Constructing patient–psychiatrist relations in psychiatric hospitals: the role of space and personal action

Abstract

This essay investigates the role of space and personal action in the construction of patient-psychiatrist relations at psychiatric hospitals. In order to explore such a theme, the writings of R.D. Laing prove to be salutary. This is namely accredited to Laing's tenet that the staff and patients of a psychiatric hospital are institutionalised by both physical structures and personal action. A central approach taken in this essay is to explore Laing's theory through an intertextual reading of Michel Foucault's Madness and Civilization (1967) and Erving Goffman's Asylums (1961).Keywords: R.D. Laing, Erving Goffman, Michel Foucault, psychiatric hospitals, patient-psychiatrist relations. IntroductionThis essay investigates the role of space and personal action in the construction of patient-psychiatrist relations at psychiatric hospitals. In order to explore such a theme, the writings of R.D. Laing prove to be salutary. This is namely accredited to Laing's (1985, 26) tenet that the staff of psychiatric hospitals are institutionalised along with the patients. To attest to this theory, Laing believes that experience (or the negation of which) is made possible by two factors. Firstly, the physical environment offers either the potential of experience or its restriction. Secondly, personal action can either open up the possibilities for enriched occurrences or it can hinder such possibilities (Laing 1974, 28-29). In recognition of these points, the following becomes apparent: staff and patients are institutionalised by both physical structures and personal action.The dominant expression and formation of this institutionalisation is the It-district. The 'It-district' can be defined as a difference constructed between staff and patients within psychiatric hospitals. This difference is neither neutral nor natural. Rather, it is a product of the physical environment of psychiatric hospitals that is structured to segregate, excl ude and observe the pati ents. In addi ti on i t i s the product of the personal action of staff that is based on control and excommunication. For Laing these manifestations are aligned to social power and not to health care. Yet these are nonetheless the dominant formation of the institutionalisation of psychiatric hospitals.The result of which is that certain modes of communication and power relations become apparent in the patient-psychiatrist coupling.Yet, Laing's views cannot be read in isolation; rather his themes are corroborated and explored by both Michel Foucault's Madness and Civilization (1967) and Erving Goffman's Asylums (1961). Together, these books represent the broader zeitgeist of an interest in the history of mental health and the social institutions of psychiatry. As such, Laing's views are investigated within an intertextual reading of both Foucault and Goffman. In particular, this exploration is in terms of the physical environment and personal actions manifested in the psychiatric hospital. In terms of the former, Foucault deems psychiatric hospitals, more specifically, asy...

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