Restrained by Daniel Åberg

RESTRAINED

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A journey through psychosis as a doctor and the search for compassionate care

Maria Ingström

RESTRAINED

–A journey through psychosis as a doctor and the search for compassionate care

Mindboozt Varberg Sverige

Layout: Daniel Åberg/Åbergs stilus et forma

Photo: Anneli Jäderholm & Linda Weichselbraun

Translated by Joakim Pedersen

Printed by Totem, Poland

ISBN: 978-91-990367-3-1

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This book is intended for informational and reflective purposes only. As every individual’s life experience is unique, readers are encouraged to apply the content with care and personal responsibility. The publisher disclaims any liability for outcomes resulting from the use, application, or interpretation of the material presented.

Thoughts on the Book

by Sven Román

I’ll get straight to the point: the book you are holding, Maria Ingström’s Restrained: A journey through psychosis as a doctor and the search for compassionate care, is unique, and I recommend it in the warmest possible terms.

In a deeply moving introduction, Maria Ingström describes how, at the age of 25 and with one year left of medical school, she was struck by a manic episode with psychotic symptoms. The depiction of how her condition led to her being essentially mistreated within inpatient psychiatric care—subjected to many and extremely long periods in restraints, incorrect medication, and severe overmedication—is downright terrifying. Unfortunately, her description is largely representative of the psychiatric care we have in Sweden today, in 2025. Based on my own experience, I would argue that things have even gotten worse since Maria Ingström was admitted in the early 2000s.

Since childhood, I have had something of a special interest in bipolar disorder and have read a great deal of literature on the subject, both non-fiction and biographies. Furthermore, between 2013 and 2014, I worked as a senior consultant at the Unit for Young People with Psychosis/Bipolar Disorder in Stockholm, the world’s first specialist clinic for adolescents suspected

of having these often chronic and very serious conditions. My experience there reinforced one of the author’s key messages: patients with psychotic symptoms very rarely have a psychotic disorder or bipolar disorder.

In her book, Maria Ingström does not only tell her own medical story. She also broadens the perspective, describing in an educational and accessible way the treatment for psychotic disorders that dominates Sweden and the Western world today. She meticulously reviews the side effects of the prescribed medications and, finally, highlights how care for psychotic disorders could be radically changed in a much more humane direction, and with better results.

She specifically portrays the psychosis care based on the Open Dialogue model, as practised in Tornio, Finland. This approach has resulted in what is likely the world’s leading psychosis care. One need only look at the figures from the book, which show that the incidence of long-term psychosis and schizophrenia has fallen from 33 cases per 100,000 in the 1980s to 2 cases per 100,000—a reduction of a full 94 percent.

I mentioned at the beginning that I have read many books on bipolar disorder. In my opinion, the finest account is Arvid Lagercrantz’s ’Mitt galna liv’ (My crazy life): it is accessible and compelling, describes the psychiatric condition with clarity and objectivity, and admirably illuminates how both heredity and environment interact in the development of bipolar disorder.

Maria Ingström’s book surpasses Arvid Lagercrantz’s. She too describes her psychiatric symptoms in a sober manner, but she also has an important and clear message: we need an entirely

new form of psychiatry for patients with suspected psychotic disorders and bipolar disorder. She believes the current pharmacological era needs to be abandoned in favour of major investments in psychosocial treatment. We need to understand that the patient’s symptoms are most often due to a life crisis and that, in the vast majority of cases, they can make a full recovery with patient-centred psychosocial treatment that involves their loved ones..

Sven Román

Child and Adolescent Psychiatrist

Stureby, Stockholm, 11 July 2025

Everyone you meet is fighting a battle you know nothing about.

Be kind.

Always.

Ian MacLaren

Preface to the book Restrained

This book is an important testimony to a reality that can affect any one of us. It contains two parallel narratives: a depiction of the treatment one receives within psychiatric care, and a personal, honest story about falling ill with a mental health condition. These narratives are relevant to how we design the care of the future and to how we give the sick hope and strength. On the one hand, there is the desire to develop a healthcare system built on evidence, respect, and a focus on recovery. On the other, there is the realization of how vulnerable the individual is when encountering the healthcare system—especially in the most vulnerable moments of life.

The scientific foundation of psychiatry is essential: symptom assessment, diagnostics, and treatment based on the best available knowledge have made a huge difference for many. But this is not always enough. There are still obstacles—structural, cultural, and economic—that hinder a caring and humane approach.

Prejudice, a lack of trust, understaffing, insufficient resources, and outdated methods can stand in the way of safe and dignified care. For example, the use of coercive measures like restraints still occurs, even though modern, evidence-based alternatives exist.

The so-called Icelandic model shows that it is entirely possible to provide psychiatric care without the use of restraints.

By working with alternative methods—such as therapeutic presence, a relationship-building approach, and modern pharmacological treatment—even very difficult situations can be managed without violating the individual’s integrity or rights.

This book is an urgent contribution to the discussion on how we can develop psychiatry into a more humane, evidence-based, and legally secure form of care. It offers a unique insight into what happens within the system—and what is possible when care is at its best.

This book is of great value. It is written in the hope of being able to change and improve the way people are treated within psychiatry. It offers an honest and personal look into Maria’s fight against mental illness—a complicated and sensitive situation when the doctor herself becomes the patient. It is a story that testifies to courage and strength—a hero’s tale with a happy ending.

Ólafur Ævarsson

Dr. Ólafur Ævarsson is a doctor of medicine and specialist in psychiatry who has worked in Sweden and Iceland.

Introduction

“The room was spinning, panic swelled inside me. I couldn’t move; my arms and legs were strapped down. In the doorway, a doctor stood looking at me like I was completely insane. Isolated, locked in, and cut off from the outside world. Just weeks before, I had been the one in the white coat, discussing patient treatments with my colleagues.”

This is the story of how I, a doctor-in-training, suddenly had a psychotic break. From one day to the next, everything changed. Instead of being the caregiver, I became the patient, committed to involuntary care. But this isn’t a story of ruin—it’s a story of struggle, of insight, and of triumph. I fought my way back and rebuilt a successful life. This is the book I needed to read back then—and maybe, it can change someone else’s life. By sharing my story so openly, I want to show that what we call mental illness can strike anyone. And that healing and a return to well-being are possible. But I also want to show how vital it is to believe in your own power—whether you are a patient, a loved one, or a professional. Psychiatric care is still defined by coercion and abuse. There is a power imbalance and a purely biological perspective that doesn’t help patients. It hurts them. The WHO and the UN are shining a light on the fact that

psychiatry must change from the ground up. It must shift from a biomedical paradigm to a focus on human rights, with a holistic view of human suffering and hardship.

That is why psychiatric care in Sweden and across the Western world must be transformed and reorganized. Not least because this makes entirely different outcomes possible—like healing three out of four cases of psychosis. But also to make care more humane, and to ensure more people can receive it. These are changes that, in the long run, will also lead to lower costs.

Our Nordic neighbors have already implemented humane methods with strong scientific backing—approaches that benefit patients, staff, and families alike. It is possible to get well again, through compassionate communication and loving care.

Once we understand this, we can begin to let go of the prejudice and fear surrounding mental illness. Then, we can change society’s stigmas and culture of blame.

We also need to remember that we are not just a body with organs like a heart and a brain. We are something more—we are a soul in a body, a part of the universe. To be human is to think and to feel. Let us be allowed our feelings and our thoughts. The people who have been cared for—and are still being cared for—in mental institutions over the last 100 to 200 years deserve justice for the abuse they have endured.

Together, we can create a new form of psychiatric care where human connection and dialogue are at the very center.

Because it is among loving people that we heal and find our strength.

Part 1. My Psychosis

1 .

When I suddenly have a psychotic episode and end up on the other side of care

The shock – The first feeling that something was wrong

I’m 25 years old with one year left of medical school, when something happens that changes my life. From being on my way to a future as a doctor, I suddenly find myself on the other side of care with a manic psychosis, which psychiatry considers one of the most severe mental illnesses. I’ve just finished my clinical rotation in psychiatry and I’m studying for my final exams. Life feels amazing because I’m newly in love. Everything is light and easy. We’ve just met and I’ve come with him to his hometown. We know each other from growing up and it turns out I’ve been his dream girl since junior high. Everything is moving at a furious pace and after a week, we’re engaged.

The year before, I had a passionate love affair with a doctor, and I still love him. But for a long time, I’ve felt a deep uncertainty about whether a future together is possible. He already has a family. Why would he choose me over them? He never

RESTRAINED

– A journey through psychosis as a doctor and the search for compassionate care contains a medical student’s experience of a manic psychosis and care within Swedish compulsory psychiatric care. 23 years after the event, and with 22 years of professional practice, Maria decides to openly share her experiences with the aim of relieving people’s shame and guilt around mental illness, creating hope, and highlighting the problems of violence and power imbalance in psychiatry that still persist.

promised me it would be us. I’ve been brooding so much this past year, over the infidelity, the love, and our relationship. So when I meet the man who’s dreamed of me for years, I fall head over heels and decide to end our relationship.

Over the past year, I had sunk so deep into rumination and sadness that I had trouble getting out of bed. I don’t understand why I feel so bad, but the situation becomes so difficult that I decide to seek help. At the health clinic, the doctor says I have depression and that I should start on antidepressants right away. For the first time, I take a medication, Cipramil, that affects my brain. It feels scary. In the beginning, I feel dizzy and a little nauseous, but after a week or so, that disappears. A counselor helps me to endure, and together we try to prevent me from having to take a break from my studies.

Psychoses are described in the book from the inside and from a doctor’s perspective. Maria has worked in the very clinics where she was once treated. Above all, the goal is that human rights should be respected by banning violent practices such as restraint, and by spreading and applying other humane methods with successful treatment outcomes. As a role model, she highlights psychiatry in Iceland and above all sees the working model Open Dialogue as the way forward for a humane psychiatry.

“Open Dialogue is a well-researched treatment model and a way of organizing psychiatric care. Developed in Tornio, Finland, with the aim of changing the prognosis of longterm psychotic disorders such as schizophrenia. With the best results in the world—where 3 out of 4 first-episode psychoses recover—it deserves to be spread to more than 35 countries and applied worldwide, not only in psychosis but in all psychological crises in children and adults.”

After a month or so of treatment, I start to feel more like myself, and after six months, the medication is tapered off and stopped. I feel so good again. In a way that makes me wonder if it’s normal. I feel a lightness and joy that is a huge contrast to my previous sadness. My doctor asks a specialist for help to assess if what I’m experiencing is an illness. If maybe I’ve become 1hypomanic1.

This is two months before I fall ill with psychosis. But the psychiatrist doesn’t consider my state to be abnormal. He relates how I’m feeling to how it was during the depression and explains that the contrast is what made me react. But I’m not sick.

1 Hypomania refers to a persistent elevated mood or irritability, but is less severe than mania.