Visiting in Mental Hospitals
The systematic visiting of mental hospitals is of comparatively recent origin and as a means to the formation of a link between patients in hospital and the outside world presents valuable possibilities in the field of mental health work for the future. In the hospital visitor, the patient absorbed in his own problems and imaginings, from which his immediate surroundings afford him no escape, finds someone who, coming to him from the outside world, speaks to him naturally of events and happenings there. A patient who is capable, at least for the moment, of dissociating himself from his own too intense inner life, will welcome the opportunity of talking to “someone sane.” To the extent that he is able to interest himself in outside events or in matters concerning the visitor’s own life, a better balance will have been effected between “inner” and “outer” in his mind.
Mental hospital visiting is not easy at the beginning. The visitor is given keys and told that she may go anywhere in the hospital, but the establishment ?f actual contact with the patients is slow and gradual work. At first she may even get the impression that she is not wanted. Only after she has become a ^miliar figure to the patients will she see faces brighten at her approach and “ear expressions of gratitude for her visit. The visitor has to learn by experience how to ” take ” the patients. She must never be disconcerted at an extraordinary remark or unexpected behaviour, but must take everything good naturedly and if possible put a little humour into the situation. A mild joke WlH often relax tension and win a cheerful response from a patient. On one occasion I suggested to a rather gloomy patient that she should look at the world through ” rose-coloured spectacles.” This idea pleased her and I heard er afterwards explaining to the other patients how they might wear rosecoloured spectacles. I cannot help thinking that this idea and the mental curiosity aroused by it may have been one of the factors which conduced to an improvement in her condition (she was soon afterwards discharged and when saw her last was making good in her own home).
38 MENTAL WELFARE In order to effect successful contacts the visitor must also cultivate the power to talk on any subject that may interest a patient. With one patient I usually discuss with animation the different makes of typewriters, he holding a brief for the ” Yost.” With another patient I was once trying to establish a contact under difficult conditions, as I could not talk to him about his wife, from whom he was separated, nor about his children, to whom his behaviour had not been impeccable, nor about his work, since he had been unemployed for several years; finally, we found a topic of friendly conversation in the Derby. The visitor must never be discouraged by an unfriendly look, for sometimes a quite morose looking patient will, when addressed, make an amiable remark about the weather.
A handshake will perhaps establish friendly relations when no conversation is possible. I have often offered to shake hands with a patient and thought that no response was forthcoming; then slowly the arm would begin to move and after the exercise of some considerable patience on my part the hand would finally be put into mine. Even when a patient refuses to shake hands it is possible that a good impression may have been made on his (or her) mind by the offer of a handshake; I had evidence in one case that the refusal was due to an inhibition of which the patient was herself aware and which she regretted; her very regret, perhaps, helping to remove the inhibition, since later she took trouble to come and speak to me and explain the former situation.
With experience, also, the visitor learns to use tact in her relations with patients. By speaking too frankly it is possible to alienate a patient and so lose all power to help her. It is best to take a patient on her own ground, listen to her with patience and then try to lead her away from the subject of her delusions. Any hint that she was in the wrong might be fatal to friendly relations; I have even established a more or less friendly contact with one patient on the understanding that I am everything that is wicked and bad. The visiting of the patients’ homes is an important part of the work of the mental hospital visitor, not only because of the actual results obtained in persuading the relatives of patients to visit them, but because of the additional link formed beween the hospital visitor and the patients through this work undertaken by her on their behalf. With most patients the chief interest in their lives is provided by the visits of their relatives. In the case of patients whom I know well, I can often tell from their appearance whether they have recently been visited by their friends or not. The gratitude which they feel to the hospital visitor when she can give them news of their friends or has procured a visit from a relative, gives her an additional power of suggestion over their minds, which she can use to good effect. In the visiting of the relatives, also, much educational work can be done; often the relatives will adopt the hospital visitor as their special friend, of whom, perhaps, they stand almost as much in need as the patient. The daughter of one patient (whom I have never seen) writes to me ” with fondest love,” and considers me quite as much a friend as her mother does.
Visits paid to the homes for the medical staff in order to gain information with regard to a patient’s previous history are also of great interest. In the case of a patient newly certified the relatives will often express relief in being able to speak to someone who understands the nature of the illness and who will reassure them as to the treatment received by the patient at the hospital. If such investigation were made more regularly much valuable material for research and data for the compilation of statistics might be obtained.
Perhaps the most hopeful element in the hospital visitor’s work arises from the fact, often noticeable, that the insane patient tends to identify him self with the visitor as ” sane,” dissociating himself from the other “insane” patients (the projection of his own ” insane ” self). Sometimes the patient will give the suggestion tiiat he is working with the hospital visitor, or at least sympathising with and understanding her work, for the benefit of the ” insane.” One would infer from this that every insane person has a sane self and that this sane self tends to come to light in the presence of someone who, coming from the ” sane ” world, can yet by understanding and intuition act as a friend to the ” insane.”
Alice Raven.
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