Picture this: you are a sexual abuse survivor, now in your teens. You´ve kept the abuse hidden, but your mind and body know what you went through. You still live with your abuser, you still have nightmares, you look forward to the days you can finally leave this house. You begin self-harming as a way to cope with it all. You feel ashamed and guilty, you think you are completely broken inside, and nobody will ever want to be with you. The secret and the suffering are eating you away. Will anyone believe you if you tell them? You have angry outbursts and thoughts of running away. At school, you cannot concentrate; they ask too much of you. You think they would never understand.

Some adults in your life start to notice your cuts; they worry and refer you to a psychiatrist and therapist. You disclose your abuse, but regardless, you are now diagnosed with bipolar disorder, oppositional defiant disorder, and borderline personality disorder at 14, and the self-blame and self-loathing intensify. You are told you are perpetually ill with a chemical imbalance and a “serious mental illness,” and given pills that make you a zombie. Now you have nightmares, self-loathing, and on top of that, you have to deal with the side effects. You have decided that if this is your life, you don’t want it anymore. You tell this to your provider, and suddenly their tone shifts to one where you have no choice, you will be taken to a psychiatric hospital.

You are stripped naked without any explanation or choice on whether to do it or not. “Squat and cough.” You have no choice but to do it. For many, this procedural ritual feels humiliating; you are in one of your most vulnerable emotional states, coming to this place “voluntarily” or involuntarily. They proceed to have you undress while you wait for “hospital appropriate” clothing, and all your jewelry is removed…while you wait, someone is surveilling you, and you have no place to lie down, it’s really cold, and they won’t provide a blanket. You can only have certain personal items with you, mostly hygienic, basically nothing that will bring you comfort.

You have just gone through the process of filling out a thousand forms, answering a thousand questions, repeating the same story over and over again. This, you will have to do again upon meeting with the providers in the hospital, and it will probably be the first and last time you see them.

You’re finally admitted, the clothes they brought you feel foreign to you, someone else chose them for you, or they were bought to meet hospital standards. They’re not the ones you would ever choose, but you have no choice. The same thing applies to everything else available to you in the hospital.

It feels like you are in a jail, and then it very much feels like a very dark, very fluorescent, and dilapidated hospital. You are locked inside with nowhere to go, you get visitors once a week, you can’t freely call people throughout the day, you have no privacy, the food is restricted to a schedule…and you have no say in the food, you have to eat it.

You can’t sleep because it’s cold, the nursing station is never quiet, they’re constantly checking on you and coming into your room, and then you’re up at 6 am to start your day…again…not by choice.

You have to shower in the cold-as-fuck air-conditioned bathroom, in the dark. This might also be a shared space, so everyone showers together with only curtains for privacy

Neither medication nor diagnosis is a choice; you are forced to go through with these chemical and discursive life-changing procedures. Whatever the food is, you have to eat it; it does not matter if it does not fit your regular diet, and if you stay hungry or are hungry outside the schedule, you are screwed and have to wait until the next mealtime.

Therapy, recreation, entertainment, and breathing fresh air outside are rare; you are locked inside, and you are a submissive little rebellious rascal, unable to make decisions for yourself. Newsflash, you lost your autonomy once you disclosed your desire to leave this world, your pain. The diagnosis is chronic, the meds are “necessary” even if you have so many side effects, and they are not really working for you. The trauma of being hospitalized does not go away, and it’s now compounded with all the other ones.

Nonetheless, mental health providers will affirm that “well, you can get over that because it was for your own good.” And then they still question why people speak of these experiences in a very negative light, and accuse us of creating more stigma for speaking up and demanding mental health care that is compassionate, human rights-based, and protects our dignity.

In these settings, a person who advocates for themselves is further pathologized, their insight put into question, and even accused of anosognosia. The idea of having a choice is an illusion; the ability to say no, or to react in any way that is not acceptable to them, is pathologized, you become “non-compliant, “deviant,” “oppositional,” and “treatment resistant.”

It happened to me too, as a sexual assault survivor, coming into the hospital to escape circumstances where I was going to be further abused, and obviously not knowing what was about to happen to me while receiving “the help I needed”; it’s something the psychiatric and sexual assault survivors I have interviewed spoke about, and outspoken psychiatric survivors such as Clementine Morrigan talk about it too. Even a recent study found that sexual violence survivors are often further abused in mental health settings.

In my research, I’ve heard the same from many others. For instance:

Gaby: “They took things from me—it feels very dehumanizing, like a prison. They take away your piercings; if they could erase your tattoos, they would. They strip you and do a cavity search—meaning you have to bend over and cough. For me, it was like, I’m already in an altered state of consciousness, and now you’re making me do things that are degrading and dehumanizing—it just makes it worse, this isn’t helping…They take all your belongings away—not even a small sheet that smells like something comforting. I had a lavender oil I wanted to keep, and a quartz that meant a lot to me—I couldn’t have those either…At one point, I asked for an extra bedsheet because it was the night I had been admitted, my family hadn’t brought my personal belongings yet, and they denied me a fucking sheet… This is also happening with the food. One of the side effects of some of the medications was that it made me hungry. There was plenty of food there, and they never let me have seconds… If the people who were there with me decided, “no, I don’t want to take this medication,” then you end up staying longer, until you decide that you “want” to take it.”

Francisco: “One time, I was cold because they didn’t give me my belongings. My family had brought them, but it wasn’t until the next day—or even two days later—that they gave me my things so I could keep warm. All the doors and windows are secured, and every section requires going through controlled access with codes and specific security keys. You’re always being watched, and there’s this sense of fear, like, “where are you going?” “stay over here” or “don’t go there.” The calls are supervised—everything is restricted… There are behavioral expectations for the participants in these programs, and if you don’t meet them, they yell at you, reprimand you, intimidate you, or threaten to move you to another unit, inject you, or give you medication to “calm you down,” or take other measures.”

Dary: “During one hospitalization, another patient touched me without my consent. I tried to ask for help, and they told me, “She doesn’t know what she’s doing.” But I knew what I felt: fear, violation, humiliation. They made me feel guilty for speaking up. I was hospitalized, I was supposed to be safe. No one protected me. After every hospitalization, I came out more confused. They handed me prescriptions, diagnoses I didn’t understand, instructions without context. I felt like an experiment, someone they tested different chemicals on until I stopped talking.”

In my case, I am a sexual and physical trauma survivor who was not protected, supported, or believed by my family or therapeutic team, and I was very obviously self-harming, and my desire to not be alive was strong then, and it’s become even more chronic now.

The Mechanisms of Silencing Psychiatrized Persons

The mental health fields and public health discussion of whether psychiatrized people deserve rights is often driven by stigma, a stigma that mental health providers continue to perpetuate. I see it often, my colleagues discussing their severest cases in public spaces, supervision, classes, and other work-related or public activities without any context or without discussing how many others have recovered and done well. The abuses are justified, as the only choice there is, “it’s for their own good,” “their own protection.” Once a psychiatric label had been given to us, we lost our humanity and became less than human, and in need of containment.

Colleagues seem not to be taking into consideration whether people haven’t done well because of what psychiatry has done to them or what has been done to them due to their being psychiatrized. Providers, the public, and other professionals argue for coercive practices and refuse to hear any of the empirical findings on how these are extremely damaging and lead to significantly less chances of recovery.

In fact, I often hear what I consider the laziest excuse: “This is how it’s always been done.” As if this could not be changed or as if they did not hold any power to push or create these changes. What’s clear in these dynamics is that in the guise of goodness, the human rights of psychiatrized people are often sacrificed, dismissed, and ignored. I have also heard my colleagues mention they would not go to a psychiatric hospital if they were in crisis, or have not, but yet recommend it for the people they work with in mental health settings.

Society only creates these separations of who is deserving of human rights and agency over their decisions for psychiatrized people. We see this now, while many are currently fighting for democracy and to retain autonomy, this does not play out when it refers to psychiatrized persons, whose capacity to make decisions for themselves is often questioned and placed in the hands of the so-called mental health experts. “Care” is then done behind closed doors, hidden from the eyes of the public, and although reports of human rights violations and harm come out of these “care” settings, these are later discredited. This is because of how psychiatrized people are seen.  Based on the perception of sanity, psychiatrized people are often disbelieved as what they recount should not be trusted. This becomes a perfect weapon to use.

This often starts with the weaponization of psychiatric diagnoses, one’s choice over a diagnosis, and what goes into one’s chart. As we all know, or should know by now, psychiatric diagnoses are based on the subjective opinions of a mental health “expert” and are often assigned during a person’s most vulnerable states, after one visit, and based on assessments that aim to assign a diagnosis. Moreover, research has found that these diagnoses do not account for the causal role of trauma, are often homogenous, and do not truly take contextual and cultural factors into account. Another way through which the rights of psychiatrized people are violated based on diagnoses that many people seem not to be aware of is how having a psychiatric diagnosis results in being treated in discriminatory ways when in healthcare settings, employment, and potentially by communities and others. Many psychiatrized people have shared how having a psychiatric diagnosis, which they may not agree with and they may not identify with, impedes them from receiving quality care, exposes them to medical gaslighting and discriminatory treatment, and limits their ability to get employment. In fact, on one of the studies I collaborated on, we found that when a person with a schizophrenia diagnosis presented at the emergency room due to back pain, doctors and mental health providers would mostly focus on the diagnosis and not treat the presenting complaint. This was similar to substance use in this study.

Additionally, through involuntary psychiatric hospitalization and all these forced interventions, such as medication, many are left paying off or accruing medical debt for years. After all, recovery is not financially enriching in the short term, and if people taper off medication, they will not have to pay increasingly high costs for these, and the add-on ones to manage side effects, or to supplement their effects. Moreover, recidivism would see reduced rates, and hospitals would see decreased earnings.

Ahh, The Meds…

In fact, this entrapment is what I hear most from psychiatric survivors; the words prison and jail echo in my memory as I type this. Trapped inside a psychiatric hospital, trapped by a new chemical that causes physiological dependence and reorganization of our brain chemistry. Ahh, the meds…how many of us received proper orientation on what they do, their side effects, and what happens when we try to get off of them? How many of us were given alternatives to medication? If you did not want the meds, were you coerced into taking them? “You need these,” “these are to correct your chemical imbalance,” “it’s like diabetes, you would have to take medication for a medical condition.” And if you don’t take them, you are “non-compliant,” “deviant,” or maybe you “lack insight.” …You basically can’t say no to meds nowadays, and boom, you have been trapped. I remember watching a documentary called Bedlam nd being horrified by the psychiatrist who, upon a woman experiencing psychosis, came into the hospital and casually said something along the lines of “although this will fatten her up and she is too young for that, we have to give it to her”. She did not seem to even attempt to speak to her and give her options; she went right to misleading her and prescribing a medication that has well-known detrimental side effects on someone’s health and well-being. This was not even someone who was in any way threatening, which made me scared how she cared for those who were angry, frustrated, confused.

This does not even account for how people experiencing distress are often chemically restrained and sedated without their consent in psychiatric and medical settings. This one is difficult to say because often people will focus on the most extreme cases where harm to others was unavoidable, and restraints were the only way to prevent further harm, the last resort. Nonetheless, the reality is that with de-escalation, heightened states can often be avoided, as research has found that escalation is often attributed to inpatient cultures and the lack of interpersonal skills of some providers. Additionally, as the studies cited above describe, many healthcare professionals seem to abuse these powers, keeping people sedated and restrained for extraordinary periods of time, and using these tools as a go-to instead of working from a baseline of empathy.

Sedated, Bound, and Gagged

Besides chemical restraints, the use of physical and mechanical restraints is often another way in which human rights are violated. For all three forms, there have been gender and ethnoracial disparities found, which suggest medical racial bias may be a driving force, but also that if a person was from a majoritized racial group, they probably used de-escalation instead of violence with them. These findings suggest that the ability to de-escalate situations is one that could be implemented, but they choose not to use it either consciously or unconsciously, depending on a service user’s ethnoracial identity.

There is also concern with preventing escalation and not reaching a point where a person is reacting to what may be happening in their environment. Even reacting to how they are being treated, which, in some cases, such as with police, they are violent with people experiencing distress from the get-go, is an obvious recipe for disaster. This is one encounter that many people experiencing high distress do not survive.

A Call to Action to Providers and Public Health Officials to Use Their Power to Stop Human Rights Violations in Mental Health Care

We need more provider allies to stand up for the rights of psychiatrized people instead of continuing to submit to the status quo. Currently, hundreds of people are suing the Acadia healthcare system for falsifying medical records, keeping people locked in psychiatric hospitals against medical advice, and extending stays just to charge insurance more. Although people who had been incarcerated had spoken up, it was not until provider whistleblowers started speaking that the news started to break out, and these violations garnered attention from the media and public. In this case against Acadia, there are reports of experiences of sexual abuse and violence committed against psychiatrized people, either by staff or by other service users, and how they are asked not to report or falsify information related to these aggressions. Additionally, staff report being underpaid, undertrained, and exploited. This is very telling of how disenfranchised psychiatrized people’s experiences are, and to me, it begs the question of how much mental healthcare leaders are getting away with. How much are they contributing to this discourse to accomplish their financial interests? The level of corruption and violations they get away with based on the “crazy people are not to be believed” discourse is astounding and should horrify us all.

In many ways, it feels like this is just the tip of the iceberg because of the many ramifications these violations have, including the psychiatrization of poverty and the perpetuation of cultures of abuse. These are potential topics for a future column. However, what we do know is how society turns a blind eye to these human rights violations due to the misinformation and public stigma around psychiatrized people, stigma that many mental health professionals continue to spread.

This column, however, should serve as a call to action. I expect my “mental health” colleagues to actually rise up to the occasion and fight for the paradigm shifts that have been called for by international institutions such as the United Nations and the World Health Organization. The vacuous and asinine attempts at social justice that currently take place in our field are only perpetuating further harm towards psychiatrized individuals. The way we diagnose determines how we address mental health as a whole. The way people call themselves experts without having actual embodied knowledge of what the mental health system does to people perpetuates paternalism and power dynamics. Society places academic and professional expertise on a pedestal before lived experience and their well-being, thus continuing to perpetuate and support human rights violations in mental health care.

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