Are
you unsatisfied with mental health care? Do you get the feeling
that professionals just don't care about you and would rather you
just went away and left them alone? Do you get disappointed or angry
when clinicians ignore your tears or tantrums. Have you ever wondered
why?
Mental health professionals deal with all sorts of psychological,
emotional and behavioral problems every day. They're trained to
assess and react appropriately to many different situations and
are often confronted by violence, manipulation, ridicule and sometimes
even honest distress. They're also human.
Not all psychiatric patients have an illness. Many are just trying
to manipulate the system. They may want to escape a court judgment
or perhaps they're keen to get more benefits from the state. Sometimes
they want to manipulate a family member and are pretending to be
depressed to get their own way. There are lots of reasons why some
people will get themselves into the mental health system. Mental
health professionals are interested in treating illness. They're
not generally too interested in spending a lot of time and energy
'treating' someone who's healthy but trying to use the system for
their own ends.
Some patients are genuinely ill but use their illness as an excuse
for unacceptable behavior. Just because you're anxious doesn't give
you the right to hurt others. If you have a drug habit or alcohol
problem staff can help you with that but don't expect to intimidate
them as well. Caring does not mean being fooled by a manipulative
threat to injure self or others and mental disorder will not always
protect a person from the consequences of their actions. After all,
ill or not most people still have choices and can choose to abide
by the law just as easily as they can choose to break it.
Very often staff will ignore a client's threats simply because they
believe them to be a manipulative technique. Common examples include:
Threats of suicide if staff don't dispense or prescribe inappropriate
medication;
Threats of violence, including veiled threats such as 'I don't think
I can control myself much longer' (a common one from people awaiting
trial for violent assault as they think a diagnosis of anger problems
will mean a reduced sentence);
Emotional blackmail such as the suggestion that the professional
is making things worse by not letting them have their own way and
thus is a 'bad' practitioner.
When faced with manipulation the usual course of action will be
to 'disattend'. This means effectively to ignore the threat and
so demonstrate the pointlessness of manipulation. Often clients
learn this lesson very quickly and then real work can begin on the
actual problems. This does not mean that the manipulation isn't
a symptom of the disorder - often it is but focusing too much upon
threats of self-injury or whatever just clouds the issue.
Of course any one of these threats could also be a statement of
fact from a genuinely distressed client. In these cases the reaction
from staff is often very different. As a rule mental health professionals
are so used to manipulation that they can quickly tell the difference.
For example the drunken young man who breaks up with his girlfriend,
takes an overdose of aspirin and then calls her to get the ambulance
is more likely to want her to feel guilty than to end his life.
Most psychiatrists resent getting out of bed at three in the morning
to interview such cases.
Some people come into contact with services with impossible expectations.
For example they may expect to sit back and wait while the clinicians
sort out their marriage difficulties or change their apartment for
a state owned house. They may have themselves admitted to a ward
for detoxification so that they can sell drugs to patients already
there - sometimes they even sell drugs prescribed to them by the
unit they're in. It's surprising how often these people claim a
mental illness defense when the hospital authorities call the police.
Mental health units generally take a very hard line where drugs
are concerned because many drugs, when combined with psychiatric
medications can cause major problems and even kill.
Inpatients are often very vulnerable and the effects of other patients
upon their mental health can be devastating. Clients admitted to
psychiatric hospitals who set about exploiting, ridiculing or otherwise
distressing their fellows are generally 'moved on' very quickly
by the ward team. It's not a good way to get help for yourself and
it can be very damaging to the care of your victim. This is also
why those patients who demand a lot of staff time and attention
will only get it if the staff think it's because of genuine need.
Time spent with one patient is also time taken away from another.
Many people are surprised to learn that this is also considered
an abuse as it prevents other patients from getting the care they
need.
Bear in mind that this does not mean that inpatients are expected
to sit quietly and wait for their medication like good little girls
and boys. Mentally ill or not adults are adults and have a right
to express their needs, fears, distress or whatever. They're also
entitled to friendly conversation and many clients do strike up
friendships with professionals as a result. It's simply that attempts
to monopolize staff time for non-genuine reasons cause problems
for patients and staff alike.
Some clients have an expectation that mental health staff are there
to be assaulted. They too become surprised at the reaction they
receive. Staff who are attacked by florid schizophrenics as a result
of a genuine delusional state tend to be quite philosophical about
it. Staff attacked by people who simply want to prove a point or
by those who just enjoy hurting people tend to press charges.
Mental health professionals are not anywhere near so stupid as many
of their clients believe them to be. It's true that they are often
deeply cynical but that's different. As a rule, however, they will
work hard to help the genuinely ill so long as the client is also
prepared to help themselves. It's often impossible to help a mentally
disordered person to move on without co-operation and so people
who spend their time trying to justify their illness instead of
working to overcome it tend not to do very well. Shortage of professional
resources often means that after a while professionals stop trying
to treat those who would prefer to manipulate them and move on to
those they can help after all.
The concept of 'treatability' is very important to mental health
clinicians. In any other job or profession people would not be expected
to spend time trying to do the impossible. Much can be done to
alleviate or even cure mental disorder but this is rarely possible
if the client doesn't play their part. Sometimes of course the
client doesn't know how to behave appropriately or isn't able to
in which case practitioners tend to do the best they can. Often
teaching appropriate coping skills is the first step. The person
who can control their actions and chooses not to however is a very
different proposition.
This does not (or at least should not) mean that clients are written
off. It's simply that clients aren't always ready to change. Often
they are so bogged down with secondary gain issues that no amount
of therapy will help. The response from services is often to stop
trying and wait until the client is actually ready to change. That's
why many clients who begin drinking or using substances immediately
after an inpatient detoxification program will not be admitted until
six months or a year has elapsed. The client needs time to come
to terms with their situation and build some motivation before trying
again.
This concept of 'readiness' is valid for many types of mental disorder
from neurosis to depression. It does not mean that medication won't
help in the meantime and very often medication is all that is necessary
but for those who need to make other changes the will to do so must
be present.
It's often very difficult for professionals to know exactly what
is going on. Patients tend to tell their doctors, nurses or social
workers what they think the professional person wants to hear. The
obvious result of this is that professionals are generally very
wary and regularly find themselves 'second-guessing' their patients.
This is not usually helpful for either patients or staff but it
does explain why professionals are so used to spotting manipulation.
Usually professionals will 'see through' the deceit to the distressed
person beneath and hopefully will always begin from a position of
trust but it doesn't take long for that trust to disappear in the
face of obvious and persistent lies.
Professionals are also very aware that a client who lies to one
staff member will usually be just as ready to lie to all the others.
That's why playing one member of staff off against another often
results in the whole team's mistrust. Mental health staff are ordinary
people who do their work in order to help people - not to be treated
as fools. Neither do they take kindly to verbal or physical abuse
and will respond with criminal charges if necessary.
Of course not all mental health service users are trying to manipulate
their careers. In many cases they genuinely want help but don't
know what to do. Some of these people use manipulation because it's
a part of their culture. They may not even realize that it's a problem.
Many people genuinely believe that everyone manipulates others and
are just doing what they think is appropriate. Until recently mental
health services have not been good at understanding this distinction.
Psychiatry is a relatively young science and there is still much
to be learned.
The process of learning, like the process of helping is always hindered
by deceit however and clients in contact with mental health services
generally do better by being honest in their dealings with professionals.
If you genuinely want help with your problems it's important to
trust clinicians to do what's right. Given the chance they generally
will although giving you what you need isn't always the same as
giving you what you want.
Permission by Anonymous Person
