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I can highly recommend ‘Breaking Down is Waking Up’ by Dr Russell Razzaque on this very subject.
I am involved assessing and (trying to avoid) detaining patients under the Mental Health Act in the UK. Sandy’s article is thoughtful and reality-based. Despite my commitment to Soteria and similar approaches I still believe there are times when people in extreme states need some form of ‘containment’ for their own or other people’s safety (often for iatrogenic reasons, but that’s another debate). It is what we do with that containment that matters, and where problems (and forced medication) so often begin. To me, that point is where dialogue needs to start, dialogue that had not been possible until the person was detained. And we should be holding off with the medication for as long as possible while dialogue is established. If we made genuine attempts along these lines, patients might be able to avoid forced medication altogether.
Excellent article Richard. I also work in the mental health system (in the UK) and I’ve had the same experience in stepping of the path of least resistance, in particular having psychiatrists express genuine interest in Open Dialogue, Soteria, Robert Whitaker etc, but then continuing with business as usual with regard to prescribing, use of compulsion etc. The cynic in me might conclude that they do this in order to retain their power. They acknowledge the counter arguments, are seen to ‘encourage debate’, but we are effectively patted on the head, and the debate runs into the sand.
I differ from you on one issue though, compulsion. While I spend my working life trying to find ways to avoid compulsion, I still believe there are times when its needed. Even Soteria used the rolled carpet technique occasionally. Sometimes people need compassionate containment. Its what we then do with that containment that matters. Certainly forcibly medicating people in those circumstances is not the way. Containment is the point at which dialogue can potentially be started. Dialogue, not medication, is the way to healing.