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)
i now have an incredible mental image of like a white leather gender binary with gold tooling, sitting in an antique store somewhere.
WHOA I just learned something wild. I started googling around, because my impression is that the gender binary has had a lot of roots in Western imperialism but I don’t actually have a lot of details on that before, say, Columbus. And look at Wikipedia:
The term gender role was first coined by John Money in 1955, during the course of his study of intersex individuals, to describe the manners in which these individuals expressed their status as a male or female in a situation where no clear biological assignment existed.
I was just thinking about him the other day! Because I returned a book to my old college library that I’ve had for about ten years, and it reminded me that I accidentally-on-purpose stole an old copy of John Money’s “Sex Errors Of the Body” from there. Like, I checked it out, around when I was learning about intersex stuff for the first time, and then was like, “okay, I can never give this book back, it is too heinous.”
(Also holy shit? I thought, from the looks of it and what I knew at the time, that the book must be really old, from like the 50s when he was first creating intersex genital mutilation as a thing. But it’s from 1994. That is some nonsense right there.)
AAAAAAAA I clicked through to the article on John Money to see exactly how terrible he was (and what the book I stole was called) aaaaand it’s actually so bad that I’m going to reblog this to add it, so that I can put it behind a cut. Like, wow. Wow. Jesus fucking christ. wow
(less egregious but still gross: he apparently also wrote a book called “Gay, Straight, and In-Between,” like… no.)
ummm anyway so
I actually don’t know if there are any good sources on this stuff, because part of the problem of binarism in colonialism and post-colonialism has been that it colors the way people have studied the past.
So for example, it’s hard to pick an aspect of the gender binary and look at when it started, because people have tried so hard to project our gender binary onto whatever writings and artifacts they’ve found.
Looking specifically at the roots of the patriarchy will probably be a good starting place, both because people have done a lot of work in that area… although it’s going to include a lot of cissexism, I can tell you that right now, and quite probably a bunch of TERFs…. and also because the difference between the gender binary, and just having gender roles, imo, is the power structure, where one way of expressing gender is considered good, and all other variations and genders are seen as less-than and gross.
But maybe someone else will have some good suggestions!
ok so, let’s talk about how John Money is one of the worst human beings to ever exist! On the plus side: the following story is a great example of how intersex people are an oppressed class, and how the roots of intersex oppression is rooted in the same policing of gender and sexuality that “homophobia and transphobia” are.
(i put that in quotes because I am deeply tired of seeing people say that biphobia is just homophobia against bi people. also because the “phobia” thing is an ableist construction, but that’s another post.)
Don’t forget to include the “i” in your acronym, especially during Pride!
And this story is also maybe the best possible example of why I try so hard to be an ally to the intersex community.
And why it’s infuriating to me when people who are not intersex either ignore intersex people and intersex issues, or try to focus on “but I heard on Tumblr that intersex people didn’t want to be LGBT” instead of being like, “our issues are interconnected, so we fight for you and welcome you.”
Like, if people do want to “play oppression olympics,” and argue that you’re not REALLY LGBT or REALLY OPPRESSED if you don’t get killed for what you are: people actively try to keep intersex people from ever being born. And as a group, they’re subjected to really awful abuse as soon as people do realize an intersex person has been born.
On the minus side: this story is just a series of really horrible things about child abuse, so. There’s that.
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
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
when i was a kid having my Bad Childhood i always dreamed about life as an adult, how i wouldn’t be dependent on anyone and no one could harm me or control me
and then becoming a psychiatric patient before i even was an adult was devastating i think because patients are treated a lot like children. in hospital i had no control over things as simple as when to go to bed, what i eat and when i eat it, what clothes i wear, whether or not i can go for a fifteen minute walk
and so i feel like in some ways the control and the abuse i experienced as a child is replicated in my experiences with the mental health system. i don’t get to be an adult, i just get to be a patient