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The Hospital Corpsman as a Social Therapist
An Important Role in Psychiatric Treatment

Dennie L. Briggs, Lieutenant, MSC, USN



Text and Permissions: Dennie Briggs
html: Craig Fees

 

MEDICAL TECHNICIANS BULLETIN  (Vol. 8, No.4  July-August 1957) 169-176

From U. S. Naval Hospital, Yokosuka, Japan.

 

The Hospital Corpsman as a Social Therapist
An Important Role in Psychiatric Treatment

Dennie L. Briggs, Lieutenant, MSC, USN

 

0PERATlNG 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 corpsmen.1 The 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.

HOSPITALIZATION

Whether they are aware of it or not, most patients are frightened and apprehensive when they are hospitalized for any reason.2 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.

One of 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 Purdy4,5 has shown the importance of the patient’s indoctrination to the psychiatric service and has given some excellent procedures to follow.

TREATMENT

Psychiatric treatment includes a genuine interest in the patient and his difficulties. Kindness, tolerance, and understanding are important ingredients. The corpsman’s 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, too.4

All of 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.

The corpsman’s attitudes. Again as Purdy has pointed out, ‘the corpsman’s . . . 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.

Good 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 corpsmen’s 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 hospitalized—psychiatric 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 them.

Attitudes conducive to good therapy do not come about easily—the 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 patient’s 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, don’t you?” The nurse replied, “You do annoy me at times,  but I don’t 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 nurse’s 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.

Social therapist. Just south of London is Belmont Hospital, famous for treating the socially maladjusted, thieves, other so-called “criminals,” prostitutes, and the chronically unemployed—those 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.

It is important in relating to patients to treat them as you would others, not make decisions or accept responsibilities for them, and to avoid emotional entanglements.7 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.

Group discussions. Every 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 another’s difficulties. In time, many of these patients felt comfortable enough to join the therapy groups and learned to face their difficulties more openly.

Corpsmen, and 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 hurry—really to handle his own feelings. This sharing of feelings leads to greater understanding between the patients and staff and hastens the treatment process.

A 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 life’s problems is the third requirement of a social therapist.

Recreational activities. The 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.

The 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.

Goals of social psychiatric treatment are direct and simple: (1) Helping the patient to gain control over his unacceptable impulses and thoughts—talking them out rather than acting them out. (2) Finding useful ways to use the patient’s 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 life’s journey. As a patient expressed it in a corpsman’s small group meeting, “1 don’t know if the hospital has helped me with my problems or not—but 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.

SUMMARY

Many 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 procedures.

 

REFERENCES

1. Rundle, F. L., and Briggs, D. L.: Beginnings of a therapeutic community; establishing group meetings on closed ward. U. S. Armed Forces Medical Journal.  8: 911- 819, June 1957.

2. Briggs, D. L.: Meaning of illness. Military Medicine. 120:198-201 March. 1957.

3. Bloom, M. T.: Dr. Rees opens the doors. Reader’s Digest, May 1956.

4. Purdy, K. E.: Interpersonal relations in psychiatry: the corpsman’s role in hospital treatment program. Medical Technicians BuIletin.7: 72-79, March—April. 1956.

5. Purdy, K. E.: Interpersonal relations in the hospital. Medical Technicians BuIletin 7:217-224, September-October. 1956.

6. Odgers, R. R.; Experiences with advances in psychiatric patient care. Medical Technicians BuIletin. 7: 244-251, November-December 1956.

7. Jones, M.: Role of social therapist. Nurse-patient interaction: The role of the psychiatric nurse on the ward. Pennsylvania Psychiatric Quarterly. 3:22-28. 1961.

S. Butterfield, D. A.: Misconceptions of neuropsychiatric technician’s role. Medical Technicians BuIletin 7: 179-180, July-Aug. 1956.

9. Wilmer, H. A.; Psychiatric service as therapeutic community; 10-month study in the care of 939 patients. U. S. Armed Forces Medical Journal. 7: 1465-1469, October. 1956.



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