Positive environments for early child and family support. Part 1: Hospitals are often neurotic environments and are therefore to be avoided

‘general hospitals I have experience of offer a rich daily mix of potential stressors with various degrees of mental disturbance, conflict, anxiety and fears’

Introduction

In this serialised essay I want to explore positive and favourable environments for providing early child and family support when babies and young children have conditions that potentially reduce their capacity for development and learning.

In the first parts I will contrast the busy and often neurotic atmosphere of the hospital with the quiet and calm space that we generally assume is required for learning in babies and young children. I will then explore the implications for early child and family support ̶ much of which is traditionally hospital-based in my country. Finally I will argue that society’s mind-set and approach to these children and their families should be less medical and more educational.

Part 1: Hospitals are often neurotic environments and are therefore not appropriate bases for early child and family support

To begin, The Chambers Dictionary defines neurosis as follows: ‘originally nervous activity distinguished from or associated with mental activity; functional derangement resulting from a disordered nervous system, especially without lesion of parts; mental disturbance characterised by a state of unconscious conflict, usually accompanied by anxiety and obsessional fears; loosely, obsession.’

In describing hospitals as neurotic environments I am also including such other health service settings as clinics and therapy centres. I am not suggesting though that the people who work in these places are neurotic. They might be, as might be people who work in nurseries, schools and colleges. It is only the environment I want to characterise here as neurotic.

But people are influenced by their environment and a neurotic environment will certainly influence people who work in it. It will also influence adults and children who attend as patients or outpatients, more so if regular visits are required. In the UK many general hospitals have various departments helping children including those housing paediatricians, neurologists and paediatric therapists. It is to these hospital departments that families whose baby or infant has disabilities might have to come regularly for help and support.

The hospital will serve as a prime example of a potentially neurotic health service environment. This is where doctors, nurses, therapists and others receive much of their initial training and first experiences so perhaps this is where any neurotic tone is set. That hospitals can be characterised as neurotic environments, I justify by the following reasoning.

For staff members, there are the stresses and strains that come with being responsible for people who are ill, perhaps in pain and perhaps in danger of dying. There is the need for constant vigilance to make sure everything that needs to be done is being done at the right time and in the right way. There are codes of practice to be followed diligently and reports to be updated. This must feel like continual pressure. Some staff members will succumb to burnout. The daily situation is surely exacerbated when a patient dies.

Hospitals have many vertical hierarchies in which staff members are required to know their place within layers of management. For example, while running tests, performing operations or giving medications doctors, nurses and therapists are monitored by their managers at the same time as monitoring others they are responsible for. Vertical hierarchies naturally bring various emotions and efforts accompanying ambitions to rise and fears of losing position.

Hospitals bring many trades and professions into a collective effort. There are workers in administration, complaints, mortuary, cleaning, catering, maintenance, transport and parking. There are doctors, nurses, surgeons, auxiliaries, therapists, neurologists, psychologists, psychiatrists, dieticians, radiologists, social workers, counsellors and others. Frequently many of these can be involved with the same patient. While teamwork might at times be trouble-free and harmonious, it can too frequently be stressful as workers feel they must struggle for recognition of their role and for the time and space to do their work in the manner for which they are trained. While there are clear hierarchies in each person’s vertical management structure, there are also hierarchies of authority and importance across the departments and disciplines. This can be a hospital-wide pyramid of prestige with the few most-expensively trained people at the top and the very many easily-replaced people at the bottom. There is much scope here for researchers interested in ego, self-esteem, power, superiority, humility, pride, rivalry, intrigue and professional identity. Physical, professional, social and psychological barriers can all impede the collective effort and here lies another source of competition, stress and strains.

There are many other influences and potential stressors both internal and external to the hospital workplace. There are professional bodies and unions jostling to influence working practices and conditions for their members. There are governments and health authorities setting rules and standards ̶ and sometimes changing them at too fast a rate for hospital to keep up. Lawyers and courts of law can become involved when disputes about treatment plans are disputed and when patients or their families sue for compensation when errors are made. A local police force can move into a hospital to investigate abuse or deaths of individual patients or groups of patients. Staff members can be arrested tried and imprisoned reminding us that hospitals do not operate outside of or separate from society.

This brings me to another major source of stress, the general public. Hospitals are where people go for tests, operations and medications and each patient might be accompanied by family and friends. The hospital is the interface between the medical profession and the local population with the result that much of what goes on is in public view. In fact there have been recent cases of serious abuse in hospitals being brought to light by family members and friends while hospital managers were choosing to look the other way. In the day-to-day (and night) running of hospitals, family members and friends of patients will seek out staff members to voice their satisfactions, gratitude, doubts, frustrations, anxiety, anger and even violent intentions.

Reinforcing all that I have said so far, there is general public awareness, often promoted by medical professionals, that hospitals can be unhappy places to work in. I have already mentioned professional burnout. Frequent surveys report that significant proportions of doctors and nurses are succumbing to pressures by considering leaving their profession or taking early retirement. Then there are reports of alcohol and drug addiction at worrying levels.

Hospitals can be enveloped in a morbid atmosphere. The Chambers Dictionary defines morbid: ‘inclined to dwell on unwholesome or horrible thoughts; unwholesome; relating to, or of the nature of, disease; sickly.’ Patients and visitors will hear the frequent sirens of ambulances arriving, will see supine patients being trolleyed along corridors, will move aside as medics rush past responding to emergency calls and on the wards will be aware of patients who have recently died. All of this is inevitable in a busy general hospital but adds to a neurotic atmosphere characterised by anxiety and fear.

General hospitals are not designed to be healing environments. I am defining a healing environment as a nurturing space that offers mental and physical health benefits to the people in it whether as patients, clients, students or visitors. Its healing characteristics include positivity, tranquillity, unhurriedness, humanity and respect. These benefits are available as the background to any specific approaches on offer. Whatever the focus, whether rehabilitation, convalescence, bereavement counselling, personal growth or something else, if the space is not also a healing environment for the people who work in it, then there is some hypocrisy and subterfuge somewhere. By definition, a genuine healing environment would not be neurotic or morbid. There is no pretence that typical general hospital are designed as healing environments.

By my thinking, general hospitals I have experience of offer a rich daily mix of potential stressors with various degrees of mental disturbance, conflict, anxiety and fears. Staff members, patients (adults and children), and the families and friends of patients are all influenced by this environment – in my terms a neurotic environment. No wonder they are such rich locations for soap operas in many countries! Staff members who arrive at work with a calm mind must have their work cut out to maintain it to the end of the shift while those who take home anxiety about their work and even lose sleep over it will probably not find solace in this workplace.

The aim of the first part of this essay is to show that when we create a building called a hospital to perform various medical functions, we also create an environment that impinges on the people in it. I am not arguing here to transform hospitals, or even to convert them into healing environments. I am merely questioning whether hospitals are suitable environments for early child and family support. I am going to suggest in this serialised essay they are not, that their neurotic environments are not conducive to learning in babies and young children. In the second part of the essay I will contrast hospital environments with environments that can more effectively support families and promote education.

Peter Limbrick, July 2020

Your comments and observations are very welcome.