TRANSCRIPT
During my 10 year career as a therapist, I worked for one very short period in a psychiatric hospital, and that was almost 20 years ago now. I have not been a therapist in the last 10 years, but it was right at the beginning, and I was a Social Work intern for eight weeks on a psychiatric unit in the hospital. I don’t want to mention the name of the hospital, but it was a combined unit for women with eating disorders and people getting electroconvulsive therapy, ECT.
So, I’d like to talk a little bit about what that 8 week experience was like. Well, overall, after those eight weeks, I remember thinking I will never ever work in a psychiatric hospital again. It’s not for me. The main thing was it was a hierarchical, authoritarian environment. It was a top-down environment. There were the big shots at the top, and that was the psychiatrist, the people who were medical doctors who had extra residency in psychiatry. They were the ones who were considered to be the ones who were in the know. They knew the most, and they told other people what to do.
Then there were psychologists, and then there were social workers, occupational therapists, nurses were down there too. But who was at the bottom? It was the patients. The patients definitely had the least power. They were the most disempowered, and the most obvious reason was they didn’t have keys. They couldn’t leave. It was locked units that I was on, and I, as a lowly Social Work intern who really didn’t know anything, or at least on the surface, supposedly according to the hierarchy, didn’t know anything, was given a key. I could come and go whenever I wanted.
I remember right from the first day when I had that key, it did something to my head. It affected me. It made me think, “Oh, I have power. I’m special. I’ve been given a privilege.” Now, did that power go to my head? I like to think that compared to at least a lot of the other clinicians I saw, it didn’t really go to my head. But at some level, of course, it went to my head because I could leave whenever I wanted. I was inherently empowered.
The other thing was in this ward, all my clients were being medicated. All of them. Even the ones who were getting ECT shock therapy were being medicated. And that’s another thing I remember. If I saw my clients who were getting ECT twice a week, let’s say, what I experienced is especially the ones who were getting it more than once a week. I think I can’t remember how often they got it, but they wouldn’t even remember me when they’d come back to the next session because they were getting all that electricity in their brain. One of the known side effects of ECT is loss of short-term memory.
But it’s not that simple because after having been a therapist for a long, long time and after having become part of sort of the anti-psychiatry movement in the mental health field, I’ve talked to so many people. I have a lot of friends who have gotten ECT, and a lot of them say it’s not just short-term memory. You lose long-term memory too. And then that’s the other side: why are you giving this to people? I heard their rationale: “Oh, these are people who have refractory depression. Nothing else can help them.” And then I talked to the people, and I read their charts, and I saw, well, what had they tried?
I remember there was one person in this unit who had been molested by her father, and yet she was living with her father all these years later. I thought, shouldn’t she not be living with her father? Aren’t there other better places where she could live? I read her chart, and all it was was reams and reams and reams of different medications and combinations of medications. They even considered, I remember at one staff meeting, they said, “Oh, her father is her, he’s in the strengths category of her life, the primary support figure in her life emotionally.” And I thought, he molested her when she was a kid. How can you say that?
And that was kind of the emotional logic that I found in this psych ward, which was really illogical. It was like emotionally very disconnected. The people who were at the top of the hierarchy, the psychiatrist, they weren’t so interested in people’s emotional states aside from looking at their emotional states as checkboxes and symptom checklists. It was like they weren’t really looking at cause and effect: why are people depressed, and how can we resolve these traumas? Because so many of the people I talked with had talked to me about the traumas they had in their life. But a psychiatrist, they just looked at people’s emotional states again as checklists: “Oh, they’re depressed. Oh, they’re sad. Oh, they have a feeling of hopelessness and hard onea. They’re not finding pleasure in anything.” Well, I thought, God, if I was on this psychiatric hospital, I was on this unit as a client, a patient, I don’t think I’d be happy. I think I would feel anhedonic also.
And it’s like people are supposed to feel happy being there. People are supposed to feel happy for being there for two or three or four months. Well, what I found over and over again, and my first experience really encapsulated it, and these are not happy places. These are not places that are stimulating or interesting or fun. A lot of times, they’re really, really boring. I saw that with the clients so many times. They’re just bored. They’re sitting around, lots of people watching television, or maybe there’s just one television, and all these people are watching a channel that someone else has chosen for them. And it’s not even the television that they’d want to watch. They’re not allowed to have their phones. They can’t go outside. Sometimes they can’t smoke cigarettes if they want.
And then there’s the whole thing with eating disorders. Well, on this hospital, they considered eating disorders, whatever variety of eating disorders, to be biological problems. Something that was like almost considered genetic, like it was some part of the person’s internal makeup. Like life touched them at birth and said, or even when they were conceived, “You shall have an eating disorder because that is in your biology.” And it was like there really often was little or no exploration of where this came from. It was like they were looking at people’s histories. They really weren’t looking at much at people’s traumas, maybe a little bit, but not that much. There wasn’t much respect for really doing deep and intensive therapy to look at people’s histories.
Instead, they were looking at people in this unit. It was all women who had eating disorders as objects. Objects to tweak in different ways with different drugs: mood stabilizers, antidepressants, sleep medications, and sometimes antipsychotics, and often lots of different combinations in them. And let’s raise this one and lower this one. What I found interesting is quite a few of the women that I talked to on this unit, and certainly since then, lots of women who I’ve talked to who had things like the diagnosis of anorexia and bulimia, a lot had been sexually abused as children, sometimes within their own families of origin, by their dads, even uncles, different people. Sometimes even women being sexually violated by other women, their moms, aunts, cousins, things like this.
And part of this whole thing about sexual abuse, and part of I think also being a person in our society, I think it’s often worse for women, is literally being objectified. Treated like an object. You are an object. Objects to take things from, to do things to. And this has a horrible effect on people, to be objectified in this way. Men – I was objectified in all sorts of different ways, and men are objectified, their muscles and all sorts of different things about them, their athletic prowess, but not being treated as human beings on the inside, not being treated as a self.
I think sometimes all this horrible stuff that happens to people, but I’m going to be specific about these women with eating disorders, things that happened in their families of origin, being treated like objects, being treated like bodies, like sexual objects, being treated like people to abuse, disrespect, people to be controlled. This is what caused eating disorders. This is what causes that, I think by and large, and living in a greater society that says often this is.
Normal, this is OK. And what I found interesting is on this psychiatric unit, they gave some lip service to the horrible things that happened in society sometimes, some lip service or not to the things that happened inside of their families, the abuse that they suffered. But more, it was just like these girls, these women were treated like objects to do things. So it’s like the treatment actually was very similar to what caused the problem in the first place. They’re objects to be tweaked. Their feelings are there to be tweaked. Their brain chemicals are there to be tweaked. They are just a bundle of neurotransmitters that we have to adjust. And if we can just find the right adjustment and also the right behavior modification techniques, we can make this person who doesn’t eat right into someone who eats right and has a healthy body weight. No wonder it didn’t work so often. No wonder so many of these treatments for women with eating disorders were so horrible. They weren’t being treated like human beings. And I found this psychiatric hospital, especially for patients, to be a dehumanizing place. It was depressing. It wasn’t fun. I didn’t actually like going in there. I didn’t wake up in the morning and feel empowered. Also, what I found is when I spoke out—and I did speak out—probably I spoke out less as the eight weeks went on. But at first, I just couldn’t control myself. I went in and I would just say what I was thinking. And I remember early on in staff meetings, staff meetings being one of the more disturbing experiences of the psychiatric hospital, that my speaking out did not make me popular. It was like, “Who are you to talk, you lowly young ignorant dumb Social Work intern? You don’t even have a degree yet. You have no right to talk. Your job is to sit and listen and not have an opinion.” But what about these staff meetings? Well, I found the staff meetings to be like a pecking party. It was like they would present some clients. Some staff member would talk about some clients they had, and everybody would talk about really openly. “Oh, this girl’s not having her period and she’s 16 years old.” Ooh! Why should all these people, people who don’t even work with her, who don’t even know her, know whether or not she’s getting her period and she’s having this much flow in her period? I’m like, this is a complete degrading loss of her privacy. And yet she’s not even there to talk about herself, let alone to defend herself. And sometimes I thought maybe it’s better that she’s not here. Maybe it’s better that she doesn’t know this is so humiliating. But then at the same time, you could see patients walking by, and they could actually even peek in and know we were talking about them. They knew what was going on. And also what happened, what I saw, is different staff members would compete with each other. They were competing for power. They were competing to be the ones who knew the most about this client. And they would say all these private things, things that were said in private and confidential therapy sessions. I knew what medications they were taking. I knew how they felt. I knew about their suicide attempts. I knew about their sexually transmitted diseases—all sorts of things. I thought I would never want to be a patient here. Patient? I would be impatient to get out of here. This is a place that I do not want to be. This is a place that is not safe for me. And even if I came here and I wasn’t depressed at the beginning, I would certainly be depressed after being a patient in this unit. Also, I thought when I became a therapist, I’m really actually very glad I did that eight-week internship there because it reminded me something that I kind of knew beforehand, but I really saw it clearly. I do not want to send my therapy clients to psychiatric hospitals. Maybe there are some exceptions. In my travels, in my work, some of the documentaries I’ve made, I’ve visited—I was going to say some, but some I believe is the number five to twenty. No, I don’t know, some maybe a couple where some really good warm loving things happen. But in general, I visited so many different psychiatric hospitals, and I make it a point to visit psychiatric hospitals in my travels. I visited many, many around the world—in South America, in Europe. I don’t think I’ve been to any in Asia. No, not in Africa. Certainly around North America, yes. And I go there because part of me feels like it’s a responsibility to witness, to know, and also to listen to former mental patients, listen to friends of mine who have been patients in psychiatric hospitals. I want to hear what their experience was like. And for me, it’s a really, really important part of my education. I have found it enlightening. And again and again and again, I’m so grateful I had that kind of horrible eight weeks there because it gave me some frame of reference to really relate when people talked about horrible things—loss of power, being strapped down, being held down, being restrained, being told what was wrong with them, being publicly humiliated, being undressed, oh, being weighed again and again and again, having their confidentiality broken, not being allowed to leave, not being allowed to go out and have a damn cigarette if they want to have a cigarette—all sorts of things like this. Being lied to, being diagnosed, being picked apart, being broken down, being medicated against their will, being injected forcibly. I could relate to it just a little bit better because I saw it. I remember they also told me when I was on this unit, “Well, if you really want to see how ECT is, you can come one morning and you can watch them do it to someone. You can actually watch your clients get shocked.” And part of me was curious, and then there was a part of me that’s like, “You know, I think I’ve heard enough. I think I’ve read about it enough. I don’t need to see it. I don’t know how I’m gonna react. Maybe it’s me, it’s gonna make me want to kill one of these people doing that to someone—all these manipulations.” ‘Cause I think a lot of them, the literature, I think I know it. I’ve read so much more about ECT since then. Oh, there’s a book by a woman called Linda Andre. I’ve met her. Fantastic book about her experience being shocked and having been a shock therapy patient herself. She wrote a fantastic book about shock therapy and about the literature on it and about the medical research on it. Also, Peter Breggin, some great stuff that he’s written and spoken about—really worth learning about for me. Oh gosh, what am I saying? I have so much—I don’t even realize I had this much to say. I’ve been holding a lot of this in for 20 years, that experience, how much it affected me. Oh, but lastly, maybe or maybe not lastly, maybe I have more to say about those case conferences. What they would do is they’d hold it in the auditorium and bring the client up on a stage. And it was, I think, pretty much the psychiatrists who would interview them because it was the top of the hierarchy who would interview them. So this psychiatrist would interview this patient in front of a whole auditorium of people—people who were professionals on the unit and people who just came, people who were invited, probably people, some who weren’t even mental health professionals at all. And what it was, was a spectacle. And they would talk, and I think what they would do first is they would introduce all about the client first and tell about their history and tell about the treatment. And a lot of times what the history was, was the history of their symptoms and the history of all the different treatments that they’d been given, meaning the medications and other biological treatments that they would be being given for this so-called biological problem, or they called it biopsychosocial. So they would give a little bit of lip service to their psychosocial problems, but really bio was for biopsychosocial. And then what they would do is after they described this human being almost like a zoo animal, because I did feel there was a lot of parallels between a psych hospital and a zoo. Well, after they would…
Describe it to this audience so the client wouldn’t even hear. The patient wouldn’t even hear what was being said. Then they would bring the client, the patient, up on the stage, and they would interview them publicly. And now, I don’t know if this is a question of my memory or its reality, but I think some of the people who came up onstage weren’t even wearing regular clothes. I think one might have even been wearing pajamas. And they interviewed these people in front of everyone, all about their personal life and their feelings and sexual things sometimes, right in front of everyone, like absolutely no regard for confidentiality, for boundaries.
And it was like, why were they doing this? What was the reason? Oh, because it was a teaching hospital. They were teaching all the people in the audience about how to interview. No, no, no, no. This was about exhibitionism. So often on the part of the clinicians, on the part of the psychiatrists, just like in those staff meetings, it was exhibitionism. They were as though there’s a lot of showing off. Look at what a big shot I am! Look how important I am that I can ask people personal questions and they will answer them.
And what was going on with the audience? A lot of times I would see the same people who were from outside the unit would come to these big case conferences just to listen. And I thought, it’s voyeurism. Is there something perverse about this? I don’t know if it was always sexually perverse, but sometimes it might have even been sexually perverse, especially with these young pretty girls who were on the eating disorder unit, to see them personally picked apart in these interviews. And it’s like, it was gross. It was like one step away from porn in a way. Some sort of undercurrent that was kind of similar.
And I remember one time they did one of these case conferences with someone that I was working with, a client that I was their lowly Social Work intern, and the psychiatrist was interviewing them. And I remember sitting in the audience and just crying and thinking, how are they doing this to this human being? How are they doing this publicly? It was disgusting. It was really disgusting. And yet this was part of treatment. Treatment for refractory depression. Depression that we’ve tried everything and nothing works. Nothing works.
And I thought, nothing works. Nothing you’ve tried works. And sometimes it was just so illogical. Like, who thought of this idea? Who thought of this idea? And it really did have an effect on me. Really, really, really, really did to this day, where it’s like, mmm, something’s disgusting about this. And yet this is the sad thing, and the scary thing is that I’ve been to mental hospitals that were worse than this. Much worse than this.
But that 8-week experience, again, I’m glad I did it because I did get that education. And I thought, you know what? It was kind of like an inoculation. It’s like I got a small dose of what it was, of what the disease was like, and somehow it inoculated me. It made me think, ooh, this is not a place for me to work. I think a lot of the people who work there really were power freaks, people who were control freaks, who loved the power, who loved to be able to control other people’s lives, to do things to them.
They were people who loved to restrain people. Some of the other places have been horrible, especially the places where there are children. I’ve been in units where they’re locked units where there are children. It’s like, who would want to do that? And yeah, maybe there are people who are just kind of ignorant, who say, oh, maybe they believe they’re helping people. Maybe some people even do get help. Maybe it’s a wake-up call for some people. Oh my god, this horrible experience, I never want to do this again.
Maybe it is motivating for some people to change their lives. But I think for a lot of people, for most people that I’ve talked to, it’s demotivating. Again and again and again, what I’ve seen with therapy clients of mine who talked about their experiences in mental hospitals, or some therapy clients of mine who, while they were in therapy, did go back to mental hospitals—not that I ever recommended. Some people wanted to try it. Some people felt they needed that extra support.
But so often what I saw most times is people who went in feeling lousy came out feeling more lousy and often on more medication. And it’s like, how is that a healing experience? Why is this a helpful experience in a hospital? And so that is what I questioned then, and that is what I still question now.
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