This morning’s Facebook has brought a paper by Dr. Rachel Bingham about “voluntary” psychiatric hospital. She references Dr. Peter Breggin and what she calls the “Breggin gap” referring to the coercion that keeps a supposedly voluntary patient locked up. Good doctors may talk to each other about this. Let me show you what it looks like from the patient’s point of view.
You are the patient. You decide that you are in so much emotional pain that you just can’t stand it anymore and you want help. Hospitals are supposed to make you feel better, so you go to a hospital’s Emergency Room, where you tell your story and agree to voluntary hospitalization on an inpatient psychiatric unit. They put you in a wheelchair. It starts right there: you are physically healthy but in order to “get help” for your troubled soul, you have to act as if you are physically ill. Then you are pushed down hallways and up elevators, and arrive at the door to the unit.
You sit and wait until somebody comes to unlock the door and let you in.
Once you go behind a locked door, nothing else that happens to you is voluntary. As long as you know that you are not free to leave, you have no freedom to do anything. Nothing is voluntary.
Behind the locked door there are many, many staff members, all of whom are committed to telling you what you must do “for your own good.” This all arises from the false premise that somebody else knows what’s good for you better than you know yourself. A 19-year-old female high school dropout now has authority over a 59-year-old male chemistry professor. He knows that she has neither the education nor the life experience to bring greater wisdom into his life but she does have the one thing that makes him have to listen to her: she has the key to the door.
As long as you know that you are not free to leave, you are in a state of coercion. How does that play out?
Let’s say that it is something innocuous: the dietary department hasn’t gotten the message that you are there, so they don’t send you a supper tray. You’re really hungry, which is making you irritable, and you know that your mood will improve if you have something to eat, so you say you want to go down to the cafeteria for supper. Your request is refused and you are told to wait. And wait. And wait. When somebody controls your access to food, you begin to get the message that you’re no longer in charge of your life. Being “voluntary” means you don’t eat according to your needs.
You are used to taking care of yourself, but your basic needs are now under the control of strangers who—it quickly becomes apparent—care more about how their system works than about how you feel. You are offered a pill, instead of food. Or, as a nurse said to me one day, “You seem angry. Can I get you an Ativan?” They will not deal with the legitimate source of your anger; they will drug you into giving the appearance of calm. And if you don’t accept the pill, what then?
Then you will be forcibly drugged. If you’ve been hospitalized before then you have seen it. Why only the day before yesterday, three staff members piled on another patient, dragged him to the floor, pinned him down and injected him with a sedative. His psychiatrist stood nearby watching quietly while this aggression took place. His psychiatrist is the same one who is treating you.
The staff members assure you that this never would happen to you, but the fact is that you have some very angry, aggressive feelings buried inside you, and you’re pretty sure that if the staff knew then they wouldn’t hesitate to forcibly drug you, too. For the patients who get angry and “act out,” there is an alternative to being drugged—they can just tie you down.
The staff members call it “four-point” and it means being tied hand and foot to a bed. Tied down on a bed. That’s what they do in the name of “mental health.” Outside the locked door, if someone tied you down to a bed, you could reasonably expect that you’re about to be raped. And this “tied-down” thing is not done by the “nice” staff members who serve you your pills instead of food: it’s done by the staff from the Security Dept.
The unit door—to which you do not have a key—opens and admits a couple men wearing uniforms and carrying radios and guns. These are the guys who invite you to lie down on the bed and let them tie you up. Are you unwilling to do so? Do you want to fight for your freedom? Do you really? Coercion occurs when there is no balance of power.
What you also know from experience is that if the staff gets fed up with you, then you can be transferred to a state hospital. That transfer out does not involve being pushed in a wheelchair. It is done by two state troopers—more men with guns—and you are put in handcuffs. You have seen it done to other people.
There is also the issue of electroconvulsive treatment—shock treatment. If your doctor decides—in his opinion—that it would be good for you then he can go to court and get an order to do it. You will be strapped to a gurney, drugged, and semi-electrocuted. Yesterday your roommate went—“voluntarily”—to have shock treatment and came back so disorganized and disoriented that he didn’t know where he was or what he was doing. By any functional definition, he no longer was a human being. They can do that to you.
The fact is that once the door is locked and you can’t run, nothing else that happens is voluntary. You go “willingly” because you have seen what they will do to you if you resist. You will be drugged, tied down, zapped, put in handcuffs and made to disappear. Your only safety lies in “voluntarily” submitting so that you maintain some small semblance of control.
It is a choice, of sorts.