#and im not saying this as a judgemnt or to put moral value on it

[trans-axolotl2]

In my last residential treatment stay, I did have one psychiatrist who I trusted and had a positive relationship with. Her name was Dr. R, and when I came in on the first day of treatment and told her that I would not take any psych meds and that I had a lot of past psych trauma, she validated me and told me that she would not bring up meds unless I did. Throughout my stay there, she was empathetic, listened to my concerns, helped advocate for me, and generally made me feel heard. At the same time, when management took away our doors-she did nothing. When I needed to get a feeding tube--she lied to me about how long it would be in, and what I needed to do to get it out. She enforced policies about restricting outside breaks, restrictions on items, and contributed to treatment plans that my friends felt were unfair and damaging.

She was a good person and I liked her, but she was choosing to work within a system where she could not control the dozens of things happening there that harmed us every single day. This is what I mean when I say there is no such thing as a good psychiatrist in inpatient units--she was a progressive, validating, nice person --but her very job description made it impossible for a “good provider” to exist. To be a provider who wasn’t a part of the harm that was occurring on that unit, she would have had to quit, because the very requirements of her job required committing ethical violations, restricting peoples autonomy, and perpetrating iatrogenic harm. If she had stopped enforcing harmful policies and challenged her coworkers publically, she probably would have gotten fired. And that really is the problem--causing iatrogenic harm has essentially become a job requirement on inpatient units, and being a “good provider” by the metrics of the system require you to participate in that harm. 

I think Dr. R did a better job than most inpatient psychs in mitigating the harms she participated in, and finding ways to resist shitty systems when possible. I was glad she was there and I think she made my treatment better, but the two of us had a lot of conversations together where she acknowledged the fucked up things happening in the treatment center, acknowledged her role in them, and also stated that she did not have any power to change them. She could not fix the system by working within the system. 

I get a lot of questions by people who are interested in careers in the mental health system, and asking me on whether I think it’s okay for them to work there. My first response is usually if you’re asking because you’re feeling guilty after seeing what psych survivors say, I’m not someone who’s going to give you permission to ignore that guilt. The second thing I usually say is this: you need to go into this job aware with the fact that you will cause people harm, you will get into ethical dilemmas, and there will be times where you will either have to betray your personal values or quit. There isn’t one right answer on how to engage with mental healthcare as a provider, with the reality that until we build up alternative systems of care, the current structures still exist and have people who need support inside of them.  If that’s something that you think you can navigate in a way that lets you create the least harm possible, then that’s something you need to decide for yourself, and to think really deeply about if the reality of the psych system matches up with your goals.

#antipsychiatry #antipsych #mad studies #disability justice #psych ward tw #i think u also need to understand that if u go to school to work professionally in mental health #if u become a psychiatrist or a therapist or a social worker #even if you're one who does it outpatientt. even if you're an abolitionist social worker #that means there are probably going to be barriers to community spaces. that some people might not trust you any longer. if you are #coming into spaces as a professional #part of that decision might be grappling with the fact that even as you gain legitmacy from a societal side. that as u gain #new opportunities for jobs. to work within systems #you might also lose community trust. opportunities within activism spaces. opportunities #to share and be in those spaces as a survivor and patient #and im not saying this as a judgemnt or to put moral value on it #but i think that's just something you Also need to understand and weigh. sure you will gain something. by getting liscenced #but what will you lose? why might people not trust you in community spaces any longer? #what trade offs will you be making and are they worth it to you? what new communities can you build #what matters to you and what are your passions #<- all things i am really grappling with right now as i decide whether or not i want to go get my masters in social work