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Institute for the Feeble Minded

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alberta hospitalI took my first drive down the meandering lanes of Alberta Hospital Edmonton on the dawn of a beautiful autumn day. The mighty specimen trees were in full leaf and just beginning to turn a rich confusion of colour. This visual splendour contrasted sharply with the squat, unimaginative buildings scattered all over the 275 acre porkchop of land. Building number one,the exception, was opened in 1923 as the “Institute for the Feeble Minded,” heralding a new era in the treatment of “mental defectives.” The air was crisp and filled with the sounds of twittering birds as I climbed from my vehicle. I had arrived for my interview.

I was early. During my 10-15 minute wait I had an encounter with a brusque minor official in the administration building that gave me a nasty sense of foreboding and I almost left before the interview but I resolved to sieze the moment. I attended the interview. I was offered the job. I accepted.

Before the job came the initiation. There was a training course which involved review of provincial legislation,institutional policies and restraint techniques. Two man takedown, three man takedown,four man takedown, five man takedown with group practice time in the gymnasium/auditorium. We also practiced individual self defense moves. We took turns being the aggressor and the defender. I remember thinking,”How are a few exercises over a few hours going to make me more able to fend off an enraged patient than I presently am?” The exercises did serve however to raise the apprehension among participants that a violent encounter was likely to occur as did the location of the exercises. The exercises were held in the forensic psychiatry auditorium; home to the criminally insane and those awaiting assessment.

In the forensic building everything is locked. It is home base for security. There are double locked doors manned by not necessarily burly but usually surly security guards behind very thick glass. These guards do not remain in their glass enclosures all the time. They sometimes emerge to patrol the general patient areas bringing with them their hardened attitudes.

We took our breaks in the cafeteria which was connected to the forensic building by a short tunnel and guarded by a phalanx of vending machines and tables with serious sounding pamphlets. This is when I first became aware of a strange emotional dullness that seemed to inhabit the operators of this tiny island. The quality was epitomized by a cafeteria cashier who bore a striking resemblance to Buster Keaton. As emotionally flat as the prairie itself.

In interactions with general staff I noticed that greetings were often not returned. Gazes were often averted in an effort to avoid interaction. The medical director himself declined to shake my hand when I offered it to him during our first meeting. There were to be many equally odd manifestations of this trend toward desensitization and away from empathy during my tenure at the hospital. They all had in common a devaluation of genuine human emotion and interaction.

Some of the problems that afflicted the staff could perhaps be explained by chronic overcrowding.

I was not employed at the hospital long before it became obvious that there were never enough beds at the inn. Always more living breathing disturbed human beings than actual beds. The extras slept on mats on the floor I suppose. There was constant strife between units regarding the disposition of these “over capacity” warm bodies. You take him! We took the last one! It”™s your turn! I suppose over time this could cause a staff member to tune out and develop a blunted affect. Also, the more patients were jammed into the existing confined space, the more volatile the situation became and hence more important that strict behavioural controls be imposed to minimize patient/patient or patient/staff violence. The fact that custodians to whom the mentally ill are compelled to turn for support, are tuned out and unwilling or unable to offer that support is no insignificant matter to those held against their will under the Mental Health Act nor an insignificant irony I might add.

On the other side of the coin, although staff may have tuned out in response to an overwhelming demand on their time and attention there is a deafening silence when it comes to public advocacy on behalf of this group of vulnerable Albertans who are clearly in no position to advocate effectively on their own behalf . If those who work closely with this sensitive population are not prepared to advocate for them then who will be? In short, I dont see concerned medical professionals beating down anyones door for redress in relation to any lack of basic standards in psychiatric hospital care.

I can see why a wise administrator might forego the eiderdown pillows and personal valet service. If things got too comfortable, patients might be encouraged to outstay their welcome. A simple bed and mattress however should be a minimum requirement in an Alberta hospital and if this standard is not met the administrator should petition the government via all available avenues to correct the deficiency. It should not be simply a question of cash the cheque, cover your ass, and let them sleep like sardines in a can and awake to an increasingly overcrowded, uncomfortable and dangerous living space.

Other problems that afflicted the patient population were the result of ego defect on the part of individual staff members that lead them to compulsively devalue others in order to feel more important and valued themselves. It is difficult to recruit appropriate candidates to some of these positions. Some of the candidates are therefor much less than suited to the task given the sensitivity and insight required in the maintenance of a therapeutic environment, particularly in an overcrowded situation.

The geographical apartness of the institute from the city has served in the past to create the perception of a state within a state in the minds of employees and a subtext for a strange sense of entitlement. In many respects it has been a state within a state. It has had its own power supply,its own water supply, its own food supply, its own police force, its own rules and regulations, its own seat of government with well appointed offices and administrative suites. It also has had its own way of doing things.

There are many employees who have worked at the hospital their whole adult lives. Their children now follow in their proud footsteps. And their childrens children I imagine. They see it as a kind of monastic discipline in which succession is natural and guaranteed. This carries with it a sense of personal entitlement within what is perceived as their domain, the AHE and it”™s environs. Honoured truths that have stood the test of time and scientific inquiry in the outside world are readily jettisoned in this milieu if the need for control so dictates. Logic is subservient to the dominant self interest. The result: Very bad policy enacted for very good reasons.

I got the distinct impression during my period of employment at the hospital that at least some of the medical professionals that were employed at AHE were there because of their lack of skill sets rather than their possession of specific desired skill sets. The prime imperative being maintenance of a controlled environment, it would not be an aberration of history if individual staff members were chosen, over time, for their loyalty and ease of accommodation to authority rather than their intellectual prowess in the furtherance of a program of control.

The imposition of enhanced control measures in the general population can be justified in the minds of custodians because of a psychological as well as physical proximity to forensic psychiatry.With this proximity comes a reduction in empathetic/therapeutic concern for patients entrusted to the care of the hospital and an increase in concerns about matters of a security nature. Nurses become less willing to trust and progress in reaching therapeutic goals is hampered. Staff are more likely to use physical force to restrain their patients. Doctors are more likely to prescribe sedative type drugs for reasons of restraint. Patients are less likely to get well.

Because of the existence of a forensic service on site where tight security and discipline are prime imperatives and given the close interrelationship between forensic and regular hospital services , in my opinion, a proximity bleed occurs resulting in an overemphasis on control in the general hospital population. These patients are , for the most part, just ordinary Albertans with problems. They are clearly not beneficiaries of any close association with the criminally insane. They are often not treated with the respect due them as citizens of Alberta merely because they are tainted by proximity. A self fulfilling prophecy that leads to a bad outcome far too often for innocent Albertans.

I do not regret the time I spent working at the Alberta Hospital although it was emotionally exhausting. I learned many valuable lessons. I met many hardheaded people who would not yield to reasoned argument. I saw things that I never wanted to see. I saw a class of people who were satisfied with nothing but the best and the income to match their desires. I saw a disenfranchised class of people with barely a bed and the clothes on their backs.

It is so easy to be deprived of ones liberty given a perfect storm of circumstance. Various combinations of infirmity, alienation of family, the passing of friends and the capricious nature of time and tide can combine to deprive us of that which we once held precious. None of us is completely isolated from that storm. And sometimes we all lose touch with that essential spark that infuses our lives with meaning. Sometimes we just lose our way

I pray that my mind will remain nimble enough that on some future date I will be able to defend my right to live freely.

I pray that you, my anonymous reader, will live a long and fruitful life and will not be beset by problems of ill health.

And I pray that the mentally ill will soon be treated with the respect afforded those in other areas of our health care system.

Joe Gitzu

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