Saturday, 8 February 2014

On insight and what not to do to people in pain ...

.... and what is much too often done.

In January Sian Whitehead published a video on YouTube:
Interview with mental health advocate who worked in South East London Hospital Trust. Discussion about the coercive nature of psychiatry, forced medication, stigma, restraint and Electro-convulsive therapy, The non-therapeutic experiences of many patients. 

Here is a link to Lucy Johnstone's original tweet and the comments: 

Quotes from the video:
Anti-stigma campaigns want us to be comfortable about mental illness. There are good intentions behind this, but what about people who disagree that they are mentally ill? The best kind of anti-stigma would be to tell them that they are not mentally ill: “Let’s find out what happened and do something about it.” (...)
Regarding medication, every single person I've worked with in the last year has been put on antipsychotics almost immediately (...) with or without their consent Either they agree to it or they're coerced into taking it or they're just practically forced. Regardless of the diagnosis it's always anti-psychotics, normally the same drugs (...) Normally the first drug they try is risperadone then they'll try alanzapine, if those drugs don't work they'll try the older antipsychotics like haloperidol and for the people who don't respond to anything they'll try clozapine which has lots of side-effects and the person has to be closely monitored. Everyone is given these drugs, regardless of diagnosis. (...)
A lot of people don’t want to take anti-psychotics (...) I've seen people develop diabetes very young, I've seen people very bloated, I've seen stiffness, a lot of people complain about apathy, difficult in concentrating, depression, these kind of symptoms. You see people with Parkinson's disease kind of symptoms, shaking, tongue is flicking in and out, and that's from the antipsychotics and it's irreversible. So people have quite good reasons to object to these drugs. (...) once the person objects to the drugs, they will be forced into taking the drugs. And there's not really much negotiation. (...)
People have insight. They know that they had a breakdown because of a distressing experience or childhood trauma or from coming off psychiatric medication. They have insight, and they don’t agree that they are mentally ill. (...)
One client was told she had a psychotic illness and needed anti-psychotic medication. She felt that what she was experiencing was more of a psychological issue and wanted support from a psychologist. She got a psychologist to come and visit and really enjoyed it and felt that she was getting somewhere. I saw her being told by a psychiatrist on the ward that because she believed that psychology could help her, this was evidence that she was ill and needed to be sectioned. I'm not making that up, I witnessed that being told. As soon as you question their very narrow and fixed way of looking at things, they won't hesitate to force you.
In our part of the world, "blasphemy" does not justify force or persecution in a religious context. Yet in a context of mental help, "anosognosia" is in the ICD-10 and justifies manipulation, violence, forced medication, humiliation and deprival of human dignity and civil rights. Here is a definition from the Treatment Advocacy Center, a bastion of the Medical Model: 
Anosognosia - "lack of insight" or "lack of awareness" - is believed to be the single largest reason why individuals with schizophrenia and bipolar disorder do not take their medications. A result of anatomical damage to the brain, it affects approximately 50% of individuals with schizophrenia and 40% of individuals with bipolar disorder. When taking medications, awareness of illness improves in some patients.
In a frame where lack of insight is a "result of anatomical damage to the brain", a kind and sincere wish to help justifies force, threats, humiliation or just plain ignoring the patient's opinions because one already knows that they are talking nonsense because one knows that they have a mental illness.

That creates an always-wrong situation:

Closing off with a snippet from DEPRESSION AND A RUSTY SPOON
When experts on the diagnosis of mental illness define disagreement and non-compliance as "lack of insight", I look for insight. 
I look for their insight into the lives of the people they find lacking in insight.
I look for their insight into their own lives, emotions and reactions.
I look for their insight into the importance of critical thinkingintegrity, responsibility and autonomy, into the difference between truth and opinion, into knowledge about frames and networks.

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