It’s the early hours and I’m awake. On a psychiatric ward for about two and a half weeks, I’m suffering from broken sleep and in the ward’s lounge as a new patient is admitted to the unit.
Middle class, she clashes with a system designed around power and prestige applied to an often infantilised working class. The system isn’t ready for people like her – ‘it’s like some sort of fucking school’ – and she isn’t ready for the system. Staff are trying to negotiate their powers into realisation. She’s being assertive. I know how this will play out in the staff’s observation notes the psychiatrist will consult as he decides on medication.
Sectioned (legally detained in hospital for observation and/or treatment), she’s facing a culture shock and isn’t sure she’s going to be able to survive the experience. She has a story while being aware that everyone has, but hers is compelling and it looks at this early stage as if she’ll get off the section. I hope so. She’s edgy but that’s understandable having experienced for the first time the effects of the State’s power to remove your liberty and mind. But she’s nothing more than edgy.
With our traditional focus on key indicators like race and ethnicity, sex and gender, class from a working class perspective, and so on, we sometimes overlook the needs of the middle class in these scenarios, but if we’re going to champion equality in services, it surely makes sense to see and work around our blind spots. The system being largely designed around a rigidly patriarchal hierarchy engineering the conformity of an often infantilised working class, people can be unprepared for the challenges such a structure throws up where everyday behaviour can be pathologised for no adequate reason whatsoever.
Current campaigns around mental health stigma tend to focus too heavily on persuading the general public to be more accepting of people with diagnoses by tackling common myths via public campaigns, but there’s little in the way of strategies for managing how those of us who are diagnosed deal with a dominant culture which is often prejudicial and discriminatory while also acknowledging that it isn’t only the dominant culture, but also we ourselves, along with the systems intended to care for us, which contribute to the problem.
While the myths in society do need to be addressed in the interests of social inclusion – though the evidence is that such campaigns achieve little, if anything – this shouldn’t be at the expense of developing an awareness of a community’s shortcomings, along with strategies for addressing them, when it comes to understanding mental health, not least if that may result in improvements.
Likewise, health services, while their very existence is contested, offer solace to many people, while they also stigmatise those they purport to care for with merely theoretical notions of such things as incurable diseases, chemical imbalances in the brain and genetic deficiencies all pointing to some internal and inevitable fault the evidence of which is still to be discovered.
We need a strategy which brings about the best in the stigmatised and the stigmatisers. It isn’t enough to be casually and conveniently dismissive of anyone, sacrificing a comprehensive and constructive understanding. We need to think creatively around how society and psychiatry positions us to think, behave and interact in key ways about certain conditions.
We need to understand how culture works us in order to redress the balance of power at a micro and macro level between ourselves and the societies we’re part of, to recognise that stigma isn’t a deficiency on the part of the stigmatised, but one of the stigmatiser or, better still, of our society and culture, embracing a more empowered way of life accordingly.
Two weeks and six days: that’s how long I’ve spent in psychiatric units this time. Looking at it all long-term, my times in hospital have become more spread out and my recovery from them quicker, so much so with the latter that I’m almost looking over my shoulder wondering how this recovery could have taken place.
Although the warning signs were there – I was yearning for the past times I’d spent in hospital, I was neglecting my social life and becoming increasingly disconnected – I’m starting to view these times spent in care as somehow necessary, something of a release from the build-up of detrimental environmental factors in the absence of adequate problem-solving skills, things you can only really pick up after the event.
My psychiatrist, however, doesn’t take the more positive, recovery-oriented view of all this that I do. To him, any form of ‘relapse’ is a sign of failure and yet, since 2007-8, every relapse has been followed by improved functioning and greater clarity.
It hasn’t been easy but the results may be worth it. Identifying that I was probably right in concluding that my initial – and mistaken – spell in hospital led to post-traumatic stress, I’ve had to almost apply treatment for this on my own though I’m pretty sure I’ve been successful, talking out issues which had been dancing in the back of my mind for years.
The plan had been to rework my relationship with past thinking and events so that they’re more power-balanced, losing their ability to cause disruption in the back of my mind, and to confuse by bringing them to the front. Again, I’m pretty sure I’ve pulled this off, but time will tell, I suppose, and it’s way too early to predict whether this has been a successful venture or some Quixotic folly.
My first week and four days, at the County’s central unit, were chaos. I was too far gone. Then, returning to home ground (where I’m writing this now) – Kidderminster’s ward – I was met with familiar faces who soon had me levelling off, stabilised, to be followed by compounding improvements in the following days to the point of a near full recovery now, though with the sense that it’s all happened so rapidly it’s a wonder any of it has.
Facebook, although the bulk of its content has become pitiful, would also provide a link to the integration of the personality, reminding me of better times and places – reacquainting me with my social self, the person I’m agreed to be. Mental health wards used to be almost hermetically-sealed worlds with no ‘outside’. You were there, that’s all there was and, before you knew it, you, too, could find yourself policing on behalf of the powerful against the weak.
Social media has changed things and, although it’s taken the NHS and psychiatry some time to jump on board and allow common access to smartphones on many wards, access to a forum which can, while being hazardous when paranoid, for example, offers an link to the wider community and providing a counterbalance to an environment which can be so conservative and infantilising as to almost drive you insane.
Things have changed. I’ve lost count of the amount of times I’ve been admitted to various hospitals, but when I first came here 16 years ago, I was struck with how archaic psychiatry is. All these years later, though change is traditionally slow, there are positive signs and I’m now struck with how much these people – the staff and patients – have to deal with and how well they often manage, against the odds, and usually with ideas and approaches which, although now almost taken for granted they’re so popularly – and blindly – accepted, can leave a lot to be desired. Improvements in even basic problem solving skills are needed here.
In those 16 years, services have declined, with all manner of initiatives dropped and space once used for activities now used for offices as managerialism has swept through the sector and paperwork rather than actual nursing and care have become the name of the game. Staff have come and gone, too. With many, because you’re meeting them at emotionally-charged times across a prolonged period, you build up an interesting and unique relationship. When they retire, the place just isn’t the same.
That said, things have improved in the two years since I was last here. Communication has improved greatly – staff are now not so rushed in prioritising paperwork and instead are frequently to be found making concerted efforts to reach out to patients and develop relationships, echoing the approach and personality of the new ward manager. That said, the issues with activities and space remain so that only one communal area has been left in place and even that’s a confined, restricted and at times claustrophobic area.
As time passes, I’m becoming one of the older patients. I first noticed it the last time I was in hospital as I developed a more conciliatory partnership with staff, rather than the old confrontational approach. The edges do tend to soften with age and I still see newbies making the same mistakes I did way back when while noticing myself making the same mistakes the oldies made when I was a newbie.
All told, though, this admission has been welcome in retrospect. Things had built up over time which I needed to stop and think about though it was unlikely that would happen the way things were. It’s also been good to reconnect with people I’d become way too dismissive of as I researched the background of mental health. And I can feel the difference even now, at this early stage, of having cleared out a lot of baggage to reach some new, better stage.
Following this spell in hospital, I’ve realised that I need to develop my social life, not shutting myself away like I did in the time between this and my last admission. Social media, alone, clearly isn’t enough. I’ll go over that, and other things, in a planning meeting scheduled for tomorrow afternoon, where I should be allowed back home for a week before being discharged from the hospital and removed off the section.
As for the future, in productive terms, there’s a project I’ve been working on for quite some time, now. I’ve now decided to target it at a general audience, rather than a mental health one as I initially planned, but I’m also thinking of postponing it to set up some sort of drop-in centre, as current offerings just aren’t cutting it, something needs to be done and the people I’ve met on my travels need something that currently isn’t being offered to them.
Rough guess: between 2-5% of people writing about madness in the media and online know what they’re talking about. I don’t include myself in that figure, because I’m still developing my thinking and have quite a bit more to learn about the field, but I’m fast getting there. The thing is, if it’s only 2%, how come?
What with the fact that psychiatry is heavily about engineering conformity to norms along with what I wrote last time about the copycat element of ‘self-harming’ not to mention the placebo effect involved in anti-depressants’ successes, I can’t help but link in the success of orthodox psychiatry’s powerful position with studies pointing to poorly considered conformity to authority and status.
Indeed, the success of neo-Kraepelin psychiatry’s smoke and mirrors can be equated with the way the toothpaste brands used to sell us their products on TV, with an actor dressed in a lab suit using pseudo-scientific phrases about whiter than white. What with bio-reductionist psychiatry flying in the face of science, along with the disempowered helplessness of people persuaded by the constructed pathologizing of much ‘normal’ behaviour, not to mention more transgressive thoughts and acts, I have to wonder whether psychiatry’s success in pulling the wool over most people’s eyes is down to little more than disempowerment by misinformation and conformity to what’s seen as a higher order.
It’s easy to stereotype dissenters when you’re living within the confines of traditional psychiatry. They must be scientologists, they’re in denial, they’re dinosaurs compared with our modernity, and so on. But, because I’ve been on both sides, now, it should be easier to see the terrain of this debate in better ways. Going on my own experiences (and having transformed them), then, I’ve often rebelled against the system only to find myself, once medicated, at the disempowering extreme of complete conformity to the norms and values of the system and my locale – both fairly reactionary and conservative – which I’m not ordinarily instep with philosophically.
In your conformity, though, you also face abandoning any argument that risks true analysis and clarity of the true state of affairs by putting such questioning and doubt down to illness in the face of what can be the overwhelming opinion of those around you, especially on mental health wards, not to mention online, in the media and, well, in society in general. You fail to even begin to realise that there are many ways of perceiving and acting around popular conceptions of causal factors and mental states, pathologized and decontextualised or otherwise. Sometimes, in desperation and the absence of any understanding of the possibility of better alternatives, you may want to believe in something – anything – and traditional psychiatry increasingly fits the bill, backed by limited perceptions and blatant falsehoods almost everywhere you look.
You maintain what many in the system have long experience of – inadequate reasoning, poor problem-solving skills and other common features of problematic relationships – to reject good arguments and laud the bad, especially when these come in the form of the sales techniques of toothpaste manufacturers. You sacrifice empowerment over even information by surrendering your mind and senses to the wit of people who don’t tell you the truth about iatrogenic effects, causal factors, how psychiatry really conducts itself across the board from research to treatment, diagnostic irregularities, and so on, but instead give an air of authority and prestige in making many declarations about things of which there’s no certainty on the one hand and make-believe on the other.
This isn’t to say that people who advocate neo-Kraepelin psychiatry are bad people. I’ve yet to meet anyone in the system who, at some stage, I didn’t think went into the service of people to help them. But the fact that their work is based on a belief system that flies in the face of reliable science means that what you’ll often find – in the rare moments when there is the chance of effective debate – is the very type of reasoning errors and bogus stunts that can look so reasonable to those who often know little better because of their past exposure to similar ways of arguing: for example, shooting the messenger, giving incomplete evidence, not engaging with arguments when you don’t have the evidence so you don’t have to admit it, ‘Crucible’ logic and the prestige suggestion so heavily involved in also selling toothpaste.
That, by my very rough estimate, merely 2% of people in the media and online actually know what they’re talking about when they discuss madness, could say many things to many people. To me it isn’t a sign of an open and shut case according to popular opinion (though I could easily become derogatory in arguing that). Instead, it says that there’s a societal problem around norms, prestige and empowerment (not to mention professional, financial and political interests) which needs an overhaul in radical and creative ways.
Earlier today, I read a tweet by a prominent psychiatrist apparently debunking a theory about madness. He was wrong in fact and dubious in his casual populism. The temptation was to engage him. I didn’t bother, partly because of the reasons outlined in this post, but also partly because, despite everything, I didn’t want to just in case I was had, as I also buy toothpaste based on the dubious claims of actors in lab suits.