sightseeing - part two

a first peek into my records

I’ve begun reading my psychiatric records – retrieved by request from my GP’s office and printed out in a thick stack of A4. I’ve got no further than the first four pages which comprise the initial record of notes from my first hospitalisation. There’s plenty enough in those four pages to digest.

A thin, young Caucasian lady, casually dressed, with shoulder length blond hair, sat holding her head in her hands and crouched over her legs.

Yes – that sounds like me. Avoiding eye contact and refusing to speak. I was in a room with several doctors lined up to observe me and pass judgment, and I was terrified. Earlier I had been brought

in to the Mental Health Assessment Service, where she tried to run away. MHAS nurses then brought Julia up to the ward.

The language here is so muted. It doesn’t do justice to my attempted escape, running from the building and tackled to the ground by the warden, where I kicked and screamed and was dragged back inside.

Julia stated that she felt fine but appeared scared, distressed and slightly low in mood.

Well, quite.

Julia initially refused a physical examination, but later consented.

No mention here of what changed my mind. I recall feeling bullied and outnumbered by officious, disinterested staff nurses. I think in the literature they call this ‘coercion.’

Following this assessment, she was started on regular Chlorpromazine 50mg twice daily. She was given an information sheet regarding this medication but was reluctant initially to take it although finally agreed.

Coercion?

A general improvement in her mental state was observed over the coming days as she became more amenable and was allowed out on escorted pass…

She expressed desire for discharge…

She reported experiencing some side effects of her medication including stiffness, restlessness and blurred vision, but she was prepared to continue the medication.

Good girl. You may leave now.

Mental State on Discharge

She appeared well kempt and a good rapport was established.... [She] had a good degree of insight with willingness to continue engaging with [MH services] and to take medication.

Ah: insight. This is a term that is used in psychiatry, to describe “the capability of psychiatric patients to recognize and accept that they are suffering from a mental illness.” (reference) The concept of insight is ambiguous, poorly studied and rests on the bizarre notion that a psychiatrist’s perspective is objective while a patient’s is subjective.

The current working diagnosis is of a first episode of psychosis, with differential diagnoses of an acute psychotic state, acute confusional state, bipolar affective disorder and schizophrenia.

And that, ladies and gentlemen, was that. A few stigmatising labels slapped onto the case, as differentials, and the medical record concludes.

Now – please do understand: I edited this initial record with a heavy hand. It’s four pages long but I’ve selected the above snippets for effect. All the same, it is one very subjective account masquerading as a medical record, littered with jargon and pseudo-objective language to disguise the sheer crime of incarceration and compelled drugging. I was only released when I acted with compliance and amenability. And did it help that I was a thin Caucasian woman? That I had education, and a job, and the social collateral of a middle-class lifestyle? That I knew well how to conform, to tone myself down, to obey the rules? Of course it did.

Let’s not pretend any longer that psychiatry is a branch of science. It is pure fiction, authored by those who hold the keys to the locked door.

photo by David Clode on Unsplash