The atmosphere of the ward: Attunements and attachments of everyday life for patients on a medium-secure forensic psychiatric unit

Abstract

The climate or atmosphere of a ward in secure psychiatric care is typically studied by examining the relationship between social and environmental factors. However the experiences of patients are irreducible to a set of discrete dimensions or factors. Drawing on recent work in affect theory and architectural studies, we argue for an approach to atmosphere that places it 'in between' persons and space, as a 'spatially extended quality of feeling' (cf. Böhme, 2017a) of which patients are intimately aware. The paper discusses empirical material drawn from a broader study of inpatient medium-secure forensic care in a large hospital in the South of England. We show how the process of becoming attuned to the fluctuations and shifts in the atmosphere of the ward is a critical aspect of everyday life for patients. Attunement cuts across existing notions of power and resistance in these settings. We also demonstrate how attachments to a range of objects, some created by patients, can either expand or punctualize attunement, enabling change in the overall atmosphere. We conclude by speculating on how we might rethink spaces of recovery on an ethospheric basis.

'You get this conflict between you as a person and you in your role…that changes you': A thematic analysis of how inpatient psychiatric healthcare staff in the UK experience restraint, seclusion, and other restrictive practices

“…Participants described limited staff capacity to manage patient distress, and in turn, an unconscious process of becoming more restrictive themselves as a means of coping. This finding could be interpreted in the context of existing literature which has described the perceived fragility of psychiatric hospital environments and the 'unsettled ward atmosphere' (Brown et al 2019;Kanyeredzi et al 2019). RP then can be an 'answering to' to this atmosphere, where teams adopt a 'common staff approach' to control perceived risk in volatile situations, which then becomes usual practice (Enarsson et al 2008).…”

“…2019; Kanyeredzi et al . 2019). RP then can be an ‘answering to’ to this atmosphere, where teams adopt a ‘common staff approach’ to control perceived risk in volatile situations, which then becomes usual practice (Enarsson et al .…”

“…Decisions to use RP are complex. Existing literature cites numerous contributors such as local policies; ward factors, such as the physical environment and atmosphere, and; staff-related factors such as staff attitudes, and team characteristics (Boumans et al 2012;Green et al 2018;Kanyeredzi et al 2019;Husum et al 2010;Muir-Cochrane et al 2018). Team approaches to RP are important as they can impact both individual staff and working relationships.…”

Organizing the sensory: Ear-work, panauralism and sonic agency on a forensic psychiatric unit

“…If that is so, then we should say of the body, as it sings, hums, whistles or speaks, that it is ensounded [emphasis in the original]’ (2011: 139). We see this as an apt description of how staff and patients experience ward space – the changes in the acoustic environment fill their bodies in a way akin to climatic or atmospheric changes (see also Kanyeredzi et al, 2019). Becoming attuned to the space is an opening up (or closing down) in relation to these fluctuations that scrambles any absolute distinction between person and setting.…”

“…However, in practice, many staff describe ward atmosphere as a highly variable collective emotional tone, ranging from 'settled' to 'unsettled', which is usually 'felt' by experienced staff members rather than formally assessed. Ward atmosphere is not localized in any one particular aspect of the environment, but is continuously shifting in character, like variations in the weather (see Kanyeredzi et al, 2019). Staff seek to acoustically attune to and anticipate changes in the atmosphere whilst they are engaged in routine tasks.…”