Diagnose and Treat…or Discipline and Punish? 

After just a week I decided to leave the recovery house. I’m not better since my admission; I’m worse, but I fear that being in the house was one of the factors in my deterioration.

When I was studying towards my PhD I became acquainted with a chap called Foucault, who had a lot to say about power and its role in modern society. By ‘power’ I’m not referring to the copper-plated buffoons in Westminster, I’m talking about the subtle mechanisms of power that make you lower your voice while visiting a church, or refer to your GP as Dr Smith whilst she calls you by your first name. 

Mental health treatment is a seething morass of such displays of power. To me, each transaction seems to be test in which the person in authority seeks to assert their power. You will receive treatment, but only if you’re humble. 

In crisis and require some diazepam? Turn up to the surgery, head bowed, in jogging bottoms and makeupless (for god’s sake don’t wear lipstick as this is a clinical indicator YOU ARE FINE). Utter your request in hushed tones, explaining you are desperate and you don’t know what will really help. It’s touch and go, but the diazepam genie may just grant your wish. Don’t under any circumstances be articulate. Don’t make your request calmly and confidently. For pity’s sake don’t point out that your consultant psychiatrist (who outranks them in their tinpot kingdom) has left instructions on your notes for you to be given diazepam in such circumstances. Because this is an affront to the power of your GP, and as a result you will be punished by them failing to find the letter supposedly held electronically on your patient records, a claim that they will need to speak to your psychiatrist directly and other such complicating factors. You’ll get your 5mg diazepam, but only after much anguish and a possible invocation of the Human Rights Act.

Such assertions of power – in fact lets call them what they are, micro-aggressions – were no less in evidence when I checked into Drayton Park, the crisis house in my London borough. If you’re not aware – crisis (sometimes optimistically called ‘recovery’) houses are places for people who would otherwise be in psychiatric hospital. I have been in Drayton Park before, and although it was not without its frustrations I found it to be a broadly positive experience. Having said this, I was really, really reluctant to relinquish my liberty and go back there. By the time I referred myself, I was very ill indeed.

I asked my best friend to accompany me to the assessment, partly because my trust in mental health services to treat me fairly and with respect has been irreparably damaged after previous instances outlined elsewhere in this blog, and partly because I’m not good at showing my mental distress. Apart from a very tiny number of occasions when I’ve fully flipped, normally the anguish and turmoil is buried deep inside. I can explain it, by god I can intellectualise it, but I just can’t bloomin’ show it.

Seemingly this makes me a less credible candidate for crisis care, because following my assessment when I was offered a place, I was told that their decision to admit me was borderline because I ‘clearly found it difficult to show my feelings’ as if this somehow makes me less ill than someone running round naked screaming. It’s as if the concept of being high-functioning mentally ill has yet to reach Islington.

I was assigned a wonderful and highly-skilled worker, who unlike me had actually managed to complete her PhD; in a similar field to my own. As well as discussing my health problems and possible solutions, she also sympathised with my feeling of being lost in the mental healthcare system. Despite having a dual diagnosis of Emotionally Unstable Personality Disorder and Bipolar Affective Disorder I’m not deemed ill enough for continuing support, but the drop-in type services which are being offered to me as an alternative are in no way suitable for my needs, because they focus on stuff I’ve covered comprehensively over the years: sleep hygiene, exercise, basic CBT and mindfulness.

Sadly my excellent worker was part time, so on her days off I was assigned an endless stream of other workers with whom I was obliged to have a one to one meeting with each shift. During the week I barely saw the same person twice. The team at Drayton are kind and committed but I found discussing how crap I was feeling depressing rather than helpful, and I dreaded the twice-daily meets. Often, because of my propensity to put on a brave face, I found myself smiling and making small talk in order to just tick the box of attending the session.

However, it was the regime of rules and surveillance that really made my stay untenable. I couldn’t bear the constant scrutiny and invasion of privacy. Strangers coming into your bedroom at midnight to (incorrectly) tell you you’d not taken your medication; being referred to as ‘non-compliant’ for choosing not to take a painkiller if I’m not in pain. 

I didn’t have the freedom to break in half a 5mg tablet of diazepam and take the other half if/when I needed it. It was take the whole pill and feel like a zombie or take nothing at all, and then risk having my script reduced because I wasn’t using it ‘as prescribed’. I’m used to managing my own medication to cope with both my moods and my chronic pain and having this taken away from me made both conditions worse since the rigid system allowed no room for me to alter my levels of meds to meet my needs (despite my psychiatrist being fully supportive of this approach). 

Because of the emphasis upon staff contact, I couldn’t relax, write or take a nap (which I sometimes need to do as my pain meds sedate me) because staff would come and knock on the door every couple of hours. I was constantly on a high state of alert knowing I could soon be interrupted.

One of my workers told me I shouldn’t sit alone in my bedroom, and when I said I didn’t feel well enough to be around other unwell people I was told to ‘sit in the crèche and watch TV’. I don’t watch much TV at home (OK, OK, apart from Ramsay’s Kitchen Nightmares), I’m certainly not going to sit in a playroom and begin now. If anything that’s more bonkers than the situation I’ve just gotten out of. 

Don’t get me wrong, I understand that every one of the rules I’ve complained about above is there for a reason, and the fact remains that Drayton Park remains a wonderful haven that provides help to a lot of people. But one of their core claims is to treat residents as individuals, and this just didn’t seem apparent in my case.

It also transpired that Drayton Park, despite its progressive ideology, is not immune to micro-agressions of power. I told my allocated worker I was leaving, explaining that it was nothing that the house itself had done but that I felt it wasn’t helping me. She was very regretful and kind, and said that a senior member of staff would want to come and discuss my decision with me; I assumed to get some feedback on my leaving and risk assess my departure.

However, in the twenty-five minutes I sat by reception waiting for my medication to be returned to me, no-one spoke to me. One of my key workers walked past me with no words, no eye contact, despite me sitting surrounded by my bags. By having the temerity to make my own decisions, it was clear they weren’t going to pay me the respect of wishing me well or even saying goodbye. Neither of the managers came out to see me, despite me being sat on the other side of their glass panelled office. I gained the strong impression that if I was going to make my own decisions, they weren’t going to bother with me. My kindly worker came to return my medication to me and I was outta there, in more of a mess than when I’d entered the week before.

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