by Marcio V. Pinheiro, M.D.
[September 1995; Vol. 22 No. 4]
In this day and age, when psychiatric hospitals in America have become assembly lines in order to maximize profits for the managed care corporations, it was refreshing to visit the Austen Riggs Center in Stockbridge, Massachusetts.
Having been there before, we were curious to learn how the treatment philosophy adapted to the contemporary health care environment, so hostile to psychiatric hospitals.
During our guided tour, it was clear that their basic principles of treatment have not changed. When “accommodation” to economic forces seems to be the road to survival, it was a pleasant surprise to see that the patients and staff at Riggs continue to work together in a network of interpersonal interactions to form a Therapeutic Community. It is an effort long abandoned by others in this “Decade of the Brain”.
The hospital has about fifty patients. Each one is engaged in individual psychoanalytic psychotherapy. The milieu is carefully engineered by patients and staff to fulfill its important therapeutic function. The hospital is “open”, and the patients themselves make sure that their peers remain within the boundaries of acceptable behavior. The patients’ participation in the decision-making processes that affect their lives is by itself an important therapeutic tool. Despite the different levels of housing, from hospital to residences, everyone belongs to the same community. Within it there are smaller groups that address special needs—for instance, substance abuse and eating disorders.
The patients participate in a variety of activities—from painting, to wood working, to weaving and even to participating in a play that is open to the Stockbridge public. At Riggs these activities are therapeutic by themselves and are not viewed as a medium for interpretative work.
Very few patients are rejected or not tolerated in the hospital community. These are usually acute patients or the ones who are unable to attain a minimal working alliance with fellow patients and staff. They are usually referred to a nearby traditional psychiatric hospital. The great majority come back after their lives are under better control.
Riggs continues to follow in the best tradition of American Psychodynamic Psychiatry, well known all over the world. There is even a touch of Jacques Lacan, the French psychoanalyst, in the approach to patients. The patients are also treated with medication when this is indicated and their families are seen by psychiatric social workers.
The treatment at Riggs is not the prevailing “quick fixes” that may work for some patients. The patient can stay a little longer to consolidate gains, and to develop insight.
When I asked about its chances of surviving as a hospital, I was pleased to learn that some managed care corporations (the wiser ones) are starting to refer patients there. These are patients who have become stuck in the “revolving door”, going in and out of short term hospitals without success. These managed care corporations are learning fast that it saves them money to allow such patients to stay longer in a place like Riggs.
Didn’t we all know that all along?...