A new article published in the Brazilian journal Revista Direito e Praxis, titled “Human rights and psychiatric power in dispute: Towards a radicalization of democracy,” provides a history of the evolving debates over the human rights of people with psychosocial disabilities.
The Spanish authors from the University of Barcelona, Pérez Pérez, Margot Pujol I Llombart, and Enrico Mora, draw on the work of philosophers Michel Foucault and Giorgi Agamben to highlight the paradoxes of modern conceptions of mental illness and disability and trace them back through time. In doing so, they highlight the medicalization and creation of mental illness categories, critique past attempts to deliver rights to neurodivergent people, and explore the recent development of the Convention on the Rights for Persons with Disabilities (CRPD). They write:
“It is from this place that the CRPD is inscribed in a project of radical democracy that aims to recognize the multiplicity of the human. The abolition of forced commitment and treatment opens the possibility of imagining and deploying forms of support and accompaniment free of violence, de-medicalized, de-judicialized, and radically democratic for those who undergo experiences of intense suffering or madness, which increases their recognition as constitutive of the human.”
The authors operate at the intersection of Foucault’s concept of biopower and Agamben’s frameworks for sovereign power in four separate historically situated sections. Put simply, Foucauldian biopower is the tacit regulation, control, and surveillance of everyday life. Whereas sovereign power, according to Agamben, is distinct from biopower insofar as it is the legal and regulatory power that influences day-to-day life but also the power that identifies you as worthy of both civil and human rights.
Next, the authors explain the genealogy of psychiatric power and the contradictions found in Foucault’s earlier and later works. They use an allegory from Agamben to highlight how a loss of sovereignty (the revocation of human rights) subjects an individual to a life of increased surveillance and control. They argue that this made-to-die/made-to-live paradox is fundamental to psychiatry:
“The idea of the semi-living, moreover, resonates with the usual descriptions given by psychiatrized people in our contemporary world of the effects of high doses of neuroleptics, such as zombification, and also with its historical genealogy, as encapsulated in a ‘politics of indifference.’”
The authors highlight the emergence of the ‘psychiatric device’ and forensic medicine. The word ‘device’ in the phrase ‘psychiatric device’ is a challenging concept in translation from Spanish but can perhaps be more quickly understood in English as a kind of framework or theory in action. The authors trace both the history of ‘psychiatrization’ and the legitimatization of psychiatric frameworks over time. Importantly, they argue that the creation of the asylum has its foundations in the aforementioned “to make live, to make die” paradox. The authors then tie the values of psychiatry to the history of eugenics utilized by the Nazi regime during World War II.
“The function of degenerationist psychiatry was, according to Foucault, the ‘biological protection of the species.’ According to the matrix of biopower that he later proposed, this was a curative displacement (to make live) from an anatomopolitical sphere (disciplinary, based on the body-individual) to a strictly biopolitical one: what must be preserved is the life of the body-species, threatened by ‘degenerates,’ who are the enemy to be eradicated (to make die)… Degenerationism does not appear in his [Agamben] study, only eugenics, but his very apparatus allows us to understand why, after this pamphlet, the first centers of extermination in Nazism would be psychiatric institutions.”
Pérez and colleagues then contrast psychiatry with the emergence of “the human rights regime.”
“After World War II, the first human right formulated by the United Nations was that of non-discrimination on the grounds of ‘race, sex, language or religion,’ set forth in the Charter of the United Nations (1945) during the San Francisco Conference, which subverted what was agreed by the United States, Great Britain, and the Soviet Union at the first Dumbarton Oaks Conference (1944). The second was the right to the ‘enjoyment of the highest attainable standard of health,’ defined as ’a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,’ which was formulated in the preamble of the WHO Constitution, approved in July 1946 and effective as of April 7, 1948.”
However, they argue that the initial formulation of the “right to health” was closely connected to Nazi eugenics and perpetuated the sanism, ableism, and heterosexism of the regime. It wasn’t until the CRPD was created with both physically disabled and psychosocially disabled people at the table that the “right to health” truly became something of substance.
In particular, the authors draw attention to Article 12 of the CRPD, which requires states to recognize all persons with disabilities as legal persons capable of bearing rights and duties within both civil and criminal justice systems. The authors see this article as giving the previously lost sovereign power of the psychosocially disabled people back to them:
“It is thus understood that the mandate of Art. 12. fundamentally restores agency and freedom, sealing the threshold that separates the exercise of power over a free subject, which is intrinsic to any social relationship, from the exercise of domination over a human being reified and reduced to impotence, for having been constituted as bare life, excepted from the human right, and thus thrown into regimes of violence with impunity.”
Although the Convention on the Rights for Persons with Disabilities is a major improvement from past formulations and conceptualizations of disability and mental illness, the guidelines are only legally enforceable if adopted by individual nation-states. Unfortunately, the United States has yet to ratify the CRPD. In addition, research has reported that countries frequently invoke the CRPD in their mental health legislation and then push measures that run contrary to the intention of the legislation, like prohibiting involuntary commitment and forced treatment.
Pérez, B. P., I Llombart, M. P., & Mora, E. Human rights and psychiatric power in dispute: Towards a radicalization of democracy? Revista Direito e Praxis. DOI: 10.1590/2179- 8966/2022/65459i. (Link)