I went to medical school in 1977. I was still only 17 years old but it was a great relief after the horrendous years I had spent at an all-girls boarding school. My fellow students and I started our first year ‘pre-clinical’ training with 4 ½ days a week of lectures. We were expected to assimilate a massive amount of information and then to regurgitate it during the end of the year exams. Those who failed would have one chance to re-sit and if unsuccessful, they would have to leave medical school.

University students are expected to be inquisitive, to ask questions, but at medical school, it was the other way round. Medical students were expected to answer questions correctly to the lecturer or teacher’s satisfaction.

I already felt disadvantaged; one of the lecturers had broadcast that any student who did not have ‘A’ level Physics should not have been granted a place at medical school. I was one of those students. I had done Maths ‘A’ level instead. My school didn’t do physics or chemistry and I had had to cycle to a neighbouring school just to get the mandatory ‘A’ level Chemistry lessons.

I clearly remember the time when I dared to pose a question during one of our lectures: We were learning about asthma, and I asked why it was that I suffered from wheezing after a thunderstorm but at no other time.

“Impossible,” said the lecturer, “grass pollen is the wrong size and cannot provoke any kind of allergic reaction in the bronchioles (small airways in the lungs).”

I felt humiliated—he had just denied my experience in front of 80 students.

It was many years later that I discovered that doctors had observed this phenomenon on a regular basis. It is now understood that aerosolization of pollen in thunder storms can indeed provoke dangerous asthma attacks for hay fever sufferers like me.

This was just one small example of how humiliation of medical students was routine. By the time we got to our clinical studies and spent most of our time rotating around the various specialities in the local hospitals, we were well used to being subjected to belittling treatment at the hands of our superiors. The ward round was a time when the consultant showed his (rarely her in those days) colours. It was not enough to dominate their junior doctors; terrorising medical students was a daily occurrence. We would be quizzed over a patient’s condition and if we failed to give a satisfactory answer, then making personal and derogatory comments to our detriment was considered fair game.

I was not looking forward to my psychiatry rotation. The prospect of spending time in the large institution, Springfield Psychiatric Hospital in Tooting, was scary. Medical students were tasked with presenting written cases on a variety of patients, finding examples to illustrate the most common psychiatric diagnoses. I surprised myself at how much I enjoyed the experience of interviewing these interesting patients. I felt privileged to have the time to sit and listen to the reasons why they were in hospital and discover more about their background and circumstances. I did well and was awarded an ‘A’ grade for my efforts.

However, I wanted to be a surgeon, so my interests lay elsewhere. As it happened my life took an unexpected turn when I became pregnant. I had no maternity leave and had no family help. By the end of the training, when I finally qualified as a doctor, I was exhausted. I was told that my decision not to go straight into work as a junior doctor was tantamount to career suicide, but I wanted to give our little daughter the best chance in life by looking after her myself.

I didn’t start work as a junior doctor until 8 years and 3 additional children later. My husband and I role swapped to enable me to work the grueling 80-100 hours a week required to get my full registration as a doctor. My intention was to become a GP, but just before I reached that goal, I was side-lined into postgraduate training to become an A&E consultant.

At that time, there were only a few brave patients who came to A&E following overdoses, and it was very rare to see any other manifestations of self-harm. The medical profession expressed a global disdain towards these individuals; those diagnosed with a mental health condition were highly stigmatised and considered weak or defective characters.

Admittedly I was tired out. I had been present during some very distressing resuscitation attempts of young children and the memories of my awful, traumatic experience of boarding school had just surfaced. I knew the reasons why I was having an emotional crisis and I went to my GP for help. The GP left little room for discussion before telling me I was depressed. I left the GP surgery feeling utterly bewildered and wondered how on earth a pill like Prozac was going to fix my problems. But I was a doctor and conditioned to believe that the experts knew best. The GP must be right.

I took the Prozac for a while, but it just gave me side effects, so I stopped it. I had no idea that stopping antidepressants precipitously was not a good idea. I had been told they were not addictive and had very few side effects.

My circumstances didn’t change, and I was still very tired, very stressed and feeling unhappy. I became increasingly anxious about the responsibility of treating very sick patients with minimal support from more experienced doctors. When I went back to the GP, I was signed off sick and told I must take the antidepressants and the dose was increased.

At home, alone, with no-one to talk to, things went downhill rapidly. I loved my husband but genuinely didn’t want to burden him with what I felt were unreasonable concerns. After all my profession told me I should be able to cope, and the GP had assured me these pills would soon make me better. I just had to wait it out. But I just kept feeling worse. I couldn’t sleep, I felt agitated, my thoughts were going round and round and then I became suicidal. Being suicidal made no sense. I had a loving husband, four beautiful children. I had a job. There was no reason to want to die.

Nobody understood that suicidal thoughts could be caused by the very drugs which are used to treat depression. When I shared my thoughts with a doctor friend, she was alarmed. I was taken to an emergency appointment at the GP, then an emergency appointment at the department of psychiatry and my husband was told I must be admitted straight away.

That was just the start of the seven-year fiasco, where I was continuously treated with a changing cocktail of psychiatric drugs and multiple ECT treatments. I never improved, instead slowly became worse and worse, as a revolving door patient.

I was given psychotherapy all through this time, but the therapists were not impressed by my accounts of childhood trauma. Apparently, nothing I told them was sufficient to cause the state I found myself in. Nobody considered that the treatment I was having could possibly be detrimental in any way. Nobody understood that the drugs I was taking could be responsible for my deterioration. Instead, I was told that my brain was disordered, that I had a chemical imbalance, and I was seriously ill.

When I started to act out on my suicidal thoughts, self-harming to the extent that my life was in danger, I was sectioned and, in the sixth year, admitted to the secure ward and placed under continual observation. The prognosis was so grim that I was offered psychosurgery. I was desperate to get better. I wanted to be normal, live at home and be a mother to my children. I agreed to the surgery, not really knowing what else to do.

At the point of the psychosurgery, the psychiatrists reduced the cocktail of five drugs at extremely high doses down to two drugs at lesser doses. When I made a spectacular recovery, even the psychiatrists thought it was miraculous. But they could not credit the psychosurgery as responsible for what happened when the ‘light switched on in my head’, nor was the reduction in the number and doses of drugs I was taking ever considered to have any bearing on my recovery.

Eventually I was discharged from the hospital, and I started to take myself off the remaining doses of antidepressants against the wishes of the psychiatrists. When I reported brain zaps, the psychiatrist had no idea what to suggest, other than reduce the dose slowly.

But I was only drug free for a couple of years. During this time, I even managed to get back to work and I was writing my memoir, going through my medical notes to glean the necessary information. The psychiatrist was worried when I reported that I wasn’t sleeping well. He convinced me that this was a sign that the depression was returning. What he said scared me so much that I capitulated and went back on antidepressants.

When my book was published in 2006, I was doing ok, but it didn’t last long. Within a year, I was back to being depressed and suicidal. I felt a terrible fraud having told the world about my successful psychiatric treatment. Once again, I was admitted, this time given ECT. This time, when I was discharged, I was told I must take high dose antidepressants for life. I was also told that I would never fully recover and suffer recurrent relapses. I was therefore advised to avoid all stress and that meant I should never work as a doctor again.

When we moved away and my husband started his training to become a counsellor, I started to hear a different story to the one that I had been taught as a doctor and different to what had dominated my life as a psychiatric patient. I had believed the psychiatrists when they told me I had a very biological depression caused by a chemical imbalance or some kind of as-yet-unidentified brain disorder. In addition to being told that my only hope was to take antidepressants, I was also advised that having any further psychotherapy which went over the events of the past was pointless, and would only serve to further destabilise my precarious remission.

But each day my husband came home from his training and started to drip feed me with alternative ways of looking at things. Maybe feeling stressed and unhappy was a normal response to terrible circumstances. Maybe believing that those supposedly negative emotions were abnormal fed the downward spiral. Maybe hearing society reinforce a message that you should be happy all the time while experiencing the stigma from my profession made it all worse. When the psychiatrist told me time and time again that I was ill and would never recover, maybe it had become a self-fulfilling prophesy.

But could these experts really be wrong? After all, they were highly trained, highly skilled doctors involved in research. Surely while these eminent professors of psychiatry said that I was one of the worst cases they had ever treated, there was no way I could have just been a normal person reacting in a normal way to difficult circumstances. Could I?

When I weaned myself off the sedating antipsychotic drug which had been added to the cocktail of high-dose antidepressants, I felt a lot better. The psychiatrist was not happy. He warned me. If I was to stop any more of my drugs, I might once again find myself back in hospital with a relapse.

When I tentatively started to return to work as a doctor—very part time at first—I was fine.

By 2016, I had seriously started to doubt that suffering awful side effects from taking off-licence high doses of two antidepressants was worth my while. Slowly I started to reduce the doses and I was fine. While I became more confident in the robustness of my recovery, I still remained ignorant about withdrawal. If only I had searched online, I would have known better.

Likewise, I was ignorant that other people who had also been sent away to boarding school as young children also suffered severe consequences as adults. If only I had searched online, I would have discovered these important facts earlier in my life. As it was, left in ignorance, I believed that I was somehow uniquely weak, uniquely flawed and terribly, terribly ill just like the psychiatrists had told me.

I didn’t want to tell doctors about my symptoms during withdrawal. I had no desire to draw attention to what I was doing, and risk being re-diagnosed or medicated again. By trial and error, I discovered that reducing the dose of the psychiatric drugs had to be very, very slow. It wasn’t scientific but I found myself cutting tiny slivers off the tablets and carrying them around with me, to make sure I could take a tiny amount when the feelings like electric shocks became too much. I had to reinstate the other drug when I found the rebound insomnia, the restless legs, the cramps intolerable. But my emotions were alive. I was living in three dimensions after years of feeling like the world was unreal and that I was completely numb. I cried and cried, but I also laughed and felt joy. It was incredibly scary at times, when I felt panic stricken and afraid. Occasionally I had suicidal thoughts, but somehow, I knew they would pass.

One day, it was like the penny dropped and I laughed out loud when I realised that I had been prescribed medication to treat my psychiatrists’ anxieties. They should have been the ones taking my pills.

I found a counsellor and talked over what had happened to me as a child at boarding school. She was amazed. How on earth had nobody taken this seriously all those years ago? I had been through hell back then, and it had been re-enacted by the psychiatric system which re-traumatised me every time I was admitted to hospital. At last, I started to process memories and emotions that had remained suppressed for decades. I had to learn to recognise my survival persona, one who was easily controlled and coerced. One who knew only how to drive herself harder in response to difficulty. I had to meet my inner children and give them the love and comfort which they had been deprived of while I was growing up.

I made a grave error when I decided to go cold turkey on one of the antidepressants – within two days I had severe burning pain and to this day, I still have the symptoms of small fibre neuropathy. I haven’t slept through the night since that time and now I know that these symptoms are very likely manifestations of a protracted withdrawal syndrome.

In the last few years, I have met two educators in different parts of the country. Both were involved in teaching medical students and/or doctors. Neither of them were medical themselves but both qualified teachers and had the academic credentials to be recognised as experts in education. One of them was employed by a medical school, but suddenly their expertise was no longer required to teach ‘problem-based learning’. The other person was also ousted from their role. They are happy to speculate that this is because the students had learned how to apply their critical thinking too effectively. They were becoming bold, asking awkward questions, no longer willing to learn by rote.

Medical research is largely funded by the pharmaceutical industry, papers ghostwritten by the pharmaceutical industry and influencers paid by the pharmaceutical industry. Regulators are not independent either and so it is that most doctors have become pawns in a system, used to deliver the drugs which provide the fundholders with the maximum profit. So far, the system has failed to eliminate corruption and bias, for one reason only, that is there is no such thing as a free lunch.

Most doctors are not capable of critically appraising the research and ‘evidence’ is sold to us as ‘gospel’. Doctors lack time and training, and are part of a historical, culture which trusts in the academic expertise of influential colleagues. My own medical training had simply reinforced the myth that expert doctors knew best. I had denied my own personhood, ignored my gut instincts and succumbed to the traditional biomedical psychiatric paradigm.

There could have been a quicker route to reach the same conclusions as I have now. There was no need for me to have done this alone; there are plenty of other voices out there, plenty of people who can guide the way.

We might think we choose what we believe but it very much depends on what information is fed to us and importantly, what is withheld. We live in a culture which is heavily influenced by social media and the advertising industry. We cannot rely on the medical profession to take the lead.

While some patients may find psychiatric drugs helpful, at the very least all patients need to be fully informed of the risks of potentially dangerous side effects, and the risks of withdrawal.

I am one of the lucky ones who survived, but others have lost their lives as a direct result of psychiatric drugs. I have written a sequel to my original memoir which reflects the turnaround in my thinking. Unshackled Mind will be published in the coming year. Please join me in speaking out, so that others may be spared from unnecessary suffering and life-threatening risks, all of which may follow an innocent request for help during an emotional crisis.

The post Doctors Are Not Trained to Think Critically appeared first on Mad In America.

In my own experience as both a patient and a doctor, I’ve seen this first-hand. I’ve endured the effects of that bullying on me, and I’ve witnessed the impact on my husband and children as well. They still struggle to understand what happened to me. 

The whole of my family had suffered horrendously during the seven years from 1994, when I was repeatedly hospitalized as a psychiatric patient, drugged, and given ECT. On top of it, during the last few years, when I spent more time detained in hospital than at home, some of the nurses accused me of “not wanting to get better” and urged the doctors to label me with “personality disorder.” 

As a last resort, I underwent experimental psychosurgery in September 2001 (bilateral anterior cingulotomy). It was never intended to be curative, but rather to give a remote possibility of improvement in only the direst cases of treatment-resistant depression, where there was nothing else left in the psychiatrist’s “tool kit.” Out of the third of cases they reported as responsive, no improvement was expected for at least nine months after the surgery.

To everyone’s great surprise, I made an unanticipated and very sudden recovery after eight days. The psychiatrists simply could not explain what had happened, and it was put down as a placebo response. But I remained well, and finally, the detention order was lifted. I was discharged from hospital and relieved of compulsory treatment.

By then, all our children were teenagers—and our eldest daughter had already left home to start her new career as a dancer. Naturally I was buoyant to be back home, but I had always been regarded as “the patient” in isolation from my social and family networks. We were not given any advice or support from healthcare services to help our family adjust to this enormous change in our circumstances. 

Once the family’s initial euphoria over my unexpected recovery had died down, it was a very, very stressful time for all of us. My marriage to Phil went through a far rockier patch than during the prior years. It is a testament to our relationship that we survived, just as it was a testament to my husband that he had held on so tightly to keep our children safe and away from the clutches of social services while I was ill. The children had had little opportunity to talk about what was going on for them. My illness was stigmatized, and therefore they could hardly admit to their own feelings at school or with their peers. We did find a counsellor for one of them, but that was not a great success; the counselor found reason to blame our parenting and came round to our home to tell us.

It is amazing that we got through it all, but we did. 

Before the emotional crisis labeled as depression in 1994, I had been about to embark on a postgraduate training scheme to become a consultant in emergency medicine. Ironically, in 2001, having survived through that first nightmare experience as a psychiatric patient, I considered changing my career path to psychiatry because I wanted to help people like me. But it was a challenge to return to work at all. In 2002, I felt lucky in my role as a very junior doctor in emergency medicine. I was determined to eliminate the bad attitude leveled at patients who came into our care with what were termed “mental health problems.” I soon realized that the nastiness towards those who were labeled with psychiatric diagnoses was ubiquitous within every branch of medicine, and that the job of changing hearts and minds was huge. 

(To clarify: Throughout this blog, I use the terms “mental illness,” “mental health problems,” and “psychiatric diagnosis” interchangeably. I do this only to illustrate the medical paradigm that still exists today. I am not a fan of these terms, and I do not think that labeling a person’s distress or experiences that manifest as unwanted symptoms or behaviours as a “disorder” is helpful.) 

It took courage to talk about my experiences as a patient, and I was surprised at how much it piqued my colleagues’ curiosity. Perhaps it was in speaking of the unspeakable, being bold while simultaneously identifying myself as “defective”—since mental illness was seen as character weakness—that it struck others as an oxymoron. Encouraged by the positive responses, I embraced the opportunity, and they allowed me to conduct some teaching sessions. Knowing no better, I still held to the biomedical theories, convinced by the psychiatrists that my years of treatment-resistant depression was caused by a physical phenomenon such as chemical imbalance, which science had not yet fully elucidated. This was also the information that my family had been given—and they had no reason to doubt it. However, I did not hold back when describing some of the despicable ways I had been treated as a patient. 

The Quest for Power—and Psychiatry’s Failure to See Itself

Psychiatry, of all the medical specialties, is the one which is supposed to hold wisdom when it comes to human behaviour, but there is none so blind as those who fail to see themselves. Unfortunately, psychiatry has always harboured those who crave power. And given that it is the only place in the medical profession where holding power is legitimized and encouraged, it breeds the exact environment for those with such tendencies to hide in plain sight. While there are as many good people committed to helping those in distress in psychiatry as elsewhere, it seems they remain unable or unwilling to stand their ground and say “no” to the harm that is being done to patients. 

So, when I extend the playground metaphor to psychiatric practice, I see the patient as the victim who is bullied by the many well-intentioned practitioners under the influence of their malign ideology. In a way, such practitioners are both victims of bullying and bullies themselves.

It is no coincidence that those who are actually good at their jobs, and want to provide genuine and helpful care, wind up leaving the malevolent atmospheres within psychiatric inpatient settings and go to work in the community, where they have more freedom to do what is right. I saw this first-hand during my work and my treatment. There were of course a few brave souls who stayed working on the wards desperate for the situation to change, but all too often, they found themselves compromising their core values and suffered moral injury or burnout as a result.

All of this deeply affected my husband and kids. As a family we hadn’t talked about what had happened while I was depressed, and the reluctance has continued ever since.  Within five years of my “recovery,” the children had moved on with their lives, my husband was laid off, and as a couple we ended up moving to Aberdeen in Scotland where Phil had found a new job; as a family, we never all lived under the same roof again. I was accepted by the new deanery, and as part of the plan to finish my training in emergency medicine, I had a job at the local hospital. But one of the managers there was a bully, and I refused to submit to his regime of humiliation. 

It was 2006, and I was excited when I was offered a job as a staff grade doctor working on an inpatient psychiatric unit in the same city of Aberdeen. I expected to see the success that psychiatrists always claimed to have when they treated my own mental illness. They had told me how rare it was to be as resistant to treatment as I had been, so I was shocked to discover that few if any of the patients on my ward got better. They were just stuck in endless cycles of treatment, staying on psychiatrists’ lists for years and years. This was the catalyst that forced me to seriously question what was happening in psychiatry.

I kept thinking that if the drugs we prescribed for psychiatric conditions were, in fact, the correct treatment, then surely patients should recover. Similarly, ECT was supposed to accelerate recovery. Too often, it didn’t. I was confused. What had happened to the norm? Then suddenly it hit me: that fight I had had with nursing staff who constantly accused me of “not wanting to get better,” and who wanted me re-diagnosed with “personality disorder”? That was it. PD was exactly the “get out jail free” card that psychiatry was using to blame patients for their failures. From my new perspective working in psychiatry, I saw this repeatedly. 

While this was the start of my awakening, and I tentatively questioned what was happening to others, I still wasn’t quite ready to do the deep dive of what happened to me. 

To be clear, most individual psychiatrists sincerely believe they are right despite all the evidence to the contrary. They may be charming and good-natured, but that is not enough for people to change their opinions. Most psychiatrists still practicing today continue to believe there is no alternative to the current traditional views and use the Diagnostic and Statistical Manual (DSM) and International Classification of Diseases (ICD) to diagnose their patients and prescribe unscientific treatments. It takes courage to challenge the status quo, which might cost them their career and damage their livelihoods. 

As for me working in the system, I couldn’t take it anymore. I couldn’t keep signing prescriptions for psychiatric drugs, which made people even more ill without any hope of getting better. I was miserable as hell in the hellhole created by my own profession. But I didn’t see my response as being normal or warranted given the situation—because nobody else did. Apparently, I was the abnormal one. I was the outsider, and what was happening to me was a clear indication that I had relapsed. I will never forget the sense of hopelessness when I realized I was stuck in a career I hated. The bully who had driven me out of emergency medicine was a powerful doctor in the same locality, and I believed him when he said he would make sure that I never returned to the career where I had thrived.

We had moved 600 miles away from friends and family, and I knew no one. Before 2006 was out, I had succumbed to my distress and went into treatment for round two; I was hospitalized and back in the role as psychiatric patient. Our children were furious. I had let them down by getting “ill” again, but even worse, by giving them no warning that this was a possibility. I had told them I was cured. Yet here I was, drugged and unhappy all over again. My husband was also overwhelmed with disappointment. 

Coming to The Truth, and Sharing it With My Family

In every setting, a leader by definition has supporters. Those in positions of power or responsibility always seem to have enough people willing to suck up to them, do their bidding, and carry out their tasks. Even psychopaths delegate their heinous crimes to their followers. But whoever the leader is, most of the time, the followers are just regular people like you and me, folks who soon melt into the background if the person at the top falls out of favour. They are everywhere, these good people. They are the ones who uphold oppressive regimes and will never taste justice for their complicity. They are those who turn a blind eye to child abuse, or who become just like Pol Pot’s lackeys in the jungles of Cambodia, responsible for the genocide in that beautiful country. They are the people who inhabited the colonies and approved of discriminatory racist practices. 

Today, they are the direct beneficiaries of the pharmaceutical industry who know the harms that the drugs are doing to patients; some of them may be psychiatrists, doctors, or nurses who refuse to open their eyes when they witness their patients seriously ill from severe adverse effects. However good these people are, perhaps they are also too afraid to challenge the status quo. Perhaps that is why they would rather continue prescribing inefficacious and toxic drugs than confront the reality. Even good people are capable of deceiving themselves, believing that they are doing the right thing, even as they hold patients down or force medication on innocent victims of a malign psychiatric system.  

I witnessed this plenty when I worked in the psychiatric wards, and here I was, a prisoner again. Like so many patients, I felt unable to defend myself. We were housed in locked wards without the freedom to come and go, even though we had committed no crime, with no one advocating for us. We did what we could to survive, and misery compounded our misery. 

After seven months in hospital and more ECT, I managed to secure a discharge, but I was in a weakened state. I had been subjected to coercion—sometimes by the nicest of people. How could I complain about that? My own true nature was suppressed by high-dose psychiatric drugs, and I felt nothing anymore. I was a nobody, and it took a move away from Scotland in 2009 to pull myself out of the quagmire.

Being available to help with childcare for one of the grandchildren gave me sufficient impetus to keep going. And yet my whole family continued to be under the illusion that I had an illness requiring psychiatric treatment. Even my husband—who by then had decided to get trained as a psychotherapist himself—had to compartmentalize his thinking. He drip-fed me alternative theories during his three-year degree course, giving me confidence to rebel against the advice my psychiatrists had given. When I discovered that taking long-term drugs classed as antipsychotics could shorten a person’s life, my self-preservation instinct took over—and I managed to stop flupentixol, which reduced the sedation. I was able to stay awake for most of the day. My brain must have adapted somewhat to the remaining drugs, including the off-license, high doses of venlafaxine and trazodone, but I still had to live with severe adverse effects. 

My very lovely professor of psychiatry made it abundantly clear that if I reduced the doses or stopped the antidepressant drugs, I might “relapse” and become seriously ill again (with no mention of withdrawal). Fear secured my compliance. Work had been expressly forbidden as being detrimental to my wellbeing, but in 2013, financial necessity fueled my resolve, and I returned to work in a local emergency department.

Gaining my freedom has been gradual, and it took until 2018 to fully escape from the shackles of psychiatry. It hasn’t been easy coming to terms with the fact that all the psychiatric treatment had just made me worse, had been unnecessary, and had long term consequences for the whole of my precious family. In addition, I had to question the books I had written describing my illness, and ultimately wrote another one from my new perspective.

Since coming to the truth myself, I have tread carefully while trying to share the revelations it took me so long to acquire. I cannot turn the clock back. The fact remains that our children had to grow up with a difficult home life where their mother was largely absent and their father was preoccupied—trying to earn enough money and keep the household running, on his own, with little help. Even though our children knew they were loved, they did not receive the emotional support they so badly needed during the seven-year nightmare. As their mother, I had been at the center of their concern, when as children they should have been at the center of my concern. 

Both Phil and I recognize we made plenty of mistakes throughout the period of my illness and then again once it was over, all of which compounded the feeling that our children had lost out on their lives. I believed that although I never wanted to hurt them, I had rightly earned their fury. At the time, all I could see was my failure as a mother who hadn’t given them the lives I wanted them to have. I didn’t see that psychiatry was responsible, and even believing that I had a serious “biological” illness didn’t let me off the hook, either. The self-blame which was so pivotal in the spiral into depression was still very much in operation. Psychiatry had medicated me with pills, but never helped me tackle the root causes of my distress. As I blamed myself, I also became the target of blame, the family scapegoat. When I did finally find my way out of the psychiatric catastrophe that had defined my life, it was as if the whole bedrock of our understanding had been blown out of existence. It was necessary then to return to the traumas of my childhood and re-learn how to see myself as a good person who had a right to feel the way I felt. 

There are many times when I feel impatient, still waiting for the foundations to become secure enough to have the necessary and meaningful discussions over what really happened. But such conversations must be consensual and cannot be forced. My family had seen my life as unreliable, like a roller-coaster, when I suddenly dropped into profound depression and suicidality. How can they be sure that it will not happen again? How can they afford to become close if at some level they still fear I might suddenly leave them? It’s hardly surprising that we, as parents, need to earn our children’s trust anew.

Here we go with baby steps, reaching out and hoping that one day all of us, in a now-expanded family, might know the truth: that those nightmares are well and truly over. Each one of us will have to come to terms with deep emotions, including anger and regret, as we recognize that it could have been different. Each one of us has to face up to the fact that good people did nothing in psychiatry, just as good people do nothing in other tragic circumstances. 

I hope that my family will see that not everyone is like that; I hope that all of us will see that it is better to do the right thing than allow evil to triumph.

The post Escaping The Shackles of Psychiatry: What I’ve Seen and Survived, as Both Doctor and Patient appeared first on Mad In America.

It is relatively common for a person to come to the attention of mental health services following an act of self-harm. A proportion of these individuals will then be diagnosed as having a mental illness. The converse is also true: being given a psychiatric diagnosis can also lead to self-harm. This is in addition to the fact that certain psychiatric drugs have been found to be associated with an increase in thoughts of suicide and self-harm.

The observations below are made with the intention of provoking a creative response by both individuals and healthcare systems as to how they can help combat the growing use of self-harm as a means by which people try to get their needs met.

The History of Self-Harm

The complex questions around self-harm have always existed, and yet it’s mainly over the last 20 years that attention has been given to exploring the factors that lead up to such behaviours.  At one time, self-flagellation was thought to be a higher calling associated with spiritual gain, and there are historical records of self-harm being used during distress, including a biblical reference to people cutting themselves with stones in response to bereavement.

I had not heard of ‘self-harm’ when I was growing up, either in childhood or as an adolescent in high school. The whole concept of ‘mental illness’, was not discussed and there were only occasional whispers of people having ‘breakdowns’.

At medical school, I enjoyed the few weeks I spent as a student attached to the inpatient psychiatric wards and I accepted what I was taught by the ‘expert’ senior doctors without question. I was given a list of diagnostic categories and I had to interview enough patients from the local mental hospital, to tick all the boxes. It was a fearsome place where the patients were incarcerated and there was little hope of recovery.

Once I started work in Emergency Departments (A&E) several years later, I came across patients who overdosed or self-harmed, often by cutting. The medical culture had for decades suggested that the vast majority who did such things were weak characters, attention seekers and timewasters. They felt that if those who had not made a ‘serious’ attempt on their lives were treated kindly, they would just ‘do it again’.

At the same time, there was also a prevailing belief that if someone really wanted to die by suicide, they would do it ‘properly’ and therefore not ‘bother’ healthcare services. This sort of attitude was commonplace and led to a punitive culture, with the result that patients who self-harmed were treated very badly. It was thought that they ‘deserved’ such ghastly ordeals as having their stomachs ‘pumped out’ or being stitched without local anaesthetic. It was hard for me as a junior doctor to challenge the established culture.

Over recent years there has been wider recognition of the role self-harm plays as an outward response to emotional distress and a simultaneous decrease in the pejorative and often punitive attitudes shown by healthcare professionals towards their patients who self- harm. While self-harm is now talked about and acknowledged in society, perhaps seen as more acceptable, it is also on the increase. I have personally witnessed an exponential rise in the number of cases coming to the Emergency Department following self-injury or self-poisoning. This more or less parallels the lessening of the stigma of psychiatric ‘diagnoses’ and the simultaneous reliance on the medical model of psychiatry, which propagates the belief that emotional distress is a sign that people are mentally ill and in need of treatment.

Why People Self-Harm

I have seen self-harm from many different perspectives and I have learned a lot during my work as a doctor in the Emergency Department, yet nothing quite compares to my own lived experience. It has taken me a long time to really understand what happened during the period that I was labelled as mentally ill. It was then that I learned to use self-harm as a coping mechanism. Something that only ever happened after I began taking psychotropic medication. The relevance of this fact should not be underestimated.

I had an emotional crisis a few years into my work as a junior doctor. Events occurred that triggered memories of my troubled childhood—this compounded the exhaustion I felt from working an 80-100 hour week, whilst simultaneously trying to be a good mother to my four young children during my limited time off. I took myself to see my GP, believing that this was the ‘right thing to do’. I received a diagnosis of depression and a prescription for antidepressant drugs.

My self-esteem took a huge dip. As a doctor myself, I was well aware of the fact that my profession thought those with psychiatric diagnoses were weak characters with only themselves to blame. It was very unusual for any doctor to admit to any symptoms that could indicate ‘mental illness’ and if they did, it was hushed up immediately.

Soon, I decided that I needed to take sick leave. I was very tired, but could not sleep, was feeling unbelievably sad as I constantly ruminated over the past. I thought of myself as a terrible failure. The diagnosis had not helped at all, even though I was now convinced that I was sick and that the medication I had been prescribed was going to make me well again.

However, after a few weeks of religiously complying with the treatment regime, I didn’t feel any better and now had to contend with side effects.  I was feeling nauseous, I was shaky, my mouth was dry, I was constipated and I felt dizzy every time I stood up too quickly. Not only that, neither friends nor family understood what was going on in my life and started to distance themselves from me; I felt like a leper, as if I was contagious. This compounded my sense of isolation. I had become subject to the very real and damaging stigma that was prevalent at that time.

The downward spiral had begun. When I was in such despair that I thought my life was not worth living, I asked for help again; the subsequent admission marked the start of the next seven years as a revolving door patient. I was in and out of psychiatric hospitals, treated with different combinations of over 30 psychotropic drugs and given more than 100 ECT treatments. I was given the revised diagnosis of treatment-resistant depression (which I now believe to be erroneous.)

I have never seen myself as needing to be particularly brave when I have written or spoken of my own diagnosis and treatment within the psychiatric system. Yet, when it comes to my personal experience with self-harm, I am much more afraid of being judged than before.

Despite the reduction in stigma of ‘mental health problems’, there continues to be an underlying belief held by some of my fellow health professionals that individuals who self-harm repeatedly are fundamentally flawed in character. Simplistic answers over why people self-harm can fail to consider the root causes for deep-seated and severe mental torment experienced by some of these people. I was one such person and it led me into vicious cycles of repetitive self-harm, akin to Russian roulette; I became locked into harmful behaviours and I knew there was a risk of death, even though each particular act of self-harm may have been carried out without specific suicidal intent.

Even though my first admission to hospital was for pervasive suicidal ideation, I did not act out on any thoughts of self-harm until several years and multiple admissions later. When I first started to self-harm, I didn’t tell anyone what was happening. I was using physical pain as a source of distraction, to displace the mental torment that seemed so unbearable. But after a while, it wasn’t enough. It didn’t reduce the distress I was feeling. It was then that I started to injure myself in a more visible way.

By then I had a very low self-esteem, and I thought of myself not just as unworthy or ‘bad’, but positively wicked. Therefore, subjecting myself to punishment did not seem a difficult thing to do, but rather a natural sequalae. This resulted in some terrible acts of self-directed violence. During the final period of the seven-year ordeal, I was permanently hospitalised and became obsessed with thoughts of self-harm, which took over my mind until I had injured myself. It became another source of torment.

Often these injuries required treatment that could not be managed on the psychiatric ward. It meant I was taken to the very same Emergency Department where I had worked. My dysfunctional beliefs about myself were further reinforced, not just by staff in the psychiatric hospital, but also by some of the medical and nursing staff I came across during in the ED. Those in supposedly caring roles could be very unkind or judgemental and sometimes they were cruel. This only confirmed to me that my pre-existing self-denigrating beliefs were correct. I felt humiliated when they treated me like I was an unworthy and bad person, which created a breeding ground for the same thoughts to flourish in me, until I no longer cared about myself or my well-being.

Despite this, I still cared very deeply for my husband and children, although I began to believe that they would all be better off without me.

I know I also felt as though my caregivers, the unresponsive staff within the psychiatric system did not listen and I did not feel heard. I believe that part of my self-harm was an attempt to show them just how bad I felt inside. It back-fired, of course, because rather than lead to empathy, it led to increasing amount of judgement and a deliberate disregard for what had happened. No-one would talk about it with me. I was not asked why I had done such a thing and nobody seemed to care that I had almost lost my life. After my recovery, it was confirmed that some staff were angry and frustrated with me.

I must have been angry myself but the numbing effect of the medication meant that I had no awareness of such feelings. I cannot help wondering whether the aggression I meted out on myself was also directed at them.

I was not able to trust anybody in the hospital where I was detained. I was so lost within my head and in terrible torment.

Does Psychiatry Help or Harm?

There are many kind and compassionate people who work in psychiatric care, who are dedicated and well intentioned.

But personally, I do not see psychiatry as being a solution on the wider scale. There are far too many patients trapped within the system who are desperately in need of help and understanding. An equilibrium must be restored for such patients to be able to re-enter life away from the negative influences of psychiatry, which have been unwittingly imposed on them.

My first admission to hospital was ‘voluntary’ and I was told it was to keep me safe and I believed that it would get me better. I soon found that whether voluntary or not, hospitalisation was akin to imprisonment and little else. It was an environment used to contain patients in one place, with the stated aim to prevent them from harming themselves or in certain cases, harming others.

So here we all were, the unsafe people, all housed together in a locked ward with nothing to do except take the medication that we were told would make us feel better. The day room was the only place we had away from our bed, and here we sat for most of the day, men and women and a TV. The nurses were those tasked with keeping us safe, keeping control, and doling out the drugs. Nobody talked to us and there was nothing therapeutic about our stay in hospital.

We, the patients, watched the staff, watched each other, and soon learned the rules of survival in such an environment. I remember feeling horrified and terrified the first time I witnessed another patient use the most effective way of getting the nursing staff out of their office: throwing furniture or various objects or even attacking someone else guaranteed a response.

It was extremely stressful and unpleasant for all of us. I hated it, as did most of my fellow patients. Yet I saw some of the most unlikely people engaging in such violent outbursts just to get the attention they so desperately desired. Some even considered it lucky to get jabbed with a tranquiliser. It gave them relief from the torment of being left in enormous distress, without hope, for days on end.

Self-harm was also widely practiced on these psychiatric wards, long before it became commonplace in the wider community. I could see how it served a similar purpose to other forms of violence, in that it ensured that healthcare staff gave some time to the patient concerned. Some would say that this confirms their belief that such behaviour is purely motivated by attention seeking. I see this not just as pejorative, but also as a wholly inadequate explanation for why patients on psychiatric wards often resort to self-harm. Yet it was clear that there were times when patients really did use such behaviours to get the attention required, just to get their needs met. This way nobody else got hurt.

Once a patient is admitted to a psychiatric ward, feeling suicidal is considered very low key. There is a ladder of ‘risk’, a symptom hierarchy which healthcare professionals used to assess their patients. It seems that they were blind to the fact that patients quickly cottoned on to this.

Even today, psychiatrists, psychiatric nurses, and psychologists may believe that they are uniquely trained and talented in being able to determine how serious the risk of completed suicide is, but they admit that they cannot predict who will or will not go on to take their lives. They make superficial judgements based on a range of factors which nowadays is a variation of what is called the ‘SADPERSONS’ score. For instance, a declaration of feeling suicidal is one thing, while having a plan for suicide puts you further up the ‘risk’ ladder.

For the residents of psychiatric wards, who have become very familiar with the staff responses to those who have self-harmed, they soon see that, without exception, it does bring a measure of extra attention; even when such attention is punitive or judgmental. For those who are desperate for interaction with the staff, negative attention may seem better than no attention at all.

Most of these patients believe what they have been told by the psychiatric profession—that the answer lies in hospitalisation or in treatments that mental health services offer. I was one of them.  I believed that if I did what was advised—took all the medications they prescribed, agreed to all the treatments they offered—I would get better. I can speak from experience when I say that nobody ‘in their right mind’ would want to be locked on a psychiatric ward. Yet, once embedded in a coercive system and heavily medicated, it can be hard to break away and resume your independence.

SO, readers may be wondering, are patients playing the system? The answer is that it is no different from any other aspect of life, where we all learn what works for us as individuals and what does not.

Those who are deemed mentally ill, as I was and want to get better, will do all that we can in our attempts to find the solution to our problems. No one wants to feel sad or hopeless or anxious or frightened. I suspect that most patients who engage in self-harm and are labelled as attention seekers, as was my experience, do so in the subconscious belief that it will help them to be better understood by their psychiatric team—i.e., they do so for good reason, as a valid means to an end, to obtain the help they so desperately need. I believed that if I was really listened to, my concerns would be taken seriously.

In retrospect, I suspect that the nursing staff on the psychiatric ward thought that I was already being taken seriously. The psychiatrists and the psychotherapists thought that they listened. But I did not feel heard. They did not ask the right questions and they did not understand. I remember being subject to logical, rational answers which only served to isolate me further.

Imagine telling an addict that ‘all they need to do is stop taking the drug’ or someone in an abusive relationship, ‘all you need to do is leave’. I was told ‘all I need to do is stop self-harming.’ I was repeatedly told that the reason I didn’t get better was because I didn’t want to get better.

The worst thing about this situation is that, as a patient trapped in the system, it is easy to think that your caregivers will help you to find a way to resolve your difficulties. The relationships with your doctors, nurses, and therapists play such a key role in day-to-day life. They were party to some of my innermost and private thoughts and feelings, which I had shared willingly, believing that my dignity would be preserved. I did not expect to be judged and I thought I would be treated with empathy. I felt so vulnerable when they let me down. That betrayal in trust was devastating.

Patients treated by mental health services quite often escalate their behaviour and complaints because they do not feel heard. This happened to me, and since then, as a professional, I have seen it happen to others on many occasions. Tragically, when patients ‘up the ante’, there is a significant risk of irreversible damage or loss of life. Sadly, it is within the mental health service that acts of self-harm have flourished and spread. Historically, it was on mental health wards that patients learned about self-harm from one another, what responses will be elicited, by whom and for what reasons.

Of course, in the present day, this is aided and abetted by the internet. Suddenly, self-harm has become a commonly used method of eliciting help, even by young children. It has become the ticket of entry to provoke a response from even the most impenetrable of healthcare systems. Self-harm causes understandable alarm and panic from friends and family alike—it is seen as an indicator of serious distress and fills everyone with a desire to urgently remedy ‘the problem.’

Those who remain patients within the psychiatric system really do need to feel understood and often require considerable help to break away from their dysfunctional coping mechanisms. All too often, it is the response of healthcare professionals that reinforces the pattern of self-harm behaviours and thereby hinders, rather than helps, recovery.

As I see it, part of the solution to the increasing and global use of self-harm as a method of eliciting help is to understand how we have unwittingly medicalised very normal reactions to life’s complex circumstances.

Distress and emotional pain are part of being human, without which we will not be able to function or grow into adulthood. Pain has always been a warning system to us, teaching us what is or is not harmful—it serves us well in evolutionary terms. Yet it seems that we worship the idea of being continuously free from all pain and suffering, to the extent that it has taken on the proportions akin to religion—and this has been heavily exploited by western economic systems.

As a consequence, our tolerance of ‘normal’, adaptive or helpful distress and turmoil has declined.

Surely we must re-learn what to expect from ourselves—recognise that it is natural for our moods and feelings to fluctuate and be responsive to the circumstances around us. We need to know that it is perfectly ok to feel what have been labelled as ‘negative’ emotions like sadness in response to difficult situations; that grief is appropriate to experiences of loss, and that the goal of ‘happy all the time’ is based on fantasy. When we accept that suffering is a valuable part of life, as much as ageing is the inevitable consequence of living longer, then perhaps, our general angst will diminish.

Perhaps we should be turning our gaze away from the pseudo-scientific medical models and learn from the ancients. The old-world religions such as Buddhism give us far more insight into the attainment of peace and contentment, as well as guide us on how to live in harmony with others. Surely this is far preferable to taking psychiatric drugs or seeking out nebulous industry-driven formulas to enhance ‘wellbeing’.

I do not belittle any individual who engages in self-harm. It takes a certain courage, yet that very same attribute would better served, if used curiously, to explore what it is that is behind the distress which drives such behaviour in the first place. It can take considerable tenacity and nerve to relinquish the idea of a quick fix or to delve into the past and change past outlooks and responses. Such priorities may be time consuming and costly, but it is well worth finding the right therapy or help and can be life changing.

If I could live my life over again, I would not have sought help for my emotional crisis from any doctor. The psychiatric treatments I underwent did nothing to help me come to terms with my troubled past. Self-harm did not serve me well either; it exacerbated the torment and prolonged the agonies. Not only that, though never intended, it hurt those whom I loved.

Self-harm is a dangerous game. It can escalate from something that starts as relatively trivial to become very serious and I have seen far too many patients die as a result and far too few fully recover.

I am lucky that I did not lose my life and also that self-harm lost its mastery over me. I have come through stronger, am fully recovered and choose to share my experience only to help others do the same. I believe that it is necessary to recognise that it is not just self-harm behaviour that is dysfunctional, it is also the psychiatric system which has given it grounds to flourish. I am one small voice amongst those who share such views. But together, I believe the world really can turn back the rising tide of those who feel the need to use self-harm as a distress signal, to access what I believe is a fundamentally flawed ethos—the bio-medical model of psychiatry.

The post Why Do People Self-Harm, and How Can We Stop It? appeared first on Mad In America.