This is the start of a collection of experiences of mental health service and medical service encounters conveyed to me by patients over the years. I will add more in time. I thought I would start putting some of them together merely as an illustration of some of the bad practices that continue to go on in the UK and how they can impact people who present in a vulnerable or distressed state of mind. Typically, the individuals involved came away from the experience of having been humiliated, shamed, stigmatised and feeling that they were at fault for presenting as they did. When in fact they were merely normal people in a vulnerable or distressed state seeking help from a system built on archaic practices that continues to be passed off as mental healthcare in the UK today:
Angela had been a sensitive, very intelligent A-student all of her life but had isolated herself increasingly as a teenager, eventually leaving school after failing several exams and scraping a pass on three others. She was depressed. The school hadn’t addressed the sudden change in Angela’s grades or her depression. She had been an unwanted pregnancy for her mother and grew up in an unsupportive family in which her mother had abandoned her as a baby for several weeks, running off with another man. The family had scapegoated her ever since, blaming her for whatever went wrong around her. If her sister did something wrong, it was Angela’s fault for not taking responsibility and looking out for her little sister as the older sibling. Angela was scared of the world, chronically shy and insecure and retreated to her bedroom to avoid her father’s bullying and her mother’s scapegoating. She had elected to stay at home whilst both parents and her sister went on holiday, so in need of peace was she, despite longing to be away somewhere different herself; somewhere sunny by the sea. Angela was finally diagnosed with ‘clinical depression’ and initially felt hope for treatment and someone to talk to. She was given anti-depressants, saw a psychiatrist for what she thought was psychotherapy and was told at the first meeting “You’re only here so that I can monitor your medication”. The Doctor suggested she bring him her poetry to read next time. She brought several pages of it to the next appointment and handed it over. The doctor never mentioned it again. Angela attempted suicide some months later.
Janice Took A Knife
Janice took a knife and cut her arm at the elbow joint. She was a shy teenager, withdrawn from her family and had declined in her mood and self-view gradually since age fifteen. At nineteen she was still living at home, isolated in her bedroom and had just broken up with her boyfriend after a week into a new job that she hated and that made her feel like she was a freak because she was unable to relate to her coworkers, who gossiped about one another as soon as backs were turned. On the Friday night of the first week she drank half a bottle of whisky in one go, took the blade and sliced deep into her vein, the blood pouring out like a fountain under the covers of her bed. Finally, she thought, I can find some peace. She awoke in the hospital with a drip in her arm, and some vague memories of paramedics taking her down the stairs in her house, half conscious, whilst commenting that they thought she was pretending to be asleep. At ward rounds three doctors came by early in the morning, the lead doctor with a condescending smile on his face as he asked “How did you do it?”. “A knife” Angela replied through gritted teeth. Sensing her anger, the three doctors moved on without a word. A few hours later, Angela was assessed by a psychiatrist, told the psychiatrist she’d been depressed but had made a mistake and wouldn’t harm herself again. She was sent home an hour later with no follow-up support or other intervention.
Tom was taken to Accident and Emergency following an inability to breath properly that happened whilst out for a drink with friends. Tom had been struggling with depression and low self-esteem for some years and had been confronted by his boss late in the day, who had criticised him for ‘not being a team player’ by not mixing with his colleagues at work during lunch hour each day. After a couple of beers Tom had experienced shortness of breath and a tightening of his chest and had passed out. An ambulance was called and he was taken to hospital where he regained consciousness and began to hyperventilate once again. Unable to calm himself, the doctor treating him lost patience, exclaimed “I’ve had enough of this!” and walked out of the room, leaving Tom and one of his friends alone. Tom eventually regained his composure and left the hospital, humiliated and shamed without any further contact from medical staff or any explanation of what had happened to him.
Kevin at 3 AM
Kevin had been with a woman who repeatedly abandoned him whenever they’d had an argument, running to another man that she had kept in her life, and whose background presence in her life had been the cause of most of Kevin’s objections and their subsequent arguments. Kevin felt that his partner had been using the other man to undermine their relationship. Kevin was a sensitive man who simply wanted an exclusive, faithful relationship. His sense of self-worth declined gradually as he attempted to struggle with escalating anxieties and insecurities in this relationship. His partner’s secrecy, lies and unwillingness to remove the other man from her life had been ruinous to Kevin’s mental state. He had awakened at 6 am in the morning to find her gone from their bed. He discovered her texting the other man from the bathroom. Kevin had discovered secret mobile phones that she had kept in order to be able to maintain contact with the other man. After arguments about this behaviour she would typically disappear for several hours, unreachable by phone, during which time Kevin would agonise about her whereabouts. She would return, lying about where she had been; Kevin later finding out that she had been with the other man seeking solace from him. This went on for years, with breakups for a month or two and the woman begging Kevin to come back, which he did, only to experience a resumption of the same pattern. Kevin took an overdose of sleeping medication and was rushed to hospital. After explaining his circumstances and the reasons for his overdose he was discharged at 3:30 am and had to find his own way home by taxi, still drowsy from the effects of the sleeping tablets, with no wallet or money to pay for the cab.
Nikki had accidentally overdosed on her pain medication after a three day migraine and was dropped off at A and E on Christmas Day by her cousin after she had spent a freezing Christmas Eve sleeping in her car due to a falling out with her flatmate. Medical staff had assumed that Nikki had deliberately overdosed since she had an earlier history of self-harming behaviour and depression. Staff were dismissive, short with her and clearly inconvenienced by a young woman who was now homeless. After a sleepless night on a busy, noisy, over-heated ward with a drip in her arm Nikki tried to speak to a member of staff in order to arrange to leave. No-one was available to speak to her, so she decided to get dressed and left the hospital quietly. The hospital called the police when they discovered her missing. Police called her on her phone and said they just needed to check that she was safe. She agreed to meet them whereupon it became apparent that they had lied and wanted to take her back to hospital to be formally discharged. She was escorted back to the ward by police, like a common criminal, in full view of patients and a hospital staff team staring at her as she walked down the corridor, then once all paperwork was taken care of released late at night on Christmas Day eight miles away from her car, with no buses or trains running due to the holiday period. Two weeks later she received a hospital discharge summary which described the event in the most negative terms possible, clearly stigmatising Nikki who was described as ‘unemployed with a history of deliberate self-harm who had absconded from the ward’. This letter now forms part of her medical record. Nikki remained homeless for the next four months.
Jenny was shocked one day, upon requesting a copy of her medical records, to discover that she had been given a diagnosis of personality disorder some twenty years before whilst she attended an outpatient clinic for depression. No-one had ever discussed this or any other diagnosis with her at any time, other than to convey to her the understanding that she was suffering from depression. Upon reflection, the pejorative diagnosis had made sense to her in explaining the often strange, aloof attitudes that she would encounter whenever she visited her doctor or had a hospital appointment. None of these professionals, including her family doctor, had ever mentioned the diagnosis to her. Yet for the past twenty years she had carried an invisible label and psychiatric stigma that, rather than bringing her assistance and support, had instead served to reinforce her feeling that there was something deeply flawed about her value as a person and that medical professionals could see it. They were, in fact, viewing her through the lens of an unsupported misdiagnosis that Jenny was later able to have annotated in – but not expunged from – her notes after a lengthy administrative procedure.
It’s my conclusion from these and other cameos I’ve been privvy to that the entire approach by public health services to mental distress is crude, insensitive and harmful in some cases. The medicalisation of emotional and mental disturbance is, in my view, the fundamental error. In most cases, there is little or no medical basis to mental distress. And yet, the professions have relentlessly subjugated what are essentially human, existential and emotional experiences to the inappropriate paradigm and codification of medical diagnosis and ‘treatment’. Typically, medical staff presented with distress or disturbance may feel helpless and out of their depth in working with people outside a field that typically requires clarity of established protocols around medical diagnosis and medical treatment of physical ailments. Difficult human experiences are, unfortunately, not easily ordered and managed in a medical way, other than the obvious bludgeoning of emotional and behavioural expression by physical and pharmaceutical restraint. This is not a cure, but a means of containment. The resulting sense of alternating between professional helplessness and crudeness of forced control results in vulnerable people being disrespected and dishonoured by a system that purports to care for them.
In my view, services need to be radically redesigned to render medicine merely a useful adjunct, subservient to the patient’s needs for social support and emotional care in therapeutic environments designed specifically to refuse all forms of stigmatisation, disenfranchisement and disempowerment. And instead to provide tailored multi-disciplinary care to human beings in need of a human response to their suffering. This necessity arises in the context of a society that has allowed real community cohesion to be eroded by the pursuit of individualistic concerns. In such societies care for the vulnerable has gradually been handed over to ‘experts’ and other professionals, turning human distress with discreet patterns of aetiology and development, into ‘conditions’ and quasi-illnesses, when much of our human distress originates in an absence of real family and community caring, love and support which the professions and broader economic concerns have usurped to the detriment of those whose greatest need is often the need to be treated with kindness, respect and compassion.
*Names have been anonymised and photos do not show services referred to in the text.