This statement has been sent to the Senate Foreign Relations Committee. There will be a second hearing on the Convention on the Rights of Persons with Disabilities on November 21, 2013. Related materials include a petition posted by the Campaign to Repeal Mental Health Laws, urging the Senate to ratify the CRPD without reservations, understandings or declarations (RUDs), and letters previously sent by CHRUSP and others opposing the package of RUDs.
Statement to the Senate Foreign Relations Committee on CRPD
Tina Minkowitz, Esq. November 19, 2013
The United States has been admired as a leader in the field of disability rights because of the ADA. However, the ADA is not the gold standard for comprehensive protection of human rights of persons with disabilities without discrimination in all aspects of life. That mantle belongs to the Convention on the Rights of Persons with Disabilities.
The CRPD drew from many sources, primarily from advocacy coming from the lived experience of people with disabilities in every part of the world. The United States and other governments contributed their own best practices, but the treaty resulted from a strong cooperation between governments and civil society – particular organizations of persons with disabilities. This author has intimate knowledge of the CRPD drafting and negotiations, having been one of the leaders of the International Disability Caucus, which coordinated civil society work under the leadership of disabled people’s organizations, and having been one of the twelve NGO representatives on a forty-member group that was designated to draft the text.
The CRPD innovates beyond existing domestic laws in important respects. It brings together the full range of human rights – civil, political, economic, social and cultural. It refers constantly to a transversal principle of equality and non-discrimination in the exercise and enjoyment of human rights and fundamental freedoms, but it is more than a mere statement that discrimination is to be prohibited; the obligations flowing from non- discrimination are set out in each field. The most transformative vision of the CRPD stems from its extension of the disability rights paradigm to legal capacity and personal liberty. Articles 12 and 14 require the elimination of guardianship, substituted decision- making, involuntary commitment and compulsory treatment – human rights violations which particularly impact people labeled with psychiatric, developmental and cognitive disabilities. This might be termed a “second wave” of the disability rights movement. It is not present in the ADA or as yet in other national legislations, but a number of governments and NGOs throughout the world are working on reform of law and practices to comply with the CRPD standards.
It is therefore disturbing to witness not only the numerous RUDs of unprecedented number and scope, but the intent of the RUDs as apparent from their content and from the statements of both Senators and witnesses in the Foreign Relations Committee hearings. It appears that the intent and effect of the RUDs taken as a whole is to preclude any necessity for action by the US to bring its own law into compliance with international standards that it would claim to ratify. Ratification on these terms violates the core principle of international law that domestic law does not excuse a government from complying with its international obligations1, and its corollary that states parties are expected to conform their domestic law to the requirements of a ratified treaty2. The United States cannot escape this obligation by declaring that its law fulfills or exceeds the requirements of the treaty.
People with disabilities in the United States – including those of us from the most marginalized “second wave” – need the CRPD to be brought into domestic law, including by compliance with the obligation under Article 4(1) to repeal laws which, under the terms of the CRPD, discriminate against persons with disabilities, and to enact legislation that may be required to implement the rights recognized. To reject this central obligation or seek loopholes to avoid it does a sad disservice to persons with disabilities, and is not in keeping with the purpose or principles of the CRPD.
If the US wishes to maintain its reputation as a leader in the field of disability rights, it is not enough to assist other countries in building ramps and developing accessible technology. Those are laudable aims but are at best half of what the CRPD requires. There is a new world in disability rights, and the US risks being left behind unless there is a reversal of course that commits to full domestic implementation in compliance with standards that have been set by the international community with US participation.
Please see www.chrusp.org and contact [email protected] for further information.
1 Article 27, Vienna Convention on the Law of Treaties, 1155 U.N.T.S. 331, 8 I.L.M. 679, entered into force Jan. 27, 1980. Provisions of the VCLT reflect customary international law accepted by the United States, see Chubb & Son, Inc. v. Asiana Airlines, 214 F.3d 301, 308-309 (2d Cir. N.Y. 2000). See also Restat 3d of the Foreign Relations Law of the U.S., § 115 (1)(b).
2 See objections made by Austria, Denmark, Finland, Netherlands and Sweden to reservations by other states parties to the VCLT. Similar objections have been made to reservations under the CRPD that give broad preference to domestic law.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
Mad in America has made some changes to the commenting process. You no longer need to login or create an account on our site to comment. The only information needed is your name, email and comment text. Comments made with an account prior to this change will remain visible on the site.
Brilliant, Tina. I appreciate your efforts on behalf of our movement so much. I am still working on fully understanding the UN stuff, but I will have it in my head soon. Cheers!
Francesca, I haven’t seen that Facebook page, but I do remember your saying that, for yourself, you felt that at a certain point in your life, you were glad that you were made to take psych drugs, even though at the time, you didn’t want them.
But you also said that in B.C, where you are, advance directives, or whatever they are called there, are not honored for psychiatric inmates.
It seems to me that the solution for someone like you is to have an advance directive that you WANT involuntary drugging under certain circumstances. To me, this would still be voluntary, because it would be a choice you make when you are competent to make that choice. You are not the first person I have met who would not force drugs on others, but would want them yourself at times.
Honoring those psychiatric advance directives would solve this problem for everyone.
Ted, great comment.
I agree wholeheartedly with you on this and deeply appreciate your input.
I’ve noticed that, in nearly every online discussion between self-described psychiatric survivors, there will crop up an outspoken person (or two, or three) who claims to have benefited immensely from having had psych drugs forcibly injected into his/her own veins; and, of course, there’s the influence of huge, Big Pharma backed groups like NAMI, that push such ‘medical’ procedures, I suspect there will always be plenty of people who defend such violent practices.
And, let’s not ever allow ourselves to hide from the fact that they are indeed violent…
They are procedures which are designed to ‘break’ a person down (though, yes, here we have a case of a person who claims to have received a kind of ‘pain’ relief from her having had so-called “anti-psychotic” drugs forced on herself.
I will not dispute her interpretation of her experiences.
But, of course, for every one of those people, there are at least a hundred (or maybe a thousand or more) who, such as I, can all-too-well recall our having experienced nothing but the very worst, most traumatic sort of grief from such ‘treatment’ as this.
Such ‘treatment,’ as I recall it, was always purely humiliating, degrading and and in all ways (physically and mentally) torturous.
As there is just no way for medical-coercive ‘treatment teams’ to discern, in advance, between so-called “patients” who might be grateful in the end and those who would, instead, feel simply humiliated and broken, I suggest that, regardless of any and all anecdotal stories, from those ‘patients’ who feel grateful for winding up on the receiving end, of such violent ‘medical’ procedures, such procedures should surely be outlawed. Period.
On the other hand, promoting and defending personal ‘advance directives’ make sense to me.
Do you have any good links regarding them, I wonder?
Jonah, I don’t know if your comment was directed at me. I certainly do not advocate forced treatment but at the same time I acknowledge that it can be a necessary evil in a psychiatric emergency (or any kind of medical emergency for that matter).
I didn’t “claim to have benefited immensely.” What I said was that I was in absolute agony and antipsychotic injections brought me back to reality. I was beyond coherent conversation; I couldn’t even recognize my parents. Big Pharma had nothing to do with it! Being on fire hurts! I do defend their actions and I don’t think they can be fairly described as “violent.”
You say “yes, here we have a case of a person who claims to have received a kind of ‘pain’ relief from her having had so-called “anti-psychotic” drugs forced on herself.” That’s pretty offensive, Jonah, and you might want to think it over. It wasn’t merely a “claim” and it wasn’t merely “pain relief” and, like it or not, some of those drugs are anti-psychotic. You imply that you respect my views yet your response is riddled with snot quotes.
If you think what happened was a human rights violation, then by all means state what should have happened instead. Funny thing is that, out of everybody who takes your extreme position, not one has yet come up with a viable alternative. SO PLEASE TELL ME: WHAT SHOULD THEY HAVE DONE????
Then you say “I will not dispute her interpretation of her experiences,” but clearly you are disputing them or at least belittling them.
I certainly acknowledge that most forced treatment is unconscionable but that doesn’t change the fact that an outright abolition isn’t going to fly.
No, my comment was not directed at you. It was directed at Ted. His comment was good, IMO.
I was (and am now again, at this moment) hoping to elicit at least a quick response from him. I pray he might, soon enough, post a link or two with good info on the current legal status of personal ‘advance directives.’ (I’m curious to know how they’re generally viewed by our courts, which hold sway over our so-called ‘mental health system,’ here in the U.S..)
And, yes, I refer to our so-called “mental health system” just like I refer to its so-called “anti-psychotic medications.” I use that word, “so-called” quite frequently, as a way of pointing out my sense that certain things do not actually exist in accord with the meaning of their most commonly applied labels. Please, don’t presume my doing so is a personal affront against you or anyone else.
You say to me that my “response is riddled with snot quotes.”
Apparently, you took my words and my use of quotation marks very personally, Francesca — e.g., feeling that I was belittling your experience with so-called “anti-psychotic” drugs?
And, now you write, “like it or not, some of those drugs are anti-psychotic.”
Sorry, but I quite disagree.
In my view, some of those drugs may possibly be ‘anti-psychotic’ sometimes (briefly).
Certain psychopharmaceutical (prescription) drugs may have seemingly ‘anti-psychotic’ effects, sometimes, on some people (those individuals who are, by various accounts, experiencing ‘psychosis’); but, those same drugs can actually create seemingly ‘psychotic’ effects, at other times.
Also, people can be called ‘psychotic’ for all sorts of reasons that may be highly questionable (if not necessarily reasons plainly unjustifiable).
That may be the first step in qualifying them, legally, for involuntary ‘care’; and, so, then they can, indeed, be made, by all appearances, acutely ‘psychotic’ by forced imposition of so-called “anti-psychotic” drugs.
(I lived such experiences, many years ago.)
Some strong ‘hallucinogens’ (non-prescription and thus deemed ‘illicit’) may cause a similar seeming ‘psychosis’ in some people; however, some people claim to have had nothing but positive experiences with those drugs, which have supposedly greatly improved their mental outlook, overall, by way of their occasionally taking and experiencing the effects of such drugs.
Really, that sort of experimenting is not at all for me (never has been and never will be), yet I won’t ever begrudge any adult his or her choice, of partaking in such experimentation (so long as s/he doesn’t use it as an excuse for antisocial behavior).
You see, I look upon mind-altering street drugs quite like I look upon mind-altering prescription drugs. I don’t want any of them in my life.
But, by extrapolating from memories of my various past experiences with ‘extreme’ states of mind, and from considering what I hear of the reported effects of all sorts of mind-altering drugs (mainly from others’ first hand accounts), I say “NO” to all such drugs.
I will not even take aspirin or Tylenol (though most people may not think of those as ‘mind-altering,’ I do).
I say “NO”; though, of course, some of these drugs are clearly far worse than others, in term of the harms they can create; and, some of them are apparently potentially helpful for some people, when used judiciously and briefly.
(For that reason, IMO, few mind-altering drugs should be banned.)
But, it doesn’t make sense forcing any of these drugs on people, against their objections, because doing so is really a kind of ‘mental health’ high-stakes gambling — that’s like shooting craps in a casino, with other people’s money (and no permission to do so).
My life was all but totally decimated by such a crass ‘medical treatment’ gamble; that occurred at age 21; the effects still haunt me, in my current life, regardless of this fact that those incidents are now more than 25 years behind me.
You are not an American, and I think it’s hard for some non-American people to recognize the value of our Bill of Rights.
I will not go over those rights here and now.
But, I insist, in my humble opinion, that, according to the U.S. Bill of Rights, no drug that has been known (and which was, perhaps, designed) to radically alter a person’s way of thinking should ever be forced on anyone, except maybe if that person has created an ‘advance directive’ which clearly details the hypothetical circumstances in which, given half a chance to express himself/her clearly, s/he would actually choose to call for such use of force.
Finally, I disagree with the commenter, Cannnotsay, who, on another thread, has recently suggested that, only people who have been charged with a crime can be justifiably detained; I believe some people may need to be contained physically for a time — and can be contained, Constitutionally — but never ‘treated’ against their will, with brain-altering procedures.
(Again, I emphasize: The resulting effects of such ‘brief treatment’ can be devastating, in ways that no one anticipates.)
The violation of the brain (by pharmaceutical drugs and by shocking electricity) is what must be stopped.
That’s my view, based on experience and many years of reflection.
Fine, that you find appreciation for one experience of having had so-called “anti-psychotic” drugs forced upon you.
What more can I say?
Nothing I’ve said here should be taken as a personal affront, as I’ve said nothing personal about anyone, really.
I second this. Honoring advance directives should take care of the voluntary/involuntary thing. I would add however that in the absence of said directives, no assumption should be made that an individual agrees to dehumanizing so called “treatment”.
In general, I think, there is no assumption that the individual is agreeing. What’s being assumed is that it doesn’t matter if the individual agrees or not. I think it’s only up here that we have the offensive notion of “deemed consent.”
And, cannotsay2013, as you have stated we usually agree about most of these issues. Clearly, here we part. The word treatment, in the situation I described to you, need not be in quotes. It was a bona fide medical treatment — appropriate, effective, ethical, humane. It cannot be rationally faulted.
Yet again, nobody has provided an alternative to involuntary treatment in the situation I have described.
“Yet again, nobody has provided an alternative to involuntary treatment in the situation I have described.”
This goes back to the “retrospective validation” argument combined with anecdotal evidence that denies free will (what might be good for you, might not be good for somebody else), which, as I said, could be used to force all kinds of paternalistic interventions by government. I can certainly find people who could claim that they would be happily forced into a “fat camp” to lose weight. Said weight loss would probably have all kinds of collateral benefits (lower risk of diabetes, heart disease, etc). Yet, we don’t allow government to do such things. People who want to lose weight can do it voluntarily but government has no say in forcing anybody to lose weight.
The alternative is clear: you do something that is considered criminal, you get the appropriate punishment as stipulated by the law as anybody who would do the same thing but that would not have been labelled “psychiatric in nature”. You don’t do anything criminal, government doesn’t mess up with your life. Now, a different scenario is if you get a conviction, then I am fine with voluntary diversion programs, which BTW already exist, at least in the US, in situations in which somebody does something stupid under the influence of alcohol or drugs. That is my alternative: all forms of behavioral control should be channeled through the criminal justice system. No crime, no psychiatry (or astrology!).
“The alternative is clear: you do something that is considered criminal, you get the appropriate punishment as stipulated by the law as anybody who would do the same thing but that would not have been labelled “psychiatric in nature”. You don’t do anything criminal, government doesn’t mess up with your life. Now, a different scenario is if you get a conviction, then I am fine with voluntary diversion programs, which BTW already exist, at least in the US, in situations in which somebody does something stupid under the influence of alcohol or drugs. That is my alternative: all forms of behavioral control should be channeled through the criminal justice system. No crime, no psychiatry (or astrology!).”
You seem to forget that psychiatric incarceration IS behavioral control, and a form of imprisonment.
I was punished with restraints and an injection because I insulted the doctor (due to my intolerance of endless walking in circles, and endless waiting). I insulted her by removing two of her titles. Instead of calling her Dr. Borha, I called her Mister Borha. Instant take down. That isn’t the only time I was punished with restraints and an injection. There’s the time I needed to go to the bathroom but was paralyzed by fear and indecision. It was group time – I could go to group or go to the bathroom (and be late). One of the staff commanded me to go to group, instead of asking what the very obvious problem was (I was immobile). I couldn’t even speak so I banged my hand on the wall. Instant take down.
If you believe in criminal justice, you better wise up to the fact that a HUGE portion of “free” society, here in America, rightfully ought to be imprisoned. There are TWO prison systems and it really doesn’t matter which one a person goes to. They’re BOTH Hell.
Interesting that you mention astrology. This song makes me think of being locked up in a psych ward.
“You seem to forget that psychiatric incarceration IS behavioral control, and a form of imprisonment. ”
It is clear from the discussion that under my regime insulting a doctor would not be grounds for incarceration, psychiatric or otherwise, unless society decided to make it illegal to insult doctors (unlikely in the US, really).
My whole point is that with existing law psychiatrists have an unwarranted prerogative to take away people’s liberty outside the criminal justice system, which has a great deal of safeguards by design. That is plainly wrong.
Hi, Ted. Yes, I certainly agree with you on your definition of “voluntary” in this circumstance. British Columbia’s Representation Agreement Act should be amended to include mental health and, when I have time, I’ll investigate why it was drafted this way. I expect psychiatrists were given undue influence over the legislation.
I actually do have an Advance Directive but of course it doesn’t have the force of law behind it. I am just hopeful that my wishes would be respected. My family and friends know what and when I want something to happen.
I have several problems with this push for absolute abolition of involuntary treatment:
1. It has absolutely no chance of succeeding so it’s diverting legal and other resources from accomplishing realistic goals.
2. It makes it easy for the public to write off the entire psychiatric reform movement.
3. It makes no provision for situations like the one I described myself in several years ago.
4. It could be, at times, unethical and inhumane to uphold the new law.
5. If it were passed, mental health professionals would simply disregard the law. Once that door was opened, they would feel (more) free to ignore the limited rights we have at the moment.
There are lots of things that we could be working together on that would more effectively and quickly improve the lives of the psychiatrically labelled. I’ll save my proposed list for another post.
The one thing mental health professionals won’t do is break the law.
Keep at it Tina. You are on the right track.
Just to reiterate what I said to Jonah. For those of you who support an abolition please enlighten me as to what procedures should have been applied in the situation that I described. I’ve put this to various people and I’m still waiting for a response.
I support Tina’s stance so I will contribute a little. Involuntary commitment and forced drugging are the end point of a chain of events that have gone wrong. It’s the whole chain that needs to be addressed….it’s not just about taking involuntary commitment off the table.
Certainly I would agree with that! If effective, voluntary treatment was available, we wouldn’t have this mess to deal with. Remember Andrew Goldstein? Here was a guy who was desperately seeking help but was turned away. We don’t have the resources to help those who want it because we’re too busy forcing it upon people who don’t. And what did they do in response to this tragedy? Well, of course, they expanded forced treatment laws. Makes perfect sense to Fuller Torrey.
For starters, I want to say that I really respect what you are doing in BC to create a survivor community. I used to live in Vancouver, felt horribly isolated, and wished that I could have connected with the community there. I also have great respect for your eloquent comments on MIA, including the one above.
As for a reply, I am an unapologetic abolitionist who deeply feels the pain of individuals and families that see the good in forced treatment. Indeed, your critique is difficult to respond to. I have a very good friend whose sister went off the deep-end refusing help, and recognizing my friend’s pain and the disaster in her sister’s life causes me dissonance in my abolitionist stance. On the other hand, my own experience with treatment has revealed how ineffective much of it is even with consent and how forcing people to accept ineffective treatment may only serve to poison people against whatever utility such treatment may have to offer.
For me, the underlying issue is actually freedom of choice. If someone wants to use drugs, by all means. But their decision should _never_ be questioned based on their ability to choose. By the same token, if someone chooses to use drugs very infrequently or perhaps not at all, their decision should not be questioned. In my opinion, this right of choice is denigrated by forced treatment. Even your right to make an advanced directive in favor of treatment is undermined by the current climate that distrusts the choices of anyone with a mental illness.
I want a world where people do not reject treatment just because it might be forced on them. A world where treatments are evaluated objectively and not as instruments of power or conformity. Science would advance faster if we could only decouple our evaluation of the effects of treatments from the intent with which they were administered. Advocating for forced treatment is a bit like saying that slavery is good because it keeps slaves employed. Well, there are many other ways to keep people employed, just as there are many ways to administer effective treatments without forcing people.
Getting back to your point, what to do with people who refuse treatment but might benefit from it. Suppose for the moment that the treatment is unquestionably beneficial for this person. Why do they refuse it? Is it perhaps the threat of forced drugging that lies behind their refusal? If they think drugs are the devil, perhaps they are just responding to current societal pressures (embodied by the existence of forced drugging) to view drugs in a black and white fashion. Perhaps they have a reason that other people do not understand for behaving the way that they do. In that case, perhaps it is more productive to try to understand them (a la Open Dialogue).
I realize that my answer is unsatisfying. Particularly for people experiencing difficult, seemingly intractable situations. But forced drugging is not a panacea. It might even be part of the problem. Perhaps people would not resist drugs so much if they knew their choices were respected. Perhaps advanced directives would be respected if people were allowed an genuine choice.
In any event, whether you disagree with my answer or not, it is imperative that we on MIA have a sense of community that is stronger than our disagreements. A successful movement for change requires that our community has room for dissent and discussion. Thanks for posting.
I want to add: even if it is a bit tangential to the topic, can you share your ideas of other reform goals that you think might be more impactful in the short term?
Love to, and thanks for answering. Here’s my present list and I apologize if I posted some already:
– define consent in law as both informed and uncoerced; there can be no such thing as “deemed consent”
– define competence by independent assessment; merely declining medication cannot suffice
– legal standard for outpatient commitment has to be as high as for hospitalization [note below]
– include the mentally ill as an identifiable group under existing hate speech legislation
– amend Representation Agreement Act to allow for advance directives related to mental health
– make psychiatric coercion illegal [another note below] in any form including threatening involuntary treatment, losing social benefits or subsidized housing, avoiding the criminal justice system
– providing a free legal advocate for anyone given a serious mental illness diagnosis (this is a role I’d like to play, from something as simple as accompanying a client to her bullying psychiatrist’s appointments all the way to challenging forced treatment orders in court)
– making involuntary (except for emergencies) treatment impossible without a court order (I believe this is where our countries differ)
– something about drugging children but I don’t know what the hell to do here
– encouraging universities to do research on how many people with serious mental illness are actually just regular people who have had toxic reaction to their meds
– make medical support for tapering mandatory as too many patients get dumped by their doctors and end up going cold turkey with disastrous effects
Note: With respect to equalizing outpatient vs. inpatient criteria, this is going to help a lot of us. If the legal standards were the same, they’d be screwed. There simply aren’t enough hospital beds to hold us all. I have talked with others about this maybe being an avenue for effective civil disobedience.
Note: I use the term coercion separately from the word force. My reasoning is that coercion is a much trickier concept, harder to spot and thus more insidious.
Jonah, I wanted to write directly under your post but the “reply” button wasn’t there. Perhaps there’s a limit? Anyway, just a couple of things I wanted to say quickly:
1. I do have a tendency to take things too personally and for that I do apologize but it was easy to assume that you were referring to me when you talked about a woman here who wanted to be force drugged in order to alleviate her pain. That’s a very unfair characterization of the situation I was in.
2. Please understand that I don’t advocate forced treatment except in very rare and extraordinary circumstances like the ones I described. IMO, it’s not emergency psychiatric intervention that is the problem; it’s the soul-destroying lifelong outpatient commitment crap that’s got to go.
3. I can’t help but note that you were unable to answer my question, though. If force drugging is an abomination, then what exactly would you have done to help me? The phantom pain was still excruciating even though there was no stimulus. Surely to God you wouldn’t have just left me on the floor, would you have?
My answers to your three points, above:
1. I was indeed referencing your experience (as conveyed in your recent comments), I was not aiming to sleight you, belittle you or impugn your integrity.
I was actually hoping to avoid offering any sort of judgment regarding your experience.
Now, considering your response, I think: Perhaps, you should expect that your story will likely always create some amount of confusion, amongst readers, if and when you are offering only scant details.
From what you’re now saying about that experience, I’m inclined to gather that you were in actual (and substantial) physical pain; I wasn’t clear on that point before. (From what I had read you saying previously, I had wondered whether you had been in actual physical pain; I was thinking that maybe you hadn’t been in physical pain, but I was not judging you in any case.)
2. You say, “I don’t advocate forced treatment except in very rare and extraordinary circumstances like the ones I described.” Well, if you are talking about psychiatric ‘medicine,’ I oppose all of it, if and when it’s offered by force.
Meanwhile, here’s a bit of my admittedly very non-expert opinion, on what to do with people who are experiencing really extraordinary and persisting physical pain of unknown origins — pain that’s so very intense, it is creating utter panic and/or is really indisputably, totally impeding their ability to reason (e.g., making it impossible to recognize family members): IMHO, those who are experiencing such intense physical pain should, of course, be offered through physical exams, by competent physicians. But, presuming that the effects of that pain are totally impeding the provision of such an exam, pain-relieving medication, of some kind (i.e., a drug with notable anesthetic properties) should probably be offered; and/or, such persons should be offered muscle-relaxants and/or, maybe, ‘anti-anxiety’ drugs of some kind.
Hence, I seriously wonder why you are so satisfied, having been forcibly shot up, with so-called “anti-psychotic” drugs? (They are not considered pain-relievers.)
Even if you were, perhaps, then, unconsciously creating your own (very real) physical pain, via a temporary state of some sort of ‘hysteria,’ I seriously question their having opted to force so-called “anti-psychotic” drugs into you; to me, from the scant details you’ve offered, it seems that you were being viewed poorly, by doctors who were, most likely, highly invested in believing that you should be a psychiatric ‘patient’; the sort of ‘treatment’ you received (an injection of so-called “anti-psychotic” drugs) mainly serves to affirm (seemingly) that one ‘needs’ to be ‘held’ as a ‘patient’ of psychiatry.
(After all, psychiatrists are, in the eyes of nearly every society today, the lords and masters of all supposedly ‘psychotic’ people.)
Psychiatrists are proffering so-called “anti-psychotic” drugs, at every possible turn (and have been doing so for decades). Doing so makes them ‘special’ members of the medical community, relevant and ‘useful’ in cases wherein real physicians’ patients present difficulties that haven’t clear physical origins; often, such patients seem to ‘need’ psychiatry, as they cannot (seemingly) be otherwise soothed.
This is all to say, that your story (what very little I know of it, by this point) does not at all convince me that you were being well cared for, at that time.
In fact, I’m now wondering if you haven’t been fooled into presuming that so-called “anti-psychotic” drugs were then, somehow, the ‘one-and-only treatment’ that any doctor could have offered, which could have brought you back to your senses.
Given the fullest possible details of the circumstances of your condition (whatever it actually was in all reality, one can’t possibly know, not having been there), I suspect there are many non-psychiatric physicians who would explain to you, that, had you been in their care, they would have proceeded along different lines, quite effectively treating you without resort to psychiatry and its #1 form of indoctrinating drug (the kind of so-called “anti-psychotic” that’s most typically prescribed in ’emergency’ situations) in its very dangerous bag of tricks.
3. I have essentially answered your third point in my first two points, directly above.
But, here, for good measure, I add just a bit more, of what I would have done, had I been present, as you were suffering, as you’ve described…
You say (in your 2nd point) that, “it’s not emergency psychiatric intervention that is the problem; it’s the soul-destroying lifelong outpatient commitment crap that’s got to go.”
In my view, the latter is most frequently derived through the former.
I.e., emergency psychiatry creates life-long ‘patients’ of psychiatry, in many instances. (I nearly became such an instance, myself. Only my ultimate persistence, in absolutely refusing to be returned to the E.R. saved me from such a fate.)
I feel very strongly about this: No one should allow his/her loved ones to take their emotional and/or psychological problems to an emergency room, ever.
The risk of that potential ‘patient’ being harmed, there, by an on-duty psychiatrist, will always far outweigh the potential benefits of just doing ones best to quietly wait out the crisis and care for the person, by other means.
Also, I have studied hypnotherapy (I am a certified hypnotherapist, but I do not practice), and I believe that many emergencies, such as you describe, could well use the expertise of a really good (i.e., truly understanding and effective), seasoned hypnotherapist — as such a person would be well-versed in non-medical ways of reducing stress and reducing (even, quite possibly, eliminating) physical pain, especially if it is psychologically caused.
In considering a crisis such as you describe, once all conceivable physical causes for physical pain have been ruled out, one should begin to presume that underlying (unconscious) psychological causes are in play.
A really good hypnotherapist knows how to address such causes — even and especially with people who are seemingly incapable of calming down.
So, had I been present (e.g., had I been an observing family member, of yours, seeing that, you were in such a state, you could not even recognize me), I would likely have done my best to get you a good hypnotherapist, immediately; and, as I have no faith whatsoever in psychiatry (indeed, because I view E.R. psychiatrists as being, potentially, quite dangerous), I would have done my best to get all psychiatrists away from you.
Jonah, I was going by this (November 20, 2013 at 7:50 pm): “Francesca, No, my comment was not directed at you.”
What you call scant details I would characterize as deeply personal information. If anything, I have given too many details.
I’ve always been clear about the pain I was suffering. Not sure if it should be termed “physical” because there was no stimulus for it. In that sense, I guess, it might be called mental but I don’t know.
I said: “I don’t advocate forced treatment except in very rare and extraordinary circumstances like the ones I described.”
To which you said: “Well, if you are talking about psychiatric ‘medicine,’ I oppose all of it, if and when it’s offered by force.”
I take it, then, that I shouldn’t have been treated and should have just been left rolling around on the floor, screaming in agony.
As to your advice, pain relieving medicines wouldn’t be effective because there was no bodily mechanism for the pain. And tranquilizers might have made me more okay with the pain, but it wouldn’t have diminished it. There was no “offering” possible. I could not communicate except to scream incoherently.
Again, antipsychotics were the appropriate choice. The problem wasn’t pain it was perception.
Their actions were not based in any kind of ideology, as you suggest. They were the appropriate actions in an emergency, just as you would rush to push somebody out of the way of car, even though it could be termed assault if you really insisted.
I have shared more of my story than I am comfortable doing. They did a good job. Your suggested alternatives would have been ineffective. And, yes, I guess I’ve been fooled into thinking that they relieved my agony. Silly me.
There is nothing a regular doctor would have done except to seek advice from a psychiatrist and do it himself.
Yes, the path to outpatient commitment is through the emergency psych system. My point all along has been that it doesn’t have to be this way. They are two completely different scenarios.
“Quietly waiting out the crisis” is a naively formulated alternative. How long would have you let me scream?
I would have absolutely no interest in treatment from a hypnotherapist. In any case, in order for hypnotherapy to work, there has to be communication. This was not possible.
Looking for psychological problems would have been a dead end. This disaster was as a result of cold turkeying off various meds, consuming way too much alcohol and (cough) other chemical factors. I needed antipsychotics not talk about toilet training and unresolved issues with my parents.
When you say you “would have done your best,” what your words actually convey is that you would have left me to suffer. Please think about that for a moment.
“This disaster was as a result of cold turkeying off various meds, consuming way too much alcohol and (cough) other chemical factors.”
Francesca, pardon me,
If you have already offered that info (which I’ve quoted and put in italics, directly above), I missed it, sorry.
So, now I see, you are essentially saying, that you were suffering severe ‘withdrawal’ effects; that’s significant (QUITE).
It’s the explanation (and, indeed, reveals a clear, physical cause) for your burning pain, at that time, IMO.
I recall having experienced effects, along those lines, at least briefly, decades ago, as I went CT, off psych-‘meds’.
Wish I had realized that you were talking about withdrawal effects…
Had I known that, prior to offering my last comments (above and below), I might have offered somewhat different suggestions.
However, that’s not to say I feel I should retract anything I’ve written.
Simply, consider what I wrote as suggestions for those who might encounter someone whose extreme, burning sensations really have no physical explanation.
As for your faith, that so-called “anti-psychotic” drugs were the only way out of your pain; that you received the best possible ‘treatment’ from psychiatrists is your belief, I won’t begrudge you it.
You have considerable faith in Psychiatry. I have no faith in it.
I can respect you nonetheless.
Just, please, don’t expect me to buy that faith.
This is an article from the Scottish Recovery Network with some useful ideas. Involuntary commitment is addressed in the second half.
From your link:
“And finally, what about compulsory detention and treatment? Well first, we have to acknowledge that this is essentially incompatible with choice and control. In the short term we really need to ensure that there is a requirement for every organisation to have explicit plans to reduce its use (via increasing choice of support/treatment using personal budgets, easy access to support when a crisis is looming rather than when it has already arrived, joint crisis plans, advance directives, etc).”
This short-term plan would make an excellent long-term plan. I would completely support this in any way I could. But here it falls a part a little:
“Longer term equal citizenship requires equality under the law and repeal of laws that apply to only one group of people. There may be times when any of us lack the capacity to make decisions for ourselves, and we may decide that at such times others (of our choosing) need to make decisions for us based, where possible, on our previously expressed wishes in crisis plans and advance directives. The right to refuse treatment must be the same for mental and physical health conditions … this must be part of the ‘equality of esteem’ between mental and physical health services enshrined in the English mental health strategy.”
If our representatives are to follow our advance directives, then why would we need representatives? We would just have the law prohibit disregarding advance directives. Or is it somehow alright to get forced treatment if it’s on the say so of your representative? And the right to refuse treatment cannot be the same for mental and physical health conditions. Also like to point that not all physical health conditions are exempt. If you have active tuberculosis, you get treated. If you’re a JW and your kid needs a blood transfusion, he gets one. There are exceptions to every rule and that’s why blanket statements like the abolitionists want are doomed to fail.
There are other consequences too that should be considered. Say involuntary treatment was made absolutely illegal. Then along comes the situation I described. Any humane and ethical person would override the law. And no court on this continent would penalize that person. Once it’s understood that the law is meaningless, then the meagre rights that we presently have are in danger.
Jonah, I don’t understand this. Please clarify:
I said: “Like it or not, some of those drugs are anti-psychotic.”
To which you said: “Sorry, but I quite disagree. In my view, some of those drugs may possibly be ‘anti-psychotic’ sometimes (briefly).”
These statements aren’t at odds with each other. I don’t get the distinction. Would it have been better if I put “anti-psychotic” in quotes?
Anyway, I appreciate being included in the dialogue but could somebody please answer the question?
WHAT SHOULD YOU DO WHEN SOMEONE IS SCREAMING IN PHANTOM PAIN, IS ABSOLUTELY INCOHERENT, CAN’T RECOGNIZE FAMILY MEMBERS, IS BEYOND REASSURANCE AND IS REFUSING HELP?
Are you still going to deny relief on ideological grounds? This is why this extremist position is doomed.
“This is why this extremist position is doomed.”
I seriously question your assessment of my stated position. Why do you call it “extremist,” I wonder?
As for the question you’ve offered in all-caps, you can read my answer to that, in the comment I posted a little while ago, above (on November 21, 2013 at 10:38 am).
Jonah, yes, I did read your answer, and thank you. It’s just that it’s higher up the string because it’s a reply rather than a new post. And I have replied to your post up there.
I call the abolitionist position extremist because it involves a blanket statement, with absolutely no exceptions. Extreme. It disregards all factors except an unsupportable ideology. It’s not attainable and, if it were somehow attained, it would be neither practical nor desirable.
Holders of the abolitionist position tend to be extreme. (I wouldn’t include you here.) Discussion is shut down. I was BANNED from the Repeal Mental Health Laws facebook group for describing my situation. Wasn’t even allowed to discuss it. Refusing to engage in rational debate is one of the hallmarks of extremism.
It is an extreme position and it harms the entire psychiatric reform movement. It is unsupportable and will just give the general public more to reason to write us off.
In my opinion, certain members of the anti-psychiatry group are just as oppressive as psychiatry itself. There was a petition circulating to “end forced electroshock,” a cause I wholeheartedly support. Read a little further, though, and what they’re actually pushing for is ending ECT altogether. That’s quite a different animal and it’s deceitful not to make that clear in their title.
If people want ECT, then let them. Denying choice is EXACTLY what we complain that the psychiatric system does. I was kicked out of Psychiatric Survivors (another Facebook group) for stating that when I can’t sleep I take an occasional benzo. For this I was shrieked at for “advocating psych drugs.” I actually started my own Facebook group called “Surviving Psych Survivor Groups.”
Jonah, I did not say withdrawal effects. Cold turkeying may have been what started be on the path, but it was clearly the alcohol, etc. that did me in. I know this from previous circumstances that didn’t become psychiatric in nature.
“It’s the explanation (and, indeed, reveals a clear, physical cause) for your burning pain, at that time, IMO.”
No, what it provides is an excuse for you to jump on the one factor that could conceivably support your position. There is no evidence to suggest that the problem was solely with withdrawal. In fact, there’s a good deal of evidence that withdrawal was the least of my worries.
“I recall having experienced effects, along those lines, at least briefly, decades ago, as I went CT, off psych-’meds’.”
Every person is different. We all experience drug changes differently. “Along those lines?” As in similar to what I described?
“Wish I had realized that you were talking about withdrawal effects…”
But I wasn’t.
“Had I known that, prior to offering my last comments (above and below), I might have offered somewhat different suggestions.”
Perhaps. But I doubt any of them would have been practical. Just as, leaving aside the remote possibility of withdrawal effects, none of your suggestions (pain reliever vs. antipsychotic) were practical.
“However, that’s not to say I feel I should retract anything I’ve written.”
Nor should you. We have differing viewpoints. No biggie. Happens all the time.
“Simply, consider what I wrote as suggestions for those who might encounter someone whose extreme, burning sensations really have no physical explanation.”
No, I can’t consider what you wrote as valid suggestions. Hypnotherapy? Really? How about chanting and meditation?
“As for your faith, that so-called “anti-psychotic” drugs were the only way out of your pain; that you received the best possible ‘treatment’ from psychiatrists is your belief, I won’t begrudge you it.”
Nope, it’s not a matter of faith; it’s an accurate assessment. Wasn’t the only way out — suicide would have worked too. Thank you for not begrudging me a personal, well-support opinion.
“You have considerable faith in Psychiatry. I have no faith in it.”
Wrong. I have no faith in psychiatry. My situation had very little to do with psychiatry. A regular doctor would have done exactly the same thing.
“I can respect you nonetheless.”
“Just, please, don’t expect me to buy that faith.”
I can’t sell it to you because I don’t have it.
I’m posting this comment just to let you know that I’m now going to take a break (just a day or two), getting away from the Internet. When I return (hopefully, refreshed), I’ll review this page and re-read your comments — then offer at least one further comment, to include whatever thoughts, on these matters, seem as though necessarily ‘calling’ for expression.
I trust you’ll not take it personally that I’m experiencing this need now to pause.
Thanks for your impassioned determination to dialogue.
No problem, Jonah. Take care. I should probably give it a rest myself. I take these kinds of arguments way, way too seriously and they’re not really a good use of our time because we are never going to find any common ground.
Sometimes when I’m a little stress-y (exams or whatever) I make myself unplug the phone and turn off the computer for the whole day. This works well for me but I’ve never had the willpower to do it for longer than that.
I’m back (a couple days later) and feeling somewhat refreshed — except, having spent the past hours studying this page, my thoughts are now swimming. (Me thinks I’ve overdosed on words.)
Actually, I find myself feeling a bit miffed with a few things I’ve read here (not from you). Feel frustrated by the words of one commenter whom I’ll address with one or two points, after posting this comment to you.
Meanwhile, I agree with a lot of what was said, on this page, by some commenters!
I find myself in near-perfect agreement with Tina and Ted and Tom Jones.
Ted makes excellent points, addressing you (in both of his comments); and, I’m impressed by the thoughtfulness of Tom Jones, especially, as he addressed you in his last comment.
If you missed that comment, of his (on November 22, 2013 at 10:29 am), here’s the link:
Tom Jones does a great job of addressing some of the key concerns you’ve raised, regarding abolition; he’s an abolitionist (as am I), yet nothing he says could reasonably be described as ‘extremist’ in nature, so I think you might benefit from carrying on further dialogue with him, as he seems interested in dialoguing with you.
In fact, Tom Jones does such a great job with his last comment, I feel I have little more to offer you now, except this couple of points:
1. You say you have no faith in psychiatry, but you do have faith in it; surely you do.
Anyone who refers repeatedly to his/her belief in “psychiatric emergency” has faith in psychiatry — maybe not perfect faith, but faith nonetheless.
By virtue of your actions, repeatedly asserting that so-called “psychiatric emergencies” exist, you prove your faith in psychiatry.
You see, we have what are called “psychiatric emergencies” in our society, only because our society empowers psychiatrists to define all sorts of personal crises, that are of seemingly mysterious origins, as “emergencies,” which supposedly require their ‘assistance’.
Whatever situation ostensibly,
‘absolutely requires’ the ‘help’ of a psychiatrist, is called a “psychiatric emergency.”
So-called “psychiatric emergencies” are established, as such, by official fiat (the psychiatrists’ command) and by the faith of believers in psychiatry and in psychiatrists — not by objective means, as are real medical emergencies.
By the same token, within any culture, wherein any particular personal crisis may be, in some circles, described as a “crisis of faith,” there shall be wide acceptance that the “crisis of faith” exists, not because it is, objectively speaking, a “crisis of faith,” but only because those who are believers in the power of faith generally (or else, those who are believers in the power of a particular brand of faith) are defining the crisis as such and are occupying a dominant position, within that culture.
Actually, psychiatry is wholly a brand of faith — that’s led by priests and priestesses, call psychiatrists. All of their pronouncements (called “diagnoses”), being subjectively perceived, are accepted as a matter of faith and/or by way of coercion and drug-induced ‘brain-washing’ indoctrinations.
Worried family members may presume a “psychiatric emergency” exists, upon their discovering that one of their own is behaving in a way that seems troubling.
They take the ‘affected’ family member (the prospective “patient”) to a specially anointed licensed physician (called “psychiatrist”) who’ll determine whether a “psychiatric emergency” should indeed by declared.
You are repeatedly asserting that “psychiatric emergencies” exist; you seem to have a very strong conviction about your ability to perceive when that is the case; so, of course, you have faith in psychiatry.
(Think about that, and feel free to let me know if you feel I am wrong.)
2. You say, “we are never going to find any common ground.”
I suppose if you insist upon that, you can make it so; however, I believe we could find common ground, when it comes to the matter of advance directives.
Francesca Allan is making inflammatory comments about the Repealing Mental Health Laws group and about me and unnamed others whom she considers to be “extremists”. However, her core question deserves to be discussed. She claims that because she cannot find an answer to the situation she experienced outside forced psychiatry, forced psychiatry must continue to be legally permitted.
In fact, I did answer her question in another forum but she did not like my answer. Sorry for that. I am a human rights lawyer and would welcome for people who work on support practices to consider her situation and come up with ideas. I do find that thinking together has often helped in similar situations where a person needs an alternative to the existing system.
It is hard to imagine in hindsight what could have been done differently. Forced drugging is irrevocable in the sense that once it is done, there is never a chance to go back and try something else. It is possible looking ahead, which is why we have crisis plans and advance directives.
People have different kinds of tolerance for pain and suffering, different values about neuroleptics and other psychiatric drugs. Support for the exercise of legal capacity means that if a person is not conversing in the ordinary way, you engage with them in whatever way is possible, and certainly offer what you have that might relieve their subjective suffering. Maybe in this situation responding by putting out the fire – with blankets to smother it, ice packs or water to throw on it, whatever – might have helped. Or a sedative that is not a neuroleptic. Neuroleptics should be really the last, last, last resort that anyone should think of, unless a person has tried it and finds it useful. That is also part of support for the exercise of legal capacity.
For information on alternative practices – beyond the resources on Mad in America itself – I suggest investigating Intentional Peer Support, Soteria, Open Dialogue, Family Group Conferencing/Eindhoven Project, Hearing Voices Network, Personal Ombudsman (PO) as a start. All of these practices supply principles for how to engage with people in altered states or serious distress. They are my own resources for thinking about what can be done differently.
I would not be happy about advance directives for forced psychiatry, but if society can allow a man to agree for someone else to kill him and eat him (as has been done – I forget in which country) it should be acceptable to agree that someone will force a psychiatric drug on you even if at the time you are refusing. It is a serious decision; colleagues in the movement have suggested that everyone should be encouraged to make out advance directives even (or perhaps especially) if they have never experienced it before. (What “it” is – psychosis, madness, altered consciousness, being crazy, being forced into psychiatry.)
Yet advance directives will never be enough, as there are always people who won’t have them, just as many people don’t make out a last will and testament. Furthermore, advance directives are based on an incapacity framework so that there is no reason for anyone to actually try to engage with the person creatively, it is reduced to a simple yes/no about drugs based on the preference you declared at the time you wrote it. Some ADs and crisis plans are much more detailed, and that is great, but we still need to engage with the person in real time and not pass over their present self while looking only at what they said at some time in the past. I think that is profoundly disrespectful and alienating.
A last comment on the notion of what is realistic or not realistic. Numerous reforms have been tried throughout the years in mental health law. In 1986 the NY Court of Appeals issued a landmark decision in the case of Rivers v Katz, saying that even involuntary psychiatric inmates have the right to refuse treatment if they can make a decision about treatment. (In one part of the decision this was phrased as “a rational decision about treatment”.) Those of us in the movement then thought this was great, we had no idea that courts would almost always find that the person is incapable of making a decision. Courts fall back on their assumptions and act conservatively according to their view of the world; deferring to psychiatrists is less costly for them than taking the risk of enforcing a meaningful right to refuse. In part this is because it would require something more directive (like the court orders for school desegregation that fashioned remedies such as busing and continued court supervision), so that it doesn’t amount to leaving the person in a detention situation among people whom she has just won a court hearing against, with the likelihood of retaliation (including by retaining the person longer as a coercive measure or discharging them abruptly if they still need a place of respite). Also, while some people will just shake themselves off and go on, many people do need some active connection and support, which our psychiatric institutions simply don’t provide. Reforms within a system of abuse just create bureaucratic requirements and loopholes. That was the reason for creating the Campaign to Repeal Mental Health Laws, http://repealmentalhealthlaws.org. (BTW, the Facebook group Francesca mentions is an extension of this Campaign and is open to people who agree with the mission and the posting policy as spelled out on that page.)
A ban on forced treatment, if it is legally made and enforced, will work because psychiatrists will face criminal prosecution and personal lawsuits if they persist. But it is clear that a complete overhaul of the mental health system is needed at the same time, so that people are not simply left to their own devices when that is not what they want or need.
No one has all the answers to anything, but the issue of forced psychiatry – including psychiatric incarceration as well as forced drugging, forced ECT, restraint and solitary confinement – is something that has tended to polarize people. Doing nothing about the current situation is not benign, because people are suffering every day from forced drugging. I personally am connected with two people who are under outpatient commitment and have to take neuroleptics; one of them has tardive dyskinesia and they will not take her off the drugs (multiple ones). Having to witness this abuse and not be able to do anything about it is itself traumatizing. Of the people who signed the RMHL petition – over 760 – many have told the stories of psychiatric abuse of themselves or a family member. You can still sign the petition at http://www.change.org/petitions/us-senate-ratify-the-un-convention-on-the-rights-of-persons-with-disabilities-without-reservations-understandings-or-declarations-ruds if you haven’t done so already.
The CRPD is opening up conversations like this one around the world, and I hope that it will continue as a fruitful exploration of possibilities for change. I think we all agree that the system we have now is not acceptable, and that it violates human rights.
Yes, you answered my dilemma. Your suggestion, as I recall, was a gentle talking to and offer of medication. However, that was not an option because I was beyond talking to. I told you this but couldn’t discuss it further as you had banned me from your group. It’s hardly inflammatory to say that you haven’t been open to discussion with me.
Please acknowledge that I’m making a distinction between psychiatric practice in general and emergency intervention.
And, again, as with someone else’s suggestion of analgesics, your scenario of ice packs, blankets, etc. wouldn’t have worked for exactly the same reason. There were no messages to be interrupted coming from my sensory neurons.
To be honest, I think the source of the unpleasantness between us is that I have come up with a serious counter-example to your position and you are unable to respond to it. Rather than fault me for this (“inflammatory”), perhaps you might entertain the possibility of a little flexibility on your group’s part.
Allowing people to talk but only if they agree with you isn’t a very promising or progressive approach. Also, it’s going to turn off a lot of otherwise sympathetic people who could have been your allies.
A ban on forced treatment would certainly not be enforced in the situation I have described. And, as stated elsewhere, once it’s understood that it’s okay to break the law, mental health laws in their entirety will be ignored. That will strip us of the meagre rights we have at present. In other words, we would be worse off, not better. I’m not going to lose any sleep over it though because there is zero possibility of this succeeding.
Sure wish we could focus our energy on more pressing and realistic goals like abolishing long-term, soul-destroying outpatient commitment programs, providing real alternatives and getting accurate information out there.
I certainly do agree with you that the situation that we have at present is not acceptable. Where I disagree is on what we should do about it.
This is the mission of the Campaign to Repeal Mental Health Laws, as posted on its website http://repealmentalhealthlaws.org.
We are working for the repeal of mental health laws in the United States and Canada that allow people to be deprived of their liberty, drugged, restrained, electroshocked and otherwise treated against their will in the name of “psychiatric help.” The United Nations has called on countries to abolish such laws to comply with human rights obligations and has said that forced psychiatric treatment/interventions can amount to torture. The purpose of the campaign is to educate the public about all forms of forced psychiatric treatment/interventions and, most importantly, to take action to eradicate laws that allow these human rights violations to occur.
Strategies to Achieve our Goals
We are working to collect evidence of human rights violations by talking with people across the United States and Canada who have had direct experience with any form of forced psychiatric treatment/interventions and with people inside the mental health system who are sympathetic and would like to see changes made. We are working to make this evidence and these stories known to the public.
We are working to show the public that these human rights violations can happen to anyone and that the range of people who have been affected includes soldiers, children, teachers, lawyers, journalists, doctors, service workers … in short, all of us. There is no “them.”
We are exploring a number of ways to challenge mental health laws through legal action and to advocate legislative repeal.
We are working to collect and share information on alternatives to psychiatric incarceration and all forms of forced psychiatric treatment/interventions. Abolishing these laws and practices in no way means denying the kinds of help needed to support and guide us through difficult times in our lives.
Tina, I’d really like to hear your input on the situation I have described. In the absence of the option for involuntary treatment, what would you have proposed here?
Sorry, Tina, I wrote this before I read your post up above. I acknowledged your alternative given upthread and also explained why it wasn’t viable. Please consider the possibility that in some rare and extraordinary circumstances like the one I described, an outright abolition wouldn’t work.
I never asked Francesca what she proposed to do as an advocacy agenda. I am very clear that human rights and non-discrimination compels the abolition of forced psychiatry. Reaching out to discuss possible alternative responses to a particular crisis situation, and whether it makes sense to allow advance directives authorizing force, are as far as I will ever be willing to go to accommodate those who wish to deny my human rights and those of others so that they can maintain the status quo of psychiatric-state violence.
It remains my opinion that it is wrong for Mad in America to allow the discussion to be hijacked by a commenter rather than focus on the topic under discussion. It was not a post about the general question of abolition of forced psychiatry; it was rather about the danger of CRPD ratification with limitations that impede its implementation in the US.
Francesca might have engaged with the CRPD aspect and stated her own position on this, but instead she chose to do something else. People interested in the CRPD have refrained from commenting after seeing the direction the discussion has taken. I would ask the MIA editors to consider policy on this for the future.
Tina, you say:
“You reject out of hand what I propose and are not willing to engage in further discussion about it except to insist on your ideological position in favor of maintaining permission for forced treatment.”
Actually, this is EXACTLY what you do to me. You reject my argument and will not discuss except to repeat the “all involuntary treatment is torture” mantra. I gave you a very pertinent counter-example which pretty much demolishes your position and you respond by giving me impractical solutions that do nothing to further your position, except to show that you have no understanding of the neurological concept of phantom pain. (I’m still waiting for you or any of your followers’ practical suggested alternative to drugging in this instance.)
“You and I don’t have much basis for trust, so I am not surprised that this is not a helpful way for you to figure out what might work for you. I encourage you, if it is something you are interested in pursuing, to find people whom you would want to work with to figure such things out.”
Not sure what you mean by “something you are interested in pursuing” here. Trying to uphold mental patients’ rights? I’m already doing my best to work towards that. And I am in contact with many people with the same views and we all want to work towards a safer, more respectful mental health system. We are not interested in pursuing unachievable goals.
“From your posts it appears that you are dead set on arguing against abolition.”
Just as you are dead set on arguing for it. It’s not correct to assume that one of us MUST be right. It’s quite possible (and I suspect this is true) that the answer lies in a blend of the two positions.
“Yet you yourself present no alternative that will guarantee me or others who have been abused by psychiatric violence that we can be safe in our minds and bodies and lives from this violation.”
Tina, I have presented several alternatives and avenues for psychiatric reform; you just don’t want to hear them. And make no mistake, please: I have been horribly abused by the psychiatric system. It’s not a question of me not having an interest.
“You have chosen to dominate the comments to my post on the CRPD with your agenda. If the Mad in America editors allow this, it is their decision. I think it does a disservice to the discussion I was aiming for. Nevertheless, we have both presented our views and anyone who bothers to read this far will be judging for him or herself.”
The difference between MIA and your Facebook group, is that here we foster genuine discussion. I have been told privately (via email) by several members that I am a valued part of this community. You are quite right that a reader will judge for him/herself. That goes without saying.
Cannotsay2013, you said “This goes back to the “retrospective validation” argument combined with anecdotal evidence that denies free will (what might be good for you, might not be good for somebody else), which, as I said, could be used to force all kinds of paternalistic interventions by government.”
Regardless of what kind of argument you think I am making, could you please just answer the question? What should they have done? According to you, absolutely nothing because I hadn’t been convicted of a crime. If involuntary treatment were illegal, I would have just been left rolling around there screaming. Are you sure this is okay with you? I agree my story is necessarily merely anecdotal evidence, but it has an understandably powerful effect upon me.
My doctors’ actions in that circumstance really don’t require further validation, retrospective or otherwise. They were at the time prima facie valid actions, to say nothing of humane, ethical and effective.
I don’t think it’s consistent to decry all coercion in psychiatry but then to be okay with criminal diversion. Avoiding having a criminal record is a powerful incentive to comply, just as is keeping your housing or government benefits.
I have written elsewhere that abolishing involuntary treatment would merely encourage doctors to break the law. No court would have found my doctors liable in the situation I have described. What, therefore, is the point of pushing such a law? There are profound consequences to your philosophy that I don’t think you have considered here.
In any event, my situation was certainly unusual but not at all singular. There is lots and lots wrong with psychiatry, but this kind of emergency psychiatric intervention isn’t part of that. And as for something being good for one but not another, I really can’t imagine another person wanting to continue with the burning hands and feet, drinking herbal tea and waiting for the hypnotist to arrive.
“If involuntary treatment were illegal, I would have just been left rolling around there screaming. Are you sure this is okay with you?”
Sure It is :D! With rights come responsibilities. When one misuses the freedom that he/she has been given, I think that one has to be willing to accept the consequences.
“I don’t think it’s consistent to decry all coercion in psychiatry but then to be okay with criminal diversion. Avoiding having a criminal record is a powerful incentive to comply, just as is keeping your housing or government benefits.”
Once somebody breaks the law, all bets are off. I do not have a problem with people choosing a “psychiatric label” over a “criminal conviction” once they have broken the law. My problem is with psychiatric labeling forced onto people who have committed no crimes.
“No court would have found my doctors liable in the situation I have described”
If involuntary commitment and forced drugging were to be made illegal, I can assure you that, at least in the United States, such doctors would be punished. Medical malpractice litigation in the US is a booming business. In fact, with existing law, many psychiatrists have ended up in jail. CCHR has an excellent database with psychiatrists who have been convicted of crimes here http://www.psychcrime.org/. This being CCHR, the database is a bit of an exaggeration because it includes convictions for people who committed regular crimes who happened to be psychiatrists, but there are a few cases in which the psychiatrist was convicted for criminal conduct related to abusing the medical/patient relationship.
“And as for something being good for one but not another, I really can’t imagine another person wanting to continue with the burning hands and feet, drinking herbal tea and waiting for the hypnotist to arrive.”
Again, surely I can! As I said, my only beef with psychiatry is coercion. The only reason I spend time attacking psychiatry and not other pseudo scientific endeavors like astrology is because psychiatry has the power to destroy lives because of its coercive status.
There’s an instance, where I feel your use of a smiley emoticon does a disservice to your message (I have, in the past mentioned my sense, that you sometimes overdo the smiley faces).
It’s unlikely you meant readers to presume that you’re smiling about the painful scenario described by Francesca, yet such is the impression, which your smiley could possibly lend us; given the context, how you’ve inserted that one smiley face, one might even assume you felt glee at imagining Francesca’s sufferings. So, your whole message, at that point, becomes questionable. Can you please clarify your first couple of sentences?
Also, considering what little or however much I know of your views, on psychiatry, I find myself utterly baffled by that one part of your comment, wherein you’re apparently regarding the subject of criminal diversion programs, which provide psychiatric ‘treatment’ in lieu of convictions.
“Once somebody breaks the law, all bets are off. I do not have a problem with people choosing a “psychiatric label” over a “criminal conviction” once they have broken the law. My problem is with psychiatric labeling forced onto people who have committed no crimes.”
You approve of such programs?
(That surprises me, considering what I recall from past readings, of you.)
Frankly, I wonder how your approval of them can possibly square with your self-professed appreciation for the spirit of Thomas Szasz.
Though you and I have disagreed, at times, I always appreciate the courtesy of you replies. Maybe, when you have a free moment, you can explain your reasoning on this.
The usage of smileys is because in real life I tend to smile a lot. So this is just to make my comments more reflective of how I am. Needless to say, that I didn’t mean that I was happy that Francesca found herself in that situation. Not at all. The smiley was meant to mean “yeah!, I absolutely defend that no government intervention was warranted even in your case because you had made it clear in no uncertain terms that you didn’t want to be helped”.
My bottom line is that whatever the reason she found herself in that situation, it seems to me that she had made it crystal clear that she didn’t want to be forcibly drugged/committed when she was committed and that she is using her case to affirm that “potential retrospective validation” is a valid ground for forced drugging/commitment, which is exactly the same argument used by those who favor coercive psychiatry. This issue is really black and white. No amount of wishy washy, appeal to emotion type of argument is going to make me blink. I have said it many times, and I repeat it here: I only care about the abolition of coercive psychiatry. I don’t believe that psychiatry can be reformed. Even if it could be reformed, I would still oppose coercive psychiatry in all cases.
With respect to my statement, it doesn’t contradict Thomas Szasz in any way, since that was precisely his position: http://www.cato.org/multimedia/events/libertarian-principles-psychiatric-practices-are-they-compatible .
I am not opposed to the concept of behavioral control. There are people who misbehave in society, and society – as long as it is a constitutional democracy that protects individual rights- has every right to deal with those situations. That is the job of the criminal justice system. And since it is understood that this is what the criminal justice system does, ie behavioral control, there are safeguards in place to prevent abuse: lawmakers are accountable to voters, lower court judges themselves are accountable to voters and to review by higher court judges and there is a great deal of case law that protects the rights of criminal defendants. Even with these protections, abuses happen. Psychiatry has an unwarranted prerogative to do the same under lower legal standards to people that DSM committee members find “disordered” and that is plainly wrong. The words “psychiatry” and “abuse” are almost synonymous these days.
With this clarified, Francesca knows that we agree on many things, but on this one, which is the only thing I care about, we part ways, and that should be OK. I see all criticism of psychiatry as a proxy to abolish coercive psychiatry, which is the only goal I am interested in in the context of psychiatry.
At the risk of continuing what some might view as a hurtful conversation, I have a question which might be quite pertinent. I will get to the question by presenting a few scenarios.
If person is unconscious this implies consent for trained medical professionals to treat the person. (There are all sorts of complicated laws for untrained good Samaritans, but my focus is on trained professionals.)
If a person is incoherent with a fever, it is my impression that most medical professionals treat them.
What is the line between implied consent and the ability to reject/accept treatment? (It seems to me, that one problem with current psychiatric practice is the asymmetry: psychiatrists will allow you to accept treatment in situations where they will not allow you to reject it.) If we assume that consent is symmetrically applied to both rejection and acceptance, let’s consider situations which count as rejection. What is the difference between being unable to communicate rejection and being able to communicate rejection? Does rejection need to be verbalized, written, signed using ASL? Can rejection be expressed physically by pushing the drugs away? Do all of these count?
What I do not quite understand, Francesca, about your account is that you say both that you were rejecting treatment and that you were incoherent and could not communicate. Somehow, I cannot see these both being true at the same time. Is there a temporal relationship between these two? If so, when does implied consent kick in? When would it kick in for any other medical issue (besides psychiatry), such as a person falling into a fever?
Despite the differences of opinion expressed here and the tendency that we all have to ignore people who disagree with us, I think there might be an underlying issue here that involves how we interpret consent/rejection.
(Totally as an aside: I realize that people have already been hurt discussing this issue. Someone has previously been excluded from other forums. Someone, here, had to take a break from posting. I also realize from the careful wording of many posts that everyone is trying their best to not fan the flames. Unfortunately, this issue is inherently inflammatory due to the differing viewpoints that people have and the amount of pain that everyone has experienced around non/forced psychiatry.
Let us all continue to respect each others positions with our posts. Let us not call each other names. Let us find the places where our viewpoints overlap. The viewpoints expressed here are similar to those that appear in society. If we cannot discuss these things civilly, here, with relatively like-minded people, we will not be able to address the concerns that the broader society raises.)
Tom Jones, you write:
“What I do not quite understand, Francesca, about your account is that you say both that you were rejecting treatment and that you were incoherent and could not communicate. Somehow, I cannot see these both being true at the same time.”
My rejection was very clear and non-verbal and was apparent through my body language and physical actions. These two factors are not at all incongruent. By saying I was incapable of communicating, I mean that I couldn’t speak coherently and couldn’t understand what people were saying to me. My brain was simply not processing information appropriately.
I very much agree that we have to be as respectful as possible when debating these very thorny issues. I do my best and I will continue to do my best. If I need to do more, I will try harder.
“…to be as respectful as possible… If I need to do more, I will try harder.”
Yep, I will try harder, too. So, on that note, if I say anything insensitive, please tell me.
Please let me repeat what I understand you to be saying about your own experience and why you find it to be a counterexample for anti-forced treatment. You were in an emergency room, incoherent with phantom pain, unable to understand what was said to you, thought you were on fire, and were non-verbally rejecting treatment. Regardless of your rejection, treatment, in the form of an anti-psychotic, was administered and gave you (quick?) relief from both the pain and the phantom fire. As a result of the relief, you believe that the doctors did exactly the right thing in treating you despite your rejection. Many others here have suggested alternative treatments, and it seems that you believe that only the anti-psychotic would have been effective. I am given to understand that this last is inherently hypothetical, because the doctors did not, in fact, try anything except the anti-psychotic. Additionally, there was some discussion of the role of withdrawal, but you seem to think that this is a red-herring.
Is it fair to say that in some sense your rejection of drugs might not have been informed? In that you might not have even known what they were offering you, if you did not understand what they said? Would it make a difference to you if the definition of rejection involved demonstrating some understanding of what was being rejected?
Philosophically speaking, I think law is a human endevor and is not always fair. For example, perfectly innocent people wind up in jail. As another example, people get away with crimes when there is no victim. So, in a sense there is no such thing a pure implementation of the abolition of forced treatment. In some sense, if nobody prosecutes violations of abolition, then they are allowed to exist. Perhaps this would be the case for your example, particularly since you do not view yourself as a victim.
This does not mean that the a law abolishing forced treatment has loop-holes or should have loop-holes. (By the way, implied consent is still an issue, here, and might be considered a loop-hole.) It merely means that the application of any law is imperfect.
No law is totally fair. It will exclude some people and include others. This is part of why we are guided not only by law, but also by ethics. It seems to me that a law abolishing forced treatment should be written to protect the most flagrant violations of human rights. (A potentially offensive statement coming.) What I am suggesting is that there may be more cases of people rejecting forced treatment and viewing themselves as a victim than there are cases of people rejecting forced treatment and winding up grateful for it. In this case, the law should be written to protect the most people from the most egregious wrong.
Would it be possible that even if the doctors had not forced treatment on you, that you might have eventually consented? I would like to think that there is a resolution to your situation that is not black-and-white. That is more about consent than about force. Perhaps I am wrong.
(I have been in extreme pain in an emergency room trying to get help. I empathize with the situation you present, and I hope that my comments are respectful.)
Also should add that even if I hadn’t made my rejection clear, they still would not have had my consent. Thus, the pro-abolitionists would have left me screaming in agony. That’s not supportable, ethically.
Francesca, although I am sure this comment will make you angry, my conscience tells me I really have to say something here. Tina’s page about abolishing forced psychiatry was set up for that purpose. It is true that hearing differing views is important. But if you want to argue against the purpose of that group, you should not be in it.
Likewise, you expressed anger at being asked to leave the “Psychiatric Survivors” Facebook group. I am very familiar with this group, as I only recently joined it. It mostly consists of people who are struggling to get off psych drugs. Although my experience with psychiatry was horrible (shock at age six, the rest of my childhood in a state hospital) I was lucky to not get the drugs because they didn’t exist yet. I am really upset to read of the agony that people who are trying to get off these drugs have to experience, and among the WORST of these drugs are the benzos.
Like you, I have occasionally used these drugs myself, and I think in very small doses at very rare times, they can be helpful, at least to me. But there are people in that group who are in agony every day, trying not to cave in to going back on benzos. I would be doing a great disservice to them if I said anything that might lead to their caving in and going back on them.
But most importantly, that group, and Tina’s group, were set up to accomplish certain purposes. If you don’t agree with those purposes, you shouldn’t have joined them. Joining a group and then arguing about whether its purpose is correct and relevant, no matter how reasonable your position might seem to you, to me just seems disruptive. I wouldn’t do it, and I don’t think anyone should.
Francesca,check out google TheTruthAboutVaccinesAndModernMedicine MercuryJustice.org read Edwin Blacks book War Against The Weak . AMA doctors and ADA dentists are as bad as APA psychiatrists . These and other cartels controlled by the Rockefeller family and foundation along with the Carnegie foundations and family and others like them posing as philanthropists have as a primary goal “the culling of the population” while make profit off of this very high tech steeped in subterfuge ongoing operation. To your primary question .The people with the skills to resolve an emergency like you had are not allowed into the emergency rooms to do the work they are able to do individually or as a team because they would be a threat to the present day vested interests.For example people trained in Yuen Method like myself that are also psych survivors.Also people like myself that have invented new safe modalities that can’t get a fair hearing anywhere.There are different approaches to activism also.I understand you were helped and believe that there is no other approach that would have worked and that you totally want to protect the forced psych med emergency injection option so that it would be available to those that might need it. I have been forcefully injected against my will so many times I honestly couldn’t even count them.One time after having escaped from a mental hospital and recaptured in retaliation I was held face down by 4 orderlies and injected with a 3 inch long thick needle the rounded yellow-orange liquid “medicine part an inch wide and 4 inches long .Someone in a white smock brought it into my field of vision first.After the injection into my butt cheek which hurt like hell to my horror they left the needle in as I screamed. I was afraid to move for fear the needle might break off in my ass. It felt like they hit bone. They unscrewed the “medicine” part ,I was still held down the white smocked “doctor” backed up ,after about a very long minute later he proceeded to screw in a refilled “medicine” part .Then the “doctor” PAINFULLY injected it deep into the same hole. Finally he removed the needle. This is the first time I wrote anywhere of this. Of course there was more beyond belief torture ahead.But isn’t this enough for now. Eventually I’ll write a book. Go Tina Go !
To all who may have been interested in the topic of this blog post: the CRPD and the limitations being incorporated into its possible ratification by the US:
I wish that I could have engaged with you in a conversation about this topic. Please feel free to contact me if you are interested in pursuing this – and also if you manage to get down this far in the comments, please feel free to discuss topic on which I posted.