So here we go again; another meeting with another young person who describes how he is in an acute crisis – you may call it – and is diagnosed and prescribed neuroleptics. He is told by the doctor that he suffers from a life-long illness and he will from now on be dependent on his “medication.” However, after a short while he starts to suffer from physical and emotional pain connected to the prescribed drugs. It scares him and he tells his doctor that he wants to stop taking it, and so he is told that he must not stop taking his medication and that he has to realize it is best for him. His family is told the same thing, and they are also told that if they cannot support him in this case they will need to find some help to do so.
Fortunately his family does not obey. Further they decide to find out about alternatives and so they get in touch with my workplace and we met some months ago. What happens is that the young person of course is very suspicious and he lets us – my colleague and I – understand that he does not trust us. What else to expect, re: his experience in the psychiatric ward, and how to make our meetings go in a different way?
That is one of the first questions to ask all who are present during the first gathering. How to create a safe enough space for him and what he brings. What will it take from all of us; those of us being therapists, and from his family members? His mother says that she is finding it hard to tell about her feelings and thoughts since she does not know if they will be turned against her, or others in the family. That is what happened when she told her story during the meeting with the psychiatrist. She describes an experience where she found her son and the whole family in a situation where the psychiatrist seemed to focus on finding the problem, the illness.
Through the DSM manual system human reactions – thoughts and feelings – are taken out of context and during a very short period of time “put under the lens” to find out what is wrong with the one called “patient.” This happens most often when both the one called patient and people close to him are more vulnerable than usual, and it most often happens in a context (read hospital) where most of us would feel uncomfortable. Assumptions and hypothesis which are shown far too often not to be either scientific, or relevant – either in practice or in peoples´ lives – have become accepted as “truths” in a system which is very closely connected to the pharmaceutical industry. This is what psychiatry as a system relies on, and this is why I don´t believe in psychiatry. It does not mean that I mistrust every psychiatrist, nurse or psychologist working in the system, but it means that I am against a system which is built on power hierarchy and a medical model which leaves out other important aspects of being a human; as, for example, philosophical, social, relational, political, and spiritual issues.
The use of psychiatric diagnosis – although giving the impression of certainty – is based on a great deal of ambiguity and at times outright errors that overlook the connections between a person´s situation in life and that person´s behavior and symptoms. Of course our bodies, including the brain, react to emotions, feelings and thoughts and it is nowadays possible to observe these reactions in a screen. With specific knowledge it is possible to explain biological reactions. But still, this does not necessarily help a person in a crisis and it does not make the pain less.
When people, any of us, suffer and deal with hard life conditions we are not specifically asking for brain explanations and the most important is not to know which part of the brain is eventually affected. We are not searching for specific theories or methods – but for something else.
This “something else” is not possible to find in brain research or in specific methods, tables and figures but in the authentic meeting with another person. By being listened to and recognized. “To be a human being amongst other human beings,” as a young woman I met years back in therapy described it. It might take a long time, but it also happens that trust is there from the very beginning. It is hard to know how it happens one way or the other, but it is always important that it happens with an experience of trust, or as the Danish philosopher K.E Lögstrup expresses it, “to deliver part of your life into someone else´s hands and be received.”
Barbro Sandin, who is one of my mentors, used to see people in therapy who were defined as chronically “schizophrenic.” She describes how she, during her training at a psychiatric hospital, was shocked by the attitude amongst the professionals and how the so-called patients were met by standard questions and, seen as if recovery was not possible. However, she showed in action that it was not true; that change was possible even though it sometimes took a long time. Her ideas at the psychiatric hospital during the 1980s were seen as so oppositional and radical that she had to be stopped! Rumors went around that she herself was crazy and that she “used” the patients. As time passed she and her team realized they could not stay at the hospital and created a foundation where they worked for many years. Sandin took a stance since she could not stand not to do so. She used to say that it would have been unethical and impossible not to react to a system which oppressed people. Sandin has taught me so very much about the art of therapy and human life. Of the very many things she taught me one thing stands out more than anything else; the main thing is not to explain theoretically but to live things through together with the other one. To be there.
Tom Andersen is another very important person and mentor for me. Like Barbro Sandin he showed in action the importance of presence and to listen to the other one. Words were central to Andersen and he claimed that words are never innocent, and therefore we have to be very aware of the way we use words in professional settings and especially in powerful positions. He used to say that since we do not know what we mean with a word like schizophrenia, we shall not use it, either. If we use words that we do not know the meaning of there is a risk that we will construct something which actually does not exist. Andersen did not work within the psychiatric system, but he often met people we call patients and from that he learned how very many different ways there are to see the world and to take part in it. His idea about participation is central at my workplace and even though he is not alive anymore his spirit is very present.
Loren Mosher described how the Soteria Project distanced itself from the medical model and psychiatric diagnosis;
“At its core was the notion that psychosis should be dealt with face to face without the usual impediments of theory, artificial institutions, professionally acquired belief systems and practices and without chemical alteration of consciousness by antipsychotic drugs”.
While writing my dissertation I came across quantum physics and was amazed to discover some similarities in thinking about the world – and one’s self in it. Ulf Danielsson, professor in physics writes,
“However, the observer and the observed interact also with the world around them, information leaks and is lost forever, chaos increases and so the flow of time. Just as in thermodynamics. And this is actually a very positive image of time. The future does not exist yet. We can still affect it. On the other hand, in a completely deterministic world everything is predetermined and therefore time loses all meaning.”
Life is magnificent, powerful and utterly incomprehensible in many ways. People meet, sometimes for a moment and sometimes over a lifetime. Relations are created and new processes initiated, in small and large contexts, between past and the future. The fact that we know there are a million things we do not know doesn´t stop us from acting like we know everything now and then. We act as if we have control and can affect what happens. We search for answers, meaning and something to hang our existence on.
In close contact with those called clients, their families, colleagues at the office, family homes and a broad network I have experienced the meaning of engagement, love, joy, own lived personal experience, solidarity and trust. I have also experienced anxiety, mistrust, rage, difficulties and deep doubts in relation to both others and myself. In a number of situations and contexts I have experienced how each of us affects and are affected by each other and by what we are part of.
I have learned from my many years of practice and recent years also as a researcher how very important it is to follow your heart and, when needed, to take a stance. To follow your heart is not an easy thing to do and most often it is not done without efforts and doubts. But still it is crucial and especially when dealing with human beings and human life’s dilemmas and difficulties.
The psychiatric system is far away from such a holistic and what you might call dynamic point of view. It relies rather on the contrary; a system which tries to capture human nature through standardized questions which are taken out of both contextual and relational aspects, where the one called patient is observed as if the one who observes does not also influence and make an impact. It is as if the psychiatric system tries to create a situation which is far beyond what most of us would call ordinary and possible to recognize; life in all its shapes.
There are some great exceptions, and one of the most known from research and practice is the team in Torneå in Finland which – together with those called patients and their families – many years ago realized the importance of a dialogical approach, and dared to wait on both pharmaceuticals and assumptions about the “other,” but rather to be together and to let thoughts and feelings make sense in a work built on participation and relationships.
As long as Torneå is an exception and as long as people like the man described in the beginning of this post is met the way he was met at the psychiatric hospital I see no other alternatives than to, in a powerful way – by words and deeds – showing that there are alternatives. If that means being “antipsychiatry,” then I am more than happy to define myself and our work in that way.
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Andersen, T. 1991. The Reflecting Team: Dialogues and Dialogues about the dialogues. W.W Norton.
Breggin, P. 2008. Medication Madness: The Role of Psychiatric Drugs in cases of violence, suicide and crime. Springer Publishing Company.
Danielsson, U. 2003. Stjärnor och äpplen som faller. Albert Bonniers.
Håkansson, C. 2009. Ordinary Life Therapy: Experiences from a collaborative and systemic practice. Taos Institute Publications.
Håkansson, C. 2014. The Extended Therapy Room- coming from an authentic place. University of Jyväskylä.
Lundblad-Edling, H. Nine Lives. 2014. Mad in America Books.
Lögstrup, K.E. 1971. The Ethical Demand. Fortress Press.
Mosher, L. Soteria and other alternatives to acute psychiatric hospitalization. A personal and professional review. Journal of Nervous and Mental Disease.
Read, J &Mosher, L & Bentall, R 2004. Models of Madness. Brunner-Routledge.
Sandin, B. Den zebrarandiga pudelkärnan. Wahlström & Widstrand.
Seikkula, J. 2011. Becoming Dialogical: Psychotherapy or a way of life. AAFT, The Australian and New Zealand Journal of Family Therapy.
Whitaker, R. 2010. Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America. Crown Publishing Group.