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MY LATEST ARTICLE...

(Has been Published on 'The F word' today- a prominent contemporary feminist website. Apologies for lack of blogs here but a combination of getting the above edited, a bad couple of weeks MH wise and then going down with tonsillitis has made me rather quiet! One or two more blogs are in the pipeline though, so hopefully October will be a more fruitful month for Syncopated thoughts.)

Jx

Free Willy?

'Voluntary : Preceding from one's own choice or consent. Free of coercion, including any sanctions for not taking part.'

It was in the news this week that chemical castration is being proposed as the latest measure in the war against all things paedophile. The authorities insist that this would be a voluntary measure, naturally, as we are not the kind of country that goes around hacking off the balls of sex offenders in a response to the will of the lynch mob. No, we are far more civilized than that. We give them little pills, or a shot of Depo Prova in each buttock and of course, it’s entirely their choice. Isn’t it?

So this story got me thinking about the term ‘voluntary’. How it is used as a weapon to control people by those in authority. I want to explore the psychology behind it and highlight how in many cases, voluntary choices, as defined above, just don't exist.

I guess most people who can remember their childhood can relate to the kind of ‘voluntary’ decision making that adults imposed on them. I remember clearly a time in my early childhood where I was first made aware of the ambiguities of this ‘voluntary’ concept. It might be a rather frivolous example compared to castrating paedophiles but the psychology of the situation is the same.

My parents were the first to pull the voluntary trick:

‘Tidy your room or don’t tidy your room, it’s entirely up to you’, they said. ‘Go on, live in a pigsty, it doesn’t bother us. All your toys will get spoilt, your clothes won’t get washed, but we don’t care. It’s your choice, Jen, you do what you like.”

So I called their bluff. I thought I was being clever. I was fooled that I actually had the power of this so called voluntary decision behind me. I refused to tidy my room and went outside to play cricket with my brothers. When, several hours later, the sun had set and I came back inside they were both waiting, arms folded, by the bottom of the stairs.

“You haven’t tidied your room, Jen. “

“You said I didn’t have to.”

“Yes well…. (exasperated eye roll)…. I know we said that but your auntie Mary’s coming over tomorrow and you don’t want her to see your room all messy do you?”

“I don’t care. I’ll shut the door if you care that much. Can I have that ice cream left over from tea?”

“No. Not until you’ve tidied your room.”

“But you said I didn’t have to.”

“Well, you do if you want any ice cream.”

“Well, (exaggerated nonchalant shrugging of shoulders) I’ll go without then. It’s only Kwik Saves raspberry ripple anyway, and that goes all gritty between your teeth. ‘

“(audible sighs) Jennifer, stop being difficult. That room is getting tidied, tonight, whether you like it or not. Now do we have to drag you there and sit with you whilst you do it? Do you really want us to see what’s lurking under your bed? Or can you be a good girl and do it on your own?”

(Cue violent stomping up the stairs, tears, slamming my bedroom door and other general tantrumish behaviour.)

Then of course, one dirty sock at a time, in between the sobs and the foot stomps; I tidied the goddamn room. So much for voluntary decision making.

That is why I am always suspicious when I am presented with a choice and it is described as voluntary. This is why I am deeply against anything that curtails civil liberties and freedoms even on a so called voluntary basis. These things always start off as free choice, but end up mandatory. It’s the nature of the system: of power and control. When somebody demands you should make a choice, I find they usually have an agenda themselves and the chances are its not going to be so voluntary after all. The very fact that you are being told to make a choice kind of goes against the voluntary thing in the first place, doesn’t it? I mean, in a totally free world, if I wanted to live in an environment without clutter, I would just make the spontaneous decision to tidy my room, vice versa if I didn’t care about my possessions I would just leave the mess be. The very fact that my parents brought the subject up at all just highlights the fact that they have the power to make me do it. Simply by saying ‘we don’t care what you do’ they are drawing attention to the power dynamic and implying that if they did care, there’s not an awful lot you could do about it. The fact that you are being given a voluntary choice speaks volumes when in fact that voluntary choice should just go without saying; it should be part of your human rights. The fact is that most so called voluntary choices are badly disguised ultimatums. Failure to comply with the ‘right’ voluntary choice leads to further sanctions until you make the decision the authorities deem is right. Of course, if I hadn’t gone upstairs and tidied the bombsite that was my bedroom, there would have been a whole other range of escalating threats, pleas, and measures of force on the part of my parents until they got their way.

As an inpatient in a psychiatric hospital last winter, I heard person after person tell the same story- that at their crisis meetings with doctors and social workers they had been given a ‘choice’- they could enter hospital ‘voluntarily’ or be sectioned against their will. To anyone who knows anything about mental health, you avoid a section at all costs. It is, in effect, to be deemed insane. Your human rights are taken away, the fuckers can do pretty much anything they want. You have to take what they say, and comply to whatever treatment they deem is appropriate, which can include electro shocking and in some countries, a lobotomy. So when their Doctor popped the ‘voluntary’ question, were these people really being given a free choice that ‘preceded from one's own choice or consent?’ Of course not. Some people gave the shrinks a big fuck you and said ‘The only way you’re dragging me into that place is under section, I am not playing a part in this.’ However, most people I spoke to were neither as brave nor stupid as that and acquiesced. They said no to the section and went ‘willingly’ without need of police escort.

It is in this example that you see the beauty of the voluntary technique. It is effective because it seemingly passes the onus of the decision making from those in power on to you. This is no more than a smoke and mirrors trick to make them looks like the good guys. When you are ordered to do something against your will this generally causes deep wells of resentment which sometimes blossoms into rebellion. However, when you are coerced in the form of a loaded ‘voluntary’ choice (even though you were, in actuality, in the same situation as those who are forced), the process acts upon you emotionally in a very different way.

Expanding on the above example; when these ‘voluntary’ psychiatric patients entered hospital I noticed they were generally easier to control than the sectioned patients- not because as common mythology goes, those under section were actually much iller (although some were) but because the voluntary patients had gone through a process where part of them felt like they had got themselves in that situation. They felt tremendous guilt about agreeing to their treatment even though many of them had huge reservations about it and felt somehow responsible. They got angry at themselves for caving under pressure rather than getting mad at the system for the weight it piled on them in the first place. Even though, later, some of them were angry and recognised that they had been coerced, many of these people at least partially believed the lie the authorities told them; that they had come there of their own free will, they had been given a choice, they had chosen this and now they had to live with the consequences of their actions. What were they complaining about anyway? Of course, once they had entered as a voluntary patient, if they wanted to leave they would again be threatened with, or actually, sectioned, showing how empty the ‘voluntary’ label is. You can see through this example how the act of giving someone a choice makes them complicit and then less likely to rebel further on down the line.

I’m not trying to say there’s no such thing as a voluntary choice. When Owen says to me ‘do you want beer or wine?’ or ‘what shall we do tonight?’ Even though factors might complicate and influence these choices, as in I might know that he prefers wine and wants to go to the cinema; because the power relationship between us is the same, the voluntary choice is not loaded and I am free to say what I really want. I think voluntary choices only become coercions when there is some kind of power imbalance and then it’s hard to ever be truly free. As the power imbalance becomes more extreme, so can the demands of those in control. So the most vulnerable people often have the least rights. The mentally ill are drugged and shocked into submission. The paedophile is castrated. The old person incarcerated. The asylum seekers are detained, the immigrants repatriated, the Jews are exterminated. All of these horrendous things have been done under the guise of free choices, (remember that entrance to the Warsaw Ghetto was, at first, ‘entirely voluntary’) making it palatable to the public until they get used to the idea and then, eventually, it becomes compulsory.

It can be argued (and often is) that laws and regulations are necessary for preventing the system collapsing. I’m not going to get into the arguments for and against chemical castration of paedophiles. I object to it, but my real beef today is with the delusional idea that these paedophiles, who at the end of the day are considered to be the scourge of our society, the very lowest of the low, the very bottom of the power scale, are going to have any ‘choice’ in the matter at all. Yes, they may technically be allowed to turn the treatment down, at least at first, until a bill that makes it compulsory is sneakily passed in parliament ten years down the line. But, I guarantee you, behind closed doors, in the meeting rooms and on prison review committees the pressure for these men to comply with the treatment will mount and mount until the word ‘voluntary’ rings as hollow for these men as it did for the Jews, squashed together like stripy sardines on the train to Auschwitz.

The Birthday Blues

Oh God, how much I love The Guardian. Or The Observer as it is called on this long soapy showering, real coffee drinking, should be eating hot buttery croissants (but actually eating lukewarm ready break) day of rest. And God, how much I love the fact that it is free for me to read on the internet. I truly hope it always stays that way. There are some thought provoking articles in there this Sunday, including this article about Prozac, which got me thinking:

Prozac is twenty years old this week. Somehow I didn’t think it was as old as that, but then don't listen to me, occasionally I still go to write 1999 when signing in the date box next to my name. Sometimes I think I might, on some level, not have fully left behind my A level years. Part of me, somewhere, still longs for a headspace free of responsibilities. I hark back to a time when I carried around volumes of my mispelt stoner poetry that, naturally, was on the verge of getting published. Back then, everything that was happening to me was the first time it had happened to anyone. I was so irresistible that my religious studies teacher was about to leave his much loved wife and kids for me. I just knew I could get straight A’s without doing any work. Of course I could single-handedly bring down conservative Christianity, Patriarchy, and Right wing politics in general just by reading Bukowski, Nietzsche’s ‘The Antichrist’ and Greer’s ‘The Female Eunuch’ like they had only just been published and were written for me alone. Back then, consuming Marlborough reds, tenner deals of petrol laced ‘rocky’ and whole bottles of Jack Daniels comprised the highlights of my tiny self absorbed existence. Delusion was piled upon delusion but I never quite managed to kid myself. Inside me a tornado whirled and consequently the year 1999, the last of my school career, was also the date I first got treated for depression.

The doctor’s appointment was short. That’s mostly what I remember. I was very nervous, my hands were shaking. I think, although I am embarrassed to admit it, it might have been the first time I had been to the doctors without one of my parents present and I was terrified. In hindsight now I know my symptoms were pretty mild. I wasn’t sleeping well, was feeling agitated and distracted, couldn’t concentrate on schoolwork and was off food. My thoughts, although often intense, had been getting darker and bleaker in nature. In short, I just wasn’t feeling my usual chirpy self. It was like I was trying to run a race with treacle on my shoes. I also was worrying a bit obsessively about some stuff that had gone on in the past, and this was manifesting itself in some ways even I knew were strange; like not being able to sleep unless I counted to a hundred twenty five times without missing a count and if I did then starting back at the beginning (hence the not sleeping). But in no way was I chronic. I was not suicidal, I did not self harm, I was functioning in my day to day life. I wasn’t crying non stop, my mood wasn’t all that low a lot of time, even my attentive parents hadn’t really noticed a dramatic change.

In other words, the weird counting thing aside, most of my symptoms could have just been put down to A’ level stress or teenage angst. Maybe in a different age they would have been. But there are three key details I remember about that doctor’s appointment:

a) There was a Prozac clock on the wall tick tocking away as we spoke.
b) The doctor was writing with an Eli Lilly pen.
c) Her coffee, which smelt nice, was contained in a mug that proudly displayed the word ‘Prozac’.

And less than five minutes later, I left her room, clutching a piece of paper in my hand that said words which amounted to the same thing: ‘Fluoxetine: 20 mg (one to be taken twice a day)’

Questions asked to me in that interview:

What’s the problem? (I told her the above symptoms)
Are you feeling suicidal (I laughed and said no)

Diagnosis after that literally three minute assessment:

Mild to moderate clinical depression. Possible obsessive compulsive disorder.

Treatment:

Prozac for six months to a year. Then come back and see me.

I don’t even think this is a bad diagnosis in terms of our health care system. Something wasn’t quite right with me and I think many psychiatrists and doctors up and down the country would have made the same call. As skeptical as I am about the psychiatric classification system you have to have some kind of guidelines for diagnosis, I suppose. The real beef I have is with the thoroughness and type of treatment that was offered to me and the care that was available. First of all, taking three minutes to diagnose someone with a mental illness, even if it is one of the milder so called common colds of the mental health spectrum is simply not good enough. The patient education and aftercare system was appalling, after being diagnosed with what to me was quite a significant problem, I was just left to get on with my life. Not even a fucking leaflet or a Samaritans phone number. This is worsened further by the fact that I was, technically at this time, a child. I had just turned seventeen years old and I was very confused about the whole thing. I was somewhat educated, I knew from reading bits and bobs on the internet and from knowing friends of the family with similar problems that having this diagnosis didn’t make me ‘nuts’. But no one, not even the doctor checked to make sure I knew that.

When I left that appointment, and for months afterwards, I felt dramatically more ill than I had done before I went in, simply because my symptoms had been given a name and had been categorically brought into the realm of ‘sickness’. It reminded me of when, as a kid, you went to the doctors with a sore throat thinking you might, if you’re lucky get given a day off school and then are told you have tonsillitis and need antibiotics. From that moment on, even if previously you had been feeling okish, for the next week it takes a crowbar to prise you from the sofa, you feel like you have swallowed sandpaper and all you can eat is ice cream and tomato soup. It's genuine, but it is also, to a certain extent, psychosomatic. Firstly, this is a very common reaction to being diagnosed with any illness, but especially mental illnesses, and someone should have been there to talk me through that. Secondly, I’m not saying my symptoms should have been ignored, but by medicalising them and giving me a diagnosis when I was so young, sending me into the wider world with a label (always a dangerous thing to give a teenager), rather than to a counsellor to talk about some of the stuff that was bothering me and thoroughly assessing my case, was, in my opinion, wrong. Also, unhealthy aspects of my life that I now know were having a massive impact on my mental health, such as my bad diet, my excessive alcohol and drug use and lack of exercise, were never even mentioned, let alone explored. If all the ‘common sense’ stuff had been dealt with before telling me I was sick and pouring Prozac down my neck, well things could have turned out very differently.

They talk about cannabis being a gateway drug for heroin and crack. Now, I don’t personally follow that logic, but if I did then I’d have to concede that Prozac was my psychiatric gateway drug. Since that day I got written the prescription, nearly a decade ago, I have not been off psychotropic drugs. In a typical dealer fashion, they have got harder and harder, pushed with more and more force and coercion. As my mental health deteriorated further over the years following that appointment, I moved from Prozac and Seroxat to Lithium and Valium to Risperdone, Stelazine, Beta Blockers, and dozens more. It’s got to the point now where I’m practically a drugs connoisseur.

There are, it seems, two ways of looking at this:

1) The official line. My episode, at the age of seventeen was clearly worrying, with the potential to develop into something disastrous. The experienced doctor who had seen this thing many times before was good to pick up on these signs and treat them accordingly. Drug treatment is the most quick acting and effective treatment for depression recommended by the NHS, and Prozac one of the most effective in this family of drugs, especially considering the OCD type symptoms I was displaying. The doctor followed what was the recommended course of action at the time. It was simply unfortunate that I was resistant to Prozac, and many of the other drugs she and subsequent doctors threw at me, My illness, now rediagnosed as the more chronic and lifelong bipolar disorder is notoriously difficult to treat, and with hindsight, it is unsurprising that a small dose of Prozac didn’t make me better. However, the doctor, not knowing those facts, acted correctly.

Or

2) My line. If I had been offered counseling in that first appointment which had been the course of action I wanted (I was, in fact astounded that it was that easy to get a prescription) rather than the tablets that the drug pushing companies pressure their GPs to prescribe, then I may have got to the root of the problem a lot quicker and never needed drugs. Also, If my symptoms had been treated as normal and teenage, rather than sick and mentally ill, at least in the first instance, then I may have thought of the situation in a whole different light and who knows where it would have ended up. I just have this nagging feeling in my head that without all the mind fucking chemicals that were relentlessly pumped in experimental cocktails and huge quantities into my head at such an early age, my brain could be a very different place right now. Also, from a psychological point of view, without all the confusing (and often conflicting) diagnostic labels being stuck on me like superglue, maybe I would have a better self image and be leading a healthier, happier life. There is something fundamentally damaging to be told your brain and personality isn’t working right before you even hit your eighteenth birthday. After all, self perception is of paramount importance. As a young woman to be told by those in authority that you are sick in the head, with all the stigma and implications of such a diagnosis, could be something that, in itself, makes you sicker. In other words, maybe I’d be better if I’d have never gone to the damn doctors in the first place.

I’ll never prove it of course. The establishment will always argue that I needed the medicine, that it has been good for me, that without it I might even be dead. And maybe they’re right. But I will never forget that doctor sipping from the Prozac mug, and the way she didn’t even pause for thought before signing the brain of a child away to a chemical that, I later learnt, was surrounded even back then by controversy and doubt. So happy birthday, Prozac. You may have saved a lot of lives, but you’ve also helped trivialize and oversimplify a complex and dehabilitating illness, and have changed the face of psychiatry to one dominated by branding, advertisements, and false, false promises. Once, back in 1999, I believed them. Now I can’t help but feel a little bitter. Forgive me if I don’t sing whilst you blow out your candles.