Saturday, 26 January 2013

new blog

Started new blog today to include all writing at

locked doors at community mental health drop-ins

Friday 25 January 2013

I received a letter today from, in response to a complaint I'd made about a service funded by statutory agencies. The service was a sort of drop-in but with a locked door. I say 'sort of' for this mental health service that is 'in the community', is run by a voluntary sector housing organisation but does not have an open door policy.

Like a day hospital but locked door, from the outside. You can get out once you're in but can't get in if you're out. On the day I visited last year, it was in response to a recommendation from the local carers' project who said I should drop by this facility and I might buy some lunch. I thought "good idea" so dropped by, rang the bell, they let me in and I bought a roll and a drink.

Nothing was said to me at this point that I shouldn't be there. I've been there before and had lunch. So I sat down with my roll and drink, and was immediately joined by one the workers. Who asked me questions and didn't answer any of mine. It was a one-sided conversation, a bit like when I was a patient in a psychiatric ward. Very odd. Then when I finished my roll and there were no other service users about the worker said that I shouldn't have come in, a person had to be referred to attend.

And so began a most uncomfortable exchange. Another patient/service user came through the room and spoke to me, saying I could maybe come in another day when it was quieter. I said no I couldn't because I had to be referred and then suddenly 3 other workers appeared behind the food counter, joining in the conversation. The service user disappeared. Four against one, me. It felt like bullying and intimidation. I tried to speak civilly but the man in charge turned his back on me as I spoke, me sitting, he standing. I was dismissed.

I let myself out the locked door and fled to the safety of my car, thankful I wasn't a service user that had to be referred to this facility 'in the community'. Would anyone want to attend voluntarily? Maybe they would if they had the choice. I've been there before and it was quite enjoyable. They have different activities, music groups, football, snooker, other stuff.  But this time there were different staff on duty. 

My complaint to the organisation that runs the locked door drop-in wasn't upheld. They say I wasn't made to feel unwelcome even though I say I was made to feel unwelcome, and under pressure. The social work Service Manager, with the support of health services, agree with the organisation, that my views are "individual" and obviously not representative of the other folk who have to attend this locked facility.  Wonder if there is a choice?  Of anything else?

It's like having a choice of a tin of beans or a tin of spaghetti. I would rather have a fish supper. So there you have it. Only positive feedback welcome at these mental health facilities. If you have any complaints well keep them to yourself for you're only going to get a letter of complaint back, saying that you are the odd one out and everyone else is happy.

I don't believe it!

Friday, 25 January 2013

taking the psych drugs when detained in 2002 after going in voluntarily

A short post about my acute inpatient experience in Lomond Ward, Stratheden Hospital, in 2002, following a menopausal psychosis at age 50.  

I had been working full-time as a manager in the voluntary sector, in my home town of Perth.  It was a temporary post, and an enjoyable one where I did a variety of jobs, including independent advocacy for people with disabilities and in the psychiatric system.  There were challenges in the post, including a bullying situation that had been going on for some years in the workplace and resulted in workers going to the union and getting the main bully dismissed.

There were also challenges to do with a family member who became mentally unwell and was hospitalised.  But the main trigger was the hormonal changes occurring in my body as I transitioned between childbearing years into older age.  This caused me to move into a sensitive phase, described as 'psychosis' by psychiatry, where everything sensory became acute.  Visuals, hearing, smell, thoughts.

My sons were concerned because I wasn't 'myself' and took me in their car up to Lomond Ward which is just up the road.  I went in of my own volition.  I knew I wasn't well.  Took a look round the ward and women's dormitory, overlooked by male patients in single rooms.  I decided to leave.  Whereupon I was told that I was on a 72 hour detention and had to take the 'medication'.  Previous inpatient stays meant I knew that if I didn't swallow the drugs then I would be forced to take them.  So I swallowed them under compulsion.

I didn't want to take the drugs, the anti-psychotics make me clinically depressed, and so they did.  However I wasn't 'psychotic' so was released after about a week, depressed and flat, and it took me a year or two to summon up the strength and resilience to take charge of my own mental health, taper the drugs, resist the labels and recover.


Thursday, 24 January 2013

management and leadership in psychiatric situations

Is it me?  Should I not be expecting good management and leadership in psychiatric situations?  As in it's only for business settings and the real world of normal people.  Where there is accountability, evaluation and customer feedback.  Where people vote with their feet and go somewhere else for the service.

But maybe this is the issue after all.  For in psychiatry we don't have the choice of setting or doctor or treatment.  You have to take what you're given, swallow the drugs if detained or be forcibly injected if non-compliant.  It's the name of the game in terms of crisis management psychiatrically speaking.  Unless you have money to pay for The Priory or suchlike.

Even after 40yrs of engagement with the psychiatric system it's interesting that there are surprises to be found.  For why should psychiatric system management and clinical decision making be any different to any other setting?  It should make sense, both financially and personnel wise.  So that people are consulted and the best use of money is made.  As a good manager I really don't like having to witness stuff like this.

Scotland is where I was born and brought up, and have lived here for 60yrs, so think that I can speak with some authority on its culture.  My early years up to when I got married at 19 were spent in Perth.  Then a few years in Aberdeen at university.  Living most of the next 15yrs in the Lanark area with brief spells in the Crieff and Arbroath areas.  And now in the Cupar area since 1990.  A mixture of city, town, village and farm settings.  

Working as a shepherdess, youth worker, lecturer, advocate, shop manager, volunteer co-ordinator.  Driving tractors, milking cows, selling sheep at market.  Running my own business, warden and cook for elderly, setting up church groups, writing news articles, managing websites.  Developing numerous community projects in different areas, working in schools, colleges and universities.  Above all being a mother and grandmother.

What has got clearer over the years is the different cultures in the Scottish areas, even if only 20mls or so apart.  I'm thinking it goes back to our heritage and history, of clans and settlers.  And a weaving of people through the generations, a rich tapestry which makes life interesting if challenging but never dull.  For me the latter is the most important as I really don't like being bored.  Never did.

John Knox House on the Royal Mile Edinburgh
Therefore in psychiatric system management the recognition of Scottish culture has to be considered.  It makes no sense to think only of logistics and saving money.  There are people involved, the patients, staff and family/carers.  Cultural considerations of language, background, upbringing, history and meaning.  The reasons for people choosing to live and work in a certain area.  And if it's working well then why fiddle with it?

Trying to fit a square peg in a round hole isn't a good idea.  No matter if the high heid yins think it to be so.  For Scotland is a grassroots country and we're not keen on folk telling us what to do.  Think of John Knox and the covenanters.  Or the present day plans for political independence.  We really don't want to be following orders that don't make sense.  It stands to reason.

Wednesday, 23 January 2013

cracking open a nut

You know how sometimes it can be very difficult to crack open a nut?  The hard ones require the use of a nutcracker.  To force open the shell and get into it.  Well I think this is what it can sometimes be like in the world of mental health and psychiatry.  Where the nuts are difficult to reach and it requires a nutcracker and a certain amount of skill and lived experience.  Of cracking nuts.

In the real world of nuts eg hazlenut, walnut, peanut, we know by the shell what sort of nut is inside.  But in the mental health world we're not always aware of the nut until we start using the nutcracker.  When we can be in for a big surprise, if not prepared.  Pressure applied produces resistance until we find the crack in the shell.

Except for peanuts I always buy my nuts deshelled from the supermarket, in plastic bags.  It's much easier than trying to work a nutcracker.  For I'm not an expert in it.  However the mental health world is a different matter.  I've got over 40yrs of working with the metaphorical 'nuts', and I'm not meaning the mad people.  

Who aren't nuts at all, to my mind.  It's the other 'nuts', the ones who think they are secure within their shells and safe from the 'nutcrackers'.  And we don't need a sledgehammer to crack a nut.  The real nuts know the score, that they are always at risk from the nutcrackers.  For the shells are only a temporary protection, whatever type of nut you are.

Monday, 21 January 2013

psychiatric drugs cause psychosis, let's find alternatives for human distress

The problem with pumping a person full of psychiatric drugs is that it causes psychosis.  I can say this from recent experience.  Not personal.  As if the aim is to lessen a person's emotional and mental distress by taking them into a psychosis.  From which they will have to find their own way out.  It can't be ideal.

When I had psychoses, on three different occasions, the main trigger was hormonal, after childbirth and at the menopause.  Although there were other stressors the tipping point was to do with being a woman.  However the anti-psychotics (chlorpromazine and risperidone) quickly brought me out of the psychosis into a depression.  Much worse for me.  For I'd rather be in cloud cuckoo land than down in the depths.

It's way beyond time that we came up with alternative ways of working with people in mental distress, crisis and psychoses.  The sledgehammer effect can't be the best, can it?  Or is it more about punishing the sensitive among us for feeling things more than the normal folk?  I can't get my head around this.  Why our distress is seen as weakness or biological or pathological.  

It's only human to feel sad or distressed or elated or pressured.  A normal reaction to a mad world and crazy things happening outwith our control.  But don't compound it by drugging us senseless or locking us up with other mad people, many of them paid to be there.  It's not a solution and costs more in the long term.  Financially and emotionally.  

Sunday, 20 January 2013

mental health tribunal madness

It was my third time, on Friday, of experiencing a Mental Health Tribunal, and it was the worst one yet.  The other two were in Fife and this one not.  The others were weighted against the patient and carer .  Whereas this one was like going through the motions and getting it over with as quick as possible.  A foregone conclusion as obviously a patient in a locked ward should be staying there.

I shouldn't be surprised and was prepared for some resistance, to having a voice and being heard.  But this so-called safeguard took the biscuit.  The occasion was recorded as all MH Tribunals are but the only folk taking/using notes apart from the panel were me and the solicitor.  The psychiatrist and MHO talked off the top of their heads and the advocate said nothing at all. 

I was there as a mother and carer, also meant to be named person.  But in the 24hrs preceding this it had been scuppered due to the MHO arranging for another person to be in this role.  Hence her surprise at me turning up I suppose (what are you doing here?).  As if being a carer and mother meant zilch.  So much for the mental health act principle 7 of Respect for Carers.  At the bottom of the pile as usual.

Ironically it was me who had Emailed the MH Tribunal on 9 January to let them know of my son's wanting to appeal his detention.  I also arranged a solicitor for him.  And yet by the tribunal on 18 January I had received no paperwork or intimation about it.  I had a phone call from the MHO on the 17 January telling me about it and that my son didn't want me to attend.  The same day I had a phone message from my son asking me to attend.  I visited my son in the ward that night with his younger brother, we had a good chat.

Now who would you believe?  I'd only met the MHO once, wasn't impressed.  I've known my son for 34yrs and think he's a great lad.  We get on well even when agreeing to differ.  Social workers don't know anything about me or mine.  They're paid to do a job and should be doing it professionally.  Not interfering or having personal opinions, thinking that they are somehow now 'family'.  They're not and never will be.  It's a job, nothing more, and they get well paid for it.

Well on the day my son had his say, through the solicitor, and I had mine.  I also had to correct both the psychiatrist and the MHO who didn't have their facts right.  The psychiatrist, because he was only filling in temporarily on the ward due to the other locum consultant having left the week before, suddenly.  Another locum psychiatrist is flying in from Ireland to take his place.  The locum duty doctor was also leaving that day.  

Locum doctors on locked psych wards are not a good idea, in my opinion.  Especially two of them at the same time, one who didn't appear to know the mental health act, although a nice person.  Optimisation of services shouldn't impact negatively on staff and patients.  What use the mental health act safeguards if the professionals don't know about them or know how they work?  This question is addressed to the Mental Welfare Commission, if they are listening.

Regardless of the tribunal being ineffective as a safeguard, I am to a certain extent OK about my son's care, because I have got to know the nurses on the ward.  And my son says he's happy, most of the time anyway.  Although he has mental distress because of life's circumstances.  But this doesn't excuse the safeguards not being effective.  They need to be accessible, appropriate and professional.  Otherwise it makes a nonsense of the mental health act and the protection of patient and carer rights.  Some might say like a chocolate teapot.

Saturday, 19 January 2013

I'm fed up with the blaming of mothers

Here's another bugbear of mine, the tendency to blame mothers when something goes wrong in life.  As in it's the fault of the 'caregivers'.  I've been reading this book 'Psychosis, Trauma and Dissociation - emerging perspectives on severe psychopathology', having borrowed it from the university library because the word 'psychopathology' annoyed me.

And I've started to look through the articles, it's very irritating, the medicalising of life's problems and also trying to pin it on the parents.  Why don't they just accept that life can be tough for some of us, even all of us?  We don't know what's round a corner and if we did, hey, there might be more of us running off cliffs.

Well I'm going to resist this labelling and blaming for it's just not good enough.  And it's not the truth of it anyway.  Equal rights for women doesn't mean we shouldn't have our place.  Respect still comes into it and recognition of the fact that without us there wouldn't be society.  And yet we have the continual battle of maternalism versus paternalism, demonstrated acutely in the workings of the psychiatric system.   

Where I for one keep coming up against officials or officious power holders who think they know more about my family than I do.  No they don't.  The cheek of it.  It's like going through a ringer and being hung out to dry.  Which means we mothers have to be shape shifters as required.  To keep one step ahead of the misguided patriarchs who even sometimes come in female form.  

The thing is to try and enjoy it if possible because in the short term it's not going to change.  Think of it as a game, like snakes and ladders, where the journey or process is as important as the outcome.  And as a colleague often says to me, don't let the b****** grind you down.

Friday, 18 January 2013

it's time for clinical psychology to come down off the fence

I do get fed up with psychological therapies that sit on the fence.  With patients and psychiatry, betwixt and between, for fear of losing position or power.  Echoing the mental illness mantra and justifying chemical imbalance.  Or dysfunctional labels and black sheeping tactics, keeping 'bio' models in place.

"Don't do it" I say.  It's not helpful or fair or relevant or true.  We can't help it if we feel the pain of life's struggles, weighted down by what others might think is not hard.  If it's tough for us then it's tough for us.  That has to be enough for a compassionate stance.  And solidarity with users and survivors and carers.

Get alongside like the psychotherapists and psychoanalysts do.  Feel our pain and get mad with us.  Let's bring about change to the psychiatric paradigm.  Not a quick fix technique but a relationship focus and level paths for all. 

mental health officers behaving badly

Today I was attending a Mental Health Tribunal, as a carer and mother, to advocate and ensure that accuracy of facts was maintained.  I just got in the door of the locked psychiatric ward when the MHO (mental health officer) saw me and said "What are you doing here?".  In full hearing of a solicitor, nurses, advocate, patients, tribunal clerk and others.  She soon found out.

Her remark was both inappropriate and unprofessional.  And confirmed to me that she was not up to the job.  Someone who is a qualified social worker and has received special training to be an MHO should not be blurting out their thoughts like this.  Of course I responded that I had been invited by my son to attend.  She looked surprised.

I'm not surprised at this behaviour after 40yrs experience of the psychiatric system.  But I am disappointed that yet again the mental health act safeguards are not working.  That social work is not supporting carers and appears to be colluding with the system, in this instance to separate a mother from her son, albeit a grown up son of 34 years.  It won't happen, not sure why they think it would.

Who are the mad ones?  The question has to be asked.  Social work departments that endeavour to separate parents from children, taking every opportunity to blame the caregivers rather than work with them to support.  Or folk like me who have to pick up the pieces after traumatic treatment.  

Ignorance is no excuse.

Wednesday, 16 January 2013

severe and enduring mental illness becomes psychological interventions in psychosis

Heard today, in an FOI response, that clinical psychology in Fife has renamed their service SEMI, severe and enduring mental illness, to PiP, Psychological Interventions in Psychosis.  Which is a step in the right direction, in terms of de-stigmatising mental distress and the problems of living.

However I'm now looking for the rest of clinical practice in Fife's psychiatric and mental health services to also bin the label.  It makes sense to give everyone the same opportunities for recovery and restoration, of a full and enjoyable life, as much as possible.  Where psychosis doesn't mean lifelong mental illness but a journey or transition, from one place to another.

The movement to investigate or deconstruct the schizophrenia label is to my mind another sensible action.  Too many of us were given these labels indelibly and sidelined or sidetracked.  Into a less than equal service or chance of getting back on with stuff.  We might have wanted a bit of escape but, for me, not a lifetime of it.  Just a respite period and time to take breath in a busy life.  

I'm looking forward to our 'Making Sense of Psychosis' conference in May at the Dundee University Fife campus in Kirkcaldy.  Colleagues from the mental health nursing programme are working with me on this.  It's great to be in partnership and to share resources.  And shows that you can speak out and challenge but still be accepted.  So go for it!

[update: conference didn't happen due to slow bookings]

mental welfare commission phone lines

[This is going to be the first of a series of critical posts about the Mental Welfare Commission for Scotland as I look to desconstruct what they appear to say they are doing and reconstruct it to say what they are actually doing.  Of course this is my opinion but it is also based on what other people have been saying to me over the last few years since I got involved in the mental health world.  Which is that the commission is not primarily about protecting the rights of vulnerable people.  Some folk describe it as a watchdog with no teeth.]

I am compelled to write first about the commission's phone lines, as one who has used them frequently over the last two years or more.  Especially when I have had a family member in a locked psychiatric ward, detained under the mental health act.  And needed the help of the commission to both listen to my concerns and protect the rights of my kin.

Their phone line isn't really there to help you so don't expect a relationship type of communication.  It's not about this.  Although I thought it was, being eternally optimistic in my outlook.  Or maybe I'm just ignorant.  I thought that human beings would be interested and even concerned about other human beings in pain.  But no.  In fact if you show any distress or emotion the phone is likely to be put down on you.

It doesn't have to be rudeness or aggression or cheek or slander.  It could just be assertiveness or questioning or anguish or puzzlement.  They don't respond to this or anything said with feeling.  And the out of hours phone line only has a 2 minute recording time so this will add to your stress.  I know this because in February 2012 I used it one Saturday evening after being bullied and intimidated by 5 psychiatric nurses in a locked ward.  

By the time I'd phoned back every 2 minutes for the 5th time, well I was physically and mentally exhausted.  And had to go visit a friend for compassion, a listening ear and a cup of tea.  I used this phone message line to tell my story, of being abused, but it didn't make me feel better.   Not sure if they listen to it all anyway, I've got no proof of that.  Who knows?  And by the time Monday came I'd got it sorted out anyway, having to contact other folk to do so. 

[Try Breathing Space for information out of hours or a listening ear.  I found them helpful in February 2012 for signposting on a Sunday.  They are open all weekend from 6pm on the Friday to 6am on the Monday.]

I had many other issues with the commission back in February and March of 2012.  And so got to know some of the staff personally.  We sat next to each other at national mental health events and meetings.  I thought that this meant we were building up a relationship.  Wrong.  For they are not about relationship.  It's taken a while for the penny to drop.  For I'm best at being in relationships with people.  It's what I do and have always done as a community development worker.

The last straw was the phone getting put down on me last week by an unknown man at the commission who I suspect was the same man who put the phone down on me in February last year.  Which I complained about at the time.   Expecting something to be done about it.  Silly me.  My complaints won't be listened to for I'm only a mother and a carer not a government person or anyone who matters.  So the phone line folk, or men, at the commission can put the phone down on me and not be accountable.

Great job if you can get it.  Mothers and grandmothers distressed on the phone and you don't have to be bothered listening to it.  Although I suppose if no-one listens to your pain, then you get depressed, well you may be forced to get ECT/shock treatment.  Or brain surgery.

Sunday, 13 January 2013

mental welfare commission - talk to the hand

I've been raising a number of issues to do with the management within a locked psychiatric ward.  The absence of up-to-date carer information (it was over 18 months old), no evidence of Mental Welfare Commission leaflets, booklets or anything to do with the mental health act.  No advance statement or named person forms.  And so on.

And the independent advocacy available seemed either unresponsive or unprofessional, whichever way you look at it.  It was my first time visiting this ward and I did expect there to be suitable access to information, the mental health act safeguards in place and psychiatrists in the know.  Especially since I'd been told that this Scottish area had good crisis services, by people in government.

I have been instructed to send any concerns to, rather than any named people at the commission.  And I know the main folk, having engaged with them at various national events over the last few years in my voluntary work as a survivor activist and carer representative.  Now it feels like "talk to the hand".

I'm hoping my Emailed concerns reach the right person although I have my doubts about this, due to a receptionist at the MWC recently putting the phone down on me, without due cause in my opinion.  But hey, what rights do I have?  I'm only a writer, activist and campaigner in mental health matters without portfolio.  

[to add, the local carers project responded quickly to my highlighting of the outdated carer info and got it sorted]

Thursday, 10 January 2013

"created by service users for service users" I don't believe it

Facebook post just written about a visit yesterday to a psychiatric institution:

"in this locked psychiatric ward there were ward information leaflets that said "created for service users by service users". I don't believe it. A few pages of details written for people with either a low IQ, intellectually incapacitated or dozed up to the max on psychiatric drugs. The latter probably. For it's drugs or nothing much else.

It says "we recommend you shower every day whilst you
are in the ward" and the reasons why. I kid you not. Also to "tidy up after yourself". Unbelievable really. I thought the nurses and cleaners and others were paid to do that.

And my recommendation would be to not wash if you want to, leave everything lying around, spill your coffee on the work surface, it can't be helped anyway with the side effects shaking, and do your utmost to rebel in whatever way suits you. You're keeping them all in a job.

Make it difficult for the highest paid ones and try to rewrite your notes if at all possible. You might do this by pretending that you agree with their labels, diagnoses and every word that comes out of their mouths. I couldn't do it for long. And I'm not very good at keeping a straight face. Although the psych drugs helped with this.

This leaflet also said you can buy toiletries or "feminine hygiene products" at the hospital shop. Well no you can't if you're not allowed out. And how can male nurses buy these things for you? At this hospital they only sell sugar-free drinks. For good health. It's laughable for meanwhile they're pumping folk full of psychiatric drugs that cause disabling effects and alter your brain chemicals.

Tuesday, 8 January 2013

women and psychiatric treatment, the madness of it

Murray Royal Hospital buildings
I've been bothered about the treatment of women in the psychiatric system since 1970 and seeing my mother in Murray Royal Hospital, Perth, in a locked ward.  And I knew before this that something was far wrong with psychiatry because my mother never wanted to go in to the mental hospital when she was mentally distressed or having a nervous breakdown.

I visited her, aged 17, for the first time going up to what used to be the Murray Royal Lunatic Asylum, over the bridge and up the hill, situated in a rural setting although not far from the town of Perth.  I remember the visits as being distressing, for both of us, I often came away crying.  She didn't want to be in there although she wasn't well and couldn't be at home.  I didn't want her to be in there but there was no other option.  An impossible situation.

She was in the Kinnoull Ward, all females with a variety of reasons for being there.  One woman had killed her child, this I remember because my mother kept going on about it and it stressed her out, to be in the same ward as this other woman.  There was a lot of pain in this ward and the treatment consisted of psychiatric drugs, ECT and locking the women in.  Until they had conformed or calmed down and could be let out again.

The madness of the women alongside the madness of psychiatry.  The former made more sense than the latter.  I remember meeting with psychiatrists, men, who said I had an old head on young shoulders.  It sounded like a compliment but I was sceptical of them and their system.  Thinking I would never darken their doors as a patient.  Not out of choice anyway.  

There has to be a paradigm shift in psychiatric treatment for the sake of the women, in my opinion.  And then everyone else will benefit.  For women are the mothers and grandmothers in society.  The men wouldn't exist without them and us.  The use of force in psychiatry against women is and should be unacceptable.  Forcing women to have ECT or psychiatric drugs isn't the way to go.  Men are you listening?  

Equal rights for women doesn't mean we agree with compulsory treatment or paternalistic decision making.  Women are different from men.  I am one of three sisters but gave birth to three sons, now men.  There's a difference.  Here's one.  I go to the cinema with my youngest son sometimes, not often, because there aren't many films we both could watch together.  He prefers to go with his male friends, I prefer to go on my own.  We both like action movies but I'm not so keen on the shooting and killing, the blood and guts all over the place.  He doesn't mind.  I have to close my eyes at these bits.  

My sons and I have all been through the psychiatric system.  I feel strongly against the use of compulsion, force, psychiatric drugging and the taking away of my decision making abilities.  They're not as bothered as I am about this.  Or they don't seem to be.  It's not a big issue with them, they can get over the restraint, seclusion and forced treatment done to them (although not if it was perpetrated against me or other women in their family).  I think these actions are barbaric and demonstrate system failure.

Now I'm an activist and campaigner, always have been in different settings, a resistance fighter you might say, standing against bullying and intimidation.  But this has very seldom ever been about physical contact or actual fisticuffs.  Although there is always the threat and the possibility when people invade boundaries.  It's happened with me often in psychiatric treatment and once or twice in real life, in 60 years. 

So here's the challenge, as I see it.  How to help women in their madness without using force or compulsion, and in the doing of it to bring about a transformation to the psychiatric system which is long overdue.  I believe that the treatment of women in psychiatry is key to a just society both inside and outside the asylum.

Monday, 7 January 2013

wrong tools for the job

I've often thought of psychiatry as being about tackling a skelf (splinter of wood) in the finger with a sledgehammer.  The wrong tools for the job. 

Mental ill health, stress and breakdown, for me was to do with mind and body, not brain.  So giving me psychiatric drugs that affected my brain chemicals didn't deal with the root cause which was the disruption to my wellbeing, peace of mind and feeling at home in my body.  In fact it added to my stress and caused me depression, lack of confidence and alienation.  To self and others.

I can only speak for myself in this.  Maybe others find the psychiatric drug regime helpful, the controlling measures of benefit, the abdication of personal responsibility a useful procedure.  Although I wanted an escape from pressure and stress, I didn't want another person taking charge, in loco parentis.  And this seems to be the only deal when you enter the gates of psychiatric institutions, the land of make believe.

Of course the biomedical model of mental illness is the reason for it.  They think it's a brain thing and act accordingly.  And so we have brain altering chemicals, shock treatment to the brain and neurosurgery for mental disorder (NMD) or brain surgery for mental illness.  Wrong tools for the job.

I never believed psychiatry and the brain thing, so managed, eventually, to take charge of my own mental health and recover.  Despite the psychiatric labels that still linger in my medical notes.  Indelibly written, subjectively given.  A work of fiction to my mind.  Lacking substance or power.

It helps if you're non-conformist and free thinking, although you won't be popular.  At least not openly.  It means walking your own path, doing your own thing and being prepared to stand firm when necessary.  The sledgehammer can do a bit of damage in its quest to remove the skelf.  Which often works its way out, either by itself or with help from a friend.

I'm looking forward to a new paradigm where mind and body are the focus, when a person is known to be the expert of their experience and the right tools for the job are in the hands of a caring profession.

Sunday, 6 January 2013

strength and resilience, madness and insight

I'd come upon this interesting 2 part interview from 2011 with Robert Whitaker in 'Behavioural Healthcare', on the topic of 'Transforming our thinking about psychiatric medications'.  Interviewers Lori Ashcraft and Bill Anthony.

Part One, July 2011

Part Two, October 2011

The introduction, likening the Wizard of Oz story and Toto pulling back the curtain, to the somehow unmasking of psychiatric drugs, drew me in to the piece.  And I've been thinking on the answer from Bob Whitaker, in Part Two, page 3, to Lori's comment about maybe becoming stronger if she hadn't had to take psychiatric medications for 30yrs:

"I think that is a very important point. We have been conditioned today to think that when you are feeling emotional pain or psychiatric distress, then that may be a symptom of a mental disorder, and you can take this pill to squash that symptom. But there is evidence that if people can struggle through an initial bout of depression or other form of psychiatric distress without going on medication, they can come out stronger on the other side.

But clearly that can be hard and it can be painful, and at least in certain situations, it can be risky to forgo the medications. If a person decides to forgo the medications, then it would be nice if he or she could get other psychosocial support."

The challenge nowadays is to be able to access psychosocial support for mental distress when the first recourse is to pop a pill to make it go away.  For physical pain this can work, pain that is occasional and not to do with major issues, as in paracetamol or ibuprofen for a headache or flu.  The problem with psychiatric pills for mental distress is that the treatment can be worse than the cure.

And for those of us who are find ourselves in an alternative universe, an escape from the trauma or stress, nowadays called psychosis, used to be called nervous breakdown, then it is a harsh bringing back to reality with brain altering chemicals.  Dictated by doctors under the mental health act, otherwise known as compulsory treatment.  Depending on the skill of the practising psychiatric nurse as to whether this is forced or persuaded.

I really don't like the psychiatric drugs so wouldn't want to swallow them if I could help it.  They make me dependent and vulnerable, unlike myself and lacking in decision-making abilities.  And take me considerable inner strength and resilience to get off them.  By taking charge of my own mental health, defying the labels and prognosis, and recovering.

Therefore I think this inner strength and resilience has to be a positive thing, even when psychiatrists and psychiatry don't seem to like it and do everything they can to squash it.  Or that was my experience.  Even yet I get psychiatrists trying to tell me what to do, what to say, what not to say etc.  It's very irritating.  You know who you are.  Even recently I had to tell one that I was 60, not a teenager, and knew what I was doing in my blog writing.

There's something in psychiatry that won't let go of the patient, even when they are getting better and have insight.  Almost like they could be out of a job if all their patients recover.  Yes that's the point of it all, in my opinion.  Getting better, recovering.  Has anyone told the psychiatrists?  That there is a time to let go and let live.  And people can have insight in the midst of their psychotic experience.  Maybe not the same insight as the psychiatrist.  But some would say the psychiatrist has left their insight at the door of the psychiatric hospital, on the way in.

I'm being cheeky and provoking.  It's needed, especially in the topsy turvy world of psychiatry.  Where it's difficult to tell the mad people from the others, except for their badges, uniforms and suits.  Otherwise we just wouldn't know, would we?  I remember a time when the psychiatric nurses weren't in uniform and if I didn't see their badge well I really wasn't sure who was a patient.  It wasn't obvious.  And nowadays the uniformed ones are the maddest, in my opinion.  They must be to do what they do.

I hear from other carers who say that the person they care for doesn't believe they are mentally ill, don't have schizophrenia etc.  I reply that's good, it shows they have insight.  But I'm in the minority because the carers who aren't survivors don't usually have the same opinion as me.  They probably think I'm mad and lack insight too.  We agree to differ.  It's a matter of having been there, done that, wore the tee-shirt sort of a thing.

Until you've been a psychiatric patient, labelled and forcibly drugged then you won't really know what it's like.  It can't be imagined.  Same as having a baby, what that feels like.  Or, for me, what having an alcohol or drug addiction feels like, which I can't imagine.  I've never liked alcohol or been tempted by recreational drugs.  So why would I have an opinion on resisting them if addicted to them?  

But I do have strong opinions about psychiatry and the need for alternative treatments.  Also ways of encouraging inner strength and resilience in children and young people, in adults too.  So that they can be self governing, self aware, self confident, while also being responsible citizens and balanced individuals.  A life worth living, for all of us, including when our mental health is being challenged.

Thursday, 3 January 2013

Making Sense of Psychosis

[Mad in America blog post 3 January 2013] 

I can remember when psychoses used to be called nervous breakdowns and people just disappeared for a while and came back better, or at least more acceptable to society.  This was in the 1950's and 60's of my childhood and youth, when diagnoses were either schizophrenia or manic depression.  Things seemed a lot simpler then.  And what happened behind closed doors stayed there.  Shock treatment and other brain stuff.  They kept asking if you heard voices and even if you said "no" well the label schizophrenic still went in your notes.

We're much more sophisticated these days, with the range of psychiatric drugs, therapies and diagnoses on offer.  Courtesy of DSM5 or ICD10.  Nervous breakdowns have become psychoses and manic depression bipolar.  And there are many more classifications betwixt and between, as professionals attempt to get a handle on the madness that keeps breaking out and through.  While the survivors among us are continuing the rebellion and non-conformity, in the certain knowledge that we are the experts of our own lives.  It stands to reason.

As a survivor, of 3 psychotic episodes and the subsequent psychiatric involvement and incarceration, I am keen to see alternative ways of working with psychosis.  My experiences of the whole weren't positive.  Same can be said about other family members.  For me the psychosis was a coping mechanism at a time of stress caused by trauma (childbirth, menopause).  An escape from reality although still having insight but with more sensitivity to the world around me.  I wasn't angry or sad, however to others I wouldn't have been 'myself'.  No doubt this was interpreted as risky or unpredictable. More than usual.

The challenge, as I see it, is how to help a person come out of, or go through, a psychosis as gently as possible.  Since trauma or stress took me into a psychosis it surely makes sense not to compound the trauma by forcing me out of it.  Adding injury to insult.  The drugs didn't do it for me.  The anti-psychotic depressed me and the anti-depressant depressed me more.  Working against my recovery and taking me further away from myself and the real me.

Although this might have been the purpose of the treatment.  An assumption that the psychosis was an attempt to become a different person.  Which might be the case for some folk.  But not for me.  I was happy with who I was and it was only the situation at the time that caused me to remove myself from reality.  The pain of childbirth and of life changes, the wonder of it all.  Therefore it makes sense for psychiatrists to find out what led to the psychosis, rather than a 'one size fits all' treatment.

Shocking someone out of a psychosis is like telling them to pull themselves together.  The psychiatric drugs are a shock to the system and the brain.  A harsh bringing back to reality that takes no account of why a person went into an altered state of mind, without the use of substances.  After my most recent episode, in 2002, I remember the psychiatrist at an outpatient appointment keeping asking me "are you tearful?".  Well no I wasn't, being on risperidone and venlafaxine I was as flat as a pancake.  And that was the problem. Feeling no emotion for me was very depressing.  I wanted to cry and laugh, it would have been good for me.

I suppose that the psychiatrist was used to other patients being very distressed and needing drugs to keep the feelings at bay.  But he didn't know me as a person when well.  Now he does.  And I often say that people probably prefer me being on psychiatric drugs.  Then I would do as I was told, follow orders, be predictable and tow the line.  Rather than the non-conformist individual who is opinionated and passionate about causes.  Much easier if I could listen to the 'professionals', believe what they said and be nice. Not likely.

Thinking back to my first psychotic episode, in 1978, thirteen weeks after the birth of my second son, when I was living with my in-laws, on their farm.  My mother-in-law was mentally unwell at the time, had taken to her room 24/7, and we were living in the room next door.  A very stressful time and I escaped by going into what the doctors described at that time as a puerperal psychosis.  It had spiritual elements to it, in that I had hallucinations or flights of fancy, depending on how you describe them.  I wasn't sleeping and everything became a bit surreal.

I remember two doctors coming out to the farm to visit me and they seemed friendly if concerned.  The only option was to go voluntarily into the local psychiatric hospital, Hartwoodhill in Lanarkshire.  Leaving my baby and 2yr old son back at home.  It was very difficult.  I'd been breastfeeding so had to be bound to stop the milk.  I felt bereft without my baby.  And then they wanted me to take pills, which I wouldn't do.  They were strangers so why would I accept drugs from them?  So I was forcibly injected with chlorpromazine.

It was the era in the late 70's when ECT or electroshock was in fashion.  Many psychiatric patients got it, for this and that, and I used to see them lining up for it in the ward.  I was approached by the nurses who said I should have ECT, wanting me to sign a form, agreeing to it.  By this time the chlorpromazine had brought me harshly out of the psychosis.  I knew I didn't want ECT, my mother had got many courses of it throughout the 50's and 60's, against her will, so I wouldn't sign the form.  And, in my pyjamas (all patients had to wear them, our clothes were locked away), I got my husband to take me home in the car that night, escaping from the hospital.

But I had to go back in, because of suddenly coming off the chlorpromazine, getting muscle spasms, my neck going back.  The family probably thought I was doing it on purpose, part of the mental condition.  At that time I didn't know about the issues to do with suddenly stopping psychiatric drugs.  Ignorance is bliss?  And so I was taken back into the hospital, fearful I was going to be forcibly given ECT.  However I had avoided it, although the nurses kept saying to me that I'd have recovered quicker with having it.  I didn't believe them.

I think that ECT and psychiatric drugs do similar things, shocking a person out of a psychosis or alternative reality.  Like a knock on the head or a shake to the system, the ECT in my opinion being worse as it causes memory loss and I didn't want to not remember.  The treatment was like a punishment for having lost my senses or of not being able to cope.  It felt like this also for me in 1984 and 2002.  And I still am not happy with the way I was treated, the lack of respect and indignity.

I'd like to see a new way of looking at psychosis so that people are treated individually, according to their own experiences.  The hearing voices movement, inspired by the work of Romme and Escher, is doing a great job of deconstructing and reconstructing the experiences of voice hearers "the ethos of the hearing voices movement is to accept a diverse range of explanations for voice-hearing and support the person to find empowering ways to use these understandings- if an individual claims to be communing with God, and finds the experience valuable, no efforts are made to divest them of it, but discover what it means to them" Rufus May website.