The Coca-Cola Crisis and Coercive Psychiatry

I know of a psychiatric unit that once faced a deadly crisis.   It was a crisis that split unit staff badly.  It affected the perception of and treatment of patients.   It literally brought things to a standstill.   Finally a series of major meetings were held to address the issue and bring resolution to the crisis.  
It was the Coca-Cola Crisis.

There was on this unit a coca-cola rule.   If you ordered a Coke for your meals the expectation was that you would immediately when the meal came pour your coke into the plastic drink sipper you were given upon admission and discard your bottle.  

Patients whenever possible ignored this rule.   They the truth be known thought it a stupid rule.   They were adults.   Their insurance companies were paying over a thousand dollars a day for them to be there.   They just didn’t see the point.

Part of the staff whenever possible also ignored the rule.   They also truth be known thought it was a stupid rule.   When there were so many life altering issues to focus on coca-cola bottles just didn’t make their top ten.

But there was a portion of staff who found the rule crucial.   They enforced it rigorously often with lectures about responsibility.  In their eyes the willingness of patients to follow the coca-cola rule was an index of how much the patients bought into treatment,  how much they really wanted to change their lives.   They felt like the inconsistency of the enforcement of this rule threatened the stability of the unit and the control the staff had.

The staff was divided into sipper people and bottle people and the patients got each day to see them play their issues out.

So what is the point of this story?

Treatment easily becomes about who is in control and how do you take charge and keep charge.   It becomes about conquest and not connection.

I have a psychiatrist friend who hates the Murphy Bill.   More than anything he hates the coercive elements of it.   He told me one day,  “Coercive nothing works.   It destroys my relationship with people.   They only have a couple of options.   They can fight which only confirms their diagnosis and gets them further stuck in the system.   They can run which does the same thing or they can comply because in the end it is the only way to get people off your back.   Then when people do what they are supposed to do you are stuck in an endless debate about rather or not they really changed or just told you what you wanted to hear.   I  hate everything about it and think Rep. Murphy is simply stupid for trying to make it the prime directive of the system. ”

I told him the coca cola story and he just shook his head and laughed.   He is an unusual person.   He believes being a human being is more important than being a doctor and devotes a lot of energy into leading his life that way.

When you talk to your representatives about all this tell them that how people are helped is more important than how they are controlled and that you think the system needs to start with realizing we are people rather than judging how good of people we are by how well we follow the rules.


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