Way to go

Time and again, I read threads about attacks of psychiatrists and psychiatry. I have just come across another such thread and want to comment.

Dr Ben Janaway published this thread on attacks on psychiatry and himself.

and I mostly agree with what has been said there, including with references to life saving, diagnostic criteria as guidance, holistic outlook on patients and other stuff. I am also truly sorry for the personal emotional toll such attacks have on clinicians. But I think the thread is one-sided. What’s missing from the thread is understanding where the aggression comes from. And before I continue, I want to say that this blogpost is not about condoning abuse, it is an appeal to acknowledge much suffering psychiatry and psychiatrists have and continue to inflict on their patients.

When I started my interest in psychiatry, I became an intern in the psychiatry clinic on Jagiellonian University in Krakow and I quickly changed my views from strongly anti-psychiatric (here is my post on why I rejected anti-psychiatry). I witnessed psychiatry at its best. The shrinks there were thoughtful, reflective, open to challenges. I have no doubt their patients did and do receive very good care. But I was often told that that was not psychiatry. What I saw was elite psychiatry to which only a handful of patients have access. Go and see a local loony bin, in a small town, then you’ll see really psychiatry, I was told. And as it happened I did.

So, let me share with you two images (there are many, many more) that I wish I could unsee. They are images that have haunted me and to a considerable extent they also define what psychiatry is for me.

I was waiting (I can’t remember what for) in a closed psychiatric ward, just mindlessly looking ahead, when suddenly I saw a figure of a young woman, perhaps in her late twenties, dressed in heavy duty hospital pyjamas. She was heavily distended, so her belly was clearly seen as the trousers were tightly wrapped around it. She had long hair which had obviously been unwashed for a significant period of time, greasy strips of hair on her front and back. But the most haunting were her eyes. Her eyes were empty, unseeing. Hollow. She shuffled her feet with effort, moving very slowly along the corridor. That young woman, drugged out of her mind into a psychiatric zombie, is also what psychiatry does.

But the second image is worse; it comes from a local psychiatric hospital in a small town in Poland. I entered a closed male ward, looking the psychologist with whom I had an appointment, only to witness the following scene. Two orderlies, big men, had just got hold of a patient, shouting at him to take his medication. The patient, considerably smaller than the orderlies and only in his underpants (which hadn’t been in a washing machine for a long time), distressed, was shouting he didn’t want to take his drugs. As he was wriggling out of the orderlies’ grasp, one of them lifted him and smashed him on the ground, pinning him down.

If you ever saw action movies with a hunky protagonist smashing his enemy flat on the ground and thought it was not possible, let me tell you, it is. I saw it happen, in front of me, to a patient receiving psychiatric care. And as the patient was lying on the floor on his back, the other orderly produced a watering can, and said something like (obviously, he said it in Polish):

If you don’t swallow your medication, I will shove this fucking thing down your fucking throat and drown you. But you will take your fucking medication.

I was watching the scene with my mouth wide open, wondering what would happen next. I was considering my options, but the psychologist I was waiting for appeared in front of me, with a polite smile. She invited me to her office. For a second or two, I was wondering whether she would react to the scene. She must have seen the patient lying on the floor, held by a big man, as the other was preparing to put a watering can into the patient’s mouth.

No, she didn’t. She did nothing. She didn’t even blink, like there were not there. I am not certain what was worse, the violence or the clinician’s complete indifference to it.

And let me add – these two stories are not from times past, they are about 21st-century psychiatry which knows full well its history, legacy and has reflected on it. And please do refrain to see of those stories are representing the ‘few bad apples’. I don’t think they are. I could also tell you much more about what I saw in psychiatric hospitals, what I heard from the patients I spoke to. It is psychiatry in Krakow which is an oddity, something that doesn’t happen all that often. And then, when you read clinical notes, when you listen to interviews, you begin to understand how bad it can get.

So, when I heard a shrink once mock the word ‘survivor’ used in reference to psychiatric patients, I thought (and said) that perhaps he should reflect some more on what he does. He wasn’t persuaded. And that’s another side of psychiatry. Too self-obsessed, too defensive, and too  ignorant…You name it, it’s probably guilty of this too.

So, I must admit that I baulk at Dr Janaway’s statement of forgiving those who attack psychiatry and psychiatrists. I would like him to remember that he is part of an institutional system that is not only oppressive (all medicine is), but it can crush you, fall on you like a tonne of bricks and obliterate all that is you. And it has done, always full of itself, to countless of patients. So, if there is any forgiving to be done, it’s not the shrinks’, I don’t think.

I want to repeat, I think psychiatry can and does save lives and I still think it is the most useful way in which to see human misery. But when a shrink asked me once when psychiatry could stop beating its breast, saying ‘mea culpa’, my answer was: Don’t worry about it, you have a way to go.

  1. Such psychaitric abuse is appalling. But is it where the attacks on psychiatry actually come from? To establish this would require considerable empirical research into not only the psychiatric histories of those who make the critiques, but also into their psychologies. For it’s not exactly unheard of for people to project shame of their brokenness into their parents, into particular doctors, something called ‘society’, into something called ‘psychiatry’, etc. In short, to understand what prompts the critics of psychiatry we’d need in particular to assess the *quality of their animus* in individual cases.

    1. Dariusz Galasinski

      Thank you, Richard. Of course, attacks on psychiatry have more sources. It can be prompted by one’s own experience, by another’s experience, it can be prompted by anti-psychiatric literature. My favourite, I suppose, are continual discussions about real/unreal illnesses together with shaming the ‘language of disorder’ (imo, such a phrase has no referent in any reality). And so, as ‘we’ rightly persuaded people to be me watchful as to what happens in the medic’s surgery, we also gave them permission to question everything.

      To give an example that is now happening in my TT timeline. One shrink said ‘the pain is real to them’. Like on cue, he was criticised for saying ‘for them’, and immediately accused for ‘invalidating patients’ experience’. Needless to say, nothing of the sort happened, but individual experiences, together with professional point-scoring found a way for yet another blow. I think psychiatrists should be aware of psychiatry’s legacy (as I said in the blog), but that doesn’t mean that each and every one of them should carry a whip and wear a tight cilice on their thighs, making sure they hurt too.

      And so, I continue to think that ‘we’ spend way too much time on whether this word or that word should be used, rather than on what kind of care people receive.

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