What we say and how we say it counts. It has an effect on those who hear it. Likewise, what we hear affects us too. It is the power of language that works to connect us with each other or, to alienate. It is quite rofoundly magical in its effect. Perhaps that´s why we call the construction of words and the speaking of them out into the air, "spelling". Context and interpretation play their part in these exchanges. Add in to this mix the equivalencies of power and authority and we have an intriguing mixture of component parts. We can make our choices when it comes to the words we speak and the effect it may have on another. Just as important, we can also choose to be persuaded or not, to believe or not, when words are spoken by others and to us in return. In my many years of patient representation in psychiatric hospitals, I sat in on hundreds of consultations, care meetings and patient tribunals. My role? To keep my own opinions to myself, to listen and to help the patients, often detained against their wishes, to represent themselves and share their points of view. It wasn´t always easy. In such trying circumstances,whether a person agreed that they were ill or not with a psychiatric condition, the odds were stacked against them. Finding the best words to debate nursing staff and psychiatrists, well versed in the terminology and concepts which has been their exclusive training, often proved to be an uphill climb. Resistance was deemed to be "non-compliance", expressions of frustration were sometimes written up in nurses notes as "anger". and "lack of insight" rather than "frustrated" and " has a different opinion to the staff". I suppose, if you only have a hammer, you only see nails, this being a result of training, Add to this the loss of liberty, the often outdated and cramped conditions, forced medication and limits placed on personal autonomy, even temporarily, and it is easy to see that, even with the aid of a patient advocate, trained in negotiation skills, representing themselves and speaking to their situation was hardly a simple task for people faced with trying to get used to strained and uncertain circumstances and negotiate themselves through an entirely new personal experience. Let´s say too, that the views of trained nursing staff are pretty much fixed. For all the necessary reasons, they have been trained / indoctrinated ( you choose) into a model of understanding and analysis that is focused on identifying illness symptoms but can struggle to identify signs of wellness. They become inured against patients self- presented evidence that all is well, as they have learned too, that patients know that, in order to escape or ease their path out of a system they feel trapped in, they minimise and under report distress and emphasise that they are feeling better, often for fear of extending their time in the hospital. Many patients learn to do this and they often pass on tips and hints in coffee rooms and quiet conversations on the wards in gaming the system / winning freedom. The task? To persuade staff that they are ready to go home as soon as possible and leave the environment that, although intended for healing, is too often a distressing and disturbing place to be. . And so it becomes something of a game, individuals trapped in a kind of labyrinth, a maze, a hall of mirrors, where words are meaningful or meaningless, depending on who is speaking and who is being believed, the recovering / recovered enough patient or the trained psychiatric professional. Of course the staff trapped in this labyrinth are pressured themselves. There is too much paperwork, not enough time for people. They often work in inadequate buildings, under funded services, always on amygdala alert standby for crisis management and firefighting, taking up too much of their valuable time. They came into this world to help with healing. What they often find is institutional and outdated ideas around patient management, inherited from the past, bed shortages, symptom suppressing treatments and very little else. We desperately need fresh thinking and recovery focused perspectives for all. patients, people and staff, but we muddle along and make do with makeshift approaches and not enough resources. Hospitals ought to be beautiful places, designed with wellness in mind and not functional, grey walled, crumbling ruins like many parts of the one I worked in. If there is one area of interaction where words had authority and unchallenged power, I would say, based on my experience of sitting in on brief consultations with newly admitted individuals, it would be the words spoken by consultants to the person. Specifically at the point of issuing a diagnosis. Often quite soon after initial admission. In my seven years at one of Britains largest teaching hospitals, I am happy to say that there were a small number of consultants who were CAUTIOUS and CAREFUL. They wanted to more patiently explore, ideally, the circumstances that led to a persons admission before announcing a label or diagnosis that they knew might be given too hastily. However, there were some consultants who seemed to pay minimal attention to a persons story of difficulties and misunderstandings. They were busy listening for signs of symptoms as they conducted all too brief interviews and ticked the relevant diagnostic boxes, often ignoring the potential clues given by the patients connected to areas of social distress, relationship issues and emotional and psychological support needs. Areas where practical and psychological help was definitely needed. But no. There were few resources for much of those needs too. And so, the focus was on fast prescribing and, sometimes, after an initial "interview" lasting several minutes. And this when, quite often, the newly arrived person was at their least able to comprehend what was being said and decided, a time when they were often confused, hesitant and highly anxious. All traits, of course, that can be seen as symptoms of pathology, i.e lack of focus, inhibition etc. There´s no way for them to win that particular battle and it is only after that the realisation dawns that this initial interaction will prove to be a vital force in the future. Once given a pathologising label it is very hard to get rid of it..It sticks to you like an invisible plaster that only the medics can seem to read. These fast drawing doctors were " thought leaders", paid by large drug companies to put their own clients onto specific medications, while encouraging colleagues to do the same. They received bonuses in the form of gifts and cash.They were taken to conferences in glamorous locations in the Bahamas and USA, all expenses paid. They got to play golf in the evenings and drink cocktails. Sounds beautiful, Their job? To get as many people on these particular drugs as possible, as quickly as possible. Because that is where the big bonuses were earned. And so there was an inbuilt incentive to prescribe. This meant we had competing ideologies within the senior ranks of the psychiatric service team. Let´s call them "careful" and "quick". The "quicker" ones were always faster with the diagnosis. Faster to insist on medication and faster to tell the person that they will" get them well". They just had to start taking the medicine for the rest of their lives. I was often shocked and a little bit scandalised when I witnessed these exchanges. I began to research the long term effects of taking psychiatric medication. It´s the subject that they never really wanted to discuss with me, psychiatry had a dirty little secret you might say. It´s not a popular subject of discussion. And this is also a meeting point for language and personal and political power. The consultant psychiatrist is, to all extent, a sort of senior management figure. Revered by underlings and treated a little like a small god. No one dares to challenge him or her. Nurses are required to carry out orders, patients are meant to , ideally, agree with given diagnosis` and follow the rules,the procedures and the instructions. Once and if they begin resisting any of this, they are perceived as difficult clients without insight" into their pathological condition. In itself a further sign that they are mentally unwell. Increased medication and more restrictive control measures may be required and back into the labyrinth of experience they must go. The game continues. But it is real. Psychiatry is an interesting and unique branch of medicine. it is, as far as I know, the only discipline that can forcibly treat people without their permission. It can insert experimental and established neurochemical drugs and treatments into peoples brains and bodies. That itself is a very powerful state sanctioned action. Imagine if your family doctor turned up at your house and started treating you, even if you protested and resisted that you did not wish it. It is often contentious. it touches on civil liberties and the rights of citizens to exercise choices and express preferences. It is a power that is unique in medical practice. And here we return to the power of words. Who says what to who and who believes what is said. In situations like those above, who can not see that a person can feel hypnotized by the expertise, spellbound by the magic words, words spoken eloquently by the arch magicians and modern wizards of medicine, the psychiatrists. Aided ably by their alchemists, the chemists. the apothecarists. The good news? Things are beginning to change. Maybe in small ways and by degrees but, with the introduction of advocacy and patient representation, the support that is given to encourage and allow people who become patients to get their voices heard in hospital settings sometimes means that treatments get changed, care plans get altered. Voices are heard, I saw his many times too. Mental health professionals, doctors and nurses, would benefit themselves and so many others, by relearning the skills of listening and providing an empathic presence. We would we see that there is at least some element of authentic inclusion and genuine reciprocity and balance getting injected into the systems of institutional thinking and rigid beliefs that, all too often, are, either by blind design and developmental habit, acting as self serving guilds. Words are powerful. They mean a lot. When people find themselves under the authority of state sanctioned power, the role and responsibilities of a good advocacy worker help to get those words, so often lost and silent in places where they are most needing to be heard, , heard. And then people will feel included, respected and involved.
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July 2021
AuthorActivist/ Health worker/ 20 years. Specific interests : wellness/ voice hearing/ coping/ exploring/ sharing/ stigma reduction. |