Squares, revisited…

A couple of years ago I wrote a post about a woman in hospital that I visited. I was thinking about her recently, and reworked some of my words into a poem- as part of my on going ‘protest poetry’ project. This poem still has more of a narrative quality but here it is.

Argyll and Bute hospital 2

Squares

 

The ward squeaks disapproval at my

polluting presence

The hospital is brand new.

 

There she is.

After 40 years of patience.

Something went wrong when her husband died.

She was swallowed whole by the grief of it;

Captured in a concrete cocoon.

 

She was the recipient of all the best psychiatric science;

drugs greyed out her vision;

electric shocks blew holes in her memories.

They even tried psycho surgery in a futile attempt

to scrape grief from her brain

with a scalpel.

 

And here she remains – toothless, but given to scratching.

Occasionally abusive, but with sense of humour

largely intact.

They say she has behaviour problems, that she is manipulative.

Who wouldn’t be?

 

She was once a worker, a wife, a mother.

She wore a white cotton dress to picnic once

She loved to dance

 

Today we meet to stitch bureaucratic blankets for her next bed.

I clear my throat and speak out care-clichés

whilst people in a hurry to look busy

shuffle paper and steal glances at the time passing.

 

She looks up at the crisp suspended ceiling and cackles.

I hate those bloody

squares.

Everything is so square in here.

Put me outside next to the hedge.

Just put me

outside.

 

I follow her gaze to the brown beech hedge.

Out through the square window.

Last year’s dry leaves still rattle on close cropped branches.

 

And I want to wheel her out there

sit her under the winter sky

wind waving her long grey hair in a curve of protest

against all those bloody awful

squares.

 

 

The voices in my head: Eleanor Longden’s ‘psychic civil war’…

This blog has featured a lot of discussions about mental health. This is because I have served my time as one of societies psychiatric policeman- an Approved Social Worker in England, and a Mental Health Officer in Scotland.

I started out 25 years ago with a clear idea about mental illness- people who were ill did not always realise that they needed help. It was my job to try to make sure they got help. I had all sorts of different ideas about what this help should look like, and lots of frustrations with the psychiatric machine that I had to deal with, but fundamentally, the idea of mental illness itself was a stable reality within what I did.

Sure, we challenged the medical model (Illness-diagnosis-treatment (maintenance)) as this failed to take into account the social context in which some ones illness develops, but the dominant paradigm that affected work with people with ‘severe and enduring’ mental illness remained firmly medicalised. It was the only way to make sense of the psychic chaos we were faced with – hospitalise, medicate and sanitise it out of our immediate circle.

Increasingly I became a skeptic- not just of the machine, but the actual underlying concepts of ‘mental illness’.

It started many years ago when faced with young men and women who, once diagnosed with schizophrenia, were condemned to half-life at best. The medication we gave them to control their symptoms (particularly the ‘voices’) often did not work, and had such destructive side effects that everything would slowly slide downwards into a kind of suppressed humanity. Is this really the best that we could do?

Alongside this other movements were emerging. They were dangerous and threatening. One of these grew up in and around Manchester, where I was working, and was called ‘The Hearing Voices Network‘. It dared to suggest that hearing voices was a NORMAL human experience- not a symptom of ‘illness’. Rather it was a way of coping with trauma for the most part.

Rather than pushing the voices away, suppressing and chemicalising them, the HVN suggested we needed to embrace them, engage with them, understand them- even the destructive aggressive ones.

More recently we have has another movement- around the idea of ‘recovery’- living fully in the presence (or absence) of the ‘symptoms’ of mental illness.

None of these are easy concepts- they are really stories of life long journeys for people experiencing one of those ‘psychic civil wars’ that all of us go through to some extent.

What convinces me most about these revolutionary ideas in relation to mental health issues is the HOPE that they bring. The best that psychiatry can offer to many is ‘maintenance’. All the so called break-through s of the pharmacological machine that spend millions convincing doctors to use their new wonder drug have done little to change this. Suddenly however, people are saying clearly- The treatment you are offering me is NOT WORKING. I want something better for my life. 

That is not to say that there are not people in the system who see it this way too. I heard this wonderful TED talk the other day. It is saturated with hope, and the raw joy of life…

Enjoy;

Is it time to change our whole approach towards mental distress?

In May, the American Psychiatric Association will publish the fifth edition of the Dignostic and Statistical Manual of Psychiatric Disorders, otherwise known as DSM 5. Although originating in the USA, this publication is immensely influential, and is likely to form the basis for Psychiatric diagnosis the world over, as with the out going DSM 4.

Does it matter?

Well, the answer to this is YES. It matters on an individual level because all of us will be affected by mental disorder. One in four of us will be diagnosed according to one of the classifications above, so even if this is not you it will be someone you love or someone you work with. Lots of us feel a strange relief when distress is given a name – it suggests understanding, companionship, a removal of uncertainty and the possibility of treatment. However, for many these can easily become self perpetuating and destructive as they may have the effect removing responsibility, ownership and even hope, which some never find again.

It matters too on a sociological level. Our societies are increasingly regulated by psychiatry. We medicalise, medicate and plan ‘evidence based interventions’ into all sorts of human variation. This may simply amount to the application of science and knowledge to the alleviation of mental illness, but the question is whether this is ‘healthy’? Are we seeking to make a world in which the mess and gristle of life is edited out, tidied away, chemically suppressed? And is it working?

Psychiatric classification almost always demands treatment, so step forward the drug companies, with another product to push by fair means or foul. All those countless drug rep funded lunches, gadgets, even holidays, in the name of publicity for the next wonder drug. Even if the drugs do half of what they promise there is no doubt that our population is increasingly medicated. This from here;

Prescription Pricing Authority data shows that more than 30 million prescriptions for SSRIs (selective serotonin reuptake inhibitors) such as Prozac and Seroxat, are now issued per year, twice as many as the early 1990s. Researchers at the University of Southampton found 90 per cent of people diagnosed with depression are now taking SSRIs either continuously or as repeated courses over several years.

Professor Kendrick adds: “Our previous research found that although these drugs are said not to be addictive, many patients found it difficult to come off them, due to withdrawal symptoms including anxiety. Many wanted more help from their GP to come off the drugs. We don’t know how many really need them and whether long-term use is harmful. This has similarities to the situation with Valium in the past.”

Unsurprisingly, there is evidence that the current economic recession is also having an effect. This from the Telegraph;

The number of prescriptions for drugs such as Prozac has risen from 16 million to 23 million since 2006 with many GPs saying patients are increasingly expressing concern about the recession.

Figures obtained by the BBC under the Freedom of Information Act found the number of prescriptions for the most common group of antidepressants rose by 43 per cent during the period covering the banking crisis and housing crash.

If we can agree that in terms of practice, prescription and intervention psychiatry is increasingly involved in our lives, then the emergence of a new set of diagnostic criteria must be a considerable significance to all of us. We should also know then that this classification process, already controversial, is in the middle of a storm of criticism following the release of advance details of the new DSM 5.

Firstly, what could be regarded as the ‘tabloid headlines’. This from here;

Bereavement, which has always been excluded from the mood disorders, will become a mental disorder. Mild forgetfulness will become a mental disorder (“mild neurocognitive disorder”). Your child’s temper tantrums will become a mental disorder (“disruptive mood dysregulation disorder”). Even preferring one of your parents to the other will become a mental disorder! (Yes, really: “parental alienation disorder”).

You will need to display fewer and fewer symptoms to get labeled with certain disorders, for exampleAttention Deficit Disorder and Generalized Anxiety Disorder. Children will have more and more mental disorder labels available to pin on them.  These are clearly boons to the mental health industry but are they legitimate additions to the manual that mental health professionals use to diagnose their clients?

You can listen to a short Radio 4 Today Programme debate on some of these issues between David Kupfer who chairs the DSM 5 committee for the American Psychiatric Association, and Peter Kinderman, professor and honorary Consultant Clinical Psychologist with Mersey Care NHS Trust about this between on this link.

Then there is the murky world of classification of ‘personality disorders’. Many people regard these as the ultimate examples of how abstract description of patterns of behaviour can become viewed as some kind of unassailable concrete ‘illness’, which then take on a reality in the same way as we might understand influenza or cancer.

DSM 5 complicates this further by adding more categories, for example “Apathy Syndrome,” “Internet Addiction Disorder,” and “Parental Alienation Syndrome”. This has raised so much concern that the American Psychological Association has begun an on line petition to allow people to express their concerns. This from here;

It is particularly concerning that a member of the Personality Disorders Workgroup has publicly described the proposals as “a disappointing and confusing mixture of innovation and preservation of the status quo that is inconsistent, lacks coherence, is impractical, and, in places, is incompatible with empirical facts” (Livesley, 2010), and that, similarly, Chair of DSM-III Task Force Robert Spitzer has stated that, of all of the problematic proposals, “Probably the most problematic is the revision of personality disorders, where they’ve made major changes; and the changes are not all supported by any empirical basis.”

How about this side of the Atlantic? This from the British Psychological Society (not renowned as a radical organisation) response to the consultation;

The Society is concerned that clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation. (p.1)

We believe that classifying these problems as ‘illnesses’ misses the relational context of problems and the undeniable social causation of many such problems. For psychologists, our well-being and mental health stem from our frameworks of understanding of the world, frameworks which are themselves the product of the experiences and learning through our lives. (p.4)

These comments go to the very heart of how we approach mental distress.

The Hearing Voices Network have been making a case for change for many years. Psychiatrist Marius Romme for example claimed that many people who hallucinate “are like homosexuals in the 1950s — in need of liberation, not cure.”

There is a change underway, akin to that of other great liberation movements and I believe that when we see chains on people it should be the intention and hope of the followers of Jesus to seek to break them. What is unfortunate is that the classification found in DSM5 do little to break chains. If anything DSM5 might yet forge new ones and as such, we should resist…

How might they be broken then? Here is my reading of (and my hope for) some of the changes;

Away from ‘illness’ towards ‘distress’

Away from ‘symptoms’ towards understanding that we develop different  means of coping with this distress.

Away from restrictive labels towards listening to individual experience.

Away from medicalised interventions, towards encouragement and support of individual recovery.

Away from simplistic distinctions between ‘psychosis’ and ‘neurosis’ towards a greater interest and understanding of the effect of trauma.

Away from segregation and ‘otherness’ towards seeing mental distress as an essential part of the human experience and as such, part of all of our experiences.

Away from ‘maintenance’ towards, hope.

Square world…

I went for a meeting today in a posh new hospital. Everything squeaked as if in disapproval of my polluting presence.

I was there to chair a meeting about one of the patients, who had been transferred there recently to receive more specialist care. She had previously spent most of the last 40 years of her life as a resident of the local psychiatric hospital. Things went wrong after the death of her husband, and she somehow lost herself in the grief of it all. The whole range of psychiatric science was rolled out for her benefit – drugs that greyed her vision, Electric Shock Therapy that blew holes in her memory then finally psycho surgery in an attempt to cut grief out of her brain with a scalpel.

And here she remains – toothless, but given to scratching. Occasionally abusive but still with sense of humour intact.

She used to be a worker, a wife, a mother. She used to go on picnics and loved to dance. She enjoyed holidays and gossiped with her friends about the comings and goings of the village.

But that was 40 years ago.

Today we met to discuss her future care – a likely move to a specialist nursing home, and the legal issues around that given her lack of capacity to understand or to give consent.

But in the middle of this, she looked at the ceiling and said;

I hate those squares. Everything is square in here. Put me outside next to the beech hedge. Just put me outside.

And I looked out at the brown beech hedge, with dry leaves still rattling on the close cropped branches.

Through the square window.

And I wanted to wheel her out there, and sit her under the winter sky, wind waving her long grey hair in a curve of protest against all those bloody awful squares.

Jonathan Miller on life, and psychiatry…

Jonathan Miller said this-

I hold all contemporary psychiatric approaches – all ‘mental health’ methods – as basically flawed because they search for solutions along medical-technical lines. But solutions forwhat? For life! But life is not a problem to be solved. Life is something to be lived, as intelligently, as competently, as well as we can, day in and day out. Life is something we must endure. There is no solution for it.

Miller J [Ed] Ch 15. Objections to Psychiatry: Dialogue with Thomas Szasz States of Mind:
Conversations with Psychological Investigators London: British Broadcasting Corporation 1983, p.290, Quoted in this really good article, ‘The mythical self, we make ourselves up as we speak’- here.

Amen Jonathan. Amen.

Miranda Epstein- cartoons about recovery

merinda_epstein_sanity_fair

Following on from my earlier post about mental illness stereotypes and the Mental Health Machine, I thought I would post some more of Miranda Epstein’s wonderful cartoons. Check out her site here.

I think they speak for themselves.

(Click to enlarge)

Mental illness- challenging the stereotypes.

1mad

Everyone at work is discussing the first episode of a BBC TV programme at the moment called ‘How mad are you?’

You can check this out on the BBCiplayer on this link

Now I must confess to being someone who loathes reality TV programmes- although I did watch Taransay one (Castaway?) which kicked the whole genre off in the UK. I am a sucker for anything filmed on a small Hebridean island.

However, the idea of this one caught my interest even before I watched it. 10 people in a castle. 5 of them have diagnosed mental illnesses, the other 5 are (wait for it) ‘normal’. They all get to perform lots of tasks and batteries of tests from psychiatrists, who then have to declare who they think is mad, and who is sane.

Anything that challenges the prejudices and stereotypes about mental ill health that still prevail is great as far as I am concerned- particularly if in the process the power relationships get reversed, and the black arts of psychiatry get placed in the hot seat…

I should confess to a bias here- I have worked as a Mental Health Social worker, then as a therapist, and now as a mental health manager. I was drawn to work in this area because my faith lit in me a desire to make a difference- to seek brokenness and try to bring healing. I have been inside the Mental Health system in the UK for most of my working life- and have discovered that it can be a very frustrating and at times an infuriating experience.

At its worst the psychiatric system in this country tends to suck in people at the most vulnerable time of their lives. The next part of their experience is often about LOSS.

Loss of freedom and choice.escher_about-institution

Loss of opportunity

Loss of relationships

Loss of employment

Loss of identity

Loss of motivation

Loss of hope

Loss of self esteem

…and once these things are gone, it becomes very difficult to transcend the circumstances you find yourself in. It becomes almost impossible to escape.

Sure, the system also GIVES people things. It offers a kind of sanctuary- either the physical safety of a ward or care environment, or a more emotional/psychological kind of security given by the label- ‘depressed’, ‘schizophrenic’, ‘manic depressive’. It also offers a whole new role- that of a ‘sick’ person, who needs help from the ‘experts’ who can treat them with medication or therapy- people who can take the messy chaos of their humanity and squeeze it through a scientific colander and filter out all the bits that are not helpful. (If only huh? I think we could all do with this process about once a week…)

And all these things too become like prison bars.

There are some encouraging signs though. Some people who have carried mental health labels are starting to take back the power. This can be best seen in the ‘recovery’ movement. Check out this article on the Re-think website, or The Scottish Recovery Network site.

Recovery thinking perhaps grew out of the hearing voices network, who dared to suggest that just because people heard voices, this did not make them less human- it did not make them mad. Many people even questioned the very nature of psychiatric diagnosis- suggesting (not for the first time) that schizophrenia was nothing more than a reaction to trauma- both trauma outside the system, then more trauma within it.

The voices from the recovery movement are mostly those who have been through the system, and managed to come out the other side. They have often found themselves in conflict with the powers within system- because they speak a different language, and do not conform. Some of their rhetoric is seen as (and perhaps actually IS) downright dangerous. They no longer are interested in talking about ‘cures’ to ‘illness’- rather they seek the right to choose their own path, and their own solutions to life crises.

merinda_epstein_the_consumer

(Cartoon from here)

That is not to say people do not need help. We are surrounded by people who are damaged and vulnerable. But many of us in the system, and many others who are subject to it, are convinced it needs to change. And the ideological challenge brought to us by the Recovery movement is like light in darkness.

And so as a Christian, I reckon that this is a flavour well worth seasoning.