A growing body of evidence indicates that forced “treatment” in today’s mental health system, including all forms of forced hospitalization and forced drugging, may actually cause FAR more harm than good. Recent published studies and articles (1)(2)(3)(4) point towards evidence of physical and psychological harm that, in some cases, may contribute to more suicidality and patient deaths, as well as overall worse outcomes in a person’s state of recovery. This is aside from the somewhat separate (but yet intimately connected) civil and human rights violations involved in taking away someone’s freedom for merely having different thoughts and behaviors that never actually break any laws.
When all this evidence is combined with the growing number of powerful narratives by psychiatric survivors articulating horrific stories of the damage caused by the use of ‘force,’ (including many who write here at MIA), the only conclusion that makes any moral and political sense is one of TOTAL ABOLITION. That is, all forms of force in the mental health system must be CATEGORICALLY opposed without ANY exceptions for so-called special and/or extreme circumstances.
Some mental health reformers and partial critics of the current system would counter that this is an “extremist position”; a position that does not take into consideration certain special, or rare, life and death circumstances that require ‘force’ to save lives. And that maintaining such an “extreme” position will only lead to isolating articulate critics of the system and harm any movement for change.
Nothing could be further from the truth! I would say to those who defend the use of ‘force’, including those system critics who advocate for its use in only very rare and so-called extreme circumstances: It is you who are holding on to a truly extremist position, and it is your ambivalence and lack of decisiveness on this dividing line question that is giving up important political and moral ground to the leaders of this oppressive mental health system, thus actually slowing down the struggle for its ultimate and necessary demise.
This dangerous lack of clarity on such a vital issue makes it easier for the leaders of Biological Psychiatry to justify ‘force’ by using certain system “reformers” as a “more reasonable” wedge against the more revolutionary activists in our movement; those who advocate for a complete dismantling of the current mental health system. This allows the perpetrators and defenders of psychiatric abuse to promote themselves as the TRUE guardians of order and safety, in what they would portray as an increasingly more dangerous life and times in our communities and in the country as a whole. This fear mongering and demonizing of people labelled as “mentally ill” must be firmly opposed on all levels, even in its more subtle and reformist forms. In the final analysis, it is this kind of half-baked reformism on such a key dividing line issue that only strengthens the status quo and weakens any serious movement for change.
Not that long ago I would have been one of those persons (still working in the system) who would have argued that there were some extreme circumstances where certain types of ‘force’ might be “reluctantly” necessary. However, over the past few years of carefully reading and analyzing survivor narratives and discussions at MIA, I have become more and more convinced that we all need to take a firm abolitionist stance on this question and fight for it publicly. Thanks to the following MIA discussion writers: Anonymous (here) http://www.madinamerica.com/2013/06/mad-in-australia/#comment-25723 and Jonah (here) http://www.madinamerica.com/2013/12/homelessness-hospitalization-compliance/#comment-35070, Frank Blankenship and others, I am quite comfortable speaking out and advocating for NO FORCED “TREATMENT” WITHOUT EXCEPTION! Here is why:
One of the major pillars supporting any type of oppressive mental health system is its use of ‘force;’ specifically its use of forced “treatment” or hospitalization and forced drugging. The use of forced drugging usually follows ‘force’ in all its other manifestations. The standard justification for the use of force is when someone is declared “a danger to themselves or others.” This declaration may, in some cases, be decided by a judge in a court of law (usually at the recommendation of a family member supported by a psychologist or psychiatrist), or more simply (in a community mental health setting) by the mere signature from a psychiatrist’s pen after having a five minute discussion with a family member or a mental health care professional. Oh my, how easy it has become in America (even when no laws are broken) to completely ignore or throw away any semblance of a Constitution or Bill of Rights!
For those who call themselves “reluctant” supporters of the use of ‘force,’ many will admit that it can be a drastic form of stripping away someone’s freedom, which can often lead to a cascade of traumatizing events that may have no immediate end, and may lead a person into a maze of unknown consequences; consequences that could negatively affect that person for the rest of their life. HOWEVER, in the minds of all supporters of ‘force’ (reluctant or otherwise) these consequences are ALL justified as an alleged necessary means to ultimately “protect” individual lives and the public at large.
The “reluctant” supporters of ‘force’ will rationalize all sorts of exceptional circumstances where they believe there is no other choice but to take away someone’s freedom to “protect” themselves and others from harm. They will usually end their argument by stating that distressed people (especially those acting in a threatening manner), after all, are better off in the hands of the mental health system (with all it problems, including forced drugging) than in the hands of the cops or guards at a jail facility, which they say is the only other alternative provided by the system (more on this later).
Is it true that forced “treatment,” in certain limited instances, has actually HELPED some people in psychological distress or, in some cases, even SAVED some lives? Even the most ardent critics of the use of ‘force’ would have to objectively answer, a highly probable yes, to this question. HOWEVER, answering yes to this question does NOT mean, in any way, that force hospitalization or forced drugging should THEREFORE be supported. Here is why.
We can NEVER truly know for sure who could possibly be helped by the use of ‘force’ in the future, or somehow recreate the final outcome of those crisis scenarios in the past where “force’ might have been denied and another path taken. We have no way of reconstructing a new historical path for those past series of events to determine if another outcome (perhaps even a much better one) would have occurred if ‘force’ had been denied and never used.
But we DO have some growing evidence (references included) detailing that the use of “force” can be very harmful (even leading to possibly higher rates of suicide) and reams of personal testimony detailing the psychological and physical harm resulting from the various forms of forced “treatment.” Being physically restrained and tied to gurneys for hours and eventually mind raped (in the words of many survivors) with powerful neuroleptic drugs are only part of the many powerful stories of harm being done by the use of ‘force.’
There may be some former psychiatric patients who will say that they are glad they were forced into “treatment” or even forced to take mind altering drugs, because they believe they were dangerously close to harming themselves or others. But this deeply personal and subjective testimony as to some POTENTIALLY IMAGINED outcome is, after all, only hindsight. And there is no objective guarantee or way to scientifically analyze that it is anywhere close to being 20/20 hindsight, especially given that we have NO WAY of knowing what these individuals might have learned or done if left by themselves, or in someone else’s control (including the police or jailers) or if they eventually found alternative forms of care (family members, friends, or some other unknown options).
Let’s examine, head on, the most challenging argument that can be made by the proponents of the necessity for the use of ‘force’ in today’s mental health system. All supporters of ‘force’ (including the “reluctant” ones) would most certainly point to specific instances when family members, mental health workers, or law enforcement agents resisted taking decisive COERCIVE action when someone in extreme psychological distress implied or somehow directly threatened self-harm or violence, and then subsequently a death or severe injuries (to oneself or others) was the end result.
Yes, we know it is true that a small number of people in these extreme psychological states have killed themselves and others after they have given direct or even vague signals that impending violence might take place. It must be clearly stated that the vast majority of these types of threats are mainly gestures, only suggesting harm, and represent a dramatic or desperate call for help, and no violence ultimately occurs. But yes, in a tiny minority of these situations suicide and/or violence to others takes place and we must face this reality.
The essential questions we must ask in response to the justification for ‘force’ in the above mentioned scenarios are as follows:
How many of these suicides or violent acts were strongly influenced by the PRIOR use of ‘force’ and the resulting coercion (including those Mafia like “offers you can’t refuse”) especially to take (and/or remain on) powerful psychiatric drugs?
How many suicides and violent acts occur because distressed individuals FEAR that some type of ‘force’ is impending or will soon to be on its way into their life, and they can’t begin to bear the thought of being on the receiving end of that ‘force’ ever again? And here it must be noted that in these situations, if you are poor and/or a minority does it not exponentially increase the danger and likelihood that you could be beaten, shot, and/or killed by trigger happy law enforcement agents in these highly volatile circumstances.
Just by raising these questions the strong implication is being made that the prior use of ‘force’ and the fact that it often hangs precariously over people’s heads may, itself, act as a causal factor in incidents of self-harm and violence. And this becomes just one more reason why ‘force’ must be rejected without any exceptions.
As to those situations where family members, mental health workers, and law enforcement agents held back from using ‘force’ with resulting bad outcomes, we have NO WAY of knowing what the outcome would have been if some other less intrusive option or form of support was offered. And given that we now have increasing evidence that ‘force’ is causing FAR MORE short and long term HARM THAN GOOD, are we not, once again, morally and politically obligated to reject the use of ‘force’ without exception?
Yes, it is true that at this point in history we have very few well established (more humane) alternatives in the mental health system. There are sadly very few trauma informed crisis teams or respite homes that incorporate non coercive, non-drugging programs. IT IS MY CONTENTION THAT IF MORE PEOPLE TOOK A STRONG ABOLITIONIST STANCE AGAINST THE USE OF ‘FORCE,’ ESPECIALLY THOSE WORKING WITHIN THE SYSTEM WHO REFUSE TO BE INVOLVED IN ANY ACTS OF ‘FORCE,’ THE MORE PRESSURE THIS WOULD PLACE ON THE STATUS QUO TO PROVIDE MORE BENIGN ALTERNATIVES, INCLUDING INSIDE THE JAIL SYSTEM.
Obviously this involves taking some risks for those working within the mental health system, but there are some people who participate at MIA who can share some powerful experiences regarding going against the grain of hospital, clinic, or residential policies on similar questions of ‘force.’ People working within today’s mental health system must constantly be ready to challenge the status quo and take careful and calculated risks doing so. Without this kind of approach (that ideally includes outside support from other activists) it becomes so easy to find yourself on the oppressive “path of least resistance” that ends up reinforcing the status quo while ultimately causing one to lose track of their own moral compass.
This focused battle against all ‘force’ and coercion, by itself, will not lead to an overall systemic change in the mental health system, but it could become a key dividing line struggle that lays bare the true essence of today’s oppressive system, while rallying new allies, and saving more victims from the damaging effects of ‘force.’.
Another controversial issue concerning the use of ‘force’ involves the role of jails and the entire prison industrial complex. If we are more successful in building a movement that severely limits the use of ‘force’ in today’s mental health system, then jails (without other alternatives developed) will inevitably become a more frequent option used by the power structure. Mainstream psychiatry promotes its own “treatment” options (including those involving the use of ‘force’) as more humane than what is offered by today’s prison system. We know better.
Even when there are a few more conscious and humane people working inside those programs where ‘force’ is still used, very few of these people are in positions of power to maintain a consistently safe environment. And even where more humane practices exist today they tend to be fleeting and temporary, more often overruled by others or unable to be sustained for the long term. Drugging and other oppressive forms of social control are still the ultimate “standard of care” that dominates the entire mental health system.
As bad as jails are in this society (and they are horrible) they may actually represent “harm reduction” compared to what the mental health system has to offer. Even the more subtle forms of coercion and control exercised by Biological Psychiatry, that more often leads to long term drugging and learned helplessness, may in the end surpass the short term horrors of today’s jail system. OUR GOAL SHOULD NOT BE TRYING TO REFORM THE MENTAL HEALTH SYSTEM TO BECOME MORE HUMANE SO THAT ‘FORCE’ CAN BECOME MORE ACCEPTABLE, BUT RATHER FIGHT AGAINST ALL FORMS OF ‘FORCE’ AS A MEANS TO CREATE THE CONDITIONS FOR A REVOLUTIONARY DISMANTLING OF THE ENTIRE MENTAL HEALTH SYSTEM!
So all of these arguments regarding the use of ‘force’ in the mental health system boil down to the following points:
- ‘Force’ causes FAR more harm than good.
- ‘Force’ violates every precept of human rights in a so-called free society.
- ‘Force’ inevitably leads to more sustained psychiatric drugging and its related iatrogenic damage to the mind and body.
- ‘Force’ leads to greater forms of social control using threats of future incarceration (in psych wards or jails) and coercive forms of monitoring within the community at large; this includes various levels of coercive psychiatric drugging.
- We have no way of proving where the use of ‘force’ will ever lead to positive outcomes, or where its lack of use has led to an increase in negative outcomes.
- We know for sure that force has caused great harm to some people, and ultimately fatal or permanent harm for far too many of its victims.
A principled and uncompromising stand for the abolition of all ‘force’ in today’s mental health system creates the most favorable conditions to challenge and educate people about the true nature of psychiatric oppression. It shines a spot light on everything that is wrong with the mental health system and the unjust and abusive power that psychiatry wields in today’s world. Such a stand unites with the highest aspirations of those people desiring true liberation and freedom from all human rights violations and forms of oppression.
To all those survivors of Biological Psychiatry and those at risk of falling into its clutches, AND to all those working inside the Beast yearning for radical change, MAY THE ‘FORCE’ NEVER EVER BE WITH YOU!
1. Bradshaw, Maria; Evidence That More Psychiatry Means More Suicide, Mad in America blog, Jan. 12, 2014.
2. Hjoerthoj, Carsten; Rygaard et al, Risk of suicide according to level of psychiatric treatment: a nationwide nested case-control study, Social Psychiatry and Psychiatric Epidemiology. Sept. 2014, Vol. 49, Issue 9, pp 1357-1365.
3. Large, Matthew M. and Ryan, Christopher J., Disturbing findings about the risk of suicide and psychiatric hospitals, Social Psychiatry and Psychiatric Epidemiology, Sept. 2014 Vol. 49, Issue 9, pp 1353-1355.
4. Rajkumur, A., Brinda, E., Duba, A., Thangadurai, P., Jacob, K., National suicide rates and mental health indicators: An Ecological Study of 191 countries, International Journal of Law and Psychiatry. Sept.-Dec. 2013 36(5-6), 339-342.
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.