In my book Fragile Minds, I wrote about my recent experiences as a student mental health nurse in England. I wrote about real incidents and real things that staff said and did, which I scrawled down in disbelief while training.
Since its publication, I am beyond grateful for the survivors and staff who have contacted me or written in support of the experiences I needed to make public, though the book has also been called a ‘furious attack’ on psychiatry that doesn’t ‘ring true’. I have been labelled as having a ‘saviour complex’ and as being ‘grandiose’ for asking questions about the treatment I witnessed. It has been claimed that I must be writing these things for my own gain, or that I must be a scientologist, or that I’m not knowledgeable enough to have an opinion on issues that are ‘far too complex’ for people like me to understand.
Publicly criticizing psychiatry and our treatment of mental ill health can feel terrifying; it fuels vehement responses which cloud our ability to hear each other and drives us to lash out. It threatens our understanding of ourselves, and our relationship with the world, and highlights our ability to repress and ignore the things in society that are too painful to confront.
So despite having no public profile, I was genuinely frightened of the backlash I would receive. I wondered: if I somehow managed to portray an equal balance of ‘good and bad’ care experiences, would the undesirable truth of the shocking and at times cruel treatment of service users that I witnessed could be digested and believed more readily?
Can we, in fact, continue to champion our free health care system, which I am extremely grateful for, whilst also calling out its abuses both on a systemic and—the really tough one—individual level?
Yet, this desire for a balanced depiction felt fraudulent. The reality was, much to my surprise and disappointment, that I hadn’t witnessed much inspiring or even reassuring care during my two years on mental health wards and in community teams. What I had actually witnessed was overwhelmingly and starkly not good enough.
Stories of good or even excellent care by medical staff, including mental health staff, are of course dominant in our media. The narrative that we are all immensely empathetic, selfless and dedicated despite the challenges feeds into a national pride that I have also felt enveloped by.
I know from both my training as a mental health nurse, and later as a psychotherapist, that we are largely encouraged not to engage with or question other practitioners’ approaches. I’ve been told to ‘ask fewer questions’ about staff, to avoid putting across concerns and instead ‘try and see the best’ in them. The same with therapy training, where we are encouraged to generally assume that if there is a complaint from a client, or that they stop coming to us, or claim it wasn’t helpful or even harmful, we largely see the client’s response as something to do with them and their difficulties or ‘illness’, rather than with ourselves. I think this is a very worrying and even dangerous culture.
So, when are we allowed to critique and potentially criticise mental health staff?
We know that giving humans power often leads to abuse. When journalists do uncover abuses on psychiatric wards, we as a society seem to be willing to accept it as long as it is in the past, or, if it is within institutions that are painted as an ‘exception to the rule’. Likewise, the ‘bad apple’ staff members within a barrel full of virtuous ones.
We also relish books by medical professionals who write about how they are understandably also struggling within the system, mostly due to the long hours, lack of funding and support, or their own mental health. But they are stories about how caring they and all the other staff are, how almost super-human their unending kindness is, despite all the odds.
This is a very understandable narrative, and there are staff like this, I’ve met and worked with some of them. And we as a society want these stories; they fit with the narrative we desperately need when we are at our lowest and seeking support. We also want these stories as staff; it helps us feel better about ourselves while doing a job that is incredibly hard and largely poorly paid and exhausting.
Questioning ourselves as staff or calling out poor care should not be seen as an ‘attack’ on a medical system. It should be an essential part of our love and respect for it, our desire to make it and ourselves better at what we are trying to do.
While on nursing placements and then again while trying to write it all down, I attempted to make sense of why some staff had lost their empathy or dissociated. Why some were even rude or cruel or abusive.
I wanted to dissect the stark divide of patients versus staff, and why nurses huddled in offices and avoided patient contact.
As a student nurse, I know that I occupied a unique position within the psychiatric maze. My time there was finite. I had less paperwork, less pressure and responsibility. I wasn’t seen as the jailer, so I could observe. I had more time to talk, I could listen and absorb, read through years of notes, compare assessments, look for inconsistencies. I was both powerless and powerful.
I know that it’s very different to whistle-blow when you are fully imbedded, when your family depends on your income, or when you’ve been working within a flawed system so long that your brain has moved past fight or flight and into dissociation.
I saw first-hand that when despondency grows, it’s easier for us staff to numb ourselves, to hide amid banality and follow orders, than it is to challenge anything.
Of course, with some staff it was easier to see what had happened to bring this dissociation and hopelessness on, than with others.
Some staff appeared to have been devastated too many times by the poor outcomes of their treatment or the suicides of their patients to keep attempting to care for new patients.
Others seemed to have been drained of empathy by the long days and relentless emotional toll of working with people in distress and not having been trained in how to really help them, or been emotionally supported to do so.
Others still, by the orders to restrain or forcibly medicate over and over, or the doctrine of psychiatry itself which encourages us to ‘other’ the patients experiences from ourselves.
There were also staff who seemed to have shifted their focus to protecting and empathising with other staff who they saw as being under attack from the interminable workforce shortages and unsafe demands, leaving them with little time or consideration for their patients.
Yet more challenging, there were the staff members whose behaviour was difficult to understand. The staff who seemed to enjoy provoking patients into behaviours they were then punished for. Who told me they enjoyed the ‘action’ on wards, describing how it was a ‘rush’ for them to wrestle people to the floor or to inject them. Staff who seemed to hate their job and therefore the patients who embodied it. There were also staff who just flat-out lacked the skills I assumed were vital to working in mental health: patience, thoughtfulness, curiosity.
It’s odd to see how readily we accept and even crave these characters in our films or books, but don’t want to believe that they exist within our real staff. Why is this?
Of course, some of the backlash I’ve received has also come from service users who are protective of a system they feel has helped them. I can understand this. Though I question whether they are the minority, the minority among the many, many others who feel harmed. And it is the grateful service users who shout the loudest, who are given the biggest coverage in the media, whose stories we hear most.
But at what cost do people have their good experiences? At what cost to all those who are silenced? To those who are shouted down as ‘anti-psychiatry’, shamed as conspiracy theorists, or are simply derided and told they are mad?
When I started recording the worrying incidents I was witnessing, I was advised that my complaints would go nowhere and make it difficult for me to pass the course. So, I thought, what can we do when we’re unable to complain? When we can no longer explain?
We can document. We can record as an act of evidence, as the basis for examination. We can attempt to capture the disorder of the whole so we can tease it apart, see its makings, and empower people to act. At least, that is what I’ve tried to do.
I can only hope that Fragile Minds adds to the canon of survivor and activist literature in a way that helps people with similar experiences to speak up and be believed, both the survivors of psychiatric treatment and the staff who resist the pressure to conform.
***
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.