PBH Volunteers Help the Mentally Ill

Just inside the entrance to ward E-3 a patient in her early thirties sits on the floor most of the day with her face buried in her hands, rocking back and forth and moaning; another woman looks blankly into space and pats her on the shoulder. In the center of the room, women in shabby dresses walk up and down, waving their arms. One of them stands and shifts her weight slowly from foot to foot. Other women just sit quietly and stare at the walls.

Ten or twelve PBH volunteers who enter the ward each Tuesday afternoon face the task of communicating with these people, who have been left to spend the rest of their lives in the chronic section of the Metropolitan State Hospital. Only a few of the fifty patients in ward E-3 have much chance of leaving, but the volunteers, if they are successful, can move them a long way toward recovery. At the very least, they can bring friendship and social contact to patients who may have been in the ward for 20 or 30 years.

The "Met" is ranked third-highest among state mental hospitals; yet, it employs practically untrained attendants (some of whom were once patients themselves) and only eight doctors for more than 1800 chronic cases. When a patient first enters the hospital, he is placed in a modern, well-staffed building and given excellent treatment; but if he is unable to leave after six months he moves to the "back wards," and receives virtually no therapy at all.

"Bad" Patients

E-3 is one of the worst of the "back wards"--a long, dreary room with wooden chairs and windows on both sides letting in barely enough air to keep the heat of fifty bodies from causing suffocation. The patients themselves are the kind that make trouble for the attendants--hence they are "bad," because a "good" patient at the Met is one who sits still and says nothing. It is easier for the staff to deal with bad patients, when they have all been shepherded into one barren room. There is no danger that a television will be damaged by destructive hands, because E-3 has no television.

And another thing about E-3: eighty per cent of the patients there are drugged.

A volunteer who walks into E-3 will not see much violence, because the most violent patients are usually manic-depressive, and get excited only occasionally. I met one 20 year old girl with a quiet sense of humor, who offered me a limp hand in greeting. She seemed depressed. I was surprised when one of the volunteers told me that on his last visit to the ward she had been beating her head against the floor.

Silence is a much more severe barrier than violence to a volunteer who wishes to communicate. Some of the patients remain hunched over in their chairs or lying on the floor and will not even look up when they are spoken to. Confronted with this, even the most determined volunteers become discouraged. But if individual approaches fail, group activities--singing, playing checkers, strolling outside the ward--can sometimes draw a patient out of his shell and reaccustom him to communicating, at first without words, and later verbally.

Peter A. Pitzele '63, Adult Unit Head at PBH, recalls a catatonic patient in one of the men's wards who lay under a chair all day, wrapped around one of its legs "like a puppy." He had not spoken for four years, and would look up only when he had to take medication. But at a Christmas party in the ward the volunteers induced him to make a greeting card, and as he wrote "Merry Christmas" on it he said, "I can't write too well. I can't write too well." Once the barrier had been cracked even slightly, he grew steadily more responsive, and in a short time was going on walks outside the ward.

Even when the volunteers can do little to help a patient toward recovery, they can at least brighten the ward for a few hours each week. A dozen cheerful faces and a few movements of the "Pastorale" symphony create practically the only breaks in the monotony of the patients' lives. One of the saddest looking women in the ward managed to smile when a volunteer held her hand and asked her, "How can you be so sick and have such warm hands?"

This is not to imply that patients have exalted notions of the volunteer. As Pitzele has observed, "they may regard the students as a source of food and cigarettes, as entertainers, as a way of getting off the ward for a while, or as employees extraordinary of the hospital and therefore as people who are potentially dangerous and should be impressed." Hours of group activities, therefore, often produce only casual friendships, and may seem little more than a good way for patients to kill time.

Time-Killing Diversion

My first half hour in ward E-3 was spent playing bingo with three or four elderly patients. One of them mechanically placed bits of paper on her card, without saying a word or responding to suggestions that she was putting them on the wrong numbers. The other women were talkative enough, but the conversation never went beyond calling out numbers, and occasionally commenting who was winning. No one enjoyed the game--least of all the patients.

A much more challenging experience for both patient and volunteer can come through serious conversations. This, of course, raises many new problems--differences in age, sex, or social background may make it impossible to get a conversation started, and the volunteer usually must find a pretext for talking with a patient who is suspicious of his motives and sees little need to converse.

If these initial obstacles are overcome, the volunteer usually finds one good topic for conversation--memories; eventually he will probably ask the patient about her family and her past experiences, and some patients have much to say in return. But there is a problem--almost all the women in ward E-3 are chronic schizophrenics, and their memories may have little connection with reality. Over long years of hospitalization, they have discarded experiences which they cannot face, and their minds have substituted huge barriers of fantasy.

I talked for half an hour with one of the most uncurable psychotics in the ward, a friendly old woman with a very intelligent face who spoke like a senile politician, using clear but sloppily elegant sentences. She informed me that she knew the entire Kennedy family intimately, and had worked for 23 years on the Massachusetts State Democratic Committee with both John Kennedy and his father, looking up the records of men who wanted to run for office. Later, she said, she had been Director of the Occupational Therapy department at the "Met," and was in charge of buying materials for the "poor mental patients" to work with.

Only a year and a half ago, according to her story, she was walking through a flooded cellar when she fell and cracked her head open--"that's how I became mentally ill." "I used to have beautiful blonde hair that I could sit on," she told me, pointing to her old grey head, "but when they stitched up my head it was ruined." She assured me that her illness was only slight, and that she would leave the hospital in two or three months. "I'm just waiting until I'm well enough so I know I won't get sick again. Tell me now, sir, can you blame me for that?"

Actually, this woman has been in the hospital for about twenty years--not a year and a half--and she will almost certainly never leave.

A volunteer who talks with people like this finds it hard to know how to react. As Pitzele has said, "it is difficult to decide whether to contradict the patient, suggest that he means something else, or pretend to believe the statements and continue the conversation on that basis. As most volunteers are considerably younger than the average patients, they are reluctant flatly to contradict the patients' statements--a discourtesy in any case--although it seems impossible to agree. I think that an all too frequent reaction is to try turning preposterous statement into jokes and to leave it at that."

For the volunteer, the ward program is as much an educational experience as it is a humanitarian effort, and he will learn more if he plans his own activities in the ward and finds his own best method of communicating with patients, without too much professional advice. Volunteers have occasional group discussions with psychologists and members of the hospital staff, but they are not junior theraputists, and in most cases do not even look at patients' illness records. They concentrate on bringing fresh ideas to patients who are accustomed to an impersonal machine that merely gives them pills and locks them in a room by themselves if they get out of control The limitations of the ward program, as well, would make concentrated psychotherapy impossible. Most of the patients in ward E-3 would need months and years of continual help even to approach recovery; a volunteer can spend at most a few minutes per week with each patient.

Growing numbers of volunteers have become interested in concentrating their efforts on one patient, and have joined the "case-aid" aspect of the PBH program. Here each student is assigned one patient, who is considered near enough to recovery to have a chance of leaving the hospital. The volunteers meet frequently with professional psychiatrists, members of the hospital staff, and other "case-aid" students to discuss the progress of their work, and they study carefully the records of their patient's illness. But the difference between the ward and "case-aid" programs is more a difference in goals than in methods. "Case-aid" volunteers have a specific objects in mind: to get their patients out of the hospitals and help them to stay out.

Terry Murphy '63, Chairman of the Mental Health Committee, is working with a "case-aid" patient who has been in the hospital since 1943, long enough to forget what it is like outside. She has become so dependent on the ward, Murphy said, that it is extraordinarily difficult to teach her to stand on her own feet again.

Murphy thinks he can get her out of the hospital, but the question is whether she can stay out. "There is a 50-50 chance that pressures outside will prove a little too much to take," he remarked, "and that she will purposely act strangely to get back in again."

To make her more secure, Murphy attempts to help her understand her own illness better by gradually steering the conversation into sensitive areas. It is a slow process: Murphy has worked with her since September, and last week was the first time she would admit she had a father.

Success in case-aid work depends on the individual's ability to form a close personal friendship with his patient, which is much different from the one-way relationship between a patient and doctor. So far, the results have been partly encouraging; one out of last year's 30 case-aid patients left the hospital for good.

There is still a third aspect to PBH's Mental Hospital Program, the newly developed "halfway house," where a few ex-patients live with students until they are ready to become part of the community. By living in a normal environment at "Wellment," the patients can learn the social behavior, forgotten during their long years in the hospital.

One of five ex-patients has already left "Wellmet," another is ready to leave, and the rest have shown marked improvement. The activites at "Wellmet" are similar to those in the wards--they include projects such as renovating the cellar and painting rooms, as well as parties on Friday nights. Once a week the students meet with professional psychologists to discuss the program.

Besides acting as advisors to the students, these psychologists are engaged in a research project to find out how effective volunteer work really is, and to stimulate mental hospital work in other parts of the country. Supported by a grant from the National Institute of Mental Health, they are comparing data collected in two wards--a controlled ward and a ward with volunteers.

There are no conclusions yet, but the psychologist I talked to was confident that volunteers can bring patients a long way toward recovery. "The process is long and heart-breaking," he said, "but there is no such thing as a hopeless patient. I've seen too many bad cases come too far.""The Saturday Evening Post."