vignettes from a psychiatric history on #worldbipolarday

I can tell you about all the time I have spent among the thyme
thinking of the dark Thames that river I’ve seen
both in TV shows and up close
its dark waters inviting me to sink in its good-bye waves and
ink its darkness on my arms and there is a river dell I see
when I close my eyes and wonder what Virginia Woolf felt in her river
a wolf in me is ready to jump through (s)now and fall through the ice.
Sometimes it’s frenetic energy with a voice of reason that
falls flatter than the paper thin hospital gown that I wore,
highlighter butterflies on my wrists.
I can (out)pace the world, wield
every word as a razor sharper than
the knives I wanted to use for an off label use.
I can be higher than the hills I once wanted to die on
and still see the rivers from on high.

When I was a child, I loathed my psychiatrist. He made me take tests every time I visited him. He condescended to me. He diagnosed me with anxiety and ADHD (accurate) and denied that I was autistic (inaccurate). He told me to focus, focus, focus, also calm down. I ended up throwing child toys at him. He put me on Clonidine first, then more ADHD meds.

I later found out he is held in high regard in the area of ADHD.

Seven years ago, I went on a potent drug ostensibly as an adjunct for a depression diagnosis at age 16. I don’t know what the psychiatrist knew about being angry all the time at home and aggressive at school. The drug gave me uncontrollable urges to move, far different from merely wanting to stim. My mother called the psychiatrist to explain that I seemed to feel like a “Mexican jumping bean.” The doctor prescribed a muscle relaxant.  

I later learned the side effect was akathisia and could have been much worse.

When I told a psychiatrist years later that I was aggressive in high school, he nodded.  “Yes, that’s why they put you on it.” He was an autism specialist a second hospital found and seemed to agree with the decision to put me on it.  “Well, now that you’re not aggressive, we could probably take you off of it.” Besides the issue I had with medicating for compliance, I already had tried to go off it several times. . No psychiatrist ever told me there would be withdrawal, even with tapering, that would last for months.

Each time was so hellish from withdrawal that I asked for it again.

In college, one time, I objected to eating outside on the campus quad on the grass – some of my friends wanted to. They went anyway. I ditched dinner and left the dining hall, almost in tears. I sat near my dorm building. Another friend found me there and asked if I was okay. I wanted to lie, to keep pretending that my brain hadn’t been trying to kill me for the past several months, to talk in circles around my friend and the thoughts. Instead “I don’t want to exist anymore” burst out like Gusher fruit snacks breaking open. My friend took me to our dorm’s resident assistant, who got me an appointment with the campus psychiatrist  for the next day. She upped the dosages of the medications that hadn’t been working.

I pretended things were fine after that.

Fourteen months since college graduation. I’d been at a new job seven months. Six months since the first psych hospitalization. One month since the second. There were still people who didn’t know about them. My mother, who was in town, mentioned I had been published. We were at a lunch table with relatives. But the publication was on my experience with those hospitalizations. My cousin asked if they could read it and I realized a hole had been dug, pushing the conversation in a dangerous direction. “It’s something I don’t really want relatives to read,” I said. I pushed dirt back in the hole the same way I used to pat down the earth around flowers and herbs in the garden, alone.

I pushed dirt back in the hole the way I once imagined filling my early grave.

The featured image for this post is a neurodiversity necklace from Spacerobot Studio for a reason. The need for neurodiversity and mental health movements to intersect is vital.

Not every person with a mental health disability has to see it through the neurodiversity framing, but we should be at times working together to push back against the narratives that frame autistic people, people with intellectual or cognitive disabilities, people with mental health disabilities, as inherently Other. Ableism manifests in different ways toward disabilities that have been categorized in different ways. But the end message is of Other.

As we approach Autism Acceptance Month, we should take care to remember that neurodiversity values all kinds of minds.

Rewriting the Narrative on Psych Ward Abuse in Journalism

Psych Ward Reviews gained a new feature in January 2017: a news article repository of staff-on-patient abuse in hospital psychiatric wards. It is an ongoing effort, both of searches and a morbid set of daily Google Alerts with phrases such as “psychiatric patient abuse.” As part of my search process, I have read over about two hundred articles so far.

One thing of note was that many of the articles on staff-on-patient abuse I found were not in major publications. They were in local news outlets or smaller magazines. And as I knew, there are many failures of psychiatric wards as a crisis care model. These failures can involve staff-on-patient abuse, suicides, ill-maintained facilities, and Medicaid fraud. My focus here is how journalists cover abuse and other failures.

Journalists do so with a few different lines of thought. Many fail to address issues that come with psychiatric wards as the main method of crisis care. These problems include taking away patients’ rights and ability to make decisions. Instead, they discuss issues such as funding and staffing shortages, and overcrowding and bed shortages. However, the reasons for psych ward abuse are power dynamics and ableism.

The system requires institutionalization in secured wards away from the public. Patients then lose their rights (available in theory). The power shifts to doctors and staff, who make decisions about a patient. Many hospitals seek patients for profit. These are settings prone to abuse. We must build a stronger network of community-based crisis care, including peer respite centers and support. There must be meaningful oversight and accountability for any community care providers.

But why don’t journalists talk about creating alternatives to psych wards? The reasoning by many journalists is that shortages result in increased abuse and neglect of patients by staff. They then describe hospital failures as inevitable because of these shortages. But the psych ward system’s issues are structural, rather than wholly solvable with money. Journalists could instead talk about these structural failures. They could do so in many ways.

They could cite the various works around abuse in institutional settings, and question power imbalances. They could push for more accountability and data on abuse rates in articles. They could interview former patients, to see what community options they want. Depending on the size of their platform, they could craft a new crisis care narrative for the broader public. The narrative would present alternatives entrenched in community-based, rights-affirming crisis care.