Forced Drugging with Antipsychotics is Against the Law: Decision in Norway

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In Norway, the Ombudsman concluded in December 2018, with reference to the Psychiatry Act, that it violated the law to use forced treatment with an antipsychotic in a concrete case.

According to Norwegian law, forced drugging can only be used when, with “high probability, it can lead to recovery or significant improvement in the patient’s condition, or if the patient avoids a significant worsening of the disease.” Many other countries have similar laws, but sometimes the probability criterion is related to forced admission rather than forced treatment — it is then understood that forced admission allows forced treatment.

“High probability” for a significant improvement of forced drugging means a good deal more than 50%. Referring to science, the Ombudsman noted that the probability of achieving the intended improvement is only 10-20%, which means that for decades, unlawful decisions about forced drugging have been made.

The Ombudsman criticized many other issues, commonly seen also in other countries. It is a prerequisite for forced drugging that the beneficial effect must clearly outweigh the harms (called “disadvantages”) but, in violation of the law, the authority had not assessed this balance.

The authority referred to “what arose” in a conversation with the patient; what was in the patient’s files; and a conversation with the staff that mainly was about how the patient appeared and behaved. It was a breach of good administrative practice that no notes were taken from the conversation with the staff, or from conversations between the hospital and the authority.

The authority also pointed out that the staff expressed they had come to the “end of the road” concerning achieving an improvement without antipsychotics; that the responsible professional believed it would be “irresponsible and unethical” not to initiate medical treatment to prevent significant deterioration; that the general knowledge of the effect of the medicines had to be relied upon; that the patient was ill and needed help; that the person responsible for the treatment had chosen to use the relevant medicines; and that they had broad professional expertise and experience with a focus on the patient’s best interest. None of these explanations were accepted by the Ombudsman, as they have nothing to do with the law’s requirements to the probability of a significant improvement.

The authority also referred to the Drug Compendium, but the Medicines Agency replied that one cannot say anything about the probability of a positive effect for an individual patient.

The authority asked why the Ombudsman wanted to go into an academic issue of whether the responsible therapist had used relevant drugs in the specific case. Similar arguments are heard elsewhere when outsiders try to objectively assess the issues, and their aim is to keep people away so that the psychiatrists are not accountable to anyone. The Ombudsman was surprised about this question because his legitimate task was to find out whether the law had been violated.

I have collaborated with Norwegian former Supreme Court Attorney Ketil Lund on these issues, and already in 2016, we explained in a law journal why forced medication cannot be justified.1 The efficacy of the medicine is poor, and the risk of serious harms so great that forced medication seems to do far more harm than good.2 We also explained why it is misleading to assert that antipsychotics can prevent relapses in a quarter of the patients, which the Ombudsman mentioned. What is called recurrence when the patients no longer receive the drug is very often withdrawal symptoms that appear because the brain has been accustomed to the drug. What is seen in a randomized withdrawal trial in the drug-free group is therefore usually the damaging effects of the drug and not the relapse of the disease.

In all countries, we need to work for ensuring that forced medication for psychiatric patients becomes forbidden by law. Virtually all countries, apart from the United States, have ratified the United Nations Convention on the Rights of Persons with Disabilities,3 which prohibits forced drugging, but as far as I know not a single country has done anything.

In 2003, using scientific arguments, lawyer Jim Gottstein convinced the Supreme Court in Alaska to decide that the government cannot drug someone against their will without first proving by clear and convincing evidence that it is in their best interests and there is no less intrusive alternative available. Unfortunately, this victory for human rights has not created a precedence in Alaska where the authorities continue to force people into being treated with antipsychotics. Just like anywhere else, including Norway. This must stop.

Show 3 footnotes

  1. Gøtzsche PC, Lund K. Tvangsmedisinering må forbys. Kritisk Juss 2016;2:118-57. ↩
  2. Gøtzsche PC. Deadly psychiatry and organised denial. Copenhagen: People’s Press; 2015. ↩
  3. United Nations Convention on the Rights of Persons with Disabilities. General comment No. 1 2014 May 19. http://daccess-dds-ny.un.org/doc/UNDOC/GEN/G14/031/20/PDF/G1403120.pdf?OpenElement. ↩

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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.

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16 COMMENTS

  1. Thank God for this legal decision- perhaps other European nations will follow and then perhaps Canada and the US-if only my daughter had the law behind her when she tried to resist (futilely) and was forcibly medicated many times-she might be better today. Her rebound psychosis was not recognized and she was polydrugged to cover up the iatrogenic harm-now her brain is habituated to neurpleptics and her dad and I dont know if she can ever safely titrate off them to deal with her original emotional wounds and live an independent life-we try to remain hopeful and resist despair but these kind of protections are important to give the next generation of young people a shot at true healing.

      • “….What is called recurrence when the patients no longer receive the drug is very often withdrawal symptoms that appear because the brain has been accustomed to the drug. …”

        I Completely Agree:-

        In 1980 I was happy to “decline” psychiatric drugs and to ask for psychotherapy, but by 1983 when I was given permission to discontinue Modecate depot injection, I quickly found that I could not survive without it.

        By 1984 after a number of further hospitalizations I managed to stop taking the Modecate depot injection. To do this I had to switch to oral medication and to taper carefully, with psychotherapy.

        It took me 6 years to reduce from 25mg of Modecate depot injection per month, to 25mg of Mellaril per day (which eventually became nothing).

  2. Thank you for this encouraging report Professor Gotzsche.

    Abuse of Human Rights.

    The absence of professional accountability, and failure to deliver the professional Duty of Candour, is responsible for diagnostic complacency, and for repeated failure to differentiate the potentially fatal harms of psychotropic drugs from “functional psychosis”.

    Each new psychiatrist sees only the harms caused by the drugs of the previous psychiatrist.

    Not only do those “patients” whose antidepressant induced AKATHISIA is misdiagnosed as “severe mental illness” find themselves incarcerated and deprived of all human rights from the moment they cross the threshold into what is allegedly a “hospital”: – They are compelled to suffer irreversible antipsychotic/psychotropic induced harms to brain, endocrine, metabolic, cardiovascular and other systems.

    Antipsychotic induced acne is seldom recognised as an ADR. Its disfigurement and pain may persist as a legacy for years after drug discontinuation.

    Educational/occupational, economic detriment, societal rejection, and iatrogenic, psychological injuries result from absence of empathy combined with the terror of incarceration, as well as being MIS-labelled for life.

    It is beyond the belief of most families to believe that an alleged “medical speciality” can routinely impose, and defend practices and drugs which are so injurious to people who have no valid medical indication for such maltreatment whatsoever.

  3. Another weak decision. We want repression, repression, repression! For all the violence they have done, they must suffer in turn! A revolutionary state must crush these criminals! Violence against violence, the power of the state will not always be in their hands!

    Here again, a crime has been committed, and no one is punished! As soon as it has a doctor’s title, it can make drug trafficking without consequence! It is the repression that is necessary, the brutal repression of a pitiless state against the high officials and the slavish and privileged Nomenklatura!

    CRIME = REPRESSION.

  4. The “aim is to keep people away so that the psychiatrists are not accountable to anyone.” It is true that the psychiatrists are NOT being held accountable to anyone. And this has resulted in another, unmentioned in the mainstream media, ongoing, psychiatric holocaust, worldwide.

    https://www.naturalnews.com/049860_psych_drugs_medical_holocaust_Big_Pharma.html

    The psychiatrists are playing judge, jury, and executioner to millions and millions of non-criminal, innocent people, whose stories they do not even listen to, because psychiatrists are delusional people who believe all distress is caused by “chemical imbalances” in people’s brains. Thus there’s no need to listen to their client’s stories.

    The “mental health” workers’ primary targets are innocent child abuse survivors, who they can NOT even bill to help, according to their DSM billing code “bible.” So the “mental health” workers are required to misdiagnose all child abuse survivors in order to get paid.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo

    https://www.madinamerica.com/2016/04/heal-for-life/

    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

    In other words, today’s “mental health” system is, by design, primarily a child abuse and rape covering up system.

    And the antipsychotics/neuroleptics do create the symptoms of the serious DSM disorders. The negative symptoms of “schizophrenia” are created via neuroleptic induced deficit syndrome. And the positive symptoms of “schizophrenia” are created via antidepressant and/or antipsychotic induced anticholinergic toxidrome.

    https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome

    https://en.wikipedia.org/wiki/Toxidrome

    Why in the world should it be legal for the psychiatrists to ever force treat other human beings with drugs already medically known to create both the negative and positive symptoms of “schizophrenia?”

    Oh, that’s right, since neither NIDS nor anticholinergic toxidrome are even listed in the “invalid” DSM billing code “bible,” the psychiatrists all claim ignorance of the fact that the antipsychotics create the symptoms of “schizophrenia.” And as they watch their patients become ungodly sick and die, the psychiatrists delude themselves into believing they made a correct diagnosis.

    I couldn’t agree more, forced drugging with the antipsychotics should be illegal everywhere. Forced drugging with any drugs should be illegal. We should return to being a society that has rule of law, and giving the psychiatrists the right to play judge, jury, and executioner to other people, outside the law and hypocritically under the guise of “help,” means there is no rule of law. “This must stop.”

  6. Dr. Goetche (sorry, I do not know how to do the special character to make the proper spelling), I love that you pointed out that as soon as a person is forcibly incarcerated, anything that happens is forced. Of course it is. You’re behind locked doors! And might I add that in the USA, any incarceration is involuntary. You may sign a “conditional voluntary” paper, but you sign it when you’re on the ward already. Also, once you are there, you can’t get out. Not voluntary! Anyone who thinks it is voluntary is surely deluded.

  7. PIG IN THE KITCHEN.
    In my own case there was NO Official Admission Procedure to my Original Maudsley Hospital UK Stay of 1980. The name of the ‘social worker’ that accompanied me to the Maudsley is NOWHERE to be found in my Records. I walked through one door and then through another door – and then, I was IN.

    After this I wandered around the Hospital coming and going as I liked, without interference.

    Several Maudsley “patients” even invited me to their houses, and I accepted, and one of them cooked me dinner.

    At a later date (following a visit to an Irish ‘Social Worker”, at Kilburn ) Maudsley Staff attempted to “raise” a Section on me – but I wasn’t Officially “THERE” to begin with!

    My Maudsley Hospital “Discharge Summary” of 1980 (as presented to the Irish Medical Council by my historical Psychiatrist Dr PA Carney) – contains NO Admission Date.

  8. Massachusetts c/s/x’s, members of the Mental Patient Liberation Front, brought a court case against the the DMH of Mass., in 1975, which was known as Rogers versus Commissioner Olin (https://web.archive.org/web/20080521101254/http://www.psychlaws.org:80/LegalResources/CaseLaws/Case3.htm.) The plaintiff, Ruby Rogers and 7 others, petitioned the court to prevent forced treatment with antipsychotic meds. The case went to the US Supreme Court who referred it back to the Mass Supreme Court. The resolution was that a competent person in a psychiatric hospital or the community cannot be forcibly medicated until a special hearing has been held and they have been assigned a “Rogers guardian” who uses substitution judgement (decides for the person based on what their expressed wishes might have been before they we are that decision point) to decide on treatment. In theory, these Rogers Guardianship hearings should give a level of protection against forced treatment but because very few psychiatrists will testify against another psychiatrist, the judgements go against the labeled person 97% of the time.

    • Daniel Fisher, I am so, so happy you mentioned that. They did the Rogers thing to my late boyfriend. That’s how they forced him to take “meds.” He kept telling me the “meds” were poison and he would not take them. He was right. The “meds” killed him. I’m convinced that what happened was a combo of “meds” and smoking, but the smoking was due to “meds.” The meds make it nearly impossible to quit smoking.

      I believe they were trying to do that to me, but they did not succeed. I was so, so lucky! They were pushing Zyprexa on me. I had tried it back in 1997 and the doc stopped the drug almost immediately and told me I should not take it. I knew it would cause ridiculous weight gain. I found out that this was their aim. However, it has already been proven beyond a doubt that forcing weight gain by coercing a person onto antipsychotic drugs does not cure anorexia, and very often, it worsens ED. I’d already been through it! It took me a while but I figured out that they wanted to get me on the injectable. Their aim was to try out the Zyprexa just to see what happened, and then, get me into a psych ward, sending me to my doom.

      One reason the psych wards wouldn’t take me (thank goodness) is that my kidneys had failed. This meant too much liability. An outside agency came in to evaluate me. The conclusion was that any agitation I was displaying was due to the abuse by hospital personnel and due to the extreme noise level on the hospital floor. Thanks to those very young crisis workers, I was freed from that horrible place.

      It took me a very long time to recover from the abuse trauma to even get to a point where I was functional. All these years I have not really had anyone to talk to about what happened. No, anger isn’t a disorder. It is a normal and expected reaction to abuse. (Do I need to boldface that?) I relied on writing to help me. Even now, I can get very worked up if I am re-traumatized. Very slowly, I’m getting over it, piece by piece. I channel the anger into activism. It makes me a better activist for sure.

  10. Julie Green, you are right on about activism,
    . “I channel the anger into activism. It makes me a better activist for sure.” Activism heals two of the greatest wounds of trauma. The collective nature of activism overcomes the isolation and the empowering feeling that comes from being part a change that reversed the abuses overcomes helplessness. I still am fueled by the anger smoldering in my belly from the forces hospitalizations, the forced medications forced seclusion and forced labeling I went through. I hope to make the world safer for my children but we have a long ways to go.

  11. Thanks for this update Dr. Gotzsche and your ongoing work to see forced medicating of psychiatric patients become forbidden by law. It is good to know the Ombudsman in Norway had the courage and decency to stand up to the authorities. In my battles for justice the Ombudsman here has simply gone long with the other ‘authorities’ whose obvious goal is making sure psychiatrists will never be held accountable. Hard to comprehend that after most countries ratified the UN Convention on the Rights of Persons with Disabilities they continue to drag their feet and have not enacted laws on the matter.

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