White Paper Presents Case Against Forced Treatment


Alaska Attorney Jim Gottstein, together with Faith Myers, Susan Musante, Peter Gøtzsche, David Healy, David Cohen, and the International Society for Ethical Psychology and Psychiatry (ISEPP), have published an in-depth “white paper” on improving psychiatric patient outcomes.

While it was written in response to a legislative initiative in Alaska, Gottstein hopes that it will provide an evidence-based resource for all to use. “I think it presents compelling evidence for abolishing unwanted psychiatric interventions in favor of non-coercive approaches, such as Soteria Houses, peer respites, Open Dialogue, warm lines, the Hearing Voices Network, emotional CPR (eCPR),” and so forth.

Doctor holding syringe, a patient cringing away in fear out of focus in the backgroundLast year, Gottstein explained, as the Alaska legislature considered bills to implement a “Crisis Now” initiative, which was part of a settlement over the state’s illegal detention of people waiting for court-ordered psychiatric evaluations in emergency rooms and jails for an extended period of time, it decided to require the state to submit a report to the legislature about aspects of Alaska’s mental health system, including keeping track of patient injuries and how well the patient grievance process works. Gottstein suggested the legislature add “improve patient outcomes,” which it did. Gottstein is a member of the legal subcommittee providing guidance to the “advocacy team” that is expected to make decisions about what will go into the report submitted to the legislature.

The white paper describes psychiatric incarceration and forced drugging as violence perpetrated against psychiatric patients that violates international law under the United Nations Convention on the Rights of Persons with Disabilities (CRPD). While the United States has not ratified the CRPD, the papers argues that Alaska’s mental health program should not violate international law.

“I see the white paper as the culmination of my 40+ years of advocacy for people diagnosed with serious mental illness and subjected to psychiatric incarceration and forced drugging, compiling much of what I have learned into this one document,” Gottstein wrote in an email. “It presents the compelling evidence our so-called mental health system is massively counterproductive and harmful, reducing recovery rates from a possible 80% to 5% and reducing life spans by 20 years or so. Then it presents non-coercive alternatives with the overriding theme of asking people what they want; what they would find helpful, which is heretical in the current system. It is the citation of evidence and authority all in one place (with links) that I think makes the white paper so potentially useful around the world.”

Gottstein added: “The report is also required to make recommendation on the practical ability of patients to avail themselves of those rights. The white paper addresses this issue with the obvious point that the legal representation of people accused of being mentally ill and as a result a danger to themselves or others is totally ineffective and the most important step to take for patients to be able to avail themselves of their rights is effective representation.”

However, Gottstein doesn’t think the other members of the legal subcommittee and advisory team will be receptive to the evidence presented in the white paper.

“I expect they will want to largely ignore this and the other issues raised in the white paper,” he wrote. “The legal subcommittee and advisory team has representatives from the Alaska Public Defender Agency, which represents almost all the psychiatric respondents, the psychiatric hospitals, and the court system; NAMI (the National Alliance on Mental Illness); Adult Protective Services; and the Public Guardian, all of whom are invested in and support the current coercive system. I told the legal subcommittee and advisory team when I submitted the white paper that if the report is to seriously meet its charge it needs to grapple with the issues raised in the white paper. I doubt they will, but I will be pressing them and then the Alaska legislature to do so.”

Gottstein added: “I have gotten to the stage in my life where I am no longer able to carry PsychRights-type litigation by myself the way I did when I defended psychiatric respondents at the trial court level, making a record for appeal, and then taking them to the Alaska Supreme Court where I won five cases holding Alaska’s coercive psychiatric regime illegal in various respects, including being unconstitutional. However, as my new hero, Cherene Caraco of the Promise Resource Network in Mecklenberg, North Carolina says, ‘There is no alternative if there is no alternative,’ and I am now focusing my efforts joining with many others on creating such non-coercive alternatives.”

He and others are pursuing this goal through the ongoing work of the International Peer Respite/Soteria Summit. “Independent of that,” Gottstein wrote, “the purpose of the white paper is that it can be useful in efforts around the world to end unwanted psychiatric interventions.”

In addition to his legal fights against forced treatment in Alaska, Gottstein helped create several alternative programs in Alaska, including a Soteria House that operated from 2009 to 2015. In his book The Zyprexa Papers, he detailed how his litigation efforts ultimately led to a court case in which Eli Lilly threatened him with criminal charges for obtaining and releasing documents that told of how the company had hid from the public evidence of how its antipsychotic drug could cause diabetes and other metabolic adverse events.


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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    • La psiquiatría no son más que píldoras que te matan veinte años antes, son vendedores de drogas extremadamente dañinas y tóxicas. Los psiquiatras no curan nada, pero si dañan a los que ellos llaman “enfermos mentales”.
      Dudo de que el sistema de salud mental llegue a cambiarse. Demasiadas personas apoyan a los psiquiatras, a los médicos, y a sus medicamentos.

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  1. Zyprexa was my first real taste of psych medications, I gained over 100lbs and was sleeping 16 hours per day. they don’t need to incarcerate you if they can get you to take their meds you quit being a problem quite quickly. We begged the psychologist to change the medication his answer was don’t eat so much and don’t sleep so often. Finally they lowered me from 30mg to 5mg and I only slept 12 hours per day and only gained 7lbs per month instead of 10. I stopped taking it after about a year and have refused any antipsychotic medication since.

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  2. I don’t think anything is going to change. The coercion will be subtle but the “mental health” profession will still belittle ignore, fear monger and shame people as stupid if they complain about treatment. They know well that you don’t have to lay a hand on a person to steal their will.

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  3. Coercion is a very complex subject. I despise psychiatry as much as the next person, but the problem is, everything would be much easier if people in general society understood the problems people face (which make them end up in psychiatry in the first place) and had the intellect and knowledge to tackle such issues. “Professionalisation and pathologisation” of these things would not be necessary to the extent it has become. The way psychiatry has inserted itself into our lives would not exist.

    Money is another issue. A lack of money forces people to live in horrible situations leading to them becoming agitated, mentally unstable which ends down the path of coercion.

    As an example, take hoarding. Living with someone who hoards is life ruining. Some people who do that, take responsibility for it and change for the better. My kudos to them. Others remain in denial that they do it for decades, make the lives of children or spouses living with them hell, and if pointed out, they start insulting, blackmailing etc. Hoarding has its reasons. But it’s very difficult to live with someone who hoards (and takes no initiative to change) and not end up screaming at the top of your lungs after years of trying to get them to change their habits to no avail (ruining your name in the process). The person who hoards will then start rationalising and tell others that because you’re screaming she can’t be clean rather than the reality of it being the other way around. I can understand why someone who’s living with a hoarder would be forced to call psychiatric services too just because they don’t know what to do.

    The alternative would be, both the individual who hoards and who doesn’t and wants a clean environment around them have their own places and each can live the way they want. But that requires money which people often don’t have. And snoopy people in society will ask “why are husband and wife, mother and son not living with each other, what’s wrong” etc.

    Also, coercion as unwarranted blackmail, as a tool of gaslighting by immorally minded people is a different subject. Psychiatrists would talk about the hoarding example, but when it comes to the latter…nah, they’d rather give speeches on systematic reviews because acknowledging those things would put their careers in serious jeopardy. If you’ve spent a 30 year career labelling people as schizophrenics, bipolars, borderlines etc. and those terms ruined people’s lives and became weapons against them, it’s much easier to keep that aside and talk about something else.

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  4. My 58-year-old brother made the mistake of taking himself off of his Valium cold turkey. The resultant temporary sleep deprivation-induced delerium could easily have been treated with a slow taper after first reintroducing the Valium. But instead, he’s been forced to waste the past 4-plus months so far, as three psych hospitals and two medical hospitals have each plundered as much profit as they can from the pharmaceutical company kickbacks – via his medical insurance. After seeing him being – for all intents and purposes – kidnapped this way by the hospital industry, our elderly mom has cancelled all her medical appointments and discontinued all her medications, and I have cancelled my medical insurance – keeping only my dental and vision coverage. At 62 years old, I’ve never needed any medications, and I intend to keep it that way.

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    • Yes, this is what we all eventually learn. Big Pharma, and their staggeringly deluded medical industrial complex, is only here to financially help themselves. So divorcing oneself from them is needed. But how very sad, we may no longer “trust our doctors.”

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  5. I would like to get involved establishing Soteria Houses here in Northern California. Back in 1974, I was involved in a serious burnout while I was in Vancouver, but found myself in the Vancouver Emotional Emergency Center, very similar to a Soteria House, where I got the emotional support I needed. After that I spent the summer traveling on Greyhound busses and sleeping on peoples’ floors in 12 or 15 cities, recruiting people to a conference that played an important role in building our psychiatric survivor movement. Without VEEC, I would have completely lost it. We need places like this, instead of the drugs and abuse offered (actually, forced on us) by psychiatry.

    If you are in Northern California, and would like to get involved in starting a place like Soteria House here, please get in touch with me.

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  6. I was trapped in my bathroom in my underwear by the police and taken to the mental hospital. My wife abused me by placing me in the mental hospital because she was afraid I was a threat to her safety. As a minister of the gospel I had to file for divorce to stop her from doing that to me. We have now been separated for almost seven years and she refuses to set me free by giving me a divorce. I take my medication and am compliant with all of my doctors orders. The courts must not allow wives of the mentally disabled to abuse them as my wife has abused me.

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  7. This article reflects a complete misunderstanding of the profession, and what’s involved. There are many individuals who are remanded to psychiatric hospitals and who desperately need such attention. It’s all very well to demonize psychiatry, but that does nothing for patients who desperately need attention to treat severe psychotic symptoms and associated suicidal and often homicidal ideation. While on the one hand, it’s important to listen to the patient and try to understand his or her problems on the other, it is important to address acute psychiatric symptoms until the situation is out of hand, or is too late.

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    • Saying that these folks need help does NOT translate into we should assume and accept that what the psychiatric profession has to offer is the kind of “help” that they need. It is absolutely wrong to postulate that needing attention means needing the kind of abusive and destructive behavior that is often accepted and even encouraged in the name of “psychiatric care.”

      Those “helped” by psychiatry with psychotic disorders die on the average 20-25 years YOUNGER than those who don’t receive such treatment. While it’s obvious that there are many variables involved, I challenge you to name another profession where receiving treatment REDUCES average lifespan. Something is not right here. The problem is not that these individuals need attention, it’s that the kind of attention they receive is not the kind of attention then need in a large proportion of cases.

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    • I was kidnapped because they claimed I was suicidal (a bald lie) and that I was a threat to others because on *one* occasion I drove without a license (it expired while I was in Hawaii so I couldn’t renew), a traffic offense that comes with a $200 fine in the actual legal system. This was for my own good, they said. (And for society’s good too, yeah!) But I found it far from my own good. It was like a cult. They controlled everything. Being at their mercy and knowing they could hold me for an indefinite life sentence was terrifying. I was/am forced to take drugs that caused my hands to shake with Parkinson’s disease. If this were done to prisoners in Guatanamo Bay, it would be considered a war crime. Doing it to a free American, though, is just business as usual in this free, just world we live in.

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    • How many of these disturbed patients could properly be diagnosed with akathisia (in other words, the psych drugs in their system are the reason they’re disturbed?) How many of these patients are diagnosed with akathisia?

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    • “it is important to address acute psychiatric symptoms until the situation is out of hand, or is too late.”

      Freudian slip? This *is* what happens. When psychiatry does address acute symptoms, the situation often does become out of hand. It’s the whole “psychiatry addressing symptoms” that leads to extreme suffering for the patient and others.

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  8. The drugs are the problem. Forcing an intelligent human being (under threat of violence – the gang of 8) to take a substance that gives them a heart arrhythmia, compromises Kidney function, or actually “causes suicidal thoughts” – all the while not believing a word they are saying – is torture. I was on my knees praying (which they call crazy, also). It was insurance fraud (the state health department shut the offending facility down). I can never forget what humanity is capable of doing. I am in hiding and have been for the past 6 years. I have recovered and made a life for myself. I am happy.
    But, as described above – no doctors and no relatives – neither are in my best interest. It is impossible to “change the times we live in”. We are living in times where anyone can point the finger and your liberty be taken from you. No crime need be committed. No scientific evidence of disease necessary. No rational logic needed. I am a survivor. I simply walked away. Always, always, always – trust yourself.

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  9. Doug says, “…it is important to address acute psychiatric symptoms…”

    As long as our culture keeps seeing psychotic states as “psychiatric symptoms”, people will keep ending up in psychiatric prisons, because this type of thinking does nothing to address the reasons why people end up in psychiatric prisons IN THE FIRST PLACE, which are usually because they were not listened to and understood IN THE FIRST PLACE, and further brutalization from psychiatry’s “treatments” is just another way of ignoring why people end up in psychiatric prisons IN THE FIRST PLACE —

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  10. My experience as a recipient of mental health care left me at one point one night in a very real life/death struggle when I was forced to take the wrong medication. It was clearly labeled with another patients name. I had to spend some days in coronary care. Today, in the lack of aftermath that might have helped me through the lack of trust scars as well as the other “you are barely anything to us’ scars, it is so rare a treat to find a document able to stand legal and scientific scrutiny freely available for use in standing against coercion, and calling it out as harmful. In my instance I have cause to ask why this hypocrisy is rewarded ie my being considered a danger and punished, while theirs is far worse than mine and the foolish justice system rewards them. Thanks to all involved in presenting us with what may be a lifeline to assist assertiveness and redress the phenomenal imbalance of credibility. I hope to use my copy soon. All I wanted was to optimize my recovery. Now I’m pressganged into some form of modern medical ‘sl*very’ just because I asked questions and wasn’t all breathtaken about chemical imbalance theory being used presumptuous as scientific proven truth. The RANZCP (southern Oceania college of psychiatry) was asked to adjust its web page by psychwatch Australia after that theory was found to be used as more than a theory. As I mentioned it is falsely used as fact. Could write more because I love righteous justified writing but my dopamine is tampered with against my will so no feelings of satisfaction. Nice to know I can connect with others thinking and perhaps experiencing similar.

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  11. Firstly to the editor team: thank you for updating the comment process!

    All my gratitude to Jim for continuing this fight! The ‘Zyprexa Papers’ and ‘The Law Project for Psych Rights’ are invaluable.

    I hope his successors can tap the vast wealth of experience and knowledge within the ranks of psychiatric survivors. People who survived the totalitarianism must be invited into reform: our experiences are earned and our skills are finely honed. I believe Jim knows this but I worry about the future. The more reform is embraced by the mainstream MH complex, the more our efforts become “controlled opposition”.

    The future must include a safeguard of “nothing about us without us”- basic epistemic justice can prevent clumsy infiltration from savior types. Performative abolitionist therapists are a wet blanket to the fire of change. I know Jim understands this and will put measures in place to maintain his effort’s original purpose: guaranteeing human rights after psych cruelty.

    Thank you MIA for posting an update about these crucial projects. Thank you to Jim for walking that psych survivor tight-rope to actual change. Your work has restored dignity to many. You created pathways that never existed before. I hope many more can follow and tirelessly pave the way to decency, dignity, and justice. I am always appreciative.


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  12. Doug says, “While on the one hand, it’s important to listen to the patient and try to understand his or her problems on the other, it is important to address acute psychiatric symtoms until the situation is out of hand, or is too late.”

    It sounds to me like you’re trying to justify brushing aside the vital component of listening people in order to assuage your own feelings of helplessness by exercising brute force on vulnerable people, which undoubtedly has the positive effect of making YOU feel invincible.

    And what’s psychiatry’s idea of “addressing acute psychiatric symptoms”?


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