The Big Institution Trap

Six months following her arrival at this large psychiatric hospital crowned with a reputation for humanist and open psychiatry, the general practitioner is disillusioned. She deciphers here the other side of the coin, the scattering of tasks, the disempowerment, the sprawling organizations, everything that makes the institution become overwhelming…

There was a trap. Of course there was a catch. It’s sneaky, the institution. It’s treacherous. It’s ambivalent. It’s like people. It’s as crazy as Monsieur D., the institution: a maze of procedures, full of errors, dramatically slow.

When I was an intern, I had idealized this particular institution, the psychiatric hospital, for having experienced the violence of the general hospital and having narrowly survived it. They had spared my sensitivity, my eccentricity, my freedom.
The institution gave me the feeling of being accompanied in the discovery of the complex link with psychotic patients.
And then, following a few years spent in liberal, beautiful years certainly, I was relieved to find the institution for what it simplifies the administrative procedures and distributes the tasks. The institution is also a treasury, a management of medical affairs, a salary that falls every month, a pre-filled tax return, and to hell with Urssaf. It is also secretaries who send mail, who call, who make appointments and specialists at hand.

An institution that bears, therefore.
Yes, which relates to the relationship with the patient. Which diffracts and dispatches. Which helps us, as individuals, to endure mental illness. To support the complicated and sometimes heavy link with patients. I considered with indulgence although a certain weariness the proliferation of meetings on my schedule and that of everyone. Meetings and their place between us, the patient, the clinic, and the institution. But it’s also an opportunity to be with others, to be supported.

The institution: the paradise of “those who know how to delegate”

Today, however, I realize that the institution crushes us for everything else.
Admittedly, it is easier to manage an unbalanced psychotic in the institution, because there are nurses, psychiatrists, the social worker, this facility to say “That’s not my role, it’s that of the social worker, the secretary, the psychiatrist…”.
It’s easy, and that’s also why he’s never addressed the right person, in short, the new guy, that poor guy in hospital pajamas who hasn’t yet identified everyone and who’s been there for four hours already, and who hasn’t seen anyone, and doesn’t know where his damn phone is, who can’t have a shadow of a roll of toilet paper in his room.
Everyone has their own tasks.
The institution is also a form of group inertia, softness, the facility for some to rely on others, for everything, too much, to hide. It’s heaven for those who know how to delegate, hell for those who can’t say no, like me. Everyone has their own tasks, but there is such an infinity of them that there will always be bastard tasks, poorly informed, on the edge of functions, just as there will always be patients who will not fit into the boxes or who will suffer as a result. . Tasks that will therefore fall from hand to hand up to those of the agent who will have the biggest superego, who will invest himself in it as if on a mission. Because his professional conscience does not allow him to bury his head in the sand or to say no.

The institution is a form of strangulation. It’s a big soft octopus that grips everyone in inertia, procrastination, institutional slowness.
When I arrived at the hospital, I ordered a stamp in my name, and lunch vouchers. I returned emails, a month later, three months, six months. So I gave up. Basically, I’ve always signed with a pen, and if the pharmacist isn’t happy, let him call. To find himself in this castle of Kafka, the person who takes care of ordering the stamps, passing by the service A of the pole Z, building X, circular B65. As for the lunch vouchers, I finally received them a year later.

“There is a general practitioner, she is there for that”

It is therefore also all that, the institution. And you, the general practitioner, the world is crashing down on you. Because there aren’t enough psychiatrists anymore. They vanish as soon as they arrive. Because the nurses let themselves little by little go to no longer know how to do anything somatic.
Because one day a psychiatrist answers: “There is a general practitioner, she is there for that”, while a nurse alerted him to the constipation of a patient who had arrived a week earlier, put on tercian/lorazepam/loxapac and in an isolation room.
Because we address psychiatrists as you say, we don’t have lunch with them.
Whereas I do. The young GP, kinder, more accessible. Conscientious. We dare to tell her everything, ask her everything, in return we share with her the jokes, the meal, the coffee. And I plead guilty since I asked to be familiar with and I hate this class separation.
People like me in this universe end up compressed.
And that’s how six months later, the little GP has become more aggressive, more formidable. More pessimistic. And of a frightful lucidity.

Vanawine Sylviery, General practitioner. Picture © Alain Signori