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Using the law to fight for the vulnerable
maria [dot] lindh [at] kommunikation [dot] lu [dot] se (Maria Lindh)
- published 27 May 2021
"Mastery of the law gives you power. And I want to use that power to support the vulnerable" says Sofia Åkerman, doctoral student at the Department of Law with personal experience of vulnerability and self-harming behaviour. She survived, but several of her friends did not.
The Lego bricks occupy a central position in the middle of the living-room floor of Sofia Åkerman's home, a terraced house in Bjärred. The two children, aged five and seven, are at daycare and school this morning, as the biting north wind rules out the possibility of an outdoor interview.
"Help yourself to coffee in the kitchen", says Sofia, settling down with her teacup in a roomy sofa with a view of the garden. The safety net around the trampoline (which takes up most of the lawn) is flapping wildly.
This is where she also grew up and experienced the worst time in her life as a teenager, when she developed both an eating disorder and self-harming behaviour.
Psychiatric care powerless facing self-harming girls
At that time, in the 90s, psychiatric care was completely powerless when faced with the young girls who most often showed these behaviours. Sofia Åkerman and several of her friends in similar situations were severely affected. Some of them are no longer alive. She recounts how she did several dangerous things herself, but never wanted to die.
"Self-harming behaviour is so complex, which is probably why many people have trouble dealing with it. Public healthcare is still fumbling to find solutions – even though many things have improved", she says.
Driven by obvious deficiencies and struggling friends
Knowledge has increased and this is largely thanks to Sofia Åkerman herself. Her books, Zebraflickan [The Zebra Girl], För att överleva [To Survive] and Slutstation rättspsyk [Last Stop, Forensic Psych Ward] received a great deal of attention when they were published in 2004, 2009 and 2011. For many years after that, she was a frequent speaker to both public healthcare staff and lobby organisations in the whole of the Nordic Area. She also founded the non-profit association SHEDO for knowledge, support and opinion on eating disorders and self-harming behaviour.
"Those were intense years. I was driven by the obvious deficiencies. Even after I had started to feel better myself, I observed them again and again through previous friends who were still struggling".
She also received thousands of emails from sufferers and their relatives after The Zebra Girl was published, which prompted her to remain committed.
Wrote a book for her children's sake
Last autumn, Sofia Åkerman published a new book, Ärr för livet [Scarred for Life], which describes her own journey, but also follows a couple of the young, self-destructive girls she got to know around the turn of the millennium.
"I feel so over my own medical history now. But it was important to write it, also for my children's sake, as being able to read my whole story when they grow up will make it easier for them to understand. I was so young when I wrote The Zebra Girl, which felt incomplete. The new book became a rewriting and a conclusion."
From institutional care to some power in society
Sofia Åkerman herself is fascinated by the journey she has been on – from years of being sectioned and undergoing institutional care to now having some kind of power in society. It feels almost unreal, she finds, but also so hopeful.
"It feels so good to have my entire story written down now, even though it was often painful to go back to that time", she says.
As a lawyer she could do most good
It was during her most intensive commitment for the women who were sent to the forensic psychiatry wards in Sundsvall and Växjö, without having been convicted of any crime, that Sofia Åkerman started to pay attention to law. By then she had already trained as a nurse so as to be one of the positive forces in public healthcare where she had suffered so much herself. But it became obvious to her that she could do most good as a lawyer when she discovered that the way young women with self-harming behaviour were treated in the forensic psychiatry ward in Sundsvall came under the UN's definition of torture.
"That is, the use of isolation, straps and other methods of impairing movement such as restraint mitts and hockey helmets – as punishment. So not only to protect the patients from harming themselves and others, but as a purely disciplinary measure."
There was a lack of knowledge in compulsory healthcare law and Sofia Åkerman discovered that the situation was equally poor in the control stations around the healthcare system. It seemed impossible to rectify the shortcomings.
Represented several vulnerable woman to HSAN
She recounts how she and her co-author for Last Stop, Forensic Psych Ward Thérèse Eriksson, turned to all the institutions you are "supposed to" call on when, as a citizen, you discover irregularities – to the supervisory authority, the ombudsman and the police. Despite this, the mistreatment didn't stop. Only when they both acted as representatives for the vulnerable women and brought a number of cases to the Medical Responsibility Board (HSAN) did it lead to disciplinary sanctions and so much criticism in the mass media that the forensic psychiatry ward in Sundsvall stopped admitting women with self-harming behaviour. A national project was launched to improve public healthcare and the National Board of Health and Welfare investigated how common the use of unauthorised restraints was in psychiatric care. Due to changes in legislation and in public opinion, the forensic psychiatry ward in Växjö also decided to stop admitting self-harming patients in 2014.
"It felt hopeless when we were fighting our hardest. But with hindsight I can see that our work really did make a concrete difference", says Sofia Åkerman.
Detained for two years with people committed for crimes
The reason why young girls with self-harming behaviour were detained together with people who had committed serious crimes, mainly men, was that twenty-four-hour care in general psychiatry was not intended for long-term treatment, but only for emergencies. Despite this, Sofia Åkerman was detained for two years.
"And those of us who were there only got more and more ill. The principle behind the care was to protect us from ourselves and the world beyond the ward, which made a healthy everyday existence feel increasingly remote."
She says she was lucky to meet a brave physician who eventually discharged her, marking the start of her salvation.
The idea was that the forensic psychiatry wards offered a type of long-term treatment, which was why the self-harming patients were sent there. Not necessarily with any evil intention, says Sofia Åkerman, who avoided this fate herself.
"Healthcare staff believed they had done everything they could for these patients and did not know what more could be done. So the solution was to send them to the forensic psych ward."
Researcher within medical law
When Last Stop, Forensic Psych Ward was published, Sofia Åkerman was studying her second semester on the law degree programme; she is now in the second year of her research studies. For a long time, she wondered what research subject she would choose and had her doubts about getting too close to her own personal experience. So she didn't choose compulsory psychiatric care.
"I was afraid that if I did, my research would not be taken seriously because of bias. But is there any such thing as completely objective research?" she wonders.
However, it was important to research something she was passionate about and she found that subject in medical law. Now she is investigating how systemic and individual perspectives are weighed against each other in cases of medical error-related injury. She explains that it is now considered important to have a culture of patient safety, a permissive atmosphere that supports openness to enable lessons to be learnt from previous events and to build safer systems.
"At the same time, healthcare staff have personal responsibility in the exercise of their profession. So it is a difficult balance in terms of the situations in which personal responsibility is to be demanded."
She also points out that there is a conflict between the increasingly strong focus of public healthcare legislation on systems, and the criminal justice system's focus on individuals and reprisals.
She was a bit worried last autumn about how her book Scarred for Life would be received in her workplace. She did not need to be.
"Several colleagues have said that they like it. And it is even included as suggested reading in our specialisation course on medical law."
Åkerman has taken part in a research seminar on the book and the Law Society has highlighted self-destructiveness in its seminar series "Daring to speak" for students.
"It feels as though I have opened up the possibility for conversations about not feeling OK. Many people feel lonely in that situation and believe that everyone else is doing just fine", she says.
Sofia Åkerman is grateful that she has emerged from the patient identity and found a positive context at the Faculty of Law.
"My story is written on my body in the form of scars on my arms, so I will never get away from it. But it is important to know that I have never been refused a job or treated badly because of the scars. People see that this is a part of my story, which has contributed to making me the person I am. But it is history now", she says.
The first edition of Lund University Magazine – LUM – was published 1968. Today, the magazine reaches all employees and almost as many people outside the university. The magazine is published six times a year. Editor Maria Lindh.