Coercion remains one of the most controversial aspects of psychiatric care. From legally sanctioned forced hospitalizations and involuntary treatment to more subtle pressures—such as patients feeling compelled to take medication to avoid staff backlash—coercion permeates the psychiatric system in both overt and insidious ways.
A new study, published in Synthese by European scholars Mirjam Faissner, Esther Braun, and Christin Hempeler, examines why coercion persists in psychiatry despite ethical concerns and patient resistance. The authors argue that one key reason is epistemic oppression—a systematic silencing of patients’ perspectives on what constitutes coercion.
While psychiatric staff and institutions narrowly define coercion through legal and policy frameworks, patients experience coercion in much broader ways. This disconnect is not just a difference of opinion—it is a structural issue that maintains psychiatric power and prevents meaningful reform.
As the authors write:
“In an interaction between two agents A and B that is not affected by such prejudice, A’s testimony about having felt coerced by B would normally lead B to consider whether the situation was in fact coercive, and potentially question their own assumptions about what constitutes coercion. In the case of coercion in psychiatry, this process can be impaired by prejudice: while psychiatric staff might grant that patients felt coerced in a specific situation, it seems plausible that they treat patients’ contributions as not sufficiently relevant in determining whether a situation was in fact coercive, so that their contributions have limited impact on how psychiatric staff understand coercion.”
In other words, psychiatric staff may acknowledge that patients feel coerced, but they rarely reconsider their own practices based on this testimony. This dismissal is not simply a personal failing—it is baked into the structure of psychiatry, reinforcing an ongoing form of epistemic oppression.
Hate throwing cold water on such insightful journalism, but don’t think for a minute that the leaders of psychiatry haven’t already come up with a clever response to these “epistemic” arguments.
I suspect psychiatry’s collective response will be along the same lines as the “bio-psycho-social” lip service line it now dishes out that nevertheless almost inevitably concludes with an M.D. writing endless prescriptions for psychiatric drugs which tells us the following: psychiatry won’t meaningfully change because A) it doesn’t want to and B) it doesn’t have to.
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Most people who go through medical school do so because of a subconscious desire to eventually exercise more power than the average person — meaning most aren’t about to change their ways — especially when the law protects them from unhappy “patients”.
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The image communicates the challenge well! Each patient has to figure out their code, to unlock the tempo and rhythm of thinking. The Mirror image of understanding the dialogue from within oneself to at times with those across from you in the physical sense. The power to restore and engage others, by typing and sharing a few words may not fill the need, though to understand how the field can pick up information in need of exam! Coercion also exists when the bills are not paid, and no support fails to show.
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“Their study echoes research showing how psychiatric diagnosis itself often functions as a site of epistemic injustice, where individuals labeled as ‘mentally ill’ find their knowledge and agency systematically undermined.”
As one who – fifteen years after being weaned off my last psych drug, and a decade after getting a non-medically trained psychologist’s misdiagnosis off my medical records, by a well respected medically trained doctor – is still dealing with “epistemic injustice,” defamation, by the head of my former religion, a religion which has a Faustian “partnership” with the psych industries.
And as one – who was initially misdiagnosed to cover up a “bad fix” on a broken bone, and medical evidence of the abuse of my small child – two illegal motives, for the provable misdiagnosis.
I thank you for this blog, Samantha.
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Structural modifications, such as participatory research, inclusion in service delivery, and staff training, will not sufficiently address the issue of epistemic oppression within the field of psychiatry. The only genuinely effective approach to this challenge is through abolition.
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Thank you for saying so. Please say it again.
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Almost all psychiatric drugs (at least in the long term, after months/years of psychiatric drugs use) cause permanent chemically induced brain damage and possibly related permanent mental illness. Because of this feature of psychiatric drugs… Involuntary psychiatric hospitalization and treatment means damaging people’s healthy brains (brain damage). In addition, psychological problems become permanent.
For this reason, sort of… Psychiatrists prescribe psychiatric medications to CONFIRM their mental illness diagnoses of healthy people. This is what is happening in psychiatric institutions today. Psychiatry prescribes psychiatric drugs not to ‘treat’ mental health, but to create it. (To create a chemical imbalance in the brain) This is actually a known fact. Psychiatric medications do not correct chemical imbalances in the brain, but rather create them. So.. Psychiatric drugs do not fix people’s psychological problems, on the contrary, they make them worse.
So, sort of.. Performs a chemical lobotomy. Chemical lobotomy is the name given to the ‘chemically induced brain damage’ caused by psychiatric drugs. In summary.. Involuntary psychiatric treatments chemically damage the brains of people with healthy brains. And it probably causes ‘permanent mental illness’, linked to chemically induced ‘brain damage’.
The interesting and sad thing is that… Nowadays, the courts… Under the name of ‘mental health treatment’… It’s as if they’re making decisions to ‘chemically damage’ the brains of people with healthy brains. The courts are probably unaware of the chemical lobotomy (i.e. chemical brain damage) properties of psychiatric drugs.
In short.. Involuntary psychiatric treatments chemically damage the brains of people with healthy brains. And possibly cause related permanent mental illnesses. (natural psychological problems becoming permanent..) Sincerely… 🙂
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Yildirim, I am writing as someone who experienced a psychotic episode years ago. There are cases of severe psychosis in people who were not using any psychiatric drugs (I was not using any before my psychotic episode). When people experience psychosis, they may be unable to sleep and extremely terrified. This can’t be good for their brains. Moreover, such people can do things which seriously endanger them.
During my psychotic episode there were nights where I could not sleep at all because of the “voice” I was hearing (I was literally listening to it all night). I was often terrified, even convinced that my mother wants to kill me (which was not true at all). And before I was involuntarily committted, I was planning to travel to another part of the country without telling anyone where I was going.
I am against forcing people to take psychiatric drugs and psychiatric hospitals are very oppressive places, but there are people who truly need help. My mother was ready to look after me during my psychotic episode, but unfortunately I started being very afraid of her. There was no other person willing to look after me.
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Joanna Badura.. You’re right, but psychiatric drugs are still very dangerous… 🙁 Get well soon.. 🙂
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Yildirim, you are right and I am definitely against forcible psychiatric drugging. But if a person is unable to sleep or is frequently terrified, s/he needs some form of medical help, especially if s/he becomes afraid of family members. Thank you, fortunately I have fully recovered from that psychotic episode and have never had a relapse (I am not using psychiatric drugs).
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Sad, but seemingly true, Yildrim.
“In short. Involuntary psychiatric treatments chemically damage the brains of people with healthy brains. And possibly cause related permanent mental illnesses.”
Indeed, that is where we are.
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Someone Else .. Yes.. But people are still not aware of this danger. 🙁
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Well, at least it’s not another article advocating a penis up the backside cure for schizophrenia (I’m allowed to say that – I’ve done the whole penis up the backside thing, so been there, done that, but you’ll be releaved to know I haven’t kept the t-shirt), but you could save yourself an enormous amount of work by just getting me and Birdsong and others on this comment section who are fellow insightful human beings (nutcases) to tell you everything you need to know and are labouring fruitlessly to grasp, because you’re creeping so slowly forward, and are always creating slowly toward what we always thought and said in the first place before you psuedoexperts, academics and ‘professionals’ gasslit us with their useless anvice and useless talking shops like this one even those who write from experience distort reality because then it’s just the story of ‘the victors’ (sic), or those who are intellectual enough, therefore heavily socially conditioned enough, to write articles for this site and therefore produce the same kind of boring gunff that perpetuates the very problem it purports to want to solve. But no-one needs to be an expert in having a ‘mental illness’ as you call it, but everyone can be an expert human being, and through that expertise can help other human beings. Otherwise they impose shoddiness and mediocrity and project it into social process, To become an expert human being obviously means to become an expert in what you already are, which is in terms of action so utterly simple, yet in practice is made excrutiatingly complex by the problem of a brain that is riddled with social conditioning, socially conditioned prejudices and so forth all of which need to be observed, understood, and through that understanding resolved. A perfect expert human being would have observed themselves so intensely and attentively as to have understood every kind of movement, gesture and vibration of the body, feeling, emotions, mind and sensation in order to grasp the total structure and movement and unity and meaning of huma existence as yourself, and all this stuff is beyond words, in your actual, in your consciousness, so no book can help you with it, obviously – only the eyes and the brain need to have direct contact. The illumination of these movements or layers within consciousness (feeling, emotion, thought, imagination, sensation and so forth) makes them and the brain act intelligently in relation to each other. It is an illusion that the brain sees or is aware, because awareness always ever is, but the brain has socially and biological conditioned security seeking, reality testing and desire oriented functions which it needs to see and undertand in order to see their redundancy when one lives in perception, which is part of the removal of social conditioning through meditation. So there is no doing in the true state of consciousness, because awaeness, which is all that you fundamentally are, doesn’t do – it sees and feels and hears and tastes and smells and thinks and imagines but it cannot touch or be touched by a sensation, feeling, sound, taste, smell, thought, vision etc. When the brain uncovers all this through perception and understands all this naturally it transforms radically in terms of function which if you spend a moment to think it through is absolutely inevitable, because the brain’s structure clearly adapts to what is through the perception and apprehension and understanding of what is: we all know that, and it’s called neurological adaptation or ‘learning’, so remember it transforms brain structure to learn, and if you learn from books it socially conditions the brain but if you learn through a penetrating and silent awareness of what is, the brain is being conditioned by perception of what is which makes the brain as intelligent as it is structurally and functionally able to be in relation to environment. I didn’t read this stuff in books. Awareness illuminates, and books at best just give a social language through which to convey what has been illuminated. And you can never know if what I say is the truth through awareness of me. YOU can only see and know, and that is the beauty of it. No-one can own truth and each must come upon it themselves, a process which authority in psychological, spiritual or intellectual matters makes in possible. Believing what someone says because it’s convincing is inadmissible to the consciousness of tomorrow which is the freedom of pure awareness of what is, which is the whole movement of life.
Awareness illuminates, but it is the brain that needs to grasp the centrality of this awareness to true intelligence, illumination of what is and transformation of the brain through means other then those socially conditioned means such as filling your brain with useless knowledge or stuffing your face with tasteless cakes.
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I have to admit to a sense of shock at the comments i have written, because when reading them back it was like listening to someone else and I really had no consciousness of this total picture until reading it back. And this is the wonderful thing about meditation. It changes your brain silently, unlike intellectual learning which is always announcing each mile stone to itself, and the only way you discover the brain’s capacity to describe the actual is by writing something to something and then reading it, on some level you see the whole clear picture for the first time. It’s very different from honing your knowledge and your argument skills because then nothing you write ever really surprises you. And who is the one being surprised, and who is the one surprising? The thing being surprised we can certainly say for sure is part of human ignorance, for if it wasn’t ignorant it wouldn’t be surprised. Instead it would say ‘oh, that figures’. Theoretically then it could be human intellectual consciousness or the body consciousness that is surprised, and in this case I can assure you it’s only the body consciousness that is surprised. Therefore the human intellectual consciousness already grasped that which the body consciousness discovered on reading. They call me psychotic. I am psychotically super-sane, so much so that I can’t handle it and go insane. I’m basically a vegan fisherman who lives in Brighton, UK which is a town of vegan fisherman where everyone including women are vegan fisherman.
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Coercion is common in the primary care setting also. Dealt with it too many times. Breaks down trust and often has interfered with getting a correct diagnosis 🙁
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Samantha Lilly would be silly building houses where it’s hilly.
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