Discussion of Super-ordinate Theme Two: Terrifyingly Out of Control –

Findings of the present study also indicate that involuntary hospitalisation can be experienced as frightening and chaotic, with the ward itself being perceived as an absurd-lade e i o e t i hi h patie ts ul e ability can be further pronounced. Thus, the individuals in the current study described in detail about being confronted with an overwhelming sense of powerlessness and at times an infuriating and futile

struggle for freedom and agency. Thus on one hand, and in accordance with Fou ault s ie , patie ts a e pe ie e the sel es as helpless i ti s of the powerful structures of the mental health system (Fendler, 2004; Giddens, 1991); however, on the other hand, powerlessness can give rise to the feelings of anger (Johnson et al., 1998) and as Chambers (2005) argues, patients can exercise some control through resistance and non-compliance and such endeavours have been described by the participants of the present study. Nevertheless, Chambers (2005) suggests that any form of coercion may trigger unintended consequences, as non- compliance, in one way or the other, would be an understandable response to such measures. However, this may form a vicious cycle of further distress and even necessitate subsequent involuntary admissions, generating and reinforcing the feelings of coercion and powerlessness (Chambers, 2005). These occurrences are also portrayed in the accounts of the participants of this study. Thus, it seems that the ward frequently provokes profound feelings of impotence and worthlessness.

Patients often experienced staff members, who exerted their power over them and adopted a patronising attitude. Most individuals also felt that there was a distance or a battle between them and the professionals and felt attacked by the staff. Thus, patients often felt fragile and unprotected at the whim of an omnipotent and totalitarian system and in the hands of uncaring or even abusive staff members. Individuals often viewed themselves as having no credibility and being defenceless and alone in their predicament. The ward was often depicted as reminiscent of the prison and nurses resembling the jailers, the police or referees, rather than carers. Individuals experienced their treatment as degrading in many ways. Not being app oa hed ith espe t a d ei g oe ed, st ipped of o e s ights a d p i ileges often seemed unjust and humiliating. However, in some cases, it was also perceived as a o fi atio of o e s i e evilness, and therefore experienced as punishment, violation and oppression. Notably, it has been previously accentuated that patients can experience their involuntary treatment not only as imprisonment but also as punishment (Roberts et al., 2008; Katsakou and Priebe, 2007). Individuals often described how staff members did not allow much room for manoeuvre, and flexibility in their approach might have offered the much-needed opportunity to rebuild and ei state o e s se se of effi a . “u h epo ts see i li e ith the classic debate concerning psychiatry and its institution, which has been viewed as patriarchal in culture by exalting mastery and domination. Foucalt (2004) coined this phenomenon po e o alisatio , which threatens the patient identity (Thesen, 2001). Reciprocity, collaboration or interplay and empowering opportunities seem to have formed rare instances. However, they constitute a powerful reparative and healing component. Such non-involvement of patients in their own care has also been long noted in the literature (Deacon and Fairhurst, 2008).

In line with existing literature (Sainsbury Centre for Mental Health, 1998; McGeorge et al., 2000; MILMIS, 1995; Barker, 2000), patie ts ti e o the a d is also characterised by a sense of insecurity, as they described being exposed to various threats, which the had to i u e t i o de to su i e . For example, facing the prospect of being restrained or mistreated by the staff, bearing witness to fellow patie ts st uggles, as well as, being exposed to the violent behaviour of other patients. Physical restraint was particularly depicted in terms of assault, which often elicited the feelings of bewilderment and dismay to the necessity and reasons for its implementation. Participants also noted how medication seemed to be the main concern of the staff in the ward, constituting to a bigger priority than their well-being. Medication was associated with the unpleasant side effects, which often contributed to the feelings of being out of control or not being able to rely on anything that was previously familiar and safe. Medication, however, is also noted to have alleviated the psychotic elements in the end. Forced medication and particularly injections represented the coercive, invasive and intrusive elements of the treatment. Patie ts difficult relationship with medication during psychiatric treatment is also highlighted in the literature as being largely counter-therapeutic (Hagen et al., 2010; Rogers et al., 1993; Rettenbacher et al., 2004; Mancini et al., 2005; Flynn and Bartholomew, 2003). Present findings, therefore, mirror previously demonstrated the possibility of distress being retriggered in a vicious cycle by interactions on the ward that may seem punitive and resulting in a profound state of disempowerment and hopelessness (Hart, 2004; May 2004).