The
International Journal of Psychosocial Rehabilitation
A Table
Tennis Tournament in the Psychiatric Hospital:
description and suggestion for salutogenic
implications
Iulian Iancu, M.D.
Rael D. Strous, M.D.
Nadav Nevo, M.D.
Joseph Chelben,
M.D.
Psychiatry B. Department, Beer Yaakov
Mental Health Center, Beer Yaakov
and the Sackler Faculty of Medicine, Tel Aviv University, Tel
Aviv, Israel
Citation:
Iancu, I., Strous,
R.D., Nevo, N., & Chelben, J. (2004).
A
Table Tennis Tournament in the Psychiatric
Hospital:
description and
suggestion for salutogenic implications. International
Journal of Psychosocial Rehabilitation. 9, 11-.
Correspondence
address: Iulian Iancu,
M.D.
Psychiatry B.
Dept.
Beer Yaakov Mental Health Center
POB
1, Beer Yaakov, Israel
Fax"
972-8-9258389
e-mail:
iulian1@bezeqint.net
Abstract
Psychiatric
inpatients are often passive
and frequently complain of boredom and apathy. Unfortunately, sports
therapy maintains
only a marginal position in psychiatric rehabilitation. Therefore,
we describe the implementation of a table-tennis contest in a
psychiatric
hospital and present three vignettes on patients' reactions during the
tournament.
Despite a paucity of controlled
studies examining the therapeutic potential
of exercise in psychiatric patients, exercise should be integrated in
the
treatment of psychiatric disorders. The
role of sports in the management of chronically ill
inpatients is of great importance and we discuss the positive effects
of the
tournament and regular physical activity on patients.
Introduction:
The therapeutic milieu in contemporary
psychiatric
wards comprises sessions with psychiatrists, psychologists and nurses,
morning
groups, group psychotherapy, occupational therapy, etc (Schjodt
et al, 2003; Gutheil, 1985). Despite all the above, decreasing
hospital budgets and patients' needs provide the impression that this
is not
enough. Patients often complain a great
deal of boredom and although some of the complaints are defensive and
result
from negative symptoms of young schizophrenic patients (Csernansky, 2003), one wonders whether
there is "lacking" in today's psychiatric hospitals. In addition, patients
often report that they expect that their inpatient
program will include recreation and sports (Fleischmann, 2003).
Many schizophrenics are
characterized by significant passivity, impaired mobility, lack of
communication and tendency to "autistic" thinking and regression,
which result in reduced physical working capacity and minimal sportive
activity
(Dencker, 1971). Furthermore,
antipsychotic medication may lead to physical side-effects, such as
fatigue,
circulatory disturbances and extra-pyramidal side-effects, each
reducing the
ability to exercise. Therefore, physical activity may
be considered as a necessary ingredient in mental disease, and
especially in
the rehabilitation of chronic inpatients.
Sport has been reported to be one
of the most beneficial recreational activities, with positive effects
on the
physical and mental well-being of both healthy and ill individuals (Briazgounov, 1988; Deimel,
1980). The last century was
characterized by
an abundance of severe
metabolic health problems, with many people turning to exercise as a
means of
controlling body weight, achieving well being and long-term health, and
reducing mortality, all serious problems among psychiatric inpatients (Briazgounov, 1988). Various sport
activities have been described as being beneficial in psychiatric
patients,
such as horse-riding, jogging and dancing (Scheidhacker
et al, 1991; Lion, 1978, Gunning & Holmes, 1973). The motor behavior,
emotionality and social behavior of the patients may be significantly
improved
(Deimel, 1980). Sports can improve the
mood of these patients and can also be a pleasurable part of the
rehabilitation
program of chronic psychiatric patients (Meyer & Broocks,
2000; Chamove, 1986). Sports may improve
self-concept, promote relaxation, and function as a period of
"time-out" during the day (Chamove, 1986). Additionally,
as many as 78% of patients with schizophrenia have reported that they
have used
exercise in some way to reduce hallucinations (Falloon & Talbott,
1981).
Chamove (1986) studied 40
schizophrenic patients and compared their subjective and objective
sensations
in days of activity as compared to low activity days. He suggested that
activity is beneficial in the treatment of this population. The greatest
improvement was found in less severely disturbed patients, overweight
individuals, females and those with lower levels of normal activity (Chamove et al, 1986).
With the above considerations in mind, we present the organization and
the
implementation of a table-tennis tournament in our psychiatric hospital. We
also present three short vignettes regarding
some of the participants in this tournament. In addition, we suggest
that table-tennis lessons and tournaments on a regular basis can in
fact
improve the well-being of chronic psychiatric inpatients and might
constitute
one of the crucial "ingredients" in rehabilitation programs.
Method:
The
implementation of such a program derived
from the first author's initiative, who is an amateur table-tennis
player. The present tournament,
the second
held in our hospital, was planned
to take place during the Jewish Holidays in 2003.
Organization:
The planning was implemented by the
first author, with some help requested from two patients. One typed the letter of
the contest, announcing the date, the prizes and the fact that the
competition
will involve both a patients' tournament and also a doubles competition
(patient and therapist). The second patient was
told to distribute the announcement among the hospital's wards. As the patients were
reluctant to do a "bold" promotion (maintaining that they are shy),
the first author also visited the wards and talked with both staff and
patients.
The prizes totaled the amount of
50$ and included 3 trophies, 2 sport shirts and two hats. The money was received
from the Hospital's Friends Committee and the prizes were brought from
a local
sports shop.
The tournament:
Eight patients participated in the
tournament (out of 200 patients in the hospital). All were young males,
suffering from schizophrenia. In the Doubles Competition
we had 4 therapists, 3 schizophrenic inpatients, and an outpatient, a
recently
discharged manic patient from the ward who also happened to have been a
social
worker. After the gathering of the
participants, the rules of
the tournament were explained and a draw was done. The tournament took
place in the ward's lobby, ensuring that it could not be missed by any
of the
staff or patients.
The matches were one set long, up
to 21 points. The patient who won the set
qualified for the next round. Patients who won the
first three places were awarded prizes and trophies. Due to matters of
brevity, we will describe only the singles tournament.
Vignettes:
M., a 24-year-old patient
with chronic schizophrenia has been in the hospital for six months due
to delusions,
serious behavioral problems and negative symptoms. When the competition
was announced, he declared that he would win it. He implied with a smile
that he was a "dangerous" player and that the rest should be afraid
of him. At the tournament, he felt some
apprehension
concerning the level of the other players, but exhibited good table
tennis technical
abilities during the warm-up. He easily won the first
match and then subsequently disappeared. His absence was discovered
during the semi-finals and it was decided to start with the second
semi-final match. Meanwhile, a second patient
was sent to find him. When back, he reported he thought
he had enough time prior to his next match. M. lost the semi-final match
and was "in despair". It was explained that
he could still win a prize as he would play for the 3-4 place. His mood then improved. During that match, he
led by a few points, but was tense. Each time, the opponent
closed the gap, he became very fearful. He declared that he must
win a trophy, but regarded the prize (a sports hat) with little value. When close to victory,
someone said that the trophies will be awarded on the next day. M was stunned and
everybody laughed. M won and we calmed him and
promised to give the trophy today. He wished to get it
immediately after his win and had some difficulty to wait until the
prizes ceremony.
Mi., a 30-year-old
schizophrenic patient, who immigrated to Israel one year ago, suffers
from
severe negative symptoms, has no family in Israel and is during a
rehabilitation
process. The night before an important
interview, he took a heroin
overdose during a hospital leave and after returning to the ward, he
experienced
respiratory arrest. After resuscitation and a short
intensive care unit admission in a general hospital, he returned to the
ward. The tournament takes
place several weeks after this incident. M is the favorite to
win the tournament, but he refused to wake up for it. Following firm
persuasion, he left his bed and subsequently won the tournament. He smiled heartedly while
lifting the trophy.
L- a 33-year-old
chronic schizophrenic patient, is performing a diagnostic assessment as
his
mother, a general physician, does not accept both his illness symptoms
("he makes them up") or the diagnosis. His parents divorced
during his childhood, and L. grew up with a nervous
and ambitious mother. L. participates in the
contest with some fear and encouragement from us, and finally wins the
second
place. He does not tell his mother about
this, as he is not
proud of the win. He remembers that winning a trophy
during his military service was not joyous as he felt he was not good
enough
(not a combat soldier).
Discussion
We describe the successful
organization
of a table tennis tournament in a psychiatric hospital. It is important however
to bear in mind that although both staff and patients reacted
sympathetically
to the tournament, there was significant difficulty to engage patients
in the
program, especially due to the negative signs of their illness as
clearly
demonstrated by the clinical vignettes. Nevertheless, patients (both
contestants and audience) experienced several hours of excitement,
interest and
joy.
Our focus is that concentrating
solely on occupational rehabilitation (i.e. work), may be less
stimulating to patients than leisure activities such as sports and
social games. Sports activities may constitute
an enjoyable recreational activity during the long leisure time on the
wards,
and for some might even develop into a hobby, may be even a reminder of
a
childhood hobby or childhood wish to excel in sports. This intention, if
strengthened by regular sport activity, might even influence
patients'
motivation to engage in the rehabilitation
process and improve social skills in an indirect way, as sports are
characterized by lesser anxiety than social gatherings. Moreover, negative
symptoms might affect the occupational function more adversely as
compared to
sport activities. It would be easier for them in
sports, rather than in work activities, to prove that they are still
"worth something".
In the therapeutic milieu, the
sport activity might provide a projective tool, mirroring the internal world of these
patients, with revival of topics of aggression, competition,
inter-personal
problems, and low level of frustration, etc. Patients could be
observed in the weekly game, similar to the observation by nurses in
the ward
or during bibliotherapy sessions. For the aggressive
acting-out patient, the vigor of certain aspects of sports activity may
serve
to constructively rechannel constructively
some of
the energy which might otherwise be spent in undesirable, destructive
acts
(Gunning & Holmes, 1973). Finally, the training
could result in mood improvement due to plain pleasure and endorphin
secretion
(Harte, Eifert
& Smith,
1995). It could also affect ward
organization, add to the
therapeutic milieu and increase the closeness between therapists and
patients,
thus decreasing alienation characteristic of many patients. Since these patients experience
serious regression and even ego disintegration, coordinated motor
activity
might have a beneficial effect on fostering the ego. It is important to
stress at this point that the construction of the body ego and its
boundaries
is a cornerstone for further developments.
Table-tennis requires motor
engagement and coordination,
technical abilities, cognitive processing (knowledge, exploration,
planning,
mental rehearsal, decision-making, disguise of strong and weak points),
all the
above in a setting of substantial time pressure (Lees, 2003; Seve et al, 2002, 2003). One question that can
be raised here concerns how these issues might apply to the psychiatric
hospital setting and to inpatients who have motor and cognitive problems. Nevertheless, table
tennis really is
an ideal activity for patients,
as its motor and cognitive demands are not excessive. This activity might
improve motor and cognitive abilities, even if expectations are
somewhat low. Also, sport activities
provide an excellent opportunity for studying and influencing certain
components of human actions (Seve et al,
2003).
Finally, sports activities as part of the care of
chronically ill psychiatric patients are effective, as well as
cost-effective
and should receive more attention in both practice and research. Due to our
experience from these tournaments, it is the intention of our clinical
team to introduce
a weekly table-tennis lesson with the tutorship of a professional coach
in the
hope of finding someone who is both patient towards these patients and
could
also influence them with some of his
charisma and energy. In doing so, patients
will be assisted in the rehabilitation process and experience.
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