Some time ago, I insisted that ‘It’s not OK to talk’. I quoted an article in which an American professor described his experience of psychiatric ward. Unsurprisingly, the account was anonymous. And this what I want to write about again. It’s not OK to talk.
The reason why I come back to the topic is two-fold. First, recently I wrote about the tragedy of a doctor who killed herself basically because she wrote about her mental illness on her blog. But here, second, is what tipped the balance. I came across another personal account of psychiatric care. This time it’s from a consultant psychiatrist who, as she put it, she “had a taste of her own medicine.”
If you clicked on the link, you will have already noticed. Yes, also this account is anonymous again. And I really would like to ask: “Why?!”. Doesn’t the psychiatrist know that it is OK to talk? Doesn’t she know it’s good to get it off her chest, that talking helps. After all, as I heard so many times, it’s OK to talk, innit? Or is it?
Let me put it like that: when you say “It’s good to talk’ whom exactly do you mean? I can hardly speak to your average person, including friends, often families. It is the average person’s complaint that started this unbelievable chain of events which resulted in a doctor’s death. And to be honest, there is so much research on stigmatisation of mental illness, that there is hardly any point in labouring this point.
Can I speak to a doctor, though? Let’s see how the hospitalised psychiatrist fared. Here is a fragment:
My consultant was a former colleague of mine, a peer. She was kind but paternalistic, and my care became a battle of wills. She believed her plan was faultless and that her ward was entirely beneficial. She conducted her ward rounds like job interviews and treated me like an adolescent. I watched helplessly as she pathologised my normal behaviour and denied promises to get me to comply.
Let me sum it up. Not only is not OK to talk, it’s bloody pointless to talk.
Now I’ll say a few things about talking, I am sorry, if they are completely obvious. In order for communication to occur, three things must happen. First, there must be the communicators, the speaker and the addressee, normally, taking turns when speaking. Second, a channel of communication must be open, that is to say, not only must you be able to hear each other, but also you must listen to each other. If you stop listening, you close the channel, like you would by hanging up the phone. Third, the speaker and the addressee must cooperate in communication, i.e. they must talk to the point, tell the truth (without the so-called truth bias communication is nigh impossible), they must say just about as much as is needed, and be clear. Obviously, points one and two describe the basic model of communication, while the third describes Paul Grice’s Cooperative principle.
And here is the problem. Whenever you say ‘It’s OK to talk.’, you should stop and consider these points. Will I have anyone to talk to? Will they listen to me? Will they be engage with me? The stories above suggest that the answers to such questions are mostly ‘No, no, and no’! No, no, and another no!
Judging by the account of the hospitalised psychiatrist, her doctor – a colleague!! – wasn’t really interested in establishing communication. And if she did, she seems not to have listened much, and, to round it off, she simply lied. And, let’s be very clear, that’s to a patient who, in her own words, can stand up for herself! Yes, please do wonder, what happens to those patients who cannot stand up for themselves.
When I read or hear such stories and they are legion, it always seriously irritates me when I hear yet another ‘It’s OK to talk.’. Not it’s not. And quite recently a person killed herself because it is so bloody not OK to talk! As these well-intentioned appeals to talk are repeated, I keep wondering whether all those making the appeals think about the risks involved (yes, also like the doctor above). What if I believe you, but I am also not listened to. What if I am ignored, treated like a child, lied to?
Let me finish with a story. Many years ago I was invited by a psychologist to his office in a hospital, where he was seeing patients. He wanted to tell me of a technique he was using. It was quite a shallow box, about a metre long and half a metre wide. It was filled with fine sand. Next to it was a cabinet filled with figures, mostly, but not exclusively, human-like, in different sizes and colours, representing people of different genders and age groups. Basically, he asked his patients to position the figures in the sand, which he interpreted in one way or another.
I was barely listening to him as he was telling me about it, as I was thinking about being asked to play toy soldiers in a sandpit. Yes, if I were his patient, I, a grown man, would be asked to play in the sand. To be completely honest, my thoughts about what I would do with the (bleep) sandpit cannot be repeated here.
He never gave it another thought what his method might mean, he never questioned his assumptions. I can only imagine what his patients were thinking as they were ‘playing in sand’. I know what I would, struggling to keep calm, knowing full well that if I say anything, I will have acquire another symptom. Perhaps this story, a true one, will help in understanding what ‘It’s OK to talk’ means. When you say this, you offer a promise, a reassurance. You can’t. So stop saying it.
In the initial post I suggested saying: “I will listen.”, but perhaps even this is too optimistic. So if you want to say something, say:
It’s important to talk. If you have someone who will listen.