Recently I was listening to an interview on CBC radio – the Canadian equivalent of NPR – with Kay Parley. (Click image below to view the CBC website). At age 93 Kay recounts her experience of being admitted to a psychiatric hospital as a young woman – the same hospital where her father was a patient and where her grandfather had been treated. While the webpage plays up the LSD treatment piece, this is really an aside. The more interesting elements of Kay Parley’s story, for me at least, were around her recovery journey and her discussion of how important certain professionals were. She talks of how valuable it was to have recreation therapists who engaged her in tasks and of how important working on the hospital farm was for many patients.
I’ve met older psychiatrists who also spoke with real appreciation of the value of the farm work that went on years ago in the large psych hospitals of years ago.
Meaningful work is tremendously important for most of us including persons with severe and persistent mental illness. At the same time I have very mixed feelings about the history of work in the asylums for which patients were rarely adequately paid.
In teaching psych history I ask trainees to consider the case scenario below. It could also be used for an ACT teaching session, maybe facilitated by the vocational specialist on the team.
Consider listening to the Kay Parley interview – it’s really quite interesting.
Case Scenario: It’s 1930. Dr. David Young, medical superintendent of the Manitoba Asylum ( or insert name of large hospital in your area) has died and you’ve been asked to take over the role.
One of your first challenges is to make a decision around the Asylum’s farm facility. For years patients have performed a variety of tasks and such activity has always been considered therapeutic.
Several labour unions have threatened to protest in front of your office and to launch legal action unless you put a stop to the practice of making patients do unpaid work. While you point out that patients are never forced to perform work, the union reps are unmoved. You’ve appealed to the provincial/state government for funds to pay patients and this request has been repeatedly rejected. (Keep in mind it is the Great Depression with roughly 30% unemployment across the country)
How would you address this?
Some additional questions to ask might include:
- If rehabilitation is important isn’t it reasonable to press patients to work?
- If lack of motivation is a symptom of schizophrenia might patients benefit from being encouraged to work?
- What is the difference between rehabilitation and recovery?