on my experience with psychiatric services

written by Anonymous

Around seventeen years ago I received a vague psychiatric diagnosis of paranoid psychosis/schizophrenia. Over the course of about a year, I was institutionalised twice, with each period of psychiatric incarceration lasting just over three months. A couple of years later I was hospitalised again, this time for a much shorter period of about two to three weeks.

I am still in the process of coming to terms and articulating this experience, with writing this article being part of that process. Whilst there are many aspects of my contact with psychiatric services that I can write about, in this article I want to focus on the subtle and not-so subtle ways through which I was stripped of agency and my subjective experience invalidated, in addition to having the ‘lacking insight’ label ascribed to me.

Perhaps one of the most conspicuous ways through which I was stripped of agency was when physical force was used against me in being hospitalised in a psychiatric facility against my will. Specific examples of physical force being used against me as part of the process of being sectioned include the police physically handcuffing me and manhandling me into a police car in order to take me to the psychiatric facility. Another example occurred when I was first admitted to the hospital and attempted to leave the facility. This involved me being pinned down to the ground by psychiatric staff and injected with sedatives.

On reflection, one of the main ways in which this experience was significant to me is that it constitutes the first time that I had first-hand experience of state violence, i.e. physically coercive force backed by institutional authority, being used on my person. Whilst I was aware of agents of state violence, such as police, army, etc, my perception of them was influenced by their portrayal by the media industry, and second hand accounts from acquaintances. As naive as it sounds, I did not perceive state violence as something that would ever be used against me. Before this experience, I only had a vague awareness of what psychiatric detention was, and again this vague awareness was completely conditioned by the media industry. Before then, pre-reflectively, I would not have viewed psychiatric services within the context of being agents of state violence. You may well ask where I thought I was living up until before then, and indeed it is a question that I regularly ask myself.

During that initial contact with psychiatric services, another, but less conspicuous, way in which I was stripped of agency and my subjectivity invalidated was the hospital staff’s insistence on addressing me in an over-familiar way by my first name. From the outset, for example when in the police car that was taking me to the hospital, they kept insisting on addressing me in over-familiar terms by my first name, despite my explicit request that they address me formally by my surname i.e. Mr… . Indeed, instead of carrying out my modest request, they more or less stated that it was a manifestation of illness.

Another way I found myself stripped of agency and my subjectivity invalidated is psychiatric staff’s use of the term ‘agitated’. This term is normally used by psychiatric staff to describe one’s state when one reacts strongly to one’s circumstances, such as being incarcerated against one’s will, and when one finds oneself vigorously acting on genuine beliefs. In many circumstances the term encompasses having rational emotional responses to these beliefs and stimuli. The use of the term ‘agitated’ suggests that one’s behaviour or reaction is being subject to some external force outside oneself. It is suggestive of contexts of where one reacts to the stimulus of a political or social ‘agitator’, or the context of physics and material science where some material is ‘agitated’ by an external force e.g. such as when a liquid is stirred. I experienced the use of this term and its connotations as constituting a direct invalidation of my subjectivity, as my behaviour or reactions that caused psychiatric staff to use the term ‘agitated’ to describe myself at that moment in time arose from genuine subjective states immanent to oneself. When the label is invoked it is also used as a rationalisation to further strip people of agency i.e. it used as a justification for further psychiatric interventions or measures against oneself.

I was also stripped of agency by having requests regarding my treatment disregarded. When I was first detained under the Mental Health (Scotland) Act, I became aware of my having the right to make an Advance Statement regarding how I would like to be treated if I became unwell to the extent that other people had to make decisions about my mental health care e.g. decide to detain me under the Mental Health (Scotland) Act. Immediately after I learned about my right to make an Advance Statement, I submitted one to hospital staff. For reasons that are beyond the scope of this article, the statement requested that in the event of my being mentally incapacitated I would not like anybody with strong religious beliefs, especially a belief in an afterlife, to make decisions about my treatment. This request was shot down immediately, with the psychiatrist informing me that I had no right to make such requests via an Advance Statement as it was submitted after I had been diagnosed by them as being mentally ill. I perceive both the refusal of the request, and the reason given for its being dismissed, as further stripping me of agency.

In relation to the content of my Advance Statement, there was a particularly pernicious incident whereby by psychiatric staff stripped me of agency and invalidated my subjectivity during a period between my psychiatric incarcerations. In this period there were multiple meetings in my home in which the psychiatrist, MHO, myself and family were in attendance. During one of the earlier meetings, I asked the psychiatrist if they had any religious affiliations. They answered yes, without going into detail, and then subsequently informed me that on the basis of me asking that question that they were going to increase my medication to the maximum dose. I experienced this as a particularly pernicious form of agency stripping, given that it left me highly conscious of what I said in front of psychiatric staff and had very much a chilling effect on my ability to speak freely with them and in communicating many aspects of my subjective experience.

During one of these meetings between myself, psychiatric staff, and family that took place in my home, I remember being asked a question. Before speaking, I took a small pause before answering, as a I normally do, in order to think about what I wanted to say in response. The psychiatrist told my myself and my family the pause was a manifestation of illness. I view such pauses to think about how to articulate what I want to say as part of the expression and development of my interiority. I interpret the psychiatrist saying what they said as an attempt to the flatten my subjectivity and an attack my interiority. I very much see this incident as highlighting that there must be a stark contrast between what the psychiatric practitioners that I had contact with deem as constituting mental health and what I deem to constitute what it is to be mentally healthy.

The flattening or ignoring of my subjective experience and interiority by psychiatric staff described in this article is one of the aspects of contact with psychiatric services that in many ways surprised me the most. Before my direct contact with psychiatric services, I had naively imagined that mental health intervention was about delving into a person’s subjective experience with them in order to help them address whatever was causing the distress or pathological behaviour, and aiding them in developing a healthy interiority.

The process of hospitalisation also stripped me of agency in many other ways, including it constituting for me a process of inducing mental and physical atrophy. When I brought this up during tribunals this was not addressed in any way and the point was completely ignored.

Another agency stripping aspect of my experience with psychiatric services is the sense of fatalism they seemed to try and induce. This was exemplified during one routine visit to a psychiatrist where they said that I ‘suited’ a particular anti-psychotic.

Whilst this article recounts experiences with psychiatric services that occurred around seventeen years ago, I still live with the diagnosis and am still on the anti-psychotic medication. I have been fortunate in some ways, in that I have the time and the means to be able to reflect on my madness and contact with psychiatric services, and make the best of a bad situation through using my experiences as a form of reflexive character building. I am also able bring this to bear into how I contribute to society, which is through being very active in the voluntary sector. There are those who have been much more unfortunate.

image by J R Korpa via Unsplash