Raising Adults as Children? A Report on Milieu Therapy in a Psychiatric Ward in Norway

Abstract

Milieu therapy is widely used as a therapeutic approach in psychiatric wards in the Nordic countries, but few studies exist that report on what practices a milieu therapy approach implies as seen from an ethnographic perspective. Therefore, there is a need to obtain insight into how milieu therapy unfolds in a psychiatric ward setting. The present ethnographic study aims to explore this in a locked-up psychiatric ward that was tied to a psychodynamic-oriented milieu therapy approach. Metaphors from traditional nuclear family life were widely used. Patients were often understood as harmed children and were taught self-management skills; the staff aimed at providing a caring atmosphere; and the patients seemed to behave, sometimes, in a childlike manner. In a Foucaultian framework, milieu therapy can be seen as a therapeutic normalization technique used to produce self-governing individuals. Milieu therapy "raises" patients in order to transform patients' odd behaviour and nonconforming lifestyles. We see this "raising children" approach as a type of intervention that nicely connects to the national policy of normalization and integration politics towards persons with psychiatric diagnoses.

Mental Health Patients' Experiences of Being Misunderstood

“…Patient reports of being treated like an object, interactions with health care providers who did not make eye contact or take time to listen, and encounters with detached nurses are consistent with findings in several studies (Johansson & Eklund, 2003;Kralik, Kok, & Wotton, 1997;Lilja & Hellzén, 2008). Testimonies of being treated like children and the resulting negative effects on patients' confidence and self-esteem are also congruent with the findings of Oeye, Bjelland, Skorpen, and Anderson (2009). Our study findings also support Riikonen's (1999) description of "sickening or disempowering, noninspiring interactional-linguistic practices we must move away from" (p. 149).…”

‘Men just drink more than women. Women have friends to talk to’—Gendered understandings of depression among healthcare professionals and their implications

“…The double bind is characterized by the fact that the person can neither opt to leave the situation (as they desire and need help for their distress) nor challenge the recommendations of the professional for fear of being punished or dismissed for doing so (Bateson, ). As pointed out in similar Scandinavian research, the implicit threat (of not being provided with help) puts into perspective how patients feel pressured to conform to the category of a good, weak and childlike help‐seeker who submits to being dependent on the professionals and compliant with their recommendations (Glasdam & Oeye, ; Oeye et al., ; Oute & Bjerge, ; Skorpen et al., ).…”

“…First, the very organization of psychiatric and drug and alcohol treatment systems contributes to the exclusion of substance‐using patients from psychiatric treatment systems (Davidson & White, ; Hansen & Bjerge, ). Second, international research, including that from Scandinavia, elucidates how disenfranchising, stigmatizing and disempowering attitudes towards patients, professionals’ unwillingness and inability to navigate complex systems, and poorly timed services within the welfare systems often obstruct such patients’ access to care (Jacobsen, ; Ness, Borg, & Davidson, ; Oeye, Bjelland, Skorpen, & Anderssen, ; Oute, ; Oute & Bjerge, ; Skorpen, Anderssen, Oeye, & Bjelland, ). However, little is known about how gendered understandings of patients can inform professionals’ discretionary actions and decisions to include and exclude patients in clinical practice (Hansen & Bjerge, ; Ness et al., ).…”

The Politics of Mental Illness and Involvement—<i>A Discourse Analysis of Danish Anti-Stigma and Social Inclusion Campaigns</i>

“…This discourse drew on psychoanalytic signs of the patients' weakness that constituted and legitimized a hierarchical order of ruling amongst the professionals and the psychiatric patients. In a Norwegian context, Øye et al equally pointed out that the psychiatric care and treatment are organized based on parallel psychodynamic notions of the patient as a weak, vulnerable and childlike subject (Oeye, Bjelland, Skorpen, & Anderssen, 2009). Furthermore Øye et al have shown that the underlying medical-ethical rationale in the psychiatric field in Norway is based on articulations of the patient as weak or vulnerable, because national policies for this field and the medical ethical committee system signal consent to this rationale (Oeye, Bjelland, & Skorpen, 2007).…”