Ana* is a young woman in her twenties who is white, Scottish and a survivor of the psychiatric system. In this brief interview, she speaks about an interesting exchange with a psychiatrist within a mental health hospital admission as an experience that brought to her awareness issues of identity, difference and, the importance of finding safe spaces and of feeling connected for those within whom difference is located…
Have you ever become conscious of you, as a socially located being, within psychiatric services?
I think being in psychiatric services was the point that I really realised that I had a social identity! I was aware of being a woman but beyond that as a white person I have been able to go through life without the experience of having my identity picked over, thrown back at me and so on. In our society white and straight is seen as the ‘default’ and it’s easy not to realise that those are identities in themselves and that we aren’t identity and history free (as much as we might wish to pretend we are). I inhabit quite a confusing place class-wise as outside my working life I am often perceived to be someone who has a degree (I am not sure why) when in fact I have no GCSEs.
Inside of my working life, I am presumably perceived as working class because of the jobs I have held. Only in psychiatric services have the two worlds collided when histories are taken. After an admissions assessment in which I’d tried to explain to a nurse and a psychiatrist that really, I had had quite enough and just wanted to die now and that a hospital admission was pointless, the psychiatrist smiled and said ‘Well you’re certainly very well spoken!’ I was flummoxed, did he mean for a mentally unwell person? For a Scottish person? For a cleaner? For someone with my diagnosis specifically?
Mental health services as microcosms of society.
Perhaps for the first time in my life I wasn’t quite sure which part of my identity I was being judged on and realised there were lots of parts to the whole. I started to wonder about other people’s experiences – clearly Mental Health (MH) professionals aren’t immune from issues in wider society, being people just like everyone else. I wondered how these perceptions affected other people in services. I was alarmed to find statistics that showed quite starkly how different people’s experiences of the MH system can be, particularly with regards to race. Understanding this was a good introduction to the idea of systemic oppression and the idea that we can make decisions that unwittingly build oppression into systems.
I think MH services are a microcosm of society – all the same issues are played out within hospital walls. Whether it is a lack of understanding of the needs of women who have experienced male violence by placing them with men, or an inability to recognise racism built into the system – it’s all there. I am not sure we can affect change in the MH system without doing so in other systems and in society as a whole. The Mental Health system isn’t its own entity, it’s not simply buildings but the people within it – who are all part of society and prone to the same ‘not seeing’ or ‘not wishing to see’ as we all are.
To what extent do you feel solidarity or empathy with those who experience the more adverse/coercive end of the mental health system and; do you have any view on whether such empathy or solidarity could be useful in terms addressing such inequalities?
I certainly feel empathy, but I am not sure ‘solidarity’ is quite the right word, for me. Solidarity is often based on shared interests and I don’t think that everyone in the MH system do in fact share interests – I think we are often asking for very different things. I think for me it’s recognising that there are people who go through the same system as I do, but have completely different experiences – in some cases they go into parts of the system that I haven’t been, or experience the same parts of the system very differently. I wonder if my experience of using services is even relevant, when experiences can be so different.
When I write about or discuss mental health services I try to be open about the limits of my experience, and highlight the differences. I try to use an intersectional approach to understanding how different oppressions affect us, and to consider how that might affect how people experience the system. I try to put this across without attempting to write or inhabit other people’s experiences. I try as best I can to share information or the experiences of others that is relevant as best I can. I try not to talk over people with different experiences and so on.
I’ve used the word ‘try’ a lot here, because I am sure that I am not always successful with any of this! I feel quite limited in my ability to affect change as one person who is quite isolated – I think change is usually achieved by groups and collectives and on a practical level, at a very basic level, I think we cannot change things if we do not know and so knowing and listening to others are good first steps. I am still at the very beginning and have a lot to learn and need to listen more than speak I think. Sometimes just shutting up is a good first step!
What have you learn from your experience which may be useful to others especially those who may be ‘different’ in some ways?
I’d say find others who share your experiences, or your understanding of your experiences. That has been immensely valuable to me. Those people haven’t always been the people who I’d expected they would be – I’m glad I kept an open mind. Whether people choose to or are able to build safe spaces into current groups (support groups, or service user groups for example) or build supportive spaces within communities they are part of or build new groups entirely based on shared experiences I think people deserve a space where they don’t need to constantly explain themselves in order to make themselves understood.
I think sometimes having spaces we are understood can be safe places of retreat from the world – where our experiences or understanding of ourselves may be misunderstood. These may be physical spaces, online spaces and so on – there are lots of opportunities to seek out people like us, and also people not like us – both of which are valuable. On a really practical level, I’d suggest that everyone asks to have some personal information about who they are, what their beliefs are and what is important to them included in their notes. My trust has an ‘advanced statement’ template with space to include this information.
This makes particular sense if you have cultural, religious or dietary requirements that need to be known about but that you might be unable to explain if unwell. It can make it clear that your beliefs are part of who you are, and aren’t going to be misinterpreted as signs of ‘illness’. There is no guarantee your needs will be met, but the chances are increased. A lot of baggage travels with us through services, including our diagnosis and perceptions that people have of us due to our gender identity, class, race, faith or culture. Having something travel through services with you that is written by you and that offers a more complete picture of who you are is at least symbolic and will hopefully allow professionals and services to consider these, where they don’t already or more fully where they do.
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* Ana is pseudonym.
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