How to think about social hospitalization and institutionalized patients

（What is the recovery of autonomy? How to think about social hospitalization and institutionalized patients）

When I go to psychiatric nursing training, the patients I am introduced to have no symptoms at all, as described in textbooks. (Residual schizophrenia 💦)

Some patients have similar descriptions in their past electronic medical records, but most are "normal people".

When I tell my training supervisor or supervising teacher about this, I am told in a condescending manner that I have a "shallow perspective and way of thinking" and "lack of knowledge".

However, in reality, 90% of the psychiatric patients that nursing students are in charge of are socially inpatients, so they don't have any symptoms at all.

They are people who are drugged and lethargic.

Especially in private hospitals, they are all patients who are hospitalized to maintain bed occupancy rates for business reasons.

To give an example of a socially inpatient,

"Even though I don't have any cold symptoms now, I caught a cold 10 years ago, and the pneumonia got worse and became serious, so I am still giving them cold medicine to prevent a recurrence."

The leaders are quick to assume that "these people don't know how scary pneumonia is, so they don't have any awareness of their illness."

"It's scary when you start to catch a cold because you don't have any symptoms, but these people are taking it lightly."

It's laughable. It's as if they're saying that "people without symptoms = asymptomatic carriers."

They also say arrogantly, "These people may seem to be living normal lives, but their symptoms are being suppressed by psychiatric drugs, that is, drug therapy."

They genuinely believe that "their cold symptoms are mild because they take cold medicine on a regular basis."

(They're deeply brainwashed, or there's no medicine for idiots.)

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If a student says, "If you don't have any symptoms, you can be discharged, right?" they get a condescending response: "You can't continue taking your medicine by yourself, so we're managing your drug therapy like this."

"What kind of rehabilitation can help people learn self-management skills?"

"These people can't do it because they have a disability"

(Actually, they just do it routinely because checking their medication is too much of a hassle)

Listening to conversations like this, it's just foolish.

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Long-term hospitalized institutionalized patients have been isolated from society for over 10 years, unable to work properly, and robbed of the ability to endure.

Try living a life of three meals a day, naps, and food being served to you for a year, even though you're hospitalized.

You'll surely start to feel foolish about working.

In this way, private psychiatric hospitals reduce people's motivation, making them like livestock.

Also, psychiatric drugs make people feel dazed all day and slow to act, so motivation is reduced in two ways. (institutionalization, secondary negative symptoms)

Domestic animals are animals that are sheltered from the wind and rain and are given food if they obey their master.

It is a "master-slave relationship."

What happens to a domestic animal if it bites or harms its master?

It will be tortured, or worse, tortured to death.

This is the reality of punitive isolation and physical restraint.

If you express your will, you will be punished, and your autonomy will be reduced.

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That's enough of an introduction. What do you think is necessary to increase autonomy (independence)?

"Chasing your dreams."

For example, let's say one of your patients has a dream of "really wanting to get married!"

So, what does it take to marry someone of the opposite sex?

① Financial strength,

② Appearance and looks,

③ Conversational skills such as topicality and interpersonal skills,

④ General household skills (self-care ability),

⑤ Physical strength (ability to maintain health),

and more.

In other words, if you want to accomplish something, you can't get it unless you acquire various abilities and skills.

This may seem difficult at first glance, but if you have a dream, you can overcome it.

This is because it is not an effort that you make because someone else tells you to.

When people recognize that the problem is their own, they will make a serious effort.

This is the driving force behind "autonomy" and "independence".

(Doing things that others tell you out of obligation will not help you to develop autonomy and independence.)

It will be difficult to do all five of the above during your internship.

However, if you can tackle even one of them, isn't that good?

You have come up with the idea of ​​"taking care of yourself in your life!"

Let's use a marathon as an example and say that the journey to marriage is 100 km long.

If he had stayed in the hospital and followed what the doctors and nurses told him to do, he would never have entered a marathon.

But once he started working with nursing students, he was able to "put on shoes, change into comfortable clothes, and walk 100 meters."

In other words, there were 99.9km left.

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If we compare humans to bicycles, the most difficult thing is to "start moving from a stopped position," that is, to "go from 0 to 1."

It is easier to increase speed after starting to move, that is, to "go from 1 to 10."

Having students accompany him and run alongside him is "going from 0 to 1."

In fact, this process is the first step in nursing for socially hospitalized patients.

It is the first step in transforming them from livestock that wait for instructions into people who can think and act for themselves.

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There are some leaders who say hypocritical things like, "Since the patient says that he is happy with his current lifestyle, shouldn't we just leave him alone?"

But is that really what the patient wants?

For example, the cost of psychiatric hospitalization has increased, the amount of the second-class disability basic pension has been reduced, the burden on patients has increased, and food subsidies have increased,

"People without financial support from their families cannot be hospitalized,"

and hospitalization has become impossible.

Can the patient maintain "the current lifestyle" depending on the policies of the Ministry of Health, Labor and Welfare and the Ministry of Finance?

They will be forced to live with their family, or receive welfare assistance and start living in a group home or alone.

At such a time, if they are told, "The law has changed, so you will have to live alone from next month,"

and have no ability or skill for living alone, the patient may become desperate and choose suicide or crime.

In fact, many psychiatric hospital patients choose suicide.

This is because they face the reality of their inability to become independent and despair.

So, saying "I'm fine with the person being the way they are, so let's leave them alone" is actually just a nice-sounding idea that doesn't really take the other person into consideration.

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Humans cannot make their dreams come true on their own.

Even if by chance their dreams come true, "they won't be happy" and "the joy is fleeting and the happiness won't last."

What is true human happiness?

What is a sense of happiness?

The answer can be found in the Bible, and in the Rapt Blog, which unravels the Bible in even more detail.

In a sense, the job of nursing is to help people find happiness.

In order to help people live with hope, it is necessary to have a clear understanding of "human happiness."

I sincerely hope that more people will find the answer in the Rapt Blog and understand what it means to help people find happiness.

(Recommended audio)

RAPT Morning Meeting June 2024 https://rapt-neo.com/?page_id=59738

"Thursday, June 13, 2024
People feel happy when they have peace of mind, time, and finances, and feel unhappy when they lose even one of these. And all of these things are given to us by God in abundance by loving Him. (We cannot control our hearts, time, and finances by our own abilities alone. We can only control them if God controls them.)"