New Reason, New Thinking

I first entered the world of madness and “mental illness” aged 21 when I left home in Northampton and started my mental health nurse training here in Suffolk. I had worked for Mind, in a drop-in centre in the town centre as part of the Youth Opportunities scheme previously, but there the attitudes to people were different, more understandable and compassionate. Not so mad, and not focused on “mental illness”.

Our induction in the first two weeks of nurse training included a tour of St Audrey’s Hospital, which was created as the County asylum in 1829.  I don’t think anything I had experienced in my life up to that point could have prepared me for my first exposure to a psychiatric ward.  We were shown through the locked doors of a ward for older woman who were diagnosed with dementia. The woman’s bodies were emaciated and twisted as they were sitting in padded, high sided wheeled chairs called G chairs, all tilted backwards in reclining positions. Trays were attached to the front, I learned later that the trays and the reclined position meant they could act as restraints.

The cleaners were working on the ward and had moved all the chairs to the middle of the dining area. There had been no regard for the fact that people occupied the chairs. They were randomly pushed to the centre of the linoleum so that the number one task of cleaning could be completed as per routine. Thinking back, I know that I was deeply shocked, but I had no words for that shock.

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My first proper work placement was on an acute admission ward at St Clements in Ipswich, and on my first day I sensed that something bad was going to happen. There was a rush of activity and concerned faces. Male nurses from other wards were called upon to come over and assist. They arrived in the staff room and began to roll up their sleeves, unclip their ties, remove their watches and prepare for action. They had an air of anticipation, adrenaline and ritual that I could only liken to when I was part of a team that were about to go on the pitch for a football match. It was a familiarly male atmosphere thick with tension, cigarette smoke and bad taste humour. They were preparing themselves for a violent situation, I think secluding someone and giving them an injection. Again I was shocked and frightened but coped by switching off from the feelings and the consequences of feeling that way.

Trauma and experiences that happen in life that challenge us, are increasingly being recognised as the most important factors in understanding and helping people who are emotionally distressed. Evidence is consistently supporting the view that it is what has happened to people that is most important to acknowledge and address. That, arbitrarily attempting to classify and group people into pseudo-scientific categories, serves only those who might gain in some way by doing so. That denying the relevance of life experiences serves to enable others to avoid having to address the issues that people’s difficult feelings and traumas might force them to acknowledge. To avoid us collectively addressing our cultures, our society and how it permits abuses, how it labels people already discriminated against, how it enables people to ignore poverty, ignore inequality, hypocrisy and greed.

The evidence is clear and becoming more unequivocal as time goes by, there is no proof for theories of chemical imbalances, and there are no discoveries of genetic predispositions to any “mental illnesses”. We are discovering that of course genes are relevant to who we are, however there are so many variables that are influenced by life. We are discovering that nurture has far more influence and power than nature.

We are hearing more and more evidence from around the world that when we change our perceptions and harness the skills that we all possess as human beings, we can all make a profound difference to how we and others see themselves and the world around them. We can open our eyes, our ears and our hearts. This is true for us all, our life experiences, our reactions to them and the reactions of those around us, and our traumas influence us all, including we who are workers.


‘I will never forget the look in her eyes, it was one of pleading desperation and anger, and I think she could see in mine that I was confused, frightened and that I did not know what I was doing.’


 

On that first placement on the acute inpatient unit, I made my first real connection with someone who was there for help. She was a middle aged woman who was diagnosed as being depressed. I would often sit with her for long periods, usually in silence as she appeared to gain some comfort just from having someone close to her, sometimes she would cry, occasionally she would tell me about her life and I would listen.

She was then prescribed MECT. This was obviously something that frightened her and was something that she didn’t want. I had been asked about MECT in my interview for the training, and although ignorant to its reality I had expressed an open mind, as if it really helped people it could be a good thing, right?

Such was her fear this woman refused to have it. I think it was fear, but in the depth of her despair she wasn’t really able to articulate her reasoning, just her refusal to have the treatment. The response to her refusal was to put her on a Section of the Mental Health Act and to force her to have treatment.

On the first day that she was due to have her treatment there was a rota drawn up to continually observe her so that she couldn’t eat or drink. People have to be fasted prior to treatment, as it involves having a general anaesthetic and a muscle relaxant prior to the electric current being applied to the brain. I was one of the people on the rota. Continual observation meant staying alongside someone within touching distance at all times.

This was to be a truly significant day in both our lives. Me as a shocked and bewildered observer, but I know now, complicit in my passivity. She as the victim of violence and oppression in the name of care and science.

One thing that is significant to what was happening, and informs about the culture within the services then, and probably now, was that no one considered changing the routine of administering treatment. There was no thought to what this woman would be going through, except to stop her eating and drinking prior to the normal process being followed. MECT always started at a set time and therefore she had to be controlled before this time. No one said let’s arrange for it to be done earlier. The routine, or probably more significantly the Psychiatrist and the Anaesthetist routine were more important and this wasn’t even questioned. The feelings and fears of this terrified woman were not the number one consideration.

The woman was small, she was slim and wiry with long auburn hair. She had large features and large eyes that sat deep in their sockets. When I took over my observation duty she did not speak, she hadn’t for the previous days, but acknowledged me with a small nod of her head. She sat on her bed in the dormitory, her legs not crossed but twisted, wringing her hands and twisting her head. She would occasionally stand suddenly, making me jump, pace backward and forward looking out of the three panels of window that looked out onto the car park. She would then return to her place on the bed.

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After around 15 minutes, half way through my time of being with her, she did not return to the bed. She left the dormitory and went down the dark corridor leading to the day room. She then quickly jumped into one of the bathrooms and tried to shut the door. I had been warned about not letting her get to the taps to drink but wasn’t alert to what she was thinking. She attempted to shut the door on me and I tried to stop her, we were pushing on either side of the door.

I will never forget the look in her eyes, it was one of pleading desperation and anger, and I think she could see in mine that I was confused, frightened and that I did not know what I was doing. She then suddenly released her pressure on the door, stood upright and came out of the bathroom. She didn’t speak, all I could say was “thank you”.

I was unable to process what had happened, because in a way that part of me wasn’t there. I spent long periods of my training disconnected from how things made me feel as I really don’t believe that I had the resources to do anything else. I was, and am now, considered laid back and to be taking things in my stride. However, this can often be a disguise for disassociation and an unconscious survival strategy.

What I am now able to reflect upon, that is something I have observed many many times during my career in others who are in the midst of incredible stress and emotional turmoil, is this woman’s compassion, empathy, dignity and respect. In that moment, struggling with the pushing on the door, she was able to act upon what she saw in me and care for me! She saw my distress, she responded to me, she took care of me, to the detriment of herself. We didn’t ever discuss that moment and people could interpret her actions differently, but I know from the way that she looked at me and responded to how I felt that this was an act of enormous grace, courage and compassion.

I went on that day to witness that woman being carried into the treatment room, held down on a bed until the anaesthetic was given, and then “treated” with MECT.


It was one of the most distressing days of my whole working life because of what happened to her, my complicity in it and failure to speak out on her behalf.


 

I felt guilty, but don’t think I really thought through why at the time. I was told that it was for her own good, she is ill, and sometimes you have to act in people’s longer term best interest. I know I listened to this and could see this was an attempt at justification, but I just didn’t believe what I was being told, I didn’t argue as I didn’t have anything else to say, other than “surely what just happened can never be right”.

I am left to wonder whether, in understanding and recognising trauma and the affect that life has upon us all, in this beautiful crazy world, maybe we could all acknowledge that this applies as much, if not more sometimes, to the people working with people who have experienced or are experiencing distress. We must ask to what extent the exposure to other people’s, and their own distress, influences the “science”, the therapy, the research and the theories that are applied to people. To what extent do the life experiences of the worker influence what they do long before they even start their work, set out their goals, and make decisions about the paradigms they are working within?

May be we can begin to accept that people, life, feelings, creativity, cultures, beliefs, behaviours, minds and souls are so complex and unique that they are out of reach of explanation by current science, research, facts or truths. Perhaps this acceptance could enable us to be more accepting of difference and less fearful.

We could look closer to home for explanations of people’s struggles and acknowledge that poverty, inequality, discrimination, bullying and abuse challenge people profoundly and that these challenges have consequences.

Whilst we all look for explanations that can reassure and provide a sense of stability and certainty, we must take care that they are not seen as universal truths and that they are not tarnished by discrimination, by prejudice and then enable traumas to be compounded, and the majorities comfort to be at the expense of those that are different or in the minority. We are all uniquely the same and simply complex.