How to Deal with Madness?
I want to clarify that I am using the term ‘madness’ to highlight the colloquial way people have to refer to certain mental disorders. You will understand more of why I chose that particular term once you read this chapter.

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Ten years ago I had the chance to work in a very peculiar mental asylum. It had been established as a response to the request of the authorities of a municipality located in the capital of Chile, which, overwhelmed by the problems of madness and the lack of resources that could provide a worthy place, asked a well-known Church congregation to deal with it. During the last decade, there had been a policy of dramatically diminishing the number of psychiatric patients in the most important hospitals of the country.

The congregation established then a small asylum for patients who were diagnosed with psychosis, which is the name used by psychologists and psychiatrists for what people colloquially know as madness. There were thirty male patients living in this asylum, with ages between thirty and fifty years old.

The conditions were not bad, at least compared to other asylums. There was a room for each patient, plus a living room and a yard as a common space. Unfortunately, the living room door was locked, and it was used only when one of the workers brought a movie for everyone to watch. The yard was a space of nearly 100 square meters, bare dirt and nothing else. Not even a chair or a table. Not a single thing.

The only office of the asylum, used exclusively by the personnel, had in a corner a great number of boxes full of the patients’ files. The first thing I did, of course, was to check them. They contained nothing but diagnoses. One after the other, they contradicted themselves, and were made by dozens of interns or psychology students who came to do their assignments in this place, and then leave. 

The director of the asylum, who was the only psychologist working there, told me that the reason that there was nothing about the treatment in the patient files was simple. The only kind of psychological treatment that was carried out in the asylum was the weekly body psychotherapy carried out by her, in addition to a pharmacological control made by a psychiatrist once a year. That meant that the patients in the asylum practically did not receive psychological or psychiatric care at all.

After reading the files already described, I proceeded to make a new diagnoses of the patients. What for? I needed clear diagnoses and, especially, ones that allowed me to define what would be useful for the patients. For their benefit, for their dignity. A patient is not interested in knowing what kind of psychosis they are suffering from, if it is not reflected in the treatment they receive. I wanted information about each one of them, what was their opinion about living here, what things did not seem right to them, what changes they would make. I wanted to treat them like any human being deserves to be treated. 

Besides making the diagnoses of the patients, I had to look for a place where I could see them. Even though there were rooms for the patients, they only had a bed and a bedside table. I finally chose to take one of the chairs from the living room and turn it into ‘the therapist’s chair’, bringing it to the room of the patient I would be seeing at that moment. After a short time they were able to perfectly distinguish between the psychotherapeutic context when the chair was in their room and the informal context when we were in the yard or having breakfast. 

What did I find out? I think that the first conversation I had with a patient reflects the situation quite well:

Jorge: How about talking for a while?

Patient: Yes, no problem. I like talking, no one here talks with anyone. Sometimes other psychologists come. Are you going to show me some spots or something like that?

J: No, none of that… the idea is to just talk, maybe more than once, so I can get to know you better.

P: Hmm… I’m not someone interesting… my life has become something pretty boring… the only thing I want is to get away from here, I don’t want to be here anymore… I don’t have any problem talking with you, but if you ask me what I want, I want that, I want to get away from here… every time someone asks me how I’m doing, I say the same thing… I want to get away from here… but nobody listens, nobody does anything…

When I asked him about what he would like to do, he said “a lot of things… being able to do things with my hands… we can’t do anything here… we just lie down in our rooms and that would be it. They don’t understand that we’re still alive, we have faults but we can live, it’s not a death sentence…”

The rest of the first interviews with the patients were practically the same. Everyone was bored and tired of not being able to do anything. However, shortly after I talked with each one of them every week, they became more active and started to spend a little more time with each other in the yard.

The director told me that it seemed odd to her that they spend time in the yard during the day, instead of being in their rooms. “Why do they go to the yard if there are not even chairs?” she said. 

I contacted the congregation then, and I obtained some second hand tables and chairs, that we put in the yard. I had the idea of painting a checkerboard on each of their surfaces, keeping two sets of checkers in each room.

When I came back a week after, the professionals that worked there were not so happy with the results. 

The patients now spent most part of the day in the yard, either playing checkers with each other or talking. Some of them had asked the director for chess pieces, a request that had not been answered by her yet. 

The professionals explained to me that when the patients spent all day long in their rooms, they worried less about them and focused on the administrative duties of the asylum instead (cooking, cleaning up, among other activities), and now they had to watch them all the time, which made their work more difficult. 

The director told me that they would leave the tables and chairs one more month, since maybe the patients were interested in them because they were something new to them, but she also told me to stop encouraging them to interact that much and “causing trouble for the staff.”

After a month, the situation just got “worse.” The patients kept playing in the yard, talking with each other. The daily meals were not in silence anymore, but with the human noise of conversation. Some of them even told me their ideas about new changes to the asylum. Above everything, they wanted to do more things. They wanted to feel useful. They wanted to feel human.

The rest of the professionals did not know what other things the patients could do in the asylum without causing them any problems. Finally, after an exhausting meeting, they agreed to give the patients a dusting cloth so they could help clean up their rooms. It was hard to imagine the smiles that this simple right brought to the faces of the patients. 

The few relatives who visited the patients were aware of the changes, especially the fact that now their relatives talked with them more easily and pleasantly. It was not like the conversations they could have with the rest of the people, but to them the change was meaningful. The frequency of their visits increased, and we managed to make them bring movies for everyone to watch. 

The lesson I learned from all of this is that the way we treat the people that society had deemed insane -in a treatment that will last most likely for a lifetime- is fundamental to their recovery. As you can see, in this account there is not a single psychological technique applied, just a little common sense, empathy and compassion. I would have loved to immediately start applying the treatments of the school where I was trained, meeting the problems of psychosis and facing them with the tools I learned at university. Yes, I would have loved to, because I love my profession. But first I had to just be a human being. 

Unfortunately, this story does not have a happy ending. After being in the same conditions for a couple of months, the director told me that the asylum could not go on like that. Due to the activity that the patients were showing then, interacting in the yard, going to visit each other in the rooms, the presence of relatives, it was necessary to have more people in the professional staff. She said that there were not funds for that, so they had to make the patients spend more time in their rooms, setting a schedule to use the yard, and limit the frequency of the relatives’ visits to the weekend.

It is not clear who are the insane ones.


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Art made by me, of an schizophrenic person that lived in my city. He was a poet and sold his texts on the street.
He called himself "The Divine Antichrist"