Intervening or Interfering?

How many people in this world, spanning decades, made it through deepest darkest despair & distress & trauma without any ‘medical intervention’? Please do not underestimate that too. When money is a driving factor in any treatment, it becomes a business, it’s no longer ‘care’. https://t.co/3sbfEpF2XH

— Gisella (@ladiegiz) July 24, 2019

This tweet from fellow activist Gisella, got me thinking this morning, about how mental health professionals have positioned themselves to be the indisputable and indispensible experts when it comes to human distress and subsequent breakdown. But is that true or is it a carefully crafted illusion?  Certainly in recent days, I've seen many tweets from medics, proclaiming their vast expertise and experience, and suggesting that without a medical degree, no one else knows what they are talking about. But I challenge that position, and I'd like to try and explain why.

The man standing second from the right with his arms folded is my Grandfather Tom. He died in 1965 aged 75, and although I was only 4 when he died, I have a vivid memory of going to see him at the flat in Southall, west London where he lived.  He was a gruff but not unkind man, but as an adult I have come to appreciate his journey through life and the experiences he had, and to appreciate why he might not have been the easiest man to live with.  

My grandfather as you can see, was a soldier before war broke out in 1914, a private in the Lancashire Fusiliers, and he was therefore shipped off to France with his unit fairly early on in the proceedings.  He was wounded three times, the last time in early 1918, and seriously enough to be sent home for the remainder of the war.  There was no rising through the ranks to become an officer.  He remained a private, doing the job he had gone to do. He was, I have no doubt, a brave man, and he bore the scars, both physical and emotional for the remainder of his life. We can have no comprehension of the experiences of the average British Tommy from where we sit in our 21st century world, but I am indebted to author Pat Harper for her Regeneration Trilogy, which gives a window into that world of trauma and devastation, and to the work of Dr William Rivers, a military psychiatrist at Craiglockhart Psychiatric Hospital, who knew, even a century ago, more about trauma than some present day psychiatrists will ever know.

From conversations I have had with my aunt, Tom's youngest daughter, I have come to know more about this ancestor of mine. I know that he drank, and I know that my grandmother, who would not hear a word said against him, made allowances for his drinking as she knew it was his favoured coping mechanism. He was never violent towards her or his children, and the family never went without because of his drinking. Nor did he miss a day's work because of it. And so when he came home drunk and passed out in a chair, she would loosen his tie and collar, throw a blanket over him and go upstairs to bed. She understood him.  I think I do a little now too.

Perhaps it was that sense of feeling understood by my grandmother that enabled him to cope, what stopped him from cracking up.  But had he cracked, it would have been the result of the horrific experiences he must have endured, and not some illness or disease of the brain.  Today we would call this distress PTSD or post traumatic stress disorder, but in another blog I have expressed my opposition to the word 'disorder', as distress is a perfectly normal response to deeply disturbing situations.  Disorder suggests that something is somehow wrong about experiencing distress in an abnormal situation.  I would argue that it would be abnormal not to feel distress... We are pathologising normal human responses, and in doing so the additional pressure of feeling abnormal or simply ill is added to the mix.

Pathologising distress also cements the idea that we have no control, and that the only way to regain control is to hand over control and be medicated.  And this simply isn't true.  As Gisella points out, how many people over the years have experienced extreme states of distress and somehow found a way through.  Many members of the prescribed harm community have chosen to withdraw from medication, with varying degrees of success, but many now live unmedicated when they had been told they had an illness for life and would therefore be medicated for the rest of their days.  

In the last week, there have been tweets about the role of ECT (Electro Convulsive Therapy) in modern psychiatry, and it is clear that it's a polarising issue.  As you can see from the Allen Frances tweet above, quoted in Gisella's tweet, there is a sense that only psychiatrists are allowed to have an opinion on it's appropriateness and efficacy.  How very condescending? Particularly in view of the dire treatment of those who have suffered a brain injury from ECT only to have it denied by the medical profession with a consequent lack of support and rehabilitation to regain some semblance of a normal life!  Add to this the fact that not a single sensible explanation has yet been offered as to why ECT allegedly 'works'. Not one.  There are a few wild outlandish guesses going on, but what is actually happening, no one can adequately explain.  A patient is deliberately given an electric shock (something that is normally avoided like the plague) and a grand mal seizure is elicited (again, normally avoided), which is thought in some circles to 'reset' the brain in some way. I find this simplistic and ham fisted tampering astonishing with something as incredibly complex as a human brain, and it doesn't surprise me in the least that in this violent process, an acquired brain injury can sometimes be the result.  What does surprise me are the levels of denial and lack of support given to a patient when this happens.  It is something that is deeply shameful and it requires immediate attention from the medical profession.  Levels of empathy towards damaged patients appear to me to be shockingly low.  Never mind 'first do no harm' - when you have undoubtedly done harm, to deny it is unforgiveable.

Current mental health services do not seem to me to employ the resources we were given to problem solve and cope with stress.  In fact I would argue that in medicating and numbing the symptoms of distress, we are in fact losing the ability to access those resources.  I am not suggesting for a second that we do nothing to alleviate distress, but to work in conjunction with the patient's own resources to regain balance and emotional wellbeing.  Making an inventory of their needs and the resources at their disposal to help meet those needs will often give some sense of control back instead of feeling helpless and fearful.  Surely as mental health professionals, our work should be about empowering not overpowering.  The need to be the 'expert' in the situation is problematic, and needs to be questioned.  It is the reason, I believe, why the medical model perpetuates the idea that some kind of illness exists within the patient that needs fixing, when what may actually need to happen is a change in circumstances, or to employ underused resources the patient has in order to cope with a situation that cannot be changed.  We should also never underestimate the power of feeling heard and understood.  Even in the very worst of circumstances, the fact that someone has acknowledged our pain and distress and has heard us is of immeasurable comfort, and may be the cheapest, least damaging and most effective intervention we could ever make.

So I'd like to encourage a little humility from the medical profession, although with a few notable exceptions, there is little sign of it at this stage.  I would invite them to be honest about what works and more importantly what doesn't. I would like them to be honest when things have gone wrong and harm has been caused, to prevent further harm being done in denial. And lastly I'd like them to have more faith in people without a medical degree than they currently have.  Believe me when I say your degree is not conclusive proof of your ability to know best.  There is still much to learn, and learning from a patient's expertise in their own life experiences is a huge opportunity that many are currently missing.  People have survived hugely traumatic experiences throughout the ages.  How have they done that? How can we enhance that ability and re-enforce healthy coping mechanisms? It's a little late, but we need to realise fully that medicating en masse is not a good or sustainable model. There are much more interesting paths to explore, and explore them we must.