Christopher Lane, Ph.D.

By Mel O'Dea
County Cork, Ireland

Next Stop: Proactivemad

Originally posted June 2009

As always though I agree with most of the ideas or work of others posted here, I do not always agree with every word. Please do not assume otherwise. Pat Lefave. My friend Mel states:

I was under a psychiatrist for three years in which time we had about 4 appointments lasting for about 5 minutes each. And yet he seemed to feel; that he was in some way 'authorized' to make statements concerning my mental health, and to prescribe certain medications. I asked him how long he had known me, and he was silent.

I said, 5 minutes times 4. 20 minutes, is that right?

He did not respond.

I then asked him 'how long have I known me?'

He did not respond.

I said, 35 years (my age at the time). So, I asked him 'who did he think knew me better?'

The point is this-one can only judge something (or someone!) effectively if we know what we are judging. Psychiatrists have not only in general a pretty polarized outlook, experiences that might be common to 'patients'-poverty, marginalization, addiction etc, are not normally within the psychiatrist's sphere of experience (most come from comfortable middle class backgrounds). Through allowing 'user participation' treatment can be more 'accurate' as the relevant experiences of 'patient' can be made known. This can give a much better indication as to what might be 'wrong' with the 'patient' (if there is anything wrong with him or her at all). Without user participation, there is a real risk that the psychiatrist might make decisions that are poorly informed, and from thence may be utterly inappropriate.

Question:'Are participants of service user groups/ self help groups empowered to be active in their own treatment'?
I don't know much about this one! But it is my experience that many 'in the system' have addictions, either to drugs, to alcohol or both. a friend of mine in London was addicted to heroin. Through that, she displayed certain symptoms which in the opinion of the doctors described a schizophrenic illness.

And she was told that 'the addiction' was actually part of her schizophrenia', she was an addict because she was schizophrenic and a schizophrenic because she was an addict.

I have seen myself how vital a part in the real recovery of persons described as 'mentally ill' was played by groups such as AA, NA, etc. And yet in my experience psychiatrists seem unwilling to 'liaise' with these groups. These groups read addiction as addiction, and deal with it as addiction, a vitally important process when it comes to contradicting many forms of mental distress and their manifests, whereas psychiatrists treat it as an 'illness' which has to be treated. Greater coordination between these groups (NA,AA, etc could substantially alleviate a lot of unnecessary pain.

Question: 'Are there obstacles that could be hindering service user participation'?
The attitude that many psychiatrists exhibit that they 'somehow know better' (even though many of the experiences that are relatively common amongst service users are often outside of the doctor's sphere of experience, as stated above) is for me a major obstacle towards service user participation. Psychiatrists should be a little more 'meek' and should show a greater will towards acceptance of the potential validity of the experiences that their 'patients' quote them! I think, for example, that if one has been abused, one has the right to have that experience taken seriously, and encompassed fully before a 'diagnosis' is made. The fact that psychiatrists are unwilling to actually 'listen' to what is being described to them (and embrace suits possible validity) is a major obstacle here, as is the 'inevitable illness' model-there is no reaction without action!

Question: What are the views of professional psychiatrists/ clinical psychologists on service user participation'?
I am not a psychiatrist or clinical psychologist, and, just as I don't want them to speak on behalf of me, I do not wish to speak on behalf of them! My own experiences is that there is a profound indifference to the potential of user participation, and its very real relevance to treatment. I think most of them 'prescribe something' and then walk away. I have seldom seen a doctor interested in, say, engaging with his or her 'patients' or recommending user support groups such as NA, AA, etc.

Question: How does Irish service user participation compare to that in New Zealand'?
I have never been to New Zealand, nor do I know anybody living there, so I cannot answer that one!

Question: What does the term user involvement/participation mean to you'?
The right to be fully, and granted the right to contest, as to any treatment that I might receive, whether through medication or something like ECT, and to be fully informed as to potential risks, such as side effects, etc, and from thence being invited to give my own opinion with respect to said treatment, and the right to have that opinion considered extremely seriously, along with my right to object, before any treatment is prescribed to me (and the right to form of a legal challenge if I might argue that any treatment was given against my will, or might have caused me harm, particularly if it is likely that the doctor was aware of potential harm before the treatment was given, and yet did not obtain my proper consent-this is particularly relavent in the case of 'aggressive' treatment such as ECT)

Also, the right to expect that the doctor will, before making any decision with respect to my mental health, diagnosing me with anything, and the right to obtain 'a second opinion' if I might argue that diagnosis or treatment was either misinformed or inaccurate) me with anything, prescribing me with anything, will listen to my experiences in such a way as does properly and appropriately encompass their possible reality (it is not 'delusional' to have been abused, for example). It also means that all decisions, diagnoses and medications are properly explained and throughout the process I am given full capacity and right to contest anything I might not agree with and that, if detained against my will, in hospital or similar, to have the right to contest that, and the right to immediate 'release' unless the doctor can legally prove that the detention is necessary, and to have a full part to play in that legal process.

Question: 'Do you think that user participation is an important aspects of people's lives and does it help'?
User participation is vitally important! I remember that through being 'diagnosed' in the 1990's for many years I just 'curled up my toes and gave up'. User participation gives at least some sense of control, and some sense that we can make real decisions over certain things that can, ultimately, affect our lives profoundly.

Many 'patients' that I have known, including myself during the 1990's 'gave up'-there was little point in NOT drinking whiskey at 8am because everything was hopeless anyway. If one can give to people some ability to manage their lives, the likelihood is that they will manage their lives better. Being completely subservient to the will and decisions of others will ultimately cause us to 'give up'. Handing back some of the power is vital towards recovery.

Question: 'In your opinion, are health care professionals adequately involving service users'? If not, how do you think mental health professionals need to treat service users to enable/ allow them to be more involved in their own recovery?
AS I have stated above, I feel that it is vital that the very real experiences of service users need to be recognized as both valid and deeply relavent to any distress. That is, there needs to be some shift away from the 'inevitable illness' model, as this makes people 'give up' (and can be at least as part to play in behaviors that might aggravate distress, such as alcohol and drug abuse).

I feel that any 'treatment' has to come from consensus, and that at all times the service user should be consulted and informed of any treatment that might be given to him or her. I feel that 'forcing treatment' both dis empowers and will aggravate, any problematic behavior-it should be noted that there is a strong correlation between the levels of dysfunction, such as violence, exhibited by a given community and the levels of marginalization that the community has to face. Directly 'hostile' treatments such as ECT or forcible injections should be avoided at all costs.

It should also be the right of any person detained (including in a psychiatric hospital) to contest the legality of that detention. Aggressive' treatments force the 'patient' into greater marginalization, and from thence increase the possibility of what might be called 'deviant' behaviors. In my own experience all 'patients' I have met that have exhibited violent behavior have been the victim of forced injections. Also, it should be the right of any person to 'display their own humanity' without being punished for it; this includes a 'humanity' that certain others might find to be 'eccentric.'

Psychiatrists must move away from 'medicine as coercion', towards 'medicine as treatment' and it is not rightful to punish someone just for being who he or she is-it should be noted that per capita rates of violence are higher in the 'non mentally ill' population than they are in the 'mentally ill' population. But if someone sees 'society's reaction to him or her as 'punishment' then he or she will be more likely to act aggressively. Also, as started above, psychiatrists need to move away from polarity, and recognize the very real contributions possible from groups like AA. NA, etc (and the relavence of often very real experiences to manifest distress). Allowing the 'patient' to be involved in his or her recovery will encourage them to recover, rather than veer into destructive or self destructive bahaviors through giving him or her an idea that they can control their lives and actively participate in society in a fully functional way.

Question :'what do you see as 'successful' participation/involvement?'
When the 'patient' is allowed to actively participate in the treatment he or she receives, and is allowed to make real decisions about that treatment. For example, if certain opinions outside of medication are explained, and the patient is allowed to 'choose' some of these options (ands reject others) Also, the right of any 'patient' to legally contest any 'enforced detention' (or other violation of their rights such as forcible medication or 'agressive' treatment' such as ECT). That is, successful participation involves at all levels of treatment a real dialogue with the patient, the giving to him or her sufficient information to make an informed decision, and the assurance that his or her decision will be considered meaningful, and upheld through all processes of 'treatment'. I also feel, as stated above that it should involve the right to legally contest 'aggressive' treatments such as ECT, forcible injections and the prescription of medications without information and consent.

Question: Have you seen or experienced being treated differently, for being male or female by mental health professionals in regards to your treatment? In your opinion are males or females encouraged to be more active'?
Not in my own personal experience. But I have heard of distressing stories of male psychiatrists using their authority to coerce certain female patients into doing things that those patients did not want to do

Question: 'It has been suggested that the power imbalance between a service user and mental health practitioner cannot result in a true partnership-what are your opinions in this'?
Absolutely! There is scant facility within the 'system' to effectively challenge the authority of doctors, and it is vital that legal mechanisms are put into place through which this authority can be genuinely challenged if it might be argued that it is being used in a manner that is inappropriate. If a 'patient' is given ECT, for example, there exists scant erasures through which this might be contested-the 'doctor has the authority' and that is it (and there have been distressing cases of ECT not being used as treatment but instead as a direct means of coercion-I think there are few if any that currently claim with any surety that there is any 'therapeutic' value to ECT).

Any power is potentially dangerous, but there are real problems with a 'basis of power that cannot be held accountable to those that might be subjected to it. Intrinsic to any 'democratic system' is that the people governed are provided with the facility and right to participate actively in the processes that govern them-this is one of the major 'checks' against dictatorship. If one has a system through which uncontestable power might be imposed on an individual without their acquiescence, then I think we have a real problem.'

'Respect' is in general something shared between equals. It should also be noted that 'impunity' is one of the greatest contributers to human rights violations worldwide. In international law, 'impunity' is described as a mechanism through which, resultant to their own power or their connection with a given power, certain individuals can in effect do what they like without needing to feel accountable for their actions.