Saturday, September 14, 2013

5150: One Who Flew Into the Cuckoo's Nest by Kathi Stringer

5150:  One Who Flew Into the Cuckoo's Nest, Kathi Stringer.  self-published:, 2011 and 2007.  e-book, 416 pps.

I have been aware of Kathi Stringer and her contributions to mental health via her essays for several years.  Her website can be found at:  The content of her website has changed somewhat throughout the years.  In its' present form, it contains some very well-written essays, some information about trainings that she has conducted, and stuff about her book 5150.  So I decided to get the book.  It was not all that I expected.  It was far more.

It is an act of bravery when any person who has received one or more mental health diagnoses freely talks about their symptoms.  We live in a society which retains some xenophobic leftovers from the days when tribal unity was all-important to survival.  Some of diagnoses have become especially problematic to the individuals bearing the labels.  Giving a survivor of horrific childhood abuse a diagnosis of Borderline Personality Disorder [whether the symptoms fit or otherwise] often heralds that survivor as having a reputation for being an uncooperative, argumentative, spiteful patient.  The diagnosis Multiple Personality Disorder has been recently changed to the lesser known Dissociative Identity Disorder.  Folks used to refer to people with MPD as "Sybils."  The new name hasn't been largely associated with the movie or the book yet.

Kathi Stringer is a trans-folk who has been through quite a lot.  She survived an abusive childhood only to have her abuse replicated at the California psychiatric facility where she had to go in order to be stabilized on medication.  There was a doctor there who came off as being quite the bad guy.  His reported encounters with Kathi Stringer can only be described as controlling and condescending.  The institution certainly made some mistakes.  I think the worst mistake was the "red tape" which forced Kathi to ask permission for basic things such as going to the bathroom or getting a drink of water.  The raid and seizing of her personal possessions is something that would have sent me into a fury.

There is an essay in the back of the book which Kathi Stringer wrote and which should be read first by any reader unfamiliar with infantilism.  Kathi Stringer does have that.  She refers to "Little Kathi" throughout the book.  Although she wanted to be diagnosed as having some form of DID in the book, Little Kathi did not come across to me as a true alter.  Folks who have survived childhood trauma do become multiples but not all do.  Some percentage of the ones who remain singletons have primitive unmet childhood needs and may prefer to think of their expression of those needs as other-- a part of the personality that is somehow contained within yet separate from themselves.  The arrival of a self-induced personality fragment may be thought up in adolescence or early adulthood.  Although I don't believe that Kathi Stringer in 5150 evidences true multiplicity, I am certainly willing to accept the necessity of what I remember from basic psych classes  what was referred to as  "regression in service to the ego."  And I can certainly understand why staff rejection of Kathi Stringer's need to feel and act little via little Kathi would result in her feeling that staff has also rejected Kathi Stringer the adult.  The clinical picture was complicated by her probably medical need to wear diapers.  [My speculation is that perhaps something went wrong surgically during one of the sex-change operations when the genital-urinary system was reconstructed but I don't really know]. 

Bruno Bettelheim was one of the remaining champions of the idea of allowing the patient [or specifically children at the residential school he founded and was director of] to regress via the use of baby bottles at will.  Kathi Stringer wrote a letter to him and was privileged to have received a response which basically said that her using a bottle, blanket, and stuffed animal at times comforted her, did not hurt anyone, but that she should not make her need for transitional objects known.  I found the idea that he had written back to her to be very believable.  Naturally, the court and court players did not.

Kathi Stringer in the book did have a view of what would constitute the mental health treatment she needed-- hospitalization on a unit where she would be given free rein to be little Kathi and to have nurturing parental responses from all staff.  She had not come to the conclusion at the time of the writing of 5150 that this was an unrealistic expectation and that her childhood lack of nurturing was something that she would have to learn to address in a different way.  In spite of the popular axiom, you cannot have a happy second childhood.  Adults who have survived neglect and/or abuse have to learn how to nurture themselves in whatever form that takes while also keeping the adult intact.  Not knowing this, Kathi allowed herself to roam the streets of her city in a regressed state which directly resulted in contact with police and at least one psych hospitalization.

The evil shrink/ Medical Director had decided that Kathy Stringer had Schizo-Affective Disorder rather than Major Depression.  His stance was that she would not receive any psychological treatment while in-patient until she had agreed to take an anti-psychotic rather than the anti-depressant that she had stabilized on in the past.  He used the idea of little Kathi to justify her "need" to have a court-appointed guardian who-- as an employee of the State Mental Health Office-- would sign off on the use of the anti-psychotic even if Kathi Stringer refused it for good reason.  Unfortunately, she was forced to take the anti-psychotic and landed in restraints and/or in isolation for refusing to do exactly as the staff ordered her to do.  Specifically, the evil shrink referred to little Kathi as being part of an intermittent psychosis.  As a layperson with no special skills or qualifications and having never met Kathi Stringer, I totally disagree with this interpretation of her status.  Little Kathi is a construct in my view, and certainly not a psychotic construct.

Kathi Stringer had many severe personal losses which resulted in a high number of psych hospitalizations within eighteen months.  This was also used against her in court.  I did not think much of the legal approach of the professionals-- some of whom were endeavoring to protect Kathi Stringer from herself and a few who perhaps were a bit more sinister in their motivations.  I also did not think much of the conduct of some of the staff people on the mental health unit where she was housed.  Nurses who hide behind a desk gossiping rather than attending to patients on the floor is not a sight that is limited to mental health.  It happens.  It ought not to.  Even patients who are hearing-impaired usually have some speech-reading ability.  Staff people somehow think that all patients are not able to hear the gossip and laughter.  But patients can and do hear it.  In a situation where patients are being stabilized on psych drugs and may already be especially vulnerable, this gathering of the forces behind a desk or in an office within view of the patients ought not to happen.  Giving report is one thing.  Staff gathering around to "talk" is quite another.  No patient should have to wait for a mini-break to conclude in order to get their needs attended to.  Period.

Kathi Stringer went on to have most excellent successes after the period in her life described in 5150 which was unsettling and marked by frequent psych hospitalizations.  In fact, she is an advocate today for patient rights.  She served on a committee to reduce the use of restraints.  She also was invited to conduct an in-service for mental health professionals which she excelled at.  Kathi Stringer has written some excellent essays dealing with object constancy, countertransference, and borderline personality disorder.  I was happy that 5150 included the personal growth that Kathi Stringer experienced after the hospitalizations.

sapphoq reviews says:  I came away with an increased respect for Kathi Stringer through the reading of 5150.  This book illustrated some alarming flaws in the mental health system in Kathi Stringer's community.  5150 stands as a testimonial to the strength of a woman who has survived and is now thriving.  Highly recommended to professionals who work directly with people in in-patient and in out-patient mental health settings, as well as to consumers and ex-patients.

No comments: