I Saw Psychiatry from Underneath, Inside, and Above

I came away from my first episode of psychosis feeling angry. I had spent a month in a psychiatric intensive care unit, and many of my experiences were objectively indicative of poor practice. Much of what happened is detailed in my book, Fought Disorder. People who have read it and who also work in services have told me they were horrified by how I was treated and how my condition was managed.

It would have been easy for me to find solace in the harmed-patient community. I could have shared my experiences in forums, written blog posts for anti-psychiatry publications, and engaged in forms of activism at the more aggrieved end of the spectrum. Instead, I gravitated away from these people and their ideas—not because I thought they were wrong to be angry, but because I felt that the way they expressed that anger was unlikely to bring about the reform they seemed to want.

I ultimately concluded that the people managing my behaviour were, for the most part, well-intentioned. There were indications, though, that I was not the only person who felt aspects of my care occupied morally grey territory.

I recall becoming severely delirious before my arrival on the PICU and being profoundly disoriented on my first night there. I have fragmented memories of trying to escape; of being dragged down a corridor, howling in tears from confusion and the physical pain of the holds. I assaulted one of the men dragging me and was kicked in the head while wrestling with him on the floor. I woke the following day covered in yellow and purple bruises.

Two nurses took me into a side room and told me that, if I wished, I could complete a body map: a diagram of a human body on which I could mark my bruises and injuries. The nurse offering it to me was in tears. I sensed that I was not safe, and that I was in the presence of people who were at once complicit in what had happened and aware that something was wrong.

I then joined the service that had once contained me, believing that if I became one of the staff, I might come to see what happened to me differently. I hoped I would understand why force was sometimes necessary, and why patient injuries were sometimes unavoidable, if not justifiable.

The more time I spent working with patients and colleagues, the more I came to believe the opposite. Restraints were often avoidable. Communication failures were often traceable to staff burnout, frustration, and unresolved distress. Challenging behaviour was dismissed as “behavioural”, while genuine patient frustrations were pathologised. When combined with a personality disorder diagnosis, ordinary and understandable irritation could be reframed as “splitting”.

At the same time, I was working to contain my own symptoms while navigating the culture of gallows humour on the ward. I recall one patient whose infant child had been rehomed through adoption because she was too unwell to parent him. She came to the office only to be met with staff singing, “Bye bye baby, baby goodbye.”

I asked my team lead whether she understood the significance of what she was doing, how it might be perceived by a woman with schizophrenia, and whether they were intentionally being cruel. They had not realised how it could land.

I found myself occupying a strange space: trying to uphold the model of care while feeling fundamentally connected to the inner lives of patients in ways that many of the staff around me could not see.

I met with the medical director to discuss these concerns and proposed new communication training that could be delivered as part of my role as a restraint trainer. I was told that, if my aim was to influence practice and policy, I should gain credentials.

And so, eventually, I left.

I spent a decade in isolation, working on a PhD from home. Much of that time was spent reading books in a garden shed, learning about schizophrenia and formal thought disorder. When I finished, I became active on the platform X, where it quickly became apparent to me that there were two camps of prominent voices: those challenging mainstream psychiatry from a critical position, and those defending it.

I learnt very quickly that my thoughts would travel if I echoed the sentiments of mainstream psychiatric thinkers. If I dismissed someone asking whether psychotherapy could benefit people with psychosis as “anti-psychiatry”, I would be boosted. If I drew on my knowledge of research design and methodology to challenge an intellectually dishonest take, I could rally support from medical and mental health professionals.

But once I began introducing my own criticisms of psychiatry, I was ousted and othered. I revealed myself to be an unknown quantity: someone embedded within mainstream psychiatric discourse, who spoke the language of psychiatry, but who also advocated for reform and patient benefit.

Critical psychiatrists were reluctant to engage with my work because I had historically challenged the ways in which they presented their ideas, rather than necessarily the ideas themselves. Mainstream psychiatrists were hesitant to explore my work because I was no longer a clear ally of psychiatry. I had essentially dug myself a private little hole, where I explored difficult topics from multiple positions using the vernacular of the establishment, and no one really knew how to respond.

I occupy a strange position.

I spent a decade trying to convince myself that psychiatry is good, and that aggrieved patients simply do not appreciate the work involved in caring for people in crisis. I cared for people in crisis. I used the positivist methods of clinical research. I take my medication. I am a good boy.

But those ten years taught me that there is much within psychiatry that could change, and that many of the points raised from critical positions are worth listening to—even when they are undermined by an affronting and politicised style of argumentation.

I have specialised myself to the point of being unplaceable. I am neither critical nor pro-psychiatry. I am an ex-patient who became staff and then a researcher; someone who saw the system from underneath, from inside, and from above.

Those insights are of little interest to people who thrive on the conflict of warring ideologies. What is sad is that these people—the ones engaged in an endless exchange of blog posts, provocations, and rebuttals—are often those with the positional influence to make changes for the benefit of patients.

They use their power to challenge each other, rather than the problems experienced by those at the bottom of the heap.