The Hospital Senses Collective
Clothing can be considered a person’s most ‘immediate physical environment’.[1] It impacts upon how a person moves, sits and stands, affecting the wearer sensorially and emotionally. Traditionally, clothing within health and social care settings involved the use of overalls and gowns. Such institutional garments typically create limited possibilities for being active, symbolising as they do the low status of patients in the hospital hierarchy whilst also reinforcing notions of sickness.[2]
Graham Stokes presents a troubling account of a man with dementia who arrived in hospital elegantly dressed in a navy suit and yet was required to wear pyjamas all day, every day, when in hospital: ‘[H]e dressed inappropriately, wearing two shirts, refused any assistance from nursing staff. Getting verbally abusive when told to take one of his shirts off. The day after he became very aggressive, hitting and kicking out at staff when they attempted to change his wet clothes. Clothes removed to prevent Stanley re-dressing in day clothes. Mattress removed from bed as patient continually laying down trying to sleep’.[3]
The account indicates that wearing pyjamas impacted the man’s spatial and temporal orientation, yet it can also be considered a material symbol of his loss of agency and autonomy. While this example focuses on the imposition of clothing against the patient’s wishes, other clinical examples show that attending to strong attachments to one’s clothing can form part of careful treatment itself. Writing of his clinical work with mothers suffering from postpartum psychosis, the French psychoanalyst Alain Vanier presents the story of a woman who refused to wear anything but yellow pyjamas: ‘[T]wo days before her scheduled delivery, she showed up at the centre completely naked, screaming “Get this thing out of my stomach and get it over with!”’ [4]
The crisis was quickly resolved by getting her back into her yellow pyjamas, but she was then unable to step out of them until after delivery. Her pyjamas helped maintain her physical unity, acting as a surface enveloping her body at a time when her physical unity was particularly threatened. Here, the staff’s quick appreciation of the central role played by material objects in illness helped to avert a crisis.
In recent years the NHS #EndPJParalysis campaign has seen clothing reconsidered at an institutional level. The initiative, founded by Professor Brian Dolan, aimed at achieving one million days of patients being up, dressed, and moving by encouraging people to get changed out of their pyjamas and into their own clothing. Narratives collected during the campaign highlight feelings of dignity, agency and autonomy that patients felt when dressed in their own clothes.[5]
These examples demonstrate the direct link between the external reality of the clothes we wear and our internal sense of selfhood. Both realities are intimately tied up with ideas of care in physical and mental health. This is not only true of pieces of clothing, but can also apply to textiles close to hand, such as blankets, cushions, and twiddle muffs (purpose-made textile objects used to provide tactile stimulation for people with dementia), the sensory experience of which can be a stabilising force.
Drawing upon the idea of a baby’s ‘transitional object’, such as a soothing, sensorially pleasurable teddy bear or security blanket, which stands in for parental care, can help us think about how we as adults use textiles like these as a source of comfort.[6] Such objects are important to us due to their sensorial properties, including how they feel, look and smell, and the meanings that we attach to them. Notably, many of these objects may be brought from home, or made by volunteers, acting as a personal alternative to mass- produced objects in health and care settings.
References
- J. Twigg, ‘Clothing and Dementia: A Neglected Dimension?’, Journal of Aging Studies, 24:4 (2010), 223-30.
- P. Topo and S. Iltanen- Tähkävuori, ‘Scripting Patienthood with Patient Clothing’, Social Science & Medicine, 70:11 (2010), 1682-89.
- G. Stokes, And Still the Music Places: Stories of people with dementia (Hawker publications, 2008).
- A. Vanier, ‘Clinical Experience with Psychotic Mothers and their Babies’, in L. Caldwell (ed.) Winnicott and the Psychoanalytic Tradition: Interpretation and Other Psychoanalytic Issues (Karnac, 2007), p. 64.
- End PJParalysis, http://www. endpjparalysis.com/ [accessed 9 August 2020].
- D. W. Winnicott, Playing and Reality (Psychology Press, 1991), pp. 1-34.