My social media feed is often visited by strange pieces of propaganda, although they hold aspects of subjective truth, they largely present a shame inducing stigmatization toward seeking professional help. In an attempt to transcend stigma, articles can actually provide a form of normalization that is dangerous and limiting. Not all mental illness is the same and not all mental health provision is equal, but opinions that don’t consider the larger paradigm are problematic.

I have been seeing (in various forms) a quazi-first hand account of experiencing mental health services through primary care services and or within an acute psychiatric hospital setting. The most disturbing element of this narrative is the characterization of the inept psychiatrist, and of the unwilling patient.

The reality of mental health couldn’t be further from these caricatures.

As I left the acute psychiatric hospital where I work today, I passed by the locked ward, and I thought about these articles I’ve been noticing –I realized that the majority of patients (I prefer the term client or service user) that I’ve known have either: taken themselves into hospital, or gone willingly when someone called for help. Granted there are a few who experience their primary psychotic break, or who find themselves foul of drug use and attend the ward, and there are those who feel suicidal or homicidal and are involuntarily committed. Contrary to popular belief, it is actually quite hard to be committed to a psychiatric ward – unless you are a danger to yourself or others (a true risk of grievous harm or death), or you are gravely disabled (i.e. unable to safely feed or care for self) then you most likely aren’t getting in.

For the most part though, I experience people who have sought safety, and help –people who acknowledge that non-professional care represents a greater danger than the discomfort, and sometimes overbearing structure, that comes with staying on a psychiatric ward.

There is a hostility toward mental health practitioners, in part it is rooted in new-age psychobabble, part in conspiracy, part in unfortunate experience, and part in the trite representation that media portrays. Stories, articles, films, and TV shows about the largely unglamorous, and highly upsetting, experience(s) of working within a psychiatric hospital are not going to attract much attention from the public – in no small way because the lay person has been fed a fantasy surrounding mental health, almost an either or: that either it represents genius/cool/edginess, or it is evil Big-Pharma and the psychiatrist cronies destroying families and ordinary lives. It is akin to the recusant anti-vaccination ‘debate’ – of which there should be little to no debate. Education, experience, research, practice, reform, and evidence based practice has to stand for something – lest we return to shaking sticks over the dying and sacrificing livestock in an attempt to appease evil spirits.

Professionals within the field of psychiatry and psychology are (for the most part) wonderful, humane, ethical, inquisitive, and caring individuals that provide a service to lives where nearly all hope appears lost. Some of the experiences I have had, and some of the things I have come to understand about others, will travel with me to my grave, but will also haunt me forever. I keep those things to myself not only out of strict privacy regulations, and not only because it is honorable to do so, but also because they are terribly sad, and I accept that I must hold them within my role as a clinician. I see no reason to traumatize anyone with my knowledge. It does effect and affect workers deeply though, but we recognize that our clients and their families are more deeply impacted by the experience of mental illness – so we try, and we ponder, and we re-try, and we evaluate, and we try again… to help.

The horror that I am willing to share is that we are still far from universal ‘cures’. We try our hardest, but why an intervention works for one and not another is still somewhat of a puzzle to be solved – that doesn’t mean we can’t work though, it simply means we must be progressive, professional, and adaptive. Human beings are highly complex and multifaceted, mental health intervention must match that.

Back to the articles though, back to the concept that we are somehow out to get you or just bumbling in the dark, or that we simply don’t care enough. It is incorrect to infer that mental health is a collective made of psychiatrists and nurses; it is a multi-professional field. As psychiatrists might represent the beginning of care – psychotherapists, social workers, counselors, occupational therapists, and (most importantly) peers represent the continuum of care; the action of getting better. Medicine is only a part of wellness, it is adjustable, it is transferable, it is largely reliable, but it is not the entirety of care. Without professional input, without guidance, insight, a supportive network, and coping skills the medicine offers a temporary respite to the impact of illness.

Mental health is as much to do with how you act as it is how you think, and both of those things are better affected by therapy (often in combination with psychiatric drugs) than by medication alone. But not everyone needs ongoing prescriptions, some require a little fine-tuning and then medication can be replaced by ongoing supportive services; others require medication for their life-course and readjust their lives accordingly.

The articles largely express great love and compassion for those who experience mental health issues – even in the face of a narrative that is sad, upsetting, heart-wrenching, and quiet scary. For a professional though it is a very frustrating read. The matter that (often times) the contributors and publications themselves have little to no qualification in health is troubling. That isn’t to suggest that all critique of mental health should only come from professionals, or that service users do not understand their experiences – it is simply to say that the narrative of anti-psychiatry, and anti-professionalism (at its core) has a dangerous contradiction. It posits the crime of psychiatry narrative against the People First, Labels Second movement of service user led determination represented by organizations like Mad Pride, but underpins the thinking with the more worrisome perspective of mental illness representing mad gifts – something I have already addressed here.

I believe in People First, I advocate for empowerment and service user rights, I work from a principle of the client as expert in their life, and I recognize the diversity in symptomology – but I cannot discount the absolute benefit of my profession.

These articles often reference how professionals interjected to treat the onset of an illness, but the narrative frequently shifts to a bold anti-psychiatry manifesto, only to return to a vague allusion at the end of being able to make it with the help of establishment services, and psychiatric medication.

Let me make it very clear that I am not directly attacking individual experiences, I am not blaming or shaming people’s thoughts, hopes, or the trials they have experienced – but I am wondering what was the point of it? What is the purpose of the anti-psychiatry inclusions? Authors championed by anti-psychiatry movers, such as R.D Lang, are not a viable critique of modern psychiatry or psychology; a decades old narrative of practices absent from objective patient experience. To address Lang’s fallacy that he’s never met a schizophrenic who can say they were loved: I have met many schizophrenic patients who say they are loved. I have met many who say they love themselves and have never considered suicide. I have met many who love in return – because they are people, they are people who experience a set of transitory symptoms that impact their lives to greater or lesser degrees, and they retain their humanity and worth throughout. As much as I respect the experiences within the articles, their understanding is foggy. To some extend my profession has to take responsibility for that, psychoeducation should be a huge aspect of treatment; insight oriented work and transparency is the making of modern practice. Conversely, no treatment is given (long term) without some level of permission – be it from service user, family member, or court ruling. We simply do not act of our own volition.

We are reliant on patients reporting the machinations of their mind, observed diagnosis is not enough to fine tune an intervention, and it may appear to be a blunt instrument because in some ways it is. When presented with psychosis we attempt to reduce symptoms through known methodology, so we can get a better look at what is going on; and this includes the clients’ perspective. It is from here that we work.

There is growth in the field also. Only recently a report was published on genetic signifiers to schizophrenia’s multi-faceted presentation. It is imperative to note that medicine is progressive; attempting to critique it with observations from generations ago (or from bad science) is poor and dangerous reasoning.

We are not monsters, we are not shills for Dr. Evil of Big-Pharma, we are not uncompassionate automatons who have had our humanity removed – we are human beings who recognize the worth and wonder in all fellow human beings. We help those who would otherwise be helpless, who are marginalized, and we do so with the best of intention, with the best information we have, and with an understanding that all intervention must meet the complexity and nuances of the human condition. Of course the DSM is full of labels, of course it is reductive – it is a diagnostic manual. It is not a literal bible. It is a guide, not a script. I challenge the detractors of psychiatry and psychology to present a workable and viable alternative to my profession where we can also operate under the premise of identifying and treat presenting symptoms, of re-evaluation, of continued assessment, of informed treatment, of evidence based practice, of consultation, and of working with the patient to understand their condition.

It is no foul that we might see depression turn to psychosis, or that we might transition through signifying labels of disorders – we do so because illness manifests in stages, because the life-course of an individual is complex and varied. We do so because we are improving and fine-tuning our diagnosis, not because we are fumbling.

It is dangerous to imply that a psychiatric hospital is something to be avoided if a person is unwell, and articles (although focusing on the pain of the experience) actually relate a stigmatization of seeking help.

My friends and my family who have experienced mental health issues have all benefited from the intention and intervention of professional services. My own professional experience aside, I see no evidence to the contrary that professionals represent serious help and hope for mental health.

Within my own practice, I had a conversation with a young man who had been told by his community to reject psychiatric services, to abstain from medication, and this was causing him distress because he could relate the benefit of his experience under our care, and recognize the differences in his functioning with and without medication – but he was highly concerned that he was making a mistake, that he would become worse off by accepting medication. He was confused by propaganda, not by science. So I empowered him with his choices, with an understanding that his treatment plan is a partnership, between himself and a multitude of professionals (seen and unseen) who will adapt and communicate with him along the way to address his needs and his fears, because this is his life, and his experience, and we are here to help him to get better. That is our job.