Episode 12: A bad day at the office...

Patients in high security psychiatric care may lie. It is important to realise that no negative judgement should be placed on such a statement and to appreciate that there may be a number of reasons they do so. Reasons may include memory based trauma to do with psychological or physical injury – people may remember events in a very particular way.

Some psychiatric conditions such as Munchausen’s Syndrome have diagnostic criteria which includes the faking of physical or mental illness – for themselves, or in Munchausen’s Syndrome by Proxy – of others. This syndrome and some other psychological disorders are believed to be a consequence of severe emotional difficulties. Some people with schizophrenia or psychosis may express false beliefs and an inability to distinguish own thoughts from reality*. Some patients have disruptive behaviour or personality disorders and will be uncooperative, hostile and actively disruptive. Nursing and medical staff are committed to listening to the patient voice and astutely aware that many of the female patients have a dreadful history of not having their voices heard – in cases of abuse for example – and so take very great care to carefully evaluate information given by a patient. Over time and experience they learn to read body language, look for patterns and consider motivation. However, allegations against staff will always be taken seriously, even if they appear to be based more in mischief than reality. Staff in special hospitals fully understand this, but it doesn’t make it any easier to instigate an investigation - or to be investigated…

Communities of people with schizophrenia, especially since the development of the internet, have been challenging the notion that medics can talk about the ‘right’ kind of reality, whilst their own hallucinations are said to be ‘not reality’. They not unreasonably ask ‘how can you tell?’ Additional points have been raised about voice-hearing experiences being differently experienced and differently valued in other cultures. This is a fascinating area where the patient voice is central to furthering understanding, compassion and tolerance for difference.


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