Part I
Do the patients at KKB hospital know that it has been designated a teaching hospital?
Do the women in labour know they will be subject to students staring at their vagina as they give birth? Do the 10-year-old boys know that they will be filmed as their foreskin is snipped off?
Do the patients in the wards know that they will be subject to endless -
and I mean, endless - history-takings & physical examinations?
I don't think my patient did.
P, 19, having endured the previous afternoon a barrage of students palpating the thrills at her mitral & pulmonary areas, and listening to her pansystolic Grade 4 murmur from mitral regurgitation, was understandably
not keen to have Azri & I take her history the following morning.
We asked what questions we could ask under the guise of chit-chat... I may have not been able to find out how long was her fever before she was admitted to the hospital -
she has subacute bacterial endocarditis - but I did manage to build some form of rapport with her.
Enough for her to agree to allow me to examine her.
Without Azri.
After I let her palpate & ausculate my 4 cardiac regions.
Since I wasn't a doctor, I figured it was a pretty fair trade-off for her to examine me in exchange for letting me examine her.
I don't know if what I did was the right thing.
I just know that I've a soft spot when it comes to young patients. She
is only 19.
P/S - Will the next bunch who heads to KKB please look in on H? She's a 10-year old patient suffering from asthma in the paediatrics ward. Thanks.
Part II
Having researched & debated endless rounds on schizophrenia, autism, mental healthcare, and yes, even institutionalisation of patients, during the past week for IMU's NHSD -
which bore the theme, "A beautiful mind - the mental health enigma" - the irony of watching a movie on the dehumanisation of mental patients in an institution was not lost on me.
During our small-group discussion of the movie, some interesting issues came up:
"The doctor should have gone to see the patients. We only see the patients being brought to the doctor when they do something wrong, or they need serious help."
- Pei Yee
Yep, I also found it stupid that the doctor's idea of "observing & evaluating" McMurphy was to have 1 interview, 1 Q&A session & 1 panel discussion during the entire 4-week duration he was staying there.
"People should have more interaction with the patients outside."
- Theresa
Which brings us to the question, is institutionalisation the answer to patients with mental illness? Some people in the U.K. favour jailtime for dangerous mentally-ill patients, arguing that the conditions in mental institutions are akin to jails, anyway.
Ah, I shall digress for a bit here.
I couldn't help noticing from the outset that the institution depicted in the movie was structurally excellent. The grounds of the Oregon State Hospital were lush, the building was stately, and the staff was nice. At the outset, I said.
Which makes me wonder, if fine institutions such are these are still capable of generating the screw-ups seen in this movie, how must it be like in real-life, real-time institutions, that lack resources, support & funding? Proof that no matter how bad things are, they can always get worse.
Some people in the U.S. favour community-based care, ie. releasing patients into the care of family & friends. The whole idea behind it is to integrate them as much as possible into the fabric of society. I was surprised to find out that Malaysia, famous for hiding its crazies in loony bins with fancy names like "Tanjung Rambutan", actually adopts this form of treatment.
(in a creepy tone) They are among you...
Discriminatory jokes aside, I also noticed that the nurses spoke to the mental patients & the janitors in the exact same tone of voice. It might be helpful to note here that the janitors were all African-Americans. Politically correct term to use in place of niggers. Or even blacks. This movie was, after all, set in the 1960s.
Where does all this lead me?
Basically, this movie is about fear & control.
In fact, nurse Ratched's desire to control is born of fear.
Fear of the mental patients. Fear of becoming one like them.
We see this fear manifesting itself in the barriers she puts up in her interactions with the patients under her care - the glassed-in nurses' station, the "cardinal rule" that no one except nurses are allowed to enter the station, the patronising tone of voice she adopts when talking to the patients. (And the janitors.)
The successful conditioning, or to be exact, the learned helplessness, she instills in the patients in her ward.
And when someone challenges her authority, the primary instinct that overtakes her judgement is not anger, but fear. She bullies people into submission - people like Billy, Cheswick & McMurphy - because she fears what will happen if she loses control over them.
She seeks to establish her superiority, because if you have authority over someone, then there's no reason to fear them. If you're above someone, then you're not like them.
And what's scarier than the thought that there are crazies walking among us, is the thought that sometimes, we too, control because we fear. That sometimes, we too, fear because we control.
"If Billy doesn't feel like talking, why are you pressing him? Why can't we go on to some other business?"
"The business of today is therapy."
