Losses of power and control are driving forces in a number of people’s \ experiences of emotional distress. Many people find that their emotional distress is rooted in past traumas. Whether trauma happened in the form of an accident, as a component of racism and other forms of systemic oppression, through physical, sexual, or emotional abuse, or in some other form, loss of power and control typically played a role. Even people who find their distress to be biologically rooted and seeming to come out of nowhere commonly find that these losses still factor in.
Unfortunately, such losses of power and control are often replicated within the systems that are supposed to be designed to support people through their emotional distress. These losses show up in many different ways in the mental health system including (but far from limited to):
- Use of violent and power-laden language like ‘non-compliant’
- Meetings held without the person present
- Food choices made for someone in a group residence (sometimes even using their own food stamp money)
- Orders to take psychiatric drugs a person may not want to take
- Diagnoses applied as if they are absolute truths with no space for other ways of making meaning of experiences
- Forced to live or room with strangers
One more subtle way that the mental health system replicates power imbalances is through the use of honorifics. Honorifics are used throughout our culture and include Mr., Mrs., Mx. (a gender neutral version) and beyond. However, in (and outside of) the mental health system there is one particular honorific that automatically seems to command a level of respect, credibility, and power unlike any other: Dr.
The power of ‘Dr.’ shows up in many ways. Even though they typically spend the least amount of time with a person receiving services, a doctor’s opinion on what “to do” with a person tends to carry the most weight, including whether or not someone should be forced into a psychiatric facility and/or to take psychiatric drugs. Meanwhile, doctors are least likely to be lured into a training that might discuss new innovations in working with people, but they still get paid the most. And, while much of that is for reasons well beyond their title, the reality is that people who carry that honorific are often the only ones not referred to by their first names even in a room full of providers, immediately elevating them in every space and every conversation into which they enter. They are the only ones (with a few other power-laden exceptions including judges, legislators, and so on) who wear their power in such a visible way. We are kidding ourselves if we fail to recognize how that regularly silences others and most of all the people carrying diagnoses that already draw into question the validity of what they say.
Perhaps this seems like a trivial point to some, but for many of us who have historically had our diagnoses listed next to our names instead of our academic degrees it is less so. The impact of loss of power and control can show up in many different ways. For example, research has found that loss of power and control contributes to increased suicide risk. And, it’s not simply the case that if there is any loss of power and control then there is some increased risk of suicide. No, rather, the more loss of power and control someone experiences, the more their suicide risk goes up, or so it would appear. For example, the Adverse Childhood Experiences (ACE) study found that people with an ACE score of 4 had a 1200% increased likelihood of having a suicide attempt over those who had an ACE score of 0, but for those with a score of 6 or more, that increased likelihood went up to 5000%.
The Wildflower Alliance found similar results when they conducted some research on the impact of the loss of power and control many have experienced through the COVID quarantines on suicidal thoughts. Specifically, among those who participated in the research:
- Among people who had no history of being in a locked psychiatric facility or experience force in the mental health system, 25% of them reported an increase in suicidal thoughts during the quarantines
- Among people who had been in a locked psychiatric facility, 54% reported an increase in suicidal thoughts during the quarantines
- Among people who explicitly said they had experienced force in the mental health system, 60% reported an increase in suicidal thoughts during the quarantines
But this is not just about suicide. Research also suggests that— for people who hear disturbing voices or see disturbing visions— they are more likely to be able to navigate those experiences well the more power they feel they have over them; Not how much power the doctor has, but how much power they themselves have. And so on.
Again, this is not all caused by calling people Dr., but language is a powerful thing. It represents the invisible flag waving over each room and dictating who should be heard the loudest or shown the most respect. It undoubtedly signals to others whose opinions should hold the most weight, and who we’re allowed to question (or not). Fortunately, for those invested in dismantling power imbalances, it is also one of the easiest things to change. It carries no cost, and requires no change in legislation or even organizational policy. Who knows how different conversations may begin to feel if we simply start by changing this one little practice; Taking this one small step toward dismantling power imbalances and sharing power in new and different ways.
We recommend you try it. Start calling the doctors around you by their first names today. If you are an organizational leader, introduce it as a recommended practice and model it in meetings. If you’re going one-by-one, start with the doctors who hold the most privilege (as women and non-white doctors are already likely accustomed to this practice for very different reasons). And if you’re not willing, at least spend some time exploring why.