“It’s hard to fight an enemy who has outposts in your head.” – Sally Kempton
I’m looking at a webpage with links to reports about human rights abuses in psychiatry. I could read these reports, but they’d just make me angry. Not the kind of productive anger that makes it easier to write stuff and change things, but the kind of futile undirected rage that would tear me up inside, make me kick doors and yell at my friends. I already know about these things, and don’t need to be reminded, but what we’re reminded of in the first place is selective. There are tremendous human rights abuses going on in certain institutions, yes, and they need to be fixed as soon as possible. But the nature of these reports worries me. They make it look like if you just cleaned up the walls, gave the inmates food and medical care, and stopped beating people, that these places would be acceptable. While these are basic human needs, meeting these needs does not mean freedom. It doesn’t even mean freedom from abuse.
Institution survivors are all too willing, sometimes, to share what seem like the worst of our horror stories. I don’t know about everyone else, but I do it because those abuses are the most tangible. It is easier to write about the mark of drugs and electroshock on the brain or restraints and beatings on the rest of the body than it is to write about the mark of the institutional environment and psychotherapeutic control on the mind. The former are solid and quantifiable; the latter are elusive, insubstantial, and sometimes more terrifying and longer-lasting.
I have a recurring nightmare. I am in a beautiful building with a hushed, playful atmosphere. I have been there as long as I can remember. Everything I could possibly need is there. There are no locks on the doors. People follow me everywhere, but just out of sight, to give me the illusion of freedom. They want only the best for me. I can go outside and play in the woods, and I climb trees. And they treat me like a child. Everything is controlled perfectly. Nothing seems to be wrong, but nothing seems to be really right, either. Everyone is very sweet and very kind and very nice and very forgiving, but there is no freedom. Anywhere. This makes the apparent happiness of the place empty, shallow, and false. That, to me, is the essence of the intangible horrors I fear. Only when I wake up from this nightmare do I realize it’s a nightmare, and that in turn makes it all the more frightening.
I was forcefully reminded of the less tangible aspects of institutionalization last week. During a period of flashbacks, the wrong person heard I was having trouble. I spent the night and part of the next day in a psych ward before I could, along with my support staff, convince them that I was better off out here. If I weren’t in the developmental services system, I might have stayed there, but psych wards don’t like dealing with people with developmental disabilities. All the real but unquantifiable horrors came rushing back at me even during that short stay, and they need to be documented just as surely as the tangible ones do.
I wish I could be the one to document them extensively. I’ve tried, but whenever I do, the words slip away from my mind and I’m filled with an uneasy dread and the smell of that place. I’ll try as much as I can — both things from that place, and elsewhere — in list form:
- Constant monitoring.
- Fear of staff because of what they could do, and inmates because of the staff.
- Begging for basic items, and for “privileges” that those outside see as rights.
- Looking forward to tiny things to relieve monotony that’s impossible to relieve.
- Everything you do, say, and think being put in psychiatric terms (“No, no, no, I’m not anxious for my meds, I just know that being late on that one gives me migraines, and I don’t know anyone in the world who likes migraines.”)
- Separation from everything and everyone familiar.
- Not being allowed my own staff, advocate and cognitive interpreter (whom I have a right to under the Americans with Disabilities Act as surely as a sign language interpreter), watching her have to fight to get in outside of visiting hours.
- Having people control when, where, whether, and how I can speak to familiar people and advocates.
- Discouragement of bonding among inmates or between inmates and staff.
- Catch-22 on displays of emotion — every emotional display has a corresponding psychiatric label, but a lack of emotional display is considered a sign of depression.
- Being told what you’re “really” thinking and feeling, as opposed to what you are thinking and feeling.
- Having your motivations constantly questioned and scrutinized.
- Backwards language: ‘Getting with the program’ is a ‘good step toward independence’, but making your own decisions is ‘non-compliant’, ‘manipulative’, or ‘attention-seeking’.
- In this case, some of staff’s inability to grasp that I was genuinely abused in previous settings and I didn’t just think I was (I told the near-death horror stories when asked; I knew they wouldn’t understand the subtleties), and that it was mainly staff, not inmates, who perpetrated it.
- Assumptions on the part of staff that if abuse was perpetuated against me in the psych system, then it was my fault, and asking questions about what I had done to cause it.
- Condescending chatter from staff who think they’re being nice but who’ll become suddenly grouchy if you show any sign of not liking it.
- Trying hard never to be noticed, ever.
- Knowledge that whether I stay or go free is contingent upon other people’s desires and other arbitrary factors, and that false reports can easily be written and justified.
- Knowledge that my housekeys and wallet are in a locker in the nurse’s station.
- Fear of thinking one’s own thoughts or feeling one’s own feelings, and constant questioning of whether they’re real or delusional.
- Fear of speaking out, feeling — and sometimes being scolded — like an ungrateful child if you do.
- Being patronizingly told of the seriousness of your actions or thoughts, as if you’re unaware of this fact.
- Knowledge — from previous experience — that if I stay too long, I will have to either kill all desire for freedom; or go berserk, violent, and self-destructive and risk dying or being kept even longer.
- Knowledge that most of the world still condones this, either overtly by calling it ‘treatment’ and ‘necessary’, or by never having to think about it.
The defining element here is control. If you strip away the abuse and neglect that is considered more obvious, there are other aspects of institutions that can be much more insidious. The idea of staff control over so many aspects of inmates’ lives — no matter how benevolently constructed — leads to a situation in which the inmates will feel controlled. And rightly so. The problem is that in many of these environments, the control is so covert, ever-shifting, and confusing, that the inmate may doubt that there is control going on at all. If you are beaten, you know you are being beaten. Mental and emotional abuse — intentional or unintentional — can be strong and subtle at once.
You start to doubt yourself. You believe these people are doing you a kindness, and some of them sincerely believe that they are. All your schooling in the value of good intentions comes into play, and you find yourself wrestling with whether or not it’s okay to object. People are always there. They are too there, too eager to be of help. You wonder harder, “Are they hurting me? Or are they just being nice?” The concept that they may be hurting you while trying to be nice to you is hard to grasp, and once you do grasp it, you don’t know what to do with the information.
That is only one of the best-case scenarios. Many people aren’t even trying to be nice.
These things don’t describe it adequately, but they’re better than nothing. This doesn’t get into many of the details, and many of the long-term effects. There’s no easy way to describe the way these things encroach on your mind, to anyone who hasn’t been there. I’ve lived through the traditional horror stories, the ones that are, paradoxically, easy to talk about. I can get used to saying that they almost killed me, and if I harden my mind in the right places I can describe how.
But how can I get used to saying that they trained me into ways of thinking, degrees of self-hatred and self-denial, that, without diligence on my part and support on the part of others, could come close to killing me every day of my life for the next seven years or more? This is where the outposts in our heads come into play. We are trained in these destructive ways of thinking, by both well-meaning and cruel people alike. One of the most dangerous thoughts among them is the belief that these thought patterns are just about anything — ‘delusions’, ‘organic psychiatric disorders’, ‘signs of pathology’, ‘manipulation’ — as long as they are not the responsibility of the people who teach ‘patients’ these ways of thinking. But one of the most important things to learn is that it is their responsibility. These mental outposts that destroy so much of people’s lives are not the fault of the people whose lives are destroyed. They are the responsibility of the people who perpetuate them and the systems that support them.
These things are, of course, difficult to say. I have to fight my training all the way, and for someone with a lot of Special Individualized One-On-One Training ™, that isn’t easy. I can, as I type this, almost hear the words of my psychotherapists in my head: “You were delusional. We were desperate. We thought we were going to lose you. If you get paranoid about things like this, check them out with me.” That last sentence is the catch. I have checked out my observations with other people, and they have been confirmed several times over. I was taught not to trust my own thoughts, but now my thoughts are confirmed. This is not a delusion. This is hard, scary reality. And it’s a reality that I can think for myself. I don’t need a psychologist hanging over me telling me that my belief that he is abusive is a delusion and an exaggeration. But I have to fight the “Don’t think for yourself” training I got all the way. I was told that my psychologist would get in my head and never get out — that he would build these outposts in my head — so that I would be sane. It seems to me that the sanest thing I ever did was start kicking him out of my head at the earliest opportunity. But he holds on tight, and sometimes it’s hard to defy him even though I haven’t spoken to him in years.1
The things he told me are confirmed by the majority of the culture around me. People believe that some people — sometimes me, sometimes not, but it doesn’t matter — need to be treated as I was treated. There are entire books written on miracle cures like me, books that make my blood run cold because they look like the therapist manipulated the patient until they acted a certain way. Just like me. These books sell a lot because people like that this happens. The brilliant therapist saves the incurable schizophrenic (or multiple personality, or autistic, or whatever) from a life of certain institutionalization. People like my abusers are considered heroic. People like me are considered weird bags of flesh without real value until someone comes along to give it to us. Then we are supposed to feel grateful for the abuse that has been heaped on us. People tell us where we would have been without it — sometimes it’s true, sometimes it’s not, but it doesn’t matter — and think that anything less than fawning gratitude is a sign that we’ve still got problems.
Difficult as it is, someone needs to talk about these things. Maybe not everyone, certainly not anyone for whom it’s simply too painful or dangerous to think about at the moment. But it has to be someone. Otherwise, we will succumb to the belief that cleaning up institutions makes them humane, that changing their outer trappings makes them no longer institutions, and that mental and emotional invasion and abuse only happens in a few isolated cases. An institution can be the size of a single room, and can take place even under the guise of utmost kindness. To paraphrase a friend, the restraints they put on our minds can last for long after our bodies are untied and sent home. We must not forget this, or those who come after us will live in the clean, beautiful, sanitized hell that haunts my nightmares.
Copyright © A M Baggs, 2003
I began to write this in July 2003, shortly after a stay in a psychiatric ward brought on by the wrong people hearing the wrong things and my own trained submissiveness that made me go along with something I should have fought. I finished it in October 2003.
1 This particular institution he worked at was one of the remaining holdovers in the mid-90s of the era when autism was a part of the nebulous and fairly useless label schizophrenia.
For a detailed description of the intangible horrors of one institution, read Congratulations! It’s Asperger’s Syndrome by Jen Birch. It’s in part her work that made me able to write this, because she wrote so purely about the mental control techniques and so little about physical brutality. I have also tried my own description of one of the effects of this mental abuse, called Why It’s So Hard To Write Directly About My Life.