Notes to accompany Psychiatry 2: Student Daze


Notes on poem 10: would you consider …

Nursing has, by tradition, always been a female dominated profession, and nursing work-forces were Matron led and heavily starched.

This tradition had begun to change by the time I came along and stumbled into the game. In Psychiatry, in particular, the workforce was split about 50:50 between males and females.

Some of the reasons were simply historical – male wards and female wards causing a marked degree of segregation.

At the time of my entry, however, I think the reason was that student nurses were paid. It was not a lot, but it meant the difference between being able to become a nurse, or not for young men who were, as likely as not, the breadwinners for a young family, as in my own case.

A complicated calculation that I recall very well: One half of one fortnight’s wages (paid in cash in an envelope) was sufficient to pay the mortgage repayment on my home for one month.


Notes on poem 11: wearing the colours

The institutions were a highly segregated place, with rigid demarcations and hierarchical structures. Little pity was taken on a fledgling who couldn’t determine who was who and what was forbidden from just a quick glance.

The divisions were mind-blowing and knowing the colours could keep a young fellow out of trouble, on a good day.


Notes on poem 12: for a long time

Doing a first tour of the institution was a daunting experience.

The wards and units were spread over many hectares of land, and there was a lot of walking involved in getting around all areas, and having a tour of some of them.

The ‘locked ward’ was a particularly daunting unit – not really the reality of it, but the reputation that preceded our visit – ‘the worst-of-the-worst’ the hardest-of-the-hard’, the dirtiest-of-the dirty’. In reality, the unit comprised ‘the-most-forgotten’.

When we were met by this strange little gnome-like creature, every one of us believed we were meeting a ‘locked ward’ patient. It took a long time for us to believe that the party involved was a senior nurse on the ward.

We were a bit of a laughing stock, for awhile.


Notes on poem 13: the most important thing

As with most institutions, there was a form of hazing practiced on new entrants to the workplace, as a kind of cheap humour.

Senior students lorded it over junior students and took great pleasure in winding them up with misinformation of by shocking them with information they likely had never encountered before in their lives – which left a lot of fertile ground for the innovative to tease with.

In this case, outrageous information, casually dished out while on our orientation day walk, served for a very fine (senior student) laugh.


Notes on poem 14: pecking order

A little more on the rigid hierarchy that was just beginning to be broken down when I and my school group joined the ranks in the late 1970’s.

The customs seem quite ridiculous now because, well, because they were ridiculous then, I suppose. They were also much more rigidly enforced and upheld on the female side. A laxness of discipline that persists to this very day, I suspect.

My group were set up differently from those that went before in many ways, and there are still a few folk around who will loudly declare that we were the beginning of the end.

It would be nice if that was true.

Just a little note on meals for staff.

Generally, cooked meals were provided at all meals. Two courses for Lunch and for the Evening meal (three meal breaks of half an hour each per day). The meals for staff were prepared in the Mess Room, as opposed to the Main Kitchen where bulk meals were prepared for patients.

The quality of food in the Mess Room was always a little bit better than the patient meals – possibly because the especially chose the cooks allocated to the job.

All meals were subsidised heavily and were paid for by a ‘ticket’ system. A book of meal tickets could be purchased on pay days for a modest amount of money. One ticket = one meal.


Notes on poem 15: character formation

Trust Exercises.
Growth Games.
Gestalt Therapy.
Fritz Perls.
Reichian Therapy.
LSD  and Psylocybin Therapy.
Psychodrama.
EST Training.

There was a new breeze blowing through psychiatry at around the time my group were recruited. Many people were excited. Talk therapies. Touch therapies.

And this, the newest group of recruits to the cause were going to learn it all, right from week 1 of their employment. They were going to be a fantastic representation of modern psychiatric nursing.

There were a couple of minor problems. Any random group of strangers thrown together has strengths and weaknesses, both as a group and as individuals. Psychological experimentation usually requires some degree of willingness on the part of the volunteer to participate.

Significantly, perhaps, there is at least some small expectation that the people conducting the experiment actually know what they are doing, and aren’t simply grafted-on disciples of the latest version of the newest fashion.

Ours was an interesting introduction to psychology. Exhilarating and terrifying in equal measures, and there were victims along the road.

This was before the landmark period about 10 years later when some clear parameters were set around what the purpose and role of public psychiatry should be. For instance, there is very little ‘talk therapy’ in public mental health provision now. If someone can become ‘better’ from their mental illness by talk therapy, they should not be in public mental health service.

Back then, it was all new, all exciting and open slather. Also, quite risky and dangerous.


Notes on poem 16: token economy

Token economies were all the vogue in the asylum system around the world for a time through the 1950’s, 1960’s and early 1970’s. These were Psychology’s contribution to the treatment of psychiatric illnesses in institutions.

Positive reinforcement by reward to encourage certain behaviours. Negative reinforcement to discourage undesirable behaviours – think Pavlov’s dogs to get the drift, although rewards and discouragements took many different forms, in practice.

To make sense and be effective, they had to have meaning in the person’s life, and so the rewards and discouragements needed to target the way people lived – pleasure and pain and all that stuff.

When I started my career, we thought we were above all that, but the fact of it was that cigarettes were simply the greatest reward/punishment tool available. The whole world and life of most patients revolved around the cigarette ration and allocation.

Withholding a cigarette was a very powerful weapon in the arsenal, and absolutely subject to the caprice and whim of the nurse in charge of the cigarettes.


Notes on poem 17: where the air

It seems bizarre to think of in this day and age, but the social consideration of smoking outside of a house or restaurant, or a mental asylum residential ward, is a relatively recent phenomena.

When I was a young child, my family regularly traveled four hours down the highway to Melbourne with my father smoking in the car all the way as he drove.

When I was a student nurse, smoking inside the wards was still acceptable, and the consequences are as described in the poem. On wet days the atmosphere in the Day Room could be pretty horrific.


Notes on poem 18: to pharmacy for tubes

I think every department in the Asylum had its own approach to mild and not so mild hazing of new entrants into employment. Given the nature of the institution, some ‘welcomes‘ could be extreme indeed.

It was fairly standard for a new Student Nurse to be asked, in all earnestness, to go off and acquire some Fallopian tubes. None of us knew a lick about anatomy, and it presented a mild enough sort of laugh at the student’s expense.

The pharmacist was a very dry-witted fellow, as I recall. He’d seen it all a hundred times before.

‘Yes, very droll, run along now’.


Notes on poem 19: a dead parrot

The experience of the Mental Asylum and the institutional nature of it, required all – staff, students, patients – to adhere to rules and to conform with requirements that were not always clearly understood.

It was an idiosyncratic experience, to say the least.

As a student, and as a patient, we were often at the whim of the lunatic nurse in charge on the day. If that meant listening to Monty Python skits via the loudspeakers, so be it.

Monty Python were a sketch comedy ensemble in Britain in the 1970’s with a huge cult following in Australia and around the world.


Notes on poem 20: toilet routine

Rigid routines operated throughout the 13 hours of a shift in most of the long term wards. This was particularly so with the psycho-geriatric wards. From recollection, a lot of the routines had as their lynchpin the need to schedule meal breaks for staff – 1/2 staff released for the first meal break, 1/2 staff for the second, three times per day.

In the psychogeriatric wards the key tasks were something like:

– up and into the bathing first thing. Many patients were incontinent overnight and would need to be bathed, beds made and so on. This generally was structured to happen before so that patients could be at table in time for their meal, which in turn would facilitate 1/2 staff to have their breakfast break. A fair question at this point might be – how many baths were there in each ward, compared to the number of patients needing to be bathed? The answer – not enough.

– after that calmed down, residents were arrayed in chairs around the rectangle of the day room. My recollection is of two lines, back to back in the centre and facing outwards. Many of the residents were not independently mobile. Routine cleaning, tidying, linen and laundry tasks, not to mention medications to be dealt with in this time slot somewhere.

– pre-lunch toileting. This involved lift and transfer of patients from (now sodden, most likely) chairs, onto commodes for wheeling down to the shared toilet block, where they would be parked like so many dodge-em cars piled up together, for a period of time adjudged long enough for toilet functions to occur. Ambulant patients were urged to the toilet under their own steam at this time.

– lunch, medications, staff meal breaks, general sorting and tidying.

– afternoon tea – much the same as above.

– evening meals (usually early by community standards), medications and into night wear.

– early retirement to bed. Notes in patient files, rounds to check on patient welfare.

There were many other functions and elements to the typical day, but these were some of the key routine elements – bathing, feeding, toileting, linen in/linen out, bed making. They were dreary tasks, for the most part, and nurses generally didn’t want to lay eyes on a patient again after about 6 pm.

Direct communication with patients in psychogeriatric wards was generally quite limited, as verbal skills were quite deteriorated.

I was always bemused that the toileting routine actually backfired, in instances like the one in the poem, seemingly creating work, rather than facilitating any good outcomes. It was a pretty gross process, but I wonder how different it is now?


Notes on poem 21: cleaning up

Some of the male student nurse (like myself) were the bane and despair of certain old-school matron-types of Charge Nurse. There was often an idiosyncratic authoritarianism exercised by the Charge Nurses, which extended to perfect lines of folded line and tight, coin-bouncing, hospital cornered bed making. Personally I was a complete failure at such tasks and only got by on my charm and silver tongue.

Fortunately, there were a few patients that also distracted the ire of that old blurgl urgl and others of her kind. I do recall wondering, however, what part of psychiatric nursing involved washing someone’s mouth out with soap and water.

Live and learn, Frank-us, live and learn.


Notes on poem 22: So long miriam

I think it’s fair to say that we drank to for…
um
something.


Notes on poem 23: famous flying choppers

It’s gruesome to think back on some of the practices of the day. Collection of dentures, removal to a place – often the ward laundry – and then a manual scrubbing was the lot of the most junior students.

From memory, gloves were not involved.

It was a tedious and unpleasant chore that many students found difficult to take seriously – particularly as they had no experience of dentures in their lives to date.

There was a famous occasion when attempts to match correct denture with right gums took many days of diligence and angst to achieve.


Notes on poem 24: birdies at meal time

Casual and random acts or threats of violence were frequent within the Asylum setting. Psychotic conditions were, at best, marginally well controlled and the force of voices that are chattering within a person’s mind, unseen by others, are powerful. Often random, often sporadic.

At the time, a third year student was considered senior enough to be solely in charge of the ward and we were often rostered ‘in charge’ when we worked in some wards.

A 3rd year ‘in charge’ may well have a 2nd year as the remainder of the nursing compliment for the shift.

Inexperience was a potentially deadly skill attribute and it was incumbent on all to get smart quickly.


Notes on poem 25: bathing the locked ward

The locked ward was a horrific place. Horrific in the sense that it was pathetic. When I look back on what is now a long career for memories of the terrible and disgraceful, it is the scene described in the poem that always comes to mind. A scar from the old institution that is mine for life.


Notes on poem 26: row your boat

The Mental Asylum institutions were mixed in terms of their clientele. At that time, intellectual disability, as well as a range of brain related conditions, and unexplained epilepsies were lumped under the banner of ‘Mental retardation’ and grouped within the asylum in dedicated wards (often known as Cottages, or as Kids Wards). Many of our highly derogatory insults today come from the lexicon of descriptions used in Mental Retardation – idiot, pinhead, cretin, for example.

Later in my time in Psychiatry the field was removed from medicine/psychiatry, and became intellectual disability, with an abhorrence of the use of medications which became equated with ‘chemical restraint’ and in a more general sense Psychology took control of the field.

As student psychiatric nurses we had no dedicated placements in the mental retardation wards, as they were considered a specialty area and had their own 3 year course of training, just as did psychiatric nursing. At that time, Mental retardation Nursing had its own register as a branch of nursing practice, but, I digress.

Patients from both the retardation and ‘mental hospital’ wards had free rein of the asylum grounds, if they were judged competent to not get themselves or anyone else into any kind of trouble. Many had ‘jobs’ assisting with one or another of the sundry departments – Gardening, Tailor’s shop, Engineering and so on. The gentleman featured in this poem was a very tall fellow, dressed in orange overalls and mumbles who wandered about and did odd things that often caught my eye, including rowing a paper napkin boat that he’d drawn himself.

I have no information on his destination.


Notes on poem 27: a day at the races

There were many reasons why the old institutional system of providing mental health services had to be abolished. My own view is that all institutions become incurably corrupted after a period of time and come to serve other needs more than those they were originally aimed at.

In the case of the old Asylum of forty odd years ago, it was a time of regimented control, based on seniority and tradition. If the person running the ward was inclined to a ‘big day out’ with alcohol, it was permissible for that to occur, with the details of what the outing involved and ‘looked like’ glossed over in any official accounting.


Notes on poem 28: getting stuffed

I don’t think any of my group had seen a corpse when we started our nursing careers.

It’s a heck of a shock, let alone realising that you have a role in preparing the body – even if it is mainly standing around in horror and watching the process.

Interesting to experience first hand the lack of compassion evident in a member of the ‘caring profession’.


Notes on poem 29: in charge of retardation

I’ve mentioned previously that as student nurses we had no placements, and therefore no experience of working on the ‘retardation side‘ of the institution. I had many anecdotes from my mother, who worked there a lot in her years on the job, and from sundry colleagues, given that I was a third (final) year student by this stage.

Given staffing shortages and the lack of properly qualified trained staff in retardation, however, a half-cooked 3rd year student psych nurse working overtime as the in charge was better than no-one at all, seemingly. In practice, the student would do well to keep quiet and let the experienced, though untrained, staff who routinely worked in the ward run the shift, and simply do as they were told.

It was a completely unique and vastly different world.


Notes on poem 30: medication jam

Amazing levels of compliance were achieved through the use of either sweet things, or cigarettes.

In the retardation wards, very few patients retained many teeth. They were lost to either the medications (Phenytoin sodium (Dilantin) affected the gums), or to poor dental hygiene, or to regular applications of sweet things – like jam at medication time. The jam came in tins that held, I suppose, about a gallon in quantity. Tablets inserted into the middle or underneath the dollop went done without any fuss.

No false teeth were in use in the retardation wards (to my recollection, at least). I think the prevailing view was that the patients could not be trained or trusted to manage them without coming to or causing grief.

The whole process of medication administration had the air of formal ritual associated with it, that was, I guess, an evidence of the dreaded institutionalisation at work.


Notes on poem 31: bounce and flow

As a 3rd year student, I had placements in the acute treatment unit where patients had shorter term admissions for more successfully treatable conditions.

Seclusion is more a management option than it is a treatment. Essentially, when a patient was unable to be controlled – perhaps while we were waiting for medication to take effect, perhaps for other reasons – Seclusion (confinement alone in a single room) might be considered.

In the case of this poem, a dis-inhibited young woman, liable to place herself at risk due to a manic presentation was placed in Seclusion to keep her safe.

As I recall, it was night duty and I was very, very late to notice the seepage of water under the wall and into the corridor.

A practical issue – if male only staffing, how to manage female dis-inhibition. Very tricky.


Notes on poem 32: huntington’s marionette

Huntington’s Chorea – the condition associated with Woody Guthrie (and his mother), as I recently discovered. Woody spent 5 years in a mental hospital with this condition at the end of his life.

Huntington’s is a ruthless and ugly killer of a disease that often strikes relatively young people – in their forties (Guthrie was 55 when he died). It’s a bit of a sick joke that often gets trotted out that the disease could be eliminated within a single generation – if no-one currently carrying the gene reproduced.

My experience of the condition is limited to a few people I’ve known as patients. The woman in the poem is the only one I nursed closely – in the psycho-geriatric ward of the institution.

Very distressing.


Notes on poem 33: better than that

There is an argument that mania allows people to do whatever they want to, without taking responsibility and without facing consequences. Sickness is its own excuse, right?

Bipolar disorder (manic-depression) of a magnitude that brings a person to the attention and into the care of public mental health services ( generally Involuntary  Treatment against the will of the person affected, and invoking the provisions of the current day Mental Health Act) is a serious mental illness and quite a big deal to treat and manage and to live with.

Getting a slap to the face unexpectedly is also a big deal. I was ready to throttle and could not allow myself close proximity to the patient for a long time.


Notes on poem 34: after the ball

The Hospital Ball was a very big event in the life of the institution, as it was in the township. These were the days when every important town grouping had it’s own dance event to conclude the year – the football club, the cricket club, the shire council.

They were wild affairs and didn’t stop until they couldn’t go on.

I’d never before had the experience of having to go to work without having actually stopped partying. Many of those around me were not so inexperienced.

In some ways, the days I am writing of were naive and simple.

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2 thoughts on “Notes to accompany Psychiatry 2: Student Daze

  1. These are great notes/additional thoughts, information Frank.

    And I have to say: you totally caught me with this: “In reality, the unit comprised ‘the-most-forgotten’.”

    Interesting and somewhat a sad commentary on how stigma so often continues to date the mentally ill – the words “dirtiest-of-the dirty’” are haunting – really.

    And I had to laugh – “When we were met by this strange little gnome-like creature, every one of us believed we were meeting a ‘locked ward’ patient. It took a long time for us to believe that the party involved was a senior nurse on the ward.”

    I can bet the sheer volume of the what you were experiencing on an orientation tour must have been more than just a case of jittery nerves and all ….. and of course, “what? WHAT?” …. undoubtedly, as mentioned in the post “the most important thing” …. an eye-opening education.

    Liked by 1 person

    • Pat, it only occurred to me belatedly to add the notes, and I nearly gave it away because figuring out how to put ‘targets’ in posts was just about beyond me. I was saved by good folk at the forums for WP.

      There’s a lot I could say about the back wards and the locked wards, in particular. Some of the experiences from 40 years ago still travel around with me, so ‘haunting’ is probably the right term for it.

      I suspect the poems will tell enough for most people reading them.

      Cheers again,

      F~

      Liked by 1 person

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