Sing “Banned by the BMJ” to the tune of “Born in the USA” by Bruce Springsteen (click on the picture for link to the song)
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Removing references to forced treatment, seclusion and post-traumatic stress disorder, and links to patient blogs describing experiences of poor care, is to reduce a piece on coercion in psychiatry to a sanitised grumble about poor food, thin curtains and the wrong type of tea.
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This afternoon, I was informed by the British Medical Journal that, despite us having worked on the piece (commissioned by the BMJ) since September, it would not be published in the 7 November issue without the following deletions:
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DELETION 1
“… and avoid being assaulted. I was repeatedly medicated by force. I have since been diagnosed with post-traumatic stress disorder.”
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DELETION 2
“I was repeatedly subjected to forced treatment, as a first resort. I was locked in seclusion with no water, no food, no access to a toilet and no contact with the outside world, without even my glasses or shoes.”
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DELETION 3
“If patients can’t go elsewhere for medical advice because they are locked up and the law gives staff the right to use force, there’s no need to hone these skills.”
[The skills referred to in the preceding sentence are “engagement with patients and persuasion”]
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DELETION 4
Ref 1. – Smoking and psychiatric wards – Georgia Rambles blog, Dr Georgia Belam @GeorgiaBelam (30 September 2014) https://georgiarambles.wordpress.com/2014/09/30/smoking-psychiatric-wards/
DELETION 5
Ref 3. – Do you remember your first time? – Sectioned UK blog (16 November 2014) https://sectioneduk.wordpress.com/2014/11/16/do-you-remember-your-first-time/
DELETION 6
Ref 4. – A smoking ban for mental health workers in the workplace – Nurse With Glasses blog, @nurse_w_glasses (15 November 2013) http://20commandments.blogspot.co.uk/2013/11/a-smoking-ban-for-mental-health-workers.html
DELETION 7
Ref 5. – Smoking – Wardipedia, a World of Ward Knowledge, @WardipediaNews http://www.wardipedia.org/21-smoking/
DELETION 8
Ref 6. – How can psychiatric wards become better, healthier places? – Sectioned UK blog (26 October 2015) https://sectioneduk.wordpress.com/2015/10/26/how-can-psychiatric-wards-become-better-healthier-places/
DELETION 9
Ref. 7 – On the ward – abuse in the mental health system – Schizoaffected3 blog, @schizoaffected (27 June 2015) https://schizoaffected3.wordpress.com/2015/06/27/on-the-ward-abuse-in-the-mental-health-system/
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My piece is about coercion in psychiatric care. The The BMJ would only permit me to refer to my experience as a psychiatric inpatient in the following terms:
“I am very much in favour of making psychiatric wards healthier and bringing about sustainable improvements to patients’ health. When I was fragile and detained, the ward environment was toxic. Food with no fibre, poor sleep hygiene measures, no access to exercise or fresh air, no therapy and nothing to do except sit round eating biscuits and drinking coffee [DELETION 1] [DELETION 5] There was no smoking reduction or cessation help avaiable. There is a great deal of scope for psychiatric hospitals to make wards healthier.” The BMJ would permit me to say, “Patients experience wards as coercive, not therapeutic.” However, the link to the blog post of @schizoaffected (reference 7) in which she describes her experience of a psychiatric ward, was to be deleted.
I was told I could not mention my personal experience of forced treatment unless the staff involved had been prosecuted. That’s akin to telling someone who’s been sexually assaulted that they cannot detail their own experience unless their attacker has been prosecuted. Expecting psychiatric patients harmed by poor services to prosecute staff before they can detail their own experiences is too high a bar for most of us to ever reach.
Removing the reference to use of forced treatment; removing the reference to post-traumatic stress disorder; removing the reference to having been held in seclusion with no food or water, no access to a toilet and no contact with the outside world, without even my glasses or shoes; removing links to two patient blogs describing our separate experiences of poor care; is to reduce a piece on the coercion that runs through psychiatry like words through a stick of rock to a sanitised grumble about poor food, thin curtains and the wrong type of tea.
To strip out a referenced blog piece written by a London psychiatrist; a piece by a community psychiatric nurse about a smoking reduction course; a well-known ward resource for inpatient psychiatric wards; and a collation of tweets where patients share how wards could be made better; is farcical. It smacks of inexperience, laziness or stultifying caution.
The justification for these deletions is that, the BMJ claims, I will be identifiable at the Maudsley public debate; that staff on the ward where I was detained may be in the audience; that they may recognise me all these years later; and that the NHS trust responsible for the ward where I was detained could sue the BMJ for libel. To try to accommodate those concerns, I offered a number of different forms of alternative wording. I offered, in place of the deletions, the phrase “BMJ legal advice says I may not refer in this article to other experiences on ward or the impact it has had on me.” I offered to sit on the panel wearing a face mask. I offered to sit in the room next door to the lecture theatre – the room where a patient can sit if their case is presented to doctors or medical students and speak via video link – and participate in the debate via video link with my back to the camera. BMJ refused. It was the deletions in their entirety, or nothing.
As a result of the BMJ refusal, my piece will now not be published in the upcoming issue. Happily, however, within half an hour another journal had agreed to publish my piece (slightly edited for length), as well as invite me to comment on an upcoming editorial on a related topic. Writing the piece has forced me to think well in advance about the issues I should focus on at the debate and has hence been good preparation. It has not been wasted effort.
However, it has been an upsetting episode. I was shaking with anger earlier. It has felt as I were being silenced; as if my own descriptions – brief as they were – of what was done to me under the guise of “care” – were being sanitised from the scene, buried, denied. As if coercion in psychiatric care is so entrenched as to be unmentionable. Reflecting on what I was told of the legal advice given to the BMJ and the BMJ’s refusal to consider my suggestions, it seems clear to me that stigma and prejudice against people with mental health problems has played a part. People with mental health problems are often considered unreliable witnesses to our own experiences. We are not believed. The more we insist something is so, the more extreme our experience seems to be, the more – as in this case – it appears to deviate from the accepted picture of what care on a hospital ward should be like, the more our credibility with others appears to be undermined. Tell an extraordinary tale as a mental health patient and it will be seen as a tall tale. The BMJ and the barrister they consulted didn’t, it seem, consider they would have any defence in the unlikely event they were sued: after all, I’m just a mental patient.
As I wrote in this piece, it seems that, on the one hand, professionals want to be seen to be listening to diverse voices; and yet, on the other, they aren’t prepared to make any accommodations that would make invitations meaningful. Write like a doctor. Fit in this square expert-by-profession-shaped hole even if you’re very much an expert-by-experience round peg. Don’t frighten the horses with your personal experience of brutalising inpatient hospital care. The BMJ will not be shining a light on the realities of coercion in psychiatry for the benefit of a diverse range of doctor readers. I wonder what will appear on those two pages instead.
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Click on the pictures below to link through to the blog posts or Storify stories of tweets
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BMJ refuses to print article ahead of smoking ban debate – Velvet Glove, Iron Fist blog – Christopher Snowden (30 October 2015)
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Reactions on twitter & conversation with the lovely twitter people (from 30 October 2015)
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Conversation with Simon Wessely (Storify story of tweets) (30 October, 01 November)
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Tweets follow the discovery that the BMJ had hired a doctor unrelated to the debate to write a piece instead. (Storify story) (02 November)
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BMJ Censorship Complaint – by RITB, 25 March 2016
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Sectioned 
Feels wrong to ‘like’ this when I am so angry for you. Supporting you in sharing your story.
Thanks very much. I appreciate your support.
Stunned really. What were they expecting you to say when they asked you to write for them? Short of a panorama/horizon expose, how are most inpatients meant to get evidence of the way they are treated? When so many professionals object even to the private recording of routine outpatient appointments, there is no chance of brutalised patients having any record of what has been done to them behind closed doors. It seems only patients who die in care, and whose families leave no stone unturned to get justice, will ever be heard by the mainstream.
Initially when the BMJ asked me to write for them they were clearly expecing me to write like a doctor. I made it clear I would not be doing so.
Yes, how are patients supposed to get evidence sufficient to prosecute staff for poor care when the evidence of our own mouths is not believed? My phone was taken from me by the nurse who first assaulted me even before I’d entered the ward (she believed I’d recorded her assaulting me and wanted to make sure there was no danger of getting caught). My camera was also removed.
I did dial 999 from the ward payphone after one patient assault when staff told me to go back and sleep in the same room as my assailant; however, rather than investigating, police spoke to staff then ‘no-crimed’ it.
It’s important to shine a light on what’s being done to people behind closed doors, but placing the bar so high will not help with that.
My mind just went Wow! And then it went, Not surprised. The BMJ wouldn’t open their stultified minds to the concept of lived experience, especially by a **gasp** mental patient. Their loss. I’m so proud of you for your activism and tenacity for the sake of all of us who suffer from mental illness.
Thank you.
I don’t know about the BMJ but simply took it at face value when they contacted me to ask me to write the piece for them. Initially they did seem to expect me to write like a doctor but that misapprehension was ironed out.
Yes! Don’t change your story for anyone! I’m shocked and not at the same time. I’m glad you’re speaking out about it!
Thank you.
I didn’t feel I could accept those last-minute deletions, which is why I bent over backwards to try to accommodate BMJ concerns. Taking those phrases out, as well as all those references, cut the heart out of my piece and misrepresent the entire basis of my argument.
I would much rather have had the piece appear in the BMJ, but it wouldn’t have been my piece with those deletions.
For sure. You can’t deny your experience and you shouldn’t be made to.
Reblogged this on Pride in Madness.
I want your story to be heard in all its uncensored fullness.
Thank you.
Seems odd that they don’t even want the inclusion of forced treatment when that is the very purpose of a section 3 – giving professionals the legal right to impose treatment and denying the patient the right to refuse (assuming appeal is not successful).
I’ve worked on an acute ward, and though generally decisions appeared to be taken in the best interests of the patient in the case of psychiatric treatment, the institutionalisation of staff, and the way this impacts on how patients are treated, is clear.
Though the law may have the right to enforce treatment (usually medication), no other right or freedom should be denied someone detained under the MH act. This means that patients should have the choice to have a hot drink whenever they feel like it and to exercise their right to smoke if they so choose.
It is not within the remit if the MH act to enforce lifestyle or behaviour modification. Support to improve health is one thing, enforcement is immoral and barbaric.
Thank you. A person is sectioned because they are a danger to themselves or (more rarely) others yet what seems to happen in too many cases is that, once behind those locked ward doors, people are expected to fit in with whatever they’re told (or forced) to do. This goes far beyond any necessary treatment, care and support for the acute problem.
I agree with Mark Brown when he says that going beyond that is “awesome mission creep”.
BMJ is implicated in the coercion. In this context, insisting on edits with the threat of no publication is coercion.
And coercion, silencing, denial of abuse/experience are the most crazy making experiences. Would it were possible for the writer to sue the BMJ.
Yes, the deletions were given on a “take it or leave it” basis. There was no negotiation over even a single comma.
I was sectioned earlier this year, following a manic episode. This was my first experience of any mental health services. As a senior nurse I can totally relate to your article, my care was poor to say the least, I was also experiencing stress induced asthma which was not being treated, following contacting 111 and 999, my phone was removed and I was placed in seclusion, where I had an asthma attack. Stick to your guns and try to get your article published as much as possible to try to change the stigma experienced.
Hi Nurse . WoW . You work for the NHS more than likely . Say denied help for an asthma attack and your mobile phone taken from you . Could the asthma attack have harmed your health in any way . Do you want to give your story of what happened with your connection to psychiatry at ( www. psychiatric-patient-stories. org.uk ) With being a Nurse and knowing more about medical issues than some what would you like to see from the NHS Mental Care in the future . ?
Nurse,
I’m so sorry to learn you were treated so badly when you were vulnerable and needed care. It sounds like there are some similarities in our experiences in that my physical care was also neglected (causing great suffering) and I also dialled outside services to try to get help and my means of contacting the outside world was also removed. Some of the things that are done in the name of psychiatric care are dreadful.
I hope you’re feeling much better now.
This gave me chills. I am horrified. Speechless. I wish I had more I could say right now but I just finished it and my head is on fire…….
This shouldn’t have happened to you and they shouldn’t be doing this now. It is outrageous and proves that we are indeed a discriminated against group of people.
Thank you. We’ve come so far but there’s still a very, very long way to go. I guess we just keep plugging away in our own different ways.
This is disgraceful. Can I ask if the BMJ invited you to contribute your article, or was it sent by you unsolicited to them? I intend to artist to the editor when I return home early next week.
The BMJ contacted me and asked me to write the piece for them.
I would like it if you would consider publishing your BMJ article as part of the Mad World Archive which is very receptive of critical perspectives: http://www.ragged-online.com/mad-world-archive/ – also, would you be interested in taking part in the next Mad World exhibition in 2017 ? Please get in touch with me (Alex) via @raggedtalks. I think your work is great. Best wishes, Alex
Dear God I am left speechless, shocked but not shocked. When I was hospitalised in August, I saw some distressing things, a woman clearly out of control, screaming all night, trying to break things in her room, not receiving any help except eye rolls from members of staff. When I saw a doctor and explained this, and I begged to go home because I could not take anymore screaming(when I’m around people my paranoia and noise in head is amplified) I saw the report recently, nothing was noted about this poor woman and her screaming, they just wrote that I was ‘keen and happy to go home.’ Complete dismissal of something I had seen and thought was wrong.
There is so much wrong with psychiatric hospitals and things need to drastically change.
I was sectioned, assulted by staff, forcibly injected with medication which wasnt prescribed (a second assult) given a whiplash injury by staff and diagnosed with PTSD as a result of my experience. I put in a complaint and got an apology. Later took legal action too. This type of abusive behaviour by staff on vulnerable people appears more common by the day and is not acceptable.