VOX WINTER MEETING
Hello everyone and thank you for letting me come to speak to you.
I am here to talk about incapacity or impaired judgement and what it means to me.
While I talk I will also refer to the HUG report which we are just about to release on the subject of detention but mainly I will talk about my personal experience and hope that it helps with the debate you are about to have.
Two weeks ago I got, through the post, the papers that told me that my detention under the mental health act had been renewed for the fifth year running.
In the section under whether my ability to make decisions is significantly impaired it says the following:
“Mr Morgan does not have insight into his diagnosis and doesn’t believe that he has schizophrenia. It appears that his understanding of his illness is based on abnormal ideas that are part of his condition. He views his illness as some sort of mistake.”
Now I have to say that more or less does sum up my opinions even though I don’t like seeing it down in front of me in black and white.
It’s not that I don’t believe that schizophrenia exists, I have no ideological or philosophical opposition to mental illness as a reality and in fact when I sit down and tick off my symptoms and my past with my c.p.n. I can’t avoid the fact that, put together, I have to almost agree that I have schizophrenia.
But my heart, my soul rebels against the idea that I might have schizophrenia. It sticks within me, tells me not to take my medication, tells me that next time everything will be ok if I am allowed to live medication free.
It is hard to say what may seem to be illogical things to people like you.
When I don’t take medication, as I have seen time and time again in my notes, I stop sleeping, get irritable, avoid psychiatric professionals and get the usual ideas, these are all about devils and evil.
They inevitably lead me to try want to die, I have wanted to burn myself to death , to electrocute myself, to drain myself of all my blood, to hang myself.
At these times, I am sectioned, taken into hospital and kept safe in a slightly undignified way and in due course released to resume my ordinary life again.
There is not a shadow of doubt in my mind that being sectioned has saved my life on numerous occasions and there is equally no doubt in my mind that this compulsion was the only alternative.
At these times I am not interested in reason or sweet words or the wishes of those that love me I am intent on only one thing and that is my death and for me hospital seems to be the solution that avoids my destruction.
And nowadays, when I am out in the community I cannot explain why I resist so strongly my medication and my diagnosis, I really like my c.p.n. and have a lot of respect for my psychiatrist but I cannot agree with the need to take my jag. I cannot accept it even though in my deepest heart I almost know it might keep me alive.
And that is hard to explain to people.
It is hard to say that in almost every other aspect of my life, I am seen to possess the sort of judgement that means that I can make decisions ranging from the simplest which are about getting out of bed and what to have for tea to the complex which can be about managing staff, or thinking of strategic approaches we can take to the development of our organisation and yet in this area of my life my judgement appears to others, to fail me and to fail me so obviously that even I am almost aware of it.
This is not something unusual, a survey of HUG members showed that 99% of us feel that some of us reach points when we are mentally ill where we lose the capacity to make the sort of decisions we would normally make and that 86% of us feel that it is sometimes justified to section us if our safety or the safety of other people is at risk because of our illness.
That doesn’t mean that we don’t feel uneasy about the impact of detention or that we don’t resent the restriction on our freedom or the imposition of force on us or that we don’t think that services couldn’t be organised better to reduce the need for sectioning but it does mean that the vast majority of us believe that in some circumstances the decisions some of us would normally make are so impaired and so bad for us and others that intervention can be justified.
And yet I have to pause here and give another perspective.
One of our members, who I have great respect for, huge admiration for, a person who is creative and inspirational and gentle has heard voices for all her life.
These voices can be positive and they can be negative, the negative ones can be very destructive and put pressure on her to do destructive things but she knows how to cope with them and deal with them.
She is terrified of being sectioned, it would be worse than death to her to be incarcerated and to be honest I think the chances of her ever being sectioned are very remote indeed as she is no threat to either herself or other people.
And yet when we look at her voices, they influence her, they do more than influence her, they are an integral part of her. Her voices in many ways are her identity.
And yet no one else can hear them and some people might say that when she acts on the instructions of her voices she has impaired judgement because in their view they are a symptom of illness not reality.
Some people might say the fact that her living conditions are seen by some as poor and that she lives a very unconventional life could be a reason to intervene in order to give her a quality of life that she may not be aware she could have but she wouldn’t share this view.
And I know that luckily services don’t work quite that way nowadays and that that sort of intervention is very unlikely, but it strikes me.
When she says sectioning would be worse than death for her, at the back of all of this is the plea to let her rest in her identity.
It is the bare naked fact that her voices are as much a part of her reality as the clothes she wears, the name she is called by, the way she looks, the beliefs she holds.
If there was a guaranteed way of removing these voices from her, these voices that she sometimes says have caused her a lot of trouble it would be like removing her from her and what could be worse than this?
Impaired decision making is such a complex idea and the interventions that need to be taken when our judgement is faulty vary from person to person.
For me, intervening against my will keeps me alive: in the words of the mental health act treatment benefits me and should be available, while for the HUG member I mentioned treatment would not benefit her and should not be provided unless she wants it.
And identity – I wish with all my heart that I could believe that I had schizophrenia because the alternative is to believe that I am fundamentally evil and I spend much of my life trying to convince myself this is not the case.
In contrast the Hug member I mentioned identifies as a ‘voice hearer’ in a very positive sense: much as some people would identify as being part of a minority group who deserve the autonomy and protection of its experience that any other community may assign to itself.
This is such a complex topic . I don’t think mental illness is the only experience that leads to impaired judgement, I know some people who experience abuse react to that abuse in irrational and ultimately destructive ways and sometimes I feel they need protected from the power their abusers have over them, I know that some people with addictions act in ways they would never normally dream of doing and that some peoples’ religious or ideological beliefs lack the logic and rationale many people would expect someone of sound mind to take and yet because they are not mentally disordered no intervention is taken.
And yet why? – Why is illness in itself something that allows restrictions on freedom and action while other experiences which are equally damaging not subject to this intervention which on the one hand may be seen as liberating and on the other restricting?
Why is a biological mechanism seen as distinct from other aspects that influence people’s judgement and capacity over which they may have just as little control?
Personally, I am so glad judgement impaired by mental illness does merit intervention. Without it I would probably be dead , my life wouldn’t be the wonderful joyous experience it is, it would be miserable indeed.
But when our report on detention is finally finished you will see that although most of the people who have been sectioned are glad, in the end it happened, for everyone it was traumatic and shattering and within this there is so much that will need talked about and debated as long as sectioning remains a reality for some of us.
Thank you – I do hope your discussion today is interesting.