HANDS: Psychiatric Occupational Therapy

[Music] in the past a man's livelihood depended on the skill of his hands now these functions have been replaced by machines to his unquestioned betterment but one of the satisfaction work with his hands once brought what happened to the tension that once was relieved this way and of the satisfaction of having made something not according to a certain pattern but the way he saw it and wanted it to be occupational therapy and psychiatry offers a means of release of tension of escape for manga that can't be put in words or that has been directed against oneself then to a patient has a chance to make something in which he can take pride this helps the patient and helps in psychiatric treatment and understanding the objects made and the way they are made reveal what the patient may not know of himself or if knowing cannot express [Music] this is a case history in clay a record molded by a schizophrenic girl from the time when she was mute inactive and frozen in her own perplexity until her recovery and discharge from the hospital [Music] first her history as it was discussed with the occupational therapist by the psychiatrist let's review this patient's case before we discuss her progress in occupational therapy jane is 27 and has been hospitalized for two months with a diagnosis of schizophrenia she's a college graduate married and has no children since the time she was admitted she has not spoken she's fed with difficulty with some persuasion and coaxing she will dress herself and she will attend occupational therapy if undisturbed she will maintain the same position for hours at a time paying no attention to anything transpiring about her behavior is somewhat unpredictable occasionally it is noticed that she moves her lips as though whispering and holds her head as though she were listening to voices it's believed that she's hallucinated all right jane let's try again why don't you try to make something that doesn't upset you how about making a head let me show you how easy it is it doesn't have to be perfect just make it any way you want to look it won't win any prizes but it's good enough since i enjoyed making it go ahead give it a try that's the idea that's fine that's all right jane sometimes we can't help destroying what we make we'll try again [Music] doctor i want to discuss jane's case with you and these heads she's been making in occupational therapy i need a little advice and information on how to proceed all right let's line the heads up here on the desk and take a look at them what order were they made in let's see i've numbered them in the right order incidentally these are only a few of those she's made most of her work she destroyed i saw a note on her chart that she's still destructive but you haven't any choice but to let her destroy what she makes if she wants to this figure is the first one well this is certainly a picture of dejection and hopelessness is this the way she looks well that's the way she was the first few weeks she came to ot she sat ben over with her head on the table covered with her arms did she show any interest in people none finally she began to work with the clay we put in front of her she seemed to relate to things even though she couldn't tolerate people well clay is somewhat safer and more predictable than people this figure is quite unusual in the movement she's shown now this is unusual let's see she meant it to be viewed from this angle this turning away of the head and body would that be the way she responded to someone who approached her that's right at first anytime you spoke to her or even looked at her she'd turn her head away as this figurine does now these were made last week say this is better here she's dropped her hands to the neck and in this last pose the head's held upright even though the figurine is still faceless does it strike you that these figures are of infants or at least young children yes i believe these last two are of children according to the history as a child she was very shy she didn't mix with other children and seemed dissatisfied with herself do you have any idea why i don't think the girl was ever at ease with anyone she felt that people were as critical of her as she was of herself this feeling was aggravated by an episode that occurred when she was seven years old she'd made a drawing when she was in the second grade and brought it home to show to her mother jane where's my little girl will you turn that thing down for a minute where's jane huh our daughter jane you do remember we have a daughter don't be sarcastic how should i know where she is well did she come in from school i think so what's this i don't know jane said it was a little girl some seven-year-old artist that kid she's beyond me i don't understand her well who tore it up oh she did she got mad because i thought it was funny where'd she go you do look after her sometimes don't you now you caused me to have a headache does seem you could be more considerate after all i spend all day here all right all right i'll try to find her as usual don't start that headache routine again jane jane always worrying about that kid you'd think i wasn't even here after all of course this was just one of many episodes every child gets rebuffed it's part of growth but it seemed to jane that she always lost and never won could that explain why she destroys what she makes now yes i think so she's still afraid of being ridiculed or having people laugh at the things she makes well everyone has a little of that fear sure but not the abnormal amount that jane has her fears aren't any different than anyone else's they're just exaggerated it's clear that jane's mother didn't understand how did she get along with children her own age well not at all if you mean playing and shouting and carrying on as most children do do you think she wanted to play yes very much but i don't believe she could because she was afraid of looking awkward doing the wrong thing or being teased i think it's the same way about her talking now maybe that's the reason for no mouth on these figures at 27 she can't talk because she might be teased well it may not seem possible but saying the wrong thing or making a fool of yourself bothers an adult just as much as a child well she hasn't talked for a long time that might make it difficult to start again her own voice might sound strange she might have trouble finding words to express herself it may take her a while anyway let me know how she does hello jane how are you today go ahead [Music] how do you like working with clay it helps doesn't it this is an interesting head is it someone you know let me show you another way to work with this clay clay can be whatever you want it to be it can have detail or form or both you may use only your hands or you may use a tool it may be easier if you use this tool but you do it any way you want we're quite pleased with your work and if i can help well anyway i'll check you again later goodbye goodbye yes jane goodbye goodbye all right jane you let me know if i can help you well a new group of figures i see what progress have you made she talked good what'd you say well she didn't overdo the talking any when i told her goodbye she just kept repeating it that was all well that may not seem like much but after a couple of months of turning her head away and never saying anything it seemed like quite a bit to me well it probably seemed like a great deal more to jane was there anything else yes there was the way she said goodbye she just kept saying it even after i left her as though it had no particular meaning just words these heads seem to show some progress the ones we saw before were faceless and childlike but these are different yes there is a pattern that seems to follow her general improvement as she begins to show a little interest in herself the figures seem to become more as you mentioned for a while there were no faces at all and then she added a nose in another group she added a nose and ears and then a mouth here is one complete including the eyes but the faces are becoming slightly distorted like these instead of having a natural look it does look as though there's a pattern of adding one feature at a time there must be a great deal of conflict in this girl as she tries to get everything in some sort of order it seems almost as though she adds the features as rapidly as she can tolerate them you mean she's trying to get things straightened out within herself well something like that for many reasons that we don't know this girl has become more and more perplexed and puzzled about herself and other people she's made numerous attempts to solve her difficulties and she's failed as a result she has lost the self-confidence she needs to try again i can sure agree with that on the other hand the distortion shown in this head may be how jane appears to herself but if she thinks her own face is so misshapen can't she just reassure herself with a glance in the mirror i'm afraid it's not that easy any more than a person who's afraid that he has heart disease can check his own pulse and stop worrying then when she destroys the heads she might be trying to destroy her own fears about herself either that or what she hates in herself doctor i have another thought about these heads when she left off the ears it was at that time i talked to her and she didn't seem to hear did she respond in any way no she didn't not to me at least do the faces show this isolation they may it seems that as she's become a little more responsive she's added features to the faces i believe she's improving maybe that's just my hope i don't know well i think she's better at least she's better organized but i wouldn't push her too fast it took her six months to be able to speak to you i'd leave her alone for a day or two but why i think i understand her and maybe she can start talking the quicker the better perhaps you do understand her but she doesn't understand herself yet and your enthusiasm could frighten her remember there hasn't been any emotion in these faces yet and any added emotions the one thing for which she is least ready all right i'll wait the next conference is scheduled in two weeks right in two weeks hello jane how are you this morning this is fine do you feel like talking a little [Music] i'm sorry if i upset you but i thought maybe i could help well maybe it would be better if i left you alone and came by again later i'll just sit here a minute is there some reason you can't talk jane you seem frightened i'm afraid afraid jane of what oh i don't know what i'm afraid of i think it's people what people i don't know they're all like that inside not all people jane they're all laughing they read my mind and do things to me maybe working with this clay will help what are you anyway another psychiatrist trying to make me talk no i'm an occupational therapist i don't know what that is and i don't care what it is all you do anyways go off and laugh about what i do i'll stop by again next week jane [Applause] hello jane i see you're working on a belt will it bother you if i sit with you for a little while i don't care stay or go that's up to you i'll stay what did you say you were supposed to be i'm an occupational therapist what's that well occupational therapy is part of the treatment program used in this hospital you might say it's treatment through activity treatment through activity well i suppose everybody has to do something that's what they've always told me well you're certainly doing well with that leather are you making fun of me no jane i'm not i think you're much better how could i be better when i've never been sick [Music] how's jane been doing better she talks a little but she's pretty angry bring me up to date well she's very skeptical of people she thinks they laugh at her and she says that inside they're all like this [Music] a rather frightening prospect to see this and everyone you meet she said she was afraid but she seems to feel both ways at the same time afraid and angry you know one incident that may have given her a basis for her doubt about people occurred in her teens at a dance boy did you ever let me get stuck five dances i walked around with her shut up she'll hear you she's your date why didn't you come and get me she stiff as a board forget it you'll survive i've had her all evening i doubt that jane ever really recovered her self-confidence in any event she never attended another dance probably the most upsetting thing was that she thought she was being accepted and then she found she was only being tolerated what did she do then drawn to a shell yes superficially she showed no interest in any of the social affairs attended by the others in her age group but at the same time in her day dreams she was the opposite and was popular in the bell of the ball the daydreams of course were quite safe too safe because she turned more and more to imagination and less and less to reality not because she wanted to but because she was afraid to do otherwise that's right but there must have been a lot of hate and anger along with her apparent resignation judging from these heads at least incidentally she's been dancing at the patient's party but she's still as stiff as a board where she'll continue to be until she can overcome her fear of being ridiculed whenever she makes a mistake doctor what about her marriage what sort of a man is her husband well let's see if we can find him here in these other heads on the tray as it frequently happens jane married a man temperamentally her opposite he's outgoing and bluff and he doesn't have the vaguest idea what makes jane tick well i can't find him here not from the impression he made on me when i talked with him i wonder what attracted them to each other well each had something that the other lacked her husband mistook jane's reserved sophisticated and cold exterior for total self-confidence jane found in him an individual unbothered by life's subtleties he responded only to the obvious in other words jane's husband was pretty relaxed and not real sensitive to other people's opinions yes he was comfortable with people just as she had always wished she could be these two heads may reflect some of their differences but what jane overlooked was the fact that being undisturbed may merely be evidence of being unaware i see their wedding is a good example of what i mean you have the ring sir ring uh the wedding ring oh sure here you are i bought it this morning i can't get it on it looks like you might have asked me about the size say that's quite a meat hook you've got there meat hook mitt hand here use this one of mine we'll have to get down there and get you a bigger one uh shall we begin yes sir preacher let's get started i've got a lot to do the husband told me this story says she brings it up whenever she's mad at him the husband isn't too sensitive to jane's ideas or feelings is he no but he did help her over many a social hurdle by breaking the ice when they met people actually he's very fond of jane and quite tolerant of her peculiarities by the way she asked me for advice the other day and the question was quite unusual what do you want to know she wanted to know how to make a happy face how to make a happy face well that's a pretty fair question what'd you tell her well it went this way hello t i see you're back again checking up on me no jane i just wanted to see how you're doing there's a difference yes there's a difference you see i'm here okay okay don't get mixed up trying to explain it anyway there's one more face i want to make and maybe even you can help how do you make a happy face oh well i guess you just make a smiling face i guess you don't know either any fool can smile just make what you think a happy face should be suppose you don't know what it is then what do you make don't know what it is yes suppose you don't know what happiness is oh don't get to thinking about it or you may need some clay too that would be something one ot working on another ot yes it sure would jane well she did give you quite a going over it seems the anger she's been taking out on the clay is directed at you now i can see that all right you can expect jane to try her hostility out on you for a while how did the happy face turn out here it is jane didn't break it unfortunately it was broken while it was being fired what do you think i think it is a happy face [Music] how's the belt going jane oh hello ot belle i finished the bell who's confused now this is a billfold very good let me show you how to handle this tool always got to find fault don't you don't you want me to show you the belt i made you're supposed to ask me you know i'm the patient you're the ot right right i'm sorry where's the bell you probably thought i cut it up but i haven't here it is this is very attractive well done jane you know i'd like to keep this bell it's the first thing i've ever done that turned out right and 27 years is a long time to wait to do something right did you ever think of that ot think of what jane how it would feel to fail at everything you tried for 27 years no i guess i haven't that's why i want this belt and i want to wear it when i leave here how about the figurines do you want those no they remind me of something i can do without i hope in fact i don't want any more clay i don't want to see the heads again and i don't want to talk about them got it i understand i doubt it you must get pretty mad at me but i guess you understand that too anyway i need to start talking again if i'm ever going to get out of here and back to work could you arrange it unless you think it's too much trouble i wonder why i always have to add a crack like that i'll get you the typewriter use it anytime you want i'll be around next week i'm a little slow but i'm gaining they've got me typing up diets that's about the dullest or as they say here the least disturbing stuff they could find i hear you were home over the weekend how did it go oh i was a little on edge in fact i was ready to come back sunday afternoon imagine wanting to come back to a psycho ward well you've been away from home quite a while 18 months no wonder everything seems so strange anyway i called my boss and my job's waiting for me good what did your husband think about your feeling better oh he thinks i'm fine but he thinks everyone's fine i told him he ought to be an ot that's fine see what i mean jane i'm glad you got along so well i wonder what'll be said when i show up for work fresh out of a cycle unit nothing i should guess oh there'll be some remarks which i hope i don't hear remarks yes they'll have to whisper a little and some fool will have to giggle they'll tiptoe around for a few days until they get tired of waiting for me to do something odd well jane's getting along quite well at home and at work how was it when she first got back as she so correctly guessed they were unsure of her at first but it wasn't long before this was all forgotten according to jane it went this way and would you type this up jane you're finally acting like a boss again work work work say you know i forgot all about your being in the hospital as the ot always said that's fine [Music] [Applause] this my [Music] [Applause] you