Why did they revolve.
Who came back and who stayed out?
The ones who went out into a
hostile and anxiety exposed world; a world irritated and alarmed by
a
change to habits that were alien compared with previously
accustomed
behaviour. The behaviour expressions of the symptoms of
schizophrenia,
which were so different from what were the expectations in the
house.
And unacceptable.
The reality to be faced - that the illness had been treated and
was
still there; and the community could not tolerate or understand or
allow
for the difference in these aliens, the loss of their future hopes
for
their family member and for the loss of their own expected hopes
and
their aims for their own future.
Who revolved; the ones who went back to family. Or those who
were
then to manage on their own.
The family, because ..
... If you went home to
your
parents , you were tops to be re-admitted. If you went to your
spouse;
next likely to be re-admitted.
If you went into lodgings, the least likely.
The explanation.
1.
Different standards of expectation. Families were more
likely
to accept the more ill - and were expected to - than the
landladies. So
they got the more sick ones. More prone to relapse. More likely to
strain the tolerance of the parents, who in turn became anxious,
angry
and continually on edge. And eventually to conclude that if there
was no
improvement as a reaction to the toerance and ecouragement invested
,
then what was the point in cintinued family care.A depleted and
spiritless companionship which had its effect in turn on the family
member
2.
But also - unavoidable, unresolvable, inescapable
subsequent,
adverse emotional expression( EE ). EE was born. High EE did you
in.
If this is what was the reaction, you soon broke down and were
readmitted.
Neither spouse nor parent could stand, adapt, to the change of
expectation towards an accustomed loved one. There was not enough
regular break from the burden of dependency and the disappointment
in
expectation.
Landladies did it for money, and general - not personal
investment
soon worn down. They took what they saw as what was the given. If
they
checked out the medication, it was acceptable - you were in their
house.
But for the others - well it was your home - you were freer -
and not
going to accept parental control; or from the
spouse.
Unresolvable anxiety and frustrations in personal living and
social
exchange, losing the routine of medication; were the two things which
led
to breakdown and readmission.
The community and its agents had not been prepared for a new task.
How
to give those with residual difficulties from a severe and enduring
mental
illness a life direction and a future aim to shape their intentions;
help
which in any case they did not always seek or accept. There was no
overall
authority to initiate this. The funding for after-care social work
had
separated from the hospital service. It was always cash limited and
not
ready to receive the burden.
Those who left Mapperley Hospital at that time, had not
accumulated the ready personal habits and personal possessions; nor
the
social awareness appropriate to living outside.
Nor did they find the shaping weekly schedules of regular
occupation
activity of a meaningful kind, a personal song,a feelowship with
those
in a like way, a direction in their life aim. Such substitutive,
regularising activities, and a supportive personal and domestic
care
routine, supporting natural neighbourhood living, were not there.
A sheltered workshop was built, but in the hospital grounds -
land,
funding, and regulation being sympathetic there.
As is customary in the history of provision for those with
mental
illness one aspect is advanced and stops because the other services
have
not marched in step, or in the same direction.
The overall budget, and the overall management were never in
place.
The much later closure of Friern Barnett Hospital in London,
took
place over many years, starting with a substantial starter bumper
fund
of an extra years funding. Even so, many who were placed in single
rooms
in lodgings, or in flats, in staff hostels found the change to
loneliness overwhelming, and the hazards of taking a lonely part in
reclaiming society too much for them.
Readmission facilities were not there. The admission wards
became
overcrowded.
The residual elements of their illness found the challenge of
personal management too high. The occupational and social activity,
and
even what had seemed the little companionship available within the
hospital grounds were simply not provided.
They were too
without the
will to find and sustain their own.
Over all they preferred their existence outside - but measurable
improvement in their quality of living, or in the level of their
illness, was insubstantial.
And the cost - no savings there.