Clusterfuck! (Part Three)

Down But Not Out! From Fight to Freeze to Fight with my Psychiatrist!

It’s been almost four years since my one and only Tribunal. The Tribunal is the harbinger of mixed feelings for me. While it was the thing that was responsible for me finally being spat out of the Mental Health system, that ultimately set me free, the way it seemed to kowtow to Dr Khan’s will, Dr X’s predecessor, really irked me. Particularly as pertains to conditions of my discharge, such as my number one bugbear, the stipulation of medication, had me thinking it was something of a Kangaroo Court for privileged professionals to strut their stuff. Paradoxically, at the time, I was both elated like a butterfly and a bear with a sore head. That said, if I want to be done with the current conditions of my discharge, in favour of a full discharge, I will have to go through another nerve-wracking Tribunal. Be that as it may, the third and final instalment of this Clusterfuck series sees the villain in my redemption story, Dr X, administer what was something of a begrudging schooling unto me on the Tribunal system. I hope you can muster some compassion for me because it’s safe to say that this part of our meeting was a rough ride for me.

“Yes, I get that. I get the technocracy of it all. But the reality is that you have the power to say whether I should be on this medication or not, and they will tow the line as far as you're concerned,” I said.

“Who’s that?” said Dr X.

“The Ministry Of Justice. The MOJ. And if you have a conviction that you don't believe that I should be on this medication, they will have no choice but to accept it,” I said.

“I don't know,” said Dr X.

“That is the nature of the technocratic ruling on this whole situation, let's say,” I said.

“So it's more of a complicated web, isn't it, really, because, I've seen this, you know, I'm not. I'm not saying this because it will improve matters, but they are -, they're the people who decide whether community living is the right thing. They can also decide to end the conditional discharge and they can recall you. Not me,” said Dr X.

“Indeed, but you're a consultant to the MOJ,” I said.

“No, I’m not a consultant to the MOJ,” said Dr X.

“Well, the reality is that the only reason -, put it like this, the only reason why I'm on a conditional discharge which requires me to take medication is because Dr. Khan said so,” I said.

“Um, well I would say because a Tribunal accepted that the management plan, which we’ve looked at, because they accepted the management plan was sufficient to -,” said Dr X.

“And who came up with that management plan? Dr Khan!” I interrupt.

“Well, this is where I say it's a bit of a complex thing, isn't it? Because actually, you know, if Dr. Khan can make the decisions about your medication, if they fall awry from the Tribunal at that time, then they could say, or the Tribunal will say is, we don't accept discharge, we don't like your management plan." said Dr X.

“Sorry, what do you mean by fall awry?” I said.

“In terms of -, if the Tribunal, Dr. Khan sets up a management plan and says, this is the management plan that I think will be acceptable to you as a Tribunal and they decide, yes or no, okay? So it's the Tribunal on which the MOJ decide to change your situation?” said Dr X.

“Well, I can tell you that having sat in that Tribunal, that it was Dr. Khan who had the final say. He insisted that that was the case. And the reality is that the Tribunal asked him, does he need to be on medication? “And Dr. Khan said, yes,” I said.

“Yeah, but that's how our Tribunal works,” said Dr X.

“Indeed, but the reality is that it's ultimately down to Dr Khan, not the MOJ. They asked him, they didn't insist that I had to go on the medication because they didn't have the information necessary to make that decision. So on that basis, they went with the expert’s perspective,” I said.

“Well, and that's why they have a Doctor and -, they don't always,” said Dr X.

“Sorry,” I said.

“They make -, like any court in the UK, you can get ‘are they right?’, the way they do the things, but you know they take evidence, don't they? So they hear the evidence and they like it or not. But Courts can take evidence and dismiss it. Say, I don't like this evidence. I'm not accepting it. And the Tribunal -, and sometimes they do, in fact I have had that experience where, you know, it's the Doctor -, and you may agree -, come to an agreement, essentially, about it, and the Tribunal say no. They don't agree with that at all. But it happens quite often. So, I mean, I suppose it's having that experience in a sense makes me know where the power lies. Yes, we put forward the treatment plan. The question is, ‘what would the MOJ do if I stop the medication?’ They're separate, they might recall you, I don't know -. I don't know,” said Dr X.

“But you still have the ability to influence the decision?” I said.

“Um. Not if they don't like the decision,” said Dr X.

“Um if they think the risk -, say you came off medication, and they felt the risk was going to increase. They make a decision!” said Dr X.

This is turning into a fight/flight/freeze situation. My heart is now sinking at hearing his insights. I’m starting to freeze but I, somehow, fight the instinct to freeze.

“See the question is on what -, on what -, on what -, what's the word I'm looking for? On what conditions do they feel like they have the power to make that decision ultimately? Because as far as I can see, they, in my particular circumstance -, having sat through the entire Tribunal, were clueless, ” I said.

“I think -, if I can -, and I don't -, you’re mistaking clueless for not giving opinions, because that is the way. They give their opinions at the end. They've given quite a lot of opinion, we went through the written account, they've actually given quite a lot of things. The idea that they don’t have an opinion about things is, you know, a myth. They have quite strong opinions, you know, they are actually making the decision, but they accept and not accept. If you look at the reason that say, well, I accept that from Dr. Khan, I don't accept that from Dr. Khan, but they might do. I accept that, I don't accept that. They use other people's opinions to -,” said Dr X.

“To inform their decision,” I interrupted.

“Well, they take what bits that they want, that they agree with and come to their own decision, don't they?” said Dr X.

“Indeed,” I said.

“But behind that is their decision. They write and use other people's evidence -,” said Dr X.

“That was the thing see -,” I said.

“You say that that's right - wrong!” said Dr X

“Having sat through the Tribunal itself, it was very much a pen-pusher exercise where basically they took accounts from my solicitor, from nurses in TGU, from me and then they asked Dr. Khan, what do you believe the conditions need to be in order for him to be discharged? And he went through the whole gambit. Namely with the whole issue of medication, et cetera,” I said.

“So, I mean, you know, that's one particular -, you know, and in most cases, that's a rather more pleasant Tribunal than some, because they’ve -, and it sounds like if you've got the vibe right, which I’m supposing you did, that they, of course, they've already read the reports,” said Dr X.

“Yes,” I said.

“They've already met and had a discussion beforehand. They are coming to their -, they haven’t come to a formal decision, but they are -, they've taken a point of view of how this is going to proceed, and they're gonna hear the evidence, most of which they've already got,” I said.

“But -, and that's your experience. And I expect that was what -, there was an element of that, because they'd already decided. But if you went to another Tribunal, where they hadn't decided, you'd see where the power lies in terms of the Tribunal and what they can say about Psychiatrist’s opinions and practices. It isn't a pen pusher exercise at all, a bit more like the Parole Board I mentioned earlier. It can be a quite challenging environment for everyone,” said Dr X.

Spiritually speaking, his words hit like hitting the canvas in a boxing bout. I’d been here before with him and other Psychiatrists. In those instances, the freeze instinct was particularly debilitating but - of late - my powers of recovery, have sped up. I am far more resilient in discourse. I bounce back quicker; no overwhelming grogginess.

“See, it still comes down to the fact that I don't need the medication,” I said.

“Yeah, we've gone off the tangent, but I mean, you know, I mean, because I think it's helpful. We're coming round to, you know, from my perspective, perhaps sort of clashing on the key thing, well, you know, there were symptoms and they mean something. To me, they don't mean -, we have to talk about the context.

I gave my Apple Watch a fleeting look. The hour was pretty much up.

“Sure, let’s do that, let’s do that next time,” I said.

“To, you know, understand the position. And I hope we are sort of, you know, this is sort of clarifying. I think -, I think everything we've discussed today is sort of building the sort of position about it. You know, being open about, well, this is what I think about this, well, this is why that. It's all relevant, I think,” said Dr X.

“Well, that is the crux of the matter as far as I’m concerned,” I said.

“Yeah. Well, I know what I'm saying is -, I know the crux of the matter is there, but, you know, we've all -, we move on because, well, that's because of that, because of that, because of that. And then we talk about that, if you see what I mean? Which I think is still useful. Anyway, we have to, I think, we have to finish there,” said Dr X.

“Sure,” I said.

“Thanks. And, um, yeah, so you sent that link [Dr Timimi’s 72-minute interview]. So I'll have a look at that. Well, in terms of homework, I'll have a look at that link, but obviously you can send anything else,” said Dr X.

“Yeah, as far as the video that I've sent you, as I’ve said, it's the full interview for that two minute trailer,” I said.

“Be interesting that,” said Nurse Y.

“So it will give you the context and a variety of subtexts as well that explains why he thinks the way he thinks. So that can be the end of it or it can be the springboard for you into reading the book, it's entirely up to you,” I said.

“Excellent,” said Dr X.

“Well, you know, for me, it's a case of I am in the throes of life again, unabandoned, just a little bit more cautious. And so on that basis, I'm putting my best foot forward,” I forthrightly said.

Have to admit, Dr X had me on the ropes but I’m still standing. I find myself reflecting on the dynamics of the Therapeutic Relationship, of which there have been too numerous to mention over the past thirteen years. I’m the life and soul of the party. Dr X and Nurse Y are the soul-sucking Dementors. I give of myself, they give nothing. There is no spiritually nutritional value in our monthly engagements. They refuse to engage me on a human-to-human level. Because if they did, they would have no choice but confront the reality that we are all humans on our respective journey’s, something to which drugs add zero value for most of the most psychologically unstable of us. That their only value is in enabling the human to build resilience in addressing the innate instability or fragility of being human.

On these terms, I don’t need them more than they need me.

As ever, all views are appreciated, feel free to let me know how you feel in the comments.