Consent and Psychiatry: Problematizing the Problematic 

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It is rare to get involved in a dialogue over psychiatry without sooner or later someone defending the use of such “treatments” as ECT “as long as they are consented to,” with the term “informed consent” periodically employed. Herein lies the context for this piece. The issue that I want to probe, to be clear, is not whether force should be used—for of course it shouldn’t—but the thorny issue of consent itself—what exactly constitutes consent and what other issues besides consent are critical to factor in when considering what it is and is not legitimate for a “medical” professional to offer.

Let me begin by suggesting that the standard framing of such issues is conceptually impoverished. Nor is the problem limited to the psychiatric arena. It is part and parcel of the dominant liberal, rationalist, individualistic notion of choice generally—which has little do with how “choice” concretely plays out in the world. The point is, despite the image that we all have of an independent person scrupulously sifting through information and carefully coming to the best position, even calmly made choices are seldom arrived at this way. Our choices and our thoughts about what is possible and best are increasingly managed by institutions, prepackaged by forces and processes outside of our view. While of course it is important to keep others in mind, we can be under considerable pressure from family or friends. And others beyond our ken have a frightening degree of “interest” in what we “decide”. Moreover, oftentimes we find ourselves forced to jump in one direction or another at moments so charged that we can barely breathe. Nowhere is this more obvious than with psychiatry.

We are at a strange moment in history. On one hand psychiatry places little value on the rights of others and is only too willing to run roughshod over them. Reinforcing this infringement way more than actually constraining it, we have a rights apparatus managed by the state which creates but the illusion of safeguarding rights—consent primarily (see Burstow, 2014). In the process of defending rights—in itself absolutely vital—meanwhile, so many of psychiatry’s critics themselves slip into acting as if consent were the only value of significance, and in the process invest themselves in this liberal conceptualization.

The issue “in a nutshell”? It is commonplace for otherwise critical thinkers to take the position that as long as an individual “consents” to something called “a treatment,” then by definition it is more or less unproblematic for a separate individual called “a doctor” to administer that treatment or an institution called “medical” to include it in its repertoire. Nor is it deemed relevant that the procedure being offered has no medical validity, exists only because it in the interests of an industry, and beyond that, that it does profound damage—electroshock, for example (for literature demonstrating the lack of validity and the harm caused by ECT, see for instance, Breggin, 2007 and 1991). In some formulations (and admittedly not others) nor is it deemed significant who said what to a person just before she consented or what is likely to befall her afterward. What such a position does in essence is to at once hollow out and fetishize consent. It is as if we had substituted law for ethics and the technical for the meaningful. We have likewise conflated two very separate issues. While no one should be subjected to a “treatment” without consent, the giving of consent does not in and of itself make a “treatment” acceptable.

That noted, some questions to reflect on: If a way of being is not a “medical issue,” what happens when we call it medical? Irrespective of whether or not a “patient” consents, does a doctor have a right to offer an intervention as if it were medical when it is not? Or is it enough that his/her fellow doctors keep talking as if it were medical? Is it acceptable for what is not medical to be taken up as such, promoted, and popularized by a putative branch of  medicine? Does a doctor have a right to offer what substantially harms—and does little else? When a figure as esteemed in our society as a doctor offers a “bogus” product, is that the moral equivalent of a businessman offering it? Who benefits and who loses from that happening? Has anyone the inherent right to brain-damage another? If brain-damaging is not okay on the face of it, does “the recipient” signing on the dotted line make it okay? Is informed consent sufficient? When is “informed consent” not “informed”? Should the reason why one consents have a bearing? Or are reasons irrelevant? Should the context in which one consents have a bearing? Or are contexts irrelevant? Are we responsible only for what we force on others? Or are we also responsible for what we introduce, make available, recommend, offer?

As help in pondering such questions, correspondingly, I would introduce the following testimony by an ECT survivor (now deceased) named Chris:

I would like to speak briefly about electroshock and informed consent. Although they are inextricably linked, I will address them separately . . . I was hospitalized twice. I received ECT in both hospitalizations. The first hospitalization . . . was two courses of treatment . . . The second time I received one course of treatment . . . I was never given any information about potential risks, let alone any reliable information about the potential risks . . . What I was exposed to was the usual psychiatric propaganda. The sort of stuff you . . . hear in the media frequently. The idea that ECT saves lives. [That] ECT is now safe and effective. Is not damaging . . . is now safe and modern. It is as though beating someone with a plastic stick is much an improvement [over] the old wooden stick. I was shown a short video in the hospital. The video actually showed the person going through a course of being shocked . . . The video did not show the person awakening in the recovery room alone and disoriented . . . The very obvious and important thing is that blunt force trauma to the brain is not healing. Blunt force trauma to the brain is damaging . . . Finally on the topic of consent, I would like to say very clearly that when you are in a state of complete terror, absolute despair, and utter isolation . . . when you are in such great pain that suicide seems the only reasonable way to escape that pain, you cannot be said to give consent. (http://coalitionagainstpsychiatricassault.wordpress.com/articles/personal-narratives)

Implicit in this testimony is the position that giving “informed” consent to ECT is close to impossible for the “information” given is a “party-line” generated by the industry. More particularly, not only are key elements characteristically missing (e.g., that it damages the brain) but it is factually inaccurate and egregiously misleading. The same generalization, I would suggest, can be made about consent in psychiatry generally. I would quote in this regard from a comment by Mead (2014):

I for one consented to take the drugs because I was told all sorts of “facts” about biological illnesses, correction of chemical imbalance, “unmasking” etc. I was told that the drugs were “safe” and “effective” “medicine” and was rarely told about risks, particularly of permanent damage . . . The fact remains that I willingly embraced psychiatry because I believed it was the only rational choice — in essence, not a choice at all.

Of course one answer to the dilemma of “inadequate information” and egregious “misinformation” is that those of us with the knowledge and “fire in the belly” create and disseminate accurate information—and many are doing just that. As long as the current system prevails, it is a mistake, however, to think what information we provide will be afforded the same credibility as the misinformation churned out by the system, or indeed will even be seen by the average person confronted with such a “choice.”

What implication ought these and related conundrums hold for critics? The evolution of Dr. Peter Breggin’s position is significant in this regard. When I first started organizing against ECT, already his medical position was that there is a one-to-one ratio between the “therapeutic effect” of ECT and the damage done (see Breggin, 1979). Nonetheless, he did not take an abolitionist position. What he advocated instead is pushing psychiatry to provide better information, just as so many critics do today. This notwithstanding, he eventually shifted to an abolitionist stance on ECT. Why? The degree of damage done and his growing sense that there is little to to be gained by arguing for better information, for psychiatrists are in the business of circulating misinformation among themselves (see Breggin, 1983). By the same token, with misinformation continuing and with ever more proof of the damaging effects of the various “treatments” having materialized, minimally, critics today should stop taking refuge in the concept of consent.

To be clear, I am not denying the possibility of official information materializing that is less egregiously wanting than what is provided now. Indeed, some hospitals’ consent forms are “less inadequate” than others. But the point is that no matter how improved the information became—and let’s be clear, it is going in the opposite direction—it is predictable that neither a consent form nor the verbal information provided would ever go far enough for anything resembling meaningful consent to be enacted. The point is the misinformation is being produced en masse, and it is hardly in the industry’s interest to substantially change.

I am reminded here of the article “A Model Consent Form for Psychiatric Drugs,” by Cohen and Jacobs (Cohen and Jacobs, 2000). Cohen and Jacobs did an admirable job designing a form for psychiatric drug consent, including such information as there is no proof of any mental illness, that if problems arose, the doctor would probably deny that they stemmed from the drug; moreover, they clarified the enormous likelihood of permanent impairment arising and specified the precise nature of the risk for each major class of drug. The “kicker” is, however, almost no “patient” would take a drug were it accompanied with this information, and accordingly, no such consent forms would ever figure in the official repertoire. The point is that psychiatry is built on lies and cover-ups and it has a huge vested interest in continuing both. Nor does the problem of “consent” stop here.

Note, consent must not only be “informed,” it must be freely given. “Free and informed consent” is the precise discourse used. What we are assuming when we say that “free and informed consent” has been given is that the person has not been manipulated in any way and was able to say “no,” with no repercussion arising from this refusal other than those inherent in not taking the procedure in question. We hear these concepts in medicine proper so often that we tend not to question that they are being applied. While such an assumption misses the point in general, when this assumption is extended to psychiatry, what is left out is precisely the nature of the context. The point is that these are inherently coercive institutions, and so even if you got beyond the propaganda, and even if you are technically allowed to refuse, subtle and oftentimes not-so-subtle pressures are almost invariably and inevitably brought to bear. Take the many many women who over the years have been told that they would never get well if they did not comply. Take being chided that you are being something less than a good wife to your husband if you reject “the treatment” (see Wendy’s story in Burstow, 2009). Take the change in tone, the condescending looks with which people are faced. And beyond pressure of this ilk is pressure by family and loved ones who themselves have been socialized to believe in the medical model. Such pressure may be imagined as existing on a continuum, with withdrawal of empathy and support on one end and further along, such phenomena as those experienced by Connie Neil, who accepted ECT out of a well-reasoned fear that if she did not, she might never get her baby back from her mother-in-law (see Burstow, 2006 and Phoenix Rising Collective, 1984). And then there is the pressure that comes from within, from having being told for so often that you are mentally ill that you have internalized the message and in the process become your own enforcer.

The point is that consent in this arena is neither “free” nor “informed.” Nor would amassing an even larger army to oversee the consent process make it so. Ironically, indeed, in the long run all that expanding this sphere of operations would succeed in accomplishing would be augmenting the size and credibility of the institution. While it beyond the scope of this article to cover this dimension, I would add, nor do the prepackaged alternatives with which people are presented even roughly equate with what, in our deeper moments, we actually intend by the word “choice.”

Moreover, putting all this aside—which we can do only hypothetically—even were consent free and informed, and even were we convinced that real choice was involved, the question remains: Is what is happening ethical? In this regard, Chris points out quite correctly that “blunt force trauma to the brain” (inherent in ECT) is not healing and is always damaging. That said, bracket off for a moment the lack of real consent and ask yourself this: Is it ever acceptable for a medical institution to unleash such unmitigated damage on a person? Violence, however cosmeticized? To be clear, I am not suggesting that individuals do not have the right to harm themselves. Indeed we all of us do. However, doctors per se have no right to do harm—never mind to advocate for it or to call it “medicine”.

The issue at hand, I would add, becomes still more confused when people contend that we would be interfering with someone’s right to choose by eliminating a treatment. Treatments in “real medicine” are discarded all the time as a result of an assessment of the harm caused. If it is valid as opposed to an interference with personal liberty to stop offering a  treatment because of the enormity of the harm caused when the treatment is actually medical, how much clearer this issue should be when “the treatment” is not medical. Nor is okay to pass off the non-medical as medical, regardless. Bottom line: doctors should not be in the business of introducing bogus treatments and passing them off as medical. It is likewise confused, I would add, to defend such abuse on the grounds that people need choices.

Still other dimensions come to light in Chris’s testimony—some transparently present, some lurking just beneath the surface. He states, “I would like to say very clearly that when you are in a state of complete terror, absolute despair, and utter isolation . . . when you are in such great pain that suicide seems the only reasonable way to escape that pain, you cannot be said to give consent.” In essence, what Chris is telling us is that he was so terrified and so alone he would have agreed to anything. Comments like this, minimally, should give us pause. As we are all painfully aware, being in such a horrible state that one would hazard anything is hardly uncommon for people in “psychiatric institutions” and/or in crisis. But does that mean that “anything” is fair game for a psychiatrist or anyone else to “offer”? Or rather, as Chris suggests, should this very vulnerability put a greater onus on others to take care in what they offer?

Chris himself states very clearly that agreement under conditions such as this cannot be called “consent.” Finally, he hints at something that I will only briefly allude to here for it is not central to my argument, albeit it is a dimension that we forget to our peril —that accepting such a treatment may be part of a suicidal wish, born precisely out of agony and despair. Again something to bear in mind.

At the very end of his testimony, Chris makes one final point. To whit:

Support and compassion do not cause brain damage. And as far as I know, no one has ever died from oversleeping.

If Chris’s main point is that consent to psychiatric “treatment” is inherently compromised, his secondary point is that it is unacceptable for a doctor to perpetrate harm. This is so, I would suggest, irrespective of consent. I would remind readers here of the ancient Greek medical principle “primum non nocere”—first do not harm. Also, the Hippocratic Oath, which obliges the physician to use medicine to approach disease and in the process “to do no harm” (see http://en.wikipedia.org/wiki/Primum_non_nocere). How is it that we have so strayed from the basis of the profession that we are defending the right of doctors to approach non-disease as if it were disease and to do so in a way that harms? How is it that we are conflating individual choice with what “medical practitioners” should or should not be providing?

Which brings us back to where we began.

To sum up, our prevailing conceptualizations of choice are out of keeping with our experiences as human beings. With regard to psychiatry more particularly, we have fetishized consent to such an extent that we have lost sight of ethics in a more expansive sense and the nature of consent per se. Moreover, we have trivialized hegemony and the fact of institutional rule. The point is, a liberal and individualistic notion of consent is wanting at the best of times. Beyond that, it is seriously at odds with the truth about psychiatry. When it comes to psychiatry, typically, consent is not even close to informed, is not even close to “free.” Additionally, what is far more basic, “doctors” should not be offering bogus medical “treatments, nor interventions that essentially harm—and yet such is the nature of psychiatric “choice.”

(for research, articles, and interview excerpts on these and related topics, see  http://bizomadness.blogspot.ca or follow author on twitter @BizOMadness)

References

Breggin, P. (1979). Electroshock: Its brain-disabling effects. New York: Springer.

Breggin, P. (1983). ECT ban controversy (www.breggin.com/ECT/ECTBanControversy.pdf).

Breggin, P. (1991). Electroshock: Scientific, ethical, and political issues. International Journal of Risk and Safety in Medicine, 11, 5-40.

Breggin, P. (2007). ECT damages the brain. Ethical Human Psychology and Psychiatry, 9, 83 ff.

Burstow, B. (2006). Electroshock as a form of violence against women. Violence Against Women, 12, 372-392.

Burstow, B. (2009). Electroshock: The gentleman’s way to batter women. Domestic Violence Report, 1 ff.

Burstow, B. (2014). The Consent and Capacity Board: Justice enacted (http://www.bizomadness.blogspot.ca/2014/07/as-researcher-investigating-psychiatry.html).

Cohen, D. and Jacobs, D. (2000). A model consent form for psychiatric drugs (http://laingsociety.org/colloquia/polofdiagnosis/modelconsent.htm).

Mead, E. (2014). Comment. http://www.madinamerica.com/2014/07/attrition-model-psychiatry-abolition/#comment-46145.

Phoenix Rising Collective (Ed.) (1984). Testimony on electroshock. Phoenix Rising 4 (3&4), 16A-22A.

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62 COMMENTS

      • Bonnie: I see that you are new to MIA, but that you also are a long term advocate for our community based on the content of your post. In 1988, I was hospitalized with bi-polar and given Lithium. Within the first week of this ordeal I broke a window trying to escape, and I was put in a choke hold, dragged to an isolation room-see Foucault for the disciplinary force of the panopticon form of punishment, also the diagnosis of Drapemonia for slaves-stepped to the bed, ordered to swallow a pillow whose Origen and purpose was made unclear to me-I refused-“have it your way” the unidentied person said to me as she forced a needle of Thorazine into me. No specified time was given as to how long I was to be there. The drug reaction was thoroughly terrifying, compounded by the restraints and the fact that I had to defficate and urinate on myself. Compared to other stories I have read here on MIA, I maybe somewhat fortunate, but nonetheless, I insist that any part of my subsequent compliance with the psychiatric was highly compromised and could in no way be considered informed consent, given that what psychiatry is capable of is truly terrifying. Moreover, I have heard the pithy phrase that they did not know what “you (in this case me) were capable of” as an excuse for the system. Several days after the incident an un identified women explained that they were worried about me harming myself with the glass, and in addition, they were worried about the safety of suicidal patients, who May have squirrel away broken glass in order to do harm to themselves later. As God as my witness, this truly made me feel bad about my actions, but on further reflections, what did any of this have to do with medical treatment. The nurse and psychiatrist involved in the restraint, seclusion, and drugging never followed up with me to inquire about the treatment which would be done in a normal medical procedure. In fact they assiduously avoided eye contact with me for the remainder of my stay.
        Flash forward to autumn 2010,my primary care physician as well as the kidney doctor conclude that the lithium has caused kidney disease. The psychiatrist reduces the dosage but refuses to stop the lithium altogether. I go against medical advice and taper off on my own. So when I go to my psych appointment in December 2011, I don’t know what to expect-owing to the invaluable information supplied by MIA contributors I know that there are in existence Out Patient laws, but I did not not if they applied to my situation in WVa. Subsequently I learned that they did apply in WVa, but to my surprise and relieve, the psychiatrist punted. A few months she relocated to NC, where my wife learned that she was leavening the psych profession for real medicine-my wife over heard her at the dance studio confiding to another parent about how thankfully she was not she was not going to have to deal with psych patients any more.
        I have cycled through many psych meds including Thorazine, Haldol, prolyxzine in hospitals (1989, 1990), Mellaril, Depakoate, Abilify, Lamictal, Zyprexa and Klonapin. I weened of lamictal about six months ago, and have successfully tapered to about 1.75mg Zyprexa-a hard drug to get off of and .5 klonapin. I am down twenty-five pounds with 20 pounds to go. I am taking it slow on the final tapering as there is much hard earned experienced advice on this site regarding the dangers of tapering.
        I have not seen the new psychiatrist since May 2013. He keeps writing the prescriptions, and has not hassled me for not rearing Lamictal, at least not yet. When I was released in 1989, I missed an appointment with the community mental health organization I was pawned off to from the state hospital. The bells and whistles that went off on this account were truly amazing-something a diabetes patient would surely not experience, even though the psychiatrists were insisting that bi-polar chemical imbalance was akin to diabetes.
        When I married my wife, I left the community based system and went with the behavior medicine component of the hospital where my wife worked as a nurse. This makes me wonder if there is a two tiered system in mental health. In the community mental health system, would I have been allowed to get away with taking some degree of control back over my life. While in the graduate counseling program a fellow student who worked as a psychodyametrician once remarked about the patients who showed up at her office to take their “meds”-never a more condescending term in the English language. At least for me at least, no more six month appointments for blood work to check my lithium level-or what else they may be checking without my permission. I have not completely divorced myself from the system- but I have managed to maintain a degree of control over a very unpleasant situation. By the way, the legal system in my community at least, is pretty stone deaf about doing anything about the abuses I have described here.

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        • Chrisreed

          I just want you to know that I find your story terrifying and inspirational at the same time. What a powerful story, and we probably have not heard but a small percentage of your narrative so far.

          I sincerely hope that you contribute more here at MIA and that you consider writing a more detailed memoir of your experiences within this oppressive mental health system; this could be extremely educational for many people out there.

          All the best, Richard

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          • Richard: thanks for the confidence booster. I just started blogging here yesterday, and I am already getting more feed back than in the counseling program at the local graduate college. Despite the jarring introduction to the institution of psychiatry (Two different state institutions separated by two days and a panic attack) the experience was strangely life affirming Two superb human beings, orderlies by any other name, had my back. After the window breaking accident, I was put in seclusion with Willie to guard me. Willie was a very large black man about my age who took to calling me superman-a play on my name Christopher Reeve-Christopher Reed. We played basketball together together, and when I asked him at my darkest moment what he thought of me, he did not hesitate, “down to earth”he said. Tod my other personal guard tracked me down by calling me on the phone at home about a month after I got out,saying that he was very impressed with me and that I helped him to learn a thing or two about life. Tod was about eight years younger and was working to put himself through school,to be as a x-ray technician When he called, I was in the depths of a Haldol hanger and he completely caught me off guard. I thanked him, but not really to the point that the occasion called for. I have been trying to work up the courage to bounce back at him on Facebook twenty-four years later. Also at the first hospital, some of my housemates came to visit me. John gave some really heartfelt comfort to one of my fellow patients who was there for a suicide attempt. Ordinary people don’t get enough credit. Small random acts of kindness in crucial times can be the difference between life and death.
            I have blogged on Laura’s and Bonnie’s post.
            Thanks again Richard

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        • “I insist that any part of my subsequent compliance with the psychiatric was highly compromised and could in no way be considered informed consent, given that what psychiatry is capable of is truly terrifying.”
          That is surely correct. I have some similar experiences and I know that the first thing they do in these institutions is to threaten you with: “you either do _____ or we will force you”. There is no possibility of free and informed consent if the refusal to give it makes no difference except for additional violence and humiliation being perpetrated on that person.

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  1. Hi, Bonnie. Informed consent entails two separate concepts, of course. “Freely given” is implied in the second.

    Clearly, psychiatry is not going to be voluntarily forthcoming with information about the risk/benefit ratio of ECT and there is a huge need to get further information out to the public. Beyond that, we could lobby for legislation that insists individual doctors provide such information.

    Consent, however, is far more problematic. Not just for ECT, but for all psychiatric treatments, I would like to see an advocate made available to all patients facing forced treatment or the more insidious, grey area of coerced treatment. Can’t stress enough that such an advocate would be chosen by the patient and be immediately available, free of charge.

    Of course, it’s not just the routine lack of informed consent, though, that you and others object to. It’s the notion of someone choosing a course of action that you would not. I would suggest that this is similar oppression to what psychiatry practices: “We know better than you do what’s good for you so what you think really doesn’t matter.”

    There are many medical procedures that carry little or no benefit yet substantial risk so ECT isn’t unique. Unfortunately, what works against Breggin’s position is that ECT does often give short-term improvement measured subjectively. Now, for most of us, that very brief relief is not nearly worth the brain damage that accompanies it. For others, though, it is and that’s a choice that needs to be respected. The only issue is whether that choice is truly informed and truly free.

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    • Among other things, my argument is that such choice can not be free or informed. But no, that is not the only issue. Re your issue of relief, lots of people get short term relief by for example, cutting themselves. As a feminist and feminist therapist, I have long advocated that this is everyone’s right and that no one should interfere with this. That is very different that cutting people being a legitimate medical procedure. So with things like ECT.

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      • There is no basis to claim that the choice to undergo ECT cannot be free and informed. A patient can be provided with all information available, be entirely aware of the risks, and choose nonetheless to proceed.

        ECT cannot reasonably be compared to cutting one’s self. But if you choose to “advocate that this is everyone’s right,” then your assertion that ECT ought to be abolished outright is even more untenable.

        I read your work carefully, Bonnie, and agree with much of it. However, all I’m getting from you on this subject is that you don’t like ECT so nobody should be able to have it. As I said before, your position on this is parallel to the top down “we know best” attitude that psychiatry exhibits.

        From a pragmatic standpoint, ECT is not going to go away. Why don’t we work instead on promoting full disclosure and abolishing forced ECT? Those are achievable goals.

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        • “ECT cannot reasonably be compared to cutting one’s self.” Why not? Both ECT and cutting may bring about temporary relief from mental distress at the cost of bodily injury. It’s a perfectly reasonable comparison. Francesca, would you approve of offering”cutting” as a medical “treatment” to alleviate mental distress? How about DIY shock machines? What if I want mental relief without the visible scars? Shouldn’t we be free to shock ourselves in the comfort of our own homes? The more choices, the better, right? Or how about offering shock in bars as an alternative to the relief provided by booze?
          http://www.shock-girl.com/dont-drink-and-drive/
          Which brings up another possible choice – how about offering booze therapy as a medical treatment?

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        • Sure, as long as you hook yourself up to electrodes at home and do it on your own volition you can have ECT. But you can’t have doctors offering this as medical treatment any more than you can go and have a doctor cut you, or beat you up over the head with a baseball bat or give you cyanide etc. That would be criminal for anyone and should be so, even more, for a doctor.
          Either you assume that ECT is an effective medical treatment with a decent risk to benefit ratio which I find hard to believe you do (?) or you have to treat it as any other type of bodily harm.

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      • Bonnie: I feel that I bit off as much as I could have in the previous posting on the role of consent in mental health treatment. A lengthy post I know, but I hope that I have not gone too far a field. One of your related topics was the role of the views of family and friends regarding medication. I think there was unstated assumption that I was expected to comply. I certainly did not want to disappoint, given that friends and family did not take the option of abandoning altogether.
        An important tie in to the view of family and friends would be to explore why they believe in the medical model. I know in the case of my mother she has never read any thing critical of psychiatry. She has a pretty delusion view where she she sees me as the good mental patient versus the really dangerous bunch out that we must be protected from. (As a white middle class college educated person in a state hospital, I had more agency than most of my other patients, and I had visitors where other patients had none. But I certainly saw no sliding scale of sanity and insanity.
        But before I digress to far, I belief that the tie into the belief system is the mass media, particularly the entertainment media’s portrayal of mental illness. In the olden day upstanding women such as Olivia de Havilland in the Snake Pit could be cured. This was of course before the discovery that “mental illness” was a life time advocation. How many times on television and the big screen in the past 25 years have there been allusions to the dire necessitie of mental patient to take their medication. Of the dozens of examples I can think of no modern exceptions-Winona Ryder in Girl Interupted was set in the mid 1960s. Let alone, has anyone ever recovered from drugging, seclusion, and restraint even with the aid of medication in any media depiction. In such a situation you are truly alone against the world, and if you do not have an abiding faith in yourself you are truly sunk. Adam Sandler and Don Cheadle in Reign on Me do a fine job of demonstrating the importance of support for someone in a crisis situation, and the film itself does offer up an opportunity to critique the institution of psychiatry. But the problem is that the film opens up topic, but nonetheless keeps it swallowed in PTSD, the single psych. Diagnosis that seeks to tie real life suffering, rather than limiting bio psychiatric diagnosis of other “mental disorders.” One final digression-300,000 9-11 era veterans diagnosed with PTSD, but also another 30,000 diagnosed with the hair splitting and benefit denying diagnosis border line personality disorder.
        Looking forward to jotting down some notes on how to approach the withering away of psychiatry.

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        • Sorry to hear you were treated this way chrisreed, though if it is any consolation it comforts me to know I’m not alone.

          I have a question, and it is directed to anyone who has been treated in this type of manner to obtain ‘consent’.

          Would it have been different if you were aware that you did not have any rights?

          I know that the false belief that I held that people in my community actually had a right to consent, and the use of force, was the biggest problem for me. Of course politicians are not going to broadcast such information, but I know that had I known it would have changed everything for me.

          This myth believed by the community may be doing more damage that is known.

          Anyhow good luck with your journey.

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          • Shot myself in the foot really, haven’t I?

            I’ve just admitted that I thought I lived in a democracy, and had a right to bodily integrity. That’s proof that I was delusional.

            And those documents that they call the law, our Chief Psychiatrist and the Minister for Mental Health don’t seem to be aware of the protections afforded by the Mental Health Act.
            Funny you would think the author and the person charged with implementing the Act would know what the intent was.

            Guess it doesn’t matter to people until it’s their rights being violated, and then your on your own old son.

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          • Thanks for responding:I was not sure what you meant. Later, I think it came to me. Did it occur to me that I didn’t have mutual consent from the get go, not just when I was stuck with the needle. Prior to that incident,I had been hiding the drugs under my tongue a la R.P. McMurphy- I noticed on Orange is the New Black and Prison break that the authorities on the show made the characters move their tongues around to show that they had swallowed the medication, any way this was 1989-I remember the psychiatrist telling at some point how much I had improved, despite the fact that I was not complying. But this was twenty-five years age so all the chronology is not perfect. At one point the psychiatrist showed me a copy of my EEG in front of every one in the commons area. “I am sorry to tell you this mister Reed, but I am afraid that the LSD you took in college caused you permanent irreversible brain damage. It’s such a shame. You Are so smart.” At such point I fainted. This involved me their wild goose chase. So with the EEG and fainting spell, now they wanted to test me for temporal lobe epilepsy. So this involved some time latter, being transported strapped down strapped fashion with two or three orderlies across down to the local hospital for a CAT scan. I am a little claustrophobic, but I managed to keep it together to comply with the test. Later, the neurologist informed that irregular EEG are not out of the norm, but not before making a dig about my “odd jobs” history. I guess in some parallel universe all this could be construed as helpful. Instead off all this, maybe a week long retreat with Quakers or Unitarians with some Valium and no Snoring roommate would have done the trick. It seems like launching a missile to kill a mouse.

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          • I suppose it is really like launching a missle to kill a mouse lol

            I guess I’m not too clear on what I am saying about this, but before being introduced to mental health services I had a belief that there were mechanisms in place similar to the criminal justice system, due process and a requirement of evidendce etc.

            I simply wasn’t aware that a citizen who had done nothing more than wish to leave their home because of threats by meth users had “potential for damage to reputation and meaningful relationships”, and could therefore be deprived of their liberty, and have evidence of a mental illness fabricated by simply ommitting the threat from any documentation. Must be paranoid if you can see what i’m saying.

            I just havent spoken to many people in the community that are aware that the State, at any point in time can snatch anyone they wish from the street with no “reasonable grounds” and give them a life sentence. And yet this is the situation.

            To me it is a bit like American citizens believing that they have a right to a trial before a death sentence can be imposed, and yet Anwar al Awlaki clearly demonstrates otherwise. Say something the government doesnt like, they can have you killed without the requirement of evidence.

            I’ve been aware for many years of how the police deal with corrupt officers in ‘informal’ manners, ie they tend to have ‘accidents’ or commit ‘suicide’ if they look like they might sqeal if caught. It is effective and protects those of the brotherhood who may be damaged by any whistleblowers.

            I just wasnt aware of this paralel system in mental health that is actually significantly more corrupt than the justice system.

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        • “before being introduced to mental health services I had a belief that there were mechanisms in place similar to the criminal justice system, due process and a requirement of evidence etc.”
          Oh boy, I was naive like that too, kind off – I have a healthy disrespect and mistrust for authority and I’ve never held psychiatry/psychology in high regard but what I saw in the system has shocked even me.
          I was even naively assuming that they only can force drug you when you’re psychotic or that ECT was no longer used. I wonder how many people still believe that and are for a rude awakening if they have the misfortune to enter the system?

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  2. Informed consent as practiced at CAMH in 2002: My son fell into a profound existential funk and stopped eating because he thought the world was coming to an end. He was absolutely correct on that point as he was no longer able to continue as a university student and his family lived a continent away and couldn’t visit him regularly. The doctor sent me a message that said that if he didn’t snap out of it soon, he would receive electroshock. What did we know about ECT? Were they planning to ask us (we would have consented to anything at that point being the naifs we were). The message said nothing about asking my son if it was okay. As it was, a visit from the college chaplain was enough to get him over the depression. What a radical thought – compassionate, human contact as an alternative to running an electric current through your brain.

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      • Agreed, John. The idea of ECT used as a last resort is not how it is practiced. My son had been put on his first drug a month before this latest development. Obviously, starving yourself because you think the world is going to end should be taken seriously, but it was ludicrous because the shrink suggested that he discuss his existential concerns with someone else, like the college chaplain. I mean, really, should the shrink have been able to exercise the same philosophical muscle of his brain that the chaplain did? I guess it only confirms that psychiatrists don’t read the great thinkers and philosophers. Their patients do.

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  3. Bonnie,

    I am just thrilled that we have gained such an honest, ethical, intelligent “antipsychiatrist” like you at MIA. This is a superb article that pulls no punches about all the fraud, abuses and huge harm done by psychiatry in the guise of “mental health” and “treatment.” Your other articles on MIA and your web site are excellent too.

    I’m also delighted to meet the “smart cookie” who came up with this fantastic title about the old boy network in general and psychiatry in particular in their “treatment” of women:

    Burstow, B. (2009). Electroshock: The gentleman’s way to batter women. Domestic Violence
    Report, 1 ff.

    Brilliant!! It’s so nice to meet the very smart lady who came up with that gem that says it all about our misogynist world!!

    I’m very grateful for Rob Wipond introducing you and your antipsychiatry web site to us at MIA though your name and works are familiar to me as another “old timer” all too familiar to those of us who have been researching the biopsychiatry/Big Pharma cartel for decades when forced because our loved ones were put at risk in the 1990’s. I am also very thankful for Dr. Peter Breggin exposing this fraud in such works as Toxic Psychiatry and Your Drug May Be Your Problem, 2nd ed. in the 1990’s when the vast majority in what I now call “the mental death profession” sold out to Big Pharma while voting in their bogus DSM stigmas to push the latest lethal drugs on patent as well as electrical and surgical lobotomies. I am very glad that his works helped you to see through this fascist agenda and that you give him the credit he so greatly deserves for standing alone and unsupported and withstanding the many attacks he endured for fighting against ECT, lobotomy, “the war against children of color,” and so many other atrocities committed by the horrific psychiatry/DSM assault on humanity. He certainly deserves to be called the “conscience of psychiatry” and continues this battle to this day in his many books, web sites, numerous media articles and appearances in the media and before Congress. I am very glad that his works helped you to see through this fascist agenda and that you give him the credit he so greatly deserves. I am glad to see that he has lived to be totally validated for taking the brave stand that he did that helped so many people during this crisis of conscience and humanity.

    Of course, all too many politicians have been enriched with generous campaign and other “contributions” by Big Pharma by selling out to biopsychiatry with its revolving door with government and Big Pharma, so it is little wonder that they have colluded in creating the “therapeutic state.”

    To argue that electroshock should be an available choice is like saying bloodletting with leeches should still be a valid medical choice as well. Plus, even if somebody like Kitty Dukakis wants to fry her brain to a zombie state, that doesn’t mean she should be allowed to put others at equal risk. Have you seen/read the highly regarded book, Doctors of Deception by a highly educated woman who became a victim of ECT herself? The fact that Ernest Hemingway, Sylvia Plath and Virginia Wolf all killed themselves after being manipulated/forced to have ECT because they lost their memories and ability to write/create says it all.

    What is most vile is that the KOL’s of psychiatry ensured that no social or environmental stressors such as rape, abuse, bullying, mobbing, oppression, injustice, racism, sexism, growing inequality, poverty or other nasty isms would be considered in their junk science DSM to blame the victims of their corporate and other old boy network cronies to prey on them with impunity with special focus on women and children in typical cowardly fashion. Robert Spitzer, the narcissist editor of DSM III, admitted that if such causes of their junk science DSM stigmas were considered, the whole house of cards would fall apart. Fortunately, Dr. Thomas Insel, Head of the NIMH has been forced to admit that the DSM is like a dictionary while none of its stigmas like the latest fad fraud bipolar have a shred of validity, evidence, science or anything medical behind them. Of course, anyone doing any research has been all too well aware of that for decades.

    I look forward to reading more of your “take no prisoners” approach when calling a spade a spade when exposing biopsychiatry in your future articles.

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    • Thanks, Donna. What you have referred to as a “take no prisoners” approach, I think is very important. I don’t think that we can afford to be what most people would called “measured” here, for we are talking about an assault on real human beings no matter how it is prettied up and no matter who “consents”. And of course, it is critical to be clear abut patriarchal aspect of all this. And yes, I do greatly appreciate Breggin–another old timer here. To be clear, I was well aware that the drugs were highly problematic before Peter began writing about it. However what we started to get with Peter were precise mechanisms of damage–informative, frightening, and useful to know. Thank you yourself, thank all the other “old-timers” and thank to all the new folk who are contributing to this struggle.

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      • In terms of overall psychology re the general public (including „proud“ and most of all potential „users“ of the current system, their families and friends) and „traditional“ (meaning medical model-oriented) mental health practitioners of any kind, what we are also up against here is a milder form of what the Israeli psychiatrist (sic! 🙂 Zvi Rex remarked upon as:

        “The Germans will never forgive the Jews for Auschwitz.“

        (http://en.wikipedia.org/wiki/Secondary_antisemitism)

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  4. This is a wonderful article for so many reasons Dr Burstow.

    I can’t help but wonder if there has been a typographical error somewhere in history, and that the term should be spelled conscent.

    Con –

    verb
    1. persuade (someone) to do or believe something by lying to them.

    noun
    1. an instance of deceiving or tricking someone.

    Scent –

    noun
    1. a distinctive smell.
    2. a trail indicated by the characteristic smell of an animal and perceptible to hounds or other animals.

    Certainly there is an element of the con about the whole process, and whilst a scent is usually associated with pleasantness, there is something about this notion of consent in psychiatry that stinks.

    I look forward to reading more of your work.

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  5. The “Model Consent Form” link itself was worth the price of admission and the article is priceless!

    (If you don’t get too many responses it’s only because it’s very hard to disagree with anything you write.)

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  6. Thank you for the article! The issue of informed consent also comes down to a question of values, I think. There seems to be something that feels very much like excuse making to take an argument that goes something like, “well the person wanted it, so my hands were tied.” Thankfully, I’m not in a position to “prescribe” treatments of these sorts. But if I was, and a person came to me saying that the were absolutely certain they wanted ECT, I would not participate in them doing it, anymore than I would assist someone in having a lobotomy. It’s true that the individual can continue their attempts to receive certain “treatment,” but I don’t have to support it or be involved in it.

    The other serious piece of this discussion is the matter of what actually constitutes “informed” consent. I personally suspect that informed consent is almost never obtained for nearly anything aside from possibly the most simple voluntary outpatient counseling. I believe that the system too frequently treats consent as a political game in which full, comprehensive information about “treatments” being proposed are presented with the complete description of possible benefits and risks, a review of the evidence – if any – about such a “treatment” and a reminder to the individual of their full range of rights, including the right to decline without reprisal, the right to withdraw consent at any given time, among others.

    I believe there are two major biases that give “professionals” a much greater sense of freedom to rationalize and justify the lack of truly informed consent. The first is the nature of the dominant medical model that establishes a framework of “doctor” to “sick person” with all the paternalistic authority contained therein. The second, somewhat less discussed, is the issue of class. Poor people are seen as “other” in this society. A rich person will likely have infinitely more say, more information, and more consent in his or her own care than a poor person ever will.

    The state mental health system, wrapped up in medicaid and medicare, and the disability system, which grants benefits at at or below the poverty line, overwhelmingly interacts with the economically marginalized. A person’s intellect, character, and basic status as a person are all seen completely differently as a torrent of cultural biases and bigotry run completely unchecked. “Those” people don’t know what’s best for them. But “we” do. So if we shade the truth a little bit, or gloss over the details, or talk of “evidence” that doesn’t really exist, that’s all OK because those “other” people really just need to do what we want and stay out of the way of the “real” people in the world.

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    • “Patients,” do not usually get informed consent in psychiatry, even when they are voluntary patients, they get high pressure sales tactics. It is worse if you have been detained under the mental health act as people then get frightened they will be forced to take these drugs if they decline to take them.

      A friend, who is suffering several bad effects of Quetiapine, was told he needs these drugs by his psychiatrist when he told them about the bad effects and asked for a reduction. The psychiatrist noted that he objected to every drug he has been on, and he has been on quite a few, being a long time “Patient,” (in his case, survivor of psychiatry seems a more accurate description) and he felt harmed by every one of these drugs. Yet the psychiatrist, while noting this, seemed to minimize the damage and my friends desire to reduce the dose. So it becomes the patients fault for refusing the drugs, not the psychiatrists job to provide accurate information so the patient can make and informed decision.

      Recently we have been discussing what was happening before he had his breakdowns. Guess what, every time appalling things were happening in his life and guess what, the services ignored them every time. And guess what, being on the drugs or not being on the drugs made no difference as to whether he had a breakdown. So after decades of psychiatric indoctrination he admitted that maybe the breakdowns were to do what was happening in his life and perhaps he did not have a serious mental illness (bipolar in his case).

      So I bought him a pill cutter – by the look on his face it was the best present he’d had in years.

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  7. Dr. Burstow, thank you for speaking the truth. I wholeheartedly agree, it is morally and ethically wrong for the medical community, as a whole still, to be advocating belief in “disorders” that have no scientific validity. And it is morally and ethically wrong for doctors, who’ve promised to “first and foremost, do no harm” to even be offering “treatments” that are not proven to be effective, and whose true long run harms are supposedly yet to even be researched properly.

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  8. Informed consent is usually misinformed or dis-informed consent. People are consenting because they are not being told the truth. How many people would consent to a procedure that caused, often and usually, brain damage? How many people would consent to take drugs that they were told are going to destroy their looks and their physical health? Not many I’d warrant. They are being told that ECT is safe. Ditto psych drugs. They are being told out and out lies. Great article, Bonnie. It’s terrific to have you posting on Mad In America.

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  9. A cerebral and beautifully written article.
    I simply cannot comprehend how, after 50 years of anecdotal and scientific evidence revealing that this barbaric “procedure” is brain disabling closed head injury that destroys lives and families, it is allowed to continue. We know athletes are concerned about TBI’s resulting from multiple head concussions causing brain damage, resulting in memory loss, rage, anxiety, depression, and dementia, but “doctors” will administer 3 head injuries a week for a month and not question the damage they are inflicting?? If 50 years of protests, marches, conferences, survivor testimonies, hundreds of scientific and academic papers, protests from neurologists, and individuals like Peter Breggin have accomplished nothing, what is the point?? The public relations propaganda, the rebranding of the “kinder, gentler, safer” ECT continue to draw in victims. If a few dozen women are injured by “vaginal mesh bladder implants”, the product is banned, the procedure halted. The same is true of other consumer products that cause injury. Why not ECT??
    Would multiple rounds of lawsuits keeping hospitals tied up in litigation work?? Probably not, since the injured victims rarely have the finances or the focus to pursue this avenue of recourse. They additionally suffer from trauma that would be exacerbated by reliving their experience in court. If there has been a recent ruling of about 29 billion dollars in favor of a man who died from lung cancer because the cigarette companies were culpable, why cannot multiple lawsuits be launched on behalf of the victims of electrical lobotomy??
    The only other option seems to be stealth terrorism that seeks to destroy or disable the machines themselves and the factories that produce them, while avoiding injury to anyone. Now here is a job for Jack from 24, minus the guns and violence.

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  10. Thank you Bonnie ,analysis at this level is like music to my ears. Isn’t it amazing that the “educated” psychiatric complex behavioral control freaks are the real people whose criminal behavior needs to be eliminated and yet they have immunity.
    Maybe a modern day Madame Defarge that is not fictional wielding an electric shock machine and a mixed bottle of neuroleptics instead of a guillotine determined to hunt down every last bogus psychiatrist and nurse rachet and pharma executive and collaborating government official to give each one a dose of their own medicine as needed is what it will take to turn the nitemare around. The attack on the people that is going on is the same as an accelerating time released war and we are the frogs in the pot.

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  11. As far as science is concerned here’s a great quote I found.
    “There is no proof. There are no authorities whatever no President, Academy Court Of Law, Congress Or Senate on this earth has the knowledge or power to decide what will be the knowledge of tomorrow.”
    Wilhelm Reich (a man whose discoveries and ideas are worth investigating.

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  12. so glad to finally have an explicitly and dedicatedly FEMINIST WOMAN on MIA. Keep spreading the good word! I wish this article had more explicitly linked the feminist work on consent in sexual situations to the issue of consent in psychiatry, but it is still a great article.
    THANK YOU!!

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  13. As I stated, after considering all the time and energy expended on a variety of approaches that have failed to end this human rights issue involving abuse and documented permanent injury and disability, it is essential that another approach or approaches be implemented. Are there passionate lawyers willing to work pro bono for a righteous cause? The only way to stop the ghouls administering this procedure and the hospitals providing it and the governments sanctioning it, is to launch a flurry of lawsuits on behalf of the injured and walking wounded. Peter Breggin’s testimony was central to Peggy Salters’ award of $600000+ for the damages she incurred as a result of ECT. And, yes, that was in the United States, where lawsuits are more common, but it is not to late to begin. So, we have the experts quite willing and able to testify, lawyers whose fees could be covered by fundraising or donations from people injured by this “modality” or human rights advocates with cash or access to wealthy individuals looking for a cause who are appalled and indignant at the egregious harm that continues to be done under the guise of a medical “procedure”. Tie up the courts, launch multiple suits against doctors, hospitals, and the governments of every province in this country. Make taxpayers aware that they are paying for brain damaging procedures sanctioned by their government which is failing to protect its citizens. Let newspapers publicize the survivor testimonies and bring the latest scientific research to the public, in the process inspiring revulsion and absolute indignation that those who pledge to “first do no harm” are injuring thousands of unsuspecting victims under cover of lies and disinformation.
    Any lawyers out there with an insight on how well this might actually work?

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  14. “defending the use of such “treatments” as ECT “as long as they are consented to,” with the term “informed consent” ”
    Sure, we can also demand that doctors should be allowed to administer blows with a baseball bat to the head if someone consents to it. Or giving someone cyanide or snake oil.
    There should be a difference between what people are allowed to do to themselves (which I believe should be up to an individual) and what is being sold as medical treatment and prescribed or performed by medical professionals.
    Interestingly, psychiatry will administer ECT on you against our will but if you want to cut yourself then they’re going to lock you up and take away your civil rights.

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