You Can Have Any Kind of Treatment You Want, Providing it’s Our Kind

Alec Grant, PhD
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Mental health nurse education supports institutional psychiatric practice in an insufficiently questioning way. Its formal curricula in universities are often undermined by the informal curricula of practice environments. As an institution, mental health nursing pays insufficient attention to both these issues because it is an arguably un-reflexive and rule-following discipline.

It’s been five months since my last blog post. Since then, I’ve made the decision to retire as a mental health academic. I will do so on my 65th birthday, in May next year. Knowing I’m in my last few months of full-time employment has been liberating, so I’ve recently been posting more on social media on the basis of my accumulated knowledge and writing, and this has extended into my email correspondence. All of this has been great as it forces me to write in different and often very concise ways.

I’ve often wondered what a realistic information sheet for service users entering UK acute mental health wards might look like. So a few weeks back I posted the following on Facebook for my friends, some of whom are survivors and some mental health nurses:

“Dear service user,

You are about to stay in an environment where, as has been repeatedly documented in recent decades, you have a one in three chance of being physically, emotionally or sexually abused.

You will receive a diagnosis that has no scientific credibility and is made on the basis of social rather than biomedical judgements, although the people making the diagnosis and those who support them pretend it is the latter.

If your stay is prolonged, your diagnosis will change repeatedly, corresponding to changes in your psychiatrist. This will also happen if, after your discharge, you re-locate and are subsequently treated in a different part of the country. This may well confuse and/or annoy you or both

During your stay with us, you will be bored a lot of the time, or anxious, or both. The chances are that the only ‘therapy’ you can realistically expect to receive will be drug therapy. You probably won’t have the negative short and long term effects of these drugs explained to you, and what should be their judicious use over a short period probably won’t happen to you. You are likely to be in drug therapy for a long time.

If you don’t like all of this and try leaving, we may well legally detain you.”

This provoked a supportive and warm reaction among my Facebook friends, some of whom played around with the information sheet, extending it, as follows:

“And you will be expected to eat, shit and watch tv, just like the rest of the population of consumer/non-citizens” …

“And be grateful for this”…

“And be ever so ‘humble’”

Soon after, in response to a newspaper article written by a mental health nurse who likened acute ward nursing to being a soldier in a war zone, I joined a twitter dialogue which had just called for more Government resources for UK mental health. I sent out this tweet:

 one critical clinical psychologist twitter friend responded with:   

To which I replied:

My twitter colleague agreed, and my parting shot was:

Within the last couple of weeks, following another twitter conversation, I responded to a request from an Antipodean professor of mental health nursing to send her my most recently published papers. These were about empathy building and the reduction of ‘othering’ practices through nurses writing and practicing on the basis of hybridity (as both mental health nurses and user-survivor). Anticipating that our exchange probably wouldn’t result in a sustained academic dialogue, I said to her at the end of my email:

“Any feedback/reaction from you would be great! In my final year before retirement, I’ve more or less given up on the idea of robust debate and critical exchange in mental health nursing (which I’ve also more or less given up on). Sad neoliberal, technical-rationalist times we live in. All the best, and thank you very much for your interest in my work.”

 She replied:

“Dear Alec, thanks for your papers. They look fascinating. Please don’t despair of mental health nursing! There are pockets of excellence in many places but neoliberalism does have great power. However the Recovery movement means that consumers /service users can take matters into their own hands more and more. (This indicates that) things will have to change for the better at some stage…”

Although the likelihood is that she didn’t intend this, I felt that my message was trivialised and that her words were patronising and invalidated my position. So I tried to respond reasonably, but firmly:

Dear XXXXX, Thank you. I know there are pockets of excellence, and I am part of the recovery-survivor movements as part of my (multiple) stakeholder profile. That said, after 42 years in mental health, in plural roles, I am firmly of the view that mental health nursing in general – at practice and education levels – lacks sufficient levels of criticality, imagination, and professional and disciplinary reflexivity. Disappointing, but not really surprising. And, like our rail system in the UK, things are always on the point of getting better. Nurses and nurse educators collude with oppressive practices in mental health, at all levels. I despair for good reason.

 

I don’t expect her to get back to me with a response to my papers; I’m not even sure that she’ll read any of them. I’ll be pleasantly surprised if I’m proved wrong.

The idea that things are not what they are promoted as in “mental health care”, and indeed may be the opposite of this, has an Orwellian ring to it. Nurse academics write about the need to make acute wards more caring and empathic. This is a bit like painting a car that has no engine and is forever going nowhere. To extend this metaphor, nurses write about choice in our neoliberal times, while the average mental health service user’s choice about the help they receive is akin to Henry Ford’s 1920s customers having any colour of automobile they wanted. Providing it was black.

20 COMMENTS

  1. Alec,
    The situation is just as bad in the United States.

    It sounds like you should hire a military plane and drop leaflets with your “Abandon All Hope Ye Who Enter Here” warning about the abysmal state of psychiatric treatment, across the grounds of your biggest mental hospitals. That would be a public service!

  2. Great post! Please provide the article or reference for the 1 in 3 chance of being abused. It’s a good argument against being sent to a psych ward. And sent to partial hospitalization day treatment instead if the doctors and family insist on conventional treatment. Too bad ppl don’t know about the recovery approach.

  3. I wrote much the same on the internet 3 or 4 years ago. It’s okay. I have always been ahead of the curve, so to speak.

    It costs nothing to be kind, they once said. It’s gradually dawning on people the true cost of our new ways of living and relating. Kindness is now something which is being commodotised. Many people are nervous about what it means, and nervous about what might happen if they attempt it.

    There is a lot of money to be made running workshops reminding people what kindness is, and challenging them to risk it.

    I think if people are going to be paid to be kind, they should earn their money. And they should be seen to be consistent. And if they are not consistent, they should be accountable.

    One problem with kindness is that humans often rationalise their cruelty as a specific version of kindness. The “cruel to be kind” conceit.

    What I say to those merchants of abuse in the name of kindness is: whatever happened to being kind to be kind?

  4. One of the things for which I am most grateful to my psychiatrist is his keeping me out of the hospital system, particularly as it has become clearer to me that my problem is not “depression” but complex trauma (including but not limited to sexual assault by a psychiatric nurse).

    The risks for women in a psychiatric inpatient setting in the state in Australia where I live are considerably worse than 1 in 3. A 2013 report (linked below) on sexual victimisation alone showed that the rates of sexual harassment were around 67%, and sexual assault around 45%. I am not sure how much the situation has improved since then, but anyone who has been following the news in the last few years cannot help but be be aware that Australia has (or should have) an appalling reputation with regard to its treatment of detainees of all sorts – in prisons, immigration detention and as involuntary psychiatric patients.

    http://www.abc.net.au/reslib/201305/r1115028_13591277.pdf

    • You are best kept out of hospital. Ultimately, mad people are best not being hospitalised at all. We need new models of care and rehabilitations. Hospitals tend to infantilise and people often unwittingly regress into child-like behavior. The nurses and doctors become mommy and daddy in a very dysfunctional family dynamic.

      Mommy and daddy have their favourite patient/siblings. Mommy and daddy conspire to utterly destroy some of their childrem to teach them important life lessons about behaviour, and adherence to rules, and knowing when and when not to speak to power.

      Mental health hospitals are sadomasochistic dungeons and perhaps to survive this many of the vitims that pass through delude themselves into thinking something kind and medical is actually happening.

      The kind of people that are attracted to these settings are — whether they know it or not — the kind of people that get off on the abuse of power.

      Of course, in an actual consenting S&M setting, there are safe-words agreed upon when the pain is too much. In this way the consenting adults can indicate that the S&M has reached its limits.

      In hospital settings there are no safe-words. Please stop this now, you are hurting me too much, will often be ignored. Instead, the torture goes on until the tortured person is expresses gratitude and thanks.

  5. I’m glad to see some treatment of the nursing factor in psychiatric care. Nurses’ discretion with PRNs appears to have the power to neutralize doctors’ reassurances not to over-medicate patients. Do nurses find themselves in double -binds as to whether to contact attending physicians? How do nurses triage the patients on the nights that are described as “war zones”? Whose best interests are served in over-crowded and under-staffed wards? Which types of patients are subjected to the worst forms of chemical battery and what factors contribute to that? What are psychiatric nurses doing to expose human rights abuses and neglect of medical investigation in psychiatric wards?

    • As a former patient in the state hospital where I now work, I would have to state that many of the nurses there are not the cream of the crop. There are some really good ones who totally care about the “patients” but for the most part they are like rejects that can’t find jobs in real hospitals. I worked around and with nurses for over fifteen years and the ones in the state hospital were the worst overall. Of course, one of the problems is that salaries for people who work there are not the greatest so I guess you get what you pay for. I don’t think anyone would ever blow the whistle on unethical practices.