Assumptions to be Challenged
•Seclusion and restraints are therapeutic
•Seclusion and restraints keep people safe
•Seclusion and restraints are not meant to be punishment
•Staff know how to recognize potentially violent situations
[Facts About Seclusion and Restraint]
•Seclusion and restraints are not therapeutic. There is actually no evidence-based research that supports the idea that restraints are therapeutic.
•Seclusion and restraints do not keep people safe. The harm is well documented; not only the physical harm, but also the emotional and mental harm. Restraints actually harm and can cause death. Broken bones and cardiopulmonary complications are associated with the use of seclusion and restraint (FDA, 1992; NYS OMH, 1994).
•Even though most staff would say that seclusion and restraints are not used as punishment, 60-75 percent of consumers view it as punishment for refusal to take meds or participate in programs.
•Holzworth and Wills, 1999, conducted research on nurses’ decisions based on clinical cues with respect to patients’ agitation, self-harm, inclinations to assault others, and destruction of property. Nurses agreed only 22 percent of the time on what constituted a violent situation. The longer nurses have worked in mental health positively correlates with greater consistency in determining potentially violent situations.
•In 1998, the Hartford Courant completed a series of investigative reports concerning the use of seclusion and restraints and found an alarming number of deaths. The majority of deaths related to seclusion and restraint are a result of asphyxiation or cardiac-related issues.
•Even more disturbing was that many of the deaths were unreported. Few States require the reporting and investigation of a death in a private or State psychiatric facility. The Harvard Center for Risk Analysis at the Harvard School of Public Health estimated that the annual number of deaths range from 50 to 150 per year—which translates into one to three deaths every week (Weiss, 1998)
it pisses me off how opposing the sexual, physical and emotional abuse of mentally ill people in institutions isn’t seen as an integral part of fighting ableism against mentally ill people, so much so that you can actually be called ableist just for talking about this kind of abuse even happening
like what kind of understanding of ableism against mentally ill people are you working with if “opposing the institutional abuse of mentally ill people” = “ableism” but “actively supporting, endorsing and defending the institutional abuse of mentally ill people and the institutions that perpetuate it” = “spreading Mental Health Awareness”
cw: sexual assault and psychiatric abuse
learned helplessness resulting from trauma is a survival technique and i rarely see it’s adaptive quality acknowledged by mental health professionals in my personal experience
when i was being sexually assaulted in hospital by another patient i couldn’t have yelled or fought him because i would’ve been punished, probably with seclusion
when i was put in seclusion i couldn’t fight back against the security guards who stripped me naked, because, as they said in their own words “if you try to stand up we will push you back down”. if i’d merely stood up, let alone fought them, i would’ve been put in restraints and kept in seclusion much longer
learned helplessness may not be helpful now, but it was helpful in the traumatic moments it originated from
patients who yelled or kicked stayed in seclusion days longer than patients who, like me, lied down on the floor and remained silent and motionless. my lying down on the floor and remaining silent and motionless was in fact encouraged by the staff as a sign that i’d “calmed down”
so now that i’m out of hospital is it helpful for me to lie down on the floor silent and motionless? no. but it was when i was sexually assaulted and it was when i was put in seclusion. and i feel like acknowledging all of the broader impacts learned helplessness has had on me has to start with acknowledging that i became this way so that i could survive
i apologize in advance for how long this will be
the first thing i would say is to maintain community with like-minded people. for me, community comes in the form of the hearing voices group i attend and friends and followers i have on tumblr
having a community of people who allow me to identify however i want – whether that’s as a voice hearer, psychiatric survivor, mad person, consumer, person with psychiatric disabilities – helps me to maintain simultaneous opposing identities.
just having a place to talk, whether physical or virtual, gives me a sense of who i am outside of psychiatry. also just being among people who share the same identity (voice hearer/psychiatric survivor/etc) can help to strengthen your own personal identification with your identity
a second piece of advice i would give is to write about your feelings, such as in a journal. i don’t journal that often, but i have found it helpful on many occasions. if you were to read through my journal, you would see an endless run of consecutive entries on how i hate the tangible harm that has been attached to me being dxed with bpd
journals are also helpful because they’re private, so you can say your full feelings about diagnoses and whether or not they apply to you without having to worry about the consequences in the same way you would if you said the same things you wrote in your journal to your psychiatrist
now finally, i’ll say, i understand where your coming from with knowing that psychiatry is “the path with all the material resources”
being on disability benefits, the money i use to buy my food and my clothes, to pay my portion of the rent, it’s all dependent on me having a label from the DSM. so how do i reconcile this with being critical of the DSM?
well, i would say this. for a moment, consider the metaphor of the trans health care system. medical professionals are often transphobic and transmisongynistic. they deny people the hrt and surgeries they need, and they can hold outdated and offensive views of what it means to be trans
but at the same time, they control the access to, and have the knowledge of, administering hrt and surgeries.
so what does a trans person do? well, if you’re going to have hormones you most likely have to go through the system, unless you are somehow self medicating, the only way to get hrt is through a prescription
but does getting that prescription mean you have to subscribe to the harmful transphobic ideas the medical professional may have? or is it possible to get what you need from the system while still recognizing it’s inherent problems?
i would argue that psychiatry is a similar situation. on the one hand, mental health professionals can be ableist, abusive, bigoted in other ways (racist, homophobic, etc). the DSM is inherently flawed. that in and of itself could be the topic of an entire post, but suffice it to say, being gay used to be a diagnosis. now it no longer is. gender identity disorder used to be a diagnosis, now it’s gender dysphoria
what happened there? did a something start, and then stop, being a mental illness? no, societal factors (homophobia, transphobia) caused the biased, flawed, fallible human beings who create the DSM to label being gay a mental illness, then in turn, other societal factors (the activism of lgbt people) pressured them enough to change their minds
this demonstrates the fluid and, essentially completely made up nature of all diagnoses. an old psychiatrist of mine used to say that diagnoses are like constellations. the stars are real, but the patterns we see are of our own making. likewise, hearing voices is real. being suicidal is real. having low/high energy is real. but the idea that these three things belong together and that this entity comprised of them and other experiences constitutes “schizophrenia” or “bipolar disorder” is something the people who made the DSM created. it is an idea rather than an absolute scientific fact, and in future editions of the DSM these categories may very well change
anyways i’ve gotten very off track
continuing the metaphor, so psychiatry is like trans health care in that the system is flawed but the services it dispenses are necessary
psychiatry controls access to things like disability benefits, housing, accommodations for school, medication and other treatments
if you need these things, you need them, and you need them regardless of whether or not the DSM is arbitrary
so my advice is, if getting a diagnosis/seeking treatment benefits you, then get a diagnosis and seek treatment
it is possible to be officially dxed, to have that dx give you material benefit through say accommodations or meds that help you, but to still remain internally disagreeing with the diagnosis
going back to my earlier question, i reconcile the fact that i’m dxed with bpd and dependent on this dx even though it has been a source of discrimination and abuse towards me in the past and as such i have negative feelings towards the diagnosis by maintaining a certain distance from the diagnosis
i use the diagnosis when absolutely necessary, when i go to the ER i don’t try to argue about what i do and do not have. when talking to my psychiatrist, i describe myself as borderline
but at the same time, i go to voices group and i describe myself as a voice hearer. i go online and describe myself as a psychiatric survivor. i keep a diary and i write entries on how i “fucking hate being dxed with bpd!!!!!”
so basically the deal i’ve made is that i inhabit multiple worlds simultaneously. i am both a borderline and a voice hearer, a consumer and a survivor, and the key basically is figuring out the nuances of how to inhabit these multiple identities simultaneously, how to strengthen identities that feel weak, and how to use identities that are necessary to obtain resources without letting them define me
so basically what i’m saying is, the diagnostic categories created by the DSM may lead to material resources. and you can take advantage of those resources. but at the exact same time, you can still be skeptical of a system while you are dependent on it. getting something positive out of the DSM doesn’t mean you forfeit the right to criticize it or disagree with it
i hope at least some of this was helpful, apologies if i was going over stuff you already know, or that is unrelated to what your looking for. i should also mention i have taken my night time meds and i feel somewhat sedated, so idk about my coherency/relevancy levels
#medication #ableism #hospitals #psychiatry #food #swearing #homophobia #transphobia #transmisogyny
It’s okay that you’re covering a lot of stuff I already know. I probably know some conflicting stuff, it’s still good to have you highlight certain things. Especially about staying in touch with community, which i know but need reinforcing.
There’s a piece I’m missing though, that’s like…when I talk about one path having all the material resources…that affects my psyche in a way I failed to convey. On some deepdown level I just believe whatever is safest or most advantageous to believe, a lot of the time. I’m talking probably about bpd too, and I mean some of the same traits that bring bpd into the conversation for me, that sort of malleability and mirroring, that “you have a great personality/ thanks it’s yours” gag, makes me feel really vulnerable and susceptible when an ideology is paired with resources that i want/need. idk how much sense i’m making, but if this means anything to you maybe get back at me tomorrow when it’s time for humans to be awake and not whatever bullshit time this is.
Either way, thank you, some helpful things + i really appreciate you taking the time and effort. that in itself warms my heart.
if i’m understanding what you;re saying, you’re saying it’s hard to maintain views that are critical of, or even just different from psychiatry when accessing psychiatric services, because you;re Supposed To believe certain things, and then there’s also the bpd identity aspect
if i’m understanding you correctly than i would say i have much of the same problem, because to an extent what i believe and my sense of who i am changes based on who i’m with and what they’re saying
as to how to cope with this, idk about the best possible advice
one suggestion i would have is to read things that are critical of psychiatry to remind yourself of the reason for your opinions
some resources you may or may not already know (cw: for psychiatric abuse):
- the disability studies quarterly – has open access scholarly articles on a number of disability topics, including some on autism and mental illness. some are more critical of psychiatry than others. i’ve personally found that i like some of the articles (or some parts of the articles) and not others. some example articles which deal at least in part with psychiatry (with varying opinions) would be Clinically Significant Disturbance: On Theorists Who Theorize Theory of Mind,
“There Is No Treatment Here:”
Disability and Health Needs In A State Prison System, Psychomimesis: LSD and Disability Immersion Experiences of Schizophrenia,
Battling Voices: Schizophrenia as Social Relation in Abel García Roure’s Una cierta verdad [A Certain Truth] (2008)
- radical psychology – another open access journal, this one more radical as the title indicates. some sample articles:
“Patient-Centred” Path towards Ignoring
Patient Rights: A
Critical Analysis of the Federal Senate Committee’s Dismissal of
Involuntary Treatment Laws and Civil Rights Abuses in the Canadian
- the psychiatric survivor archives of toronto – an archive of historical documents including the Phoenix Rising archives, which are completely available online
- psych rights – a website that links to a number of resources. i don’t necessarily agree with them ideologically on a number of points (like a number of the websites i’m linking to), but they do have quite a few links. they have personal stories, such as
My Experience Inside A Mental Ward
- judi chamberlin wrote many articles and a book (which i haven’t read). some of the articles i have read are Confessions of a Noncompliant Patient, A Working Definition of Empowerment, and The Ex-Patients’ Movement: Where We’ve Been and Where We’re Going
there were more links i wanted to include but i’m having trouble finding them
(disclaimer about the links: i don’t necessarily agree with all the viewpoints expressed in all of the links available on all of the websites.)
anyways, so yeah, i would say that reading information that is critical of psychiatry could be one way to try and maintain your views/sense of identity
another thing, which i know i already suggested, could be writing out how you feel before and after appointments, etc.
for example, when i’ve been in group therapy and they’ve said things i disagreed with, i would write letters overlapping each other about how i thought about what was going on, but i couldn’t say. for example, if i wanted to say “this is factually incorrect” but couldn’t, i would write “T” and then an “H” over top of the “T” and then and “I” and then an “S” and then an “I” and then an “S” and so on until i’ve written out the entire message, but it looks like i’ve just scribbled
also, not to keep repeating things i’ve said, but community can be helpful here. having someone to talk to, whether irl or online, can help to clarify your thoughts
i also find blogging helpful. frequently something will happen in an appointment that makes me uncomfortable, but i will feel like i’m overreacting and the mental health professionals must be right. so what i’ll do is i’ll make a post, and then when people like or reply to the post, it validates that i am allowed to feel upset about what happened and i’m not overreacting
so if you can find people to validate your feelings, that’s a good and helpful thing
other than that, i tried to do a quick google search on how to maintain your sense of identity when you have bpd and i didn’t find very many helpful results
from personal experience i would say that it can be very very hard, but i don’t know what advice to give
i have to go to an appointment soon or else this would be longer/more detailed/better edited but yeah feel free to ask me more questions if this wasn’t helpful
people: you can only be involuntarily hospitalized if you’re an imminent danger to yourself or others!
the mental health act of bc:
a person can be involuntarily hospitalized if the person “requires care, supervision and control in or through a designated facility to prevent the person’s or patient’s substantial mental or physical deterioration or for the protection of the person or patient or the protection of others” [emphasis mine]
the linked-to-on-the-provincial-government-website-guide to the mental health act: “The term “protection” covers more than just physical harm. It also relates to the social,family, work or financial life of the patient as well as physical condition. (This is paraphrased from the BC Supreme Court case of McCorkell v. Riverview Hospital )“ [emphasis mine]
CBC was not able to establish how many patients have fled B.C for other provinces. Requests to the province’s Ministry of Health went unanswered. But both Johnston and Dhand told CBC, they’ve heard of stories like Sarah’s before.
“It’s actually very devastating for people and the right to refuse treatment is a fundamental common law principle…I myself have seen and talked to a number of clients who have had to flee to different provinces because they understand they will be forced psychiatric treatment here if they’re found to be an involuntary patient,” says Dhand, an associate professor at Thompson Rivers University.
Much to her surprise, Sarah was found to be one of those involuntary patients — even though she voluntarily sought help at a hospital in B.C. to help her cope with what seemed like depression.
But she says she was told she couldn’t leave the hospital, and was instructed to sign a form without a full explanation of what it was.
“When you’re presented with something like that, especially in a hospital setting you’re already quite scared, you sign whatever is in front of you,” she said, “you listen to people who you think are an authority and you think this is what’s right.”
Though she says she was not considered a danger to herself or others, a month into her care under the province, Sarah says she was told she would be switched to anti-psychotic injection medication and that was when she realized she had to flee.
“I knew I had to leave that day…I walked out of the hospital during a smoke break.”
Knowing a missing persons report had been filed — Sarah says she managed to evade authorities until she arrived in Calgary, at which point she turned herself into police in Calgary. But police refused the request to apprehend her.
Now settled in Ontario, and financially supported by her parents, Sarah says she feels liberated by being able to have choice over the type of mental health treatment — a psychologist and group therapy — she receives.
“It’s amazing. It’s what I wanted in the beginning, and unfortunately I had to leave my home, my support network, and the people that mean the most to me to do this, but this is what’s going to help my mental health.”
the difference between the laws in bc and say, ontario (i’ve been involuntarily hospitalized in both) is that in bc involuntary treatment is automatically authorized the instant you are certified, with no additional steps (the certification process requires to different doctors to fill out a form certifying you and then they have the authority to hold you for a month, so it is relatively easy to certify someone)
as mentioned in the above quote, people will bring themselves voluntarily to the hospital and be certified anyway
this directly contradicts the laws that supposedly govern involuntary hospitalization in bc, as section 3 c) iii) states as a requirement for involuntary hospitalization that the patient “cannot suitably be admitted as a voluntary patient.”
anyways, as bad as bc is, involuntary treatment still does happen in ontario and i know people who’ve been traumatized by the ontario mental health system just as bad as people in bc
involuntary treatment in ontario is covered by the health care consent act, which in subsection 4(1) states that a person is able to consent if “the person is able to understand the information that is relevant to making a decision about the treatment, admission or personal assistance service, as the case may be, and able to appreciate the reasonably foreseeable consequences of a decision or lack of decision.”
the supreme court of canada ruled in
Starson v Swayze that
“able to appreciate the reasonably foreseeable consequences of a decision or lack of decision” means “While a patient need not agree with a particular diagnosis, if it is demonstrated that he has a mental “condition”, the patient must be able to acknowledge the possibility that he is affected by that condition…As a result, a patient is not required to describe his mental condition as an “illness”, or to otherwise characterize the condition in negative terms…Nonetheless, if the patient’s condition results in him being unable to recognize that he is affected by its manifestations, he will be unable to apply the relevant information to his circumstances, and unable to appreciate the consequences of his decision”
so in other words, if you disagree that you have a mental “condition” (which is somehow different from a mental “illness”??? this confuses me) you can be subject to involuntary treatment
anyways i’m tired and i forget where i was going with this but yeah
the basic summary is: in bc the situation re: involuntary treatment is so bad that people literally flee the province, but i don’t mean to imply that involuntary treatment doesn’t happen in ontario. or literally anywhere else for that matter
mental healthcare needs to adopt a more nuanced approach to treating suicidality.
people who are suicidal (in any sense if the word) need to be able to talk honestly about their thoughts and the surrounding emotions without fearing institutionalization unless it is legitimately necessary.
when we treat any mention of suicide as grounds for institutionalization it encourages people to stay quiet instead of seeking help, alienates people from their friends and mental health caregivers, and allows passing thoughts to become serious intentions.
#TRUEST THING EVER
THIS. A MILLION TIMES THIS
And with intrusive thoughts/violent urges/homicidal urges (with no real prepared plans of course)
also with psychosis.
we need to scrap the entire system of compulsory treatment of suicidality, because there is no evidence of benefit save for technically stopping someone from harming themselves until they’re out and ample evidence that suicide risk is increased by hospitalization. The UN agrees.
Omg please tell me you have a linked source for that. I will love you forever.
Seriously though, if the Catholic Church is doing a better job of having rational rules surrounding bodily autonomy and the disclosure of personal information than you are, you’ve probably fucked up somewhere along the way. I wish there was a way to threaten therapists with eternal hellfire if they broke doctor-patient confidentiality.
inpatient hospitalization increases suicide risk:
UN statement on compulsory psychiatric treatment:
Take a fuckin sip babes