Can treatment be effective if it’s forced?
I’ve missed writing to this blog. Got caught up with work and busy holidays and the time has just flown by. But I’ve got some time now, stranded in the Detroit airport, trying to get home after a work trip. This job was interesting – I was asked to tape two TV episodes for a series on mental health in Missouri. One episode’s topic was trauma and trauma-informed care; the other was self-inflicted violence (SIV). As much as I despise cameras, I thought this was a great opportunity to talk about what I believe and hope for when it comes to promoting understanding and healing for people with psychiatric labels, especially those who live with SIV. I really enjoyed spending time with the host of the program, Tom Parquette. The more we talked, the more I realized that we shared a vision of change. I hope that our dialogue is useful to people.
Yet sitting here, thinking about the conversations that were taped, I realize that I wish I had made stronger statements about the horrific impact of coercion in the psychiatric system. While Tom often urged viewers who might be struggling to seek help, I would occasionally caution people to be wary of the potential dangers that come from seeking help when you live with self-injury. Not all help is the same. Some of us have found hope and understanding from mental health professionals. But many of us have also been greatly harmed by people with the same credentials. When you live with SIV, you run the risk of being coerced into “treatment†– the belief that, since you live with SIV, you need to be acted upon “for your own good.†And it is not uncommon for “treatment†to consist of being locked away or tied down (and then being billed for it). While the goal of my work is to help create a system where trauma-informed care is available to anyone who wants it, the majority of the mental health system currently uses coercion in some form.
So what is the harm that comes from being coerced? As I thought about what I wanted to say I remembered the writing of psychiatric ex-patient, activist, and mentor Rae Unzicker’s words in her piece History, Principle, and Definition of Consumer-Direction and Self-Determination (published in The International Center for the Study of Psychiatry and Psychology Newsletter, Spring 2002, pg. 4-8). These are the words that I wish I had with me during the taping of the shows. It’s too late to say them to the cameras, but I am glad that I can share them with you.
In the article, Rae boldly spoke about the many ways psychiatrically labeled people are patronized and managed, even in the name of “empowerment.†While discussing the evolution of the consumer movement she forcefully brought out the reality that freedom cannot be possible as long as coercion remains an integral part of psychiatry. She made us consider that, while consumers can promote many changes in the system, of what merit are they when force remains? She wrote:
Involuntary treatment is the battleground – not better services, more money for SSI, managed care, or any of the other important issues we discuss politely.
Because it is the fear of civil commitment that drives each of us… You don’t get upset – and you certainly don’t get your parents upset. You become in a thousand little ways more cautious, less expressive, blander, less alive – so you don’t stand out, so no one notices you. And this is the beginning of the encroachment, when spiritual death begins. It is a day-to-day tyranny, a slow wearing down of the spirit.
No longer do you trust your own bright clear inner voice. No longer do you know what’s best for you. But someone else does.
Her words describe some of my experiences in the psychiatric system when I was being “treated†against my will. As a result I sometimes, after all these years, fear speaking my mind, whether in front of a camera, an audience or a friend, because I am afraid that someone will lock me away again. One look at my scars, no matter how old, and they might be able to get away with it. Is this likely to happen? No. But is there a remnant of fear deep in my gut? Yes. I thought I’d share it with you. That will lesson its power and next time, when I’m in front of the cameras or the audience or the friend, I will speak a bit more strongly and clearly. I will agree that people who live with SIV should have access to, and be able to ask for, all the help possible, but that there remains potential danger in the asking. I will remind myself and others that we must continue to create places of healing for ourselves and each other that do not depend on any organized system of care. Care comes from our own and each other’s understanding and tender hearts. Hope that you are taking care of yours and I thank you for listening to mine.
January 27th, 2009 at 3:46 pm
We are forced to go to school. We are forced to believe that HIV pills are the only way to “manage” the disease. We are to follow the laws.
I am sick of established so called “therapy” concepts.
I am sick of worrying about all things including the sports world.
I want to get out .
I think that all things illegal should be legal.
Get out of my life world.
February 1st, 2009 at 12:00 pm
I’m so happy you had time to update! I’ve missed your posts.
I give thanks every day for how incredibly lucky I’ve been. I’ve only seen one therapist and she is wonderful. She’s never tried to force me to give up my self-injury, or to control it in any way. She understands completely that it is only a sympton, not the problem. My psychiatrist is not quite so understanding, but the only thing he’s ever threatened me with is higher dosages of medication and it’s entirely my choice whether I take them or even continue to see him.
It is because of people like you that the system has changed. Thank you for being brave enough to speak out against forced care. Thank you for writing this blog. Reading sites like yours lets me know that I’m not alone and that there is hope.
February 5th, 2009 at 7:41 pm
Thanks for writing to John and Shade. What a difference it makes, the world of force versus the world of understanding and support. Those are oppositionall experiences… that can make a life or death difference for many people who live with SIV. How do we promote the healing, how do we help the public understand the harm done by force (the public that is taught to fear us, look down on us, and to “get help” for us)…? What can we do to help ourselves and each other?
February 10th, 2009 at 9:10 pm
I was hospitalized twice due to my SIV. Each time, I spent two weeks locked up as they adjusted my medication but never addressed the reasons why I cut. Each time, I was released back to the same life with the same stressors. Each time, hospitalization failed to end the cutting. After a time, I stopped cutting, more because of the fear of hospitalization and loss of loved ones than out of an understanding of why I did it. It was always waiting in the wings, calling me. The sirens song became too strong and I started again. This time, I found a therapist who didn’t throw me in the hospital simply because I cut. I am working on why I cut more than on totally stopping. I am trying to cut less but know that if I do cut, I won’t end up in a psych ward. Locking people up when they cut only isolates them further — most stays in psych wards are short, due to insurance guidelines, and only stick a bandaid on a huge, gaping wound; the wound that causes the cutting behavior. Most people are frightened and repulsed by SIV — they don’t understand it and they don’t want to. We need to be understood, not locked up.
March 1st, 2009 at 3:40 pm
Please understand that I fully recognize all of the frustration vented here. I do have to mention, however, that in my position, if I failed to intervene (even thought that would just be a referral), I could be sued for ignoring a problem. It seems to me that lawsuits, and the fear of them, drive the force in treatment. The first kid that gets ignored and dies, there is likely to be a lawsuit.
March 12th, 2009 at 11:47 pm
I’m a mental health professional who has seen first hand the horrible impact of forced treatment for SIV, paticularly forced hospitalizaton. It is no longer a standard treatment here, but unfortunately, for adults, it has been replaced by ignoring or actually judging and rejection of anyone seeking help for SIV. Fortunately a more compassionate and supportive approach is utilized for adolescents. I live and work in a rural area. The metropolitan area nearby, fortunately for me, is more liberal and progressive than the rural areas. I sought therapy, away from my rural collegues for anonymity, for help with overeating issues over a year ago. As part of that process have had to face my own (needless to say secretive) SIV, and a history of sexual abuse. My therapist has always been respectful and trusting in my own ablity to keep myself safe, and work towards healing what hurts so I don’t have to anymore. My ’symptoms’ are not completely gone, but after over 25 years of living with that particular shame, it is vastly improved, and as therapy moves toward closure I can see a future where SIV will not exist in my personal life. If I had been forced into any kind of treatment, or even experienced judgement, I hate to think of where I would be right now. Not a healing place, i can guess. My hope is once I am healthy I can advocate for change in our rural area. I am using a psudenom because of fear of being ‘found out’ by collegues. There are some that are compassionalte and understanding, but they are greatly outnumbered by those who are not. Thank you for supporting an important but under represented issue in mental health.
March 13th, 2009 at 9:31 am
I was institutionalized during my entire adolescence due to SIV. I was treated like Hannibal Lechter (jr.). I was very isolated and “treated” by being tied in a psych chair, forced to wear mittens and a helmet…I was allowed no contact with anybody except one nurse for 15 minutes per shift. The Dr. in the state hospital wrote an order that restraints and strait jacket were for 24 hours, no less, each time I was forced into those, and that happened for things such as saying “fuck you” which did happen once in a while…how could I have been so….adolescent? Also, I was force fed medication and they spoon fed me…so, here I am, still alive, not institutionalized…that experience taught me to dissociate my dissociation even. I went so far into myself that I do have a wall that I still cannot break through. I do function, have friends, have compassion, a job, car, pet…I of course was a childhood sexual abuse victim and was removed from the home for that reason and ultimately ended up in a state hospital because I was affected by the 12 years of abuse…I needed somebody to tell me that there was nothing wrong with me for being affected, that I didn’t deserve abuse from others or myself. My history was well known and never addressed other than “it’s over now, you can move on” which I took to heart and wondered what was wrong with me for not being happy now…I was told “you are as happy as you want to be, it’s up to you” I was 14…how sad that nobody could face my past with me and now I can’t face it with another, I do this alone mostly even though I do have a therapist…anyway, I no longer cut myself, I found that when I gained freedom, I found other coping mechanisms, at first they were horrible, namely drugs, but now, years later, I cannot imagine cutting myself, it would hurt now…I hope for everybody to learn that they do not and did not deserve abuse and it’s okay to be good to you…