(Vol. 8, No.4 July-August 1957) 169-176
From U. S. Naval Hospital, Yokosuka, Japan.
Hospital Corpsman as a Social Therapist
An Important Role in Psychiatric Treatment
Dennie L. Briggs, Lieutenant,
a psychiatric ward in a military hospital presents many problems in the
management as well as the treatment of patients with emotional problems.
Management of the ward often consumes so much time and energy that the
staff becomes discouraged, and the primary mission
of the hospital, that of caring for and treating the sick, becomes obscured in
the day-to-day handling of unpleasant details. At times the attitudes of the
military hospital staff - medical, nursing, and administrative - are not
conducive to giving good treatment to psychiatric patients. Administrative
details frequently prolong the period before evacuation of patients and the
resulting disappointments contribute to the illness, making management more difficult. Consequently care and
treatment of patients often suffers needlessly for, as we have shown at this
hospital, the initiation of a therapeutic community psychiatric treatment
program requires only minimal essential equipment, that is,
patients with problems, a doctor, and some interested nurses and
attitudes of the staff toward the patients are, however, very important, for
without kindness, understanding, tolerance, and good feeling toward the
patient, even the best psychiatric theory will not work. The staff must also
grow in understanding along with the patients.
Whether they are aware of it or not, most
patients are frightened and apprehensive when they are hospitalized for any
It is well known that many persons will go to
unnecessary means to avoid being hospitalized because they do not know what to
expect when they enter the hospital. Consequently they tend to fear the worst
possible outcome of their illness. Often the psychiatric patient enters the
hospital against his will, thus adding angry and hostile feelings to his
confusion. These feelings subsequently appear in his attitude toward the staff.
Sometimes it is many weeks before the distrusting patient realizes that the
staff members are there to help him with his difficulties and he learns to
trust them. The patient with a mental disorder has greater apprehension than a
general medical patient, because the public and those working in other branches
of medicine do not often understand the nature of mental illness or its
treatment. The psychiatric service operates quite differently from the other
services in the hospital, both in practice and in theory. While other services
are busily engaged in surgery or other procedures, the psychiatric service may
outwardly appear to have no active treatment program.
the most important phases of psychiatric treatment is helping the new patient
adjust to the hospital, its routines, its new language and procedures, to
master his fears toward it and the staff, and to learn to trust the staff. The
sooner this phase is accomplished, the sooner the patient will recover and be
able to leave the hospital. Without it, he will undoubtedly become a management
problem, treatment will be needlessly postponed, and in some cases, the
treatment he receives in the hospital will further disturb his
already precarious hold on reality. Rees,3 a
famous English psychiatrist, who has charge of a mental hospital with nearly
1,200 patients and no locked wards, has said that a poorly run mental hospital
can drive people insane. Hospital Corpsman Second Class Kenneth
shown the importance of the patients indoctrination to the psychiatric
service and has given some excellent procedures to follow.
treatment includes a genuine interest in the patient and his difficulties.
Kindness, tolerance, and understanding are important ingredients. The
corpsmans role in the therapeutic program is primarily that of a friend
and a model with whom the sick patient can identify, and from whom he can learn
new technics of getting along with others. Purdy
has defined treatment as:
. . . the pill for a
headache, the liberty at night; it is the interview with the doctor and the
bull session in the galley. It is something that goes on day and night-we are
all therapists . . . . More important than any other type of therapy on the
ward is the daily living, of the patient. The friendships he makes on the ward,
the relationships fie builds With the staff and the
patients, the people and situations he meets while on liberty, this is therapy,
these are means of relating to the patient which can be accomplished by every
corpsman regardless of the ward on which he works or the type of program that
is carried on in his particular hospital.
as Purdy has pointed out, the corpsmans
. . . attitudes, his conduct, and his interest in the patient will determine as
much as anything how much progress he will make.4
In order for the patient to learn to become honest, the corpsman must be honest
in his dealings with the patient, In order that an angry patient may learn to
be trusting and friendly, the corpsman must have
tolerance for the behavior of the patient, trust in
him, and have a kindly feeling toward him.
psychiatric treatment and care involves examining the attitudes and feelings of
the staff as well as those of the patients. Rodney Odgers 6 has shown
many examples of the changes in attitudes brought about by close scrutiny of
the corpsmens feelings and the subsequent good effects on patients
behavior on the wards. More and more emphasis in
treatment is being placed on the relationships the patient has while he is
hospitalizedpsychiatric treatment in hospitals is increasingly seen as
a learning and relearning process. Former unhealthy
means of getting along with others are examined and more adequate ways are
learned from the staff and the other patients. Important elements of good
treatment include being an understanding friend to the patient when he needs it
most, encouraging him to relate to as many people as possible, gradually seeing
that his difficulties are not really overwhelming and that he is not alone with
conducive to good therapy do not come about easilythe corpsman must
constantly question his own feelings toward the
patient. By developing a sensitivity toward his
feelings, he can learn to know when they are interfering with the
patients treatment. There is nothing wrong with having an occasional
dislike for a patient. The patient and corpsman are human, but in order to
render effective therapy, the corpsman must be
aware of his own feelings. A
suspicious, withdrawn, sick patient on a closed ward approached a nurse saying,
You hate me, dont you? The nurse replied, You do annoy
me at times,
but I dont hate you. She then cited examples of
things that he did that annoyed her. Another patient overhearing the
conversation gave other instances to the patient. The nurse felt free enough to
voice her own feelings and at the same time clarify an important misconception
to the patient. The patient almost immediately took a liking to the nurse and
through this simple
relationship began to build a friendship that he needed at the time. Imagining
the whole world to be hostile and unfriendly, he was reaching out for a friend,
but in a manner which was inviting rejection. He trusted no one and was
constantly doing things that actually alienated those around him. By the
nurses sincerity, his delusion of being alone in an unfriendly world was
gradually being shattered and he was beginning to experience friendly relations
with people. Robert Louis Stevenson expressed it this way when he said
... no man is useless while he has a
friend. Being a true friend to the patient then, is the first quality of
a social therapist.
south of London is Belmont Hospital, famous for treating the socially
maladjusted, thieves, other so-called criminals, prostitutes, and
the chronically unemployedthose individuals who have found it impossible
to get along in normal society and as a result, feel hostile and bitter. Here,
a very important segment of the treatment is carried out by 12 young women who
are in training as social therapists. With no special training or background
they learn in a short time to care for 100 patients and teach them the rules of
good social living. This special type of treatment consists of
helping the patients to form good, wholesome relationships and to learn to be
accountable for their behavior 24 hours a day. They
learn to live with others and to see the effects of what they do on other
people. They experience a sense of belonging to people and feel the real
pleasures of working and living closely with other humans who do not hold their
past against them. They are treated simply as normal human beings. The most
exciting part of the work at BelmontHospital is
that most of the patients recover and go out and live useful lives in society -
the total treatment time for most of the patients is from four to six months.
If these results can be achieved in such a short time in individuals with
lifelong histories of maladjustment, the possibilities of recovery by patients
with acute breakdowns in the service is enormous. Treatment, however, must
begin as soon as the patient is hospitalized.
important in relating to patients to treat them as you would others, not make
decisions or accept responsibilities for them, and to avoid emotional
When a patient reveals confidential information to a
corpsman that he has withheld from his physician, the corpsman should listen
understandingly and then encourage the patient to discuss this with his doctor.
If the patient is reluctant, the corpsman may offer to help him talk with his
physician. If there are therapy groups on the psychiatric service, the corpsman
may help the patient bring the problem up at an appropriate meeting in order
that the patient will be better understood by others and also receive help with
his difficulty. By learning to share information that is disturbing to
himself, the patient realizes that people understand
and will accept him in spite of the feelings he has. When he reaches this
point, he will then want to do something to change his ideas. The
second main task of a social
therapist, then, is to feed back information received from patients
to those who may be more experienced. In this way he is also helping the
patient to relate to others.
opportunity to communicate feelings to others should be encouraged as it
contributes to understanding and clarifies distortions. Regularly scheduled
times for getting together with the patients are essential to good treatment
and the development of a sense of belonging together. Daily meetings have been
found valuable, for as patients and staff have an opportunity to discuss their
mutual problems that arise on the ward and their feelings toward each other,
tensions are controlled before they reach an unmanageable state. Meetings can
be arranged for a specific purpose, such as a weekly ward administration hour,
or they may be open discussion periods where the staff
meet with the patients to answer and discuss their own particular
personal problems and feelings. One of the most rewarding groups I have
participated in was formed accidentally by men who gathered in the galley prior
to sick call, and offered me a cup of coffee as I walked by the door to my
office each morning. These were men who were reluctant to attend formal therapy
groups, and were afraid to recognize that after all these years they had
serious problems both in getting along with people and in their work. But
during informal daily coffee breaks they immediately delved into
the most serious problems and developed a lasting, mutual respect for one
anothers difficulties. In time, many of these patients felt comfortable
enough to join the therapy groups and learned to face their difficulties more
others learning to hold group meetings, often wonder just how to handle
problems that arise during the period. At times we have found it useful for the
staff to share their feelings with the patients when they believe it will add
to the patients understanding. At a group meeting a patient, recently
admitted to the closed ward, told how humiliated and
frightened he felt as the corpsman took all of his personal belongings and
uniform in the examination room where he was being processed. A corpsman
volunteered how unpleasant this was for him also, arid how at times he had
deliberately talked in an abrupt manner in order to get the processing over
with in a hurryreally to handle his own feelings. This sharing of
feelings leads to greater understanding between the patients and staff and
hastens the treatment process.
social therapist with a sincere interest in the patient and his problems will
suggest to the patient that he examine his own behavior more carefully. Such statements as, Could
it be that you feel . . . ? or I wonder if you have thought of . .
. ? or a friendly observation such as I notice that you . . .
are especially helpful in teaching the patient to do this. Patients soon learn
these technics and help each other - they model
their behavior after that of the staff. Being a
good model with whom the patient can
identify and from whom he can learn new ways of adjusting to lifes
problems is the third requirement of
a social therapist.
interests of the corpsman as well as the patient are important in providing
experiences that enable the patient to relate to those around him. The corpsman
may encourage patients to work with him on something that he genuinely enjoys
doing. These activities can range from cleaning the ward to recreation off the
ward. One corpsman enjoyed making model airplanes and kept a kit handy. He
worked on this in the afternoons when the ward work was finished and on his
duty nights. Soon several patients were interested and had an informal means of
getting together and exchanging ideas and feelings. Another worked on his old
car on off-duty time and three patients helped him. One corpsman took special
pride in having a spotless ward, and as a result of his enthusiasm, a group of
patients always helped him, developing pride in their ward. All of these
means provide opportunities for patients to work out
their feelings and to see the staff as human beings. The psychiatric patients
at this hospital have a weekly mimeographed newspaper they write, edit, and
distribute. Corpsmen and an interested Red Cross worker assist them in
organizing the material but the editor, who is always a patient, is responsible
for collecting information and getting out each weekly edition. Editors have
been patients on the closed ward, but this does not seem to interfere with the
production of the newspaper.
results of these methods can be most rewarding in terms of seeing patients
improve and leave the hospital with a much healthier attitude.8
Wilmer 9 has
shown how the use of sedatives can be almost eliminated and the use of
mechanical restraining devices and quiet rooms totally discontinued in handling
all types of emotional disorders. Our experiences in an overseas hospital have
confirmed these results and except for adjustment problems such as might be
found in any hospital ward, disturbances on the psychiatric service
have ceased to exist.
of social psychiatric treatment are direct and simple: (1) Helping the patient
to gain control over his unacceptable impulses and thoughtstalking them out rather than
acting them out. (2) Finding useful
ways to use the patients surplus energy and teaching him to enjoy being
with other people. (3) Seeing that there are people who understand him and his
ways of thinking, who accept him as he is and who are interested enough to help
him change some of the disturbing behavior patterns
he has learned from the past. (4) Showing the patient that he does have
problems and needs to face them even if facing them is painful. (5) If the
staff has been successful in the above
technics, the patient will leave the hospital with
friendly feelings toward the staff and the other patients. He will feel that he
has made some friends, but more important, that he has learned
how to make new friends in this
phase of his lifes journey. As a patient expressed it in a
corpsmans small group meeting, 1 dont know if the hospital has helped me with my
problems or notbut at least now I want to live. For the first time
this patient told how he had been tormented for months with a deep depression
and thoughts of killing himself. He is not yet well, but he has begun to take
an active part in his own treatment, which in the end, is the goal of all
psychiatric treatment. Problems do not cease to exist when the patient leaves
the hospital, but he is better equipped to handle them and to experience more
enjoyment out of life.
problems are encountered in the management as well as in the treatment of
psychiatric patients in a naval hospital. Because so much time and energy are
often consumed in management, the primary mission of the hospital becomes
obscured. The attitudes of the staff toward the patients, however, are very
important. One important phase of psychiatric treatment is helping the new
patient to adjust to his surroundings. The corpsman, as a social therapist, must
fulfill three requirements if he is to help the
patient adjust. (1) He must be a true friend to the patient. (2) He should
relay information he receives from the patient to those who may be more
experienced. (3) The corpsman should be a good model from whom the patient may learn new ways of adjusting to his
problems. Sharing the interests of the corpsman, as well as those of the
patient, are important in corpsman-patient relationship, and good psychiatric
treatment and care involves examining the attitudes and feelings of the staff
as well as those of the patients.
ACKNOWLEDGMENT: The author is grateful to Captain
Ira C. Nichols, MC, USN, for his encouragement and advice, and to Eugene Full,
Hospital Corpsman, second class, USN; Clyde L. Maxwell, Hospital Corpsman,
second class, USN; and Rodney R. Odgers, Hospital
Corpsman, second class, USN for their assistance in developing these
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Readers Digest, May
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