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.


References:

Briazgounov IP. The role of physical activity in the prevention and treatment of noncommunicable diseases. World Health Stat Q. 1988; 41(3-4):242-50.


Chamove AS
. Positive short-term effects of activity on behaviour in chronic schizophrenic patients. Br J Clin Psychol. 1986; 25 ( Pt 2):125-33


Csernansky JG
. Treatment of schizophrenia: preventing the progression of disease. Psychiatr Clin North Am. 2003; 26(2): 367-79


Deimel H. Sport therapy with psychiatric patients. Psychiatr Prax. 1980;  7(2):97-103.


Dencker SJ
. Physical training. II. An activating type of treatment within psychiatry. Scand J Rehabil Med. 1971; 3(1):57-60       

   

Falloon IRH & Talbott RE, Persistent auditory hallucinations: coping mechanisms and implications for management. Psychological Medicine 1981, 11:329-339.     

 

Fleischmann H. What Expectations do Mental Disordered People have about the Treatment in an Psychiatric Hospital? Psychiatr Prax. 2003; 30(S2):136-139

 

Gunning SV, Holmes TH. Dance therapy with psychotic children. Definition and quantitative evaluation. Arch Gen Psychiatry. 1973; 28(5):707-13.


Gutheil TG, The therapeutic milieu: changing themes and theories
. Hosp Community Psychiatry  1985; 36(12): 1279-85  

 

Harte JL, Eifert GH, Smith R. The effects of running and meditation on beta-endorphin, corticotropin-releasing hormone and cortisol in plasma, and on mood. Biol Psychol. 1995; 40(3): 251-65.

Lees A. Science and the major racket sports: a review. J Sports Sci. 2003;21(9):707-32.       

Lion LS. Psychological effects of jogging: a preliminary study. Percept Mot Skills. 1978; 47(3 Pt 2):1215-8.

 

Meyer T, Broocks A. Therapeutic impact of exercise on psychiatric diseases: guidelines for exercise testing and prescription. Sports Med. 2000; 30(4):269-79.


Scheidhacker
M, Bender W, Vaitl P. The effectiveness of therapeutic horseback-riding in the treatment of chronic schizophrenic patients. Experimental results and clinical experiences. Nervenarzt. 1991; 62(5):283-7.


Schjødt
T; Middelboe T; Mortensen EL; Gjerris A, Ward atmosphere in acute psychiatric inpatient care: differences and similarities between patient and staff perceptions. Nord J Psychiatry 2003; 57(3): 215-20.


Seve
C, Saury J, Ria L, Durand M. Structure of expert players' activity during competitive interaction in table tennis. Res Q Exerc Sport. 2003; 74(1):71-83.


Seve
C, Saury  J, Thereau J & Durand M, Activity organization and knowledgeconstruction during competitive interaction in table tennis. Cognitive Systems Research 2002, 3:501-522.




 


Copyright © 2004 Hampstead Psychological Associates, Ltd - A Subsidiary of Southern Development Group, SA.
All Rights Reserved.   A Private Non-Profit Agency for the good of all, published in the UK & Honduras.