Don't forget yourself
August 11, 2015 7:51 AM Subscribe
Unfinished Letters From the Most Popular Kid in the Psych Ward (TW: mentions of sexual assault, profound mental illness events). , an article by woman of colour, poet, sometime interviewer, and activist Casey Rocheteau. Her blog is well worth reading, too. In 2014, she became the first recipient of the Write a House writer's residency in Detroit.
if she believes her treatment was particularly disadvantaged by her race or if it's simply the lens she uses to view the world around her.
Both.gif
Look seriously - people of color are -forced- to view the entire world through the lens of their race. In this case, yes, she's black, and because ~the entire fucking world is possibly racist~, BOTH her treatment -was- disadvantaged by her race (which she said, explicitly) --and-- she is forced to view the world through that lens.
This is not so hard to figure out, or a difficult concept to grasp. When a main factor of your existence (race in this case) does affect major parts of your life (education, career, if you're going to get shot by a cop, if someone is going to lie and say you pulled a non-existent knife during group therapy), yes, yes yes yes you are going to view those parts of your life through a "Is this because of my race? SHIT. WHAT IF IT IS?" filter.
posted by FritoKAL at 9:49 AM on August 11, 2015 [11 favorites]
Both.gif
Look seriously - people of color are -forced- to view the entire world through the lens of their race. In this case, yes, she's black, and because ~the entire fucking world is possibly racist~, BOTH her treatment -was- disadvantaged by her race (which she said, explicitly) --and-- she is forced to view the world through that lens.
This is not so hard to figure out, or a difficult concept to grasp. When a main factor of your existence (race in this case) does affect major parts of your life (education, career, if you're going to get shot by a cop, if someone is going to lie and say you pulled a non-existent knife during group therapy), yes, yes yes yes you are going to view those parts of your life through a "Is this because of my race? SHIT. WHAT IF IT IS?" filter.
posted by FritoKAL at 9:49 AM on August 11, 2015 [11 favorites]
To all my QTPOC who struggle with mental health issues, which is to say most of us, because the multitude of oppressive systems we face would rather that we disappear than thrive:I needed to read this.
I love you. Take care of yourself. Let yourself be taken care of. You deserve love. You deserve care. These words are not enough, can never be enough. You are not invisible. You are not a problem. You are not your illness.
May you find your kin. May they hold it down and keep you safe. May we find new roads to healing.
We gon’ be alright.
posted by Juliet Banana at 9:56 AM on August 11, 2015 [5 favorites]
if she believes her treatment was particularly disadvantaged by her race or if it's simply the lens she uses to view the world around her.
I am a white person who has had roommates of color and who has worked with people of color in majority white settings. Because of the type of housing I was in and because of the type of projects I've worked on, I have often been around medically fragile people, both white and POC. POC are treated worse and with more suspicion by white roommates and fellow organizers. To my shame, when I was younger I was part of two very badly handled processes of kicking out mentally ill people of color where there was some plausible anxiety about violence*. Looking back, I know that those situations would have been handled differently if the people were white (and that in both cases, the mental instability was exacerbated if not totally created by the racism those people had been subjected to in terms of housing, work, violence on the street, etc). (We didn't call the cops and we never would have, thank god; we did try to find stable housing/help for the people in question.)
The experience that the writer reports is absolutely in line with how I've seen white people treat people of color when they're ill/confused/exhausted/precarious.
Subsequent to what I describe above, I've been part of projects and situations where white people either tried to kick out or did not support people of color in their houses/projects/organizations. After I realized what I'd been part of when I was younger, I swore up and down I'd never let it happen again, but I keep finding myself in situations where it is in process, while white people who are just as troubled/difficult are accommodated. I call it out when I see it, but I worry that there are things I'm still too blinded by racism to see.
*All this stuff was really difficult and multifactorial - there was a lot of gender stuff wound up in it too, as both were men who were in a place where they said some deeply unreassuring things around women, but I also felt that they were read as far more dangerous than they actually were because of racism, and that white men would have gotten a pass.
posted by Frowner at 10:06 AM on August 11, 2015 [13 favorites]
I am a white person who has had roommates of color and who has worked with people of color in majority white settings. Because of the type of housing I was in and because of the type of projects I've worked on, I have often been around medically fragile people, both white and POC. POC are treated worse and with more suspicion by white roommates and fellow organizers. To my shame, when I was younger I was part of two very badly handled processes of kicking out mentally ill people of color where there was some plausible anxiety about violence*. Looking back, I know that those situations would have been handled differently if the people were white (and that in both cases, the mental instability was exacerbated if not totally created by the racism those people had been subjected to in terms of housing, work, violence on the street, etc). (We didn't call the cops and we never would have, thank god; we did try to find stable housing/help for the people in question.)
The experience that the writer reports is absolutely in line with how I've seen white people treat people of color when they're ill/confused/exhausted/precarious.
Subsequent to what I describe above, I've been part of projects and situations where white people either tried to kick out or did not support people of color in their houses/projects/organizations. After I realized what I'd been part of when I was younger, I swore up and down I'd never let it happen again, but I keep finding myself in situations where it is in process, while white people who are just as troubled/difficult are accommodated. I call it out when I see it, but I worry that there are things I'm still too blinded by racism to see.
*All this stuff was really difficult and multifactorial - there was a lot of gender stuff wound up in it too, as both were men who were in a place where they said some deeply unreassuring things around women, but I also felt that they were read as far more dangerous than they actually were because of racism, and that white men would have gotten a pass.
posted by Frowner at 10:06 AM on August 11, 2015 [13 favorites]
There's a great deal of research showing that when presenting with the same symptoms, white people tend to get diagnosed with Bipolar Disorder (which is generally considered treatable) and Black people with Schizophrenia (which is not always considered very treatable). That's just one example. There is absolutely racial bias in mental healthcare.
It's hard reading this as someone who works in the mental healthcare system. What happened, overall, is horrendous, and it's hard not to pick out bits and pieces and say, "Well, it shouldn't have gotten to that point, but once it did, there's a reason they were following that protocol..." But the important part is that it shouldn't have gotten to the point where a cavalcade of aggressive interventions were set in motion. (It reminds me a bit of the pushback against the medicalization of childbirth, too.)
And her comment about no one asking about trauma -- oh my goodness yes. The lack of awareness I've seen in inpatient units about the impact and prevalence of trauma is astounding to me. I work very occasionally at a locked long-term care facility for people with psychotic disorders who have Medicaid. When I first started working there, one of the managers asked what my treatment specialty was, and I said that I mostly worked with people with PTSD or other trauma-related issues, and she said, "Oh, I don't think we have anybody with PTSD here." In a 90-bed facility for people who almost all have been homeless, all of whom are so disabled by psychosis that they no longer retain the rights to make their own medical or housing or financial decisions, all of whom have had multiple involuntary psychiatric hospitalizations in the past, all of whom are living in a locked facility with 89 other people who are also paranoid and delusional and disabled and often combative, all of whom are being treated directly by at least one manager who doesn't believe they have any traumatic experiences. I often feel mildly traumatized on leaving a shift there, and I get to leave. I am still just gobsmacked by her inability to see -- let alone treat -- the trauma in these people's lives.
posted by jaguar at 10:29 AM on August 11, 2015 [23 favorites]
It's hard reading this as someone who works in the mental healthcare system. What happened, overall, is horrendous, and it's hard not to pick out bits and pieces and say, "Well, it shouldn't have gotten to that point, but once it did, there's a reason they were following that protocol..." But the important part is that it shouldn't have gotten to the point where a cavalcade of aggressive interventions were set in motion. (It reminds me a bit of the pushback against the medicalization of childbirth, too.)
And her comment about no one asking about trauma -- oh my goodness yes. The lack of awareness I've seen in inpatient units about the impact and prevalence of trauma is astounding to me. I work very occasionally at a locked long-term care facility for people with psychotic disorders who have Medicaid. When I first started working there, one of the managers asked what my treatment specialty was, and I said that I mostly worked with people with PTSD or other trauma-related issues, and she said, "Oh, I don't think we have anybody with PTSD here." In a 90-bed facility for people who almost all have been homeless, all of whom are so disabled by psychosis that they no longer retain the rights to make their own medical or housing or financial decisions, all of whom have had multiple involuntary psychiatric hospitalizations in the past, all of whom are living in a locked facility with 89 other people who are also paranoid and delusional and disabled and often combative, all of whom are being treated directly by at least one manager who doesn't believe they have any traumatic experiences. I often feel mildly traumatized on leaving a shift there, and I get to leave. I am still just gobsmacked by her inability to see -- let alone treat -- the trauma in these people's lives.
posted by jaguar at 10:29 AM on August 11, 2015 [23 favorites]
Anyone who hasn't read personal accounts from the psych survivors movement should understand this is what institutional psychiatry does. It's normal. Casey's story isn't that unusual, and I think there's a perspective problem here, akin to the one white society has with police violence and the justice system.
Much like a traffic stops for middle-class white people are predominantly safe and fair, many only know the mental healthcare system from the outside or had enough social standing that all their experiences with psychiatry have been respectful. Casey's experience on the other hand, is a pretty typical account of what happens when the doctors and nurses have all the power. Psychiatry is the only branch of medicine with a non-consensual side, and we pay far too little attention to the potential for abuse, and to the stories of people who have been on the wrong side of the system.
This particular account obviously has a racial dimension, but really, whenever anyone disadvantaged in the social hierarchy (esp. women, children, the poor, the elderly, minorities, etc.) falls into the trap of institutional psychiatry, this is what happens. They're often dismissed, ignored, medicated for convenience rather than treatment, lied to, confined, stigmatized by the doctors themselves, and otherwise treated as less than fully human. Abuse is tragically routine.
And yet, nothing changes, because really, who are we going to believe, the doctors or the "crazy" people? (compare with the credence white juries give to cops vs. black men) We forget that historically psychiatry has been used as a tool of social control, and — contrary to protestations that it's been reformed since the days of lobotomies, straitjackets, and homosexuality in the DSM — the "mental healthcare system" still functions as an institution of oppression.
posted by Wemmick at 3:33 PM on August 11, 2015 [1 favorite]
Much like a traffic stops for middle-class white people are predominantly safe and fair, many only know the mental healthcare system from the outside or had enough social standing that all their experiences with psychiatry have been respectful. Casey's experience on the other hand, is a pretty typical account of what happens when the doctors and nurses have all the power. Psychiatry is the only branch of medicine with a non-consensual side, and we pay far too little attention to the potential for abuse, and to the stories of people who have been on the wrong side of the system.
This particular account obviously has a racial dimension, but really, whenever anyone disadvantaged in the social hierarchy (esp. women, children, the poor, the elderly, minorities, etc.) falls into the trap of institutional psychiatry, this is what happens. They're often dismissed, ignored, medicated for convenience rather than treatment, lied to, confined, stigmatized by the doctors themselves, and otherwise treated as less than fully human. Abuse is tragically routine.
And yet, nothing changes, because really, who are we going to believe, the doctors or the "crazy" people? (compare with the credence white juries give to cops vs. black men) We forget that historically psychiatry has been used as a tool of social control, and — contrary to protestations that it's been reformed since the days of lobotomies, straitjackets, and homosexuality in the DSM — the "mental healthcare system" still functions as an institution of oppression.
posted by Wemmick at 3:33 PM on August 11, 2015 [1 favorite]
Psychiatry is the only branch of medicine with a non-consensual side
That's fucking adorable that you think so, considering how many people have been forced into sterilization (both women of color and trans people)or unwanted procedures during childbirth.
Non-consent in medicine, the horrible treatment of the mentally ill and in particular the even more horrible treatment of minorities in health care in general are awful - but this problem is not unique to psychiatry, not by -far-.
It's probably not even unique to psychiatry and reproductive medicine.
posted by FritoKAL at 5:22 PM on August 11, 2015 [2 favorites]
That's fucking adorable that you think so, considering how many people have been forced into sterilization (both women of color and trans people)or unwanted procedures during childbirth.
Non-consent in medicine, the horrible treatment of the mentally ill and in particular the even more horrible treatment of minorities in health care in general are awful - but this problem is not unique to psychiatry, not by -far-.
It's probably not even unique to psychiatry and reproductive medicine.
posted by FritoKAL at 5:22 PM on August 11, 2015 [2 favorites]
Psychiatry is the only branch of medicine with a non-consensual side
As FritoKAL illustrates, this is not true. Especially when you get into something like geriatrics, or public health and contagion.
And speaking from experience, "institutionalized" psychiatry is one of the fields of medicine where issues of consent are examined very closely, repeatedly, through both ethical and legal lenses. But in medicine in general, you have two different issues of consent. Not just the capacity to refuse proposed interventions, the negative capacity, but the capacity to accept proposed interventions, a positive capacity. I've too often had to come in and help where someone with diminished capacity (or absent) "consented" to a medical intervention that turned out to harm them, or kill them. I've seen 80-year-olds "consented" for risky procedures with basically no chance of an improvement in their health or functioning, but a high chance of causing them pain, injury or death. These people did not have the cognitive or affective capacity to consent. Often, they need proxy decision makers. The action of declaring that need such a proxy is the first step.
Or you have to somehow balance the consent of one person vs the consent of another. For example, say I have one patient who is psychotic, delusional, and hearing commands to attack and kill other patients, randomly, because of a dynamic delusion of possession that moves randomly between different people (this is unfortunately more common than I'd like). This person has no insight into the objective wrong of their actions - they would easily get a "not guilty by insanity" plea if they did manage to carry out their desire. I know from history that when medicated sufficiently, this person's delusions abate and they are not murderous. If they kill another person, without their consent, they have robbed that person of their essential most basic liberty - their right to continue their life as they will. So do I medicate the delusional person, even when they go to court to challenge their treatment? I do not have their consent, but in their condition their ability to deliver informed consent is significantly impaired.
posted by meehawl at 10:02 PM on August 11, 2015 [2 favorites]
As FritoKAL illustrates, this is not true. Especially when you get into something like geriatrics, or public health and contagion.
And speaking from experience, "institutionalized" psychiatry is one of the fields of medicine where issues of consent are examined very closely, repeatedly, through both ethical and legal lenses. But in medicine in general, you have two different issues of consent. Not just the capacity to refuse proposed interventions, the negative capacity, but the capacity to accept proposed interventions, a positive capacity. I've too often had to come in and help where someone with diminished capacity (or absent) "consented" to a medical intervention that turned out to harm them, or kill them. I've seen 80-year-olds "consented" for risky procedures with basically no chance of an improvement in their health or functioning, but a high chance of causing them pain, injury or death. These people did not have the cognitive or affective capacity to consent. Often, they need proxy decision makers. The action of declaring that need such a proxy is the first step.
Or you have to somehow balance the consent of one person vs the consent of another. For example, say I have one patient who is psychotic, delusional, and hearing commands to attack and kill other patients, randomly, because of a dynamic delusion of possession that moves randomly between different people (this is unfortunately more common than I'd like). This person has no insight into the objective wrong of their actions - they would easily get a "not guilty by insanity" plea if they did manage to carry out their desire. I know from history that when medicated sufficiently, this person's delusions abate and they are not murderous. If they kill another person, without their consent, they have robbed that person of their essential most basic liberty - their right to continue their life as they will. So do I medicate the delusional person, even when they go to court to challenge their treatment? I do not have their consent, but in their condition their ability to deliver informed consent is significantly impaired.
posted by meehawl at 10:02 PM on August 11, 2015 [2 favorites]
This was beautifully written and terrifying.
posted by EinAtlanta at 6:46 AM on August 12, 2015 [1 favorite]
posted by EinAtlanta at 6:46 AM on August 12, 2015 [1 favorite]
meehawl: " If they kill another person, without their consent, they have robbed that person of their essential most basic liberty - their right to continue their life as they will. So do I medicate the delusional person, even when they go to court to challenge their treatment?"
No, you don't. Because you're not the police, and people have rights.
posted by Wemmick at 10:47 AM on August 12, 2015
No, you don't. Because you're not the police, and people have rights.
posted by Wemmick at 10:47 AM on August 12, 2015
We generally have laws in place that allow for emergency intervention with patients incapable of consent, however (like someone unconscious brought into an Emergency Department). Some version of "so mentally disturbed as to be a danger to themselves or other people" is usually considered to fall into that emergency-situation umbrella, which I think overall is a good thing, but it can be (and often is) abused. I think there's a more nuanced discussion than just "Always meds" or "Never meds."
posted by jaguar at 11:38 AM on August 12, 2015
posted by jaguar at 11:38 AM on August 12, 2015
Wemmick: No, you don't. Because you're not the police, and people have rights.
You're right, not the police. But do you really want people with significantly impaired reasoning processed only through the undiluted agency of the police? That's totalitarianism. All functioning modern States delegate in varying, contingent degrees two significant powers to carceral systems: the police power and the parental power. The key issue is that people's rights are protected by due process in the delegated institutions. How that happens is sometimes less than perfect, because people and the things we make are fallible. But the effort is made. It's not a binary choice, as you would have it.
posted by meehawl at 5:44 PM on September 5, 2015
You're right, not the police. But do you really want people with significantly impaired reasoning processed only through the undiluted agency of the police? That's totalitarianism. All functioning modern States delegate in varying, contingent degrees two significant powers to carceral systems: the police power and the parental power. The key issue is that people's rights are protected by due process in the delegated institutions. How that happens is sometimes less than perfect, because people and the things we make are fallible. But the effort is made. It's not a binary choice, as you would have it.
posted by meehawl at 5:44 PM on September 5, 2015
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As an aside: not sure why, but I was somewhat thrown off by the injection of race in many of her entries. It leaves me wondering if she believes her treatment was particularly disadvantaged by her race or if it's simply the lens she uses to view the world around her.
posted by SoFlo1 at 9:33 AM on August 11, 2015 [1 favorite]