Changing the culture?
Ask service users if you want to know how to change services, says Linda Hart
Openmind 136, November/December 2005
'Changing the culture' is the latest theme or fad. I hadn't realised that those working within the psychiatric system had any 'culture' to change. Surely it is we, the patients, the survivors, who have and have always had 'culture'. They are stealing a word that rightfully belongs to us.
'Culture' describes the artistry that enables us to survive: the sheer imaginative power that leads to madness and the fortitude to manage the poverty that's forced upon us. It describes the constant vigilance required to manage the impoverished imaginations within the psychiatric system that establish and maintain institutional regimes to service their preferred way of working rather than our preferred way of living. And it describes our resilience, our resistance
to those who dampen our spirits with their medical modelling - their pharmacaust - conjured up by the Gods of Psychiatry in order to maintain their status.
If they are, as they claim to be, 'scientists', then I suggest that art therapy might be more useful to them than sitting around tables endlessly pondering how they might 'change the culture'. It never seems to occur to them, as they sift for 'evidence-based' practice that will give them the Holy Grail they seek, that the answer is so simple. It is what we, in our ignorant, unemployable, unheard voices have been screaming at them for years. "We just need the kinds of things that you need to make your lives workable and worthwhile.We need human contact. We need to feel loved, or at least to be able to gain some comfort from other human beings."
The best thing about a family is that sometimes they put you first, give you unconditional, selfless love. If you look at most psychiatric patients, their family of origin hasn't contained the necessary ingredients to make the cake rise. For one reason or another, relationships haven't worked. There has been little satisfaction for those involved; there hasn't been the right 'fit'. If you have been raised in such a family, it is likely that you felt unknown and probably unknowable. And so you come into the psychiatric system only to find you become more isolated and more unknowable than before.
Sometimes I wonder if it's a deep masochism in us that keeps us seeking for help. Then I realise that it is the very nature of abuse that keeps us captured. Abusers notoriously seek out the vulnerable to use as their victims. They are in a position of power and they use this power to convince (or coerce) us into thinking that we like what they are doing to us. They do this by telling us that our thinking, our beliefs are wrong, and that only they can bring an end to our suffering. Then they drug us 'in our best interests', which does indeed alter our brains, our thinking, so that we become 'compliant'. The main thing is not to tell anyone, because if you do there could be terrible consequences. If you try to get away or holler at your abusers, you could be put in a solitary confinement cell, brought back by the police in handcuffs, or given yet more drugs to make you unconscious for several days.
A psychiatrist once tried to describe to me how a psychopathic mind works. He said that they watch others to find out how to get what they want. Then they mimic that behaviour, but the necessary feelings associated with the situation are absent. He told me this to explain what another patient had done to me. When I said, "But I didn't feel abused by this patient," he replied, "That's exactly what the essence of abuse is like. You don't necessarily know you are being abused or will admit to it. That shows how clever abusers can be."
And that's when I thought, I have been abused by the psychiatric system itself since I was 17. I have had sexual assaults, I have had my brain irretrievably damaged and I have had many,many psychological assaults. And there
has been no one to tell because they are all in on it. I have even been accused of thinking too much!
In this system of psychopathic psychiatry, all we need is some comfort, some contact, someone who will take the risk of getting to know us and by knowing us, understand.
So how do I feel about them changing the culture? So far, all they've managed to achieve is a change of words. They will not get their hands dirty and fight for us against the injustice of the benefits system. They will not take on the absurdities of the health and safety police, which deny us so much, from having freshly cooked food to being able to knit, paint a shed or use sculpturing tools.
They do not question hierarchies and they do not question why it is that they sit in meetings for hours discussing changing the culture because it suits them to get together, show off, have a powwow and, above all, avoid having contact with us, even though they themselves see the benefits of having contact.
I keep on telling them that if they want to change the culture then employ artists or us, because psychiatry should be an art not a science. But they look at me, laugh politely and go on searching for evidence-based permission to change the culture.