Saturday, 22 September 2012

22 September 2012 - Power and Force: Bedfellows in Psychiatry

It seems like I've always been aware of the power/force dynamic in the psychiatric system which is euphemistically called care and treatment.  Since the 1950's and 60's, memories of my mother having a nervous breakdown and not wanting to go in the local mental hospital/asylum  The family not wanting to put her in.  But no other option.  I assumed that everyone else was aware of it too.  Because it was obvious.  To the psychiatric patients and the psychiatric staff.  Their family members, the nearby community and society at large.  Stories of shock treatment, brain surgery and straitjackets, chemical or otherwise.  One Flew Over the Cuckoo's Nest and 'They're Coming to Take Me Away, Ha-Haaa!'

I didn't think it was a secret because many folk who had been in the asylum or hospital didn't usually want to go back in again.  And some folk who went in didn't come out again.  Maybe for years and maybe for a lifetime.  Things are different now in that people come out, may go back in for a while then come out again.  Although some may become the Left Behind.  But through it all the power and force continuum continues.  At least in the mind of the people playing the game.  And those of us who have no option but to enter the system.  And are conscripted as players.

The perceived power in the psychiatry system means that the threat of force is sometimes all that's required to ensure compliance and conformity.  Taking the medicine and agreeing with the diagnoses.  Keeping your opinions to yourself until free to disagree.  Hoping that you don't relapse or go mad again and the label becomes permanent.  Sticking like glue and popping up at random medical appointments, to cause irritation and annoyance.  A mental health manager told me recently that the label can't actually be removed.  It's apparently written with a permanent marker, like a tattoo but not self inflicted.  Even it was incorrect or temporary or an opinion or a point of view.

In general medical circles a diagnoses would be useful in future dialogue or interaction.  As a signpost or indicator of physical health issues and resulting treatment.  However in the psychiatric world a diagnosis or label can stigmatise and discriminate.  In my experience.  Spilling over into family medical histories so as to justify a course of treatment or behaviour, by professionals.  Upon a family member in mental distress.  Without having to consult with the person or their family.  Mental illness the mantra and reason for paternalistic control.  For taking charge and taking away the power from the patient.  Compulsory treatment.  Using force if necessary.

As a woman who's been forcibly treated in psychiatric wards I won't ever feel OK about it.  Sometimes it was men who held me down and forcibly examined and injected me.  This can never be OK.  In other settings it would be assault and rape.  An invasion of the body.  Nurses being trained in restraint procedures doesn't make it any better.  There has to be another way of working with women and men in distress.  That doesn't involve a re-traumatising and dehumanising experience.  And nurses who objectify as a way of coping and remaining sane.  In an insane environment.

As a woman who's been a psychiatric inpatient on 3 occasions (1978, 1984, 2002) my stays got progressively shorter.  Because I conformed and swallowed the drugs and got back out as quickly as possible.  Mixed sex wards are very risky places for women.  Especially the 2002 experience where the sleeping accommodation for women was overlooked by men in single rooms who were across the corridor.  Men who possibly had criminal records, drug and alcohol problems, offending behaviour, attitudinal issues.  And I was being forcibly medicated into an obedient state.  How scary is that?  Would you like it?

On discharge from psychiatric hospital the issues with power and force continue.  Especially for anyone on a CTO - compulsory treatment order - who isn't keen on taking the psychiatric drugs and the resulting incapacity in decision making and other thought processes.  It requires, I think, very good independent advocacy and peer support, to have your voice heard and your wishes carried out.  Even better if the advocate has lived experience of mental ill health and psychiatric treatment, and can get alongside and give peer support.  This is what I did recently for my son.  It helps the person to take back the power and to resist the compulsion.  To taper the psychiatric drugs and/or to negotiate an appropriate plan of action.

It's not easy.  Taking back the power and resisting the force.  It makes me think of teeth gritting determination and stubborn persistence.  You won't be popular with the psychiatric fraternity or the social work collaborators (I'm not talking about all social workers, there will no doubt be exceptions).  Who are co-conspirators in the quest to minimise risk and protect us from ourselves.  Which seems to be the complete opposite of the community development approach, the world in which I've spent most of my adult life.  Empowering and educating communities to be independent decision makers.  As a non-conformist it suited me down to the ground.

And as a mother and grandmother I just can't accept the continuation of the power/force continuum in psychiatric and mental health services.  There's got to be a shift.  Of the balance of power and the use of force.  On people who are in mental distress because of life's problems.  Which could happen to any of us at any time.  Being no respecter of persons.  So time to rethink the system and remake the bed.

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