Damage

‘Mentally ill young woman killed herself hours after NHS staff called her a ‘f**king waste of space’

Sometimes a few words that catch your eye in a newspaper keep coming back to you. This  was from the Mirror a couple of weeks ago. I’m not going to say anything about the details of this particular case, but it set me thinking about the damage that is done to people in the name of care, often by the very people they are told to trust.

Many of you will say, quite rightly, that mental health care has been damaging people for years. I remember a patient of mine who had survived a leucotomy and the half-life he had lived in a long stay ward ever since. I’ve known many who have experienced awful after effects of ECT and medication and I bear responsibility for some of this myself- I was trying to help and sometimes I was successful- but not always. I have given tablets to people, which resulted in them feeling worse than they felt before they started them. But, just like we are now beginning to realize with psychological therapies too, treatments can do good but they can sometimes do harm. But how can verbal abuse by any definition of the word ever be justified as ‘treatment?’

A few days later I read the article about a well know TV presenter and his daughter who is recovering from anorexia. The original is here, (sadly behind a paywall) but it was picked up elsewhere too. He tells how she had felt suicidal after a regime, which

included an expensive regime of forced feeding, no exercise, accompanied lavatory visits to prevent them throwing up the food consumed, and monitored sleep to make sure they didn’t exercise while in bed”.

His daughter resisted and threatened to kill herself.

What I hated most about my job was treating a person against their will. It changed the nature of our relationship, sometimes (but not always) damaging it irreparably. The power inherent in my ability to engage with and forge a therapeutic relationship with a person was, for me, one of the most important and personally satisfying parts of my work. I wanted to work with a person, not against them.

In my years as a consultant I cared for quite a few young and older women with a diagnosis of anorexia and they told me what life was like in the units they had been treated in. Some experienced the style of care they were provided with as ‘punishment’, and for others I have no doubt that is what it was. What I’ve heard recently from people I’ve spoken to who went through some of those strict behavioural regimes (now strongly advised against by NICE) has confirmed that.

So what has this got to do with ‘damage’? Well I think we really do need to consider the long term harm that is inflicted every day when people are told they are ‘dependent’ because a service can only offer short term care, when what we know from attachment theory is that for a person who has never experienced secure, loving relationships, another rejection is the last thing they need. We need to consider how, when young people are sent to beds a very long way from home, this must seem like endless punishment for something they have done wrong but no-one will tell them what it is. We need to think about therapy that ‘does’ to people rather than ‘with’ them (in my experience that doesn’t work either). We need to think how it feels to be asking for help because you feel life is too awful to carry on with, but you are simply told to go away and have a warm bath. When the trauma you went through in childhood or later is simply confirmed by the way in which people treat you now. You are told ‘we have nothing for you,’ or ‘you pose too high a risk for us to manage’ or even ‘You are a f**king waste of space.’

Articles about designing our mental health services utilizing what we know from attachment theory – that the things that have happened to people early in life will affect how they behave and ‘attach’ in adult relationships, have begun to appear. Penelope Campling has talked about the need for ‘intelligent kindness’ from those working in healthcare. Yes, this costs money, and it is much harder to do it when money is short and the system is under such pressure. But some of us have long memories. Attitudes and training of staff were not necessarily so much different when the finances were healthier. Money may help but it wont solve the problem of the how the way care is provided can sometimes do much more harm than good- and the cost may be even greater than doing it differently.

I wonder what happened now to the many young women who ‘resisted’ treatment in the wards where I visited one of my most severely ill patients with anorexia. Who is caring for them now? What long term impact did a rigid unforgiving approach doing things to them rather than with them have on them? I hope that many have recovered but I cannot help wondering if some have been diagnosed with personality disorder for being ‘difficult’ and/or rejected from the system. Resistance in therapy is something to work through with a person, not punish them for.

At the end of the article the TV presenter’s daughter talks about how she was eventually helped to recover, in an NHS day care programme. Her words have stayed with me this month.

‘I had a key nurse who really understood me and saw the Maddy without the demons. She made me realize that inside me was still laughter and joy. I was lucky, but mental-health treatment should not be a lottery. The kind of unit that eventually helped me is all too rare. I feel desperately that things need to change and now is the time for action. Otherwise it will be too late’.

Maybe I am too idealistic. But I’ve resisted being damaged by the system too.

4 thoughts on “Damage

  1. Trudy Amygdala says:

    This really struck a chord with me. I’ve almost terrified now to talk to the professionals. Who knows what I’ll say wrong next? And that’s despite trying really, really hard to be a ‘good’ patient.

  2. J says:

    Just recently I’ve been told I upset and worry staff (nothing about how they make me feel) all I do is tell them how I feel or sometimes I’ve just cried so much I can’t stop. They tell me I don’t try hard enough to get better, I work too slowly with my therapist, they force treatment (ECT) that I don’t want.
    The little things hurt too that they’re always too busy to give me time when I’m in hospital or call the crisis team. It grinds you down eventually until you believe you are a bad person for making them feel this way, for being a failure. Which is how you felt before you came to them. Mental health care is indeed in my experience a pattern of abandonment and rejection and the patient is blamed for feeling upset when deserted but why not if you have seen this person for a long while and they know more about you than many others.
    So I went through a process of review several times and it was always my fault that I had failed in my duty to recover. Never a thought that perhaps they failed in their duty to me – to provide me with the treatment I needed not what they had available. Only once have they apologised to the trauma they put me through – they said they had ‘exacerbated my mental health problems and created a rupture of trust in services’.
    And now they’ve done it again
    And now I’m too afraid to say how I feel to what I have left of the service (crisis) Yes like the previous comment

  3. anon says:

    I think this a great blog but I did just want to raise a bit of caution about the comment on ‘dependency’. It’s true if people haven’t had good relationships that another rejection is going to be harmful, but the ‘dependent’ accusation doesn’t just apply to people with a history of trauma or poor relationships.
    A patient wouldn’t be called dependent for expecting regular monitoring of diabetes and would be understandably upset if they were told ‘short term care’ provision meant they weren’t going to get the level of monitoring we know helps diabetes.
    There’s a risk with always linking the problems with calling people dependent to past adversity that we overlook how very unreasonable current (lack of) MH care is and see it just as people with history of trauma needing special treatment rather than actually high quality mental healthcare being a reasonable expectation for everybody – just as high quality diabetes care is a reasonable expectation for anyone with diabetes whether or not they would feel extra hurt, because of previous uncaring relationships, by a cut in care that meant they didn’t receive the monitoring that supports management of their condition.

    • lindagask says:

      I absolutely agree with you! Long term care is normal for people with physical problems. I have follow up for my kidney disease and would be devastated if I was discharged to my GP. But no one suggests I am dependent on seeing the specialist.

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