At Maladjusted: A Poignant Reminder of How the System Defines Us

This is a guest post by CYH volunteer, Lyon Lin.

As a distressed young woman walks down from the audience and starts to share her story, everyone on stage stops improvising as they watch her break the rhythm of the forum. Her themes of her committal, an enforced medication regimen, grief, and finding love must have been familiar to an audience of whom the vast majority raised their hands when director David Diamond asked if they have had personal experience or knew family that experienced mental illness. David had someone on staff ready to help talk her down, but when they walked up the steps towards the exit she broke down again. Someone from the audience shouted “Stay!”, and others repeated the verb a few seconds afterwards. Tension in the room diffused and it felt genuinely touching that our space possessed such empathy. A few minutes later when the forum continued, I could clearly hear the young woman crying painfully backstage.

Quick background on the project. Maladjusted is presented by Theatre for Living (formerly headlines). It is an experiential and interactive play based on Augusto’s Boal’s Theatre of the Oppressed. It presents a short play about how health care currently treats the mentally ill. After that, members of the audience may replace the actors as they reenact scenes. David asks that they have an idea based on their knowledge and experience to present human-centred care policies for a scribe to record and later distill into a Community Action Report that will be sent to organizations such as the Mental Health Commission of Canada. When a scene is over, everyone on stage comments briefly about their character and then the rest of the audience pitches in. This is not the normal fixed reality sit-in-your-seat-and-watch play. You can still do that, I did that, but this play is directly contributing to real organizations, as well as heavily involving the audience.

I also attended two discussions in the dialogue series where panelists introduce who they are and what their experiences are with the system. Then, similar to the play, a moderator lets anyone from the audience open up on anything within the context of the broader topic to start an inclusive dialogue. I attended: “Cost of Caring: How values drive spending” and “What does getting better look like? The chemicalization of mental health care”. I’ve only been a patient in the system for a short time, and my mind is foggy (a cliché noun for easy understanding), something I’ve repeated to almost everyone, but the conversations in those rooms and the themes in the play were easily familiar to me. Nancy Keough and Heather Hay–panelist health care leaders–voiced that it is difficult to measure progress in patients after only treating them for short periods (a few months to a year). That reminded me of a recent follow-up appointment I had for a short therapy program I was in when I learned that the program got axed, probably because the city thought it wasn’t worth the funds. A lot of classic topics were discussed in the series. Impersonal doctors, harmful side effects, heavy focus on pathologies, lack of informed consent, no patient rights from BC’s mental health act, workers pragmatically worrying about lack of funds over patient care, corporations, omission of basic necessities in care services, lack of empathy, I think that was it. “Chemicalization” is a great term to describe where things are at. I’ve found that one of the easiest ice breakers between patients is to simply ask: “What meds are you on?” It’s clichéd as hell, but it is an inescapable part of a lot conversations I’ve had with other patients. Being that I’m still on meds, I felt very uncomfortable hearing people generalize about all psychiatric medications giving long term users permanent brain damage. I can’t think/have access to research to dispel that myth completely, but I felt like I was stigmatized for choosing to take medication. During my brief stay at a psychiatric ward, I noticed the Mental Health Act taped on a wall opposite the Nurse’s office. I can’t remember anything other than a woman that I briefly got to know well telling me that it was as if we didn’t have any human rights. This law sanctions institutionalized stigma. My favourite policy idea that I heard was an idea about giving patients the right to a lawyer, or at the very least some form of advocate, maybe an ombudsman that would allow patients the ability to say no to medications or institutionalization.

I’m writing this post to answer David’s final call of more audience contributions to the project, since I didn’t come up with anything during my attendance at Firehall. Being a sucker for any portrayal of mental illness in acting, even if they’re comedies that make light of difficult disorders or bleak dramas that don’t censor harmful coping strategies, I loved this. Interactive theatre that aims at creating real policy also helps my impression of the project. I am still going to lightly echo a criticism that a few colleagues at Check Your Head told me about their prior participation in previous headline plays; we feel that audience members act too much like stock saviours that aren’t realistic, sometimes portraying inappropriate ideas and use improvisational magic to steer everything towards a happy conclusion. Thankfully, I thought most of that was avoided the night I went, especially when David emphasizes the audience to act realistically, and moderates the audience actor if they go too far into fantasy.

There are six characters in the play: Dr. Devreaux (a psychiatrist), Abby Neill (a case worker), Jack Richards (a young man with a mood disorder who has a drug dependency),  Danielle Williams (a teenager later diagnosed with Bipolar II), Mia Williams (Danielle’s mother), and lastly Frank (Mia’s brother who works at a Recovery House). All of them are played by actors who have extensive personal experience with the system. The play is essentially a well-written stream of interactions that clearly illustrate classic problems with the system, ultimately none of the characters are on a conclusion that will resolve favourably. Paul Devreaux, Abby Neill and Frank Williams are becoming increasingly cynical and jaded about their work. Mia and Dani are becoming increasingly apart especially when, even while overmedicated, Dani increasingly harms herself. Jack has been in withdrawal for several days and he’s probably going to be turned over to the judicial system to be dealt with. And that’s where we (the audience) come in, although it felt like thanks to hindsight, audience acting mostly centered on avoiding any conflict as much as possible. As noble as that is, I didn’t learn anything from the forum. To give the forum credit, the stage actors and David kept everything real and improv performances like Dani conciliating with her family or Abby telling Jack the truth about Recovery House policy and protecting him from it, while they didn’t solve the characters’ problems, communicated hope for empathic human-centered care.

The few personal illustrations and other experiences I’ve told are only simple windows into the many common stories that are well-known among patients and health care workers. Too many of us feel that we can’t talk about what we experience to anyone else other than other patients and health care workers. Stigma can make people into professional patients, people who only know institutionalization. And when they’re out, therapy, other patients, medication, and struggling to cope with basic needs. It becomes a lifestyle.

My friends have told me that the one thing they want most out of our mental health system are workers that care. Human-centred care, as David emphasized. Yes, as the forum proved, it is quite difficult, and if I had any suggestions I would have went up, but I hope it’s not only a niche space like at Maladjusted that a woman breaking down would be so compassionately attended to.