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USER EMPOWERMENT
There is no consensus as to
what the term 'user empowerment' actually means. Its existence
reflects a growing awareness that medical practice, especially in
long-term cases, fosters helplessness. My own experience is as a
recipient of psychiatry where these problems are particularly
chronic.
Before I talk about empowerment, it would be worth looking at the
way hospital treatment disempowers people in the first place. The
admission process is the starting point. The patient is searched
and sometimes has some or all of their immediate effects
confiscated and is put in a pair of hospital pyjamas and dressing
gown. They are given a medical examination, a psychiatric
interrogation, bathed and told to go and sit down. At this point
in time, they have no power at all. I can remember immediately
reacting to this treatment by wanting to get up and do something,
but this was taken as a symptom of agitation and pretty soon
became real agitation. Although. admission is not as rigid as
this always today, the general disempowering effect of it is much
the same.
It does not end there. Initially, the nurses aim to monitor and
control the patient's every move all be it nicely so long as they
do not pose problems. "Would you like a game of table
tennis? Would you like to eat now? Lets have a game of chess etc
etc. I can't hack it myself. I always get the full treatment.
Principal medication built up to as much as 600 to 800 mg of
chlorpromazine a day and 80 mg of haloperidol and I am still
fighting it. I have had a lot of delusions I admit, but this
attempt to take me over always gets the same reaction. By the
time I am discharged, I am but a shadow of my former self and I
certainly don't think much of being told I am well at that stage.
This may not be typical of all cases in psychiatric hospitals,
but it is not unusual in psychosis. At worst, the enactment of
'user empowerment' amounts to saying "now we've got you
doing what we want we'll ask you what you want to do."
Empowerment should be built into treatment from the earliest
possible point. And at any stage attempts should be made to
respond to any reasonable wishes expressed by the patient.
Empowerment should be about giving information to the patient, to
explain what is supposed to be wrong with them in an acceptable
way and respect that they have a point of view too. After all,
'abnormal behaviour' is largely an artificial concept and still
open to debate. Empowerment is about non-coercion, taking no for
an answer and agreeing to differ. Empowerment is about respecting
the patient as another human being. Empowerment is about letting
the health and individuality of the person grow back more than
trying to reprogram them. Empowerment has not so much to do with
what is done to a patient as what they are allowed to do
themselves and what is not done to them. Empowerment is
meaningless if it is assumed that patients cannot teach
professionals anything.
It is most difficult to empower people in the hospital setting.
Never being out of the company of the rest of the ward is harmful.
Having only the pokiest lockers is degrading. Being moved from
one bed to another is disturbing. A room that is home to one for
one's stay is not too much to ask. It provides a focus, enhances
identity and enables one to 'get away'. Sitting rooms of varying
sizes are desirable as well, making the ward more homely. The
right to make drinks when they are wanted and sufficient places
to smoke are also needed. Smoking still has a special place for
most psychiatric patients as a help to getting through very hard
days. So the setting can offer more choices and individuality.
The role of the staff is obviously of equal importance. The staff
need to take more risks in communication. Positive fostering of
insight is needed. At present if a patient guesses what is
supposed to be wrong with them, they are said to have insight.
Such insight is well regarded, but does it always have to be
guessed? Are psychiatric patients always so fragile and
impossible to reach that insight cannot be built on by nurses and
doctors? Are the official theories of mental illness so
frightening that they cannot be discussed with the people they
refer to at any stage? How can any genuine therapeutic
relationship exist when the therapists go out of their way not to
level with their patients while apparently believing they have a
monopoly on truth and reason?
The provision of decent environments, as well as listening to
patients, informing them and thereby building proper therapeutic
relationships with them are not desirable, they are of the utmost
necessity if psychiatry is to succeed and gain the reputation it
would like.