Monday, 8 October 2012

how about maternalism rather than paternalism psychiatrically speaking?

A thought came to me this morning, when driving in to the garage to get my car fixed.  That maybe a maternalistic psychiatric system would be better than the paternalistic one we've had for so long?  Of course I also think that no system at all would be best but I've got to be realistic, living in a world full of systems and institutions, with mostly men at the top.  And want to come up with a better solution than the one we've got.

If women were in charge then it could mean a reduction in force and compulsory treatment.  Like the matrons of old in the general hospitals they might be able to bring some balance to a system that is unbalanced.  Keeping order without having to resort to grabbing and jagging.  Arranging for a wide variety of resources for patients in distress.  Psychological and occupational therapies.  Peer support and befrienders.  Wards with a homely disposition and yet not too comfortable that people don't want to leave.  And get back on with their lives.

I think that maybe the good asylums of old were like this, communities within a system that had a family life all of their own.  Therapeutic communities like the moral treatment that emerged in the 18th century during the enlightenment, in England led by the quaker William Tuke.  Scotland seems to have had a different foundation, more one of moral management with William AF Browne a leading psychiatrist in the 19th century, who in 1838 became the superintendent of the Crichton Royal Hospital, Dumfries.  And a focus on 'mental disorders' linked to brain chemistry while also critical of compulsion in psychiatric treatment.

"There is in this community no compulsion, no chains, no corporal chastisement, simply because these are proved to be less effectual means of carrying any point than persuasion, emulation, and the desire of earning gratification... such is a faithful picture of what may be seen in many institutions, and of what might be seen in all, were asylums conducted as they ought to be."

An interesting mix of comfy paternalism with an undercurrent of the biomedical model.  Which gave way to eventually overcrowded asylums, being places where everybody and anybody could end up.  And then to a campaign of de-institutionalisation or care in the community with the continuing coercion and control.  

Prof Thomas Szasz in 'The Case Against Psychiatric Coercion' writes about the "state sanctioned power" possessed by the psychiatrist (p486) and concludes with:

"As Orwell’s (1949) nightmarish vision of Nineteen Eighty-Four nears its climax, O’Brien explains the functional anatomy of power to Winston:

'No one seizes power with the intention of relinquishing it. Power is not a means; it is an end. One does not establish a dictatorship in order to safeguard a revolution; one makes the revolution in order to establish the dictatorship. The object of persecution is persecution. The object of torture is torture. The object of power is power. Now do you begin to understand me?'(266)

The empire of psychiatric power is more than three hundred years old and grows daily more all-encompassing. But we have not yet begun to acknowledge its existence, much less to understand its role in our society."

I mentioned my idea of a maternalistic psychiatry system today in an Email to an American male colleague and he wasn't in agreement with me.  I immediately thought to myself that he would say that, being a man.  And also because he and I, up to this point in our long distance relationship, haven't agreed on much if anything.  Our dialogue is a challenge but hey anything that isn't boring is always worth working at, in my opinion.  And I do like a challenge, being an activist and campaigner for psychiatric system transformation, and a mother.

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