finally an atla sideblog

What we know about the asylum from the ATLA universe is… not much, but the implication is that it's Not A Great Place. I've gone off of that information, but I've also heavily used the asylum in Fingersmith as inspiration. In the Victorian era, women (and men, but we're focusing on women here) could be institutionalised for a variety of reasons, from genuine mental illness (eg. schizophrenia, post-partum psychosis or depression) to social reasons (eg. prostitution) to much less acceptable reasons, such as wanting to get divorced, refusing their husbands, or the ever broad definition of hysteria.

The treatments that were included in these institutes also varied, but focused on things like menial work (mending, sewing, laundry), exercise, and even sexual stimulation. And although women could be discharged if their condition improved, many, once admitted, remained incarcerated for decades or even the rest of their lives.

The understanding around mental health has thankfully improved quite a lot since then, at least in the areas of the world I'm familiar with, but people do still have bad, even traumatic experiences in this regard. Mental illnesses can be incredibly difficult to treat, and there is still a lot of stigma surrounding the topic. Maybe you know someone who has been affected, or have even experienced it yourself. That is to say, while we have improved overall in our understanding and treatment of mental health, we are still lacking in certain aspects.

The UK introduced the Mental Capacity Act (MCA) in 2005 and it is in place to this day. It serves as a framework to protect people aged 16 and over who lack the ability to make certain decisions for themselves. There are 5 principles of the MCA: 1) the presumption that every person has capacity until proven otherwise, 2) the right to make unwise decisions, 3) offering practical support to make decisions (eg. ensuring they can understand and hear what is being discussed), 4) any decisions made on behalf of a person who lacks capacity must be made in their best interest, 5) any decision made on behalf of someone who lacks capacity must aim to restrict their rights and freedom as little as possible.

Essentially, the asylum I've chosen to portray in my ATLA fanfiction impedes on all of these principles, and you may see them in more depth in the next few chapters as well. Probably worst of all, the asylum staff in the fic have opted for the most, not least, restrictive options for their patients. This is exemplified by not only enforcing antipsychotic medication on “Azula” upon admission, but also by 1) holding her down and 2) mixing it secretly in her food, both of which are extremes of forcing someone to take medication.

During my residency, I worked a community psychiatry job where we looked over psychiatric patients in a variety of care homes, many of whom had varying forms of dementia, but also various other mental illnesses. Most of our work was actually related to de-prescribing antipsychotic medication rather than prescribing it, as many patients were being over-medicated and over-sedated when they really had no indication for these medications.

Antipsychotics are fantastic, remarkable drugs in the right context, but they can be disabling in the wrong context. There are definitely people who benefit from them and should continue taking them. There are also people for whom the risks of antipsychotics are greater than the benefits. If someone doesn't need antipsychotics but, for whatever reason takes them, they are nearly guaranteed to develop extrapyramidal (Parkinsonian) side effects. These include masked facial features, tremors, a shuffling gait, repetitive movements / muscle contractions, which I have given to nearly all of the asylum patients in this fanfiction.

Initially, I'd planned for the asylum staff to incapacitate their patients as needed with chi blocking, as we see in the ATLA comics. But having seen the amount of vulnerable people who are on antipsychotics unnecessarily because it is easier to manage them sedated than to deal with them constantly calling out or wandering due to their mental illness… well, I thought to write about something I had real experience with, and an issue that is genuinely prevalent.

In the UK, there are essentially only 3 reasons to section (detain in hospital) someone  or put them on antipsychotics without their consent in regards to their mental health. These are 1) risk to themselves, 2) risk to others, and 3) severe agitation which could lead to the two previous reasons. That's it. These indications are also time-based and must be reviewed every few days / weeks / months depending on the section’s power itself, so that patients aren’t kept in an everlasting limbo. These frameworks all serve to protect vulnerable patients.

This framework does not exist in the ATLA fic I'm writing, and as such many characters behave in ways that are unacceptable by our modern standards. And while the staff in the asylum have reason to believe “Azula” could be a risk to herself or other patients/staff based off of what information they'd had previously, they haven't actually witnessed this behaviour. It's clear in the fic that “Azula” has no firebending or even physical power to hurt anyone at this time. So again, they all went way too far with that.

In any case, that's a bit of background for this scene in my fic and how I chose to write the asylum. I appreciate not everyone has the same interest in writing it out to be so abusive, and would rather explore the setting as a more modern one with real, valuable treatments, but this was a topic I wanted to explore and I hope I did it justice!