Freedom to choose? – a discussion

The following is based on a discussion on our Facebook group. We’ve taken what people have said, tidied up spelling, expanded abbreviations removed names. Every paragraph is a new point.

We have divided this post is into three parts for clarity 1) Choices and decisions, 2) Assisted suicide and 3) Recovery and Unrecovery.

Choices and decisions

Both ‘freedom’ and ‘choice’ are neoliberal fictions, the former a dangerous one right now

There is a difference between decision making and choice. Decision is a creative (or more accurately destructive) act, it is productive. Choice implies an externality. Something we are alienated from. A choice is proffered from the Other. The decision is the cut from those external choices. The power in diagnosis lies with the person making the decision, the psychiatrist, (or at least psychiatric discourse). The tantalising emancipatory light we are dangled in the deep is that we can take ownership of that decision. But to bite on that lamp is as emancipatory as thinking you are taking power at the till of a huge supermarket (that itself is one of many).

As I have said before it follows the same structure as M-C-M’ the general formula of Capitalism where decision making is M and choice M’ the commodity sold back after surplus profit has been extracted by the capitalist

All choice contains a loss.

I think it is importance to emphasise the importance of being able to make informed choices about treatment. Whilst the myth of chemical imbalance continues to be touted by psychiatry and the pharmaceutical industry many people continue to make choices based on misinformation. Psychiatric medication cause chemical imbalances rather than correct them and of course this may be helpful for some of us who are experiencing mental distress but don’t pretend to us that they have anything to do with curing mental illness even if they do help us manage our symptoms, especially whilst other options aren’t available to us.

Freedom to choose is an illusion. In psychiatry it is generally a form of ‘Sophie’s Choice’ where you are given options but they all benefit the provider of those options. And then responsibility is passed to the service user when things don’t work out because they ‘chose’ that path.

My choices seem to have been it’s either this or nothing and if you don’t agree you’re unreasonable. I have been offered things that won’t make a blind bit of difference just because that’s all there is.

I remember a service provider on CPD course I was teaching on telling me: ‘the more I hear the words ‘partnership’ and ‘choice’ – the more rigid and limited I see services becoming’

Choice, what choice?

Choice in MH is not just about choosing between pharmaceuticals as a psychiatric pharmacist once told me

I’d like to choose not to accept your diagnoses and to choose what treatments I won’t accept

True consent is only there are if you feel equally able to say yes or no

Change choice to privilege

Is free a reference to liberty, or is it a reference to the way our bodies and work are used once we are labelled?

Assisted Suicide

Another important thing I feel here is “choice” when it comes to assisted suicide… in this context choice becomes a measurable outcome because only if everything is offered can it be discussed in liberal terms…. not against assisted suicide, just against how people seem to be so pro it yet silent over mental health support. It’s an easier option, this normalisation worries me and is a big paradigm shift that is needed?

We don’t have that “choice” in the UK, but I think we should because it’s the ultimate “choice” anyone who really suffers should be able to make.

That’s a tricky one. I’ve always supported assisted dying (for anyone regardless of any illness) & I have membership of Dignitas myself. However I don’t want it to be as freely available as it is in the Netherlands & Belgium without social justice & support. I’d want to see all preventable social factors removed. On the other hand, I can’t see that happening any time soon & can understand some folk facing the prospect of long term fear/uncertainty over ability to exist wanting an alternative now

I agree, but what do people do in the meantime? Things are only getting worse, not better. It’s hopeless…

You know my view on balance I’d like to see the option available now, but at the same time I accept and respect all the opposition there would be from disability groups. If there was a vote I would vote in favour

Also, discussing in big concepts often forgets the individual.

Sure, I totally own my comments in context of my individual situation. I’m not speaking for anyone else.
Out of curiosity (only if people want to answer), who could see themselves consider assisted dying (for whatever reasons)?

Eventually yes

Yes I would but not just yet. I’d like to plan it well in advance.

Same here I would but have a few months to plan

Would anyone involve their relatives? And friends?

I’d want to find my cats a really good home before I checked out. They’re the only reason I haven’t already…

It wouldn’t be easy to involve relatives if it were accessed without a degenerative or terminal condition. I think many relatives might object

I would consider it and have, but see that this is the way our Government wants us to think and behave so for me I would vote no right now as I do believe it’s the gas chamber equivalent for Tories. I want other fights settled before I feel safe to fight that one. Have witnessed a doctor doing ‘bed clearances’ with morphine when I was a young nurse so it’s close to the bone for me.

I completely respect and honour your position. I have also seen the protracted death horror of the Liverpool Care Pathway

I’m unsure…. I only know that being non critical does more harm than good, the fact it seems like an ultimate taboo to be discussed..

Suicide is unacceptable…. assisted is

Assisted is dignified, painless and humane

A problem is that ‘assisted’ might open the door for ‘encouraged’ or ‘coerced’ – as we’ve seen with the commodification of ‘choice’ within personalisation – so whereas I support the right to die where when and how – it would require very strong safeguards against abuse by those with vested interests (eugenics politics family gain etc)

In the UK we need to include Futile Care Policies in this discussion – where a clinical team, according to their OWN observations and apparent research, prejudices and cost of supporting someone to continue to live (using their own assessment of quality of life), decide that only palliative care will be provided or that a future life-threatening event will not be treated. This is one element of the ‘slippery slope ‘( NORMALISATION ?) some disabled people protest about. This can be challenged though a judicial court order but trying to support a person (my late husband) in this situation and get all the necessary legal support is somewhere I and our daughter don’t ever wish to be again. It’s a real condition that someone who wants to live is denied it and some who wants to die is prevented. Loads of factors involved here!

Recovery and Unrecovery

I view current neorecovery as contemporary normalisation – infact that’s my new term: neorecovery to distinguish it from recovery

It’s a tough work reclaiming and distinguishing that from angst/anger/frustration. Last couple of days posts have really helped.

For me it’s not reclaiming as recovery never meant anything to me, it’s just differentiation

Yes, Foucault couldn’t have said it better

“Our body, our choice.” On all matters of Health, actually: “No bodily authority beyond me, no jurisdiction higher than my sovereignty.”

Freedom is more important than health as without freedom we lose our will to live.

That has never been truer than now

Choice – recover or stay ill. Which is why I stand for Unrecovery.