There's an interesting literature on this, and I don't think we're quite sure what the answer is. My brief take is that psychosis, especially in schizophrenia, can cause such severe derangements in perception, processing, and reporting of pain, as well as extreme states of dissociation, that severe self-injury becomes possible. But it's probably not something like "if you have schizophrenia, then your peripheral nerves are across the board less sensitive to pain stimuli".
My self injury while psychotic was minor (although as a medical student my loathing of bare below elbows is driven by the fact that you can easily read the words I carved into my arms with the sharp edge from a vegetable peeler- I've only ever self harmed when psychotic) but my personal experience was of a dissociative/probably more delirium state, where I wasn't "in this world" at the time, and wasn't aware of pain, I was in a psychotic universe. Not sure that helps.
We’re talking here of major mutilative self harm, not mere cutting or similar. With latter, many people experience a flood of endorphins that make them feel better - but only temporarily, so there’s a compulsion, almost, to replicate the experience. The fortunately very uncommon, even rare, extreme examples in psychosis are in my experience not so much suicidal but have a ‘psychotic’ aim. Examples over my nearly 40 years’ experience in General Adult Psychiatry have been religiously/biblically mediated - ‘be eunuchs for the Lord;’ ‘if thine eye offend thee, pluck it out.’ However ‘unknowable’ these ideas are, they have some meaning for the patient, and exploring this can be an important therapeutic point of entry, and are not simply symptoms that help the diagnosis.
I’d suggest there are two main factors about pain. One is that deep wounds of this kind might be paradoxically less painful than superficial wounds which signal danger and prompt escape; another is that the psychotic shift in reality is such that pain etc is no deterrent. Understandably, the research literature is sparse, involving case studies or small series.
I've got classic bipolar 1 (late teens onset, hospitalized for mania, very medication responsive, episodic, strong family history of the same), and I struggle to explain to my more hippie antipsychiatry friends that no, I should not just quit my medications and just take shrooms when I get depressed.
On the right meds, I have had pretty much a full recovery from bipolar, other than a propensity towards depression, and it's hard to explain to friends that, yes, I am a successful employed professional, and, yes, I need to take my antipsychotic and mood stabilizer every day. If I wasn't on meds I would likely be hospitalized for mania or suicidality within a year. Much faster if I did psychedelics.
I think there's been so much over medication of personality disorders and the worried well, that people have forgotten what mental illness looks like and what the right medication (cough lithium, cough) can do for people who would otherwise be gravely ill.
I've seen in my family the progression in functioning from my grandmother, who was on Mellaril for decades but her mood symptoms were never effectively treated, to my uncle who had a miraculous recovery on lithium (after being viewed as a treatment resistant schizophrenic when his symptoms didn't respond to Haldol), to my brother and I who are happy, a healthy weight, and highly functional on lithium + lurasidone. I think there was some ECT in there but nobody talks about it.
This is very similar to my mothers case, she also has Capgras delusions. Fascinatingly she is a good lithium responder.
My wife also had a similar experience regarding superficial vs major self harm. My wife was having episodes of frenzy bought on by various drugs, including an estradiol patch. She was diagnosed with BPD and I would take her to the ED whenever her mixed states would reach a crescendo. Her self harm was extreme, and she would attempt to flay the flesh from her body. She attributed these urges to "overwhelming inner tension" and said that she wanted to "tear her flesh off". During one frenzy she plunged the knife so deeply into her arm that she couldn't remove it. Despite the grievous nature of the self harm, the hospital continued to attribute these episodes to a personality disorder. I spent years desperately begging people to explain to me where her "borderline personality" had suddenly come from, and why it kept disappearing and reappearing with such force and why she seemed so very extremely ill whereas she had not been before. Eventually a more experienced clinician made the diagnosis of bipolar in one session. As I write this my wife has no symptoms of a personality disorder and hasn't self harmed since being taken off the culprit medications. She self harmed on Zoloft, aripiprazole, oral contraceptives and an estradiol patch. None of these treatment were given concomitantly. The self harm ended abruptly when the last SGA was removed. That was 6 years ago.
Excellent article offering important insights into psychosis and its management. I appreciate your wise and gentle approach to helping this patient accept antipsychotic medication.
Was she offered a LAI at discharge? As a psychiatric nurse, I feel LAI's are underutilized and have high potential to contribute towards long term stability by reducing future periods of decompensation and subsequent hospitalizations.
Thank you being an excellent psychiatrist, and for sharing your knowledge with the rest of us.
Good point, and yes she was offered a LAI. I believe she got it in IOP shortly after d/c. We always try to offer LAI when possible. Thanks for bringing that up.
LAI's were the stuff of my nightmares... As a recently severely psychotic psych patient with NGRI. They still come into the category of 'rather be dead than'. Some of us are petrified by the sceptre of involuntary treatment, which is what LAI's stink of. Medical student here. They're not the benevolent panacea you appear to think they are.
Great post. I didn't know about Jaspers' description of some delusions as “un-understandable”, and it definitely describes something that bothered me about how a lot of these patients thought, namely - given the nature of these persecutory delusions, why do some of them take the medications at all? The patients that refuse and it ends up going through court for involuntary meds - that I understand. But lets take Sarah - she has a delusional system based on her family grooming her for some kind of sex ring. These groomers bring her to your facility, and then you and the treatment team (presumably identifying yourselves as part of the facility) recommend some pills. Why would she even consider taking them? Just so un-understandable.
I'm glad she responded so quickly and is doing well.
Thank you. I agree it's strange why some people are ok with meds when you'd think they'd refuse. I suspect a fair amount has to do with their sense of the psychiatrist as a person, in the room with them. As I'm sure you've seen, psychotic people can be unusually attuned to the emotional tenor of a situation, and can sometimes have an uncanny ability to sum people up quickly. So if the doc is seen as honest and genuinely caring about them, that reassurance of their psychotic anxiety can override the delusional narrative (or something like that). On the other hand, there have been patients who definitely refused meds because something about me just rubbed them the wrong way and they couldn't quite trust me.
thanks for this. per your introduction, when people who have had psychiatry punitively used against them go "antipsychiatry", they tend not to even think of patients like Sara. this is a shame because patients like Sara are the ones who actually need psychiatry; that is, they need medical doctors who can also think clearly and deeply about the mind. this is an important reminder. i hope plenty of people read this case study.
I did an autopsy on a woman in her early 50s which I still find hard to believe - I’m in forensic pathology. Records that we found document that, since her teen tears, she had “something inside” she needed to remove. She was on antipsychotic medication for many years, got married, had children, but then stopped the medication after her husband died. She made an incision on the left lower costal margin, dissected the left lower ribs and stripped the periosteum, then removed part of her spleen and kidney. The incision actually consisted of a fairly neat polygon of skin she removed from the chest wall. She was found in a pool of blood. However, there were many blood-soaked towels, including a couple within her abdomen, which, at least to me, shows she knew something about hemostasis. I have seen other self-mutilation cases involving eye-removal (I think these are the most common), and orchiectomy, but they ended up committing suicide. I show this case in a lecture for fellows and residents without telling them what happened, and occasionally they get the right answer.
This is one of the most important things I’ve read in a long time. Thank you for sharing it with such care and honesty.
So many people still don’t understand what psychosis actually looks like. They reduce it to stereotypes, or worse, minimize it altogether. But this makes it real. Heart-breakingly real. And human.
I work in mental health, and I’ve seen first-hand how quickly people can spiral when delusions take hold. It’s not weakness. It’s not a “different perspective.” It’s an illness, and it deserves proper care, not just containment.
If even one person walks away from this post with a better understanding of what psychosis really is, then this was worth writing. I’m grateful you did.
Well observed and helpful, Martin. Thanks for walking through this. Regarding the intelligibility of psychotic delusions, I'm curious if you've read Christopher Bollas's work, such as WHEN THE SUN BURSTS. He makes the case that delusions often have an inner logic of their own and that, in the psychotherapeutic context (not the same as your interview, I realize), it can help build an alliance and advance understanding of the patient by following the narrative and seeing where points of contact with actual (non-delusional) experience may be arising.
I haven't, but I'll check it out. I agree following the narrative can sometimes be fruitful, depending on the context. eg. I could see how with something like an isolated delusional disorder, where daily functioning is otherwise preserved and there aren't safety concerns, this is a better approach. Or someone with a schizotypal personality. Especially if it's outpatient and you're seeing them longer-term.
Also really appreciate how psychiatry can break apart dimensions of their illness - what type of mutliation, the hidden meanings of phrases and create a precision to diagnosis and treatment. Am pulm/cc and it’s this is up or that’s out of range - challenging in other ways but not in the refined ways of your discipline.
That was very useful thanks. Did she have childhood trauma or abuse that predisposed? Is late 20s atypical? Glad she’s doing better. Didn’t know the meds work that fast but it’s been decades since my psychiatry rotation.
No trauma or abuse as far as we knew. It’s possible she had family history, but neither she nor her parents knew it since that wasn’t something that was talked about back home. Onset of schizophrenia is typically late teens to early 20s for men and mid-20’s to early 30’s for women. And yes, sometimes antipsychotics can work remarkably fast, although of course there is a lot of variance.
I thought long and hard about how to respond to this post. I am pretty active in the antipsychiatry sub on reddit as well as the therapy abuse sub....
I am sure that you more than anyone can understand that rarely are things all "black" or all "white" many themes that I have come across in terms of people who feel harmed by psychiatry and adjacent fields are the degradation and lack of bodily autonomy.
Coming from a lived experience, I am a former foster kid and "troubled teen industry" survivor. Its fairly common to dump unwanted teens into abusive facilities and drug them up with a polypharmacy cocktail of antipsychotics sometimes SO many drugs that words like "zombie" feel fitting....
For the most part, as an adult I have avoided therapy and medications... I have never had a "good" experience with psychiatrist (not all were traumatic but most were largely unhelpful)
The major critiques stem from:
1. Lack of clarity around patients rights
A. I understand that safety is important, but YOU need to understand that forced strip searches while a bunch of med students watch you with a nurse thinly insinuating that if you don't comply that you will be drugged and forced anyway.... I am NOT alone in this experience. Its degrading and humiliating as hell....
B. Playing the "game" to discharge... mostly we were held as long as the state paid.... It was unclear what the doctor who spent all of 2 min. with you mostly staring at a computer while asking a litany of "yes/"no" questions wanted.... if you say "yes" you are punished with more meds... if you say "no" than you are concealing or "minimizing" symptoms... there is NEVER any winning.
C. Both Acadia and UHS have active lawsuits for abusing patients drugging them up and holding them for insurance money. These experiences are NOT unique.
D. Stigmatizing language. pretty much all girls were labeled with borderline personality disorder. Looking back I don't think that 100% of teen girls met this criteria but any sort of pushback or self advocacy was seen as "splitting" I learned to shut up and swallow pills
2. "Milieu"
A. Sitting around in a boring unit all day did nothing to "help" us.... further more if we wanted to have a full dinner instead of just a tuna sandwich we had to participate in "group therapy" hardly anyone felt "helped"
B. I have even heard some people say that Jail is better.... now its been years and I have never been to jail but I remember just how curt and rude the nurses were and just how bland and nonchalant the doctors were. I just don't understand how these places help people.
3. Honesty- I am really glad that it sounds like you helped this person... but when I say I am a SURVIVOR I mean that.... having social workers rip me from my home and put me in disgusting facilities that strip searched me and drugged me have haunted my nightmares for years.... I am NOT anti-vax but Im also scared as hell to go to a doctor.... I know that natropaths are probably quack but they dont treat you like shit you know? They have a calm environment, they give you choices, nothing is FORCED...I just cant say the same about social workers, therapists, nurses, psychiatrists.... it feels like all you do is overpathologize us and slap labels on.... no matter what there is no winning.... I think thats why I like those groups because instead of telling me that the system was trying to "help" me, they know how FUCKED up those places are....It would be really nice to be able to talk about this stuff without being labelled a "scientologist" of which I am not...
But the system HARMS. Iatrogenic harm is real! bodily autonomy matters and I just don't think that psychiatry has found the balance.... I wonder if this person had traumatic experiences in the ward.. I wonder if you actually treated her with respect.. did the nurses? Did you guys actually feed her well? Allow her to shower? Allow her to rest? Allow her to have space and talk to her family? Did you get any pay incentive to keep her longer? What about all the risperdone? did you get any kickback from making her take it? Afterall its to YOUR benefit to keep the patients rolling in.....I don't deny that YOU feel like you helped but deep down I wonder if maybe she is just partially telling you things you want to hear because she doesn't want you to know the truths that those places are traumatizing as well.
Considering I had my education interrupted many times as a kid I am not the most eloquent speaker but I hope that what I am saying makes sense. That the system and many people in the system broke me. I never felt heard or helped. I just tried to be as "compliant" as possible so you guys would leave me the hell alone. When I aged out the system I left for good. I don't know if/when I will ever come back.... I don't want those nightmares to become a reality again.
Thank you Dr. Greenwald for this illustrative case presentation. I was wondering if you're able to do any one-to-one therapeutic work with Sara during her admission? And what were the general focus of this?
Dr. Greenwald, thank you for this very educational piece and reminder about the seriousness of this illness.
Can schizophrenia deaden sensations of pain? I can't believe a person able to feel pain normally could do that to themselves.
There's an interesting literature on this, and I don't think we're quite sure what the answer is. My brief take is that psychosis, especially in schizophrenia, can cause such severe derangements in perception, processing, and reporting of pain, as well as extreme states of dissociation, that severe self-injury becomes possible. But it's probably not something like "if you have schizophrenia, then your peripheral nerves are across the board less sensitive to pain stimuli".
My self injury while psychotic was minor (although as a medical student my loathing of bare below elbows is driven by the fact that you can easily read the words I carved into my arms with the sharp edge from a vegetable peeler- I've only ever self harmed when psychotic) but my personal experience was of a dissociative/probably more delirium state, where I wasn't "in this world" at the time, and wasn't aware of pain, I was in a psychotic universe. Not sure that helps.
We’re talking here of major mutilative self harm, not mere cutting or similar. With latter, many people experience a flood of endorphins that make them feel better - but only temporarily, so there’s a compulsion, almost, to replicate the experience. The fortunately very uncommon, even rare, extreme examples in psychosis are in my experience not so much suicidal but have a ‘psychotic’ aim. Examples over my nearly 40 years’ experience in General Adult Psychiatry have been religiously/biblically mediated - ‘be eunuchs for the Lord;’ ‘if thine eye offend thee, pluck it out.’ However ‘unknowable’ these ideas are, they have some meaning for the patient, and exploring this can be an important therapeutic point of entry, and are not simply symptoms that help the diagnosis.
I’d suggest there are two main factors about pain. One is that deep wounds of this kind might be paradoxically less painful than superficial wounds which signal danger and prompt escape; another is that the psychotic shift in reality is such that pain etc is no deterrent. Understandably, the research literature is sparse, involving case studies or small series.
Thank you for this piece.
I've got classic bipolar 1 (late teens onset, hospitalized for mania, very medication responsive, episodic, strong family history of the same), and I struggle to explain to my more hippie antipsychiatry friends that no, I should not just quit my medications and just take shrooms when I get depressed.
On the right meds, I have had pretty much a full recovery from bipolar, other than a propensity towards depression, and it's hard to explain to friends that, yes, I am a successful employed professional, and, yes, I need to take my antipsychotic and mood stabilizer every day. If I wasn't on meds I would likely be hospitalized for mania or suicidality within a year. Much faster if I did psychedelics.
I think there's been so much over medication of personality disorders and the worried well, that people have forgotten what mental illness looks like and what the right medication (cough lithium, cough) can do for people who would otherwise be gravely ill.
I've seen in my family the progression in functioning from my grandmother, who was on Mellaril for decades but her mood symptoms were never effectively treated, to my uncle who had a miraculous recovery on lithium (after being viewed as a treatment resistant schizophrenic when his symptoms didn't respond to Haldol), to my brother and I who are happy, a healthy weight, and highly functional on lithium + lurasidone. I think there was some ECT in there but nobody talks about it.
This is very similar to my mothers case, she also has Capgras delusions. Fascinatingly she is a good lithium responder.
My wife also had a similar experience regarding superficial vs major self harm. My wife was having episodes of frenzy bought on by various drugs, including an estradiol patch. She was diagnosed with BPD and I would take her to the ED whenever her mixed states would reach a crescendo. Her self harm was extreme, and she would attempt to flay the flesh from her body. She attributed these urges to "overwhelming inner tension" and said that she wanted to "tear her flesh off". During one frenzy she plunged the knife so deeply into her arm that she couldn't remove it. Despite the grievous nature of the self harm, the hospital continued to attribute these episodes to a personality disorder. I spent years desperately begging people to explain to me where her "borderline personality" had suddenly come from, and why it kept disappearing and reappearing with such force and why she seemed so very extremely ill whereas she had not been before. Eventually a more experienced clinician made the diagnosis of bipolar in one session. As I write this my wife has no symptoms of a personality disorder and hasn't self harmed since being taken off the culprit medications. She self harmed on Zoloft, aripiprazole, oral contraceptives and an estradiol patch. None of these treatment were given concomitantly. The self harm ended abruptly when the last SGA was removed. That was 6 years ago.
Excellent article offering important insights into psychosis and its management. I appreciate your wise and gentle approach to helping this patient accept antipsychotic medication.
Was she offered a LAI at discharge? As a psychiatric nurse, I feel LAI's are underutilized and have high potential to contribute towards long term stability by reducing future periods of decompensation and subsequent hospitalizations.
Thank you being an excellent psychiatrist, and for sharing your knowledge with the rest of us.
Good point, and yes she was offered a LAI. I believe she got it in IOP shortly after d/c. We always try to offer LAI when possible. Thanks for bringing that up.
LAI's were the stuff of my nightmares... As a recently severely psychotic psych patient with NGRI. They still come into the category of 'rather be dead than'. Some of us are petrified by the sceptre of involuntary treatment, which is what LAI's stink of. Medical student here. They're not the benevolent panacea you appear to think they are.
I'll add it's been over a decade since psychosis... sans LAI.
Great post. I didn't know about Jaspers' description of some delusions as “un-understandable”, and it definitely describes something that bothered me about how a lot of these patients thought, namely - given the nature of these persecutory delusions, why do some of them take the medications at all? The patients that refuse and it ends up going through court for involuntary meds - that I understand. But lets take Sarah - she has a delusional system based on her family grooming her for some kind of sex ring. These groomers bring her to your facility, and then you and the treatment team (presumably identifying yourselves as part of the facility) recommend some pills. Why would she even consider taking them? Just so un-understandable.
I'm glad she responded so quickly and is doing well.
Thank you. I agree it's strange why some people are ok with meds when you'd think they'd refuse. I suspect a fair amount has to do with their sense of the psychiatrist as a person, in the room with them. As I'm sure you've seen, psychotic people can be unusually attuned to the emotional tenor of a situation, and can sometimes have an uncanny ability to sum people up quickly. So if the doc is seen as honest and genuinely caring about them, that reassurance of their psychotic anxiety can override the delusional narrative (or something like that). On the other hand, there have been patients who definitely refused meds because something about me just rubbed them the wrong way and they couldn't quite trust me.
thanks for this. per your introduction, when people who have had psychiatry punitively used against them go "antipsychiatry", they tend not to even think of patients like Sara. this is a shame because patients like Sara are the ones who actually need psychiatry; that is, they need medical doctors who can also think clearly and deeply about the mind. this is an important reminder. i hope plenty of people read this case study.
I did an autopsy on a woman in her early 50s which I still find hard to believe - I’m in forensic pathology. Records that we found document that, since her teen tears, she had “something inside” she needed to remove. She was on antipsychotic medication for many years, got married, had children, but then stopped the medication after her husband died. She made an incision on the left lower costal margin, dissected the left lower ribs and stripped the periosteum, then removed part of her spleen and kidney. The incision actually consisted of a fairly neat polygon of skin she removed from the chest wall. She was found in a pool of blood. However, there were many blood-soaked towels, including a couple within her abdomen, which, at least to me, shows she knew something about hemostasis. I have seen other self-mutilation cases involving eye-removal (I think these are the most common), and orchiectomy, but they ended up committing suicide. I show this case in a lecture for fellows and residents without telling them what happened, and occasionally they get the right answer.
It's not often that I read something that literally makes my skin crawl, so, uh, thanks I guess?
This is one of the most important things I’ve read in a long time. Thank you for sharing it with such care and honesty.
So many people still don’t understand what psychosis actually looks like. They reduce it to stereotypes, or worse, minimize it altogether. But this makes it real. Heart-breakingly real. And human.
I work in mental health, and I’ve seen first-hand how quickly people can spiral when delusions take hold. It’s not weakness. It’s not a “different perspective.” It’s an illness, and it deserves proper care, not just containment.
If even one person walks away from this post with a better understanding of what psychosis really is, then this was worth writing. I’m grateful you did.
Well observed and helpful, Martin. Thanks for walking through this. Regarding the intelligibility of psychotic delusions, I'm curious if you've read Christopher Bollas's work, such as WHEN THE SUN BURSTS. He makes the case that delusions often have an inner logic of their own and that, in the psychotherapeutic context (not the same as your interview, I realize), it can help build an alliance and advance understanding of the patient by following the narrative and seeing where points of contact with actual (non-delusional) experience may be arising.
I haven't, but I'll check it out. I agree following the narrative can sometimes be fruitful, depending on the context. eg. I could see how with something like an isolated delusional disorder, where daily functioning is otherwise preserved and there aren't safety concerns, this is a better approach. Or someone with a schizotypal personality. Especially if it's outpatient and you're seeing them longer-term.
Also really appreciate how psychiatry can break apart dimensions of their illness - what type of mutliation, the hidden meanings of phrases and create a precision to diagnosis and treatment. Am pulm/cc and it’s this is up or that’s out of range - challenging in other ways but not in the refined ways of your discipline.
Thank you, and respect all around!
That was very useful thanks. Did she have childhood trauma or abuse that predisposed? Is late 20s atypical? Glad she’s doing better. Didn’t know the meds work that fast but it’s been decades since my psychiatry rotation.
No trauma or abuse as far as we knew. It’s possible she had family history, but neither she nor her parents knew it since that wasn’t something that was talked about back home. Onset of schizophrenia is typically late teens to early 20s for men and mid-20’s to early 30’s for women. And yes, sometimes antipsychotics can work remarkably fast, although of course there is a lot of variance.
Hi Doctor,
I thought long and hard about how to respond to this post. I am pretty active in the antipsychiatry sub on reddit as well as the therapy abuse sub....
I am sure that you more than anyone can understand that rarely are things all "black" or all "white" many themes that I have come across in terms of people who feel harmed by psychiatry and adjacent fields are the degradation and lack of bodily autonomy.
Coming from a lived experience, I am a former foster kid and "troubled teen industry" survivor. Its fairly common to dump unwanted teens into abusive facilities and drug them up with a polypharmacy cocktail of antipsychotics sometimes SO many drugs that words like "zombie" feel fitting....
For the most part, as an adult I have avoided therapy and medications... I have never had a "good" experience with psychiatrist (not all were traumatic but most were largely unhelpful)
The major critiques stem from:
1. Lack of clarity around patients rights
A. I understand that safety is important, but YOU need to understand that forced strip searches while a bunch of med students watch you with a nurse thinly insinuating that if you don't comply that you will be drugged and forced anyway.... I am NOT alone in this experience. Its degrading and humiliating as hell....
B. Playing the "game" to discharge... mostly we were held as long as the state paid.... It was unclear what the doctor who spent all of 2 min. with you mostly staring at a computer while asking a litany of "yes/"no" questions wanted.... if you say "yes" you are punished with more meds... if you say "no" than you are concealing or "minimizing" symptoms... there is NEVER any winning.
C. Both Acadia and UHS have active lawsuits for abusing patients drugging them up and holding them for insurance money. These experiences are NOT unique.
D. Stigmatizing language. pretty much all girls were labeled with borderline personality disorder. Looking back I don't think that 100% of teen girls met this criteria but any sort of pushback or self advocacy was seen as "splitting" I learned to shut up and swallow pills
2. "Milieu"
A. Sitting around in a boring unit all day did nothing to "help" us.... further more if we wanted to have a full dinner instead of just a tuna sandwich we had to participate in "group therapy" hardly anyone felt "helped"
B. I have even heard some people say that Jail is better.... now its been years and I have never been to jail but I remember just how curt and rude the nurses were and just how bland and nonchalant the doctors were. I just don't understand how these places help people.
3. Honesty- I am really glad that it sounds like you helped this person... but when I say I am a SURVIVOR I mean that.... having social workers rip me from my home and put me in disgusting facilities that strip searched me and drugged me have haunted my nightmares for years.... I am NOT anti-vax but Im also scared as hell to go to a doctor.... I know that natropaths are probably quack but they dont treat you like shit you know? They have a calm environment, they give you choices, nothing is FORCED...I just cant say the same about social workers, therapists, nurses, psychiatrists.... it feels like all you do is overpathologize us and slap labels on.... no matter what there is no winning.... I think thats why I like those groups because instead of telling me that the system was trying to "help" me, they know how FUCKED up those places are....It would be really nice to be able to talk about this stuff without being labelled a "scientologist" of which I am not...
But the system HARMS. Iatrogenic harm is real! bodily autonomy matters and I just don't think that psychiatry has found the balance.... I wonder if this person had traumatic experiences in the ward.. I wonder if you actually treated her with respect.. did the nurses? Did you guys actually feed her well? Allow her to shower? Allow her to rest? Allow her to have space and talk to her family? Did you get any pay incentive to keep her longer? What about all the risperdone? did you get any kickback from making her take it? Afterall its to YOUR benefit to keep the patients rolling in.....I don't deny that YOU feel like you helped but deep down I wonder if maybe she is just partially telling you things you want to hear because she doesn't want you to know the truths that those places are traumatizing as well.
Considering I had my education interrupted many times as a kid I am not the most eloquent speaker but I hope that what I am saying makes sense. That the system and many people in the system broke me. I never felt heard or helped. I just tried to be as "compliant" as possible so you guys would leave me the hell alone. When I aged out the system I left for good. I don't know if/when I will ever come back.... I don't want those nightmares to become a reality again.
Be well.
But our medical system won’t help until they are a harm to self or others.
Thank you Dr. Greenwald for this illustrative case presentation. I was wondering if you're able to do any one-to-one therapeutic work with Sara during her admission? And what were the general focus of this?