The therapeutic value of working together by Roger Knight
Having spent most of my working life either being a part of a team or managing one, I have learnt to appreciate the difference between working in a cohesive team versus one that is riven with discord and disharmony. The impact on organizations can be so significant that in health care settings where I have mostly worked, mortality rates can actually rise and fall based on the extent of harmony demonstrated by the team delivering patient care.
I was fortunate enough to have experienced an example early in my career, of how much being part of a team that works well together can uplift and affirm one to such an extent that a synergy emerges that manifests itself in the expression of positive energy, overwhelming willingness and productivity.
That experience which still stands out from all the others deserves I think recalling, particularly when I consider how long ago this took place at a time when the concept of team building was unheard of. This also took place in the most unlikely of contexts, which was a rehabilitation unit for chronic schizophrenics and was part of New Zealand’s largest psychiatric facility, Tokanui in the Waikato. It was a large sprawling facility in a rural setting which afforded a tranquil retreat for its many patients, many of whom were there not of their own choosing.
Since its closure in 1998, its buildings remain unoccupied and derelict, a poignant legacy to a once active community. Now devoid of life, it has an eerie ghost like abandonment about it, no longer fit for purpose. Whether or not its intrinsic purpose was ever fulfilled, is difficult to determine, but it does beg the question as regards any psychiatric facility, other than removing people from social circulation.
Back in the mid 1970’s though, a typical day on Ward 9, would start by readying a group of male patients for a day’s wood splitting in some local farmers paddock, where a fallen tree, would be sawn up for firewood and sold to raise funds for the ward. This had so far enabled the ward to purchase its own transport, so that the patients could venture out more, thereby facilitating some wider social integration. Usually, there were only two staff members supervising the work group, who operated the chain saws, whilst the patients would chop, split and stack the timber in bundles ready for sale. It never really concerned me, that young and fit schizophrenics on reduced medication, part of their rehabilitation strategy, could pose a risk, with log splitters and axes in their hands. I must have placed my faith in the rapport that had been generated in the group and the abiding belief in my ability to prevent or defuse any threatening behaviour.
Any possible concern was further offset, by the camaraderie and bonhomie that was generated. We were all now on the same team, working out in the open, away from the hospital. Any division between staff and patient had quickly dissolved. We all shared a common purpose which we embraced enthusiastically. The zest with which the patients worked and their increased interaction and animation, demonstrated their ability to shuffle off their institutionalization which had clearly shown how this had stifled their personalities and dispositions.
There was also a conviviality that came to the fore during ‘smokos’ (tea breaks) that the patients clearly relished, with much joking and hilarity. Of my working group, who I was entirely responsible for, at least half were of Maori ancestry. Recognising this, I suggested at the end of each day, we could pick puha that could be used in a hangi that I had noticed growing by a nearby riverbank.
On one occasion, I ended up in mud up to my waist, whereupon the group camaraderie became very much in evidence. Several of the boys were able to eventually haul me out, by extending tree branches to me, while others became stuck in the mud themselves, in their frantic efforts to rescue me. In retrospect, it was a bonding experience, and I was quite moved at the time, by their unstinting efforts, to ensure that I did not succumb to the unforeseen quagmire.
That degree of esprit de corps, that I experienced then, transcended socio-cultural differences and mental illness, and created the satisfaction of seeing rehabilitation actually work. This was for me rewarding evidence of how healthy team dynamics can generate a significant and lasting rapport forged in a crucible of work that enables one to achieve some sense of mastery and satisfaction. The fulfilment of some meaningful purpose and direction that had been given to these young men had in essence transformed their lives.
Many of them were able to function well on minimal medication, which meant having fewer debilitating side effects. As a result, some of these patients were able to be discharged and establish themselves in society thereby avoiding the dull monotony and exile of institutional life that was the fate for so many patients at Tokanui.
Working in some paddock as part of a team had given them a sense of purpose, self-respect, and identification with something beyond their plight. It was a unique set of team dynamics which accepted them for what they were and did not treat them according to their diagnostic labels. All this came about quite spontaneously and was not in any way forced. The patients’ unique personalities were able to come to the fore which was appreciated and in turn bolstered their self-esteems.
This was an unexpected outcome that still resonates with me to this day as an example of how despite our differences people can work cohesively and productively together. It just takes a degree of willingness and mutual respect. The concept of rehabilitation had been well and truly fulfilled for these young schizophrenics as they took their place in society. For some, based on the extent of their animation there might have even been an element of renaissance too. To have witnessed this and played a part in making this possible has created an intrinsic and sustaining satisfaction for me.