Context-Informed Care: A Lonely Path

Context-Informed Care: A Lonely Path

Emily S. Cutler

I am about to have surgery, and as a victim of involuntary commitment and sexual violence, I am absolutely terrified. I have been in a state of relentless panic for the past several days.

Today I had my scheduled phone call with my anesthesiologist. The first thing I said to him was, "I am extremely anxious about all medical procedures and get very very frightened in medical settings. Do you feel comfortable dealing with issues like that?" He immediately replied, "Oh yes, of course. We have plenty of anxiety medications for you."

I want to make it clear that I am not at all anti-medication. In fact, I have spent the past year or so realizing how frequently I don't fit in with antipsychiatry or even critical psychiatry circles because I believe that psychiatric drugs can benefit people greatly, and I have absolutely no issue with people taking psychiatric drugs (or using any kind of substance) as long as they have informed consent.

But the anesthesiologist's response to me felt infuriating. Instead of taking some responsibility for what he or the hospital might be able to do to accommodate my anxiety or create an environment that feels safer for me, he immediately rushed to recommend medications to change my internal state. Instead of asking whether prior trauma might be making specific aspects of this process stressful for me that could be changed, his first instinct was to just offer some drugs. 

My critique of psychiatry is not about drugs. It is about the fact that people's contexts are not considered when deciding how to address distress and crisis. 

Surgery is an incredibly disempowering setting. The medical system is inherently laden with power dynamics: not only do medical practitioners possess epistemic authority, but they also have the power to inflict or relieve physical pain. Feeling intense panic and anxiety is a natural reaction to being powerless, especially for those who have been made keenly aware of power dynamics through prior trauma.

And yet, the anesthesiologist I spoke to could not even fathom that perhaps my anxiety was created by the power dynamics of my context. He reacted with genuine surprise and confusion when I explained that having my mind altered by potent medications would make me feel even more anxious - after all, not being able to retain information or hold a conversation can increase feelings of powerlessness quite drastically. 

There are a million other solutions he could have offered besides immediately suggesting drugs that will alter my brain in a major way. For example, he could've asked about bringing a support person with me, putting numbing cream on my skin before any injections, or informing me of exactly of the name, dosage, and effects of each drug would be before administering it into my IV (and giving me veto power). Any one of these options would have given me more agency and reduced the power imbalance, thereby reducing my anxiety.

Of course, context-informed, power dynamics-informed care sometimes includes drugs. Sometimes people may choose to take drugs to cope with an inherently disempowering situation and that is perfectly valid. But the question is one of, "How are you coping with your context?" rather than "How can we fix you?"

What a lonely path to walk. To be too pro-psychiatric drugs for most antipsychiatry circles but to be too conscious of power dynamics and pro-context informed care for most medical settings and mainstream society. 

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