‘It's unbelievably humiliating’—Patients' expressions of negative effects of coercion in mental health care

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• 作者：Olav Nyttingnes^a ; ^b ; ^{olav.nyttingnes@ahus.no" class="auth_mail" title="E-mail the corresponding author} ; Torleif Ruud^a ; ^b ; ^{torleif.ruud@ahus.no" class="auth_mail" title="E-mail the corresponding author} ; Jorun Rugkå ; sa^c ; ^d ; ^{jorun.rugkasa@ahus.no" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Involuntary care ; Involuntary medication ; Patient experience ; Psychosis ; Consumer organizations ; Qualitative research
• 刊名：International Journal of Law and Psychiatry
• 出版年：2016
• 出版时间：September-December 2016
• 年：2016
• 卷：49
• 期：part_PA
• 页码：147-153
• 全文大小：333 K

文摘

Some patients criticize coercive mental health treatment using extremely strong words. This may be connected to poor therapeutic relationships and unfavourable treatment outcomes, so a better understanding of this criticism is warranted.

Methods

Data consisted of detailed notes from 15 all-day dialogue seminars on coercion and voluntariness in Oslo, Norway from 2006 to 2009. Very dissatisfied patients and ex-patients were a central voice through the seminars. To gain a better understanding of their negative experiences of coercion, we conducted a stepwise qualitative thematic analysis of the seminar notes, with a mix of inductive and deductive coding followed by focused coding and analytic induction.

Results

Coercive care was described in strong terms, such as humiliation and Nazism. To explain this, we suggest a model of two pathways towards such strong language: (i) Participants understood their symptoms as mental crises following trauma or spiritual problems, and perceived involuntary medication to harm rather than help. Some found that their complaints were dismissed as lack of insight. (ii) Minor incidents were experienced as coercive, such as being ‘defined’ by the medical model, receiving repeated negative remarks and feeling one needed to succumb to get care. The accumulated effect could be experienced as eroding self-confidence and trust in their own feelings and thoughts.

Conclusion

Involuntary medication and dismissal of patient perspective, combined with the accumulated effects of minor negative incidents, can explain the feelings of humiliation, oppression and the use of metaphors such as imprisonment by totalitarian systems. Our model can help explain such patient reactions seen in clinical practice and the literature.