Prescription for the pyjamas

Over the last couple days I was called arrogant, ignorant, shallow, conceited, in dire need of help, anti-psychiatrist, obviously self-promoting. And that’s just by one person. Frankly, I would have blocked myself, so nothing offensive could reach me, but no, it seems it was much better to tell the world, how awful I was. I am not going to give links to those conversations – I don’t see the point. However, the thread about how stupid and awful I am has gone into low hundreds, which suggests to me I really touched the nerve. So to be honest, I want to zap the nerve with electricity. And this is why I am writing this post.

I am devil incarnate because of my previous post in which I made a few comments about a patient who was wearing pyjamas, when he came to give an interview. I also said that the reason, why this man was wearing pyjamas was, because the chief consultant on the ward was a die-hard biologist – depression is an illness like any other, when you are ill, you’re in bed, in bed you’re in your pyjamas.  That’s all I said, but given that it caused some kerfuffle (or maybe foofaraw?), I think it’s time to tackle the pyjamas.

Let me start with the rest of the pyjamas story. The first thing is that it was not only that particular man who was wearing his pyjamas. It was a pyjama-ward. All patients wore pyjamas and they were not allowed to wear anything else (but see below). Why? Well, I did ask why. The answer was as above, preceded by a look like I was asking something idiotic (is that a psychiatric thing?) and a statement that ‘This is a hospital!”. Aaaaah, that makes it clear, doesn’t it? But when I said that I had seen a few patients in tracksuits, I was told that, yes, tracksuits were allowed, but only for patients that behaved well.

Really, that was the answer. Pyjamas were ‘waived’, if you behaved well. I didn’t ask what exactly it meant – I still wanted to come back to the ward for more interviews.

Before I continue, let me tell you one thing the patient in his pyjamas told me. Biological psychiatry also meant, the man had been on the ward for 10 days and apart from the admission interview, no one talked to him. No one! He asked me:

“Do you think I don’t have those fucking thoughts all the time?”

He was referring to suicidal ideation. But then, do you ‘talk’ to a patient with flu, diabetes, hypertension or high cholesterol? No? Well, if it’s all a chemical imbalance, what’s the point of talking a man who had just tried to kill himself? You give him medication, pyjamas, a bed. He stays in bed and gets better. Simple!

Ok. Let’s go back to the exchange I described above

1. In the first instance pyjamas are described as a ‘uniform’. You wear pyjamas, because ‘this is a hospital’. Indeed, you might also wear a uniform because ‘This is a prison.’, or a school, army, or police. All those uniforms are disciplinary strategies with some common and some unique goals. Nevertheless, they are to show that you are part of a particular group with certain institutionally imposed rules. In hospital, as nurses wear uniforms, so do patients. You must wear your pyjamas, so we can tell you are a patient.

2. But things go further. What also transpired in my quick exchange was that, in fact, pyjamas had nothing to do with ‘this is a hospital’, but were a harsher disciplinary measure. If you behave well, you might be allowed to look like a human being and wear clothes. Wearing a tracksuit was a privilege you earned. As any such privilege, also wearing a track suit could be revoked at any time and, indeed, was. After all, if you slip up in behaving well, you will go back to pyjamas and will have to earn the privilege of wearing a tracksuit again.

Now, the discussion slagging me off contained this statement:

“Severely depressed can need to be prescribed pyjamas to prevent them to get out of the hospital to suicide for ex”

As a linguist, I find it fascinating. Consider first that the psychiatrist writing this, uses a very interesting phrase: “prescribed pyjamas”. Let me turn it into a question:

“Can you actually prescribe pyjamas?”

Do you write it on the same little form, as you prescribe antibiotics? Let’s go further – what else can you prescribe? How about prescribing me an Aston Martin?

Well, I actually think you can’t ‘prescribe pyjamas’ and the medical language is used to make the order to wear pyjamas more justified, more ‘clinical’, if you like. Prescribing pyjamas suggests a clinical judgement. You know, just like you are told to complete the course of antibiotics you were prescribed, because it’s not good for you, if you stop early. Similarly, you are prescribed pyjamas and if you don’t wear them, you are putting your, I don’t know, health(?), at risk.

But the prescription to wear pyjamas is more pernicious. In fact, the tweet suggests that the pyjamas are a leash on which the patient is kept. We don’t have to take care of you, we don’t even have to keep an eye on you. We can simply make you wear pyjamas and you will not want to escape. After all, you will look like a prat outdoors and the cops will be able to identify you quickly. Pyjamas in this tweet are a wonderful substitute for psychiatric help.

I am probably overdoing it (somewhat), but have you seen patients chained to beds in Third World countries? Well, we don’t do it. We make our patients wear pyjamas! Congratulations!

So, that’s my answer. I think, pyjamas have nothing to do with clinical need, with ‘helping the patient’, with keeping the patient safe. It is only to do with disciplining the patient. With keeping patients identifiably in line. And that’s precisely why I object to it. And I am very pleased to have made clear. And I am also very happy to get a few hundred notifications for a  longer thread in which I am called names, insulted, patronised. After all, I soooo don’t understand.

But let me finish with something positive. When I was an intern, one of the things I heard a number of times, was nurses moaning that they had had to run after families who would get the patient to change into their pyjamas and take their day clothing. The doctors on the ward were adamant that patients did not need pyjamas. Just like they did not need their temperature taken every morning. There were two reasons. One was that adult people tend not to spend their days in pyjamas. The other was to get them to change in the morning. You know, you get up, wash, and dress. A semblance of normal life.

I am not a clinician (gosh, don’t I know it after, by now, 300 patronising tweets?), but it really does make sense to me.


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