Psychiatry or liberation?

Jan 11, 2014: Maybe the title should be: 
“Rigidly evidence-based psychiatric/psychological mental help or liberation”?


May 28, 2015: Edited 

A Norwegian psychiatrist has written a book for children with the title «Pappa’n min er syk i tankene sine», which translates into «My daddy is ill in his thoughts». 

I applaud her wish to help children understand what is going on when a parent is having mental problems. I also disagree with the belief system she writes within, the idea that depression and anxiety and psychosis always are illnesses of the thoughts or brain.

And before I continue, I want to underscore that I do not reject the idea that there are real illnesses that have real somatic causes and mental symptoms. Dementia, for one. 

As I see it, psychiatric knowledge is based on a belief system, and I cannot accept it as “reality” or “truth” or “science”. And if people are comfortable with a psychdiagnosis, I respect that and have no need to try to  change their minds.  Neither do I reject the use of drugs. In “Models of drug action“, Joanna Moncrieff makes sense: 

The drug-centred model focuses our attention on the impact that drugs have on the body and the brain, and on all the possible consequences that drug-induced alterations can have on how people think, feel and behave. It is a necessary starting point for the sensible, cautious and safe use of drugs in mental health services.

Yet I think it would be constructive if mental help systems – all of them – had the same default start to helping people in need: Accept their stories (which does not necessarily mean “believe their stories”), ask what they need, and if they are so alienated from themselves that they do not know what they need, be with them in searching for it.

I found this in Dr Alex Langford’s blog: Committed: Is it time we stopped ‘sectioning’ people? And I respect and appreciate his willingness to question established procedures:

“If we ever want to be seen as truly equal with other branches of medicine, we should start valuing and empowering the choices of our patients as highly as they do.”

In the sentence I have quoted, Dr Langford describes the main problem I have with psychiatry. And not only does psychiatry not value and empower the choices of patients, it has the power to treat dissent, sceptical interrogation and autonomy as symptoms of mental illness. As illustrated in this reaction to an article on choice:

Brit miracle cure for anosognosia?”Service user’s right to reject a diagnosis..not be regarded as..lack of insight” http://t.co/pglNLniYgy …
— Ivana Fulli (@DrFulli) December 3, 2014

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“Anosognosia”, lack of insight, might sometimes have physical causes. And the term can be a fundamentalistic and very unscientific reaction to unorthodoxy and disagreement, comparable to “blasphemy” in a religious frame. *

I am not anti-psychiatry, I am pro-choice. And there will only be actual choice when we have an Advance Medical Directive like this German one, that makes it possible to “… specify in a legally binding manner which medical diagnoses and treatments I wish to strictly exclude and which ones I wish to allow”.

In my belief system, the collective stories of our surroundings drown out the stories of individuals. Some people, the so-called normal ones, are better able to adapt to collective stories, and the so-called mentally ill ones have problems adapting, for many different reasons. And “mental illness” is in itself a powerful and invasive story.

My mother could not adapt. Here is a link to a fragment of her story: 
http://freudfri.blogspot.no/2013/08/honouring-my-strong-and-broken-mother.html

She was unpredictable, often aggressive, psychotic or so heavily medicated that she acted like a zombie. And my sister and I were told that she was ill. That did not make our situation easier, and it left us with a huge fear that we could become “ill” in the same horrible way.

When my children were growing up, I told them an alternative story I had made for myself as a teenager:

“We don’t know what, but bad things happened to Granny when she was young, and she shut them away because they were too scary to deal with alone, and there was no one to look at them with her.

«Because of these shut-off memories, she can’t remember what it is like to be a child, which makes her act weirdly around children.

«And the hidden memories build up a lot of pressure, and sometimes the lid bursts open and so much gunk comes exploding out at once that she gets lost in a frightening nightmare world.”

Looking back at the fragments of her life that I know about, I think she was broken many times, not least by the so-called science of psychiatry. And the direction I chose in my late 30s was very much based on what I learned from her life.

In 1987, after I had  come out with my story of childhood sexual use, the local psychiatric consultant (Dr C), who had never seen me, told my GP that I needed professional help. The GP and I had been cooperating well on my psychosomatic problems, so I was surprised when he suddenly  said that he could not have me as a  patient any more unless I talked with a psychiatrist.

I agreed to what I thought were a couple of trial meetings because the GP assured me that I was completely free to choose if I wanted therapy or not. 

In our first meeting, I gave Dr C a copy of “The child who refuses to die” and told him that I was going to continue in this direction, taking responsibility for having suppressed and denied the betrayed and hurting child I had been. 

Dr C insisted that I had not been sexually used as a child, I needed to accept the “reality” that I had has a sexual relationship. 

Disagreement was labeled transference, and my refusal to trust him was also transference – all in this first meeting. 

When I said that he was invading my borders, he got angry: “You incest victims are obsessed with violations!”

When I asked how an incest victim could have a sexual relationship, he said that words were my strongest muscle, so I had to set them aside in order to be helped by him.

And he gave me a choice: “Realize that I am right, or complain and be told that I’m right.”

When I left, he wrote: “Her verbality often served to obscure problems, and she fully demonstrated omnipotent control, where she tries to control the therapist and use that as a defense against looking more closely at her own problems.”

And he began to teach the GP how to defend himself against my omnipotent control and obscuring verbality. There is a marked change in my medical files after this: Much of what I said is misunderstood or distorted.

I should of course have left in my first meeting with Dr C, when he began to insist that his story of my life was reality. I didn’t. In two more meetings I tried to answer an unanswerable question: “What do you want me to do for you?”

Before the third meeting, I brought with me a written answer in order to avoid Parallel Monologues:

I have to separate “What do you want me to do for you?” into three questions before I can answer:

What do I want to do for me? I want to give me who I am.

What do I want you to do for me? 

• Show me that I can trust you.

• Listen creatively, maybe show me new doors that I can open in the direction I am going. 

• Help me win over my fear of violations by expecting respect and giving respect. 

• Never tell me that I am going in the wrong direction; I need you to trust that my direction is right for me. 

• Give me lots of room to grow and let me build on a base of my own strength. 

• Never try to force or manipulate me into anything. 

• Do not violate my right, when I need it, to be miserable with dignity, to be helpless and pathetic with dignity.  

But I cannot program you into giving me what I need. Neither can you. You are not a flawless healer robot, you are a human being who works as a therapist. Therefore the third part of the question is yours:

What CAN you give me? That part is yours, and only yours.

Dr C repeated his offer to help me see “reality”, and when I rejected that help, he taught my GP how to treat me like a borderline psychotic. Without informing me of the diagnosis.

I took this along to my second meeting with Dr C:

I am living in Chaos right now. I have anxiety, headaches, insomnia; loose bits of my life whirl threateningly around me. I want to hide in the old defenses: Sort, understand, pull myself together, lose myself in work, put a thick layer of calories over what I do not want to think about.

I know that this will pass. Chaos is now a familiar landscape, and I am not afraid of dying in here, as I used to be. I know that the best thing to do, is to accept it.

Being in chaos was not comfortable, but it was right for me at the time, my chosen direction led through chaos. 

Do we all have chaos in us? 

Is it natural to fear chaos in others if we are scared of our own inner chaos?

Many thanks to Jason Evan Mihalko @jaypsyd for giving me the perfect metaphor: Did Dr C see himself as Gandalf who had to stop me from unleashing an inner balrog?
  

Retraumatization and dehumanisation are big words that boil down to being made into a thing by others. An object. 

“People as things. that’s where it starts.“

I started life as a parenting object of my mother and father … who had their own stuff to deal with. 

Then I became a sex object of a Catholic priest, who also had stuff to deal with. And I dreamed of growing up so that I could protect my “no”.

As an adult I became a “borderliner” in the health services without knowing it. And lost the right to say “no” again. I was an object of well-meaning, correct and legal psychiatry, an omnipotently controlling, projecting, delusional and chaotic … balrog? 

I asked a psychologist for help to unravel the mess I was in, and after a year of therapy I was suicidal, hallucinating, hearing voices and very, very confused.

And I planned to kill myself. Every day. In secret. Hiding how I felt had been a survival strategy in my childhood, and that helped me now.

But certain criteria had to be met:

• It had to look like an accident. I wanted to liberate my family and friends from me, not burden them with guilt.
• And I had to make sure that I died immediately. I couldn’t risk surviving with permanent injuries that would burden others.
• And it shouldn’t hurt. Not much. And I did not smile at this thought. 

I don’t remember much from this time, only that the parts of me that wanted to live became more and more concerned when I drove on the steep, winding roads where I live. And, one evening when I was alone, I got in touch with the part of me that wanted me dead. And I let her communicate. And promised not to stop her, not to sensor, just let her say all she had to say.

She began to write. Grunge. Detailed, poisonous grunge about me, about how evil, useless and stupid I was. Ugly, power-mad, fat, wrong, illogical, manipulating, wrong, wrong, stupid, wrong, too dumb to realize that I had no social skills and should not be allowed to interact with people, I should never have been born, I was an affront to all right-thinking people in the world … and as I wrote, my writing became larger, sharper, and the pencil stabbed the paper like a knife in flesh. 

And I began to recognize voices. Moods.  Shades of people, some of the words. Critic wrote corroding concentrates of feedback others had given me. About me being wrong. And if I could just stop being wrong, everything would be OK, but as I couldn’t, the world should not be burdened with me.  

And when the part of me that wanted me dead finally was finished, we looked at it together. And I thanked her for what she had done for me when I needed her help to survive. 

She had communicated and strengthened signals from my surroundings, so that I could try to avoid doing what people I needed did not like. And I explained that her help had been crucial then, but my life was different now. I was not helpless, not in the way I had been then.  

And Critic heaved an enormous sigh of relief and took a vacation. 

In my next meeting with the psychologist, I was able to be in the situation for the  first time in months, and after a while I asked: “Are you trying to manipulate me into realizing that I’m paranoid?”

And I insisted on a straight answer. And got “yes”. And a copy of the letter that GP had sent to him … warning him about my delusions and all my other wrongnesses. 

My first reaction to this letter was relief: “I’m not being paranoid, they really do think I’m crazy!”

When I finally stopped trying to clear up misunderstandings in the health services and sent a complaint to the oversight board, the board did not reply to a person, but to a delusional, controlling and chaotic borderliner: my complaint was “meaningless” because psychotherapy is clearly voluntary, and I had transference reactions, so I did not have opinions. A scanned version of the Norwegian document is here: 
http://ingridvaa.blogspot.no/2011/02/brev-fra-fylkeslegen.html

A lawyer said that I had one option left: I could find a psychiatrist with more authority who was willing to contradict Dr C in court. I only wanted to disagree, I had been rejecting polarization for years, so this was not an option. And because I work freelance and didn’t need sick leave, it was possible to avoid the health services and concentrate on liberating myself from psychiatric harm.

One important element in this process has been to look for and take responsibility for mistakes I made before and after being borderlined. I have collected my experiences in Communication 101. 

And there were three things that caused problems that I would do again:

• Trust that my direction was right for me. 
• Evaluate authority 
• Treat mental helpers as my equals, instead of looking up at them. 

My road has been longer and thornier and much more tangled than it would have been if my choice – to give me who I am – had been seen by the health services as an autonomous, reasonable decision.

That proved to be impossible, and looking back though these years, I see that what happened was inevitable. Might even be inevitable today. Because …

Psychiatry was on the same road that I was on, just heading in the opposite direction. Into a collective story of illness. And within psychiatry’s belief system the direction I took – liberating my private story from collective stories – was Just Plain Wrong. Sick.

In 1988 I wanted “to give me who I am”. It has been a long journey in the direction I chose, millimeter by millimeter. Often uncomfortable and painful, but it belongs to me.

When Dr C asked me where I thought I was going, I said that I had no idea. “But I know that I’ll recognize it when I get there.”

Now I am 66, and I am getting there, and I like where I am. I like who I am, after a long journey of liberation. 

And I realize that, in addition to people in my chosen and biological family and one helper who helped, the most important helpers in my life were adult friends of my childhood, people who themselves were outside the glaring streetlights of collective stories, who could see the small flickering light of my individuality, the contours of my self. They made it possible for me to see myself, many years later.

Soldier was one of them. And the story of Soldier and his friends is here:

http://freudfri.blogspot.no/2013/09/good-helpers-soldier.html

* Link to “Frames, Framing and Reframing” by Sanda Kaufman, Michael Elliott and Deborah Shmueli