Psychiatry is, as far as I know, the only form of human endeavor in which some people believe, some “experts” believe, that the consent and emotional investment of those receiving its services is irrelevant to its outcome. In the eyes of these “experts” the decisions of people, who they dismiss by saying they don’t even know they need help, are irrelevant to the success of the help they receive
It astounds me how people who “know” so much about psychiatry know so little about human beings. If you work your boss wants you to “buy in”. If someone is trying to sell you something they want you to “buy in”. Your relationship, your perception of what people want you to do affects whether or not you will try our not, if you do try how hard you will try, the likelihood you will persist when things get difficult, and how important you treat any of it in relation to the rest of your life.
I have been around the mental health system my entire life in one capacity or another most of my adult life and what I am sure of is
that coerced people rarely buy in, particularly when the coercion is perceived as heavy handed and getting people to “behave” is not the same as helping them to find a change that makes their life better and likely to persist past “treatment.”
In any relationship defined by coercion the only real issue is who is in charge and what they must do to maintain to that authority. It is to be conveniently naive to believe anything else. Anytime someone tells you that coercion doesn’t matter ask them if they have ever had a social worker in their life they were accountable to. If there is someone who has effective control of your life you basically have 3 options: give (do what they say or at least make it look that way), fight (and get stuck deeper in the system because you are not “taking the responsibility to change”), or escape (lying is the most commonly used way to escape). Think of any area of your life where coercion has played a major role, any relationship, any anything and ask yourself did that coercion affect the quality of what happened. People will run through a brick wall to do things they think are important to do. No brick walls are in danger from the things you are made to do.
To “buy into” something I believe 4 things must happen.
1. You must believe there is something in it for you. You must believe that in some way “it works”. That is exactly the reason many people avoid treatment. They don’t think it works. They don’t think it gives them the leverage, the tools to make their life better. Many people do not buy into taking medication. It seems dangerous and just not worth the risk. People don’t buy into things they perceive as not offering credible opportunities. Credible
2. You must believe you have something to give. You must believe that your contribution mattters. You must believe you have significance. You must believe what is important to you is recognized as important. In coercive relationships the biggest message you get is of your own insignificance. Empowered
3. You must believe it is safe. You have to trust the integrity of others involved. You must believe they are honest and their intent honorable. People tend not to “buy into” situations where the primary message is be on guard and protect yourself. Trust
4. You must believe someone cares. You must believe you are more than a role, more than a label. You must believe that someone sees you as a person that matters and they value you as a person. You must be more than someone’s job. Confirmation and nurturance
I don’t know that any of us totally buy into anything. All of these things are a matter of degree and the extent to which we believe they are true will change. They are all integral though to the success of anything we become involved in throughout our lives: relationships, careers, causes, interests, and yes– treatment.
To believe it is not important, that coercion is sufficient, is simply folly. The lack of recognition of these things is part of the reason that so many people see the mental health system as being irrelevant to the quality of their lives. Too many people see it as not part of the solution but part of the problem.
Identity is so very much important. Too many people believe the mental health system tells them the best they can be is a person they don’t recognize themselves as and a person they don’t think it’s worth being. People whose experience is that the 4 things described are true or can become true believe that they can decide the kind of person they are and build a better life based on their decisions and actions. They are more likely to identify in some way with the notion of recovery. They may welcome help they think is needed or important but know that it is their life and in the end their decisions and choices that matter.
To assume coercion is irrelevant to what you do with people is to ignore the experience of what it means to be a human being. It is utter folly. Power may enable you to do many things to people but almost always gets in the way of what you do with people. There are a million ethical reasons coercion is wrong but one very practical reason. It just doesn’t work.
Mental health reform is a political issue now. Tell your legislator to support change that empowers people and not something that reduces them to less than a real person.