Saturday, 25 July 2015

paradigm shift? @CoyneoftheRealm: Yes to an epiphany

slide 32 @CoyneoftheRealm
This is the first in a series of posts in response to the Professor James Coyne seminar in the Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, on 22 July 2015, with the strapline 'BPS’s Understanding psychosis and schizophrenia - a skeptic's perspective'.  Which I attended with a critical voice and from the psychiatric survivor perspective.

Firstly I want to say that I hadn't realised the event was specifically to do with the British Psychological Society's report because their name wasn't on the promotional material.  And so I was concerned at the start of the seminar that it was going to be a head bashing event:

I think my concerns were justified because it did appear to be a "them and us" occasion by the very fact that there were no clinical psychologists in the audience to make a response or challenge Jim Coyne.  The "Division of Psychiatry" is well named.  I say this as a person who is determined to cross the line and to bring down the barriers between psychiatry and the psychiatrised or those who find themselves, like I did, within their walls, being forcibly drugged, against my will. 

I would prefer to be standing with clinical psychology, arm in arm, but it's been very difficult over the last few years of trying to be "meaningfully involved" in their academic endeavours or celebrity milieu, because they wouldn't let me join their inner circle.  Despite my being one of the first Mad in America writers and the person who invited Robert Whitaker to Scotland, firstly going to Athlone, Ireland, with my son, to hear him speak in February 2011.

So I attended this seminar as a critical voice, of psychiatry and clinical psychology, with a preference for the former because it has been psychiatrists who have been there for my family, 8 of us since the 1950's, when we were experiencing psychoses, some of us receiving a schizophrenia label.  A mixed bunch of psychiatrists as in any workplace, some more helpful than others.  Two of them, in my experience, willing to support the tapering of drugs, in 1985 and 2012.

Some of my family have engaged with clinical psychology since 2002 as a psychiatric patient and it hasn't been a particularly positive experience, on one occasion it was very negative.  Although we didn't have them when in a psychosis, rather it was when we had been on the antipsychotics for a while and eventually got an appointment.  Either because there was a waiting list or because the psychiatrist wouldn't allow it or refer us.

I haven't been impressed with the competence of clinical psychology since engaging with them in Fife from 2008 when I set up the voluntary organisation Peer Support Fife to promote the model of PS in mental health recovery.  Also because I wasn't treated as an equal by lead CP managers, in any meetings I had with them in their Fife bases.  They were patronising and dismissive, as if my life experience, of community development and surviving psychoses/psychiatry, was of little value.  I wasn't used to being disrespected.  It was very annoying to be treated as less than.  At age 55, a mother and granny.  

At the seminar in the Division of Psychiatry my attendance was critical, generally and not specifically, and the fact that I was among many psychiatrists and their supporters, did not phase me.  Because I have always felt that psychiatric settings were, in some sense, a home from home, having engaged with psychiatrists since 1970, aged 17, when my mother was an inpatient of Kinnoull Ward, Murray Royal Hospital, Perth.  A locked ward for women in mental distress.  

I visited my mother in Kinnoull that summer of '70, while my younger sisters, 9 and 4 years, were in temporary foster care because my granny had died in the July and she had been helping look after us.  My grandpa was lost without her, for a time, so my auntie had to take charge of his affairs while also organising support for my sisters and I.  My father was in London, having lost his writing job with the Daily Express, and he wasn't in good mental health.  Our family had fractured.

I remember visiting my mother and she was distressed about another woman in the ward who had killed her child, and coming away crying myself.  I also remember meeting with psychiatrists, it may have been two of them, men, and they said I had an "old head on young shoulders".  And through that summer I kept in touch with my mother and my sisters, who were living on a farm near Crieff, while working full-time as an auxiliary nurse in Burghmuir Hospital, Perth, in a ward for elderly women.  Doing bed baths and emptying bedpans, tending to pressure sores, moving and feeding patients, being "let off" having to wash the bodies of any who died.  For which I was thankful.

summer of '70
I had a boyfriend who helped me buy a motorbike, a BSA Bantam 175cc, and he taught me how to ride it, to use the kickstart, and to wear the half helmet, although at that time in 1970 headgear wasn't compulsory.  We drove out into the Perthshire countryside, around Dunkeld and up into the Sma' Glen, places where I used to go with my grandparents in their wee red Mini, early 1960's.  I also took the Bantam out myself and remember it breaking down, having to push it a few miles back into town.  Great adventures which helped bring balance to my life.

On my 18th birthday in September 1970, a Monday morning, I took the train to Aberdeen to begin my 1st year of an MA at the university, and my mother was discharged from the psychiatric hospital. 

Therefore in the writing of my story about first engaging with psychiatry I realise that it was a positive experience.  The psychiatrists acting in loco parentis and social work collaborating to provide respite for my sisters, supporting us all in the process.  I'd forgotten the good bits because of the bad bits that happened in psychiatric settings, in the years between then and now.  You might describe it as an epiphany.  A light bulb moment.  

It will be the reason as to why I have always voluntarily entered a psychiatric ward when in a psychosis myself, in 1978, 1984 and 2002.  Expecting the same sort of treatment I got in 1970.  [I've also taken my 3 sons into psychiatry and supported them out]  Only to be disappointed every time with the forcing of antipsychotics into my system, against my will, despite me having the capacity to know I didn't want to be forced or drugged.  The difference being that in 1970 I wasn't a mental patient, my mother was.  And I didn't know what it felt like until I had to go through it myself.

Hartwoodhill Hospital
You don't know what it's like to have your agency taken away until it happens to you.  The disempowerment and the injustice of being held down by at least 3 psychiatric nurses who pull your pants down and stick a needle into your backside [Hartwoodhill Hospital, Lanarkshire].  Forcing you to conform to the regime and to come out of a psychosis on their terms.  Because you have felt the pain of induced childbirth and reacted to it by going into an altered mind state, to escape for a while.  (thanks to Dr Samei Huda yesterday, and at other times, on twitter for engaging and helping me make sense of my puerperal and menopausal psychoses).

So I say Yes to an epiphany and Yes to a paradigm shift that will mean treating a person in a psychiatric setting as an individual with the capacity to say No to forced drugging and invasion of personal space.  I resent the fact that I was forced.  The drugs depressed me and I had to taper them so as to recover and get back my life, the sense of adventure.  I had to do it myself every time and it's just not good enough because I trusted them to take care of me as if they were my parents.  But they didn't.  

On the contrary they put me at risk, particularly in 2002 in Lomond Ward, Stratheden Hospital, Fife, where the female patients were in dormitory accommodation with male patients in single rooms down the same corridor and no nurses around to protect or to keep us safe.  I know for a fact that women in that ward as patients were at risk of sexual exploitation, in 2010 and in 2012, and may still be.  

Fortunately nothing happened to me because I swallowed the drugs under coercion then got myself discharged within a week, so as to make a sharp exit.  Then I remarried my husband to make sure I had a close friend who would stand with me in my recovery.  Because he had stood with me after the forced drugging in 1978 and 1984, helped me to escape ECT by taking me out of the ward in my pyjamas [avoiding ECT when hospitalised in 1978 after first postpartum psychosis; then Krypton Factor 1980].

I am fortunate to have had many allies over the years when resisting the force and escaping the system.  And these have included psychiatrists, up to this present day, one of whom is a very good friend and shares his life with me on a daily basis, with encouragement, treating me like an equal and demonstrating that very quality which I glimpsed in psychiatry back in 1970 when my mother was in the Kinnoull Ward of Murray Royal Hospital, Perth [Dr Peter J Gordon: Hole Ousia].  

That is the paradigm shift which I'm looking for.  Level playing fields.  Being treated like an equal.  Having the right to say No.  Alternative ways of working with people in mental distress that don't just mean forcing drugs into us until we become compliant.  It will require psychiatry to stop shoring up the divisions and for clinical psychology to start behaving responsibly, inclusively, welcoming diversity.  Then psychiatric nursing can do the job they were trained for, being with the person, listening and supporting.  Making "the world feel like a much less dangerous place" [thanks to friend Mary MacCallum Sullivan, psychotherapist, supervisor and teacher, for this quote].


slide 7

Dear Professor Coyne I make no apologies for telling a story because for me the evidence base is the story


  1. A wonderful, thought provoking read. Thanks for sharing your experiences. I'm a newly qualified clinical psychologist working with people who've experienced psychosis and I worry about being part of a system that, for some at least, seems to have been more abusive than therapeutic. I wonder what your thoughts are about what the profession needs to do differently to be part of the change in the system that you envision?

    1. I don't really have an answer to your question but thank you for asking it.

  2. From Mary MacCallum Sullivan:

    "Response to ‘a newly qualified clinical psychologist working with people who've experienced psychosis and I worry about being part of a system that, for some at least, seems to have been more abusive than therapeutic. I wonder what your thoughts are about what the profession needs to do differently to be part of the change in the system that you envision?’

    I have no intention here to speak on behalf of Chrys, but from my own experience as a psychotherapist and a person.

    Chrys points out that, if you don't know what it's like ‘to have your agency taken away’; if you haven’t experienced ‘an altered mind state’, you should be listening to and respecting the person who has. She remarkably reveals: ‘I trusted [mental health professionals] to take care of me as if they were my parents’.

    Is it so surprising that she should resent being forced to take medication which radically damaged and curtailed her sense of self?

    She says ‘Yes to an epiphany and Yes to a paradigm shift that will mean treating a person in a psychiatric setting as an individual with the capacity to say No to forced drugging and invasion of personal space’.

    Clinical psychologists, together with other mental health professionals, could usefully seek to not only listen, but actually hear and feel, what Chrys is saying. Recognise the need – and the opportunity - for the paradigm shift that Chrys calls for, so that the subjective experience of people suffering from the degree of distress that qualifies for a mental health diagnosis is fully respected.

    Recognise also the trust that has been placed in you – we are in loco parentis. And especially when someone is so vulnerable, we must seek to honour that trust. We will fail, no doubt, but that failure should be acknowledged, and hopefully repaired if we open ourselves to learning from this other, this other that I am meeting here and now, this particular other. I should not base my thinking on what the books say, what the ‘evidence’ says, but on my attempt right now to just be with this person and pay close attention to what it is that they most strongly need from me in terms of my response and my action, hopefully in the service of their well-being – as defined by them.

    There is an important question of social and interpersonal justice, and clinical psychologists, psychiatrists and psychotherapists are in the front line here."


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