Where I live we are approaching an important day in our nation's history on Thursday 18 September 2014, when a referendum will be held and the question asked: "Should Scotland be an independent country?". Whatever the outcome it is an exciting time to be Scottish and to consider what being independent means. I think it has great relevance to the work I do as a mental health writer, activist and campaigner, a psychiatric survivor and unpaid carer of family members who have mental disorder diagnoses/labels, through 3 generations or more. Tied in as my family are or have been to the psychiatric system do we have independence or the right to be independent?
I want to consider the paradox of psychiatric system thinking which tells us that the mad people are those with mental disorder labels and the rest of the people in society, including the psychiatric/mental health staff, are the sane ones with their heads screwed on right. I have probably always seen the asylum, now psychiatric hospital, as an institution like any other eg school, army, university, political party, government, with conscripts, rules and rule breakers. I didn't believe the mental illness mantra because it didn't make sense.
Those who seem to do best in these institutions may be the ones who can say one thing and do another. Sleight of hand stuff. Like magicians and card players. You might describe it as being slippery or a chancer or a game player, ducking and diving to avoid the opposition. The end goal to be in power, to influence others and to make some money out of it on the way to the top. Nothing wrong with that as everyone else is doing it, aren't they? No, not everyone.
The problem with the hierarchical shenanigans in psychiatric settings is that the availability of "compulsory treatment" means that there are some conscripts who don't play the game and bend the rules, who are independent thinkers and expect the system to support and protect them in their mental distress. They expect the mental health act safeguards to be safe and that the principles and practice within the law will be implemented properly and monitored effectively. Unfortunately it can be more like going through the looking glass, like Alice, or falling down a rabbit hole. Nothing is as it seems or should be.
I am aware that many people are happy to be in the psychiatric system when unwell or feeling the stress of life, and see it as a refuge. I couldn't be one of them because of the disruption the system has had on my family's life. It's a matter of principle. The use of force, of ECT, of brain surgery for mental illness (my family fortunately avoided this), drugs that don't work and some staff/people who shouldn't be working with anything that lives or breathes, made me determined to be independent of psychiatric influence and beliefs. Even though they labelled and coercibly drugged me I was resistant in my being, to the religion that marked out some of us with defects that inevitably lead to stigma and discrimination. I can't be a conscript even though they make me dependent, for a while.
For madness or psychosis or altered mind states aren't "mental illness", rather they were for me to do with life transitions, sensitivity to changes in my body and in the world around me. I came out of it stronger and more self aware, self confident and resilient. But the forced drugging was traumatic, beating me into submission, or so it felt like, taking away my sense of humour and singing voice.
"I know why the caged bird sings, ah me,
When his wing is bruised and his bosom sore,
When he beats his bars and would be free;
It is not a carol of joy or glee,
But a prayer that he sends from his heart's deep core,
But a plea, that upward to Heaven he flings –
I know why the caged bird sings."
Dunbar, Paul Laurence (1993). Joanne M. Braxton, ed. The Collected Poetry of Paul Laurence Dunbar, Charlottesville: University of Virginia Press. p. 102
Why does the system do this? Fear of the unknown perhaps. Yet life is unpredictable, that's for sure. We're kidding ourselves on if we think that it's under our control. Being independent is knowing that nothing controls us even if it seems like we are constrained.
I attended a conference the other day in Edinburgh and a workshop on mentalisation ("the ability to understand the mental state of oneself and others which underlies overt behaviour" Wikipedia) facilitated by a psychiatric nurse and concerned work with patients who were diagnosed Borderline Personality Disorder, BPD. I was alarmed at the military terminology in the presentation: "secret weapon", "ammunition", "coercive bondage", to describe the usefulness of the approach, for nurses. It conjured up images of patients as the enemy.
There was a quote from nurses in training who said about the BPD patients "they suck the life out of you". I tweeted that I felt the same about psychiatric treatment. It confirmed my concerns about the government mental health strategies that read like battle plans, fighting this, that and the other, and how they reinforce the negativity for everyone involved in face-to-face work with people.
I am working with others in Scotland's mental health world for level playing fields and straight paths, and in particular these include a psychiatrist and mental health nurse, the three of us equal protagonists in the quest for justice and fairness, scientific enquiry and a willingness to learn. Here is a link to examples of work from my colleagues:
An Omphalos film from psychiatrist Dr Peter J Gordon: Ageing is Truth "Time Passes. Listen. Time Passes." and Peter's website Hole Ousia: The whole being: bridges cultures of science & arts.
And a paper from Dr Rosie Stenhouse, Edinburgh University Nursing Lecturer, Doctor of Philosophy: ‘Safe Enough in Here?’: Patients’ Expectations and Experiences of Feeling Safe in an Acute Psychiatric Inpatient Ward', Journal of Clinical Nursing, July 2013.
Rosie (facilitator), Peter and I, along with other people with "lived experience", take part in a national mental health User Led Research Group (@ScotMHResearch) with initial funding by the Scottish Mental Health Research Network.
Our first task will be to undertake research into mental health crisis and acute care services from the service user, patient and carer perspective. With the aim of inviting research questions from people with lived experience in every Scottish health board area, gathering a range of views and perspectives. We plan to engage and form collaborative relationships with other similar groups and a visit to Northumbria University in the North of England is planned.
In conclusion, I hope that this blog post has demonstrated that independence of thought and action is possible even when the system constrains us for a while with labels and drug treatment. It's been a matter of persistence as I see it. Keeping on keeping on and a determination to speak out and have a voice, in solidarity with others. I have found allies in every setting even among adversaries, people whom I have disagreed with and yet formed relationships with.
A couple of months ago one of these adversarial allies, a psychiatrist, left this earth before his time and I mourned him [in remembrance]. We didn't agree on many topics but I was free to say so and he took it on the chin. We were equals and that is what counts.
Whatever the outcome of the Scottish Independence Referendum on 18 September 2014 I know that in my heart and mind I am a free spirit even if at times I may feel restrained or restricted. These times are temporary and fleeting in the scheme of things, and I am, and will be, encouraged at the possibilities and opportunities that independence brings, in the here and now.