Memoirs of a social worker: human connection vs the medical model

Published by Professionial Social Work magazine - 6 April, 2023

Pat lay spreadeagled across her reinforced double bed. Morbidly obese, she had not been out of her house on the crumbling estate for four years.

Previous attempts to move her had been futile. A fire fighter had pulled his back trying to do so, sending him off sick for months. Even attempts to wheel her out of the makeshift bedroom had been unsuccessful; council builders had unsuccessfully attempted to widen the doors by removing bricks.

Pat’s home, alongside her physique, had become a prison from which she appeared unable to escape. At 48 stone she was perhaps the heaviest woman in the country. Her folds of skin rippled over each other. Constant friction and sweat resulted in blackened sores that the nurses tried to soothe.

Discussion ensued regarding Pat’s mental health. Was her compulsive eating symptomatic of clinical depression? I was bemused as to why the nurses charged with her care were letting her eat unhealthy food. Surely, they had a duty to help her turn things around by reducing the calories and encouraging some kind of mobility.

Before they were drafted in, Pat used to pay the local youths to nip to the cake shop for her. They’d supply the cakes but then make off with her TV and video while she lay there helplessly.

The debate moved on to discussions regarding whether Pat should be sectioned under the mental health act as she presented a risk of harm to herself. Ultimately the situation was resolved when within weeks of me visiting her she died following a massive heart attack.

On a psychiatric ward, Martin licked the thick glass panel separating staff from patients, his tongue leaving a salivated trail. Despite this, staff seemed to ignore him, misguided priorities forcing them to focus on the medication regime. Having the radical idea that he and I go out for a walk, we meandered through woods chatting amicably. He didn’t try to lick me once.

My first student placement there, three days per week, was certainly proving to be an eye opener. The hospital was far from being a safe environment. Sturdy rusted heating pipes ran across high ceilings, the building’s vastness making it difficult to monitor those who were struggling.

Ward rounds held daily focused primarily on dosages, and were dominated by the medics. I interjected with my positive experience of walking with Martin, suggesting more physical activities should be incorporated into treatment plans. The junior psychiatrists smiled patronisingly at me, one commenting that I was very new. I came back challenging them, but it seemed to fall on deaf ears.

The remaining patients were bedridden, drugged up to their eyeballs. Christopher Clunis, a paranoid schizophrenic, had only recently randomly stabbed a man in a train station in broad daylight. This caused the inevitable distorted moral panic. Schizophrenia was and still is poorly understood by the public. There was little to challenge the stereotype of knife-wielding maniacs. The vast majority of people diagnosed with schizophrenia or any other mental illness are often confused and vulnerable. The only explanation as to why the majority of in-patients are drugged up to the eyeballs leaving them in a semi-catatonic state is the dominance of big pharma, both now and then.

I did not exactly hit it off with my practice teacher. She had a reputation for trying to mould people into her way of thinking. After a couple of weeks, she called me incorrigible, implying I was beyond being corrected or reformed. I took this as a compliment. Conversely, she was in awe of the psychiatrists undermining the concept of multi-agency working. Everyone is equal, but some are more equal than others! Ultimately six people swinging fatally from those pipes in two years led to the institution being permanently shut down.  

The other two days a week I was placed in a day centre. The contrast with the hospital couldn’t have been greater. Staff facilitated activities and group discussions. The atmosphere was welcoming, and service users attended voluntarily. Many had been in long-term psychiatric care.

One of them, a middle-aged woman, had been brutalised. She suffered severely traumatising sexual abuse as a child. Back in the 70s she had set fire to her bed in the hospital. Instead of seeing it as a clear cry for help and providing her with therapy, she was lobotomised. A surgeon drilled holes into her skull and cut through brain tissue. This left her docile and slightly detached from everything, re-victimised by the system.

One highlight was a residential trip to a national park. Everyone was excited by this opportunity. Soon after arriving the boundaries between staff and service users became blurred. We prepared food together, listened to music and played table tennis in the fresh air. You could sense that people were thriving on the atmosphere.

We took a trip to some caves, the deepest involved descending myriad steps. I agreed to lead the group. Most were able to manage the steps quite comfortably. Helen, an older woman, was struggling so I accompanied her on the descent while she repeatedly told me it was the best thing she had ever done, saying no one would let her try anything.

Reaching the depth of the cavern it dawned on me that she was unlikely to have the fitness to get back up. After only a few steps she was breathing heavily. I took her hand to help her and could feel her weak pulse racing making me incredibly nervous and wondering why I hadn’t thought it through. Risk aversity has never been my strong point. How we were going to get her out, fire brigade maybe?

It took four times as long to traverse back as we zig-zagged up laboriously. Despite the arduous ascent, she continued to tell me how amazing the experience was. Eventually we emerged victorious into the blazing sunshine.

By the evening boundaries possibly became a little too blurred. Craig, a long-haired lad who’d served time, pulled out a large block of cannabis resin. Alongside a fair quantity of lager, the staff and service users got pissed and heavily stoned. I, of course, like Bill Clinton, did not inhale. I had a job interview the following morning.

We all slept in bunk beds, and it didn’t help that Geoff above me was suffering from acute anxiety. He got up frequently to rummage through his suitcase. Not ideal interview preparation. In the morning as a hangover cure, I stopped off for a full English. On my return, a colleague exclaimed how could I go in front of a panel smelling of bacon. I was left pondering whether it was better than the smell of booze and dope. 

Perhaps naively, when qualifying, I thought it made sense to gain a rounded view of different vulnerable groups, those with disabilities and mental health problems. To my surprise, potential employers were more interested in me knowing child protection processes rather than my practise skills benefitting from a broader view. Yet I don’t regret for one minute the experiences it gave me.

Obviously, I am not suggesting that social workers sit and take drugs with service users. However, I have no doubt the connections made through the day centre had far more impact than the heavily medicalised model. I do not dispute the fact that in many cases medication works but there needs to be a more humane, holistic response to people with mental health problems. Even attempts by the World Health Organisation are not enough to loosen the pharmaceutical industry’s perennial stranglehold on treatments and interventions.

Sam Waterhouse is a newly retired social worker who spent most his career working in the south of England. BASW members can read the next extract from his memoir in the May edition of Professional Social Work magazine. Names and some details have been changed where appropriate to protect identities