WOMEN’S EXPERIENCE IN THE PSYCHIATRIC SERVICES – APPEARANCE AND ARTICULACY
Following a few comments on our Facebook Group, about how some of us were lounging about in our PJs on a Sunday afternoon, a discussion about how women’s appearance and behaviour can affect how we are seen and treated in the mental health system. Joanna said there was potential for a conference and research on the issue of women’s appearance in Mental Health services as it impacts on diagnosis, assessment of needs and risk.
So we decided to start with a blog post based on a couple of discussions in the Facebook group.
HOW WE LOOK
Joanna: ‘Dishevelled/smelly (I currently qualify) required for SZC/psychosis. [Joanna is currently waiting for a plumber to fix the water supply in her flat!]. Medical student told me that during her MH placement a psychiatrist said he knew if a woman had BPD “just by looking at her” and he referred to “too much eyeliner” or skirts being “too short”.
Joanna: Some women have been refused help because they looked ‘too smart’
AE: Many women I know need to dress well when feeling bad and put on make up in order to get the strength to leave the house at all. Like putting on a costume and mask to hide behind when in public.
Joanna: for some women putting on reasonable clothes, looking clean, bit of makeup has nothing to do with ‘care’ or function even. It can be as you say the only way to face the outside world. It can also be a protection because looking dishevelled actually draws attention. It might also be the only thing a woman feels able to do for herself taking a lot of effort
Michelle B: make-up has had the thumbs up that I am well enough if I am wearing make-up — this is a sexist thing make-up hair die and so on, clothes yes angry if in red yellow or other colours
Victoria: I will never forget a comment from a nurse when I was 17 – 17-“”you silly girl, you’re pretty, there’s no need to hurt yourself”….?!?!?!?
Anon: When I was 17, my first hospitalisation… From a nurse, “but you look like a model! You shouldn’t be in here…”
Deborah: The first time I saw my psychiatrist he said in front of the ward round that I was ‘an extremely attractive young woman” and then seemed to use it to negate my description of how bad I was feeling. Sadly from then on because I hated being called that and for fear of not being believed I looked after myself less and less, doubled in weight, barely washed by hair and only wore black. At least 15 years later (after I had moved 100 miles away, still had a couple of appointments with him a year but didn’t feel under constant scrutiny) I dared to wear something brighter and put on some lipstick. And yes, you’ve guessed it, he immediately said how much better I was!
Katy: I asked my friend to buy me prison-style garb last time I was in hospital coz I was being treated like a criminal offender or a thug…a nurse in the PICU braided my hair to complete the look smile emoticon
Lydia: In my craziest days I used to test out the system. If family claimed I was ill and I had to be assessed I used to wear something slightly outrageous and it would always be picked up on by a psychiatrist. (Shows I WAS off my head to risk that). I can’t tell you the number of times my appearance has been commented on in nursing reports though, and I have spent hours changing trying to decide what to wear to give a psychiatrist or social worker the right impression e.g. not red — he already thinks I’m angry. And that’s too bright = high. Lawd what a pain!
Joanna: Assumptions are made about women who self-harm in relation to their appearance and mental state. For example, “what’s a pretty girl like you doing this for?”, and “you’ve defaced yourself”
Joanna: Through to accusations of “flaunting” of the body if any scar is visible
Joanna: Weight and assumptions. It’s always assumed that any woman with an above “normal BMI” through to “morbid obesity” has a “good appetite”. I have seen friends in hospital going doolally through lack if nutrition but staff ignoring because of their weight & assumptions. Conversely, thin women harassed endlessly about eating.
Tincey: From ignoring weight as a factor to not understanding metabolism and stress, policing the body seems to occur (at least for women, can’t speak for men) across the board in medical or other services, along with moral judgement. I was seriously ill and having a lecture on being overweight, not taking into account the various factors involved (so common to have issues in PTSD and CPTSD). So many services still espouse the idea that it’s calories in/calories out and that it’s down to our beloved ‘lifestyle choice’ so lectures along the lines of everything will be fine if you stop being a pig — miracle cure.
Joanna: Not eating, weight loss, dishevelled is the correct appearance for women SUs
Sue: I rarely leave the house without full make up /extra defence mechanism/protective layer which apparently means all is OK. And I agree with the BMI thing-still not malnourished looking enough for help apparently and if I try to lose more weight to tick their anorexia boxes I’m obviously acting out using BPD attention seeking tactics.
Liz: My favourite thing I read about myself is that once in an appointment I “sat down very aggressively”
Liz: Oh I have long been told “clothing” part of my various pathologies, this is nothing new comrade……dark clothes all the same colour safer.
Lydia: I’ve always felt that my image doesn’t help. There’s some idea that I’m a quiet wallflower, which is clearly not the case, and the more I try to act in the way that’s expected the less I am me, but I’ve also tried being myself and it means a very long section. Compliance is the key.
We made the links between appearing smartly dressed and being perceived as articulate — professionals often mistake these as meaning the person is functioning and not in distress. Alternatively, articulacy can increase the risk of being diagnosed with BPD or confused with pressure of speech and hypomania.
Katy: My ‘articulacy’ was called hypomania…I told that shrink that I was not being hypomanic — it was my intelligence talking and if he could not keep up I’d talk more slowly for him !
Jane: Yeah I had pressure of speech because the psych reviews were less than 10 mins and he wouldn’t let me get a word in. So in 2 mins a week I was meant to cover everything.
My psyche has always commented on my being intelligent and articulate, and if quiet & less arsey would be more worried re mental state
Sandra: Also I think noting if had not bothered looking better dressed. GP frequently tells me her comments on my insight. Think can be misleading re how feeling
Sandra: Maybe we would all be shocked to see how we are perceived in notes by all profs
Joanna: “Insight” doesn’t = coping or not at risk. Every woman I’ve known who has died by suicide was intelligent & articulate & had “insight”. They just couldn’t get support.
Sandra: Yeah that the most scary when I have felt at real risk have been seen to be coping well.
Joanna: I’ve been considered suicidal when I haven’t & never been accurately ‘assessed’.
Sue: ”You’re obviously an intelligent woman-I don’t know why you can’t deal with your traumas in a more appropriate manner”
Joanna: Intelligence meaning that automatically means there’s no distress
Joanna: Why is this not said to Stephen Fry?
Sue: Because he’s rich and privileged
Joanna So only poorer intelligent people supposed to think their way out of distress
Sue: Yes and PD diagnosis = “at it”
Joanna: Intelligence = insight
Anon: I can relate to this so much. One example I can give is phoning the (needless to say useless) CPN’s once when very distressed & suicidal, to be told “you’re an intelligent woman, you tell me: who’s in charge of your actions? Who’s in charge?” as if that would be “empowering” in some way…
Anon: Also being denied crisis care because I was “articulate” “intelligent” and “displayed good insight”… If you can describe your experiences of mentalness then you don’t need support. And if you can’t communicate them you don’t need support either, because “we’re not mind readers! ”
Anon: I came to the conclusion months ago that the only way to get support in a crisis is through actions, not words. Which obviously is incredibly risky. And “manipulative”
Sue: Being processed through the self harm team telling them I’m going to OD again without extra support and being told that’s my choice.
Sandra: Never ever be angry, because that is only behaviour of loons, don’t get angry with receptionists at CMHT who are asking bloody personal questions cos of course none of these ppl ever get angry fuck fuck
Joanna: Anger is particularly not acceptable from women & black men
Lydia: And swearing is not acceptable from “respectable” women which means I’m not. Maybe I need to clarify that with my psyche next time I see him.
Megan: I am struggling right now, asked several professionals for help and was told no as I was articulate. Spoke to Social Worker and Support Worker and they seen I was struggling and said it was completely wrong to judge my mental state on whether I am able to complete a sentence or not. AHHHH!
Michelle CM: My GP told me I was “intelligent enough” to grasp the concepts of therapy from a self help book so I didn’t need a referral anywhere.
Naomi: I have had issues with being too ‘open’ in that they thought it was part of my BPDness and I should be avoided…
Joanna: but if you had not been open you would have been failing to engage.
Jane: relating this to appearance/articulacy — for a woman even being polite but distant is not enough — you have to come across as ‘genuinely’ warm, respectful, deferential, of staff. Also sense that if you do behave positively/politely but staff don’t believe you share their views then you are regarded suspiciously as manipulating them somehow. I think this reflects something I once read somewhere — in psychiatry ‘compliance’ isn’t enough you have to be brainwashed too — employees/workers just need to be polite/do what they are told even if they don’t agree — psychiatric patients have to agree with what is done to them or they are asked to do — domination not just of the body but the psyche too
When women seek help from services, especially when in crisis, we are judged on what can be seen and rarely given the chance to explain our distress. Workers refuse to believe we can be as distressed as we are because we can look ok and we are not given the chance to explore what is really going on beneath the surface. We believe this is based on sexist and sanist assumptions and on the pressure on workers to refuse services to cut costs.
As Michelle said “people judge you by this idea of femininity rather than as a person”
These are excerpts from two long discussions – we have only included comments from the women who agreed to be included.
We have rearranged the order of the comments in places to make it read a bit more coherently.
The discussion also included some linked issues:
- sexual harassment and abuse within psychiatric services
- judgements on our sexuality – our sexual behaviour, relationship status and our sexual orientation
- the intersections between gender and race and class
- women’s experiences in forensic and criminal justice services
We think these deserve more discussion – look out for future blog posts on these topics.