Middle Class Blues

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.

A Realist’s Approach to Mental Health Stigma

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.

Crash & Recovery: 2016 Edition

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.

Madness, Toothpaste and the Two-Percent Problem

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.

Is there anybody out there?

Apparently, I’m in the best shape I’ve been in during all my involvement with psychiatric services. This stint in hospital lasted five and a half weeks. It could have been two. My decline was rapid, but so was the turnaround and, because problematic ways of thinking and behaving didn’t have a chance to bed in, normality’s returned and the work needed to get there was minimal. As a consequence, too (thinking long-term), I’m starting to pick up the pieces from a better position and that bodes well for the times ahead.

But this goes against the trends. By now, I should be a cabbage and it’s strange to think of how mad I’ve been in the past. Re-entry to normality’s not been an easy ride, but then the way psychiatric services blasted away my mind for over a decade was hardly a walk in the park. Now, though, I should in theory be able to come off meds completely, but it looks like I’m physically dependent on at least a small dose of them, which is a problem – you’re never told the full story about side-effects and most people who should know haven’t a clue – but one I think I’m prepared to live with. All-in-all, I think I’m philosophically and psychologically where I would have been had I never entered the psychiatric system at all.  At last, I’m grounded in a reality that’s both comprehensive and coherent.  My world and my place in it make sense, so I can take things from there and actually get more enjoyment from life.

This time it’d been two years since I’d been hospitalised, a time during which I increasingly focused on ideas I’d had before psychiatry had ‘persuaded’ me against them – most notably, the importance of context in our lives. Psychiatry, as I’ve written before, makes a good show of considering context, but it can’t help betraying its true philosophy in singling out the individual for ‘treatment’. There is no such thing as society, sort of thing, as even the left ultimately champions decontextualisation when talking about ‘mental health’ with just about every bogus and ill-informed stunt in the book.

I’d spent a long time thinking about my experiences in the system and now and again views buried in the back of my mind would emerge and chime with the sociological approach I’d once had. But it was a gradual process of picking apart my life from a number of angles – sociological, psychological, economic, historical, cultural, etc. – and informing this further with research which grounded me in a better sense of the world as it is, my place in it, and how to manage the relationship between the two – not how psychiatry had led me to believe in how things were and should be.

Psychiatry stigmatises while persuading its advocates that the public at large are the great stigmatisers. According to psychiatry, the ‘mentally ill’ are chemically or genetically deficient – a set of theories with no scientific basis whatsoever, which are put forward and adopted as fact throughout the system for all sorts of bizarre reasons. Tragically misguided campaigns formed on their basis spring up all over the place with campaigners failing to grasp why their attempts are doomed to failure (during this last spell in hospital I even had to politely tell a psychiatric nurse this as he reeled off a list of theories about ‘chemical imbalances’ while I told him that there was nothing whatsoever in the field of science to substantiate his beliefs. He wouldn’t have believed me). Indeed, so wedded are campaigners to the false assumptions of psychiatry that the wider public are done a great disservice in being singled out for doing essentially what the campaigners are doing themselves and often to themselves. You can’t win. But then, no-one can, faced with the hook and crook power grab psychiatry’s historically pulled off that blinkers so many people to the true state of affairs.

I know all this sounds as if I’m bitterly anti-psychiatry and ranting about a system out of mere dissatisfaction but a bitter-sweet moment came when I realised that, although all my thinking wasn’t original and I wasn’t some sort of pioneer – there’s plenty of people who’ve reached similar conclusions about the ‘system’ – at least I wasn’t alone.

Moreover, I’m not anti-psychiatry at all. As I see it there are three schools of thought in this area: anti-psychiatry, critical-psychiatry and pro-psychiatry. I fall into the middle category, seeing psychiatry as needing urgent and thorough reform, if not a complete overhaul, but still seeing it as an important option in assisting people at the extremes of thought and behaviour who wish or need it, so long as that’s accompanied by an understanding of what people’s full options are, aside from how we’ve been culturally conditioned to think.

The pity is that the three schools of thought don’t seem to interact and learn from one another. Learning of them and their approaches has opened up options to me that I hadn’t been made aware of by a system supposedly acting in my best interests. Psychiatry’s a powerful system and it seems highly unwilling to risk relinquishing its power – personal attacks on critics are only the tip of the iceberg of how badly it reacts to its philosophy being questioned, something that should ring alarm bells for even it’s most blinkered advocates.

It doesn’t and yet psychiatry’s a very broken system. Again, I’m not alone in observing this, but what came as a surprise to me during this spell in hospital was that many of the people working in that very system also see a need for thorough reform. In researching the subject, I’d come across evidence that there are many senior psychiatrists who are calling for change, but I still saw things stereotypically in an ‘us versus them’ scenario. So I was taken aback by how passionate many people working in the system were in their calls for change.

Does the wider public or those ignorant enough to unwittingly campaign for more stigma believing they’re challenging it have any awareness of all this? It seems not, as I was once one of those people and even wrote a dissertation partly dealing with challenging stigma, without once questioning the basic assumptions of psychiatry or that my approach would encourage stigmatising processes as much as anything else. Just as it’s frustrating to now watch most campaigners unwittingly chase their own tail, it’s also a great tragedy that there are people throughout services working so hard and to such a high standard in the face of a deeply damaged system with little realistic hope for the kind of substantial and effective reform in the near future that would see their efforts as rewarded as they deserve them to be.

For me, personally, these ideas and my experiences of the fallibility of the system, along with alternative approaches, have ultimately proven more productive than passively accepting the singular approach of one failing discipline. We live in a context that influences us, where we need to reform ourselves but also the world around us, while adapting to things as they are. Not only are there people who believe that I’m in better shape than I have been during my time in psychiatric services, but I feel better than I have during all that time, also, however difficult it was to emerge from the mire. It’s difficult to put myself in the mindset I experienced for so long, I went in so deep and at times didn’t look like coming out. But I did and it’s given me the conviction that the same can be achieved for anyone.

As for services themselves, even within the pro-psychiatry model, they’ve declined shockingly even during my 15 year time with it. Nursing staff consumed with paperwork didn’t train to be clerical workers, but that’s what most have become, with implications for those in their charge. The stigmatising social effects of diagnoses remain, but without the knowledge that they’re only theoretical and highly disputed. Social services on offer have diminished so people have even fewer places to go for therapy or even to just spend time interacting with others. Therapies that can help aren’t widely on offer while other potentially successful approaches aren’t usually considered at all. Spaces even on confined wards have become fewer, squeezing people at different levels together – with the inevitable personality clashes – as they’re ‘needed’ for yet more office space, as decreed by (as far as I can tell) centralised senior managers who understand little about the needs of people in the system.

I hear calls for improvements in ‘mental health’ care from all sorts of quarters, but they’re usually misguided and betray a shocking level of ignorance when you consider the positions many of these people hold in society. Yes, services need to be improved, but in the right way, not just more of the same because the same doesn’t work – currently, psychiatry is flawed from top to bottom, its assumptions are wrong and its practises are ineffective. Moreover, the ideas needed are relevant for everyone, not just those who enter psychiatric services, with the promise of improvements on a societal level on offer, if people would just look.

That the upper echelons of psychiatry are unlikely to risk their unjust power being challenged by calls for thorough reform doesn’t bode well, but my approach is working while theirs didn’t, never really has and never really will. That there are people with a good understanding of the issues is helpful, but that they’re still being sidelined isn’t. It’s time the bulk of campaigners did their homework, but maybe part of the problem is that, if they were going to, they would have done so by now. That said, I remain optimistic, but only in the longer-term.