Spider in a Jar: Women Who Have Recovered from Psychosis and Their Experience of the Mental Health Care System
Hagen, Brad, Nixon, Gary, Ethical Human Psychology and Psychiatry
A growing body of literature has documented considerable dissatisfaction with the mental health care system among people who use mental health services. This article adds to this literature by reporting on the results of qualitative interviews done with 18 women who had recovered from some form of transformative psychotic experience and were willing to share their experiences with the mental health care system. The participants unanimously felt that their experiences with the mental health system were very negative and detrimental to their overall healing and recovery process. Four main themes emerged from the qualitative analysis of the interview transcripts: (1) "the label factory," which described the capricious and destructive nature of the psychiatric diagnoses they received; (2) "invalidated and unheard," which described how little the women's voices seemed to matter to the mental health care professionals caring for them; (3) "violence and violations," which described the loss of free will and dignity the women experienced during inpatient psychiatric hospitalizations; and (4) "smashing the jar," which described the hopes and dreams these women had for changing the way people receive mental health care. The implications of these findings for mental health practice are discussed.
Keywords: women; psychosis; recovery; qualitative; psychiatry; mental health care system (or consumer)
The mental health service system is unique within the overall North American health care system in terms of the amount of anger, outrage, and backlash toward the system that is generated from numerous people who use mental health services. That is, no other area of the health care system has engendered "survivor" movements-such as the psychiatric survivor moment-where former users of the system coalesce together in advocacy and protest groups for the purpose of completely reforming the system and preventing the perceived abuse and maltreatment of system users. For example, there are few, if any, users of home care or cardiac rehabilitation services forming large-scale protest and advocacy groups such as "Mind Freedom," whose Web site includes group goals such as "winning human rights campaigns in mental health" and "challenging abuse by the psychiatric drug industry" (Mind Freedom, 2010). The psychiatric survivor movement appears to be just one expression of a general dissatisfaction stemming from people's experiences with the mental health care system. Researchers and authors have begun to investigate this dissatisfaction and have documented that more than 50% of mental health consumers report poor satisfaction with and/or adverse experiences within the mental health system (Allen, Carpenter, Sheets, Miccio, & Ross, 2003; Baker, Lovell, Easton, & Harris, 2006; Burstow & Weitz, 1988; Everett, 2000; Jennings, 1994; Kumar, Guite, & Thornicroft, 2001).
Although there are numerous sources of this dissatisfaction, many authors agree that one of the root causes is a profound power imbalance between the users of the mental health system, who have little or no power, and mental health professionals (namely psychiatrists), who hold almost all of the power. This power indifference exists on multiple levels, including the power to label and diagnose behavior, the power of professional language and terminology, the power to withhold information, the power of mental health/psychiatric theories and treatments, the power to coerce, and the power to incarcerate and/or hospitalize people against their wishes (Burstow & Weitz, 1988; Everett, 2000; Kumar, 2000; Kumar et al., 2001; Laugharne & Priebe, 2006; Lowry, 1998; McCubbin & Cohen, 1996).
Mental health care users experience these power inequalities and abuses in various ways, but a common complaint is that their input and wishes are not solicited in treatment decisions, and that they are offered few, if any, choices or alternatives regarding their care (Barnes & Wistow, 1994; Bassman, 2005; Burstow & Weitz, 1988; Howard, El-Mallakh, Rayens, & Clark, 2003; Johansson & Lundman, 2002; Kumar, 2000; Linhorst & Eckert, 2003; Lowry, 1998; Olofsson & Jacobsson, 2001). …