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E.S.L. as Therapy -- My experiences teaching English
in Geha Psychiatric Hospital (Part One)
by David Gilmore


The Rag launches its new column, "Special People, Special Places" focusing on teaching EFL in different settings to special populations. David Gilmore starts us off with a two-part article about teaching in a psychiatric hospital.


Four years ago, having just left a job teaching "Native" Speakers in Ramat Ha Sharon (couldn't handle the parental over-involvement), I was extended an interesting offer in an alternative framework - Geha Psychiatric Hospital. Specifically, the job involved teaching English to youth ages 13-19 hospitalized in Machleka Daled - the "closed" ward of the youth department (as opposed to the "open" ambulatory ward). I accepted the offer immediately, seeing in it a genuine learning opportunity. (At one point or another, hasn't everyone tried to imagine what it's like to be "crazy", or to be confined to a mental institution?) Well, here was my chance to find out. And, of course, there's always that little voice inside your head which whispers that maybe you can make a difference.

How much did the reality match what I had imagined? On the whole, I think that I discovered that life inside a psychiatric facility is a lot more normal than you might think. You do get kind of used to it. Naturally, the first time you encounter people in psychotic states, it is disconcerting; or when you first see an arm scarred from top to bottom with self-inflicted wounds or when you learn that the person sitting next to you tried to kill themselves a few days earlier; or when you summon a pupil from the ward and find out that they are currently being restrained to a bed. But, like any professional, you take it in stride. On the whole, the feeling is that you are teaching kids who are, basically more similar to their peers than they are different, but whose personal situations presently range from distressing to outright dire.

My first year in Geha taught me that most of the people there don't go around banging their heads into walls or talking to imaginary friends, and, aside from some scars and pajamas and really bad hygiene, they are just your average kids who like the same music, the same food, the same clothes, the same television shows, etc., as their peers. And, teaching them is more or less the same as teaching anybody, aside from a few small differences, the main one being that teaching these kind of pupils, in this kind of place, is always about more than just teaching English.

After more than three years of teaching at Geha (the last two of which have been in the "open" ward where the patient-pupils arrive in the morning and leave in the afternoon), I have to admit that I haven't completely gotten used to it, even though the pupils that I work with are in far better condition than my former pupils in the closed ward. (Most of my current patients suffer from chronic but manageable illnesses like depression, schizophrenia, behavioral and personality disorders). My inability to get used to the situation might actually be healthy -- complacency doesn't seem to be the appropriate response to the suffering that mental illness usually entails. But what these kids need is not pity, but treatment. And the purpose of the school is to provide them with a special kind of treatment--treatment through instruction.

Whatever else these kids may be dealing with, whatever problems that they may have, at the end of the day, they are still teenagers with the same needs and priorities of other Israeli teenagers, of teenagers everywhere. This is also true for learning English: Give or take a few Anglophiles, most are initially intimidated by the language, they are shy about reading out loud,and they don't understand the grammar. But, on the whole, they do want to learn English, if not for any other reason than to be able to go back to the school they came from, or a different school, and to be able to succeed in this subject. Occasionally, circumstances conspire to create a situation in which a pupil of mine, who otherwise would have done the Bagrut with his high school class, applies to take the Bagrut externally. Incidentally, I have taught a number of pupils who went on to take the 4 and 5-point Bagrut; some even achieved results in the high 90's.

These kids want to be healthy, they want to succeed. And I suppose that helping them to be healthy, to be successful and to fulfill their highest potential, is the ultimate purpose of treatment, and, in the same vein, is the ultimate purpose behind the activities of all the teachers at Neurim School whether they teach pupils who come from the closed or from the open ward.

Neurim School:

First, a caveat: The following description of Neurim School in the Geha Educational Center reflects my own incomplete and imperfect understanding of a complex place with varied and complex missions. It is not an official account, even though it received the principal's blessing. In any case, here is a basic description:


That which currently goes by the appellation "the Geha Educational Center" was established as a single classroom in the Geha Psychiatric Hospital roughly 25 years ago. Back then, it was something of an "experiment", conducted under the reasoning that it would serve to provide patients with a sense of badly-needed normalcy (for what does the average, "normal" teenager do if not go to school?)

The first teacher (and the current principal) was Ms. Noa Ofer. I suppose that at the time she was a young and highly motivated young teacher who, through her own combination of predilection and luck, arrived at the place she was to shape, to nurture, to fashion into a model for providing superb educational services to hospitalized youth (an achievement for which the school was recently awarded a Department of Education "Education Prize").

Everything that exists there today is a reflection of Ms. Ofer's vision, effort and initiative: I suppose you could say that Ms. Ofer is to Neurim School what Abraham was to the Jews. Of course, neither of them were solely responsible for their creations and over the years the staff of the Education Center came to comprise many talented individuals from diverse but interrelated fields: special education teachers with various areas of expertise ranging from computers to sports to Jewish holidays to current events; therapists (with teaching certificates) who utilize dance, music, drama, art to provide their pupils with avenues of expression that match their particular inclinations; and a couple of teachers like myself who came from outside of the special education framework, "specialists" in a particular field (although, while I was mainly hired because I was an English teacher as opposed to a special education teacher, Ms. Ofer was also moved by the fact that I play basketball and guitar and am a former swimming instructor and then, of course, I am also a male, which is quite useful in certain situations).

Over the years the school expanded, and with the increased acknowledgment of its vital importance there came a commensurate increase in space and resources. At some point, the school began to serve the outpatients (patients who live at home but who receive treatment from the morning to the afternoon six days a week) in addition to patients confined to the closed wards (there isn't much mobility between the two wards, so the division between open and closed, in the sense of their populations, norms, rules, etc. is fairly distinct. Furthermore, with only a few minor exceptions, staff members serve one or the other wards, a condition which allows them to become well acquainted with the psychiatric/medical staff in their ward as well as the kids themselves, and prevents them from being spread "too thin").

Paralleling this open/closed ward dichotomy, Neurim School consists of two sets of two-room classrooms, stocked with books, computers, and learning materials of all kinds. These classrooms are typically manned by one or two senior special education teachers, several less veteran teachers, and occasionally a "specialist", such as myself, or a computer teacher. The school has access to several other rooms, which are used for convening different groups, and there are computers, TV's, Video Players, DVD's, and all of the necessary equipment for utilizing modern media in instruction.


It's difficult to talk about a collective ideology, but, nevertheless, we all seem to be united by certain shared beliefs. If I had to pin them down, I suppose I would say that the three crucial points of our ideology are: 1. focusing on our pupils' self-esteem via successful learning experiences, 2. teaching responsibility by making pupils partners in their own learning; and 3. the inculcation of values and habits which reflect the standards of behavior and learning which society expects from them (or, perhaps more accurately, should expect from them).

It is vital for us never to forget that our pupils have not come to us primarily to learn English, Math or History - our pupils have come to us to learn and continue their education while they are hospitalized, but they are coming to us in the first place because they are not going to "school". We are temporary replacements for the normative framework, which means that we teach our pupils for a very short time. We, therefore, need to do all that we can for them in the shortest possible time because we can never be sure how long they will be our pupils.

Secondly, (and in line with the original proposition from which this deduction is based), we must keep in mind that we are teaching pupils who have come to this framework not primarily to learn, but to receive treatment, and the learning is only a part of that treatment. Our pupils have come to Geha, and, by extension, to Neurim School, because they are not well and/or because they have not proven themselves capable of functioning properly in regular (normative) frameworks and are therefore in need of diagnoses, treatment or both.

Most patients in the Open Ward (Vov) suffer from chronic mental disorders such as schizophrenia, depression, bipolar, or acute behavioral and personality disorders. Referring to "our collective ideology", above, it goes without saying that almost without exception, a side-effect of these illness and disorders is a serious deficit in self-esteem, a deficit which can be almost as pernicious as the disease or disorder afflicting them. Therefore, it is imperative for us, as teachers, never to lose sight of this fact, and to be extra sensitive to our patients' feelings, to offer praise whenever it is due and to mitigate our criticisms. If we must criticize, it is important to do so in a way that focuses on the action rather than the person and which leaves room for the possibility of positive change. In the area of being sensitive to our patients' self-esteem, we have an enormous advantage over most teachers, due to the fact that we are able to work either one-on-one or with only a few pupils at a time, so we can always relate to them as people, as well as pupils. I would say that this intimacy is perhaps the most crucial element which allows us to do our job the way it should be done.

Of course, increased self-respect is never derived solely from external sources, no matter how sensitive or nurturing those sources might be, but comes about as the inevitable result of overcoming some difficulty, of strengthening some part of ourselves which we subconsciously knew was weak and in need of strengthening. The key to achieving this kind of private victory is taking responsibility, and this is, likewise, a vital part of our collective ideology.

To the extent to which we succeed in prodding our pupils to take increased responsibility for their learning, we assist them in developing greater self-esteem. This is probably an uphill battle for all teachers, but especially so with our pupils, since many of them are extremely loathe to take responsibility. Why? Perhaps because they were not encouraged to do so by their parents or teachers. Or they might be inclined to acquit themselves from personal responsibility on account of their illnesses (the medication is making them drowsy; they are too "bothered" to concentrate on learning; they don't need or like this subject, they will learn it another time, in another place, etc.). It is precisely this tendency which we must struggle against, particularly because so many of our patients are chronically ill- and, as such, have little choice but to learn to adjust to their illnesses, and to seek to be both happy and successful in spite of them. Thus, it is vital that we stand our ground and demand that our pupils give us nothing less than the very best that they can manage at that moment in time. In so doing, we empower our pupils: They may suffer from chemical imbalances or neurological dysfunction, but they can always choose to do their very best. A good pupil carries on. Seeing a pupil realize this elemental truth, that he/she is the master of his/her own destiny, and that no obstacle can long stand before a determined will, is the ultimate goal of what we are hoping to do in our work at Neurim School.

Finally, we must always keep in mind that sooner or later our pupils will be rejoining society -- going back to normative frameworks (in special education or otherwise), and within these frameworks they will be held to the standards deemed appropriate for persons of like ability, intelligence, and age. Therefore, as teachers, we can not afford to be blind to the standards predominating in the regular educational frameworks. This means that while we should teach according to the ability and knowledge level of our pupils, we should also know what is expected of them in their particular framework (e.g. religious or secular), and to take these expectations into account. The same, of course, goes for standards of behavior, but, to be perfectly honest, it seems that we hold our pupils to higher standards than their former environments. (For example, when asked to put both feet on the ground, they are consistently surprised, a sign that they most pupils are allowed to sit in class with their feet wherever they choose to put them). In any case, we try to enforce standards of behavior that we all feel should be enforced, even in light of contemporary schools' "anything-goes" approach, they often aren't. Thus, we expect our pupils to be punctual, to speak respectfully, to sit up straight, to keep track of their materials, to concentrate solely on the task at hand. For some of them it is almost the first time they have been held to any standards whatsoever.

In Part 2, I will talk about the specific methodologies I have used in teaching English at Neurim School, how I determine which method to use with each pupil, the particular problems and difficulties of language instruction in such a framework, and, finally, the surprising and unique advantages derived from instruction in such a framework.

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