What Kind of Forced Treatment Would You Prefer?

Olga Runciman, Cand Psych BSc
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The new Danish psychiatric law which has been under development for a while has just been passed by the government and is due to be implemented on 1st June 2015. However the road to this new law, ostentatiously to improve the rights of the patients, has had an interesting history. Among other things:

Danish Government to the Patients in the Locked Wards: What Kind of Forced Treatment Would You Prefer?

This was the headline of a featured article in one of our more serious national newspapers. The purpose of the article was to highlight that the Danish state wishes to reduce the amount of forced treatment found within its psychiatric hospitals, something that has been a goal, albeit an unsuccessful goal, for many years. In fact the latest statistics were in some areas the highest ever particularly with regards to children. Denmark was on its way to achieving the dubious title of European champion in the number of people subjected to physical restraints according to the European Committee for the Prevention of Torture.

Yet for me the wording of the newspaper title was extraordinarily offensive. A national newspaper was asking the non-compliant patients, on behalf of the government, which kind of ‘torture’ they would prefer. Yet incredibly, this is not what will be seen. What the general public will see is something so normal as to be banal, in fact many probably think it is actually an act of kindness to enquire as to whether the patient would prefer being put in belts, force medicated, forced ECT, secluded or other types and combinations of involuntary treatments. Few will pause to question and think, perhaps we need to seriously start looking into alternatives. Such is the power of psychiatry that the very language of its human rights abuses has been medicalized, neutralized and normalized, rather like the euphemistic term ‘collateral damage’ meaning civilians, men, woman and children have been killed.

At the same time as opening up for choices as to which kind of forced treatment patients can choose, some now also have a new choice force treatment available to them. From the 1st of June shackling will officially be allowed. This practice colloquially known as “Guantanamo style belts” has been allowed on a trial basis for the last 4 years in forensic psychiatry and will now be made permanent. Sadly, forced community treatment which has also been trialed for the last 4 years has been granted a further 4 years trial.

Likewise, in the wake of the massive critic for putting so many people in restraints, Denmark has initiated a policy to reduce the number and open some restraint free wards. Though they have not been in existence long, our fears that belts will be replaced with forced medication is already being fulfilled as could be seen in the newspapers a few days ago.  A 9% reduction in restraints but a 12% increase in forced medication.

Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment of Punishment Juan E. Méndez couldn’t make it clearer when he in a statement to a session of the United Nations Human Rights Council in Geneva on March 4, 2013 called for a ban on forced psychiatric interventions including forced drugging, shock, psychosurgery, restraint and seclusion, and for repeal of laws that allow compulsory mental health treatment and deprivation of liberty based on disability, including when it is motivated by “protection of the person or others.”

However, just recently I discovered that in the preparation for this up and coming new psychiatric law, the Danish Psychological Association an association to which I belong also had a recommendation…

“The Danish Psychological Association recommends a more far-reaching legislation in this area [forced treatment], which allows the special psychologists* in psychiatry to prescribe non-medical force treatment on an equal footing with the psychiatrists.”

(*Special psychologists are authorized psychologists who have taken a further 4-year course specializing in adult or child psychiatry. The course is virtually identical to the one doctors take to become psychiatrists.)

I was stunned! At the same time I was convinced that this desire to be a mini-psychiatrist must belong to a small handful and that the majority had, like me, not been aware of such a wish. It turned out it was me who was naïve.

It is important here to state that what you are about to read is not necessarily representative and there can be many reasons for why those who chose to express themselves, expressed themselves in the way they did. I will at the end of this blog try to reflect over possible explanations.

I wrote to a couple of forums reaching potentially 1000’s of psychologists (though some overlap is likely) saying “I am shocked to my core! Do we really want this?” quoting the above text.

This initiated an extremely long group forum discussion,* as apparently me being ‘shocked to the core over psychologists wanting to prescribe non-medical forced treatment’ turned out to be provoking.

*(Personal communications 2015)

“Yes, we want it…”

“But it would be absurd if the [UN handicap] convention overrules what is best for the individual patient.”

“It is as if every time the word force treatment is mentioned, then those who have no experience in this area get a picture of evil psychiatrists with a perverse smile on their lips, stuffing pills down the throats of fixated patients… that’s not how it is in 2015… the change in the law that we want will equate us even more with psychiatrists and thus give psychologists a greater voice in psychiatry.”

“Olga Runciman you have a patient who starts to eat himself… what do you do…?

“Olga, have you ever worked in a psychiatric ward? I ask because I have difficulties imagining that you would be in any doubt if you had.”

“Of course uncomfortable ethical dilemmas arise in our professional work but it is no good hiding our heads in the sand over this. Psychologists have to, literally, enter into the battle. That we at the same time want to work for a more holistic, recovery orientated and less medical model psychiatry –also to reduce force treatment – is in my a opinion not a contradiction”

These are just some initial examples of what my fellow psychologists were thinking with regard to my shocked outburst.  I was truly saddened.  But then I decided to try and explore why they would want to be prescribers of force asking a series of questions based on the many initial comments.

I asked:

  • [Do you] see mental distress and criminality as related, for example genetically? And just to be clear where I stand I do not accept violence or abuse. If you believe there is a relationship then I am very interested in hearing your thoughts regarding this.
  • I feel inspired to quote C. S. Lewis: ‪“Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. [For] those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.” The CRPD exists and we as a country are obligated to follow it, which is why we are in the beginning stages of planning restraint free wards. Why then should we psychologists participate in something that is already covered by another professional group namely psychiatrists? Should we not be keeping our profession pure, ethically and morally? Is the goal to be mini-psychiatrists? I am asking because I am curious, as the desire to be able to prescribe forced treatment is incomprehensible for me and I would like to know what thoughts lie behind wanting this.
  • I hope not all psychologists fully share psychiatry’s psychopathological approach to mental distress. I certainly don’t. I also find it very difficult seeing how recovery, forced treatment and psychopathology can go hand in hand. How do you see that as possible?
  • Finally would you like to, in time, see special psychologists being allowed to prescribe medication in some form or other?

Hardly neutral questions I agree.

“Olga – I am so extremely tired of being foisted with the assumption that by becoming a special psychologist I become some form of mini doctor pseudo psychiatrist… I don’t; I become a special psychologist […] I really want to focus on the whole person and psychology in psychiatry – and that is why I have chosen to take the specialist education, that means I am allowed to have responsibility and shared decision making with regards to the patient’s treatment… that also includes forced treatment.” 

“I have no trouble seeing how forced treatment, psychopathology and recovery can go hand in hand.”

“Olga, just for clarity’s sake do you see it as better that clients who have gone off the deep end and who are viewed as dangerous, are set free to perform extreme violence against themselves or others, or should they be secluded against their will? […] It’s unclear to me what arguments you follow, do you really, literally think that people should just be set free to do whatever they want regardless of their state of mind?”

 “I will make it short. I would like to be able to prescribe forced treatment, as I would like to make independent decisions with regards to the patient that I am trying to help rather than confer with a doctor that probably does not know the patient’s case as well as I do.”

“Actually I don’t understand why it has to be only special psychologists that can in the future diagnose and use force treatment.”

Our renomé out in society amongst patients and their families will be damaged if we don’t take responsibility for making the hard and many times difficult decisions and in the end save lives.”

“Well of course psychologists should be able to prescribe forced treatment. There is nothing bureaucratic here that requires specific medical knowledge. Also, we should after a little course in psychopharmacology be allowed to prescribe certain psychotropics under the supervision of a doctor of course. It’s not that difficult to study the same (small) amount of pharmacological/biochemical knowledge that all the residents and interns in psychiatry are in possession of. […] It’s not due to lack of knowledge that has resulted in psychologists not calling the shots. The doctors just got there first, have a good union and keep a tight hold on their professional boundaries. It should be us, with only a little bit of assistance from any old doctor, when it comes to e.g., ECT, intense polypharmacy, detox etc. And yes I would rather be a psychiatrist than a psychologist. At least I would when it comes to their union, power, status, wage, responsibilities and in some situations their lab coats.”

“To use coercion can be an act of kindness. […] just like using forced treatment can be an act of kindness. I would like to take on the responsibility [of forced treatment] and use it compassionately.” 

“By the way I am wondering just exactly why forced treatment in psychiatry is so awful? Coercion and violence exists in numerous forms and everyone is exposed to it. Quite often without even noticing it as belonging to the category coercion/assault. Why is it so bad when it takes place in the psychiatric hospital?”

There were very few who wrote that they, like me, did not want the power to prescribe psychiatric coercion.

“I agree with Olga. This is an area psychologists ought to keep away from. Let the doctors do it. I don’t understand at all people who have a need for or feel good about having that position of power.”

And there was one person who joined me throughout this whole discussion

“I just want to say that I understand you and what you are on about – I think. I find it uplifting that there is finally a colleague who dares to speak her mind on behalf of our profession and ask something along the lines of what the f*** are you thinking of?

Since this discussion I have really been speculating. On a personal level the fact that so very few questioned the significance, and the consequences of psychologists aligning themselves so thoroughly with psychiatry and their policy of forced treatment was alarming to me. That my association the Psychology Association that represents among others also me, has that written down as something they are working towards appalls me.  And in the end I believe that this has very serious consequences for the trust between a psychologist and client. For if it is implemented it will seriously compromise psychologists in Denmark as the person one can go to for help.

On a larger scale looking at this through the lens of society I think I can see why perhaps this was the face shown by my fellow psychologists. I started out with the heading of a national newspaper asking on behalf of the government the question “what kind of forced treatment would you prefer?” a question that I was unable to wrap my mind around it. Yet it reflects society. I believe that this debate clearly embodies the face of society expressing what is acceptable and politically condoned. This is the norm and there is power and acceptance in belonging to the norm. I do not believe that this is the voice of the majority of psychologists in Denmark but I think the silence of their voices and the candidness and dominance of those psychologists who wish to prescribe non-medical forced treatment clearly mirrors the accepted societal viewpoint on how we view, deem and judge the so called ‘mad’ and sadly highlights the fear of going against the current political tide.

Therefore I want to make a promise that I as a psychologist will:

  • Never participate in diagnosing a fellow human being
  • Never view people through the lens of psychopathology but instead respect people’s dreadful life stories and the impact this has on their lives.
  • Not support the medical model of mental distress.
  • Never condone forced treatment.

Instead I will abide by the Convention on the Rights of Persons with Disabilities.

 

24 COMMENTS

  1. I believe the mental health world would have more credibility (which fades more every day, from what I hear out here in the world) if it were to actually focus on healing and personal growth rather than who has power over whom and who can force whom to do what. There is no civility in this. I think we need to start over.

  2. Thank you Olga for exposing the way that these psychologists talk about forced treatment and for your pledge to never diagnose anyone and never condone forced treatment. I wonder how many others would take that pledge? In psychiatry, psychology, social work, psychiatric nursing or any related profession?

    • Dear Olga, unfortunately I am not that surprised about your “results”, rather the opposite- for years I have been concerned that the psychiatric language and idea about human beings have influenced and damaged not just psychologists, but also therapists, teachers and socialworkers. As you know we decided many years ago to remove psychiatric diagnosis at my work place and to tell people another story than the “common one” re drugs and “treatments”. It is not an easy thing and each of us in the organization has to remind ourselves and others not to forget how important it is. Every day!!!! It is hard at times, and seems so much easier to follow mainstream, and to stay in the comfort zone. Anyway, I have come to the same decision as you and make the same promise. Maybe it means that I am more of an activist than a therapist nowadays…? Anyway, thank you for being there and doing the things you do.

  3. We need to use the language against the mental health movement’s, and the psych industry’s, mutilations of it. Mental institutions are psychiatric prisons, they aren’t hospitals, not so long as people can’t sign themselves in and out at will. Forced drugging, of course, is not assisted outpatient treatment, if it’s anything it’s outpatient, or rather outprisoner, maltreatment, and doctors who resort to it should be liable for malpractice, of course, when patient/prisoners are, as they all so often are, injured. Doctor assisted suicide, especially in the case of so-called “mental illness”, is not assistance at all, it is murder. Suicide doesn’t require assistance.

    Erving Goffman had it right when he critiqued the mental institution as a total institution, that is, as a dictatorial institution. The proper response, as far as I’m concerned, is, “Given a dictatorial government, what kind of forced treatment would you prefer?” The inmates of the mental, no, not hospital, imprisonment and medicine are at antipodes, prison, are not free. Isn’t this unfreedom a threat to the liberties, in a limited sphere, the rest of you take so much for granted. Also, the matter of locking people up as pre-crime suspects. If precognition is your game, know that the science behind it is weak to say the least.

    I don’t know the answer really. I just think I would try to go for the jugular vein here, and I think that that jugular vein is the amount of deceit that is practiced in the mental health industry. Jargon is a free ticket to indulge in this kind of deceit. Tell the truth, and suddenly you become, to them, offensive. Straight off, we’ve got the fact that this is somehow about social control and not about medicine at all. Real medicine doesn’t take prisoners.

  4. Thanks for this article; you come across in a very compassionate, human way. It is surprising to me that so many psychologists think in these ways… it makes me wonder whether they have intensively worked with people in long-term therapy. Perhaps they are more the kind of psychologist that works briefly with people in hospital settings rather than getting to know them on a deeper level. Their thinking reminds me more of the stereotype of inpatient psychiatrists (who meet with people briefly in hospital settings but don’t establish a long-term relationship) than private/independent therapists (who see people in outpatient settings over long periods).

    It is a good goal to stop or more realistically minimize forced treatment. But when reading these articles I wonder how much good it will do for distressed people in the big picture, even if such treatment is minimized. Forced treatment is damaging, but even more damaging, I believe, is the lack of affordability, awareness or access to long-term psychotherapy and adequate levels of social support/love from people in general. If people were not coerced, that would help them. But many would still be left in a situation where they couldn’t form long-term lasting relationships because of a lack of financial and other resources or perhaps a lack of safety in their living situation (e.g. they might even need a safe home first).

    So, reading about forced treatment in this way sometimes reminds me of the following situation here in the US: seemingly important issues like gun control, voting rights, police/community relations, etc. are vociferously discussed as if the future of the country depended on them. And they do matter. But the problems that can truly devastate in the long term – like climate change, depletion of oil/gas/coal without renewable resources scaling up quickly enough to replace them, and depletion of key resources like water and soil – these are barely discussed. And arguably these resources are much more crucial to long-term stability than the surface social issues that get people so excited. Likewise, I would suggest that if forced treatment is on the surface, the more important depth issue for many in the psychiatric system is the lack of financial/practical resources for alternative love/support, whether from family, friends, or long-term intensive group or individual psychotherapy.

    I feel it’s these interpersonal resources that can make people strong enough that they can eventually remove themselves from the psychiatric system entirely. I think that offering intensive interpersonal therapeutic interventions for periods of years would actually save society money, compared with decades of overmedication and disability. But the obstacle is getting people to see that, especially in that it would result in a loss of market share for psychiatrists and medication.

  5. I don’t mean to be redundant… Have said this for years:

    For all of those who would like to see psychiatry replaced with psychology, be careful what you ask for.

    Both groups have power. Psychiatry is built on illegitimate authority, and as it dies, it will need to be replaced. There are legitimate psychotherapists, but even among those that don’t use labels or force – there are very few good ones.

    Duane

  6. Thanks for the article, Olga. Being a danish psychologist working for the 10th year at a psychiatric hospital I too am a bit surprised by the reactions you quote. It appears to be very much powered by an inferiority complex of some sort – wanting to be like a psychiatrist. Or at least have the wage of one… I have actually found it a huge help in my work, that I do not have to be a gatekeeper to medication or forced treatment.

    I find myself very much in agreement with the above comment by bpdtransformation: What is lacking in psychiatry is interpersonal capacity. Medication can be distributed very efficiently, in the present system, but not so much with care, support and love. Which is really sad because care, support and love has this almost magical quality: When used it does not get depleted or ineffective. It grows and multiplies.

    I fear that the more we as professionals focus on medication, force and control the more we risk loosing the know-how to transform fear, shame and anger into courage, self-worth and strength by way of interpersonal connection.

    The danish psychological association, of which I also find myself a member, seems to have lost track of the bigger picture along with at least some of its members.

  7. Compassion is what is needed. Without it nothing good will come. It is not something a person learns in a school. In fact university training is apt to discourage compassion by replacing it with thoughts. However, a great deal of mental health is about money and not about healing. Thus the more “education” the better the pay. Unfortunately the men and women who are in positions of power often are unfamiliar with compassion and therefore attempt to substitute something more appropriate for a machine. In this respect unfortunately science often comes to their aid.

  8. What manner of forced treatment do I want? The kind that allows me to skin my captors alive as soon as they drop their guard. Pro-force psychiatry is a “battle” that its proponents will lose. This is not the 19th or 20th century. If we go down, we’re going to take our perpetrators down with us.

    Wanna call me “dangerously mentally ill” for my candor and rage? Go ahead, if it makes you feel less threatened by my ability and willingness to, literally, fight for Mad rights. Just don’t expect to use that label in order to keep me chained to a bed and chemically lobotomized with Risperdal. Psychiatrists are NOT above the law. Medical and economic freedoms are guaranteed to every consumer in a capitalist economy and to every citizen in a democracy. A baker can’t force dieters to buy their doughnuts. A hairdresser can’t force models and actors to shave their hair off. A high end department store can’t force environmentalists to buy their fur coats. Mad people, as well, can’t be forced to endure onerous, ineffective, irreversible, and dangerous “medical” procedures.

    The trauma suffered by a victim of pro-force psychiatric treatment or pro-force psychiatric assault is not a “delusion” or a “hypersensitivity” to “necessary medical treatment”. Mental health clinicians are usually guaranteed to succeed in exonerating themselves from public accountability for caregiver abuse on the precept that “mental patients” cannot possibly be traumatized by a hostile environment. All of our problems are either blamed on us or bright-sided as a way we can “contribute” to our own “recovery”. Even in so-called biological psychiatry, the thoughts, choices, and personality traits of the Mad person are always identified as the areas of pathology which necessitate medical intervention. This pseudoscientific theory asserts that our “immaturity” and our “badness” force other people to dehumanize us. A Mad person’s investment in a life of “sanity” is measured by their ability and perceived willingness to subsist on a ration of humanity that shrinks slowly over time. Should we object to this victim-blaming, we’ll be promptly “treated” for our “projections” until we profess our agreement with these lies and behave in harmony with them by punishing ourselves with obedience to our victimizers. The state of our health will never improve to a level that allows us to be validated by society and feel whole within ourselves in a psychiatric system that satisfies the clinician’s desire to police Mad minds, but not the Mad person’s need to heal from trauma.

  9. Thanks for an excellent article, Olga. A choice of forced treatment would be great. I would choose homeopathy, because it couldn’t possibly harm me and hey, there might even be a placebo benefit. It saddens me that we Europeans lazily copy the “healthcare” models that the Americans inherited from the Nazis. When we psychiatric survivors succeed in shutting Psychiatry’s ass down, we’ll go after its apologists, starting with the wannabe-shrink-psychologists.

    Having said that, I have discovered (online) so many survivors, like yourself, who are working within the mental health”care” system to effect change for the better. I think something has to give, eventually. The system is broken and the general public are getting wind of it slowly but surely.

    The DSM5 was a step too far. The public won’t be fooled into believing that everyone but a Psychiatrist, has a mental illness. I think there is hope for the future, but change won’t occur unless we educate the public and get them to wake up to the reality of what Psychiatry is about: pure unadulterated social control.

    Take care,
    David

  10. I assumed that the title was completely intended as sarcasm. To think that a serious article could start off with such a title is disturbing. I personally find the words “f0rced” and “treatment” very difficult to say in the same sentence. To give CHOICES of forced treatment is a ludicrous oxymoron.

    — STeve

  11. Olga – Thank you for speaking the truth in a bald faced way. Keep up the good work. Having had both my father and my son killed by psychiatry (one by ECT and the other by Zyprexa), I have had to work really hard to not let rage rule my life. It helps to know there are some within the helping professions who actually have hearts and who are taking stands, even if personally hounded and lambasted.

  12. Bravo Dear Olga , for your promise as a psychologist . Maybe we all need to carry a copy of it on our person to show others on cards and T-shirts.
    Operation Paperclip brought dedicated nazi war criminals to the USA their records were hidden from the people and they who posed as oppressed war victim scientists took over leading positions in universities across America in fields like biology ,chemistry, psychiatry etc. This was made possible by nazi sympathizers in high positions who facilitated this fascist super injection into our lives over here .They said we must bring these “brilliant people” over here or the Russians would get them as the cold war era started after World War ll . Certainly it was backed by the eugenic loving Rockefeller’s, Carnegie’s, Harriman’s and other robber baron pigs.
    Operation Paperclip can be googled and the history of eugenics in the USA , month by month is throughly documented and can be read about in Edwin Black’s book “War Against The Weak .” In my opinion the course of history and psychiatry’s and medical and dental and agricultural arrogance cannot be understood without the information in Black’s book.
    Saw an interesting picture of a bumper sticker on the net :” Better be nice to America or we’ll bring Democracy to your country.”
    We are a land saturated with eugenic enterprises including in mainstream psychiatry,medicine,dentistry, chemical and biological and genetically (eugenically) engineered agriculture,food production and poisoning with countless deadly substances mostly all time released. There could be dozens of Robert Whitaker’s writing expose’s on all these areas and more. And all this shit seeking to expand across the planet . While what can help humanity freedom, justice, equality, including health freedom is at the same time suppressed as well as Traditional Naturopathy, Homeopathy, free use of Herbs, Natural Supplements, Unadulterated food, Energy Healing , Body Work , Friendship ,Shelter , Sanctuary, Peace, Clean Air and Clean Water and people determined not to oppress their fellow human beings or life sustaining eco systems .
    Thank You, Fred