In 1980, at the age of 21, I successfully applied for a nursing assistant job on an acute-admission ward at the local District General Hospital. Eager to learn, and harbouring a heady mix of excitement and apprehension, I donned my white tunic, decorated on each shoulder with a brown epaulette, and stumbled into the surreal world of the mentally ill and their professional guardians. Thirty-three years later I opted for early retirement from the National Health Service, so ending a long and turbulent relationship with the murky world of psychiatry.
My first role as a nursing assistant allowed me to observe and interact with an assortment of deeply troubled people who psychiatry had defined as mentally ill. The middle-aged lady with ‘schizophrenia’ and a piercing stare who spent much of each day sitting alone in the corner of a quiet room, her incoherent mumblings punctuated only by shouts of ‘piss off’, directed at anyone who ventured into the three-yard virtual exclusion zone that she had erected around herself. The 60-year-old ‘manic depressive’ with constant dribbles of spittle seeping out of the corners of his mouth, on an unrelenting mission to dismantle every bed in the dormitory so he could reconstruct them to his own superior design. And the young woman pacing the ward corridor, avoiding the cracks between the floor tiles and counting in multiples of seven, engrossed in her ‘obsessive-compulsive’ efforts to prevent harm befalling her loved ones.
At 21, and armed with my recently completed biochemistry degree, I willingly bought into the notion that these oddities of behaviour and emotion were the products of a brain illness. After 12 months as a nursing assistant, I left to pursue psychiatric-nurse training at a large hospital (Prestwich, near Manchester) that had, at the beginning of the 20th century, been recognised as the biggest asylum in Europe. During the first six weeks of training I learnt essential nursing tasks, like how to read a medication prescription card as well as practising my injection technique on oranges (as a prelude to being let loose on human buttocks).
Throughout this initial phase of my relationship with psychiatry, I colluded with the traditional ‘illness like any other’ practises. During my six years in nursing I poured out copious quantities of chlorpromazine syrup, (at the time referred to as a major tranquilliser but later regarded, somewhat misleadingly, as an ‘antipsychotic’ drug), routinely syringed oily liquids known as depots into the rumps of the inmates, and assisted with electroconvulsive therapy (ECT) involving electrocution of the brain to produce a seizure – an event that would necessitate a visit to the Accident and Emergency Department if it occurred in any other setting.
I’m not proud of my behaviour during this phase of complicity with biological psychiatry. I did, however, learn a lot about human suffering and misery.
Despite administering treatments consistent with the assumption that mental health problems are the direct result of a brain defect, I harboured embryonic ideas about alternative ways of responding to distress. Keen to learn more about non-medical approaches to mental health problems, I left nursing in 1987 to train as a clinical psychologist and entered the second phase of my relationship with psychiatry which could be described as ‘seeking change from within’.
During the 1990s I developed the skills to deliver talking therapies and offered these approaches within the psychology silo, a sort of parallel world to the dominant psychiatric method of diagnosis, medication and mental state monitoring. I and like-minded colleagues tried to liaise with, and nurture, the pockets of innovative practice scattered across the psychiatric arena. At this time I believed that enduring improvement in psychiatric services – the achievement of a response to human suffering that was optimistic, respectful, empowering and helpful – could be achieved within the existing system. But I was frustrated by the speed of change, slow at best and often unsustainable. My psychology colleagues urged patience, advising me to seek ‘evolution not revolution’.
By the turn of the century my disillusionment deepened and I entered my third, and final, career phase: the recognition of the need for a paradigm shift, a revolution. Conflicts with psychiatrists, managers and some senior nurses became commonplace. I was saddened to witness the efforts of some committed individuals (from a range of disciplines), struggling to promote more humane, person-centred practices only for them to be ultimately defeated by a medical culture dominated by the assumption that mental health problems were the products of brain diseases and required hefty medication regimes to resolve them. Any innovative practices – recovery-orientated approaches, normalising interventions for voice hearers, service-user involvement in staff training – would ultimately be crushed when the mental health services were under financial pressures, the regime instinctively defaulting to the damaging ‘illness like any other’ approach where the expectation was for the patient to swallow chemicals and follow expert instruction.
Those staff who did try to promote more psycho-social practices sometimes buckled under the pressure of unrelenting opposition, as indicated by the deterioration in their own mental health or by the development of a hardened, non-compassionate shell that mirrored the management style of their superiors.
As one might expect from an institution ideally tailored to deliver treatments for physical illnesses like cancer and heart disease, NHS-led psychiatric services remain wedded to medical model assumptions: disorders labelled as ‘schizophrenia’, ‘bipolar disorder’ and ‘major depression’ are brain diseases; medical specialists possess the appropriate expertise to lead service planning and delivery; and any psycho-social initiatives might help around the edges of the disorder, but will always be an optional add-on to medication.
During the final years of my career in NHS psychiatry, 2009 to 2013, I witnessed many absurdities, including: a senior management team determined to axe an innovative ‘early-intervention for psychosis’ service primarily because the values and philosophy of the team did not correspond to those of the lead psychiatrists; managers feeling so threatened and disempowered that no one was willing to make a decision as to whether a service user could engage in four hours per week of voluntary work alongside the hospital caretaker; the insistence of senior managers that all staff on a new (and supposedly innovative) psychiatric rehabilitation unit should wear the same uniform as their counterparts on the medical wards; and psychiatric professionals refusing to participate in a mindfulness-training group alongside service users because of concerns about showing their charges that they, too, might sometimes feel stressed and vulnerable.
Thirty-three years continuous service, and a favourable pension scheme, provided the opportunity for me to opt out by taking early retirement, aged 55, and escape from the fundamentally flawed and pernicious psychiatric arena. Subsequently, I have written a book based on my experiences – Tales from the Madhouse: An insider critique of psychiatric services – a project that has provided the opportunity to express the nonsense and injustices endemic within professional psychiatry. As well as being cathartic, I hope the book can make a contribution to the emerging protests about the way Western societies make sense of human suffering.
Despite my experiences, I remain hopeful. The array of dissenting voices against traditional psychiatry has never been more compelling. The next five to ten years offers an exceptional opportunity to transform the way we, as a society, respond to mental health problems. And as I state in the last sentence of my book, ‘The prize of a more compassionate and effective response to human suffering could not be more worthy’.