Schizophrenia, forced treatment, and gender

Katy tweets at @SchizophrenicGB and blogs at ‘Female, Twenty Something, Schizophrenic, GSOH’ 

She also creates Still Here Magazine, a free online mental health magazine, available at www.stillheremagazine.com

[Content note: discusses the experience of hallucinations, forced treatment and restraint.]

Why Gender Needs Considering in Mental Health Care

My first experiences of community mental health care were back in 2006 a few weeks before my 18th birthday. I received care from a female psychotherapist who tried to help me with my arachnophobia. When I say arachnophobia, I don’t mean I just scream and run away when I see a spider, I mean my whole life revolves around spiders and I have umpteen checking and avoidance behaviours to make sure I stay as far away from eight-legged monsters as possible!

I got on with her well, but she could tell that there was something not quite right with my mood. After a brief assessment, which resulted in a very high score, she made me see my GP to make an assessment to see a psychiatrist. During the time waiting to see the psychiatrist, I began hearing a voice, who called himself the devil. The voice wouldn’t let me tell anyone about him, so I kept it to myself.

The psychiatrist I saw turned out to be a student psychiatrist who was male. I felt uneasy with this, but said nothing. After being asked many questions, I plucked up the courage to tell him that the devil wanted me to kill myself. I was too afraid of my voice to tell the student explicitly that I was hearing the devil, but I thought that saying ‘the devil wants me to kill myself’ would be self-explanatory. However, I received barely any response to this, and he sent me away with possible mild depression.

This went completely against what my therapist and GP were saying. My GP (who also was female), and the therapist were both saying that at the least I had severe depression and possibly something else. However, this student psychiatrist clearly knew me better than the therapist I had been seeing for months and my GP who had been seeing me for a few weeks, and the diagnosis of possible mild depression stood. The thing was, my therapist and GP were saying severe depression and possibly something else, but I hadn’t actually told them about the voice. The student psychiatrist was the only person at this stage that knew anything about this voice, and he ignored me.

Fast forward nearly two years, and I started seeing another female psychotherapist about my arachnophobia after moving to a new area. I felt comfortable with her fairly quickly, and after a few weeks, she could see that arachnophobia wasn’t the only thing that was troubling me. She too was a student, but she did one thing that the student psychiatrist didn’t do. She listened to me.

I managed to find the courage to tell her that I was hearing the devil, and immediately she sent me to see a psychiatrist. This psychiatrist was female, and she took this voice that I was hearing seriously. However, I ended up being sectioned a few days after seeing her and this led me to believe that I had made the wrong decision in telling the therapist about the voice.

In hospital, I was told I was being put on an antipsychotic. As I was given no information other than its name and dosage, I refused to take it. I asked a few times for more information but when I asked the nurses, I was told to ask a doctor. When I asked a doctor, they told me to ask the nurses. As a result of this, I refused to take the medication for four days until I was forcibly injected.

The bad thing about the injection was the fact that six members of staff surrounded my bed, three of them male. It was complete overkill, especially as I was a malnourished and dehydrated twenty-year-old at the time. Even worse, one of the men pulled my bottom half of clothing down halfway to my knees, while my legs were twisted in such a way that my front was on full display to the other two men. Then, after I’d been injected and a plaster put on, one of the men pointed to the plaster and laughed, saying it was wonky. The plaster was peeled off and stuck back down to more laughs. I was very aware that six male eyes were staring at my bottom at this point, and I felt so humiliated.

Thankfully, I only stayed in this hospital for eight weeks, and after being discharged, I moved back to where I had been living previously. Less than a year after discharge though, I was back in hospital. I was restrained and injected numerous times during this stay, which lasted 17 months, but there was a distinct difference. There were only two occasions where a man was present, and it was just one man each time. They only used four members of staff for the injection and on the few occasions where a man was present, he would visibly be looking away. It was a small thing, but it made a huge difference.

I was eventually diagnosed with schizophrenia, and after being discharged from my second hospital stay, I received community care. Whilst I feel more comfortable with female members of staff, I have had useful sessions with men. In fact, the therapy that turned my life around was with a male therapist that I saw for over a year. I don’t have an aversion to men, but I feel more comfortable around women.

Many women are the same. If it’s a mental health problem or a ‘private’ problem, a lot of women prefer seeing a female medical professional (whether that’s a doctor, psychiatrist or another professional). Inversely, a lot of men prefer seeing a male medical professional for mental health and ‘private’ problems, and I believe that both men and women need to have their gender preference of medical professional respected.

I believe if the male student psychiatrist who diagnosed me with the possible mild depression had listened to me properly, I would have had much better treatment. For one, when I first experienced the voice, I would have taken any pill that was thrown at me if it would have gotten rid of it. Nothing was offered though. Two years on and I was first med-reluctant, and then after that first injection, I became completely anti-meds.

Is it sexist to wonder that if I’d spoken to a female psychiatrist in 2006, even one who was a student at the same level as the male student I saw, that she would have listened to me more? I know that I would have felt more comfortable around a female psychiatrist so maybe if she hadn’t listened to the first thing I said, perhaps I would have had the courage to tell her again until she listened?

There’s no way of knowing for certain, but it has taught me an important lesson. If you’re not comfortable seeing a male medical professional, ask for a female one and vice versa! In the last year, I have made sure I ask for female support workers and CPNs (Community Psychiatric Nurses) where possible but when it hasn’t been possible, I have tried to make the best of it. However, when a male member of staff at my mental health team made a sexist comment towards me early this year, I initially tried to brush it under the carpet, afraid of making a fuss. Through Twitter, I saw that his comment was completely unacceptable and I made a complaint. The complaint was a few months ago though, and I’ve still not had a proper response from him.

I personally believe that with all medical appointments, a patient should be routinely asked if they have a preference for a male or female doctor, and then provisions be made for any who ask. I think that would result in many people feeling a lot more comfortable, especially those who are too shy to ask for a male or female doctor without prompting. Bottom line though, regardless of gender, a patient should always be respected.

First, do no harm… and respect your patients at all times!

What is Schizophrenia?

Schizophrenia is a mental illness that is often severe and debilitating. However, it is a broad term, and there are many types of schizophrenia, such as paranoid schizophrenia and schizoaffective disorder. There are two types of symptoms of schizophrenia. One category is ‘positive’ symptoms, and the other, ‘negative’ symptoms.

The positive symptoms are things that are added to a person that shouldn’t be there. These are things like hallucinations (seeing things or hearing voices) and delusions (believing in something that others can see is clearly not real). Negative symptoms are things that are taken away from a person that should be there. These are things like low or flat mood (similar to depression), no motivation to do anything (which is often mistaken for laziness) and social withdrawal.

For me, I had delusions, heard voices, had a very low mood and withdrew socially. My motivation would occasionally disappear, but until I was sectioned the first time, I was attending university and working part-time. Medication is normally the treatment for schizophrenia, although some people find relief in talking therapy. Around four in five people find medication useful, but I was the one in five who didn’t. Thankfully, I found help in talking therapy and have been in remission from the worst symptoms ever since.

However, there is currently no official cure for schizophrenia. The best a sufferer can hope for is a lifetime in remission or for a psychiatrist to change the diagnosis to something else, which has criteria for a full recovery. However, I live in hope that one day I will either be free from this diagnosis, or the stigma that surrounds it will be eradicated.

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