INSTITUTIONAL ENVIRONMENTS

Fear, isolation, and a sense of numbing helplessness characterize the nursing home, the mental hospital and other institutional experiences for the majority of inmates. To enter a hospital, especially a mental hospital or a nursing home, either as a visitor or a patient, is to encounter an environment that has no equal in barrenness anywhere in our culture except for the prisoner's cell.

These environments may be described as dis-integrated or degraded because they lack wholeness; they are incomplete. Because the ordinary everyday settings for behavior are missing, they cannot adequately support the great range of human activities and behaviors that are associated with everyday life and particularly with the recovery process. Most institutions force inmates to ‘kill time’ without purpose. More typically and destructively, institutional environments may further impair the patients' faith in their own competence to take care of themselves and live normal independent lives. Prolonged institutionalization or hospitalization, especially in a mental hospital, nursing home, or prison may seriously impair the inmate’s mental health, as individual’s responsibilities and social behaviors fall away.

Psychiatry and psychology in particular, and medicine in general, all lack a clear vision or theory of mental health and ‘wellness’, as distinct from illness, that could inform and enrich the lives of patients in their care. Since the earliest records of institutional mental health treatment there have been relatively few reform revolutions during which the quality of the patients' experience, their environment, and their care were given enriching humane attention.