Dr.X, author of a great blog, Dr.X's Free Associations: psychology,great vintage photos and more... has added an important voice into the discussion of fresh air, and outdoor time in psychiatric hospital settings with this great article.
I am posting the article here with many, many thanks.
It is not just for my daughter, (in my opinion) the thought is for everyone, everyone--- ever in this situation.
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The Use of Sunlight and Fresh Air as Contingencies
Hospitals, Not Gulags
"Stephany (soulful sepulcher) has written extensively about her daughter Lindsay's problems with the mental health system. Most recently, her daughter has been kept indoors for three weeks because she has failed to earn her sunlight and fresh air reward in the level system.
A level system is a treatment program that uses a system of behavioral contingencies -- reinforcements and punishments -- to bring about desired changes in a patient. Contingency programs are based on the operant conditioning paradigm of behavioral change.
While it's important to give contingencies time to work, there comes a point when hanging on to an ineffective contingency can be destructive and cruel. If a contingency doesn't actually lead to change in the targeted behavior(s), the contingency should be reconsidered.
In any case, I seriously doubt the wisdom of using as a reinforcer, anything that itself might contribute to the health and well-being of a patient."-Dr.X
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4 comments:
This is very revealing... "Behavioural contingencies"? And what if a system of behavioural contingencies actually contains one or more elements that are major triggers to a patient? What if these behavioural contingencies actually trigger non-cooperation?
Presumably, there's a means of checking this, so that the use of behavioural contingencies isn't counterproductive, in a given case? On the other hand, perhaps no such careful consideration is given?
Punishment is not the best means of changing behaviour. Never has been, never will be.
Matt
That's horrible! Just plain cruel.
A couple of other things have occurred to me, on this subject...
First, is the patient ever told what behaviour they're supposed to be adopting, and why? Second, is any thought ever given to the possibility that the behaviour that a person is being told to adopt might conflict with something else that they've been told that they must do, or must not do - a double bind, in other words? No idea, some people. No idea, at all. You've known this... You've always known it, in which case you must have known how much pain it caused to those subjected to it.
Well, now I know that people view punishment as an appropriate tool to secure change, I know what I've just been given carte blanche to do. There are no excuses - I know it wasn't an accident, now.
Matt
The use of "behavioral contingencies" do cause people to rebel. I saw it not just in myself but in many patients. Actually it makes a lot of sense that they would. Adults don't typically appreciate being talked to or treated as if they're children, because they're not children. This creates an adversarial relationship which is not helpful.
It's a messed up system, and I'm primarily speaking about inpatient treatment. All the mixed messages patients are given. Psych patients are repeatedly told they have a disease just like diabetes, yet they're not treated that way. They're threatened if they don't do x, y, and z well, then they will be punished - they won't be able to go home, or they can't go outside, or the staff will be angry, and so on. The message to the patient is we don't see you as an adult.
There's no doubt that threatening patients can lead to compliance, at least temporarily. This is true. Patients learn to say what the staff want them to say, and they get to go home. But were they helped?
I think there's a better way. I really believe that treating patients like adults is more likely to result in adult behavior than treating them like children. I never had any problems with staff in a regular hospital. That had everything to do with the difference in staff behavior - I was an adult in the regular hospital. It's amazing how calm and polite I am, when the staff are behaving in kind.
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