I grew up very close to a Victorian asylum. It began to close in the late 1980s, when I was in my teens, but even as a child I was aware that some of the people I saw wandering the village had been done a gross disservice by psychiatry. Many were elderly, having been admitted decades before, often for spurious reasons and with little hope of living in the community again. Recently I saw some accounts of life in that hospital. You will be unsurprised to learn that an unwarranted number of the wards were locked, and patients hugely overmedicated.
The first time I saw a psychiatrist was just a few years later. I was 19 years old. I had been referred by my GP, who was concerned about my depression, but I had been reading abnormal psychology textbooks in the university library and was beginning to suspect that I might have bipolar. I can’t begin to say how unhelpful and upsetting I found my encounters with that consultant. He was sexist, and obsessed with achievement and status. He was dismissive. He called me a liar. He implied that I drank too much. His brief but efficient gaslighting was such that after an hour’s assessment I barely knew what was true about myself. My mum came to the second appointment because I could not face going back alone. He told her I was like a silly schoolgirl and sent me off with a prescription for fluoxetine (Prozac) which he said would send me “as high as a kite” if my “red herrings” about elevated mood were true. I stuck with the antidepressant through two weeks of sleeplessness, agitation, despair and suicidal ideation, all the while thinking that I was far worse off than if I’d never asked for help.
In my recent treatment I have seen some awful things. It is (or should be) harrowing to see somebody sedated through an intramuscular injection they have not consented to, or subjected to any form of restraint. I once saw a man taken to seclusion by a phalanx of eight or nine staff. The patient was doubled over inside a sort of cage of nurses, the nurse leading holding his head down so that he could not see where he was being taken. I’m sure there were serious risk issues involved because this response was very swift, but it was nonetheless shocking. I have seen people so sedated that they could not talk, could barely move, could do little except drool. I have seen people on antipsychotics gain multiple stones of weight with no support for managing this. I have seen people detained without understanding why, moved from shorter s2 (of the Mental Health Act) detentions onto longer s3s without understanding why. I have seen many, many people given one drug or another without ever knowing the reasoning behind prescribing, let alone having actively participated in the decision-making or meaningfully consented to the side effects.
I have met (online and in real life) people who have been saddled with diagnoses they did not ask for, words which have made them the subject of others’ fear and misunderstanding. Labels that have led to professionals writing them off as hopeless cases or branding them as manipulative, that have reduced their employability, that have made them doubt their own experiences.
Well, now it looks like I’m talking myself round to thinking that a system that employs so much coercion and is arranged so hierarchically must be outright unacceptable. It’s easy to understand why there are so many people who feel themselves to have been abused and degraded by some of the things done to them in the name of medicine. Let me be very clear on this: I hear them. I think that psychiatrists should damn well hear them. I believe that their suffering must never be downplayed, and that doctors must accept that their intention to manage risk and alleviate suffering is not experienced as such by many patients.
Probably some of the psychiatrists I know online or in person are a bit disappointed in me by this point. Well, I can only tell it as I see it. But wait, there’s more. I just can’t go around saying that psychiatry is awful, because then I’d be denying the very real help it has given me, particularly in recent years. This may be entirely due to the fact that the psychiatrists who have cared for me (and I do believe they have truly cared) since my relapse in 2011 have been good people – although that’s still not uncomplicated. The same Home Treatment Team consultant who has helped through endless crises was at one point painfully paternalistic, thinking up a new diagnosis and sticking it in my notes without telling me. The same ward consultant who worked with me to find a better drug regime prescribed for some of those patients given meds that they did not understand.
But many, many aspects of their input have been beneficial. My current diagnosis, formulated with my input, has been particularly helpful. A psychologist opined on Twitter recently that psychiatric diagnoses were “meaningless”, by which I think they meant that there was no scientific evidence base for them. Meaningless? Not to me, they’re not. My diagnosis is the context within in which I understand my life. Strange behaviours and inability to honour commitments, often the cause of much guilt further down the line, make sense in terms of bipolar mood cycles. Without thinking of myself as bipolar, I had assumed I was just a terrible person. Without thinking of myself as bipolar, I cannot see the same behaviours coming and try to take action to curb them. Online I have found my “tribe” of other people whose experiences and behaviours I recognise, a kind of kinship established by a shared label/context. I have seen the same kind of connections made among people with, among others, diagnoses of depression, anxiety, obsessive compulsive disorder, and yes, borderline personality disorder. A lot of people find labels oppressive; for some people labels can be liberating. Liberation is not is meaningless.
The drugs… the drugs help. At least some of the drugs, some of the time. I have taken a large number of medications, some of which were never helpful at all. Some were a little helpful but came with such horrendous side effects that on balance I decided to stop them. Right now I have a better quality of life than I have in a couple of years thanks to a combination of two mood stabilisers, an antipsychotic and a little kick for my thyroid function. Yes, I take a lot of pills, no, that doesn’t really bother me if it allows me to just about manage. In fact there are lots of people out there who also feel that their quality of life has been enhanced by psychiatric medication, with many stating that their drugs actually keep them alive. This is clearly an aspect of psychiatry that many people value to some degree . I’ve also seen “good news stories” in an inpatient setting, the use of antipsychotics turning around the lives of young women whose psychosis had placed them in very real danger from physical accidents or sexual exploitation. They were sent on their way in a week or so without labels, with a (hopefully) one-off psychotic episode resolved.
Personal relationships help. I have been with the same community consultant for six years and he has been consistently patient and supportive and warm. He continues to be optimistic (in my view, wildly so) that my functioning can be improved and is open to trying different drugs and seeing how that aspect of treatment can mesh with insights gained in psychological therapies. I didn’t have a care coordinator for five of those six years, and he essentially provided that function although it wasn’t his job.
So we know that psychiatry can do and has done things that patients perceive as harmful, and it’s OK to fear or hate a medical specialism if you feel that it has treated you badly. It’s important to note that finding psychiatry personally helpful does not cancel out the bad experiences of others. But it’s also OK for a person to feel positively about psychiatry, or at least about the aspects of it that have helped. It’s OK to feel positively about the psychiatrists they work with, if the interactions are sensitive and empowering.
It’s not OK to shout down some people’s good experiences on the grounds of other people’s bad ones. It’s not OK to take away words that gives people a sense of meaning and a framework for understanding their own lives because the same words are not helpful for other people. Overall I am (mostly) positively disposed towards psychiatry, and despite what some people on Twitter may say I cannot be wrong on this, because I cannot be wrong about my own experiences. Denying the validity of people’s lives and self knowledge is at the core of oppressive practice, but this cuts both ways. You don’t get to pick which type of experience is “correct” and simply brush aside anyone who find their diagnosis, or their psych meds, or their psychiatrist helpful because it challenges the idea that psychiatry is and must always be inherently brutal.
I totally get that it’s hard for some people to understand why I might be broadly positive about psychiatry, but tweets about good relationships with doctors, “life-saving” medications and enlightening diagnoses show I’m hardly the only one. Rather than rejecting that, shouldn’t those who raise their voices against terrible care be celebrating the fact that care can sometimes be good? Some people find psychiatry helpful. And that’s OK.
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