7(D). Dehumanisation and coercion
Physical restraints like cage beds and straps are really only the most visible forms of coercion and control in Czech psychiatric institutions. MDAC learned that subtler forms of dehumanisation and coercion are also widely in use. An example is that in all adult hospitals visited, many of the patients were recorded as being “voluntary” patients. In law this means that they could leave any time. The reality was that staff had to agree if someone wanted to leave: people were in fact deprived of their liberty. Another example is that monitors observed how patients were forced to do chores, and that sanctions were imposed if these were done unsatisfactorily.
A system of coercion and punishments
A 50-year old male patient at Kosmonosy Psychiatric Hospital talked about punishments for infraction of rules.
Punishment: Three days not allowed to leave the ward
- Failure to complete cleaning duties to a satisfactory standard
- Smoking in the hallway
- Coming back late from day-leave
A 40-year-old male patient at Klatovy Hospital Psychiatric Department explained that if a patient on Ward 8 (the “chronic ward”) got drunk, they would be prohibited from leaving the ward for two months. Another voluntary male patient there said that he wasn’t allowed to leave the ward on his own, only in a group. To go home for the weekend, he had to apply for “special permission”.
Also at Klatovy, the monitoring team asked staff whether patients classified as “voluntary” could leave the ward as they wish. The doctor explained that the ward was locked (the monitors had all noticed) and patients needed special permission to get out. He said that this was discussed every morning, and the doctors recorded in each patient’s medical records whether or not they could go out that day.
In many of the hospitals visited, monitoring teams observed that patients who were less mobile were taken outside less frequently.
Other dehumanising practices were also observed. At Kosmonosy Psychiatric Hospital, the monitoring team spoke to a female patient who had had long hair, which was shaved off against her will when she was admitted to hospital. The reason for this? For “retaliation”, she said. “They had not done it to everyone but to around three people, and as they were doing it they were making joking comments.”
At the same hospital another female patient told the monitoring team that residents do not have personal lockers and their belongings got lost all the time. Their clothes (even if they had names sewn on them) were collected and washed together and then handed out randomly to patients. She recalled that she once saw an elderly patient going out into the freezing cold wearing trousers in which he had recently urinated. The nurse shrugged her shoulders when it was brought to her attention. Dehumanisation was a daily occurrence according to this patient: there are no towels, she said, and patients had to use bed sheets to dry themselves after showering.
Hygiene and privacy are other areas where control is exerted. At Dobřany Psychiatric Hospital, staff informed the monitoring team that patients could take a shower every day, but only under supervision. At Kosmonosy Psychiatric Hospital, the mother of one resident told the monitoring team that, “the hygiene is generally bad, some patients do not shower at all, when the nurses are asked about it, they only say, ‘they can shower whenever they want.’” She went on to say:
The staff don’t let the patients do anything for themselves, like shaving or getting their hair cut; a mother tries to make her son do all these when at home, so he does not lose the ability.
There was a general lack of showers and toilets. At Kosmonosy Psychiatric Hospital a female patient told MDAC that on her 40-person ward, there were only three showers and three toilets. She reported that the toilets were often clogged, and that it was difficult to keep clean; she worried about getting sick. Highlighting the irony of the position, she told MDAC that she attended a group run by a psychologist in the library, where patients lie on the floor and listen to a tape that tells them to imagine running water and that they are being cleansed – this in a hospital where cleanliness was impossible.
Similarly at Opařany Children’s Psychiatric Hospital, MDAC monitors were shown to the bathroom where there were only five toilets for twenty children. In the same area there was a shower and a bathtub, which could both be used simultaneously with the assistance of nursing staff. The bathtub was in the same room as the toilets and was not concealed in any way. In the ward for children with intellectual disabilities there was a smell of urine. Nurses said this was difficult to eradicate as the building was old.