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The National Council of Psychotherapists

Est. 1971

CHOICE & RESPONSIBILITY

 

Newsflashes around the world via the TV and radio – Doctor Harold Shipman is found dead in his prison cell this morning.

 

An emotive person, most certainly, and an emotive story surrounds this man – what he was found guilty of doing and what else he is also suspected of doing – of course, no answers will ever now be forthcoming from the man himself.

 

Some may believe that he has avoided the responsibility of his actions by taking his own life. Some may believe that he finally accepted the ultimate of responsibility, and in some honourable way ended his life in late recognition of having ended so many others lives.

 

However, it is the sheer amount of media chaos and attention around this news story that has struck me, and how the focus appears to be entirely upon the perceived failure of the prison service in not keeping this man alive. And as such I question the placement of responsibility here. For what reason does this man now avoid even the responsibility of his own life because he is in prison serving time for his crimes? Why is another human being held responsible for him entirely? At which point can any other human being be held entirely to blame for the actions or decisions of another?

 

This change from care to blame has been noted in the health and care services, and especially in mental health. Where once there was in places a notion of endeavouring to bring the patient back to sanity, of seeking to relieve them of their distress, the milieu has changed and it is now much more an overall culture of litigation threat and of risk removal in response to that threat. Far more people are detained under the mental health act by medics in fear of the perceived legal consequences that they may face if the person is not denied their liberty – ‘under their care’ now equates to ‘in their custody’. I have personally witnessed people with epilepsy being detained under the mental health act – which is illegal and ‘should not happen’, but I have seen it, within the last 3 years. The person, already in distress, now also has their rights and liberties removed, and the custodians are from thenceforth considered to be entirely responsible for the actions of that person, whether the person is being actively engaged or not. We can all see the headlines – “Ex-mental patient kills – why did they let him out (10 years ago)?” What level of care or of humane understanding and trust can this engender? Would this encourage you to seek the help of your doctor knowing that doing this may well consign you to months of detention? It cannot be surprising the number of desperate actions this prompts. And maybe such desperate actions, prompted by the system’s inhumane treatment of people, then prompts the system to follow the spiral further still, spurring further endeavours to control more people to greater lengths.

 

Jeremy Laurance, the health editor of The Independent, has done some laudable observational research into this issue, and has published his findings in a book, ‘Pure Madness’ ISBN 0-415-36980-0. The book includes statistical evidence, and interviews with service users and providers, and I would recommend this book for those interested in what service users say they want and what they find is helpful to them – as opposed to what they are getting. After reading this book, I was compelled to conclude even more firmly that there are many people, diagnosed with some psychiatric label rightly or not, who need respect and to be treated as fellow human beings, but who are, having received such labelling, currently not receiving anything like respect, and who may well turn up at any therapist’s door. Many will have been falsely diagnosed.

 

To my mind, it is only logical that the individual can be the only one to make decisions, and as such, in working as a therapist, the individual is assisted to seek their own meaning, find their own answers, and therefore to be able to make their own decisions. At all times the clients choice is respected and trusted, and at no time is it time for the therapist to make the decisions for the client.

 

Yes, at times guidance is needed, and the therapist may find that the client needs to be strongly pointed towards the way out of that moment of pain or distress – because it would be unkind and cruel to leave them in such a place. There may be times when such guidance will include pointing them towards their GP or other specialist, and declining further appointments until this has occurred. But this is not making the decision for the client – this is being the guide, and guiding the client towards their goal of dealing with their distress. Same as if a mountain climber hired a guide and that guide saw the person start to walk towards a loose outcrop – the guide would shout out loudly to direct the person away from danger and pain, and that’s what they’re paid for. But the decision to climb the mountain is the clients own.

 

At the end of the day, if a person decides to take their life, that has to be their choice. Who is anyone else to tell them they cannot get off this particular bus? In my career in psychiatry, the most caring and supportive families I met were those who respected the decisions made by their loved ones. They may not have agreed with them, or been at some loss to understand fully the reasons, but they were able to see that such decisions were entirely made by that person. As long as the therapist has done all that can be done to assist that person, and fulfilled all obligations, legal and moral, referring on if required, then it has to be unreasonable to expect anything else from the therapist, the prison guard, nurse or doctor. And so I say it is unreasonable to seek to blame the prison service for Harold Shipman’s choice. For in this way lies deception and dishonour.

 

Rosalyn Young. R.M.N., L.N.C.P.

 

Of interest, Roy Porter has written a small, almost pocket-sized book, entitled ‘Madness – A brief history’, ISBN 0-19-280266-6, Oxford University Press, in which he covers Szasz, Freud, The York Retreat, Bethlam, Jung, drugs, Descartes, King George, and many other subjects including many diagnoses and the DSM – series.

 

 

 

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