A new issue of World Psychiatry features an important commentary by Dr. Dainius Pūras and Dr. Piers Gooding on coercion in psychiatry and international human rights laws. Dr. Pūras, the United Nations Special Rapporteur on the right to health, has previously called for a radical shift in global mental health treatment approaches and policies. In this new commentary, Pūras and Gooding demand action and resources to address coercion and human rights violations in psychiatry and mental health treatment.
“Coercion in psychiatry and broader mental health services is rising worldwide,” they write. “This fact demands not merely discussion but action.”
Pūras and Gooding argue in favor of a rights-based approach to health that prioritizes human dignity and individuals’ will and decision preferences. They argue that psychiatry, and mental health services more broadly, have focused instead on implementing coercive practices and the imposition of treatment.
Proponents of this traditional approach argue that such practices, including involuntary hospitalization and forced treatment, do not exclude the possibility of preserving individuals’ autonomy, dignity, and right to life. Others, however, assert the opposite and take the stance that the two are incompatible:
“Those against argue that the non‐consensual imposition of mind‐ and body‐altering drugs based on narrow conceptions of impairment, poorly evidenced claims about ‘risk’ and ‘necessity’, and a limited range of alternatives, is incompatible with dignity and autonomy,” Pūras and Gooding write.
The authors promote an alternative to the status quo, urging stakeholders to “rethink conventional wisdoms, address long-standing power imbalances and implement innovative practices.” The Convention on the Rights of Persons with Disabilities (CRPD), an international human rights treaty established by the UN in 2008, has provided an avenue for dialogue and opened up possibilities for political action.
“The CRPD provides a unique opportunity to liberate not just users of mental health services but the entire field of mental health from a legacy of stigma, hopelessness and discrimination,” they write. “It does so by upholding a social model of disability that favors consideration of human rights instead of a medical model, which has perpetuated human rights violations and social disparities.”
“The directive of the CRPD to embrace a social or ‘human rights’ model of disability and move away from a ‘medical model’ of disability has strategic advantages, including shining a light on the many social, political and economic factors that create grave disparities for people with mental health conditions or psychosocial disability.”
Moreover, by implementing a medical model that obscures the impact of social disparities, social power imbalances and oppression are perpetuated and deepened, argue Pūras and Gooding.
“Indeed, the CRPD challenges centuries of legally sanctioned prejudice. However, ‘exceptions’ remain at the domestic level, in law, policy, and practice, and they filter into the norm, fostering power asymmetries, the overuse of biomedical interventions, and the disempowerment of an already marginalized population. Systemic violations follow. This status quo, which can be observed on a global scale, is no longer acceptable.”
They conclude that a rights-based approach can be implemented as a new way forward:
“A rights‐based approach can provide a pathway to the future of mental health care we want for all. The CRPD can be used to promote the investment of human and financial resources into a broad spectrum of support to drastically reduce non‐consensual measures with a view to their elimination.”
Read the full report here: https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20599
Pūras, D., & Gooding, P. (2019). Mental health and human rights in the 21st century. World Psychiatry, 18(1), 42-43. (Link)
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.
Is the brain broken or not? Today we know the brain is NOT broken, so then what is psychiatry? Is it a medical treatment? No. Will I worship the holy molecule as instructed? No, not if I have my freedom.
no chemical imbalance to be fixed by medicine https://en.wikipedia.org/wiki/Russell's_teapot
Wonderful analogy Mark, you learn something everyday! I might have to try it on a psychiatrist!
I think what is called for now is choice and rights. I really don’t see the need for any coercive treatment, unless maybe as some emergency sedative, but I’m not even sure about that.
I would also like to be able to state in advance that, whatever happens to me, I do not want to be treated by a psychiatrist, ever.
Puras and Gooding completely ignore the social function and economic interests of psychiatry, making their legalistic program utopian.
The social function of psychiatry is to relieve the dysfunctional and disintegrative institutions of their disruptive elements, to punish individuals for the deficiency of institutions. For example, a dysfunctional family punishes the weaker member through psychiatry, the school punishes a student who argues with his neighbor, accusing him of ADHD.
The more dysfunctional the institutions are, the wider the client base of psychiatry is. As the historical statistics of psychiatry illustrate, when a society is less institutionalized and more community-based, the prevalence of mental illness is extremely low: >0.5% (0,34% in the US’ 1880 Census). It is only in contemporary civilized society that we find a ridiculously high prevalence of 20%, always increasing (31% among College Students, according to WHO).
Moreover, psychiatry has its own economic interests, which is ahead of its social function. Legal drug trafficking brings in bilions, hundreds of millions are willing to consume them voluntarily because of their addiction. But the constraint makes it possible to artificially increase the number of customers, and thus to earn more money; and the physical and mental disability generated by polydrug abuse and harsh treatment makes the clients permanent.
Thus, if, in the long term, anxiolitics increase anxiety, antidepressants increase depression and neuroleptics increase psychosis, it is in line with the economic interests of psychiatry, and if the research irrefutably demonstrates this state of affairs, in front of the public, they must deny it.
We should get rid of all coerced and forced psychiatric treatment. This includes the “mental health professionals” lies about their “chemical imbalance theory,” which they have used to coerce people onto their neurotoxic drugs for decades. As well as their forced in-patient maltreatment of people, to cover up their prior iatrogenic harm of those people, with their neurotoxic drugs. Forced and coerced treatment should be made illegal.
But, of course, if they got rid of forced and coerced psychiatric treatments, then the “mental health professionals” wouldn’t be able to maintain their multibillion dollar, primarily child abuse covering up, system.
And maintaining that multibillion dollar, primarily child abuse, as well as prior malpractice, covering up system. A system which is of utmost importance and benefit to the medical professionals, as well as the child abuse covering up religions that own the hospitals. If for no reason other than that, profiteering off of turning child abuse survivors into the “mentally ill” en mass, is a multibillion dollar industry today.
But the majority in society would be better served if, instead, our society returned to arresting, convicting, and incarcerating the pedophiles and other child abusers. Rather than our “mental health professionals” continuing to defame and poison millions and millions of child abuse survivors, merely because they can’t bill insurance companies for actually helping child abuse survivors.
How charming that the DSM was actually designed as a child rape covering up “bible.” Got to commend the seminaries that are teaching belief in the DSM “bible” in their seminary schools today, huh? (sarcasm) How low can our religions and medical communities go? Rumor on the internet is that my childhood religion “hit bottom” recently.
But I don’t think that will actually be true, until their “dirty little secret of the two original educated professions,” the fraud of their child rape covering up and profiteering DSM system, is understood by the masses. But the doctors and religions really don’t want to get out of the child rape profiteering, iatrogenic illness creation business. As one pediatrician said to me recently, “It’s just too profitable.” And here’s a couple examples of how hard my childhood religion works to cover up rape of children. It’s not just a Catholic problem.
It’s truly shameful that the Christian religions have adopted belief in the fraud based DSM “bible,” given that the DSM bible’s primary actual societal function is covering up child abuse, and Jesus stood directly opposed to child abuse. The hypocrisy is staggering.
Psychiatry is based on the assumption that all strange behaviors (including some Christians would otherwise call sins) are proof of a brain disease. A priori.
Churches have subscribed to materialism. They no longer believe in human souls it seems. It may explain the drop in membership since there’s nothing real to save.
Rick Warren–psychiatry promoter–is into Moral Therapeutic Deism. He also believes in Quantum Mysticism. Like psychiatry this is a pseudo-science but less socially respectable.
There is a psychological need of depression and the need of the others states than normalcy. And psychiatry seems to negate all of the human psychopathology. All they want is normalcy, apollonian ego hegemony, the mental health utopia. This is childish destruction of the true image of the psyche. There is a need of psychopathology and that need is being destroyed by egoic people. By apollonians. They ridicule human psyche.
We are talking about things that are beyond small will of the ego. We are talking about the rights of the psychological reality. We do not own that reality, medicine do not own and anti human theology cannot cope with it.
James Hillman Re – Visioning psychology.
Psychology practitioners with the noblest of theories that would be even applauded on this website can cause severe damage to people by forcing their ideas psychologically in institutional settings that are not “psychiatric” such as universities and othe “educational” venues. This is trending. I think too much functionality and “success” can be profoundly damaging to the personal rights of people.
Any article of this sort is incomplete without the input of Tina Minkowitz, who has been intensely involved with CRPD and the U.N. for years, and should be considered the authoritative “survivor” expert and spokesperson in matters such as described here involving the Special Rapporteur’s office, also the effort to have forced “treatment” defined as torture.
It may well be that the effort to expose and defeat psychiatric oppression will ultimately be spearheaded by the international community and the U.N. This is complicated stuff that many choose to gloss over, but Tina has stayed with it. I hope she will read this and respond with her perspectives.
The CRPD drops the bat at the starting gate in that it utterly fails to consider and in fact skirt around the fact that the concept of “mental illness” itself is baseless and as such treating and mistreating human beings in distress under the dis-proven guise that they are suffering from a brain disease no one can provide a shred of credible scientific medical evidence even exists, is legal fraud. Its a criminal act and anyone obscuring it, is engaged in a criminal act.
As such to state (as many people in the movement are currently doing) that as long as someone is fully informed that there is no science or evidence that “mental illness” exists, or that the symptoms they are experiencing means they are “MI”, then it is OK for them to risk their health and life treating symptoms whose root causes have NOT yet been uncovered, with harmful drugs and agree to be a “mental patient” for life to unjustly enrich a bunch of quacks masquerading in white coats. There is no end to how much is WRONG with this position. It is beyond ludicrous to the point of absurdity.
Legal consent CANNOT be garnered via fraud or misinformation. But even IF the whole truth, that it is all a lie was understood and accepted, the fact remains that by law, no one cannot consent to a crime.
In no other branch of so called “medicine” would ethical human beings KNOWINGLY agree to collectively PRETEND that people have cancer they don’t have and subject them to chemo and radiation using the justification that they know they don’t have cancer, but they want chemo and who is anyone else to interfere with their right to freedom of thought and belief? Honestly, this is what the argument has devolved into.
I choose to believe I am “mentally ill” without evidence and I agree to risk my life ingest poison because I have a right to do so. WTF? That IS the “rights” based bullshit that is being passed off as legitimate argument by pillars in the movement.
This laza faire attitude and twisting of rights, is NOT helping humanity, but is seriously harming and further hindering society from challenging and exposing the junk science of the DSM in a court of law and putting an end to the legal fraud once and for all. It is perpetuating the mass harm and will ensure that millions of naive people will be victims because they choose to support the bogus notion that the “right” to act as if medical lies were legitimate choices makes sense. It DOESN’T.
Because no one can be proven to be “MI”, people are in fact being falsely accused of lacking “MH” or being “MI”. ‘MH” fraud is NOT a medical problem; its a legal problem and as such it must be dealt with in a court of law. Further the same test and level of evidence that is required for any other person being accused of acting in a manner that could result in them being locked up, lose their credibility, job, children, freedom, health and life without a shred of credible evidence. The state and state actors (dr’s) should be legally required to prove “beyond a reasonable doubt” that someone is mentally deranged owing to a brain disease called “MI”. Anything less remains what it already is, medical malpractice and insurance fraud.
Somewhere along the line, a whole lot of other wise intelligent people are engaged in some totally underhanded excuse making, shallow thinking, obfuscation and self interested justification in stating that its OK to play along with a mass medical fraud, rooted in eugenics, based in social judgment and control as if it was ethical in the face of the evidence proving otherwise.
I see very few, if ANY people taking an ethical legal stance that tells the whole truth. Certainly not Pūras.
©JMG 1/22/2019 MH, AB, CA
Articles from persons of stature who speak out and demand action hopefully help move the needle of change forward in some way. There are many people who are not familiar with psychiatry and still think highly of it and believe they are doing the right thing when they encourage others to “get help”. They have not yet been exposed to the reality that seeking “help” can bring much harm instead. Although the article is lacking in ways it seems any exposure of human rights violations and how psychiatry is the powerful vs. the powerless is better than none.
OK this is a little unusual but — as per my first comment above I asked Tina Minkowitz about this, but she’s having trouble logging in. I volunteered to post this on her behalf:
They are not the first at the UN to call attention to human rights violations in psychiatry (actually Gooding is not with the UN; Puras is Special Rapporteur on Health). UN Special Rapporteur on Torture P Kooijmans in 1986 called forced drugging with neuroleptics a form of torture. In 2008 SR on Torture Manfred Nowak reiterated that this applies to forced interventions ‘aimed at treating a mental condition’. The Committee on the Rights of Persons with Disabilities has said numerous times that states have to release people from mental health facilities if they are held against their will and ensure that mental health services are based only on the free and informed consent of the person concerned.
These are *immediate* obligations under the CRPD, binding in international law, and states that maintain forced interventions in psychiatry are in breach of their international legal obligations.
Puras and Gooding stop short of the international law standard, and thus are not true human rights defenders. They call for reduction of coercion with a view towards elimination. That maintains the hierarchical dominance of psychiatry and caters to the discipline’s refusal to relinquish its abusive control over those it designates as mad.
It is a sad fact that since the end to the CRPD negotiations it has been individuals such as Puras and Gooding, who are not users or survivors of psychiatry or persons with psychosocial disabilities themselves and who may have vested interests as mental health professionals, academics claiming expertise in the subject matter, and/or family members, who have taken the central role as go-to experts for the majority of UN entities. This is not what is called for under the CRPD or from its legacy.
The movement of users/ survivors/ mad people/ people with psychosocial disabilities continues to develop its own breadth and depth despite the divide and conquer tactics of others. the CPRD process was an opening of the gates, and ‘the real dragon (has already begun to) fly out.’ It cannot be stopped.
So according to Tina Minkowitz, who should know, these guys who present themselves as “progressive” are basically opportunists, primarily concerned with advancing their own careers. (Don’t everyone gasp in shock all at once.)
Thanks for the information Oldhead and Tina and also Judi for more info in your comment below. That this is not a big step forward and there are ulterior motives is discouraging but no surprise I guess (and no gasping lol) as it’s ironic and totally expected in the whole facade of psychiatry.
In the years I have closely followed this, this is the first time any obviously conflicts of interest or legitimate concerns have been admitted to. When I attempted to critique the same- I was basically told to shut up and be happy and not be “negative”. This is a huge step forward.
Since Puras’s monumental life changing (not) statement came out, the response I witness’s across social media is that (the minimal, not remotely specific enough statements he made, created a complacent lull in activists who by and large simply, uncritically, breathed a collective sigh of relief and seemed to assume that the problem would now somehow miraculously solve itself because the ‘chemical imbalance v power imbalance” statement was finally uttered.
I go back to the fact that the Genesis of the problem (that remains largely a taboo topic outside this forum) which is that the unscientific myths about “mental health and mental illness”s that justify and perpetuate the downstream abuse claiming to be eliminated via the CRPD, IS NOT remotely being dismantlement as the ground zero causal factor keeping the entire system in power and in play.
We have all the pieces of the puzzle but there is a clear and obvious failure to make a cohesive unified expose of the entire scam. We seem to only be comfortable with and willing to address small pieces of the problem and fiddle as Rome continues to burn.
Clearly it is not in Puras’s or his cohorts interest to address the criminality or fraud of the “MH/MI” system. But without the obvious being stated by someone like Tina who has an insider front row seat, a lot of facts (that we already have at our fingertips) continued to be easily obscured and only bits and pieces of the problem are being tackled, in isolated silo’s. Systems thinkers know that this is an ineffective problem solving strategy.
There was no guidance or plan for people not active in UN forums (that I have seen) that is instructive to lay people (v seasoned vets) about how to interpret, understand and take next steps to help continue moving the needle forward from a multitude of angles -under a unified umbrella- with a common understanding of all the factors that are currently blocking progress.
Tina is also offering her course on the CRPD again, which is great news. Surely the details will be posted here for anyone who wants to learn more.
I am really happy to see this conversation and thank the writers, Tina and Oldhead for ensuring that this line of inquiry was followed up on.
Just to clarify, the statement I posted above was 100% Tina’s, I was just the intermediary. I agree that her perspective is essential, however.
Hi everyone, I’m able to log in now.
I consider the CRPD essential to the abolition of the legal power of psychiatry to deprive people of their liberty (engage in arbitrary detention based on actual or perceived disability) and penetrate our bodies with their toxic drugs and shocks and surgeries against our will (engage in acts of torture). (Re torture, I think the clearest UN citation holding the administration of neuroleptic drugs to be torture is from Special Rapporteur on Torture P Kooijmans in 1986, E/CN.4/1986/15.)
CRPD is not enough however, to push us over the hurdle of medical power joined to the power of state as a mechanism of repression. The elements are there, our adaptation of the social model of disability has the power to confront and split and dissolve this alliance and its power, but it has not been successfully pushed through to clear understanding in the UN mechanisms that support us. Maybe similar to the Deaf people’s struggle to see themselves as a cultural and linguistic group, our issue is both disability and not-disability. But Deaf people are not up against the same kind of economic and political interests – the interests of the state in maintaining a form of repression notwithstanding its illegitimacy. Our struggle has been to a degree coopted by UN mechanisms’ defining it as ‘human rights in mental health’ and as a need for non-coercive supports preliminary to abolition of torture and arbitrary detention. And this cooptation has been facilitated by the moves that changed the International Disability Alliance from a cooperative alliance of DPOs, in which each global DPO had a sovereign and non-delegable voice, to a technical bureaucratic secretariat that hoards information and power and opportunities and channels everything through itself. I have said both of things many times. I fought it to the extent I could while I was in positions within both IDA and WNUSP.
Back to CRPD. We have a global movement, but here on this page it is mainly US and Canada. Though US has not ratified the CRPD, and if it does it will be with so many reservations, understandings and declarations it will be hard to see what remains, Canada has ratified CRPD and also recently its Optional Protocol. With the OP, Canadians can take complaints of individuals to the CRPD Committee and receive a decision on the violation of human rights in the CRPD. (You have to ‘exhaust domestic remedies’ for this procedure; also available in any country including the US are the Special Procedures of the Human Rights Council. See my guide to using UN human rights mechanisms, on the CHRUSP website – linked for now in a box on the home page.)
I don’t know where progress will come from or how. Peru’s legal capacity reform was a huge step but not enough, as I wrote in my last blog post on this site. We need an abolitionist movement that targets psychiatry as a social institution of fake science and repression, in addition to the abolitionist movement that calls for repeal of the mental health laws along with other ‘substitute decision-making regimes’ (in the words of the CRPD Committee), and a movement that focuses on reparations as the way to conceptualize the totality of violations and remedies needed to abolish forced psychiatry and to provide redress to victims.
BTW, I am *not* offering the CRPD course this year, but expect to do so again in 2020, and will be posting on social media closer to that time.
I would like to suggest to Mad in America correspondents that they follow the CRPD Committee, Working Group on Arbitrary Detention, and Special Rapporteur on the Rights of Persons with Disabilities to be able to catch news of statements that are upholding the correct standard and that do not seek to push us under the ‘expertise’ of mental health professionals. Those bodies usually have not publicized their stance so much with press releases and campaigns; it is too bad that the most publicity has come from the health-related entities. But it is possible for anyone to read the documents that come out of the CRPD Committee – like their General Comment No. 5 on Article 19, living independently and being included in the community, which contained this paragraph:
‘It [the obligation to respect the right to live independently and be included in the community] also entails the obligation to release all individuals who are being confined against their will in mental health services or other disability-specific forms of deprivation of liberty. It further includes the prohibition of all forms of guardianship and the obligation to replace substituted decision-making regimes by supported decision-making alternatives.’
All the best,
Great post Tina!
We need an abolitionist movement that targets psychiatry as a social institution of fake science and repression.
DAMN STRAIGHT! I didn’t know you were prepared to take such a no-bones position, but it is most welcome to hear you say. (I have some more to add later but had to say at least this much right off.)
We need to stop screwing with my comments.
“To achieve world government, it is necessary to remove from the minds of men their individualism, loyalty to family tradition, national patriotism, and religious dogmas.” “We have swallowed all manner of poisonous certainties fed us by our parents, our Sunday and day school teachers, our politicians, our priests….The reinterpretation and eventual eradication of the concept of right and wrong which has been the basis of child training, the substitution of intelligent and rational thinking for faith in the certainties of old people, these are the belated objectives …for charting the changes in human behavior.” Brock Chisholm, 1959 Humanist of the Year and former head of World Health Organization, in the February 1946 issue of Psychiatry
This article seems to have disappeared pretty quickly, I think it’s important.