THE ST. JAMES' JOURNAL

Why Therapy?
 
To the uninitiated it is not always possible, it appears, to appreciate the true value of occupational and industrial therapies but a short history will illustrate the effect it has had on the hospital, patients and staff.
 
Less strain is thrown on the nurses today, who in the past spent the best part of their lives imposing the rules and regulations that were demanded to enforce a protective custody which appeared necessary at that time. Let us go back a few years and see what we did have.
 
Before their advent, occupation of the patient was confined to domestic work on the wards, and a comparatively few in relation to the numbers that existed were employed on the farm and gardens.
 
Some enjoyed this work, which gave freedom from the closed wards, but to many it was monotonously depressing. Spread over large areas of land, they had very little contact with staff or one another. Individual attention was lost. There was a limit to the numbers who could be reasonably employed in this situation, so the majority were confined to the airing courts or closed wards. Life could become intolerable during winter months or even during the summer with a spell of bad weather.
 
With the advent of therapies, dramatic changes began to take place. Patients who had previously refused to work on the land found new interest in handicrafts or in being able to work in their own capacity as tradesmen.
 
Much to our surprise the skill that many displayed, in spite of years of idleness, was truly amazing. Airing courts emptied and no longer were the high walls or the huge doors that stood like sentinels necessary. An enthusiastic gang of patients, led by a similarly-minded member of the nursing staff, soon removed these, and the 'Walls of Jericho', named by the patients, soon disappeared.
 
Today we have a pleasant park-like atmosphere. The bricks were cleaned and put to good use in building the cricket pavilion, so that it can be said it stands as a monument to the pioneers of occupational and industrial therapy.
 
Payments to the patients were made in kind by an issue of tobacco. This always had a touch of charity about it, and it was inevitable that this was superseded by money. In order to spend this, permission was given to visit the shops outside the hospital, and many patients, not sure of their newly-won freedom, would continually ask permission to do so. Others, who were unable to do this, were catered for internally by use of a large wooden box loaded with cigarettes and chocolate. From this humble beginning the present shop came into being.
 
Ward doors opened, patients wandered the grounds at their leisure, and passed into the outside community, mainly on their own initiative. It was here that the first real integration of patients happened, and no-one can deny the advantages we have seen as the results of their association.
 
Social events had to be reconsidered, and the first coach outing that was arranged, ridiculous as it may seem, had many wondering whether we were not too venturesome. To what limits we can go was recently illustrated by the fourteen-day holiday exchange visit with Fulbourne Hospital, Cambridge. Without a doubt these changes would never have occurred with such rapidity without occupational and industrial therapy.
 
As this article appears under Nursing Notes, one may ask if it is not misplaced. It is because too much emphasis cannot be placed on the value of this therapy as a treatment.
 
With the opening of the upgraded farm building there will be the need for greater liaison between ward staff and this department. The realisation that the role of the nurse is for the exploitation of these facilities for the benefit of the hitherto unemployed patient, by encouraging him to attend and maintain his interest by an example of his own enthusiasm.
 
It is certain that occupational and social therapies, with treatment at ward level, appear the only answer at present for the complete recovery of the majority of patients.
A. C. B.
 
Winter 1966
 

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