Open Season on Mental Patients

Editor’s Note: This is the first part of an essay adapted from Irit Shimrat’s keynote speech delivered at the 2014 conference of the National Association for Rights Protection and Advocacy. The author was invited by Jim Gottstein to give an updated version in a recent virtual event. The second part can be read here.

I named this talk “Open Season on Mental Patients.” But I could just as well have called it “Open Season on Humanity.” No one is safe from psychiatry’s project of medicalizing and treating just about every variation of human emotion and behaviour.

Especially in danger, as always, are those viewed with suspicion and contempt by the powerful, including Indigenous people; Black, brown, Asian and other people of colour; big, loud young men of any race; immigrants; refugees; people with physical disabilities; women and sexual minorities; old people; millennials; teenagers, even small children.

The particulars of psychiatric treatment—labelling, incarceration, solitary confinement, shackles, drugging, electroshock, and the less obvious violence inflicted on those leading silent, terrified lives under community treatment orders—cause a staggering amount of damage to far too many minds, bodies, and souls.

Media of all kinds are always screaming at us about the current “mental health crisis.” And there is, in fact, an ongoing crisis. But it’s not what they imply. Unbearable conditions of poverty, discrimination, abuse, neglect, and all the other ills that plague our society are driving more and more people into states of alienation, despair and insanity, which are then attributed to supposed medical conditions, to be treated with drugs.

Creating and maintaining an atmosphere of despair, anxiety and panic drives clicks, but that’s not all it does. It also facilitates the marketing of various means of individual and collective social control, from drugging away your own troublesome emotions to having troublesome humans shut up, shut down, and put away.

Psychiatry’s witting and unwitting minions—including police dealing with situations seen as being caused by mental illness—produce untold suffering through their oppression of some of our best, brightest and most sensitive citizens, and non-citizens too.

In British Columbia, where I live, police have literally broken into people’s homes—no warrant required—because some acquaintance has reported what they perceive as strange behaviour.

Not only physicians and family members, but friends, neighbours and even random passers-by can trigger legally sanctioned home invasions—which may end in incarceration and forced drugging, simply on the grounds that a person is deemed “incapable of appreciating her need for treatment.”

And way too many mental patients end up being killed by police. Predictably, the most common victims of such murders are poor, and many are Indigenous. I think of Chantel Moore, a First Nations woman who was just 26 years old when police officers entered her home to conduct something called a “wellness check,” in 2020, and ended up shooting her dead. And there have been many other such murders.

Wellness checks are just one example of the ferocious increase in psychiatry’s power to inflict forced or coerced treatment, not only in hospital but even in the community, where it is administered by Assertive Community Treatment (or ACT) Teams, under outpatient committal orders.

British Columbia boasts Canada’s most regressive mental health act. The criteria for involuntary admission include the stipulation that you require “care, supervision and control in, or through, a designated facility,” either in order to prevent your “substantial mental or physical deterioration,” or for your own protection or the protection of others.

These criteria are so vague and all-encompassing that, in essence, anyone can be locked up for anything. And, of course, once you’ve been made into a mental patient, any unusual behaviour, however harmless, is way more likely to trigger psychiatric interventions.

“Extended Leave” is my province’s ugly euphemism for outpatient committal. When you’re on Extended Leave, you are technically free. Legally, however, you’re still under hospital care. At any time, a warrant can be issued for your arrest and re-incarceration—or, as they put it, “recall to hospital.”

The state is, in essence, splitting persons. You’re at large in the community, but, at the same time, you’re legally detained.

You can’t run away. You can’t hide. You can’t go underground. Your only recourse is to leave British Columbia—and how could you afford that, and where would you go?

In effect, Extended Leave transforms the entire province, notably including your own home, into a designated facility.

And what if you have no home? The cops are empowered to show up at one emergency shelter after another, demanding the list of names of people staying there. If it’s winter, and you’re staying off the street so you don’t freeze to death, they can track you down.

When you are obliged to “attend” your ACT team, your schedule doesn’t matter. They set an appointment and then tell you about it. You either show up, or risk being “recalled.”

Extended Leave has been compared to prison parole. But parole is finite, whereas Extended Leave can last a lifetime. All it takes is for one doctor to sign a new form each time the previous one expires.

There’s nothing else like this in our society—this status of a human being who is not physically confined, but who can be re-incarcerated at any time, on the word of a physician—and even if she’s adhering to conditions.

Police officers, often undercover, are essential to ACT teams. Each team also includes at least one mental health professional and, sometimes, a peer, who provides personal support. But even if there is a peer, she is in a subordinate position, and unlikely to be able to alter the intended outcome of an intervention.

Friends who have been subjected to Extended Leave have been devastated by the intrusion, into their homes, of officials whose job it is to monitor their behaviour and ensure treatment compliance. And even if you are compliant, the team may visit (with no warning) to check up on you, or on the state of your home.

A messy apartment can be used as evidence that you’re “in danger of deterioration.” And, as always, the threat is much worse if you are not white, or not English-speaking, or not “ordinary”-looking, etc.

And then, if you’re not compliant—say, you’re not showing up for team appointments, or your blood tests show that you’re not taking your drugs—the team is legally allowed to enter your home by force, grab you, pull your pants down, and administer an intramuscular injection. (As those of us who have had been vaccinated against Covid know, there are other injectable muscles in the human body, but psychiatry prefers the gluteus maximus. It’s more humiliating.)

I know of people who are afraid to spend time in their own homes because this might happen to them.

And what about these drugs you can be made to take against your will?

The drugs most commonly administered by brute force are neuroleptics, also known as antipsychotics. Long-term use of neuroleptics can crush your dreams, your hopes, your desires, what you had thought was going to be your future. It can delete or diminish the self you knew. And virtually all neuroleptic use is long-term. What mental patient hasn’t been told she has to keep taking these drugs for the rest of her life?

And let me remind you of some of the short- and long-term physical effects of neuroleptics: akathisia; dystonia; dyskinesia; dizziness; dehydration; constipation; sexual dysfunction; blood vessel hemorrhage; osteoporosis; diabetes; heart, kidney, liver, pancreas, abdominal, and other organ damage; neurological damage; seizures; obesity; parkinsonism; neuroleptic malignant syndrome; decreased life expectancy; sudden death.

As for cognitive effects, it’s very common for these drugs to cause withdrawal psychosis when you go off them. And they also commonly cause confusion; memory problems; problems with focus, concentration, and thinking; anxiety; distress; and “paranoia.”

Let’s talk about paranoia for a moment. The classic meme is of someone who mistakenly thinks they’re being followed or surveilled. But it should be recognized that mental patients often live under a terrifying level of actual surveillance.

My friend Fred once said to me, “As I get older, I realize, I’m not paranoid. The nice, kind nurse, is trying to get information from me. After she finishes sympathetically listening, she goes into the nursing station and writes everything down. When I try to get out, it’s all used against me.”

So, why does Fred keep getting locked up? For one thing, like me, he has some unusual ways of looking at the world, and doesn’t always hide that. Also like me, he sometimes gets so angry about injustice that he behaves in ways that upset people. As a white mental patient, I have been persecuted a little bit. But Fred, who is Indigenous, has been persecuted a lot—in his case, for failing to conform to white norms.

But what if normality is overrated?

And what if “bizarre” behaviour that causes discomfort or suffering to oneself or others is not, as psychiatry claims but has never been able to prove, the result of a chemical imbalance in your brain? What if your perceived craziness is actually a natural response to the craziness of the world we live in? And, what can we do for ourselves and each other, if and when we’re lucky enough to avoid, or escape, psychiatry?

Support systems and coping mechanisms are vital to this discussion—and these can be of use, not only to psychiatrized people, but also to those of those in danger of being psychiatrized. Which is, of course, absolutely everyone.

In my view, the number of so-called alternatives to psychiatry is infinite, because people keep coming up with new ones. Among the many that have worked well for me are:

• Traditional Chinese Medicine
• Aromatherapy
• Reflexology
• Various breathing techniques
• Feldenkrais and other body-awareness and integrated movement disciplines
• Physical activities, such as yoga, tai chi, bicycling, swimming and dancing
• singing
• Listening to, or playing, music
• In general, being outdoors, even in the city
• Writing, drawing—any creative activity; and, most importantly
• Human contact, and the choice of who to have that contact with. And when, and where to have it.

Ah, choice. So essential to a livable life. And so unavailable when you seek, or are forced into, professional help at the hospital.

If you’re a good girl, you sign yourself in, go straight to the ward, take your pills, and obey all the rules.

But if, like me and so many others, you get hauled into the bin against your will and try to fight it, what you get is confinement in a tiny, concrete cell, with a steel toilet-and-sink apparatus in the corner that may or may not work, and a mattress that may or may not have a sheet on it.

By the time you get there, you’ve been stripped of all your clothing and made to put on one of those humiliating hospital gowns, open at the back. You have highly toxic drugs coursing through your veins, forcibly injected by a nurse, while orderlies held you down.

And then, if you’re even more like me, and happen to have a paradoxical reaction to these drugs, they will make you a million times crazier than you already were when the cops hauled you in.

Often, you are shackled to the mattress by means of physical restraints: straps holding you down by the wrists and ankles.

The lights, if they’ve been left on, are fluorescent and harsh. The door is locked.

In the seclusion cell, no one can hear you scream. Or, at least, no one’s going to respond.

You are left alone with your rage, terror and desolation.

The process of breaking your will has begun.

Once you’ve been made compliant enough to be released into the general population, there will, if you’re lucky, be physical and creative activities to punctuate the monotony of life on the ward. These will be framed as “therapy.”

But such activities, and all activities, are always so much more enjoyable when they’re not framed as therapy. After all, this idea that the underlying problem is a medical one remains unproven.

A nice experiment would be to offer a sampling of things known to help people feel better, and let you pick whatever appeals. A trusted friend, family member or advocate could be with you, to provide kind, gentle guidance and advice.

Mind you, when you’re “in a state,” you might be unable to choose items from a menu, even with assistance. So, it would be better to put a plan in place in advance—before problems arise.

But it can be hard even to envision common-sense prevention strategies and solutions in an atmosphere of fear and a near-universal belief in biomedical fixes for emotional, social and political problems.

It would help a lot if everyone learned about extreme emotional states early on. In my ideal world, elementary-school children would be taught to understand that bad things happen to everyone; that anyone might have a hard time coping; that some ways of coping look weird; and that difference can be greeted with curiosity, respect, and even appreciation, rather than fear or suspicion.

However, here in the real world, we can at least put an emphasis on meeting basic needs such as good nutrition, decent housing, enough money to live on, meaningful work, and adequate health care—none of which should ever be tied to “mental health services.” I’m pretty sure that, if every person in Canada had unquestioned access to these essential human rights, the incidence of so-called mental illness would plummet.

A common-sense, empathic approach can go a long way.