Sure enough during a coffee break, someone is talking about an unsafe child & young person’s inpatient ward they worked on. I make a sympathetic face, but inside my stomach tightens. The worker tells me a young person was throwing chairs, that they ended up restraining that person, a Dr. (Psychiatrist) came to see what had happened then went away. The worker was disappointed the Dr. didn’t help. The restraint lasted several hours. They felt someone should have come to help them and that the person needed medication. In the end the person was medicated. I hear the passive voice in that sentence. I can feel the impact of that grammatical twist and feel an easy story taking its grip. Grimly I acknowledge to myself that the passive tense can ony mean that what happened involved forced sedation.
My mind races. I swallow and try to sound sympathetic, “That must have been tough.” They agree it was.
Culturally we seem to believe that when a child is showing threatening behaviour that the adults should take back control even if that means fighting fire with fire. We get drawn into battles motivated by the need to dominate. This gives us an easy story that shapes our response to the child’s distress. I just don’t believe that this forceful approach works. Retraumatisng traumatised people doesn’t change the problems that lead to these distressed and distressing behaviours. I believe we should strive to find better ways forward. I decide to push my luck. “Everyone seems so on their own with such a difficult situation. It’s scary when things are out of control.” The professional doesn’t seem annoyed. Perhaps they haven’t picked up that I am thinking about the patient they restrained as much as I am thinking of them.
I listen as the worker tells me that the young person was behaving that way because they were unwell. While she talks I struggle to decide which part of this easy story I want to make more confusing for her. Is it the belief in distress as an illness, the belief that the drugs correct an illness process, the belief that behaviour cannot be de-escalated, the feeling that restraint is the immedate response to distressed behaviour, the lack of a plan to intervene before things get to a head, the lack of an alternative way of making sense of what the young person was doing? As the worker talks I am remembering the one time a child hurt me, I had not realised that four of my colleagues were standing behind me in a way that was very threatening. I also remember how unaware my colleagues were of how they had contributed to the problem. I am thinking of many times that a young person throwing a chair did not end up with physical or chemical restraint.
“I wonder what happened just before your patient threw that chair?” The worker I am talking to looks confused. “Do you think it might have been possible to do something at that point to avoid things getting so unsafe?” I don’t want her to feel there is nothing that can be done to change things for herself and the young person, even though she is unsupported.
I think about people I have talked to about their experience of chemical restraint, about their feeling of powerlessness, humiliation and worthlessness after forced sedation. (“I just wanted them to leave me to cry, they say it was more like a scream. They said they wanted me to feel better. What they give you makes you feel like you are drowing in sleep, it pulls you down and you can’t fight it, it takes you over. I just felt powerless and they could take me from myself anytime.”).
As the worker talks, I remember a friend told me when she was out of hospital, “It builds up, they ignore you or don’t listen. If you say you are struggling they just put up the medication. They don’t care about you, they just don’t want you to cause a problem and they are in your face all the time. At some point, you just need some space.”. My friend was 16 years old when this happened, about the same age as the patient on this ward. In her case help in hospital seemed to mean being under pressure to see her difficulites in the medicalised way the adults wanted and control over every aspect of her behaviour. To me the experiences she told me about seemed like a harsh punishment for feeling suicidal. It also didn’t seem that she experienced a response that was likely to make her want to live. Is that what hides behind the easy story the worker is telling me? There are too many stories like the one my friend told me to dismiss that possibility. Certainly the voice of the young person seemed to be totally missing from the worker’s account. At the same time, I remember another friend who sometimes lost control when extremely frightened. She told me that she liked it that her foster parent would hold her so that everyone could stay safe and would let go when my friend was back in her own control. Eventually, she would relax and the hold would turn into a cuddle. Another story, another layer. These stories in my head are not easy stories. They are full of questions, conflicting understandings and confusion.
Maybe forcing sedation at crisis point is the least worst option. However, I decide I feel angry with the easy story the worker told. It doesn’t seem right to me to dress this up as a medicine that the patient needed. Perhaps sometimes things go too far, but in my view when this happens it should be called chemical restraint. I see it as an indicator that something has gone wrong in the way the situation was managed and the relationships between the staff and patients.
I swallow down my angry words, they won’t help here. The weight of them makes a lump in my throat. “I guess you really needed the patient to get that medication, so you could feel better.” I’m proud of myself, I managed to say medication not ‘chemical restraint’. The sentence captures a potential dynamic without going into too much inappropriate detail. In the past these conversations haven’t gone well. After the last time I was confronted with an easy story, I convinced myself that people might be more able to consider different ways of looking at the problem if I didn’t call out the ways they used language to protect themselves from what they were doing.
The worker looks at me with silent fury. One quick look, with pursed lips. We avoid each other for the rest of the conference.