anything except one man who sat in the middle of the room and tried to talk with people around him about what he read, but nobody reacted.
I was rather tense when I went there because I did not know how the patients would react. When I entered the room I saw a bar and a barman who served drinks, there were several tables where people were sitting together in silence or talking a bit. There was a place free at a table with middle aged men. I asked them if it was okay if I would sit down there. That was okay. Then the barman came to me and asked if I wanted a drink. I asked for a cup of tea. I got that and we spoke a few words about the different drinks they were offering, no alcohol. Nobody asked why I was there.
The room had a big window with a view on a meadow where a horse was standing with a foal. One of the men at the table said: “The foal is livelier today then yesterday.” “Yes,” another said “it is nice to see that it is much more active”. It turned out that this was one of the most frequently occurring conversations in the center. I also saw that all persons were always sitting on the same places with the same people. Only the barman was walking around and was the manager there.
Besides I observed that nobody was reading anything except one man who sat in the middle of the room and tried to talk with people around him about what he read, but nobody reacted.
Who is crazy?
Occasionally something happened. For example one day I was alone with my neighbor at the table. Then he asked me why I was there only once in the two days. I told him that the psychiatrist had suggested to me that I should go to the center if I felt disturbed. This seemed enough as an explanation. He told me that he had worked in Canada for many years. He liked it there. Later he went back to the Netherlands. That sounded all rather normal till he started to tell me about his special relationship with Jesus Christ. In general he did not speak about that and made a very normal impression like the others in the center. At some moment I heard one say to his neighbor: “Let´s go and play some nice music in my room”. Then they went. All seemed normal but rather extremely boring. Only one time one of the regular guests of the center came in with a big package. He sat down in the middle of the room and started to unpack what was in his package. Everybody seemed curious what it would be but nobody said anything. He went on and on and in the end it turned out to be large glasses which he put on his nose and which were of course much too large for him. It was clear that he wanted to make a joke but nobody laughed about it. The only occasion that people became active and joked and laughed about an action of another patient was when a patient with the Down syndrome came in and talked to the people. Then they felt free to joke and laugh with and about him. My impression was that they did not wanted to disturb each other. They knew that they all had their peculiarities and they did not want to bother each other about that, not being disturbed themselves as well. However extremely seldom one saw anything different from normal life except that due to this behavior life in that center was extremely boring.
Occasionally something happened. For example one day I was alone with my neighbor at the table. Then he asked me why I was there only once in the two days. I told him that the psychiatrist had suggested to me that I should go to the center if I felt disturbed. This seemed enough as an explanation. He told me that he had worked in Canada for many years. He liked it there. Later he went back to the Netherlands. That sounded all rather normal till he started to tell me about his special relationship with Jesus Christ. In general he did not speak about that and made a very normal impression like the others in the center. At some moment I heard one say to his neighbor: “Let´s go and play some nice music in my room”. Then they went. All seemed normal but rather extremely boring. Only one time one of the regular guests of the center came in with a big package. He sat down in the middle of the room and started to unpack what was in his package. Everybody seemed curious what it would be but nobody said anything. He went on and on and in the end it turned out to be large glasses which he put on his nose and which were of course much too large for him. It was clear that he wanted to make a joke but nobody laughed about it. The only occasion that people became active and joked and laughed about an action of another patient was when a patient with the Down syndrome came in and talked to the people. Then they felt free to joke and laugh with and about him. My impression was that they did not wanted to disturb each other. They knew that they all had their peculiarities and they did not want to bother each other about that, not being disturbed themselves as well. However extremely seldom one saw anything different from normal life except that due to this behavior life in that center was extremely boring.
There was one exception
Later it became clear to me that there was one exception. The man who was reading the newspaper and tried to talk about the issues he read with other people close by. They hardly ever reacted. On the other hand he never spoke about the foal like the others. He was still connected with the outside world. At some day he came in the center with the helmet for his motor cycle, showing that he went out. Some days later I saw him sitting in the center without his helmet and without his newspaper and he was talking about the foal as well like all others. Till I stopped visiting the center this remained so.
Later it became clear to me that there was one exception. The man who was reading the newspaper and tried to talk about the issues he read with other people close by. They hardly ever reacted. On the other hand he never spoke about the foal like the others. He was still connected with the outside world. At some day he came in the center with the helmet for his motor cycle, showing that he went out. Some days later I saw him sitting in the center without his helmet and without his newspaper and he was talking about the foal as well like all others. Till I stopped visiting the center this remained so.
An alternative approach against hospitallization was shown in the movie
"One flew over the Cuckoo´s nest" from 1975
"One flew over the Cuckoo´s nest" from 1975
My interpretation
My conclusion was that he had detected that the world outside the hospital was not as attractive as he had thought. Probably he had expected a better reception outside the hospital by the people he met. Given this experience, he had decided that his place was in the hospital and that he had to adapt to the way of life in the center. This was for me a shocking example of hospitalization.
Later in my teaching at the university I used this story occasionally, when it was necessary, to show that I knew what qualitative research was about. Mostly the students were listening extremely silently because it was also for them a striking story. But after that I asked them what we could conclude from this example. Of course it was only one case in a specific hospital and a specific setting. So we could not draw general conclusions about hospitalization processes. Normally this conclusion was also accepted by the students and I had little problems to introduce to them quantitative research.
My conclusion was that he had detected that the world outside the hospital was not as attractive as he had thought. Probably he had expected a better reception outside the hospital by the people he met. Given this experience, he had decided that his place was in the hospital and that he had to adapt to the way of life in the center. This was for me a shocking example of hospitalization.
Later in my teaching at the university I used this story occasionally, when it was necessary, to show that I knew what qualitative research was about. Mostly the students were listening extremely silently because it was also for them a striking story. But after that I asked them what we could conclude from this example. Of course it was only one case in a specific hospital and a specific setting. So we could not draw general conclusions about hospitalization processes. Normally this conclusion was also accepted by the students and I had little problems to introduce to them quantitative research.