HE.S.T.A.F.T.A. - Scientific Society of Mental Health Professionals

INSTITUTIONS: WHEN YOUR BED IS THE ONLY REFUGE

    • phenomenology
    • phenomenology
    • identity
    • Institution/organization
    • mistreatment

    The articles was published in “Cahiers critiques de therapie familial et de pratiques de reseaux”, No 37, 2006/2, p. 73-83

    Abstract:

    Space is a dimension that cannot be overlooked either by a family or by an institution. Both entities can obtain a place in reality only through normative architectural and spatial arrangements. These arrangements are not neutral or just referring to spatial configurations. They represent, for the members of the systems, spatial parts where emotional bonding and identity issues are put at risk.

    Key words: Identity, Institution/organization, mistreatment, phenomenology

    Given that form and context are interconnected, we cannot think of family bonding and emotional relating separately from the categories of time and space. These bonds are created and deconstructed into the context of time. They are enacted and “called off” into a space: familial, institutional, social. Ausloos (1995), Delvin (1992) and Meyckens (1992) studied with particular interest the relation between time and institutions: time that stops, time that flows, chaotic time or coincidental time.

    But what is the importance of space for emotional bonding?

    Families as well as institutions, functioning as systems, are registered in space, in a “domain” (Pluymaekers & Neve, 2000). In order to exist, they both create borders or limits in space, and are traceable.  They also create a doorstep, an entrance or ...an exit. I get in, I get out, I am born, I grow up, I settle, I run to, I escape, I die; these are some verbs that denote space, but at the same time their meaning refers to our emotional relations. Lacan (1938) already insisted on the significance of those words as well as the function of the psychological complexes in the social groups - beyond biological foundations. He is referring to the delactation complex and to the image connected with the maternal breast. He acknowledges that this complex, that might be unresolved or sublimated, does not stop reproducing, in the context of our cultural realities, something relative to its primal psychological importance.

    That form of it which is most withdrawn from consciousness, that of the pre-natal habitat, finds an adequate symbolization in the dwelling house and in its threshold, especially in the more primitive forms of the cavern and the hut.  In this way everything that constitutes the domestic unity of the family group, to the degree that the individual is capable of considering it separately, for him becomes the object of an affection distinct from that uniting him to each member of the group.” (Lacan, 1938)

    Today, social living is increasingly organized around social institutions, their timing systems (timetables, shifts), their spatial systems (installations) or a combination of these (true availability).

    Unlike earlier times, when the important moments in life took place in a family context, today they are more often organized in relation to an institutional context.

    A maternity clinic, a kindergarten, a school, a company, a hospital, a nursing home, a cemetery will mark most of us. The cultural integration of these social institutions takes place within the family and there seems to emerge a positive discourse between familial and institutional systems.

    On the other hand, for some of us the institution is something imposed. It is not inscribed in the commonly accepted discourse where internal safety allows an opening to the outer world. The usual procedure is not working. The institution is imposed as the sole reference, the only sign. Space is experienced as isolated and total deviance is not far.  The names given to such institutions also suggest this change: hostels for mothers and children, kindergarten, school, hostel for adolescents, gaol, psychiatric hospital, special unit for difficult patients, long term residence centre, mortuary, communal grave.

    The increasing power of institutions in our society bothers us. It reflects a situation which could be viewed in two ways. For some it is justified: the social institution has advantages and is at our service, so families see it as useful or even necessary. Thus it is the private realm that “privatizes” the institution—by definition a public domain. But institutions could undoubtedly be a little friendlier! Some brochures for maternity clinics or, at the other end, nursing homes for the elderly, make much of their family atmosphere.

    For others this is about something else that needs to be named. They see the public field as sneaking in like a maggot into private and family territory in an unacceptable way. Shouldn’t we resist the trend towards the “duty to intervene” in the name of prevention and distinguish it from justifiable interventions, as in the case of family violence? One example of this “duty to intervene” is the way in which, in recent years, gynecologists, pediatricians, friends and social circle feel obliged to discourage a mother from giving birth at home.

    The principles of prevention justify the intrusion into private life and even into what is most intimate to us.  Given the speed at which this idea is spreading and the great number of its opponents, we probably fail to realise that this ideology is forcing us to become “transparent”. At its most extreme, this logic removes our right to keep some of our secret gardens.

    It is still true that advertising and its consumerist tendencies preserve this discourse and do not hesitate to use all means to reduce us to the role of consumer, disregarding moral values.

    More crucially, similar practices are emerging in the social field, where turning to an institution should go with the expectation for nothing more than just caring and taking charge.

    To be reduced to the status of a “transparent object” means to be denied your existence. How can you exist without private space? How can you live without having created a home, an intimate place, a secret garden? This is the key question.

    It is the very core of our history, our historicity, our oedipal history that is jeopardized by such methods and, if I dared, I would invoke Freud to remind us of the fundamental role of the father who comes to separate the child from the mother in order to open the road that leads the child to him. I only exist if the other exists as well, and if I can distinguish myself from the other.

    Serge Tisseron (1998) reminds us of the importance of the first lie for the psychological evolution of the child. The child is convinced that his mother sees everything, reads his thoughts…and by lying realizes that she does not realize at once that he is lying.  Thus the child perceives separateness and that he exists for himself.

    This distinction is vital because it presupposes a time-space dimension where I can designate something else—something different: my own self. We all need a space, which I will call “refugial space”, and a time in which we can escape. This is the kind of space, wherever it may be, where I can be with myself and talk to myself without danger.

    Fortunately, for most men and women it all goes well: we have managed to create our refuges where we can dream, even if life’s circumstances are really hard at times. We don’t need much to create this kind of refuge, but it is a vital existential exigency. History teaches us that people inflict the worst of tortures on each other and also that those who retained the power to “construct their refuge and escape to it” were able to learn to exist within or beyond their desperation. Let us remember the fate, at once tragic and admirable, of people who experienced torture, such as Malika Oufkir or the nameless Guantanamo prisoners.

    Contrary to such situations aimed at annihilating people, the main aim of medical-psycho-social institutions is to help and relieve while showing maximum respect.

    We could assume that things are simple. If we help we are ‘humane’, but if we help without taking into account the other’s needs we are not really helping. But Manichaeism never allows us to describe human complexity. On the contrary, by expressing the problem on its terms obscures the fact that social institution often meets contradictory needs. We expect it to provide more safety, better control, easier access and the aid of modern technologies while remaining convivial and family-like.  Combining these expectations is not impossible. Yet it is not rare for the technical, financial and/or organizational principles to promote humanization while the relevant measures taken in this context remain conventional and counter-productive.

    There are two reasons that could partly explain the failure of “hospital humanization” or, in more general terms, institutional humanization. Firstly, the institution and its logic take no account of what is essential for the individual; this is taken for granted. What is essential, then? To feel unconditional respect for his/her intimate space. To perceive that it is possible to preserve a personal area and a secret garden. This is really important and many examples show that it requires creativity and the occasional rethinking.

    The second explanation lies in the paradox that inevitably rises between familial and institutional context: the former seems as suitable as the other feels unsuitable.

    Thus, frequently the social institution aims at creating an alternative time-space to counter the difficulties of the family milieu when it is thought to be dangerous or inadequate for its members. So the institution wishes to offer the best, and this depends in part on the skills of the staff. It also wishes to share and allow evolution, and it is true that in many cases it succeeds. Nevertheless it is very difficult, if not impossible, to calculate the paradoxical effect of its action.

    Before we expose certain institutional practices —some would point to the creativity of the professional staff, others would demonstrate how the essential issues are sometimes obscured— it seems important to remember that the family is not always the best context to live in. Family, which allows most of us to delineate our territory and thus to exist, may equally be a space of confusion, denial of all limits and even a space where the establishment of intimate space is prohibited.

    So we can understand that for many children, teenagers or adults who live in an institution, this becomes their “home” and their “family”, although they are fully aware that it was not their choice.

    I remember having helped a lady who made her “home’ in a psychiatric hospital: “Mrs. Louis had accumulated personal, familial and professional disappointments. As a result of her inability to control several situations, she found herself residing in a psychiatric hospital. The hospital accommodated, supported and encouraged her towards a new start but all attempts at living alone in an apartment were difficult times for her. She could accept them, but at great cost to her. Gradually she acquired an existential safety: the hospital became her home and she waited until she could find again her hospital room. It was clear that, the matter of institutionalization aside, for this lady her room was home.”

    Accommodation units often fail to realize the significance of a room, the closet or the bed to an institutionalized child, adolescent or adult.  Is the room going to become  theirs ? Or will these walls remain anonymous? Will it contain a wardrobe or such for their clothes—their “second skin”? Even if their few belongings may stay in the suitcase? So they lie on the bed, but is it going to be  their  bed? How can you make others understand—and it is not easy to explain—that the place where one sleeps must function as “home” if it is to become rehabilitative. Bed is the only “home” one needs.

    If educators and caregivers could understand that this bed is essential, a part of one’s identity, literally the space where one exists, or perhaps what is left of one’s existence, then we could all understand the violence that these children experience during weekends, when they are grouped in a single ward for organizational reasons.

    What is the magnitude of those changes in the eyes of those that have the authority to decide that “a bed is just a bed”? Four nights in one’s own bed, three nights in a friend’s — where is the problem? Especially when one knows that often the sheets will not be changed.

    “It’s like being on vacations. It’s a kind of adventure!” claim administrators when having to confront them because of the violence in their own decisions. Indeed, you can change beds every night and still live well, assuming you have chosen to be a traveller. But even travellers have a bed wherever they go, if only at a refuge… When a child has begun to feel at home in a bed but then has to cede it to another even for one night, the roommate and the adult responsible for this transfer are often seen as guilty of an invasion into the private space the child believed to be his. Isn’t that a violation?

    The same thing happens within families. Children resent it when their room and bed are given to guests without their being consulted first.

    To a prisoner, too, his bed soon becomes his only refuge... if he doesn’t have to settle for a mattress thrown on the floor at night. From the guards’ perspective or on “safety grounds’’, this appropriation is seen as dangerous: the prisoner must not settle down or he might reconstruct a kind of freedom… a secret space of his own. So we move prisoners around for a million reasons connected with organizational matters.

    The cell, or the isolation room in psychiatry, is used as a punishment that prevents the individual from ‘staying at home’—the home he has created himself (his bed, his sheets,, his blankets)— which allowed him to retain some integrity and dignity. That is his third skin, the one that comes after the second skin — his clothes.

    It may be pleasurable to lie naked in front of loved ones or under the sun, but to be stripped and exposed is entirely different. When the only thing we have as refuge is our bed, this must be inviolable!

    Institutional practices often reflect the difficulty of reconciling pedagogical and/or therapeutic objectives with the various organizational, financial, architectural or security constraints. It is rarely that therapists, educators and architects have pooled their enthusiasm and skills to create institutional spaces that meet the need for intimacy, identity –the kind of refuge where we can dream and be ourselves in total safety.

    Under the “Cantous” project, accommodation for elderly people with problems of orientation or pilot schemes such as institutions for autistic children, have multiplied within their “walls” the spaces where one can cocoon without danger. In this latter case the architect provided narrow horizontal windows with big sills along the staircase, in whose recesses one can stay alone while remaining open to nature.

    It is not easy for managers, staff members or inmates to think of the institutional space as something other than an enclosed and detached space: enclosed, because the institution is founded upon society’s demand for marginalization in order to protect and cure; detached, because mingling sounds dangerous in an enclosed environment. So we separate men and women, staff and patients, the aggressive and the quiet, the sick and the healthy, etc.

    While easier in organizational terms, this has a real cost for the institutionalized individuals in terms of identity. We don’t really exist if our body, that always occupies space, cannot be a subject —i.e. experience a unique relation to this space— instead of an object that merely survives.

    Thus, a mental institution for adults housed in single rooms has no qualms about installing cameras so that nighttime supervision can be implemented by a single keeper instead of several educators in each wing. The fact that everyone has their own room and privacy is nothing more than a gesture—at best, a meaningless luxury.

    You’ d have to experience situations from the inside to appreciate how changes in space management, on administrative grounds, would affect, positively or negatively, the inmates’ issues of identity and emotional bonding.

    This evaluation demands great sensitivity on the part of the various parties: it is often neutralized due to specialization and role allocation, which may diminish personal contact between staff and patients.

    To illustrate how complex interactions can become, here is an example from a pleasant residential care unit for the elderly, which formed part of a big hospital: “An old lady is admitted and shares a room with another aged lady. A few months later her husband must also be admitted. Administration and personnel offer a double room for the couple. They stayed there for some three years, until the husband’s health deteriorated rapidly; he died one night, with his wife and some staff members at his side.
    He was to be transferred to the morgue the next morning. So his bed was free. As the hospital had a long waiting list, the admissions’ office immediately allocated it. The widow would have to suffer the presence of another person in her husband’s bed just a few hours after his death. In organizational terms, this was no problem: once a bed is available, the sheets are changed and the mattress is sterilized to receive a new patient. The particularity of the situation was not taken into account, nor was it pointed out by the reception. It would take all the diplomacy of the staff to save the lady from what we could call relational conflict.
    On the one hand, there is a widow and her sense of intimacy about this room where her husband died, which must be respected. The room was like their “home” since they could not live at their own, and still resonated with the last moments they had spent together.
    On the other hand, a new elderly occupant arrives burdened with her own difficulties and unwilling to change room. How could she rest at this bed without trespassing, without hurting the other?  The hospital was able to reverse this decision, but only for a few hours. The staff had to handle an impossible situation.”
    So there are spaces in which we can invest and transform them into our “refuge”.

    There are certain spaces assigned to us but we cannot make them ‘ours’.

    There are spaces that we appropriate and then they are trespassed, as if it was nothing, for organizational reasons or as a form of punishment.

    What do these examples tell me?

    1.  From a systemic point of view, they remind me once again that when we try to interpret reality, it is important to distinguish between official programs —which are reasonable and correct at most times— and the ‘implicit’ rules that arise silently over time. These lead to some seemingly straightforward decisions, but which can prove abusive in certain contexts.

    In these examples you can see the power of implicit rules that lead the staff to treat institutionalized people like objects ‘on the move’, without their own space, thus attacking these people’s identity.

    1.  Secondly, ethics requires that we open our eyes to the subtle, the personal, the unpredicted: the aggressive and repressive aspects of our psychosocial institutions emerge on an everyday basis when morality and institutional logic clash against each other.

    The hospital’s nursing home seemed open and sympathetic to the couple’s needs, provided them with a room… instead of a bed. But the Hospital —with a capital H— did not grasp the importance and the symbolic weight of that space.

    Within a few minutes the widow had lost that space. The new arrival made it clear to her that the space did not belong to her anymore: for the hospital it was nothing more than a return to order, but to her it meant she was refused to experience her husband’s death in dignity.

    This helps us to understand how a piece of cardboard and a worn blanket constitute all that is left from the dignity of the homeless, and why a bed at an accommodation centre can never be an intimate space.

    For lots of people life becomes a kind of “home-restricted living”, as if having a home, even if it is no more than a bed, is not adequate for recognizing the dignity of a human existence.

    And for some this begins early in life: The incubator in a maternity hospital,
    the crib in the nursery,
    the  school desk at the end of the line,
    a bed or even just a blanket at the orphanage,
    the cell, the isolation room,
    the hospital bed,
    the wheelchair, …
    ...and finally the coffin or just a grave. We should refuse to consider these spaces as containing the entire human existence: no one should be denied a refuge, even a psychological one, where one can be alone and away from other people’s gazes, a last fortress that affords safety to each of us.

    Freudian theory offered us a theory of the parts of the psyche (Laplanche & Pontalis, 1976), differentiating the subsystems of the psyche, representing them in a spatial model and attributing either specific or interconnected functions to them.

    The systemic approach gave importance to the body and its topological appearance: to the physical body itself, but mainly to the perceived body, which phenomenologists, such as Waelhens (1958), have described as an intermediate space which is neither “me” nor “other”, whilst at the same time it could be both “me” and “other”. The “presence of the body”, which institutions have the duty to handle, may reduce the  importance of the “presence in the body”. But this “presence in the body”, coextensive with our identity, would deploy all of its creativity in order to build a space, however small or marginal it might be, in which our sense of ‘being’, through the space that our body occupies, may continue to be considered as a ‘subject’. Otherwise, if the possibility of creating its own personal spatial position is unattainable in an institutionalized context organized and conceptualized on the basis of totalitarianism, our body is at risk of lapsing into a condition of ‘non-existence’.

    Raferences

    AUSLOOS G. (1995):  La competence des familles.  Eres, Toulouse.

    DELVIN E. (1992): Le temps arête.  _Therapies familliales _ XIII(3): 282-286, Geneve

    DE VAELHENS A. (1958): Phenomenologie et psychanalyse. In  _Existance et signification, _ Ed. Nauwelaerts, Louvain.

    LACAN J (1938):  _Les complexes familiaux. _ Encyclopedie Francaise, Larousse, Paris. Reed. In (2001)  _Autres ecrits, _ Seuil, Paris.

    LAPLANCHE J. & PONTALIS J.B. (1967):  _Vocabulaire de la psychanalyse, _ PUF, Paris.

    MEYNCKENS M. (1992): Le temps en institution.  _Therapies familiales _ XIII(3): 287-298, Geneve.

    PLUYMAEKERS J. & NEVE Ch (2000): Richesse du genogramme paysager.  _Chahiers critiques de therapie familial et de pratiques de reseaux _ 25: 88-108, De Boeck Universite, Bruxelles.

    TISSERON S (1998):  _Nos secrets de famille, histoire et mode d’ emploi. _ Ramsay, Paris.

    Read the next article:

    ARTICLE 5/ ISSUE 4, April 2014

    Talking about loss and mourning. Weaving strings of meaning through the grieving process

    Next >

    MAKE A DONATION

    Support the online journal "Systemic Thinking & Psychotherapy" by making a donation today.Donate