In social science, agency is the ability of individuals to have the power and resources to fulfil their potential. It’s one independent ability to act on one’s will. John Locke pointed out that the concept of agency is the capacity of individual beings to shape circumstances in which they live. And Jacques Rousseau called it free will.
How do we exercise our agency? It all depends on a particular cultural and societal structure. As individuals we don’t operate in a vacuum. We have to abide by cultural and moral norms of the place where we live. For instance, in the Netherlands women have big agency. They receive good education at school, and can pursue a career of their choice. But if we look at women in Afghanistan, we can say that women there have zero agency. They can’t receive education, have to cover their faces, and can’t leave the house without a man accompanying them.
The agency is discussed in great length by many scholars, but what I miss is the analysis of the agency when someone is diagnosed with ‘severe mental illness’, such as bipolar disorder, and schizophrenia.
The structure in which psychiatric patients live is pretty much determined by the psychiatry, and the psychiatry has authority on people who ‘dare’ to be mad. Many of them end up in a psychiatric hospital, where the agency is totally taken away. Doctors give a diagnosis to the patient expecting him/her to ‘recover’ usually by the means of a psychiatric drug.
There isn’t much research done into the agency and severe mental illness inside the psychiatric institutions. Mostly the researchers look at the agency and its role in recovery from severe mental illness. They look how to develop agency ‘in the context of recovery’ (Lysaker and Leonnardt, 2012) and how they make meaning in their lives, like, for instance, returning to work.
I believe, however, that we should look at the agency of the psychiatric patient when he or she is in a psychiatric hospital, and especially when this person is detained against his/her will. This is total refusal of agency. The patient who is already very distressed, quite often, is heavily drugged and told that he/she has a severe mental illness. Some patients are being placed in closed units, and can’t even go out for a walk. I was once detained under mental health act in England, only because I was proclaiming I was Jesus. I was placid and docile, just basically seeking a respite in a hospital, because when I experience ‘psychosis’ I do need a place of rest. Unfortunately, there is nothing else available (at least where I lived and live now), such as Soteria house, and thus, I mostly went to the hospital all by myself, seeking help.
‘’Just let me be’’, I would ask my doctors, but it never happened. You have to accept the medication they prescribe and you have to follow the rules, such as showing ‘insight’ into your illness. You need to nod that yes, my religious visions are just hallucinations, and yes, I have to nod when the psychiatrist tells me that I am not Jesus, and it’s delusion of grandeur on my part.
The agency becomes dead in such cases.
I can talk only from my own experience, but it takes me months to rebuild my agency after a spell in a psychiatric institution. When I emerge from there, usually heavily drugged, I feel shame, guilt and despair. How come, I ask myself again and again, that religious revelations are put into the framework of an illness, where I don’t feel ill, but just overwhelmed by my visions? It takes me months to rebuilt my identity and start to trust myself again and my own thought on the matter of my psychoses, and rebuilding of the agency has nothing to do with recovery. I am not sure as from what exactly I am supposed to recover! From messages from God? From being a devoted Christian? Yes, I can act normal, but returning to my work is not the main part of rebuilding my agency. Rebuilding or rather maintaining my agency would be if I got a more compassionate treatment while in the hospital, talked with my doctor as an equal, and took an active role in deciding which medication (if any) to take, at which dose and for how long.
The agency of a psychiatric patient should stay intact while inside the psychiatric hospital, and not after.
I talk about the ideal situation in my book ‘Elena: A Love Story for Humankind’. In it a Russian woman diagnosed with schizophrenia and personality disorder ends up in a psychiatric hospital in England. She gets lucky because she meets there a nice, kind doctor, who basically saves her life. As I argue in my book, a trauma-based approach is needed in treating the cases of ‘severe mental illness’, where the doctor engages in a dialogue with the patient, instead of depriving him/her of any power, over-medicating and releasing him/her back into the community with offensive diagnosis, and little hope for the future.
Leave a Reply