“A lot of the professionals I have met are dissatisfied with the system...because they can't
interact in the way that they want to… you know there are humans in the system...it’s just that they often get swallowed up.” (“Fay”)
Patients who were active within the Movement had a considerable involvement with and understanding of psychiatric practice. They spoke of the impact of the institutionalised
Concept: Supportive
systems Participant quotes Researcher interpretation
Patients
I would like…to feel...when they ask me a question...about what I was hearing that they are not just listening for the tickboxes, that they are actually listening to what I experience of it “Fay”
Wasn’t a good place, just left there, given tablets and wasn’t anything else going on. I observed a lot of cruelty “Ann”
The patients felt there was no place for the personal or the subjective in the psychiatric system, it all felt
depersonalised and objectified.
Psychiatrists
Our approach to psychiatry...a natural extension of our tendency to build systems without flexibility or feedback from reality. We are all made ill and paranoid by our disconnected and fragmented lives because we are not aware of our fundamental needs. “Hans”
The psychiatric system produces an ontological split, forcing us to live in a world far from the real one.
devaluation of emotions and connections amongst psychiatrists who they understood to feel unable to relate in the way that they wanted to. In getting swallowed up by the system, the doctors had lost touch with the fullness of their own humanity which in turn made it difficult for them to relate to the patients. Extensive bureaucratic demands and emphasis upon short-term interventions and division of labour meant that the kind of attention needed by patients was often not available. Through their activism, patients had come to know that their life existed in their stories, not diagnoses and they wanted their doctors to adopt the same attitude and see beyond the diagnoses. They felt consistently defeated by the emphasis upon categorising and medication and complained of its depersonalising effect. Patients ascribed their experience of cruelty and a lack of positive social interaction on the ward to the institutionalisation of a biomedical narrative, within which relational aspects were insignificant.
All the patients fought against the systemic tendency to simplify psychosis and the lack of acknowledgement of the complex treatment required. Patients wanted to explore their world- view and the felt threat to their ontological security in their treatment and not be drugged into numbness. Additionally, patients demanded that their distress about increasing levels of mental fog or physical debility due to medication side-effects be taken into account in evaluating their treatment. Patients felt disempowered by the institutionalised bias against relationships, in the form of a division between ‘us’ and ‘them’. Instead of working together, patients experienced a split where the presumption was of the psychiatrists being on the side of health and the patients in the wrong. Existential aloneness and a shaky grasp on reality due to psychosis, combined with the systemic bias against relationships left patients on the defensive, and further from the sense of safety necessary for healing. Huge concerns were expressed about the power vested in psychiatrists with some comparing it to “an abusive relationship”, with the abuser “legally entitled to be judge, jury and executioner”. The biggest fears related to the power held by the system to withdraw the possibility of having families and questioning their “right to breed”. The wish for a dialogue and healing was resisted through the institutional assertion of power, with relationships used to harm rather than help, reminiscent of patients’ early experiences.
In line with literature, most patients recognized that their psychosis had developed as a result of avoidance of psychological and emotional work on their part. They recognised their need for
help with integration through explorations within safe relationships and bemoaned the dismissal of that need within psychiatric practice.
“I would tell him some very very bizarre, obscure things but he knew I just wanted that
space and he did not say, I think you should go and take your Sulpiride and go to bed” (“Keats”)
Patients contrasted their experiences in psychiatry to those within the Movement where they discovered a new coherent and helpful narrative, through being attended to holistically. They talked about the value of learning novel strategies to manage life through relationships, activism and psychotherapy by putting themselves together in a new way. The patients felt that their newer narratives reflected the complexity of human life better than the split narratives previously imposed upon them. They found a different perspective upon psychiatry by recognising that it lacked coherent answers to their questions about attention to context and psychology in psychosis. They questioned the mainstream belief in the arrival of a fully formed schizophrenic adult at the moment of the biological accident and, its neglect of how context and relationship experiences contribute to the development of the senses of self and others.