Stories from The Psychiatry Project

Do Research on Institutional Psychiatry and You Too Can Get Locked in a Looney Bin

As a faculty member at University of Toronto, I conducted many professional observations of meetings of the Consent and Capacity Board (these are the Ontario hearings in which psychiatric inmates—otherwise called “patients”—can contest being involuntarily incarcerated or having been determined “incapable” of making their own decisions on “treatment issues”). In about half the cases, I was accompanied by my trusted research assistant Philip Taucher, for besides that he was an astute observer of institutional processes, two pairs of eyes are better than one. On the bases of the detail notes made, several of these cases are analyzed in detail in my magnum opus Psychiatry and the Business of Madness. That said, with one hearing a very interesting and telling predicament materialized before the hearing even commenced. Here is what transpired:

While Philip and I had attended many such hearings before, this was the first time it was at a general hospital, and so we were uncertain where to go. Briefcase and orange chair in hand (as a person with a disability, I had to bring my own chair), we arrived about five minutes early. However, while we searched high and low, the hearing was no place to be seen. Then we spotted a nurse about a yard away. We quickly approached her.  “Nurse,” I asked, introducing myself, “I’m a researcher from University of Toronto, and I’m expected at a review board hearing. Could you give me directions to where it is being held?” The nurse quickly pointed in a direction, and we proceeded as directed. A few minutes later, it became very clear that we were in the wrong place, for we were in a corridor, with transparently heavily drugged folk passing back and forth—no lawyers, no deliberation tables anywhere in sight. I took one look at Philip and instantly went to open the huge door by which we had entered the corridor. Locked.  Nothing could be clearer that we had landed on a locked ward. Philip put down the chair and shrugged his shoulders. I proceeded to take the most obvious course of action. I knocked on the door and called out that we were trying to get to a review board hearing and had been locked up here by mistake. No response. Again, Philip and I exchanged looks, this time with a touch more consternation. I repeated my efforts. Again, no response. I now took a deep breath and knocked and repeated much louder, “I am a researcher from University of Toronto who is expected at a review board hearing; my research assistant and I were directed here by mistake. Please, could someone let us out?” Another split second of silence. Then a woman’s voice, which it was soon apparent was a nurse, responded chidingly, as if talking to a “misbehaving” child, “Well, you don’t have to raise your voice”—clearly the type of condescending “correction” that inmates are subjected to daily. A helpful piece of information and an object lesson on how inmates are treated.

Shortly thereafter, unlike with the vast majority of people who find themselves locked up,  we were “released” (Philip, me, and the orange chair, which Philip was now carrying again) and we quickly found where the review board panel was. Naturally, soon after arriving, we told people what had just happened to us. Everyone immediately laughed at the error. And then one member of that panel joked, “Oh yeah, and no doubt you said that a mistake has been made and you don’t belong here—as if they don’t hear that from everyone all the time!” Again, everyone laughed—this time, everyone except Philip and me. The obvious assumption behind the joke is that the two of us were credible because we were researchers, because we were professionals, whereas everyone else making such a claim was by definition non-credible (what presumably made the joke “funny” is that the “sane” people sounded just like the “insane”, that is, that people who might be called “us” sounded just like “them”). Question: Why is everyone else non-credible? And what does it mean that the very review panel to which inmates are appealing, to whom they are saying that a mistake has been made, intrinsically regard them as non-credible?

A moment of truth, unnoticed by the busy officials around us, who quickly went back to thumbing through “the documents”—the “evidence” of “incapacity”. And yes, another object lesson.