It is an airless void,
Rendering us voiceless
No matter how loud we scream.
Screaming. Yelling. Crying. Begging.
Straining to be heard.
Under the weight of a label
That instructs them not to listen.
It is constriction, compression, containment.
Lock us in, hold us down, drug us up
Until we’re ready to listen…
To those who would never do as much for us.
On January 23, DJ Jaffe used his National Alliance on Serious Mental Illness Facebook page to pontificate about whether or not force has any real discernible impact for those against whom it is wielded. “I am trying to track down the study that allegedly shows people avoid care for fear of involuntary commitment. I think it is one of those mental health propagated myths that has no basis in fact,” he offered without any hint of absurdism whatsoever.
Jaffe is a well-known purveyor of the Treatment Advocacy Center’s force-laden “wisdom,” so it makes sense that he’d deny any of its downsides. He uses his apparently copious amounts of free time to relentlessly self-promote his book, appear for interviews disguised as someone far more informed than he will ever be, and sow seeds of fear against all folks diagnosed across the nation with his op-ed-writing scissor hands. (His favorite pastime? Why, slicing our rights and autonomy into bits, of course!) Jaffe’s gone so far as to recommend that a system that already speaks of us as if we were not there actually make us leave the room so as to reduce whatever tiny grains of guilt might be shouldered by the “professionals” when speaking poorly of us in our presence. He shows no signs of slowing down.
But what of the questions implicitly posed in his search: Does force in the name of treatment negatively impact those subjected to it? Does it make them avoidant of seeking help again? And underneath all that, just a bit further down: What is psychiatric oppression exactly, and how does it impact us? It’s less that these questions are difficult to answer, and more that the obviousness of the answers seems bafflingly difficult to convey to someone who’s so unable (unwilling?) to hear them.
Adults unfamiliar with confinement on any kind of locked unit generally seem unable to fathom the nearly bottomless pit of loss that is involved. This also includes—though to a lesser extent—folks who weren’t ever confined long enough to move through all the stages of grief and to the point of resignment (though that can happen awfully fast). But barely a month after Jaffe’s oblivious inquiry, COVID-19 had taken enough of a hold that pretty much the whole world was getting a taste of what it feels like to have the walls close in on you by someone else’s order. And no amount of “for your own goods” can fix how that can feel.
To be clear, psychiatric oppression is not strictly about mere confinement. No, the formula that makes it so hard to bear is made up of several other ingredients, including:
- Loss of (at least perceived) value and function
- Loss of social capital
Fortunately, COVID-19 has brought many people a taste of those ingredients, too.
Part 1: The Confinement
I’ve never been much of a fan of comparing the usual challenges of life in a capitalist nation as lived by often quite privileged people to the experiences of those who have been marginalized and contained against their will. I can recall a forensic training I once attended where the big “ha ha” was a comic of someone working in a cubicle comparing their life to imprisonment. Indeed, Ellen DeGeneres recently faced a pretty stern backlash for comparing her quarantine-a-la-mansion stint to jail.
Really, the comparisons to all types of incarceration abound at the moment, including institutionalization on an inpatient psychiatric unit. However, comparing a time when you’re (sort of) required to stay in your own home with all of your own belongings, readily accessible technology, all the caffeine you can drink and cigarettes (or whatever else) that you can smoke, and the ability to wear what you want, sleep when you want, eat when you want, and more to being locked in a psychiatric facility with a stranger for a roommate, a plastic-covered mattress, and jello for dessert only when they say…. is a stretch. Yet, while my inclination is likely still to want to pop someone in the mouth (in an only-in-my-imagination sort of way) if they dare assert that they know what forced incarceration is like because of the COVID quarantine, there’s something about that stretch that rings true for those of us who’ve now experienced both.
Consider the following quote:
“We did a review of the psychological impact … Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer … duration, fears [related to potential or diagnosed illness], frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects.”
Without further imposed definition, the quote could easily be assumed to be speaking of incarceration on a psychiatric ward. And yet, it is instead speaking of the observed impacts of quarantine as found in a review of 3,166 different papers on the topic. In fact, one of the included studies found that being quarantined could predict post-traumatic stress responses and alcohol abuse even three years after the event. Interestingly (but not surprisingly), the review found that people who’d been given psychiatric diagnoses were more prone to experience anger and/or anxiety months after the quarantine had ended. Of course, one has to wonder if the study was actually measuring those who’d just been diagnosed… or previously confined and thus found their initial experience of containment further compounded. And, to Jaffe’s point, the research also found that people who’d previously been quarantined (not sick, but quarantined!) showed an increase in avoidance of any setting that they associated with the cause of that experience.
Part 2: Loss of (At Least Perceived) Value and Function
Meanwhile, on April 29, Nancy Doyle published an article in Forbes magazine, “We Have Been Disabled: How the Pandemic Has Proven the Social Model of Disability.” In the article, Doyle explains:
“For those who have never heard of the social model of disability…It separates impairment from disability and focuses on the responsibility that society holds for the disablement of others. For example, if everyone was taught sign language at an early age a deaf person would no longer be [as] disadvantaged. … A few months ago, the world was suddenly plunged into a situation where physical proximity to others became a no go. In one swoop, a whole group of people were placed at an immediate disadvantage without having done anything to deserve it. If people skills and face-to-face interaction are your key skill, then your greatest professional asset is now useless to your employer. You have been devalued by forces beyond your control and the world changing in ways that don’t play to your strengths.
In other words, in a rapidly moving shift, many people who had formed their identities around their careers… who considered at least some of their value to be wrapped up in what they did for work, and in their ability to make a living and provide for their families in general… had much of that snatched at least temporarily away with no guarantee if and how it would be returned. Professional drivers. Childcare workers. Event planners. Public speakers. Salespeople. Personal trainers. Librarians. Actors in live theater. So many others. Huge numbers of them—including some who have grown accustomed to a fair amount of adoration and praise in their roles—simply aren’t needed with the world in its current state. It would be an understatement to suggest that some elements of this mirror the sorts of identity loss that occurs when someone is committed to an inpatient unit, or even simply diagnosed and told to can their dreams for family and a career. It’s just on a smaller, more individual scale.
Part 3: Social Capital
But let’s talk about the last ingredient of this three-part recipe: Loss of social capital. Social capital comes in many sizes and amounts, but many of us have at least a little bit of it. It is what sometimes helps earn us friends, and/or stay in the know. It gains us invitations to certain meetings and events. It gets us phone numbers not publicly available, and encourages some people to respond quicker, or at all to our inquiries. Perhaps, most importantly, it is what helps identify us a “credible source,” and “to be listened to” and “taken seriously” when we speak within our families, among our friends, in our neighborhoods, at our jobs, and beyond.
Unfortunately, it is that brand of social capital that also takes a dive when we move from “those in charge” to “those to be contained.” And while the dive is nowhere near as long and hard as when one is seen as having a “brain disease” (or for a host of other reasons rooted in racism, gender, disability, educational access, socioeconomic status, etc.), it’s happening right now, too. We don’t know when this will be over, and real details about what’s going to happen next are hard to come by. More of us than not are left to tune into vague updates from state officials, hoping we’ll glean something that will reveal a light at the end of the tunnel. Say-so about what comes next is well beyond most of our grasps. We feel lucky when they deign to give us a few extra scraps.
Some may be surprised to learn that this is small potatoes when compared with the loss of social capital that comes with being locked up in a psychiatric facility. There, nurses can choose to withhold information even about what psychiatric drugs someone is expected to swallow without much in the way of repercussions, and discharge dates can be a moving target left to the whims of hospital staff and subject to outside influences such as vacation schedules and weekend staffing ratios in community-based group homes. But the comparison is still apt.
I recall a presentation at a conference during which there was a dialogue about how we could get the concept of psychiatric oppression to be discussed and better understood among the general public. One person suggested that the X-Men films were the ticket. I challenged that idea because I have not found the general populace to be especially insightful when it comes to applying fictionalized (or even their own) experiences of one type of systemic oppression or hardship to another. I fear the same is true here. I don’t believe that people will easily extrapolate the emotional impact they experienced from quarantine life to the much deeper traumas and losses routinely incurred within the mental health system. But… maybe there’s hope.
The answer to DJ Jaffe’s question as to whether or not forced incarceration in psychiatric facilities leads to fear of psychiatric facilities (or of reaching out for help in general) is an obvious one. It’s all the more obvious now that we’re witnessing many of the same components being forced on so many around us via quarantine. It is a large part of why so many of us who’ve previously been held against our will are feeling so uneasy right now. Yet, it is important that we find ways to use this opportunity to draw the connections in bold, impossible-to-miss lines, and turn this crisis into a learning opportunity that might actually help move psychiatric oppression out of the shadows of the unknown and into the light.
Let those of us who’ve “been there” be the teachers for now. We are perhaps some of the best equipped to show people the way through the current darkness. But once the light returns, I sincerely hope that the memories stick, and the gift of our wisdom can be repaid.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.