In the domestic violence field, the methods employed by men to bully and abuse women and children are identified in the Duluth Project’s Power and Control Wheel, a tool developed by survivors of domestic abuse.
Replace male privilege with medical privilege, change a few descriptors and you have a good explanation of the ways in which psychiatry maintains its dominance over individuals and societies.
Name calling (diagnostic labelling), coercion (forced treatment), threats (removal of children, incarceration) . . . the parallels are obvious.
There is no accepted definition of bullying either in statute or general use but the elements common to most definitions include the misuse of power and influence to cause fear, distress, humiliation and harm to vulnerable people. Bullying within family, work and student relationships is generally understood as being learned and practiced within social, cultural and institutional contexts.
Arguably, psychiatry is nothing more than officially sanctioned bullying and abuse.
Just as with other forms of bullying, psychiatric bullying is minimised through victim blaming, defensive posturing and self justification by those who practice it. The victims of schoolyard bullying are blamed for being over-sensitive, bringing the abuse on themselves by their behavior and needing to toughen up. Bullies are excused for knowing no better, not intending to cause harm, not understanding the impact of their actions and being victims themselves. Some even justify bullying as toughening people up’ and therefore being in the best interests of the victim.
Similarly, psychiatrists argue that their victims exaggerate their feelings of distress and experience of harm, are treated the way they are because of socially unacceptable behaviours and need to become more resilient. Psychiatrists would argue they do not intend to cause harm, humiliation and distress, are just doing what they have been taught to do, don’t believe their ‘treatments’ and attitudes cause harm and are themselves the victims of abuse by violent, abusive patients. They argue that forced incarceration and treatment are in the best interests of the people subject to it.
Not a lot of difference between schoolyard bullies and those in psychiatric hospitals then.
I was interested to read recently a review of a debate held in 2004 by the UK Royal College of Psychiatry on the topic Bullies Should be Pitied and Not Feared.
According to the paper, those in favour of the motion argued that understanding the adverse circumstances that create bullies should lead us to pity them and that rather than blaming individuals, we should pay more attention to the roles that communities can play in either condoning or combating bullying.
Those against argued that fear is an appropriate reaction to a behaviour that is unpleasant, injurious and wrong particularly where the consequences for victims range from “anxiety and depression to post-traumatic stress disorder and even suicide,” that the ‘fight or flight’ reaction is an entirely appropriate response when an individual is being bullied, and that pity gives the bully positive attention which may reinforce the bullying behavior and encourage victims to become bullies.
Child and Adolescent psychiatrist Anne York, who argued against the idea that bullies should be pitied, claimed that bullies bully in order to gain unwarranted attention and respect, and that any pitying of such behaviour is highly inappropriate.
She argued that giving bullies this recognition may result in them ending up in positions of national or even international responsibility, making us all potential victims of bullying.
Imagine. Bullies in positions of national and international power.
According to the review’s authors, the audience of adolescents who were pro the notion of pitying bullies at the beginning of the debate found the arguments against that position so persuasive they voted to reject the motion by the end of the debate.
Interestingly, the review also tells us that the one issue on which both side of the debate agreed is that all schools should have anti-bullying policies in place.
It is not uncommon for psychiatrists to agree that the practice of psychiatry contains elements that are coercive, distressing, humiliating and harmful. Would they therefore agree that, as with schoolyard bullying, all institutions in which people are at risk of encountering psychiatry should develop and implement anti-psychiatry policies?
Around the world, governments have insisted that schools develop anti-bullying policies which could be adapted and developed into anti-psychiatric bullying policies. Taking elements of policies available on the internet, from a range of educational institutions, workplaces and advisory bodies such as the NZ EEO Trust, I offer the following as a model anti-psychiatric bullying policy for any forward thinking mental health institution.
Model Policy To Address Psychiatric Bullying, Harassment, or Intimidation
Sometimes regarded as “treatment”psychiatric bullying and harassment can no longer be considered as such. During the past two decades, the often devastating effects of psychiatric bullying and harassment have evidenced themselves on the well-being of consumers and the climate of mental health facilities. Pharmaceutical and medical device advances of the last ten years have unwittingly provided another outlet for bullying and harassment, ‘biological psychiatry.’ Its message enters homes and communities and the resulting effects extend into every aspect of society. Incidents of psychiatric bullying, harassment, and intimidation have caused increasing concern among health professionals, children and young people, parents, and public officials.
Definition of psychiatric bullying
This policy adopts the definition of harassment and bullying provided by the NZ EEO Trust:
Harassment can be defined as any unwelcome comment, conduct or gesture that is insulting, intimidating, humiliating, malicious, degrading or offensive. It might be repeated or an isolated incident but it is so significant that it adversely affects someone’s performance, contribution or work environment. It can include physical, degrading or threatening behaviour, abuse of power, isolation, discrimination, sexual and/or racial harassment. Harassment is behaviour that is unwanted by the recipient even if the recipient does not tell the harasser that the behaviour is unwanted. Bullying is ongoing unreasonable behaviour which is often intended to humiliate or undermine the recipient but is not specifically unlawful.
Mobbing is a particular type of bullying behavior carried out by a group rather than by an individual. Mobbing is the bullying or social isolation of a person through collective unjustified accusations, humiliation, general harassment or emotional abuse. Although it is group behavior, individuals can be held accountable for their role in mobbing.
Psychiatric bullying, harassment, intimidation and mobbing includes any behavior by a mental health professional or group of mental health professionals which insults, demeans, humiliates, distresses, coerces, intimidates or harms a consumer. It includes, but is not limited to:
- Unwelcome diagnostic labelling
- Involuntary incarceration
- The use of restraints and seclusion
- The forcible administration of drugs or other ‘treatments’ including ECT, DBS and other invasive processes dressed up as treatment by the use of innocuous acronyms.
- Threats designed to coerce compliance including threats to remove children, take proceedings under mental health legislation and breach confidentiality
- Verbal abuse
- Use of subjective assessments which damage self esteem, reputation and future prospects
- Victim blaming
- Coercion, threats and intimidation
- Economic abuse including the prescribing of expensive medications which have no efficacy and cause harm, insurance fraud and the abandonment of patients who have no financial means.
- Discrimination on the basis of personal characteristics and ability to function.
Appointment of Anti-Psychiatric Bullying (APB) Officer
The organisation shall appoint an anti-psychiatric bullying officer who is independent of the organisation and has completed training from an accredited psychiatric services consumer group.
The APB Officer will have the power to receive and investigate complaints without restriction. Full access to documents, records, files, CCTV footage and any other materials required to fully investigate complaints will be provided to the APB Officer on request. The organisation will ensure the APB Officer is provided with any support required to conduct interviews with complainants, witnesses and those accused of bullying, harassment or intimidation.
The APB Officer may make recommendations for change, initiation of disciplinary proceedings or victim compensation.
Reporting Psychiatric Bullying
Anyone who is a victim of, or who witnesses, psychiatric bullying should report it immediately to the APB Officer. Those reporting bullying should be assigned a support person to assist them to file a complaint, to explain the investigation process and to provide practical and emotional support for the duration of the process.
Bullying should be investigated whether a formal complaint has been received or not.
All reports will be acknowledged and investigations commenced within 24 hours.
As bystander support of bullying and harassment can encourage these behaviors, mental health insitutions must prohibit both active and passive support for acts of harassment or bullying. The staff should encourage staff and other consumers not to be part of the problem; not
to pass on the rumor or derogatory message; to walk away from these acts when they see them; to constructively attempt to stop them; to report them to the designated authority; and to reach out in friendship to the target.
Training should be provided to staff on how to respond to bullying and harassment incidents. Posters and pamphlets should be provided to in waiting areas and information packs to all consumers which encourage them to report any bullying or harassment they witness. When bystanders do report or cooperate in an investigation, they must be protected from retaliation with the same type of procedures used to respond to bullying and harassment.
All criminal actions must be reported to the police. All breaches of professional codes must be reported to the medical council.
Investigations will determine, on the balance of probabilities whether bullying, harassment or intimidation has occurred.
A report will be provided to the complainant on the findings of the investigation and on disciplinary action being taken.
Now obviously this is not a comprehensive policy. It is not intended to be. Rather my purpose is to highlight the way that mandatory policy development has changed thinking and operating in response to schoolyard and workplace bullying.
Policy sometimes follows a change in thinking, but equally often it is developed as a tool of thought leadership and cultural change. Without strong leadership on preventing bullying, the ritual humiliation and abuse of children and employees would in all likelihood still be seen as an inevitable occurrence that shouldn’t be taken too seriously.
While the practice of psychiatry is governed by vague codes of rights which lack any specificity around rights to respect and safety, a culture of failing to recognize or respond to abuse will prevail. I believe that the overwhelming evidence of psychiatric abuse means those who are engaged with mental health services should be extended the same rights to protection against bullying, harassment and intimidation as are extended to others. I believe mental health institutions should pro-actively institute such policies but that governments should mandate their development.
An anti-psychiatric bullying policy would contribute to the establishment of a culture of respect, safety and accountability and make psychiatric abuse more visible and therefore more open to public scrutiny.