NOTES ON COMMUNICATION IN A MENTAL HOSPITAL.

Abstract

A mental hospital differs from every other type of medical institution in its arrangements for the care of the sick. In other medical situations admission to hospital is the outcome of a decision taken between a patient and his doctor. Certainly the doctor who will care for the patient in the hospital will have had a direct part in this decision. The information gained about the patient will steadily accumulate in a file at the nursing station on the ward. This information will form a vital part of the knowledge of all those persons upon whose actions successful treatment will depend. This will certainly include the nurses, house physicians, technicians and in some instances many other categories and levels of staff. In a mental hospital the legal arrangements for admission are clearly intended in the first instance to provide protection — protection for an offended public, protection against injury or injustice to the ailing patient. The internal arrangements of the hospital, too, seem primarily designed for the same type of protection. Thus the attending doctors have no part in the decision for admission. The information gained about the patient is kept off the ward and access to it by the staff is carefully controlled. The ward staff are given custodial power and what limited information they possess is nullified by a practice of frequently changing their ward assignments. The tenuous hold that the patient has on reality is further weakened by a policy which separates him from familiar orienting objects and persons. Thus his personal possessions are removed, visiting sharply limited, telephone usage and the mail strictly controlled. Communication difficulties arise because these admirable custodial arrangements are never referred to as such. Instead all language exchanges are conducted as if every action and arrangement was part of a treatment design. This results in a peculiar discrepancy between conference discussion and ward practice. It results in pendulum swings between actions taken with the public good in mind and those taken with the individual good in mind. It leads to confusing treatment language being used in asking the ward staff to carry out actions which they are accustomed to refer to in different terms. As with any unrecognized communication barrier, widespread problems, the result of confusion, anxiety and unexpressed hostility, appear.