Gender, madness and psychiatric care: Colour me a mad woman
By: Nicole Lee
Content warning: This article discusses eating disorders, mental illness, trauma and inpatient psychiatric services.
I’m in an acute psychiatric unit (psych ward, madhouse, asylum – or whatever other stigma-laden term might be used to characterise it). I’ve been here for two and a half weeks and counting.
It’s been over six years since I was here last, and to say it’s confronting is an understatement. How do you tell people that, at 42, your anorexia has relapsed?
I can’t even bring myself to tell my children. How do I explain that my recovery on the other side of trauma has not only come to a standstill, but has taken me back to a place I never thought I’d have to revisit – both literally and metaphorically?
Being here with the knowledge I have now makes me uneasy. Sometimes a lack of knowledge is not such a bad thing. I can pinpoint how things had failed, and the contributing factors that kept me stuck living with violence for so long.
I’m a rational, intelligent woman, so why can’t I reason my way out of this? Perhaps it’s because part of me, like much of society, buys into the myth that blame for my predicament somehow lies with me.
All images by: Katharine T. Jacobs
It’s one thing to be able to understand the how and why of mental illness and the long-term impacts of trauma, but navigating this complexity in practice is entirely different. Recovery isn’t linear, and the ugly, raw, honest truth is that I’m not the picture of coping and competence I prefer to present to the world.
So here I am. Sitting on the floor of my sparse hospital room, with its broken old curtains taped to the wall with Micropore, writing this like my opinion matters somehow.
I don’t even get a toilet-roll holder, just a hole in the wall that the roll sits in. There’s that old familiar look of distrust and disbelief on some of the nurses’ faces when I speak. I say some, as they’re not all bad – just the ones who probably shouldn’t be working in this environment.
Only a few months ago, I was delivering a presentation to the women’s hospital that sits on the same grounds I’m on right now about how the health system plays into a problematic and pervasive dynamic of gaslighting when it doesn’t listen to people with eating disorders, mental illnesses and disabilities in relation to domestic violence.
My presentation asked the audience to confront carer and disabled-person dynamics, including the ‘crazy-woman’ trope that clouds professional judgement even in 2021.
Yet here I am. I’m back to being the ‘crazy woman’, in the very place that has put me in harm’s way time and again over a period of many years. To say I have legitimate issues with trust in this system is an understatement.
I’m far more cynical than I was six years ago.
The affirmation cards and positivity mantras all over the walls make me cringe: “Choose recovery, be strong”; some bullshit about the human struggle and what we “don’t need”; blah blah blah. What I don’t need, as someone in a wheelchair, is a heavy door I can’t open independently.
This brand of toxic positivity represents an unforgivable denial of my human experience. It offhandedly implies that my brain’s current preoccupation with the trauma I’ve been subjected to is somehow a failure of resilience, and not the result of the many factors that have traumatised me.
Let’s not sugar-coat it: no matter how many pretty mantras cover the walls, public mental health is still an underfunded holding pattern that’s only one step up from prison on the human-misery-warehousing continuum.
This place does not ‘recover’ people. It is crisis intervention, and, well, I was on the verge of crisis.
The words “choose recovery” play on my mind in a continuous loop because to me, this phrase infers that my predicament involves a choice I don’t recall exercising. I didn’t know mental health or illness was a choice; I don’t know how my choices landed me here in this place.
I am surrounded, it seems, by non-choices wrapped up in the language of autonomy, which only adds to my confusion. There is no choice involved in having delusional thoughts, or not knowing where you are.
Though madness does have its more comfortable moments: wallowing in sweet delirium as the walls melt away, along with the constant demanding pressures of life. That’s tomorrow-Nicole’s problem. I’ll recover tomorrow.
I need to meet this inpatient admission with some characteristic dark humour, otherwise I think I’ll slip further into a place I’m scared I won’t want to come back from.
Step one down: I’m here. But why? What I’m actively choosing to do by coming here is hand over all autonomy.
I was starving myself and would have continued to do so with zero logic behind it. The years of abuse, coercion and control enacted by my ex were spilling out of the neat little boxes that I’d packed them all into. The boxes and pieces of string that link one experience to another had all morphed into a giant, tangled mess.
And here I am, putting my trust in a system that has failed me so catastrophically in the past. I can’t help but hear the old saying: “What’s the definition of madness? Doing the same thing over and over again and expecting a different result.”
Well, honey, colour me a mad woman, because I came back.
I’ve been asked, multiple times a day, if I’m safe. They mean am I safe from harming myself, rather than am I safe from being harmed by others. The latter is what we usually picture when we conceptualise the notion of women and gender diverse people’s safety.
Am I safe from myself? Am I suicidal? Am I going to harm myself?
Just for the record – and let’s face it, everything in psychiatric care involves a record – I’m not a risk to myself, but they really haven’t understood how unsafe these places are, or how this environment is the opposite of what many of us need.
It’s not a trauma-informed space. There are big, loud men here. So no – I don’t feel safe. I’m not safe.
I’d come here naively hoping things had changed in the last six years. Is this an example of the madness of hopeful expectation again? Or are we programmed to want the glass to be half full? The glass is definitely half empty today.
This is compounded by the worldwide pandemic. We were in the middle of lockdown number five for Victoria when I arrived and this morphed into a sixth lockdown while my attention was on other things – recovery, perhaps. This means that not even a friendly face can visit to break up the day.
No-one is allowed in, and we can’t go out.
This unsafe place has become so much more unsafe, all in the name of protecting us from an outside threat that feels so much less threatening to me than what we encounter in places like this. The imbalance of power in places like these (and any hospital ward in general, really) is amplified by the lack of oversight that lockdowns inevitably bring.
What happens if I can’t advocate for myself? There are no external visitors whose watchful eyes – non-mad and therefore truthful – keep places like this in check. They can point out mistakes without the fear of not being able to identify reality. They can advocate for better care without fearing reprisal from those who could use a little encouragement to do better.
It shouldn’t take an external voice to speak up when things go wrong, but remember: mad women’s truths often get ignored or disbelieved.
It is easier for employees to hold the view that the system they are so intimately invested in is doing good work than to acknowledge it is failing us. This makes it hard to trust them again. Yet here I am, right back to the madness of hope and expectation.
There are so many memories entangled with trauma in this place: the doors opening and closing; keys clanking together on nurses’ waistbands; all the smells mixed with the echo of voices in large, enclosed spaces. Reminders of past trauma, when mental health was used as both the reason and excuse for his violence.
There is no recovery here, only a too-small bandaid. But I knew this, and coming here was still what I needed.
Maybe I’m not that mad after all. I also know that if we want to get serious about women’s mental health and trauma recovery, we need to start envisioning a better system than this. You can’t slap a mantra on a wall and call it a safe and therapeutic space.
In saying all of this, the majority of nurses on the ground who work these wards day in and day out are deeply invested. They do whatever they can, often above and beyond, to support the patients they care for.
The issue is that they don’t hold much (if any) power. They’ve inherited a workplace that is poorly funded and developed with a top-down, one-size-fits-all approach, rather than a bottom-up, reflective and flexible approach.
There is limited dignity in public mental health units. They are a means to an end, but at what cost? They are places where the largest proportion of power is weighted against the one in crisis.
There is a balance missing here, between keeping people safe and avoiding a regimented, prison-like setting. So many fight against this system because submitting has led to many harms, or at the very least, being let down time and again.
It’s not mad to fight, or to refuse to trust a system that has been used to damage you in the past. Unwell places trying to treat unwell people is the very definition of madness. All the while, power colludes with power and we are denied our humanity in the process.
How can the mind transcend madness when it’s confined and magnified within these walls?
This place has consumed so much of the very essence of us; it makes promises that sound as unhinged as the voice in my head telling me not to eat. This blue-sky-thinking, outside-the-box idea of a trauma-informed, non-punitive style of treatment is possibly my mad thinking coming to the fore yet again.
What is the ontology of this system – its people, its walls, our minds? The incoherency of it speaks to madness – but to whose madness does it actually speak?
This article first appeared in Archer Magazine #16, the DISABILITIES issue.
Nicole Lee is an anti-violence activist with a focus on women with disabilities in the prevention of family violence space. She is a sometimes writer, public speaker, inaugural Victims Survivors Advisory Council member, and an unapologetic ranting feminist with plenty of cats.
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