No 1. On being a fellow human being

This blog was written in November 2022 and published in our newsletters and website in 2023.
Dear friends and colleagues,
This blog post was first published in Katarsis, which is a psychological journal at the University of Bergen, Norway. The author is Malin Dysjaland.

You know the human rights, the universal rights that we all have? The rights that are violated in situations of war and conflict, and that leave behind survivors who may one day need our help. The rights that sometimes have to be neglected when a person is a danger to themselves or others. How can we use these rights actively, rather than nodding approvingly and think of them as words on a piece of paper?

One day in September, I’m sitting down outside my new job. I am waiting for time to pass because I don’t want to arrive awkwardly early. Feeling the heat of the sun, my mind keeps pondering. I applied for this job because I wanted to see for myself, see what psychosis really looks like. I also wanted to confront my own prejudices, for example that working with people with severe mental illness is reserved for the extremely patient and courageous of us. I wanted to experience how psychosis can develop, rather than just read about it, and seeing it as something frightening and distant.

The people I’m about to meet may be serving a sentence, or they may be admitted for other reasons. Closed ward. My heart is pounding. Am I going to get hurt? Do I have to take part in coercion? Am I strong enough for this job? Am I kind enough towards people I don’t understand to even work here?

Nora Sveaass, the human rights legend, talked to me and the rest of Psychology Students Without Borders (PUG) about a metaphor. It is used in the Mental Health and Human Rights Information manual, for the training of helpers working with women who are survivors of gender-based violence. “The butterfly woman” was her name. In her left wing she had good memories of the past, and in the right, she had hope for the future. That was until the terrible event happened. She was raped during war, and the content of her wings was shattered.

With good support from a helper, she found coping strategies, and her wings were gradually restored. She was a survivor. Her helper used a human rights-based approach. That is, they preserved her mental and physical integrity through actions, and gave her the knowledge she needed to report what she had been subjected to. It could be as simple as asking “Is it okay if I sit here?”. It could be offering a hand to hold during a visit to the doctor’s office, since she didn’t feel safe last time.

Perhaps it is important to safeguard the dignity and integrity of mentally ill and institutionalised individuals too, even in the most extreme situations. That’s what the author of the book Tomorrow I’ll Always Be a Lion said. Here, Arnhild Lauveng, who went from being institutionalised and psychotic to becoming a psychologist, talks about a sense of security during the use of restraint belts; “I knew I had no choice; I knew I couldn’t get loose, and then the voices [in my head] would calm down, that is, they would if I felt safe. For me, it felt safe when the nurse put a blanket over me”.

There are many survivors in psychiatric wards. Many have experienced the loss of their physical and mental integrity in encounters with the health system. Perhaps because those who were supposed to help them did not have the competence or the awareness to protect their rights.

I stand outside the door of a patient’s room. He is about to be given his long-awaited cigarette. I knock gently, wait a bit, and then open the door. “Is it OK if I enter and bring you the cigarette, or should I wait outside?” It was the first time he smiled at me, then he said it was OK for me to enter.

I don’t think I necessarily would have given the patient this choice if I had never heard the term “human rights-based approach”. Don’t get me wrong, my colleagues do it too, I’m just not so sure if I would have appreciated the value of it without knowing the rationale behind it. Make no mistake, I don’t think that I have re-invented the wheel, but I may have discovered my own approach to human rights. Hopefully, it will grow and extend to more grave situations, for example if I ever have to mechanically restrain someone.

Another patient is having a bad day, there have been several incidents of aggression lately. I just recently got told that I “deserved to die”, and that I “didn’t care”. The patient asks if they can have a cup of tea. I smile and say of course.

In my mind I try to think of all the considerations I must manage; the cup cannot be breakable; the tea cannot be hot enough to do harm if it is thrown at someone. Choices I cannot leave up to the patient. “Do you want one of those brown cardboard cups, or a blue plastic cup”? The patient smiles and says they want the blue one.

It might not really matter there and then, or maybe it never will. Perhaps I’m fooling myself into thinking I’m doing something right. Still, it feels good to know I have tried as hard as I can. Tried to give people in a vulnerable situation the respect and dignity they deserve, even if it’s something as trivial as a cup.