Emergency Gardening
- Author:
FITZGERALD
Voluntary Occupation Officer at an E.M.S. Neuro-psychiatric Unit About a year ago one of the neuro-psychiatric Emergency Hospitals ? added gardening to its other branches of occupational therapy. It has been suggested that my experiences during that year might be of interest to those engaged in, or about to undertake, similar work. As I consider that a number of rather vague general statements without chapter and verse are almost valueless, I have?in this article? tried to describe our gardening in practical detail, and from this to draw my general conclusions.
While this is not a military hospital, the patients come chiefly from the non- commissioned officers and ranks of the Services. There is also a civilian ward, including men from the Merchant Navy, and a women’s wing in a house with its own garden outside the hospital grounds. Patients are sent on account of neurotic illnesses.
Occupational gardening is carried out by the head gardener and myself under the direction of the doctor in charge of occupational therapy. Our average attendance just now is 130 men each day, approximately half of whom attend for two hours in the morning and half for the same period in the afternoon. As our numbers are so large, our methods are of necessity rather unorthodox and those accustomed to the Quiet calm of occupational therapy centres will have some difficulty in realizing the very different conditions under which we work.
The patient is first of all sent by his doctor to the Occupations Office with a note stating the occupation selected for him. A card with his name, rank, ward and occupation is placed in a file to which all instructors have access. On the card there is also a brief note written by the doctor for their guidance. For example, ” An anxious man with hypochondriacal traits. Needs pushing to work.” Or it might he, ” Depressive state due to death of family by bombing. Keep fully employed . Occasionally, with apprehension, one reads: ” A truculent and unco-operative Patient.” Once a week the instructor writes a short note on each card reporting Progress made. These are seen regularly by the doctors.
The patient comes into the garden with a note stating his name and ward, which he hands personally to the instructor, thus ensuring that each man gets a brief interview before starting to work. We ask a few questions about his previous gardening experience, and try to find out if he is interested in any special branch of garden work?he may have worked in a public park or on a golf course and will choose to work on the lawns and ornamental flower beds. He may be a farmer or agricultural labourer who then does our carting, scything and so on, for us. Or perhaps he has no interest or experience in gardening, but is a mechanic in civil life who will overhaul the motor mowers and keep them in good running condition. In such cases, the men have often been misfits in the Army and are really helped simply by getting back to familiar work which they know they can do well. But many of them are quite apathetic and uninterested in gardening or anything else. Fortunately we are not sensitive, as the question, ” Is there anything you would particularly like to do ? ” frequently gets the reply, “To get out of here as quickly as possible ” ! Usually a man works with others from his ward in the charge of a section leader who is an N.C.O. patient selected from amongst them by their doctor. His duties are to see that his squad turns out for roll-call, to account for his absentees, to be responsible for the tools issued to his men and in general to co-operate with the Occupation Officer and see that his instructions are carried out. In return he receives certain privileges. He is allowed to wear his khaki, and has a pass out every evening from 6 until 8. The value of a good section leader is inestimable.
The tools are issued to each section leader, who distributes them among his squad. Each tool, as it is taken out, is represented by a disc which is dropped into a tray labelled with the name of the ward concerned. As the tools are returned, the discs go back into their box. Any remaining in the tray indicate tools missing, and the section leader is responsible for their safe and immediate return.
Originally the men worked in their groups looking after a centre communally. But, with the exception of two wards, this has not proved satisfactory. It is interesting to speculate why it was successful in two cases and failed in five. It may have been partly that the men took a pride in keeping their centres in much better order than any of the others. But it was very largely, I think, because their doctors took a great personal interest in the men’s gardening, paying frequent visits to the plots while they were at work. We are now switching over to individual allotments and already, even although still in the transition period, there has been an immense improvement. Here I would like to emphasize the advisability of having the garden in a central position and all together on one stretch of land. In this matter we have learned from very bitter experience. Gardening in this hospital has been growing continuously. A year ago we began with a few isolated plots and some thirty men. We now have an average attendance of 130 men and a number of centres all over the grounds? which are extensive. For various reasons, until very recently, it was not possible for us to have a large piece of ground where most of the patients could work. As a result we spend an exasperating amount of time simply walking from one centre to another. Still worse, the men are of necessity unsupervised for considerable periods and it is quite impossible to give the inexperienced gardeners anything like full instruction. To remedy this last difficulty we are trying to work out a scheme using patients with much gardening experience as ” technical assistants ” to each section. They will help, in return for privileges, to teach the novices in their group. So far we have only tried this out in the civilian ward, where it has worked admirably, chiefly owing to the exceptional personality of the patient selected.
Some of the patients, when they first come out, regard digging as nothing short of manslaughter ! Everybody is considered fit for general work unless the note on their card says otherwise or they bring written instructions from their doctor. As a rule, once they have gained confidence they like digging, but I think it is a mistake to let it become monotonous, and unless a patient particularly asks for it?as happens fairly frequently with those suffering from anxiety and depression?it is inadvisable for them to dig for several days in succession without a break.
Where grassland is being brought into cultivation I strongly recommend that the turf be skimmed off by ploughing. To remove it by hand is hard and slow work and in my opinion is not suitable for neurotic patients who tend to be discouraged easily and respond most readily to quick results.
We are, at the time of writing, breaking up a piece of grassland just under two acres in extent. The turf has been skimmed off by plough, and the ground measured into allotments each of which two men are digging over, burying the turf as they go. We aim at working the allotments on the plan issued by the Ministry of Agriculture in the ” Growmore ” Bulletin No. 1, called ” Food from the Garden “. As one patient leaves and another takes his place, he will be able to see from the pamphlet what has already been done and what is planned ahead. This will also have its value in impressing on the patient that his efforts are of importance in our food production.
A frequent criticism by visitors to the garden is that as the average stay of a Patient on occupation is about six weeks, he cannot be expected to take an interest in sowing seeds from which he cannot reap the crops. But we have not found this to be so. A man soon comes to regard his plot as temporarily his own ground, and although he cannot see the full results of his labour, he does see completed the opera- tion on which he is engaged. For gardening is never finished; the seasons merge into one another so imperceptibly that the work is continuous throughout the year. There is no beginning and no ending as in the other occupations. The only com- parison that can be made is that as in their work a patient may start and finish a basket or a stool, so in ours he may start and finish the preparation of the ground for next year’s crops, the sowing of the seeds, the thinning, weeding, watering of the growing plants, or the harvesting and tidying in the autumn.
There must be a certain amount of discipline before the work can be carried out successfully. Therefore to maintain an orderly atmosphere we do not hesitate to report absentees and habitual latecomers to the military authorities who are respon- sible for the discipline of the Service patients. We have found that it is fatal to ignore them, as in a short time the defaulters’ list will have lengthened incredibly and soon be completely out of control. Patients who are troublesome in other ways we report directly to the doctor concerned.
In any number greater than six on one piece of work, the tendency is for the more unco-operative patients to create a very difficult and even antagonistic atmo- sphere. But, if a truculent patient is introduced into a group of four or five men who work steadily and with some pride in their efforts, as a rule he falls in with the rest and becomes as co-operative as any. We have found this an excellent way of dealing with the recalcitrant. Another successful method has been publicly to Praise, say, his digging, and then to select him?again publicly?for some special work.
For the completely unco-operative and mischief-making type, we have cleared a local ” Devil’s Island “, which is a piece of ground well away from the rest. The man who regards himself as a martyr forced to work for the hospital for nothing, the bully who tries to make life miserable for those anxious to work, the man who insists on ” swapping symptoms ” and, in short, anybody likely to upset the chances of the other patients, sooner or later finds his way there. He is, of course, kept in ignorance of its nature and is simply sent to work on that particular centre. Here let me again remind the reader of our large numbers. It is only these, combined with our rapidly changing population, which render these measures necessary.
The garden work is the same for all classes of patient unless the doctor gives specific instructions to the contrary. But as the civilians are, for the most part, rather elderly or delicate they generally do only the lighter work. We keep them apart from the Services, as we find that they do not mix.
The women maintain their own garden entirely. It is chiefly devoted to vegetables, and in addition each patient has her own plot of ground. The average daily attendance is about twenty-four, and they work with real interest and enthus- iasm. I am sorry I cannot describe their work more fully, as the results have been most satisfactory and unquestionably of value to the majority of the patients. One of the chief factors in this has been the magnificent co-operation given to me by the nursing staff both in the pleasant atmosphere maintained among the patients and in the facilities they have provided for carrying on the work.
I have found a problem which I think must be general wherever the instructor has to work with a professional gardener. I think it is almost impossible to make him realize the dual purpose of occupational gardening. In my opinion first and foremost by a long way comes the benefit to the patients, and while one wants to raise the best possible crops this must always be of secondary importance. I would always risk the sacrifice of a crop if it gave a good chance of materially helping the patients. But your professional gardener can never, never do this. It is contrary to all his instincts and experience. For him, the crop is of paramount importance, and nothing must be allowed to threaten it. He will try to prevent the patients sowing the seeds themselves, applying fertilizers or harvesting the crops in case they ” make a mess of it “. If a,piece of ground is to be dug over, his one aim will be to get the work completed as quickly as possible, regardless of its effects on the men. If a patient is obviously ill, his reaction will always be that a man in such a condition ought not to be sent out, as he will be fit for nothing and only be a nuisance. The situation here is aggravated by the fact that everything sent in from the garden is debited against the outlay on seeds, fertilizers, etc., and very naturally our gardener is anxious to show a profit financially and cannot understand that there is another balance sheet to be taken into account?the help given to the patients. As I have mentioned above, another lesson learned is the tremendous importance of individual work. We find that the patient responds more quickly to sympathetic interest than to almost anything else except encouragement. It is very much easier to get to know them and gain their confidence if the men are spaced out on separate work, as they are less self-conscious and will talk more freely, describing their gardens at home and making suggestions about the working of their plots. It has been argued that the work should be communal in order to promote social feeling among the patients. But gardening by its very nature serves the community; it is only the effort that is individual.
From the point of view of the patient, the work is of much greater interest. More and more frequently they are now asking if they may come out and garden in their spare time. We never had a single instance of this when working on the communal system.
The advantages to the instructor are:? (i) Competition is encouraged, for very few patients are sufficiently apathetic to allow their plots to fall very far behind the others. For this reason I think that each plot should be prominently labelled with the name of its owner.
(ii) In the case of those with particular weaknesses, the work of encouraging them to use the affected part is greatly simplified. In group work they are apt to stand by and let others do it for them unnoticed. (iii) It is possible to measure exactly the amount of work done, the interest taken and the progress made by each man. This, incidentally, is an aid to discipline, as the truant’s or lazy man’s plot soon gives him away. (iv) A better report can be given on a patient’s suitability for an agricultural unit. This scheme is still very much in embryo but promises to be of great interest when it is possible to get information about the progress of the man drafted from here.
1 would like to make it clear that by individual work I do not mean that the Patients work only on their own plots. Variety is essential and, except during the spring rush, general work on the grounds, grass cutting, hedge trimming, wood chopping and work on the flower borders and in the greenhouses, is carried out as well. We have also learned the importance of providing enough work to keep everyone fully employed during the occupation period, and to insist on its being done to the very best of the patients’ ability even if it means re-doing it several times. For nothing so discourages effort as the acceptance of slipshod work. But I consider that the foundation of successful gardening is co-operation? co-operation with every department, but above all with the medical staff. To our Occupation Office we are indeed indebted. I hope I have given some idea of its place in our organization. Briefly it acts as liaison between the occupations and all other departments of the hospital. To me, ” Occupation Office ” and co-operation ” are synonymous terms.
With the massage department we are working more and more closely. When we have a mutual patient with, say, a dropped foot, the chief masseuse demonstrates to me how he should keep his foot placed when at work and I try to remind of this whenever it is necessary. She also pays visits to the garden and watches her cases at work, suggesting movements that will correlate with her treatment.
In my opinion, however, without the full co-operation of the medical staff, occupational gardening can never achieve its full value. The doctor can do so much to enlist the co-operation of the patients by stressing that their occupation is part of their treatment, that it is ” therapy ” and not forced labour. And if he will periodi- cally discuss their progress with the instructor, not only is this the greatest possible help but it adds very much to the interest of the work. The assistance given by regular visits?however brief?of the doctor to his patients at work cannot be overestimated.
As we gain in experience, the number of men really benefiting by gardening is mcreasing to a marked degree. The possibilities are almost without limit. I wish to thank Dr W. S. Maclay, the Medical Superintendent, and Dr Russell Fraser for their co-operation and encouragement.
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