Feminism, psychiatry and Mumsnet

[OnceThereWasThisGirlWho]

This started as a reply to a post on another thread (not a thread started by me). I don't want to upset anyone by theorising in a support forum so am posting my ponderings here.

My brain is not at optimal functioning to rephrase everything, so here is part of my reply:

"OP is understandably and justifiably frustrated and distressed and some posters are seeking to justify shoddy treatment and the smoke-and-mirrors operation of MH services. Which obviously makes the OP more frustrated and distressed.

It baffles me that an online community which appears to encompass thoughtful discussion, criticism of existing power structures/services/wider system, and has many strong feminist viewpoints/posters, should be so lacking in any kind of understanding support about how crappy the mental health system can be. Or, dare I say it, any kind of vaguely antipsychiatry/survivor movement type experiences/thinking/feeling."

At this point I realised this was a discussion to be had elsewhere. Personally, I have found it immensely helpful to look at alternative ways of viewing things to the narrow medical model of psychiatry. To realise that others have similar experiences of the system, similar criticisms or frustrations or alternative viewpoints encompassing the wider context. Even if I am very distressed, talking to someone who understands generally ends up in a lot of dark humour and discussion of the sociopolitical context. Especially helpful when things like gender role expectations, male on female violence and control, and issues around poverty and homelessness form part of the issues.

To be honest, if someone had started talking to me about the things I now agree with (including feminism!) in the past, I would have been polite but inwardly patting them on the head, trying not to dislodge their tinfoil hat. So I do understand others not understanding in general... but so surprised to see it on Mumsnet, where issues are normally pulled apart with alternative viewpoints argued.

I hope I'm making sense, and hope this is the right place to ask...

"Appearance is one of the items in a mental state examination so you would expect there to always be a comment on appearance in a psychiatrists letter as the mental state exam is the equivalent of a cardiologist doing a chest exam." I can imagine that. But are the expectations for women's appearances different for men? Or is more emphasis put on women's appearances than men's when doing examinations?

I have no idea btw, just putting it out there.

Interesting discussion and thoughts OP.

Sorry Hrumphing - you did mention about appearance perhaps having a different meaning for women and men. Must. Read. Properly! In my defence I have a streaming cold!

"Appearance is one of the items in a mental state examination so you would expect there to always be a comment on appearance in a psychiatrists letter as the mental state exam is the equivalent of a cardiologist doing a chest exam."

All of medicine is relative, with few exceptions (birth? death? menarch? menopause?) with targets that move, and the soci-political context pervades medicine in all sorts of ways. Psychiatry is a tool for determining behaviour that society will tolerate, and bringing the rest in line. This is also true of medicine to an extent. The law precludes treatment against the patient's will everywhere except dependent children and those that society defines as mentally ill or unable to consent. The goal being the safety of the self and others. The line that constitutes safe moves regularly.

The power dynamics in psychiatry are terrifying because one person can legitimately override another person where no crime has been committed by the person being overridden.

Any MH professional saying 'oh you must be okay if you've put make up on' is just ridiculous if it's the first time they've met you.

But if you see someone regularly who usually has greasy hair, wearing pj's etc and they arrive/you visit one day and they're wearing jeans and a top, their hair is clean or 'styled' and they're wearing make - up (if you know that they always used to wear make-up before becoming unwell) then that might be an indicator that something has changed for them and it's important to examine that.

I've written clinic letters commenting on clothing/appearence because it's often an indication of current functioning or mental state. If you tell me you're fine, looking after yourself with no problems and showering every morning but you're dishevelled, in dirty clothes with matted hair and smell of body odour then my assessment of the incongruency of what you are reporting is important.

If you say that your loved ones are exaggerating about you seeming elevated in mood or acting completely differently to how you normally do and you're dressed in a ball gown or a karate outfit then that's important.

If you're wearing dark sunglasses and refusing to take them off in a dim room but you normally don't wear them, if it's a hot day but you're wearing a thick coat with the hood pulled up, if it's a freezing cold day and you're dressed in shorts and a vest - all of this things are relevant when you're assessing mental state.

I don't have different expectations of the appearence of women - if I was assessing a woman for the first time without styled hair or make -up then I wouldn't think anything of it as make up and styled hair is not how many, many women look. If your family tell me you're usually never seen even at the local shops without full make-up and a blow dry then it's perhaps significant. Otherwise, no.

Oops, missed this: Xenophile Are you suggesting OP that you aren't getting what you want out of MH services because you're female?
Not exactly. But I think decisions and judgements made along the way have been influenced by my sex and expectations and assumptions around that, yes.

Or, are you trying to have a general discussion about feminism and MH services?

This. But I feel the need to have that discussion because it is so very personal. Also other elements like ableism and race. As well as looking at the social context.

Hrumphing Practioners shouldnt take any element of a mental state exam or history in isolation and should consider all aspects though obviously that doesnt always happen.

So, it seems a "one size fits all" approach is a problem, whereas taken in context appearance can be an important indication.

erin I absolutely agree with you on the victim/survivor dichotomy. I was referring to the "psychiatric survivor" concept/movement rather than the more commonly know one, oversight on my part, apologies.

One can discuss and debate any of psychiatry, anti-psychiatry, or the contexts in which these movements and more are embedded, and these debates should not be silenced.

Yes. I'm not necessarily saying "antipsychiatry is the way forward" but putting it out there as part of a wider discussion.

Nonetheless, debating these systems with posters who are so desperate as to turn to internet strangers for what they feel they need is not kind.

I sort of see what you mean. So it would be like if someone posted in Relationships and was in imminent danger - they need support and advice on how to get out, right now, not discussions of spotting red flags in future relationships, male abuse and patriarchy.

However... as part of their healing process they will need to have those discussions in the long run (to a greater or lesser degree). Especially if the societal message around them is "why did you leave such a nice chap", perhaps stigma for being a single mum or needing benefits, whatever. Generally unsupportive and increasing their confusion and distress. Yet with mental health, people are encouraged to go along with the societally endorsed messages, as channelled by the mental health system.

To give an example that incorporates both of these aspects - women in abusive relationships are advised not to have relationship counselling as the abuser can manipulate the therapist. This would be an example of where the person actually needs an alternative viewpoint; and an understanding of the wider context and fallability of professionals as they are part of society, with all its norms and prejudices.

Buffy Totally agree. It seems to be happening more and more across society - structural problems being pinned on individual failing, or in this case, "illness".

Oh, fuck it. Keep messing up with NCing, fuck it, it doesn't really matter, I am the OP. Can't keep hassling MN to correct names on posts. Arse.

I think decisions about access to services are influenced by sex. Psychiatry isn't just about health, there is always a tension around control. The Mental Health Act is only the most obvious manifestation. I think services are therefore preoccupied by risk and particular types of risk eg violence to others. So a man with schizophrenia might be more likely to be violent than a woman and therefore more likely to get a service. Services might prioritise care for schizophrenia over something like post natal depression. Inpatient care might be prioritised more than community work and the inpatient environment more set up for dealing with men than women and a poor place for women to recover. A lot of decisions being made due to concerns about risk and control than about need for care because of suffering. Which is an odd position for a health service to be in.

There seems to be a big gap between what yu can talk to anyone about in "normal" life and what the mental health services deal with. Complex interpersonal trauma falls in this gap. It is terrifying. Im sorry.

I can't really comment on a lot of what is being said here because it's very intelligent, and I'm not.

I will add though that I had a period back in 2007/08 when I was very ill with out of control anxiety. More than once I was told, by separate doctors, that I looked as though I was "on the mend" because I went to my appointment with a full face of make up and groomed hair. I wasn't better at all and I felt really dismissed and not taken seriously. As though I was alright now because I'd put mascara on and straightened my hair.

Going back to read and try to understand more.

Radically reject the notion of normal life. It helps one to reframe everything.

OnTheTurningAway In complex interpersonal trauma, I have heard what is needed described as "love and boundaries". I once heard of the experience of childbirth from the point of view of the mother described as the start of a lifetime of limitless empathy. It's about time fathers fucking learned to experience the same. I consider physical safety coupled with limitless validation coupled with the most gentle form of psychosocial reality testing to be the starting point for complex interpersonal trauma. The really smoke-and-mirrors aspect of the treatment of complex interpersonal trauma is the way in which the very effects of complex interpersonal trauma send the patient, either running or dragged kicking and screaming, into the arms of psychiatry. And so it goes.

It is not the personalities that are disordered. Really, really, it is not. What the fuck were they thinking when that diagnosis was concocted? It makes me so, so angry. Names matter. Labels matter. Really. They do. Language matters.

Someone more astute than I am describe neurosis as the combat stress of the sex wars.

What do you mean, "have I hit a nerve in you?"

Great thread. Are verboten on the FWR board? If we request a Venus-symbol-coupled-with-raised-fist emoticon, will we be thrown off MN and sent to the separatist communes?

It is not the personalities that are disordered. Really, really, it is not. What the fuck were they thinking when that diagnosis was concocted? It makes me so, so angry.

Makes me angry too. Of course, that would be "unreasonable anger" according to the psychiatrists, which handily happens to be a pointer for personality disorder! Beautifully stitched up, there.

It's scary how Borderline Personality Disorder in particular carries many of the same connotations and is often viewed in a similar way to "hysteria" in times past. It's also a handy way to pin the result of childhood abuse on the victim - "personality disordered" what a fucking revolting insult. (Feel compelled to state I did not experience CSA, but was horrified to find that so many had and were still treated like attention-seekers who just needed to snap out of it.)

I keep typing stuff then deleting it. Feeling overwhelmed and hard to put thoughts in order.

One thing I will mention is that until 2007 peope labelled BPD were routinely excluded from services.

Another thing springing to mind is the way soldiers with PTSD used to be treated. The men had their trauma recognised but the women have not. Is calling to mind something I read on a great blog a couple for years ago... a thought about "the 'good' abuse victim gets labelled PTSD, the 'bad' one gets labelled BPD.

Another thing is quite a few times I've read something along the lines of someone being diagnosed BPD after breaking down after a rape, or similar. This just seems really wrong - how can they tell what is the person's "personality" and what is a reaction to current life events?

I just really feel that BPD is the point at which feminism and psychiatry collide head on.

Sorry - just to be clear I'm not sock puppeting - accidentally posted under other username. OnTheTurningAway (a great can't-sleep-thinky-song btw!). Have kept making mistakes and getting MN to change name on posts and then realise there's no point anymore.

Erm, sorry it's not a neat analysis but wrote this a few years ago. It's about my first serious approach to "get help", when I wasn't offered any right from the start and seemed to aquire the BPD label without due process. I wasn't told what I'd been diagnosed with or why I wasn't being allocated a counsellor.

As things worsened, I was regularly being taken to the hospital under section by the police, usually offered no assessment, and always sent away as a waste of time. [I was also held in police cells when the police didn't know what to do but MH services didn't seem interested. They had to assess me then. Also it was often the crisis team who called police on me in the first place, to do a "welfare check" after I'd called them. The utter fucking waste of everyone's time!] If I tried to stand up for myself they gleefully used it as 'evidence' of BPD, being disagreeable. I made a complaint and the extracts from my notes, the lies and manipulation they used, showed me it was a losing battle. To this day I daren't read my NHS records because it would break me.

I was also in an abusive relationship at the time, and living under threat of violence due to a separate situation (I reiterate: I was 19 at the time!). Because of the BPD label I was refused housing assistance from the council. The MH services colluded with my abusive (older) boyfriend and if I was ever upset at how he treated me I was accused of 'splitting'.* He was offered sympathy and supportive phonelines ["carer" type support ].

*Splitting is also conveniently a BPD symptom.

Sorry. Need to look up studies and stuff. Am rather angry.

OnceThereWasThisGirlWho

Stay safe - Stay angry

You do not need to look up studies and stuff for me. I believe you.

Thanks. I'm ok. Wishing you all the best as well.

You've mentioned before that people labelled BPD were routinely excluded from MH services before 2007. Where did you get that information?.

I was working on acute MH wards and PICUs from 1998 to 2004 and I'd say probably 20% of service users had a BPD diagnosis and obviously were also on CMHT caseloads.

I'd say people with a BPD diagnosis are far less likely to be on secondary MH caseloads now than then but that's because hardly anyone who isn't acutely psychotic are on CMHT caseloads now.

I'm not saying people with a BPD diagnosis have been well-served as a group by MH services but I certainly didn't see that group being excluded from services prior to 2007.

I work in mental health and do very much agree that women are over diagnosed and under diagnosed with specific things because of their gender. For example over diagnosed with BPD and personality disorders in general and underdiagnosed with things like ME or Endometriosis. I think some of it does stem from gender expectations. It works the other way as well where men being under diagnosed with certain personality disorders.

I do not believe in mental health diagnoses.

It is not the personalities that are disordered. Really, it is not.

If you speak to someone who is psychotically ill, they will tell you matter-of-factly that they were locked up in a psych ward and poisoned with medication.

If you speak to someone who has an untreated PD, they will claim that all services are conspiring and victimising them.

Most HCPs are actually skilled enough to tease apart actual abuse vs. symptoms of an illness, it's a major part of the psychiatric process.

It is unhelpful, in my view, for the OP to constantly name change and post on the forums for the same things over and over, changing her story, in order to elicit sympathy, and will not help her to recover in any meaningful way, as thinking the world is against her is undoubtedly part of her emotionally unstable worldview.

Posters who are seeing this post in isolation have not seen the suicide threats, total loss of emotional control, compulsive frantic posting, the fact that OP has apparently been abused by every HCP she has ever met, because she has begun splitting up her posts and is changing the narrative yet again. But those of us who recognise her, know the backstory.

pennefortheguy

Wow, just wow.

If you speak to someone who is psychotically ill, they will tell you matter-of-factly that they were locked up in a psych ward and poisoned with medication.

You do not speak for all people who have been labeled as psychotically ill. Really, you do not. Who defines what psychotically ill is?

What you are doing is speaking for a great swathe of people. Maybe some of them have been locked up in psychiatric wards and taken medicines that did not make them feel like themselves.

If you speak to someone who has an untreated PD, they will claim that all services are conspiring and victimising them.

Personalities are not disordered. Maybe somebody feels that all services are conspiring and victimizing them. Maybe services are doing this.

Most HCPs are actually skilled enough to tease apart actual abuse vs. symptoms of an illness,

Are you able to explain what "actual abuse" and "symptoms of an illness" are?

it's a major part of the psychiatric process.

And what is the goal of this process? Why does this process exist? What purpose does it serve?

OP, a post on another thread made me think of this one. I saw you had posted a week ago. I'm so glad there has been such a useful discussion here. At least I hope you have found it useful OP.

I've read your previous threads and offered what support I could. FWIW I see no inconsistencies. And there are many reasons to name change, not least when speaking about difficult personal issues. I would ignore those comments.

I hope you are ok. Thanks for the discussion here.

The problem with a mental health diagnosis, is that it pathologises me. It names me as defective and broken, when actually, these problems are primarily to do with factors outside me. Stuff like putting a very impatient and creative person into the relentless, lonely grind of caring for young children (like Adrianne Rich describes in Of Woman Born, though I'm not such a good poet!). And shitty, shitty behaviour from other people.And yet, the psychological/psychiatric model of mental health says I'm wrong, for struggling with it. Thanks to this thread, for that insight.

That's what I meant about the system aiming to make women function in patriarchy.

Some women are able to function (not necessarily be happy, but function) in a system that continuously undermines their confidence and puts an undue burden of work on them. That is considered normal.

Those who cannot cope with that kind of thing are labeled "disordered".

If a canary in a coalmine stops singing, you don't give it medication, you get the hell out of there. The canary might indeed be sick due to causes unrelated to the coalmine, but you don't take that risk.

Yet we are expected to take the risk of living under patriarchy.

I have often observed that modern medicine in general seems obsessed with finding a single cause for an illness, and treating that, instead of just removing the patient from the harmful environment that is likely to have caused the illness in the first place.

Bad hospital food is something that always baffled me - how is one supposed to recover from any illness when the food is overcooked, lacking in vitamins and high-carb, high-sugar?

I would therefore be very surprised if psychiatric clinics acknowledged that patriarchy is bad for their female patients and should be eliminated from their lives. Which in my opinion would be necessary for the system to work for and help women in a sustainable way.

"The problem with a mental health diagnosis, is that it pathologises me. It names me as defective and broken, when actually, these problems are primarily to do with factors outside me. Stuff like putting a very impatient and creative person into the relentless, lonely grind of caring for young children (like Adrianne Rich describes in Of Woman Born, though I'm not such a good poet!). And shitty, shitty behaviour from other people.

And yet, the psychological/psychiatric model of mental health says I'm wrong, for struggling with it."

Yes yes yes!!! I keep reading different threads on this board and enthusiastically agreeing.