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She didn’t do what was nice…

“You taught me to be nice, so nice that now I am so full of niceness, I have no sense of right and wrong, no outrage, no passion.” Garrison Keillor

I remember when my parent was in hospital I was always being asked to be nice. Be nice to the nurses. Be nice to the doctors. Be nice. My mother knew exactly how I felt about the staff. She wouldn’t talk about how they were treating my father and so why I had a problem with the workers behaviour was ignored. She would admit that she thought they weren’t that nice, but wanted me to be nice to them anyway. She had the ultimate punishment if I tried to explain why I was upset at the way people were treated by staff in the ‘horrible place’. She could say I was not being nice enough and she could refuse to take me with her when she visited. “If you can’t be nice, it’s because you can’t cope. Everyone will understand that it’s too much for you, I won’t take you.” Learning to be nice, I guess, is about experiencing what it is like when people with power find very reasonable ways, that sound nice, to not be nice at all.

What I learnt was that people can hide a lot behind nice words. Nice words are like smoke, confusing and blurring what is really there.

Esme Weatherwax didn’t do what was nice. She did what was needed.

The Shepherd’s Crown by Terry Pratchett

I read a lot at that age, not having too much in common with my friends and it was a good escape. I knew that ‘nice’ really meant ‘accurate’ as does ‘subtle’. I decided that I was being very nice as I was being accurate in what I observed and subtle in how I behaved.

“He fell,” the Nurses said, when I pointed out bruising on his upper arm.

“They fall a lot, the patients here,” I said.

“Well, a lot of them are very old,”.

I did think that about 50 years old or more was VERY OLD. “He didn’t get bruises like that if he fell at home.” I felt stubborn, looking directly at something that was happening that I could not quite see, but somehow being pushed away and back by niceness. Persistance felt like some sort of victory.

When people fall the bruising is all down one side where they landed, not on one or both sides at the top, with finger marks. I noticed. I drew a picture of the outline of the body and marked the bruises on it. Over time, there were lots of little diagrams like that in my notebook.

I sat in the Day Room and noticed the absence of the nurses (Why was I in the day room on my own? Who knows… Mum might have been with Dad?). I sat in the Day Room and noticed Patients sitting staring into space. A lot of people had strange movements in their limbs and were drooling, when they walked they shuffled, but then again, nobody moved or spoke much. It was oppressive. I didn’t write anything down in my notebook about that, as there wasn’t much happening. I just guessed this was how the illness progressed. Sometimes the harm is so thoroughly hidden that you can’t see it.

I did notice some other things. I noticed that the nurses only turned up if someone started making a lot of noise and movement, then they turned up en masse and the person was removed very quickly. I wrote it down in my notebook.

Sometimes patients were in the Day Room, sometimes they were not. If you asked after them, there was never any answer about where they were, from Nurses or Patients. I thought this was weird. I would have thought people would have said, “Oh, they went home”, or, “Oh, they were in their room, so don’t bother them”. Sometimes it feels like something is up, but you can’t note anything in your notebook.

Once I was in the Day Room and called out ‘No’ when one of the nurses tried to pull someone up by the wrist of one arm. I knew you could do damage handling someone, especially that particular patient who seemed frail, that way. As I moved quickly across the room to show the Nurse how to help someone up, a lot of nurses turned up, looked at me, told me to be quiet and to my relief went away. I felt frightened. Did these people demand absolute silence? Why was it quieter than the school Library? If I made too much noise, what would they do to me? What did they do the patients when they made too much noise? I wrote it down in my notebook.

I was with my Mum and younger sibling. Dad’s room was in a mess, sheets all over, bed pushed away from the wall. He sat in the corner, being very quiet, he didn’t seem to be ‘with us’ though. He was a very tidy person so the room puzzled me. The person he shared a room with wasn’t around either which was unusual. Mum quickly sent me and my younger sibling out. I wrote it down in my notebook.

My younger sibling caught some Nurses talking to our Dad. They had found out that if they saluted him, he stood up and saluted back saying, ‘Captain’ and they were laughing. Dad thought he was back in the army, which he had hated and where he had especially disliked his Captain. He told me that he had survived the army by doing what he was told and keeping his head down. This was one of the stories Dad had told me often, usually in an effort to get me to keep my head down, which he felt would be a good life skill for me to grasp. I wrote it down in my notebook.

Over some time, I came to some conclusions:

  • there were no activities and nothing to do, even though there was an activity schedule on the wall it never changed. Patients looked blank when I talked about it.
  • there was a kitchen for families and patients, but it was always locked for some reason
  • the door to the garden was always shut and locked so everyone was always inside
  • the nurses turned up if there was any sound at all and never came alone
  • when people had more strange movements in their limbs they were more likely to get up and call out, then many Nurses turned up at once and took them away
  • the bruises on my Dad all the time were not consistent with a fall

One day I found a Psychiatrist in the Office, I had been looking for one but Psychiatrist’s seemed even more scarce than the Nurses. The Nurses had told me the Psychiatrist was in charge when I asked questions, as they thought I should speak to him, not them a bout any concerns I had. I hoped he could change the things that were bothering me. I showed him my notes. He took my book, flicked through the pages and said, very gently “Well, it’s up to the nurses how they do their job. I prescribe the medicine, they give it. Don’t you want your Dad to get better?” My Dad didn’t seem to be getting better, he seemed to have suddenly got a lot worse. The Psychiatrist left, taking my book with him. His answer was more puzzling than my observations though. In my teens I didn’t understand what medication and treatment could have had to do with a silent day room, an intolerance for even a normal amount of noise, poor skills in handling and lifting, no activities, persistant patterns of unexplained bruising, a closed garden, a shut up kitchen, intimidating gangs of nurses and messy rooms.

When we got home my Mum was fierce. In a rare moment of clarity, she held me by the shoulders against the front door and shook me.

“Why did you do that? You’ll make it even worse for him.” she hissed. “Be nice.”

Then the clarity subsided back into silence and stories about how the way they were treating him was necessary and helpful. I could see one story sliding out of her mind as she shook me and the easy story rising up to take its place.

Many years later at Univeristy my friend who was studying psychology and I had an argument one evening about schizophrenia, the dopamine hypothesis and anti-psychotics. I learnt then that brutality enforced by law is based on a highly contested viewpoint. The extent of the lie and the extent of the abuse that the lie can allow hit home, the image of the Day Room and the patients, the meaning of what the Psychiatrist had said and fragments of memory came together and pushed me away from the world. I was aware that my friends were talking, trying to get me to give them my attention but I repelled the society we lived in away from me and as I did so their voices became distant as did the lounge I was in. I couldn’t be there in the world we had made, so I went away. I didn’t respond to anyone for several days while I processed the answers to the questions I had been trying to ask in my notebook. When I came back from wherever my mind had been driven to, there was a row of mugs of cold tea outside the door of the spare room where my friends had put me, my best friend was lying next to me reading and some anxious whispering was going on in the lounge. I didn’t really have anything to say about it when I came downstairs though, as there is just not really much to say about a lie that big and that catastrophic.

It’s well known abuse causes trauma. Psychiatric patients are traumatised by inhumane and degrading treament when they experience it and some survivors talk of this experience as torture. Witnessing abuse also causes trauma, in everyone that witnesses it, including those who take part in abuse. It was the State and its Officials who traumatised me. I won’t call them Mental Health Professionals, I am absolutely certain that until they sort out the coersion and Human Rights Abuses underpinning their professional practice, that they don’t deserve it. They have not earnt the right to the word ‘health’ or the word ‘professional’.

Chapter 1- We are all surrounded by voices…

There are so many messages in the world; murmurations and susurrations, humming, whirring and buzzing: intimating suggestions, declarations, demands, wishes, hopes, entreaties…

In the repository of goods and people that was the city market place the volume of activity overwhelmed the child. Chris could see all the stories of the human world in their multitudes; the cooking smells, sudden impressions of the decorations on clothing, the metre of steps, groupings of stalls, unexpected convergences of people, obscure cries and calls. At some points these suffused per so completely that there seemed to be no boundary between per and the abundance, yet at others felt so unreal, so remote that each detail was preserved as an endless series of detatched, precise instants.

Anything could be bought in the market place, for the makers were skilled at crafting objects to enable complete delight. Anything could be sold or acquired – if you could pay the right price. Marvellous blooms that could summon lost children home, sumptuous fur coats that would protect against the deepest cold, shoes that never rubbed blisters however far you walked, brooches that changed colour if a lover lied to you, compasses that led to an adventure- all sorts of inventions of ingenuity and vision. In the human marketplace however, one person’s satiation is another’s painful confusion. Slaves could be bought too, for whatever use their master saw fit for them, servants struggled under innumerable burdens, dancing bears heaved and laboured. People who could not afford the produce mingled with those who could have everything they wanted.

For those who knew how to look these hidden things could easily be brought into view. You needed to have been born with one specific powerful capacity: a little known type of magic. The inability to lie. This child did, unexpectedly, did not know how to avoid seeing. Being unable to avoid seeing is a terrible deformity.

Chris was confused at how many things the multitudes in the market place did not see. They saw the brooches, but not the people making them; they saw the cloaks but not the skinned animal carcasses discarded and ignored; they saw the people-sellers gaudy and ornamented, but not the people they sold… When the child brought per attention to the people nearby, per saw the hot smoke resting on the adults’ faces, thick vapours cloaking their veiled eyes, trailing around the soft contours of their faces, leaving damp traces of condensation congealing on their lips; per saw delicate webs of slick tendrils weaving between eyelashes ready to trap unwelcome images; per saw scales of skin creeping through the people’s eyes, scabbing over the eye socket and eyelid; per saw splinters of silver flecks crowding the iris until they spilled over, relentlessly filling up the pupil with a reflective gloss, like the mirrored surface of a dark pool. The filtered, unprocessed images that could not reach the adults’ eyes floated about the square, still disengaged from their origins, occluding what was going on. The lost images, unseen, filled up the marketplace, creating a procession of insubstantial chimera. A scattering of small children’s teeth formed a necklace that attached iself around a woman’s neck, although she remained oblivious. Animal bones formed an intricate framework which was picked up and carried as an umbrella by a well-dressed banker, as, looking up at the heavy clouds above, he darted up from drinking a coffee from a cup. Spectres of the invisible people who had made the shoes or served people’s needs drifted around, following the buyers who had the things they made, scratching at the chains that bound them to people who had stolen or bought them, pulling uselessly at the scales or cobwebs or smoke in front of the buyers’ eyes, struggling to get them to see. Barely audible above the everyday noise was a dry soughing as the unreal brushed up against the real.

The wean also saw other things, terrible things that were undeniably parts of the real people; revealing secret lives of pain and hope, their bodies spoke loudly in an uncertain language of their inner worlds. In the man with a cavity for a chest Per glimpsed the dull, throbbing redness of his beating heart where the weapon of his self-criticism had pierced the sterum, crushing the bone. His whole torso shook with carrying the enormity of the injury, even as he exchanged gossip with housewives, bagged up groceries or chatted up eligible daughters. Although in secret he continued to tinker with a private invention which he hoped would bring him fame, respect and riches, he knew that he could not get it to work, but nevertheless kept trying to breathe life into it during lulls in the crowd. At times, the child stood watching the birds with the wicked razor beaks that were still slashing at the man who’s suicidal feelings had led to the sellers in the marketplace finally chaining him to the wall of the hut behind the bar to stop him killing himself, the furthest away place they could find. Were the birds the cause of the wish the man had to die, or the consequence of the brutality of the isolated hut? Chris did not know. Certainly, the birds were not telling as they occupied themselves single mindedly on gorging themselves on their still-living feast. At other times, per crouched in the crease between two stalls, carefully, silently, avoiding the river that accompanied a man whose daughter had drowned years before. Per did not want to get drawn into the sucking weir that followed him as so many people did. The child had seen the lost, surprised expressions on people faces as they re-emerged when the threat had passed over them. It seemed that some remained drowned, never to resurface. Chris, alone and cold, stared at the unclear blue figure hovering over the back of the recently married women, its hands on her shoulders. The girl’s protective grandmother, gently checking her cherished granddaughter. On good days, per cautiously drew close to the slight girl who was at the same time a light, whose flame was always accompanied by a fear that cut through pers numbness, because it seemed so bright against such a dark sky.

The wean moved around the market place, never touched or touching the images or the people, immune to both the real and the unreal. Sometimes it seemed one or another might have seen per. They reacted by yelling, raising a fist or turning away, yet they did this with a sense of futility and confusion, as though, once they had started to ferociously respond they couldn’t, quite, completely realise what it was that had set them to such an energetic attempt to repel a threat. Once it seemed a dog ran to the length of chain to bark at per, before yelping and hiding in its kennel. Later a cat, arch as well as impertinent, slowly, deliberately looked per up and down. Then all its fur stood on end. It hissed and slipped off.

Suddenly next to per, in the middle of the market place Chris felt a flurry of corvie’s, sensed a involution of feathers, arms, wings, hands, talons, nails, a staff and bright eyes which resolved itself into a strange figure. One taller than it actually seemed at first, moving fast, yet limping and uneven in it’s gait. The wean had seen her before, travelling purposefully in whatever direction she chose on her self-imposed tasks.

“You and your Dragon companion could sit with me”. The figure’s bird eyes are intense and coruscating.

Inexplicably, Chris recoiled from the touch of the eyes which could see so acutely, as the gaze itself felt like it drew into form some insubtantial part of her. Wait! As a metamorphosis always carries itself to its conclusion once the conditions for it are right; like a spindle, once started draws the fleece into yarn, like the magnesium once lit explodes in a flash, like the ice forms on the surface of winter lake, the transformation had happened. Raw, newborn per stood firm on the ground of the marketplace, feeling suddenly solid and permanent, muscles anchored to bone through tendon and sinews. Yet, less tangibly, there was also another manifestation. At first a light pressure, like the brushing of a moth aginst a window, which increased relentlessly. Implacably it gained mass and substance until it became a distinct impression on the mind. Each sense compelled to register the immense presence as though its very existance produced a weight that could not be endured. Chris froze, the ancient response of a prey animal aware of a predator. However, there was no hiding – this entity was one that was already acutely aware of per, although it was so alien that perhaps any hunger it felt could only be satiated by the fiery death of distant suns. The membrane that formed the line of separation between two different types of being that had somehow become bound together was now delineated. Here there was a great talon around per heart cradling it tenderly and there, another, resting its point finely against the thread that held per soul to per body. The sinuous lines of the fury’s body followed the convolutions of per gut, the collossal limbs unbelievably intertwined with pers, the lungs taking corrosive breaths along with per. Subtley, per experienced per mind terribly fused with the Dragon mind. Zie’s eyes looking through per eyes created a perception that blended the things of this world with the visions seen from the other one. The dry, hot, empty land where Dragon lived.

Steady, steady the child lowered per breathing. Chris looked back at the Maimed Pilgrim, staying steady by locking onto her face while immersed in surviving the embodied sensation of being both a child and a myth. The child developing a comprehension of how to be a chimera. Calmly, the Maimed Pilgrim looked back, adjusting her weight on the staff as the burn on her face and one side of her body made her stiff . She settled herself, the twisted arm held into her shoulder, the two smallest fingers tight and spasmed into her palm, calmly ready to stay and wait as the child located perself in relation to the Dragon.

The child grasped onto the Maimed Pilgrim, a sailor embarking on a thousand mile journey looking out over the stern of a boat, seeking connection to land even after travelling on and on and out of sight. The staff was a setting point, the marker that connected the real and the unreal. As the child eased into the pause, per felt the intricacy of the way that per and the Dragon grew together. It was certain that Dragon was too much part of per to be fought, too much part of per to be removed. Disconnecting from the Dragon could only take per mind, take the oxygen from per lungs, the nourishment from per stomach, the strength from per limbs. Indeed, it was questionable whether such a separation could even be done. Yet the Dragon was a powerful God, so much stronger than per, giving visions to per eyes, wrapping per in its embrace and taking per away from the real world. Remaining peaceable and not struggling was effort. Holding perself to perself and not being erased was effort.

“Good, Good”, approved the Maimed Pilgrim.

But this was a child who could see for perself. Chris looked closer and longer at the Dragon. Dragon relaxed its hold. Involuntarily, per muscles relaxed too, per intestines stopped gripping, per heart beat more freely. Then, without warning, the wean’s mind was assaulted by the impact of all the images per had seen and all the events per had experienced. All the emotions that went with them, which had been attenuated, assaulted per at full force. Pain billowed up Chris’ spine and impacts of long forgotten attacks rocked per body; assaults from buyers, rejection from stallholders, the deep scoring of the finger marks of the forgotten people. Per insides were conflagration. Per bones combusted. Per thoughts were embers. The heat devoured air.

“Zie is a terrible God”. Per gasped out through charred lips.

“A Small God, maybe.” The Maimed Pilgrim was stabilised on her staff, counterbalancing the weakness of her burnt side against its strength, unperturbed.

Then the daunting moment left, the terror was gone, leaving an image of a vast desert whipped into a frenzy by a strange wind, accompanied by a fading sensation of the resuming of tension in lithe limbs.

“I am either lost in the numbness or lost to the Dragon.” In trembling and dread Chris looked to the only person who might have the wisdom to untie that impossible knot.

“Companions need balance. One way or another.” Then the Maimed Pilgrim was off on her interminable progress, leaving the child with the inadequate clue.

“I’ll meet you there, I’ll meet you here.”

It’s complicated

When people say things are a lot more complicated than that, they mean they’re getting worried that they won’t like the truth.

Carpe Jugulum by Terry Pratchett

I was just thinking about some phrases that professionals use on Twitter that stop me in my tracks. I think that they were phrases that similar people used when I was forced to be in contact with them when I was younger and they were involved with my family. Invariably when I was a child certain phrases made me angry with the officials. ‘It’s complicated’ was definately one of them.

It’s a peculiar thing but I seem to be saying online what I used to say in the past. I think I was better at being clear when I was younger because I had not had all the experiences of bullying and callousness that I later learnt anyone in the ‘care or ‘health’ systems were collectively capable of. Now I get distressed more quickly because all those old feelings come back and I have the experience to notice old patterns and predict how the conversation will go. Feeling defeated and overwhelmed with hopelessness happens more easily when you have lot of experience of what is likely to happen.

‘It’s complicated’ is the response I got from when I was 12 yrs or so onwards to observations I made to the officials who were meant to be helping my parent, or had to find something to do with me because of the situation, like:

  • forced treatment is not treatment it is abuse and unless someone is being actively violent there is no justification for it
  • if someone is hurt by what you are doing you have to stop
  • many interventions in the psychiatric system are about behavioural control and are not used to help someone get better; including seclusion, restraint, medication and detention
  • the function of psychiatric nurses are to deliver medication either through voluntary means, increasingly coercive means or force however well you wrap it up in nice talk, otherwise their social support and healing role could be done by someone who could be kind without threats
  • if you detain someone in a context where they are likely to be further damaged, such as the current mental health system, then you have chosen to be responsible for that damage whether you directly inflict it or not, being a ‘cog in the wheel’ is not a defence against complicity in Human Rights Abuses, actions being state sanctioned is not a defence against Human Rights Abuses
  • the mental health system is confused about whether it is a service to promote healing or to enforce social control
  • you cannot be a Dr and a prison govenor; you cannot be a nurse and a prison guard; you cannot be a health system and enforce social control
  • it makes no sense to say someone is ill and has no responsibility then make them responsible for their behaviour when you don’t like it
  • if you separate me and my sibling you are not showing ‘care’, you are displaying power and doing harm. I will never trust you again because you are not trustworthy and I do not forgive.
  • if you come into my house with violence and say it is help I do not in any way have to believe you or do what you say
  • if I could resolve this situation without brutality and force you adults are failing and showing your true colours every time you resort to it
  • I have done nothing wrong, you cannot force me to leave this house and go with you
  • You have the power to make me go into care or separate me from my brother, but not the courage to accept the consequences of the damage, you expect me to take that difficult bit from you

What is particularly obscene about the response ‘It’s complicated….’ to these sorts of observations is that I clearly understood the tensions in the various systems that made it impossible to navigate them safely. Every one of those statements already acknowledged things were complicated and each comment is evidence that I was deeply engaged with interacting with people in the system to highlight those inexplicable processes. When anyone started their response with ‘It’s complicated…’, the unspoken things I actually heard them say were:

  • You don’t understand you are too stupid
  • I can’t change it and it’s my job to make sure something happens
  • I don’t understand what’s going on myself
  • I don’t want to understand what is happening better because if I can remain blind to what is going on things will be better for me
  • I don’t want to implement your solution
  • I can’t do anything about this
  • I won’t do anything about this because the personal cost to me is greater than I wish to pay
  • Know your place
  • I don’t care
  • I don’t have the skills
  • I don’t want to change
  • I don’t like you
  • It’s not my responsibility so I am not going to do anything
  • How dare you challenge me
  • Don’t expect a service that claims to help you to change so that it actually helps you
  • I don’t want to acknowledge that your society doesn’t care about you and so as a direct reflection of that this service and everyone in it doesn’t care in any meaningful way either
  • Stop being difficult
  • I want you to believe in these systems because it’s all I’ve got to offer you

Every so often people who already knew that the system was complicated and had their own ideas about how the tensions played out in any given situation came along. Generally these people didn’t say, ‘it’s complicated’. Unlike most officials they didn’t accept things and they were not pushing back on all fronts like me. Generally these people didn’t respond to me by saying what they were doing and justifying it again by repeating themselves, trying to force me to agree with the status quo. These people tended to give me better explanations for the way people were. Even more importantly they were able to follow where my thinking was going. I felt that these people had a capacity for radically imagining how the world could operate differently and the courage to take steps to move towards that world. Most officials seemed to be unable to cope with the idea that things could be different and seemed stuck at the point where they could only make sense of concrete, easy to understand things like a written procedure. Sometimes the phrase meant ‘there are a range of factors working here and these are what I understand them to be.’

I didn’t think things were really that complicated. From my point of view each and every adult had more power than me and each and every adult was using that power to hurt me and my family. That was a choice each one made not to help. All they had to do was think my sibling and I were worth enough to choose to hear that they were hurting us and to have the courage to stop. After all I was expected to stop hurting them by not being upset, by not asking questions, by understanding how difficult it was for them, by doing as I was told, by accepting that the way things were was for the best. The fact that this made my situation complicated didn’t matter. ‘Complicated’ is a mask for a lack of empathy and an assertion that the person highlighting a concern or a tension doesn’t get to define what the problem is. It always preceeds a statement about how nothing is going to be different. It is an excuse of inaction. ‘Complicated’ is a matter of power.

I think ‘it’s complicated’ is perhaps true. It was complicated for me because many people can’t see their role in the system clearly, it was complicated for me because many people can’t see the irreconcilable tensions in the system, it was complicated for me because people lack integrity, it was complicated for me because many people are ideologically blind, it was complicated for me because people have chosen to be indifferent, it was complicated for me because officials don’t understand trauma, it was complicated for me because avoidance or denial of pain distorted thinking, it was complicated for me because people like power trips and enjoy being unkind, it’s was complicated for me because systems pit people against one another to maintain power.

An important thing I learnt to remember is that complicated service systems are set up to keep themselves going. They make each person in that system untrustworthy because each person is limited by the system. Individuals can seem well intentioned, capable and skilled, but their limits are set by the system they are in. Intentions are a poor barometer of whether an individual will act helpfully, or of when they will stop being supportive. Survival for an vulnerable person in contact with a complicated system requires learning very quickly the system limits in order to predict the actions of the people in it. Those system limits are not what people claim the system is offerring- the limits are the gap between what you imagine might help and what you discover you can reasonably expect. Understanding the system limits requires imagining the best possible system and bearing the disappointment of being in receipt of the one the officials accept.

Really, when the officials said, ‘It’s complicated‘ it just meant, ‘It’s too complicated for me so I am going to keep on making it simple so I can cope with it. Stop complicating things for me.’

Most staff are well-intentioned

And then Jack chopped down what was the world’s last beanstalk, adding murder and ecological terrorism to the theft, enticement, and trespass charges already mentioned, and all the giant’s children didn’t have a daddy anymore. But he got away with it and lived happily ever after, without so much as a guilty twinge about what he had done…which proves that you can be excused for just about anything if you are a hero, because no one asks inconvenient questions.

Hogfather by Terry Pratchett

Most staff are well-intentioned‘ is a phrase which comes up over and over again. A tweet has just come up which, for instance, says ‘excellent blog on how, even with the best of intentions, we still often let down sexually exploited children’. This phrase is beginning to make me extremely angry.

The world is a dangerous place, even though for the most part many people do not experience it that way. The dangers and its harms it holds, like its joys and blessings, are not equally distributed. It is a more threatening place for some than it is for others. Nevertheless, each person is vulnerable, to adverse events or acts of cruelty that may affect them alone, or touch upon a group that they form a part of.

What comes to me out of these sort of thoughts is a sense that our joint humanness is founded on our need to trust in one another, in ourselves and in the world. Surely, when people have had their trust betrayed, our collective humanity is re-established only by rebuilding that trust. Therefore, in order to be fully human, and to create a world where we do not accept atrocities, we must dare to make an honest attempt to heal the harms that do happen, even if that attempt does not work out. Surely, if we do not reach out to one another we are all discarded in a terrible aloneness. Indeed,each and every one of us are lost, even those who seem safely marrooned in the world where danger has not yet touched them. These people also remain exposed to the possibility of what might happen or what others might do, although they may remain unaware of their own vulnerability, or heedless of the risk that they may well be alone with what nightmares may come should others not help them at their point of need7.

So, although I agree that when we are faced with the most difficult and intense experiences of human life we may, in our total disorientation, not know how to avoid doing harm, I outrightly reject the glib phrase ‘most staff are well intentioned‘. I think that phrase is one that seduces everyone into not expecting too much. I think it is a phrase which asks us to accept that; as horrors exist which profoundly distort human relationships, as these forms of brutality should be completely intolerable within the human community, it is also intolerable for us to expect those who choose to offer help to focus their minds on those cruelites. It is a phrase which doesn’t just understand that it is hard to stay with pain, but which requires us to be too understanding of our instinctive tendancy to find ways to block comprehension.

Captain Quirke was not actually a bad man: he didn’t have the imagination; but he dealt more in generalised low-grade unpleasantness which slightly tarnishes the soul of all who come into contact with it- rather like British Rail

Men at Arms by Terry Pratchett

This delibarate and delibarative blocking of sensibilities and responsibility is far too infrequently questioned in public discourse about a range of institutions: prisons, refugee detention centres and mental health. Mental health is particularly problematic as it claims to be about help and support, unlike the other institutions which are, perhaps not overtly, declared arenas of inhumanity and punishment. I read a tweet by Allen Francis about mental health care, which went like this:

Worst career moment. 50 years ago I had to watch a therapist induce vomiting in a man watching gay porn to ‘cure’ him. We’ve come a long way.

and in a comment which explicitly links abusive behaviours by staff and previous traumas, in the second chapter of The Body Keeps the Score, Bessel Van der Kolk writes

After she refused to eat for more than a week and rapidly started to lose weight, the doctors decided to force feed her. It took three of us to hold her down and another to push the rubber feeding tube down her throat, and a nurse to pour the liquid nutrients into her stomach. Later, during midnight confession, S. spoke hesitently about her chidhood sexual abuse by her brother and uncle. I realised then that our display of ‘caring’ must have felt to her much like a gange rape.

These respected people were taking part in actions which they now choose to recognise were causing physical and psychological distress in situations where their patients were utterly powerless. This is a betrayal of trust, a further example of human cruelty. They do not strike me as people who enjoy the experience of power play for its own sake. Yet they undertook those actions, and judging by their writing, to varying degrees do not accept those actions as ones that they were actively responsible for. This behaviour is not the mental life of someone with ‘good intentions’; it is the mental life of someone who can make the suffering of others just distant enough that they can live well with the violence that they themselves enacted.

I expect people who are entrusted with the care of others to do more than engaged in a complex form of dissonance where they disengage from their own actions, while simulataneously acknowledging that they took them. I am remembering a time when I said something harsh to a Mental Health Nurse on Twitter who had previously commented that he had been involved in forcing injections of medication when people were in psychiatric detention in the past. I also remember that people comforted him after my comment by passing their opinion that he was a ‘good nurse’. I wonder what atrocity would be beyond a ‘good mental health nurse’ and what brutality woud be beyond the limits of our acceptance. It is not possible for me to believe that mental health nurses are ‘well intentioned’ when I trace with diligence the convoluted path of the ways they talk about what they do; the evasions, the blaming, the disavowals of their own actions, the focus on my feelings about accepted practice, the request that I empathise with their position, all having their effect of obscuring their behaviour.

I think it is probably true that sometimes people are disorientated and do not know how to help, but we should not lose sight of the convenience of creating a mutually re-inforced fiction by repeating the mantra “most staff are well intentioned“. If we are looking for comfort, and at times the searing contact with what we as people are capable of doing drives us to need solace, perhaps we should say, “I need to believe that most staff are well intentioned, or I, myself, could not carry on”. If we are looking for progress towards a better possible future, which is to say looking for path that leads us to mutual support, we have to demand something that is more accurate and true, if not subtle. In such circumstances, we might risk making a challenge- we might be brave and state that most staff- like most people, are indifferent. That is, while not actively punitive, they:

  • choose not to see that people are harmed by their actions
  • choose not to see that people are hurting because of difficult life circumstances or events
  • believe that not seeing is the same as not knowing
  • can warp their mind into the belief if you do not know, you do not share in the complicity

If you say “most staff are well intentioned“, check in with what you really mean and expect me to ask you what it is you have glimpsed that horrified you to the extent that you wish you had not uncovered it. What was the void that in spite of all your attempts to reseal the facade, you cannot quite unsee?

Accepting behaviour as ‘well intentioned‘ is not demanding enough, given the nature of the damage that humans are capable of doing. To accede that this is how the world is, is to argue fervently for a fatalisic acceptance that any harm that comes to any of us, in the mental health system or in the wider world, is an inevitable outcome of human limitations. It is an act of submissively concurring with the idea that all of us are alone in a far too dangerous world.

Resistance

One of the hardest lessons in young Sam’s life had been finding out that the people in charge weren’t in charge. It had been finding out that governments were not, on the whole, staffed by people who had a grip, and that plans were what people made instead of thinking.

Night Watch by Terry Pratchett

Sometimes when I am interacting with professionals on Twitter, as I respond, I suddenly remember where I first had that thought and the situation that gave birth to it. In some senses, professional responses are just very predictable. Yet, I wonder how much I am repeating old situations and whether I could do something new. Indeed I wonder, looking back, whether I can think of different ways my 12 year old self could have handled it.

I remember how it felt to be a 12 year old thinking about the rights of the police and officials to enter and arrest people, to use violence and force, of adults to order that another is detained, and to use force while that person is detained. I remember not understanding why using state force to terrify frightened people whose behaviour is annoying and troubling, but not dangerous, made any sense at all. I remember thinking about things in the hope that terror would become less terrifying if I could put a shape around it with concepts and words. Making sense of state-sponsored brutality is never an easy option, making sense of state-sponsored brutality in a context where what the officials actively claim is being offered is compassion and care is impossible, but I needed to do it. I could see the limits of the professionals’ thinking and it was evident that the one thing that they would not be able to do was listen to me: instead they would patronise me, telling me I would understand when I was older; or try and play power games, inappropriately reversing the roles in the situation by asking me what I would do if I had to make the decisions they had to make; confuse me by simply repeating what they had said before, but with subtle differences; attack me by suggesting that my motives were to try and harm the family or because I wanted to stop the medics making my Dad better.

Mostly I thought the adults were very confused, or hypocrites, or both. I had also found that questioning them didn’t really get you very far as you ended up going around in circles, not getting any further towards answers to very urgent problems. After my parent was sectioned I was extremely frustrated with adults’ inability to give any sort of coherent account of what they were doing and why they were doing it. I was delighted that I could give up on the adults completely when I found that the library at my school had books which gave better answers than real people. Real people seemed to have an amazing ability to be evasive or choose not understand my questions, books, however, had answers, and then left me to my own resources to work out what my questions were. In my opinion any early adolescent who reads Every Good Boy Deserves Favour by Tom Stoppard; 1984 by George Orwell; The Contract of Mutual Indifference by Norman Geras; Ekman in Jerusalem: A report on the Banality of Evil by Hannah Arendt and The Long Walk to Freedom by Nelson Mandela to try and make sense of the behaviour of the officials in their world, is questioning every underlying assumption of every institution in their society by taking a long hard look at the common processes which operate against human dignity and respect. I felt then, as I do now, that that form of attempting to address troubling questions is much more exhausting than the ‘take your feelings out and look at them’ approach that professionals seem to think is reflective practice. As I read the books I formed the view that the anguish and loneliness I experienced happened entirely because the adults had always been or somehow become immune to suffering, were very insensitive to the pain they inflicted on others and were happy to blindly carry on doing what they were doing because they had bought into an ideology or personal morality which allowed them to abdicate their individual responsibility. What I saw happening to my parent and to the other people I knew in the mental health system was about control, power and dominance, and very much less about care, even if that confusing diametrically opposed package was wrapped up in softly spoken words. I was not sure what was motivating the adults to behave in this way though: whether it was for the sheer sense of joy in harming others or as a way of managing their own fear or pain. Around that centre was the need not to know, not to be a part of it, not to see the pain in case it hurt you in your turn. However, although the books told me that the adults had not learnt any personal lessons about the processes of dehumanisation and indifference from history, I also knew that I couldn’t find the history I wanted. It was many years before I realised that people who experience mental distress have historically been so marginalised that they don’t have a history that can easily be found- and certainly not one that could be easily found in a secondary school library. The stories linking madness, trauma and human rights were present but unexamined in books that tried to engage with other events that are present in our current social consciousness, such as Colonialism, Genocide or Apartheid, just as the repeated lessons which can be learnt from those events are still not yet accepted as our collective responsibilities to one another as human beings.

I took some things from reading those books though. I learnt that the word ‘because’ is not magic, that if I didn’t want to fall into the same intellectual, spiritual and emotional death that the adults had succumbed to that that it was imperative to listen to the explanation that followed that word. The resistance is to notice that the space after the ‘because’ is where the adults try to trick you into their collective blindness. Explanations that are not compelling are often lies. Explanations that are confusing are often lies. The tactic is to say why the explanations are not good enough and to point out the different ways the adults are explaining things are indeed just ways of repeating the same thing. The other tactic, when you are exhausted, is just to say that you disagree. This is very powerful.

I learnt that the word complex doesn’t really mean that things are impossible to understand, it can mean either that someone doesn’t want to explain or that they lack the skills to be able to explain it. Crucially, however, ‘complex’ so very often meant that what the adult was trying to get me to believe was in the most absolute sense not possible for them to explain, because the justification was not even coherent to the adult themselves. The resistance is to understand the excuse of complexity is not true. The tactic is to refuse to accept that anything is too complex to explain and make the adult explain it.

I learnt that just carrying on asking the questions sends you round and round in circles, feeling disorientated, exhausted, frustrated and confused, but makes the adults angry. That led to more learning. I learnt that if you ask a question and someone gets angry, you are on the right track. There is a reason why they are getting angry and trying to hurt you. I learnt that the feeling of confusion in itself is the clue that something is not right here. Confusion is what people who are doing harm feel when you ask them to look directly at the consequences of their actions, but it is also a strategy they use. It acts to stop your behaviour, to stop you thinking, to stop your questions and it gives them opportunity to take control. The resistance is to notice who or what is causing the confusion and work out what the effect of people being confused is. The tactic is to name and carry on naming the institution, organisation, person, or concept causing the problem and what they get out of people’s responses.

I learnt that the people in charge just denying there is a problem is very powerful, a good argument is ineffective and presenting the best evidence can be just ignored if it doesn’t fit with what people want to see. Ideological blindness is a true blindness, as it renders people unable to learn and able to change. I found tactics: I learnt that just stating that I was in disagreement might not change anything, but it did give me a space to stand in that was not invaded by the view of the world that they were trying to impose on me. Disagreeing was resistance.

I learnt that if I disagreed or asked questions, there were consequences. People who are doing harm because they find it satisfying, because they are thoughtless or incompetent, or because they are choosing to be a blind bystander will do anything to find ways not to be put in touch with the outcomes their actions. I discovered that they do this because they were afraid and could not bear it. They were angry because they needed my abject fear, my acquiescence to feel safe. If they needed my fear and needed me to be very afraid, that meant they were reliant on me for their feelings of power, which made my questioning more powerful than they were. In the shifting sands of trauma, I discovered that the balance of power was not where anyone expected it to be. The resistance is to learn to feel your own strength in the space where the people causing the harm do not know that you are strong. The tactic is to plan to avoid people with those needs as much as possible and, if I had to be near them, give them as little information about my thoughts and feelings as possible.

I learnt that you will get hurt by the anger of people who have power if you speak up, at the same time as I worked out that you will be hurt by what they are doing even if you do not speak out. I realised that they do not consider this a potential source of power: the people causing the harm do not realise that once someone has grasped neither speaking up nor remaining quiet is protective, they have lost a lot of the power they were relying on. The resistance is to hold on to an understanding of different bases of power. The tactic is to struggle to find a way to speak.

I learnt that what I felt in these situations was powerlessness and rage. Powerlessness is the level of fear that steals your words because it takes the ability to even think about the things that are happening. Rage is what happens when you learn that even when you disagree, the terrible thing is going to happen and keep on happening anyway. I discovered that our societal response of dismissing strong feelings is a gift to those who cause harm. Powerlessness and rage, the very emotions abusive situations cause, are the ones used to show that the person experiencing the harm directly or as a witness, is not worth listening to. I realised the resistance is to listen differently if we want to stop the harm: we need to hear that fear and rage are caused by something. The tactic is to refuse to be distracted from the harmful actions by people’s focus on the emotions shown by the person harmed.

I learnt the professionals will find ways to hurt you because its easy; it is the easiest thing is for them to carry on as they were, the harder thing is for them to change. I learnt they could carry on forever and that I could not. I learnt that nothing I did would stop it happening: it will just make it harder for it to happen. The resistance is to not be stopped. The tactic is to choose your battles.

I learnt that some people try to get you to identify with them, either with their emotions (Do you understand how hard this is for me?) or with the difficult decisions (What would you do in my situation?). I learnt this is a distortion of the professional relationship and a trick. Of course it is a trap- they studied for years to learn their job, they know all the facts, they will always have an answer about why they couldn’t do anything that you might suggest and it will distract from the concerns and criticism that you bring. I began to resist by noticing when they tried to trick me into doing their job by reversing roles and I developed the tactic of making it clear to them what the roles should be reiterating what my role was in that situation, that it was their job to listen to the concerns raised and address them not mine.

I noticed when they were patronising me and this just annoyed me. Anger, I found, helps with resistance. I told them that the issue was not that I didn’t understand, but that I didn’t agree.

I noticed that sometimes when I did this some of the powerful adults said ‘sorry’ and tried to empathise with me. I learnt this was to meet their needs, not because they were genuinely sorry and willing to change things. Resistance was not to accept a meaningless apology. Wisdom was not to think that empathy was anything but a ploy to undermine my opposition. If they were still doing the same things and they had not changed, their sorry did not mean anything; resistance meant refusing to absolve them of responsibility for all the harmful things that they had done and were still doing.

I also learnt to keep my own notes when I was with professionals and not ever, on any circumstances to give them to anyone.

In the end I learnt that none of this works when you are reliant on professionals to change things. That changing things from the position of relatively less power was not possible. That for me then resistance was about being silent and compliant and doing what was necessary to get them to go away, which was easy because they were not interested in me. I learnt that in good well-behaved children who are doing well in school, rageful silence is not noticed. Being invisible is a form of resistance.

And on Twitter, it seems to me I am still pretty much saying the same things, to pretty much the same professionals.

Professional Abuse

You couldn’t say: It’s not my fault. You couldn’t say: It’s not my responsibility. You could say: I will deal with this. You didn’t have to want to. But you had to do it. A Hat Full of Sky by Terry Pratchett I take part in conversations about mental health because of my experiences as […]

You couldn’t say: It’s not my fault. You couldn’t say: It’s not my responsibility. You could say: I will deal with this. You didn’t have to want to. But you had to do it.

A Hat Full of Sky by Terry Pratchett

I take part in conversations about mental health because of my experiences as a child when one of my parents became unwell. At the time I commented a lot on parallels between totalitarian regimes, human rights abuses and mental health services. I am still thinking about these everyday ways of enabling and allowing abusive behaviour. I just want to own that perspective and its limits. An Enormity of Unbelief is the post where I think a bit about that event. I blog to make sense of my feelings and thoughts from that time. This means that I am informed and interested but much less well-informed or interesting than the many people who blog who are using the system currently, either as people who experience distress/ altered states, professionals or both. On a lighter note I am also exploring the idea that anything I want to talk about can be summarised in a Terry Pratchett quote.

Twitter is an interesting place. Partly because people talk about things that they might not talk about face-to-face. I do get quite upset when talking about mental health as so many people seem to have had so many bad experiences. I’ve started to get my head around the reasons why the things I hear upset me for instance in Why I don’t like easy stories… , Small, sad stories (1) and Small, sad stories (2). One of the reasons these experiences do not seem to get resolved is that the people who are reporting feeling harmed by interactions with professionals are not believed and are not respected. This seems to me to be a subtle form of violence; precisely because people are in pain and struggling, their reports of feeling harmed are undermined. In general, officials seem to react to feedback and complaints by attacking the validity and meaningfulness of the client/patients as a knower of their own experience. In my view this is professional abuse. It is also a lost opportunity for professional to learn how to be with and alongside people in extreme states and to develop better understanding.

These discussions seem to me to be highlighting a concept which is notable by its absence in discussions between professionals or in general conversation about care, whether in the domain of physical or mental health. The absence of professional abuse as a concept that is actively named and confidently discussed, in contexts where one person is extremely vulnerable and the other has relative power, seems strange to me. My take on it is that it makes no sense for this to be a concept that isn’t acknowledged when the explicit aim of the professional is to promote the best interests of a vulnerable person. If we do not and cannot talk about how and when this goes wrong, we are making an environment where it is more likely that the harm will happen. It seems to me being able to talk about it would help the relationship or support safer and feel safe. Like many things in mental health I think the absence of the concept itself and also the absence of upfront conversations about the concept tells us something very eloquently. Silence speaks. As people and as a society we need to start to hear silence, as around any form of abuse there is avoidance and denial. These are active, but not necessarily conscious, processes which lead to silencing. Around any form of abuse there are collective distortions in the sense-making of those involved in the situation. These distortions can be very subtle but the underlying message is often similar. People involved professional abuse are likely, in some way, to put up a shield. The shield looks like this:

  1. Act as though it didn’t happen or you don’t care
  2. Say that the client/ patient is lying (even when there is a lot of evidence for their point of view)
  3. Blame the victim (‘It was the client/patient’s fault’, ‘They made me do it.’ ‘They may not like it but it is in their best interest.’)
  4. Minimise the harm their actions had (‘It wasn’t that bad.’, ‘It’s over now.’, ‘Why are you making so much fuss?’)
  5. Become angry (‘You are always blaming people.’, ‘You aren’t being fair.’ etc.)

Interestingly, these tactics fit pretty exactly with how people react when they are denying feeling a core sense of shame. They are the same behaviours for those who harm across different types of abuse in different contexts too. I will have to think a bit more about how shame and the ability to hurt others might link together specifically for professionals who harm. This is because I had always thought that professions who act in harmful ways do it because it satisfies some need in them, but now I am considering what else might be going on. This is a website link which goes into more detail about shame. http://oohctoolbox.org.au/trauma-and-shame

Professional Abuse is about harming someone in ways that are only abusive because the person doing the harm is a professional in a professional relationship with the person they are harming. A consensual sexual relationship between two adults is OK, unless it is between two people who have a professional relationship, for instance. It is also a type of harm that can only happen because one person is offering professional skills to help another person. For instance, only a doctor or nurse could sew up a serious cut. This becomes professional abuse when the same standards of care and support are not offered because the healthcare provider is providing this service to someone who has self-harmed, for instance.*

Professional Abuse can be more subtle and hard to spot when it is about interpersonal boundary violations. Some people have blogged about the persistent derailment that people who have been in contact with services get when they raise concerns. This blog is very useful http://sectioneduk.wordpress.com/2013/08/16/00but-were-not-all-like-that/ **. I am also starting to comment on specific forms of this phenomenon, for example in the post It’s not why we trained. These derailments are also professional boundary violations, when they happen in the context of a professional relationship. In my view, when these derailments happen on Twitter or general conversation, they just indicate an acceptance of bad practice. Depending on exactly how the derailment happens, they also add to the dynamic of collective silencing of professional abuse. I increasingly take the view that because ethical values and principles underpin professional practice, derailment by professionals is also an issue of professional abuse. However, boundary violations in a professional relationship can be more subtle than these derailments and include behaviours such as excessive personal disclosures by the professional, role reversals in therapy, the therapist/ provider failing to take a report of an adverse experience by a client to supervision, breaches of confidentiality and treating people without respect. Boundary violations in and of themselves are always a betrayal of trust in a professional relationship.

One way professional abuse continues is that it is not challenged by staff when it happens. The behaviour is not named for what it is and the links between specific actions, ethical principles, values and rules are not made clear. In some ways staff seem to have no official, accepted protocol or script for helping each other to maintain professional boundaries. My observation is that what seems to happen instead is that all staff join in with collective distortions in their thinking. They seem to also identify with the staff member not the client/ patient/ service user. Indeed, this happens even though in all professional settings, the professional might be in the client/ patient role at a different time. It seems that this is linked to the ‘Them’ and ‘Us’ culture which seems so strong in mental health discussions. In some ways it seems like it could be a defence against staff knowing that they could be on the receiving end of their own behaviour if they ever became vulnerable. A clear indication of this is the use of the pronoun WE in contexts where there is a disagreement or a complaint is being made. The organisation seems to act as one to protect the professionally abusive actions of staff. I was surprised during a conversation on Twitter recently when a Tweep reported* that when she was sutured after self-harming the nurse made a complaint about the doctor who did this without providing anaesthetic. I might have had serious questions about to what extent the nurse failed in her professional duty and was indeed professionally abusive in not stopping the doctor from suturing without anaesthetic at the time. Nevertheless, the behaviour is still unusual in that it happened at all. It should be celebrated and breaks down the ‘Them’ and ‘Us’ culture which seems to permeate mental health services. The nurse’s behaviour made a lot more sense to me when the Tweep made it clear later in the conversation that the nurse was an agency one – not likely to be around for long. This made me think about the bystanders professionally abusive behaviour. In most codes of ethics allowing others to continue to abuse is not allowed. It seems that staff are most likely to recognise, name and act to stop professional abuse when:

  • they are not themselves reliant on the organisation e.g. for pay or promotion
  • they are not themselves part of the organisation e.g. agency staff
  • they are new to the organisational culture and so have not come to see the organisation in the same way as other staff
  • they do not identify with the organisation
  • the member of staff complained about is already isolated within the organisation
  • the member of staff complained about is already being bullied within the organisation

I guess that it might not be a great idea for people who are in contact with ‘services’ to talk about professional abuse or put it on the radar for conversations, as lots of judgements which might not be helpful are likely to be made about them. If you are a service user reading this and it chimes with you, be wise, be safe, take care of yourself. However, I do think it is professionals’ job to talk about this concept and topic. I do think it is the job of bystanders to these conversations to make the radical move of naming professional abuse and linking professional behaviours to ethical values, principles and rules. Society needs to learn how to encourage everyone to query behaviour when it does not seem to reflect these core elements of human decency and morality. This is an act that has its dangers. I predict that when anyone makes the links between ethics, behaviour and professional abuse explicit, the shield will come up. That ‘shield’ is not neutral, as like any form of defense it works best if it is an attack. It is weaponised. The only way abusers can continue their behaviour is to destroy the person who is trying to stop them – destroy them as valid knowers, destroy their strength to carry on or destroy their social support. It makes sense then, doesn’t it, that the staff who act to stop professional abuse do so as whistleblowers, after it happened, when they have left the situation and not at the time. Like the nurse in the Tweeps story.

*I have asked the Tweep concerned if I can use her Twitter story and she agreed it was OK.

** I have permission from @sectioned_ to post the link to her blog here

The systemic is sort of individual

You can either be on the stage, just a performer, just going through the lines… or you can be outside it, and know how the script works, where the scenery hangs, and where the trap doors are.

Maskerade by Terry Pratchett

I was engaged in a Twitter conversation that really distressed me. I had Tweeted something that wasn’t that controversial to me along the lines of ‘Most mental health professionals are pretty incompetent and out of their depth‘. I just believe it is true, it’s my view, born out of my experience.  I was also responding to someone’s comment about an insensitive remark by a mental health professional and felt momentarily despondent. Actually, as it was someone else sharing their story I think a professional who commented said something much more helpful than I managed to. I will learn and I am learning. But really context people! So when another Tweep added in their view that ‘People generally attempt to do a good enough job‘ and they are not ‘bad people’. I had quite a strong reaction.

It boils down to that suggestion, which she expanded on in her blog post, just being beside the point. It is beside the point that she has a dual role as a professional and as a service user/ client/ patient, that she has (in her current service) had a good enough experience of care, that she feels (right now) that she has a voice in her care, just as it’s beside the point that I too agree that many professionals are well-intentioned and doing their best. It’s beside the point because the system still does a lot of harm and that harm happens precisely because it is the system that is doing the damage as much as individuals.

So it is hard to convey systems understandings in a tweet, or even in a blog post. We seem to believe in systems as machines, arranged with the management organising things and a body of workers that carries out the actions of the system. This means our cultures believes lots of things like:

  • if we tell people how to change, they will use those instructions to change
  • if we criticise and frighten people in organisations they will be motivated to change
  • that problems happen because the organisation is not designed correctly

In a way this gets individual mental health workers off the hook. If the problem is that the organisation is not designed correctly, then the organisation is experienced by them as either neutral or something that stops them doing their job the way they would like. If everyone else agrees with them, then they are an actor on the stage. The play is set, they just carry out the scripts. They don’t need to think about the stage or the production. There is an alternative view. That people make organisations because organisational systems are created by people’s relationships with one another. They are living human systems. The beliefs associated with this are different:

  • appreciation of what people are trying to do helps them to grow towards that appreciation (this is not the service users’ responsibility, or the outside observers’ responsibility by the way)
  • as we interact with the organisation/ professional culture we are likely to produce a change in the organisation
  • how we talk about our organisations changes things, though unfortunately, we tend to see the world as we talk about it
  • imagination can be used to create desirable objectives and this makes changes in behaviour as it becomes organised to achieving that outcomes
  • language is creative and can create change
  • the stories we tell about our organisations matter

The system is it not quite individual. It happens in the networks of spaces between people.

The people who really run organizations are usually found several levels down, where it is still possible to get things done.

Small Gods by Terry Pratchett

So if I get frustrated with ‘It’s not why we trained’ or ‘See it from my point of view’ (see blog post It’s not why we trained)  it is because these conversations aren’t  just a one-off, they are repeated and they create organisational cultures. I am not part of your culture, or your mental health service, as a user or as a professional. In terms of ways I can influence, I’m fairly far down the food chain. All I can do is pick up the patterns on Twitter and say- Why don’t Mental Health Professionals centre the concerns of users? Why do you centre positive experiences when at times people need to think about how to make sense of and respond to negative ones? Why don’t you even acknowledge that negative interactions happen?

If you are telling stories about; how in Mental Health Services professionals are powerless to do better, or that professionals are powerless to do what they trained for, or powerlessness to act ethically, or powerless to stop their human rights abuses, or stories which say that however many stories there are of hurtful practice, well, there are other places where bad things don’t happen, then those stories have power. Oh and yes- it is not all Mental Health Professionals. I’ll get onto that later. I am starting to find ways to (gently- I hope) cast a light on all those organisational stories. I would add that many professionals who I pretty much feel do an honest and committed job contribute to these stories in ways that I think are problematic.

And I maintain that if the issue is one of Professional Abuse, Mental Health Professionals have no opt outs, it is an ethical obligation (if not yet always legal one) that you act to stop the abuse. There are no excuses on that one.

So if you are a professional, in order to start to change the conversation, why not stop with the ‘It’s not all mental health professionals’. Instead take a breath.  If you want to talk about how good your practice is – great. If you have a dual role and want to talk about having had good experiences great. Start a thread, write a tweet, post a blog. It’s useful to know that some people have good experiences or are committed to good practice. However, take your defensiveness, whether you have dual role or a single role and park it. Think about how in that conversation you can change what is being done to replicate the culture of Mental Health Services. You know what? Practice choosing not to engage with those powerful stories. Learn to change them. I cannot do that for you, you have to do it yourselves.

If you are a Mental Health Professional here are some tips:

  1. Offer empathy and understanding. Dare to recognise the poor practice in clear, unequivocal words. ‘I believe you’, however it is expressed, matters. Acknowledging what happened and the impact it had it important. Try expressing empathy for people’s feelings of being harmed or hurt. Try actually feeling the pain not pushing it away because it is uncomfortable for you. I do notice when professionals do this. Examples from professionals on Twitter:                                                                           Oh my. That was so scary. That was a very insensitive and unhelpful remark.                                                         That is not care, that is abuse.                                                                                                     You should not have had to experience that.                                                                             It is sad that I have to acknowledge that I have colleagues that I would not want to be cared for by if I became distressed.
  2. If you have a dual role, before you tweet, try thinking about which role you are speaking from. Identify that and which role other people might think you are speaking from. Think about where the person you interact with is coming from. I am clear that I am speaking as someone harmed. My twitter handle is pretty unequivocal.
  3. Create your own space to blog about your own good practice, or start your own threads about good practice. It’s good to hear about it. A good example is @drmikepsych.
  4. Ask some more interesting questions instead. Recasting the conversations as ‘What can I do to improve what I do in every interaction‘. Try asking people who are talking about their experiences what is giving life to the system from their point of view, not your old ‘See it from my point of view‘ stance. Be careful with this as it is not people’s job to educate you when they are on Twitter. Develop your questioning skills so you don’t ask questions instinctively, but thoughtfully and yes! this can work even on Twitter. Who knows, you might actually learn something. For me, I know sometimes people have good experiences. Too many people don’t. If people are talking about a ‘not so good’ experience,  I’m not that interested in hearing about good times elsewhere just then – I’m interested in thinking about what might change things so the bad parts of the system are less bad. Try questions that are reflexive (yes, there are questions other than open or closed ones);

-If a professional were to impress you with how they handled a concern, what would they be doing?

-If you could offer a piece of advice to me about how to respond better, what might it be?

-What might professionals need to do to convince you that they welcome feedback?

-If I was able to convey to you how important it was to me that we got it right, what might that be like?

and (if someone happens to be talking about a time they  felt a professional handled a concern really well)

-What sticks most vividly in your mind about that time? What might move me/ my team towards working in that way more?

If you think my interactions aren’t that good, this is my response it, I AM NOT A MENTAL HEALTH PROFESSIONAL. I am not claiming to be one. My other point is that I am practicing talking about extremely difficult subjects, ones where anyone with any human understanding would get that it will be hard for me. I will improve. Watch this space.

And by the way, if I have to write a blog post like this, well I feel quite justified in my comment ‘Most mental health professionals are incompetent and out of their depth‘. I have set the bar high. The professional needs not only to understand things at the individual level, the service level and the organisational level, but also the systems and systemic level. They also need to have the courage to do something about it. I absolutely believe that if they are not doing that they have not earnt the trust they demand from the people who need them. Some professionals on twitter show the skills they need. Most don’t. Just saying.

 

References

Appreciative Enquiry for Change Management: Using AI to facilitate organizational development by Sarah Lewis, Johnathan Passmore & Stefan Cantore