I held a webinar on December 6, to present Highlights of the Deinstitutionalization Guidelines. You can view the video recording (in English original, or in Spanish or Chinese interpretation) at: https://youtube.com/playlist?list=PLUNZ98VHvVKSjdMJt07PxtkuxzBMe3avk
I held a webinar on December 6, to present Highlights of the Deinstitutionalization Guidelines. You can view the video recording (in English original, or in Spanish or Chinese interpretation) at: https://youtube.com/playlist?list=PLUNZ98VHvVKSjdMJt07PxtkuxzBMe3avk
I’m coming back to this post to let readers know that the Guidelines were adopted by the CRPD Committee on Sept 9, 2022. The result has met many of my hopes and expectations – most particularly, leading colleagues involved in the Global Coalition on Deinstitutionalization characterize the Guidelines as taking as a ‘reparations’ or ‘reparative justice’ approach as a whole. There is a substantial section on reparations and repeated reference to ‘survivors of institutionalization’ as the key constituency along with those whose rights are currently being violated by institutionalization. Please see here to read the Guidelines: https://www.ohchr.org/en/documents/legal-standards-and-guidelines/crpdc5-guidelines-deinstitutionalization-including
It’s interesting to me to consider your identification with schizophrenia (diagnosis) as a culture and a personal choice.
It gets complicated when the same words are used in many different ways. I can entirely accept your relating to schizophrenia as a word to describe your anguish. Not sure what I think about your ascribing that label to others like Van Gogh, did he similarly identify with schizophrenia?
Also there is schizophrenia as a diagnosis given by psychiatrists or ascribed by someone else generally (which I’d argue is an act of appropriation in itself) and schizophrenia as a word that people might claim for themselves as a culture. (Like mad.)
BTW, I was given that label once. It has at times interested me to speculate as to what they say in me that might have merited it, but in the end I would rather just tell my story or not, in my own ways. It’s both that ‘schizophrenia’ even as a personal/cultural claim doesn’t work for me, and that ‘schizophrenia’ as a diagnosis is wielded to terrorize and scapegoat.
I appreciate the discussion.
I agree with Bob that psychiatry needs to be abolished and with many of his points along the way. I am uncomfortable with, and disagree with, framing discussion of psychiatric drugs and their effects in terms of treatment for illnesses.
Abolishing psychiatry, even understood as removing it from authority in any domain of life, requires us to acknowledge that there is no reason to medicalize our personalities, thoughts, perceptions or emotions and that psychiatric diagnoses are value judgments in a symbol system that is only way to think about ourselves. Intentional Peer Support training and practice (among many others) rejects the use of diagnosis and mental illness narratives and instead looks for plain language talk about what we’re feeling, seeing, thinking, how we react to someone else’s talk about their thoughts and feelings etc. Diagnosis creates distance and a false claim to an authoritative understanding of someone else’s inner and outer world. Peer support in general and other egalitarian and communitarian practices of support have to be based in mutual respect for each other’s self-knowledge and a perspective of solidarity that allows the supporter to empathize with a person’s needs at the moment and how they understand and go about meeting those needs. (See my book Reimagining Crisis Support also on this, which Irit Shimrat reviewed for MIA recently, the book’s website is https://www.reimaginingcrisissupport.org.)
Two additional points to make on Insel’s duplicity. First, while I get the reason for the headline it’s somewhat misleading and might lead people who don’t actually read this article to think Insel is calling for abolition and promote his book. Not sure what to do with that, but be careful in how you share this article for that reason.
Second, ‘biopsychosocial’ is the latest thing among those critical of psychiatry who don’t want to take an abolitionist stand. I don’t know how many MIA bloggers use it, or where it originated, but I first noticed it in the work of Dainius Puras in his term as UN Special Rapporteur on Health. It was one of his fudges but probably he also simply believed it – wanting to move psychiatry and health practitioners closer to a true social model in line with Convention on the Rights of Persons with Disabilities, but not wanting to give up the medicalization with all that has means – the diagnosis, the unproven and unprovable theory of chemical imbalance, the promotion of medications (drugs) as actual treatment (even if not cure), the authority of psychiatrists as central to any ‘mental health’ team or related supports – while giving more space to ‘psychological’ and ‘social’ or ‘psychosocial’.
It is axiomatic that any human experience has a biological component. To type this I am using the functions of my brain, my hands, heart and lungs and muscle and nerves. But to say that this is a biopsychosocial activity (as anything human would have to be) says nothing about anything being wrong with me and needing to be fixed. The medicalization of thoughts and emotions is not just a claim about human activity having a biological component which can be studied (that is called neurology) but a category error attributing differences in consciousness, communication and behavior to brain biology. It’s not a true hypothesis as it cannot be proven false, so it will come up again and again so long as anyone wants to promote it, there will always be something on the horizon that ‘looks promising’ if that’s what you’re looking for. There’s also inherent cultural, gender, class and personal bias both in aiming for an objectifying view of someone else’s mind and in how others’ minds are judged.
So again, until we’re ready to do true abolition of the authority of psychiatry in all these dimensions – including (which I take as a given but needs to be stated since it’s not yet done anywhere) absolute abolition of the power of involuntary holds/commitment and any treatment, services or support without explicit free and informed consent of the person concerned – everything will be bandaids that maintain the power inequality intact.
Your take is very interesting to me! I agree that spirituality is one important way that the kind of orientation I envision can be focused and put into practice. I also share your deep concern about the fundamentalist and right wing co-option of Christianity that has become a political force in the US threatening everyone who doesn’t fit their narrow prescriptions.
In the section of my book where I talk about situating my own values and standpoint in relation to others, I identify ‘lesbian ethics’ as a core part of where I’m coming from and a community I relate to personally. Communities of any kind that are willing to challenge oppression, whether they are based explicitly on spirituality or on some other set of values, are important allies to work with in creating practices of supporting one another that don’t depend on the mental health system – and that start from the point that nobody gets thrown away, that calling 911 (or 988) on someone experiencing personal crisis is not an option.
I agree, this community should be aware of and be wiling to discuss these things. I don’t like to call it a ‘mental health community’ – characterizing all our unusual states of mind as ‘health’ issues gives power to those who claim to be experts on our health, not because of the language per se but because of how things are in the world, with mental health systems systematically disempowering and oppressing us, enacting torture and arbitrary detention and enforcing oppressive social norms.
I am interested in what you say about bringing spirit into the conversation. It can be hard to do that because some people relate to that language/concept and others don’t, and some people relate to it through their own particular lens which might be a religion or faith or belief system. But I agree that a spiritual outlook on life – so long as we see ourselves as spiritual agents and not just the recipients of a divine law from outside ourselves – is useful in thinking about these things.
I think whether one resigns oneself to a disability or seeks to overcome it, can depend on a lot of things – and even that language would be incorrect from the point of the disability rights movement. (That movement would talk about accepting oneself as whole, including an impairment or difference/unusual personal characteristic of mind or body, or trying to change some part of that to make one’s life better.)
In the survivor/mad/anti-psych oppression movement I think many of us relate to this tension in an active way, what is about ourselves that we love and accept despite society’s negative judgments, and what do we see as undesirable and want to change? In relating to this tension whether discussing with others – in peer support or therapy or with friends – or contemplating alone, how we see it can change over time. There’s nothing that automatically belongs in one category or the other.
I don’t use the impairment for myself or other people in relation to the issues we’re talking about here, at all. I use the term ‘distress or unusual perceptions’.
Your reply isn’t pertinent to my comment, as I was addressing disability in relation to psychiatric oppression and not the built environment, but thank you for engaging.
Your article deserves more careful reading and close attention than I can give it now. But I will say that the social model of disability, like everything else in human rights, keeps evolving. I have long advocated that we do not need to accept the concept of impairment to be included for rights purposes as people with disabilities.
For myself as a survivor of psychiatry, I am someone whose life is significantly impacted by having been perceived as a person with a disability and discriminated against violently on that basis. Psychiatric labeling that was used to lock me up entails the view by those who did that, that there was something ‘wrong’ with me – exactly the medical model of disability that the social and human rights model in CRPD weighs in against. And furthermore, that I couldn’t look after myself, that I was probably dangerous, that I might have needed some kind of help to manage during a difficult time, and therefore the only thing they could think of to do with me was have other people ‘care’ for me against my will in a locked space – the social welfare model of disability, in part, that still locates defect in the individual, and which the CRPD also militates against.
I have come to use the terminology of ‘experiencing intense distress and/or unusual perceptions’ as a non-pathologizing way to describe what someone might be going through when they are labeled as mad or mentally ill. And the social stigma, prejudice, and discrimination including the violence of forced psychiatry that we face when we have these experiences – and also when someone else thinks we are even if we’re not – are the barriers that together with this experience create disability, according to the social model.
Many disability rights advocates talk about diversity now and may or may not use the term ‘impairment’. (I am just reading a document that will be launched on Monday, that takes this approach – avoiding the term ‘impairment’ in favor of diversity – and explains it well; I will try to remember to update my reply here to share a link when available.) Deaf people may be most similar to survivors of psychiatry in our rejection of that term, but the framework of ‘diversity’ to understand all kinds of disability is in the CRPD principles (Article 3 paragraph d) and the former UN Special Rapporteur on the Rights of Persons with Disabilities Catalina Devandas did one of her thematic reports on disability-based discrimination in the field of bioethics, highlighting the principle of acceptance of diversity that bioethicists have widely failed to respect.
The disability framework is also useful in another way, I believe. It helps to bring together in one framework, the rejection of the ‘normality/abnormality’ dichotomy that oppresses all of us, and the fact that some of us but not all actually do need and want supports, services, and reasonable accommodations in relation to the distress/unusual perceptions we experience whether once or many times or all the time. The disability rights framework opens up space for us to think about what we need apart from the question of ‘are you or are you not mentally ill’ which I think is a shaming discourse on the whole.
I’ve addressed an alternate vision within the disability human rights framework in my book Reimagining Crisis Support: Matrix, Roadmap and Policy. As I’m not sure if MIA allows urls, I won’t add it but it should come up in a search for Reimagining Crisis Support with my name.
I’ll come back to your article later to read more closely.
That is a way of looking at it. Makes some sense. For people who can’t get work though, something is needed to keep them going. I agree that social worker evaluations and requirements like not being able to work, are a problem. All that could in principle be put up for discussion and done differently. What would be the best human rights-based approach to reparation?
I have been told that individual activists can participate – send in a statement and register to speak if they wish. Contact the secretariat. It is prioritizing the voices of persons with disabilities, which includes survivors of psychiatry.
I don’t know what you mean about making it more visible – you can circulate this blog on social media etc., and also get involved in the CRPD Committee’s consultations to bring out whatever moves you most in the survivor perspective.
The UN processes are not so hard to participate in, many of them, like this one, are meant to be wide open. There are formalities to follow, like length and such, but the aim is to include everyone whose rights are impacted.
Thanks for the feedback. It does feel as if the work is assembling itself out of all the pieces, right now. 🙂
I hope you and everyone commenting here will consider participating in the consultations. It means something for the UN to hear from all our voices.
Yes, that’s a good way to approach it.
I don’t know where you are, but watch the CRPD Committee website for notice of when the consultation will be held for your region.
I’m glad Irit. I do feel it’s a huge opportunity. It’s the big picture.
Great article. You and I met a few times way back when. I stand on the shoulders of giants, it was MNN writings, and the conferences, that formed me politically and where I first read anyone talking about forced psychiatry as state repression and torture. Thank you for this history, and I hope more of our true early history gets written and collected.
Good points about pathologizing the impact on individuals of racial oppression and the even heavier use of repressive force in the mh system on Black, Indigenous, and People of Color. Black women are particularly affected by the double impact of racism and sexism, in both areas of pathologization and disparate repression. Lawyer Stephanie Franklin wrote a shadow report to the UN Committee on Elimination of Racial Discrimination in 2013, pointing out how African American girls in the foster care system are psychiatrized for ordinary behavior that is wrongly perceived as aggressive (this is race/sex/class/age/vulnerability of being in a kind of state custody). It’s all a system of policing race, and the mental health system should not be involved in policing or coercion/control at all – we need to dismantle all coercive elements of that system including involuntary commitment/involuntary treatment laws, and make sure that disability as an intersectional issue is brought into the discussions of defund the police- invest in communities, where mental health services are being advocated. As my colleague Jolijn Santegoeds says, coercion is not care.
Thanks for mentioning CHRUSP and for sharing your beautiful letter. What you said about the country needing to come to a standstill, and that it won’t resonated with me. Choosing love and learning that forgiveness heals is a powerful lesson, to be able to go on living in the face of evil directed at yourself and your loved ones personally and in the world. I have been reflecting on the need to ground myself in love and open-heartedness when going to these protests, in the spirit of MLK and the civil rights movement and also Che Guevara, who said the revolutionary is motivated by love.
Thank you for shaping your pain and learning into something beautiful that keeps hope and optimism alive.
Thank you. This is a great article from a social model of disability point of view, very concrete and descriptive. Much needed.
I tend to agree with Steve here, and human rights – especially using the principle of non-discrimination – is what has proven most powerful in a legal sense, that is the work I do.
There are aspects of anti-psychiatry politics or abolition of psychiatry politics, that I agree with and see as compatible with a human rights approach. Calling psychiatric institutions and the mental health system as a whole a ‘torturous environment’ as I discussed in this post is a way to point out the abusive character of the system as a whole.
We need also the strong criticisms of psychiatry from a health/science point of view, that much of this site is concerned with – including the position that it’s fraud and criminal. How to make that actionable in a human rights framework, what are the implications of taking that position for law and policy, is the question.
And it may, as oldhead suggests above, be a question of focus.
‘There can be no such thing; if there were truly “informed” consent the only people consenting to taking neurotoxic drugs would be those with self-destructive motivations.’
Attributing self-destructive motivations to a person, and denying them the possibility of doing something they choose based on this attribution, is against their human rights, particularly the right to legal capacity. That is straight out of psychiatry’s playbook, along with other hierarchical ways of thinking such as sexism and colonialism.
I do think that it’s possible to argue to deny any substance the status of being called medicine. There are a lot of complex aspects to that, and it may well be that all psychiatric substances should be taken out of the category. But there’s a difference between saying that psychic suffering and any kind of consciousness or behavior are not pathology, that diagnosis is name is calling, and saying that there should not be any use of psychoactive substances to feel better. (Herbs are part of that too – valerian, St Johnswort. So how are you differentiating, in ways that can be acted on in law and policy?)
Thanks for that Initia. What you say about ‘being supported to get through that aspect of the torture quicker’ resonates. How do you see that happening? (I mean, what would it look like?)
ps. – after reading Initia’s comment in another thread here, I realized that systemically the issue is exactly what the report on psychological torture is dealing with – people being deceived and manipulated into trusting someone who harms them, if not by deliberate cruelty then by systematic dehumanization. It’s a feature of the system that we can talk about, that is bound up with both the coercive power and social norms of deference to managerial elites.
There is still a need to address policy regarding psychiatric drugs, so I will leave that comment up and not delete it, but it is somewhat tangential to this post on torture. I think it is justifiable to say as some of you have, that anyone harmed by psychiatric drugs in our current system should have a claim for torture. The details of individual experiences matter when we talk about kinds of harm, and those are unique to each person. But all of us are included in the human rights standard.
To everyone who is addressing the harms caused by psychiatric drugs per se:
Let’s discuss the differences and commonalities among our experiences.
For some of us (like me) the drug was never experienced as medicine, as something to try to cope with distress or unusual perceptions. It was purely an act of torture from beginning to end. It was known to be harmful, anticipated with terror as harmful, experienced as a violent sundering, and left me with injuries at all levels.
In terms of the international standard, I would agree that not only forced/coerced drugging but also the short- and long-term consequences of psych drugs when prescribed without free and informed consent are torture. This is how I understand ‘free and informed consent’ from a person-centered, human rights point of view: Consent has to be free – not coerced, not unduly influenced by incentives/disincentives/threats implicit or explicit, and it has to be informed – given after providing the person all known information about adverse effects, likelihood/unlikelihood of benefits, comparison to placebo, other options, with an opportunity to get their questions answered and make a decision they are comfortable with.
It is clear also that psychiatric drugs all cause harm, and that they don’t seem to provide much benefit, based on studies. Yet there are a lot of people – I know a number, including the survivor movement as I said – who take the drugs knowing all the harm, but finding something that helps them cope, that peer support, therapy or anything else they’ve managed to find can’t actually do in the same way. That is outside my experience, just as it is outside my experience to consider taking any of those drugs as a way of coping. I would like to find ways for my advocacy to support everyone’s human rights.
So here are my questions:
1 – Would it work, policy-wise, to talk about free and informed consent for psychiatric drugs, from a person-centered human rights point of view? (Take what I wrote as one approach, others have written it up in various ways.)
2 – Should we advocate taking psychiatric drugs off the market?
3 – Do we need different approaches for different drugs – e.g. taking some off the market as too harmful based on weight of the evidence, while leaving others? (E.g. individual drugs like haloperidol, olanzapine, etc., or classes like neuroleptics, stimulants, SSRIs etc.?)
4 – How would we want to see the development of such policies and/or regulations take place?
I believe that in any case psychiatric drugs cannot be viewed as ‘treatment’ based on the construct of ‘mental illness’, ‘symptoms,’ and diagnoses. Joanna Moncrieff’s drug-based prescribing as opposed to illness-based, makes sense to me, as that is how people I know who use the drugs by choice, do so. They have a particular effect the drug does that they want, and they use it for that purpose.
They are highly risky – withdrawal/physical dependency, tardive dyskinesia, all the endocrine and cardiovascular problems, I can’t keep track as I used to since there are new drugs all the time. But many drugs are risky for your health; people make different choices based on their own self-knowledge of their bodies, their needs, the relative discomforts caused by the drug vs the illness or symptom or kind of suffering that the drug can diminish for them.
I’m open to different views about the way forward: anti-psychiatry/ abolition of psychiatry has a lot of value. And so does a people’s health movement/ feminist women’s health movement/ women of color health movement that affirms people in their self-knowledge and decision-making about western medicine, other systems of medicine, homemade medicine, healing practices. These two ways of thinking sit uneasily with each other but I’d rather come up with win/win solutions than have them be opponents.
Sam Plover, thanks so much for asking. Currently I am not in need of additional funding for my own work, but we always welcome funds for CHRUSP projects that help us to put on events at the UN and support the representation of CHRUSP at UN meetings by other volunteers and board members. We have a GoFundMe and you can also donate through Network For Good or by choosing CHRUSP in Amazon Smile. I hope that this answer does not violate any policy of Mad in America, and expect moderators will let us know and take appropriate action if it does.
And no, I am not going away. This is a lifetime commitment and will go on beyond my lifetime. And the work is already much, much bigger than me and I am looking to grow it by advising, mentoring and promoting newer human rights activists all the time.
In terms of the world – I’d say there are a lot of positions being debated about how how to analyze the exact nature of our oppression. We have moved the window substantially to the ‘left’ in the sense of a pro-liberation position, through the CRPD. The discussions among people who identify as ‘users’ or ‘survivors of psychiatry’ or ‘people with psychosocial disabilities’ who relate to human rights and development contexts take abolition of forced psychiatry as part of what we fight for, as a starting point. There is still a counter-movement of ‘peers’ sponsored by the mental health system (that is how they are referring to themselves; I don’t think identifying as ‘peer’ or ‘peer support’ in itself is counter to human rights, and there is a lot of good ‘peer’/mutual support work that I admire and promote), but this human rights premise is strengthening and gaining ground all the time.
My own analysis keeps evolving. I don’t base my work on opposition to psychiatry per se or psychiatric drugs, because l see too many people, including many who are identified with the survivor movement and are, legitimately, survivors of horrendous psychiatric violence, using psychiatric drugs. Even psychiatric diagnosis, if it’s understood not as an objective practice of medicine but as one way of naming unusual subjective experiences and distress that a lot of people take for granted, many find harmful but some find useful – I want to limit and take the legal and hegemonic power away from, and don’t see a way to end it completely unless something else takes its place as a way to approach experiences that are unknown and confusing and can be frightening.
In practice (in advocacy) my positions often come down to rejecting psychiatric practices when presented in their particularities, because they are based in top-down, paternalistic, patriarchal, hierarchical relations that are abusive for demanding to be trusted while reserving a right to break your trust with impunity. If I saw a psychiatric practice that entirely disavowed coercive control I might say it’s ok.
And I’d say there are lots of people in the Absolute Prohibition Campaign and otherwise in the global movement in every region of the world, who take a position that similarly opposes any hegemonic role for psychiatry along with coercive/control ideology and practice.
You may define the movement of psychiatric survivors differently – but I define ‘survivor of psychiatric violence’ as someone who has been victimized and lived to tell the tale, or victim-survivor to be more inclusive. And so a movement focused on ending psychiatric violence, yes we have one and it is growing stronger all the time.
Re lawyers – I think they need to take an abolitionist approach as the starting point, based in the non-discrimination framework we created in the CRPD. There is a ‘deep’ (or ‘substantive’) approach to non-discrimination that is what we applied there, which means deconstructing and dismantling all the justifications for practices that are abusive that target this particular group of people. Finding the language and concepts to express the discriminatory, unequal, scapegoating, bigoted treatment we are experiencing, rather than just applying some yardstick that exists already in the law and that may be prejudiced against us. (Now with CRPD, that is created to address the violations we face, so we have to argue for its strict application including the guidance of the treaty body, in countries where it is binding.)
Re Bernie, sadly I agree. I don’t know about the general election. Won’t get into that here, about people’s voting choices – but I agree that the Democratic establishment is showing its worthlessness along with the Republicans right now.
Will respond to your email.
I agree that we in the US need a viable independent autonomous movement of survivors of psychiatric oppression. A few comments… not intending to nitpick what you’re saying but rather as dialogue about a few points.
Many people in other countries would look at our discussion here and wonder how you could say there isn’t even ‘a movement’. We in the US have a history and we have a lot of work going on – at this point in time it’s not a ‘separatist’ movement for the most part, and it has been seriously depoliticized through the intervention of mental health funding that (deliberately) channeled more people’s energy into peer support and cooperation with the mh system than activism that challenged its fundamentals.
Also… I’m not sure who you are including as survivors. Through WNUSP I was representing not only survivors of psychiatric oppression – those who define ourselves as having been victimized by, and survived, an atrocity – but also those who use services and don’t want to be abused while doing so, and people who identify as having experienced madness or mental health problems irrespective of whether psychiatry caught them or whether they used services. I still think of my work as relating to that entire community of reference, though for some purposes – like talking about psychiatric violence, like in this post – it is survivors per se who are ‘us’.
Laura Prescott once talked about not speaking for anyone she’s not, if a program is about young women she will not go and speak about them but will insist on having a young women invited alongside her. We all have to keep that in mind even as survivors, I have not survived electroshock or restraint, someone else might not have survived neuroleptic drugging.
Also the term ‘survivor’ can be hard to relate to for people who are now being subjected to abuse and resisting or enduring it. Initially NO in Australia is using the term ‘victims of psychiatrists’ for this purpose which also makes it clear we are talking about abuse and not some kind of ‘graduation’ from psychiatry or even survival of ‘mental illness’ which the term ‘psychiatric survivor’ has sometimes been coopted to mean.
The question of grass roots knowledge vs professional expertise, and how that contrasts with the slogan ‘nothing about us without us’, is worth thinking about. I am mulling over some ideas and may post about that soon.
I agree with that, and think it is going to require sensitivity on the part of the listener, from a gender perspective and a disability perspective at the same time (intersectional).
It’s often the case that domestic and family abuse, by an intimate partner, parents, siblings, or adult children, can get carried over into psychiatry, using psychiatry to continue that abuse. Psychiatry replicates the abuse both because it is structurally simply the same – it’s a patriarchal, paternalistic system of coercive control, as practiced in a context of mental health legislation that authorizes, and sometimes requires, them to act that way – and because they view our reactions to abuse as ‘symptoms of mental illness’ within their frame of reference. There is a lot that needs to be unpacked, parsed, and dismantled before any mental health service, or any service that uses mental health framing and concepts, can meaningfully support survivors of any kind of abuse.
(Also since the mh system is currently structured as a coercive control system, i.e. an abuse relationship, we have to address reactions to the mh system itself as reactions to abuse, and provide supports that guarantee safety from that system. It’s logical, but needs a political shift that takes power away from a lot of vested interests.)
This is a document of the Special Rapporteur on Torture. All the work done on the question of forced psychiatry post-CRPD that supports its abolition takes the CRPD as its starting point (from the 2008 report of an earlier Special Rapporteur on Torture, you may remember me commenting on – UN Doc A/63/175 if you want to look it up, and see paragraph 44).
The CRPD Committee has addressed forced treatment in psychiatry and generally as a violation of legal capacity and physical and mental integrity, amounting to torture or other ill-treatment. I expect they will take into consideration this current report by the SR on Torture and hopefully they will incorporate it into their approach to the abolition of forced psychiatry.
It is going to be up to us, especially in the context of parallel reports (shadow reports) and other submissions in the country reviews, to suggest to the CRPD Committee how to do this.
Good question. I am not sure if it is distributed to them individually, but it is an official document of the UN and can be brought to their attention as such. It was presented to the Human Rights Council on Feb 28, in a scheduled dialogue with the Torture Rapporteur that happens in every session of the Council. Now it is available in the ‘advance unedited version’ in English, but will be translated into all UN languages and will appear here then: https://undocs.org/en/A/HRC/43/49 (for now, that link gets you a ‘sorry, we could not locate your document’). But the link in my post goes directly to get the AUV in English from the UN website. Hope this helps.
Thanks for that history. It would be good to put it together someday, all the antecedents.
Hi Reyna. You are right, we need lawsuits.
We need attorneys who are grounded in US disability rights law, as the best starting point that has a similar outlook to CRPD. I know that Kathy Flaherty in Connecticut (executive director of Connecticut Legal Rights Project, and also a survivor herself) is working on Olmstead issues and also using international human rights when it relates to her advocacy. But there are few. Jim Gottstein of course has been involved in writing his book on the Zyprexa Papers, which is now out.
In the US we need a strategy of civil rights litigation to build up over time, the way that Thurgood Marshall and Ruth Bader Ginsburg and others did for the African American civil rights movement, women’s rights, lesbian/gay rights. But it has to start from the right perspective, and for me this also means being led by lawyers who are also survivors and part of a survivor movement, who know in their bones where the pitfalls are and what is a con and a dead end.
I would love to be involved in anything like this to bring my knowledge of CRPD and other countries to what lawyers grounded in US context know and do.
I can’t tell where you are but guess from some of what you say that you’re in the UK. The UK, like many other countries that have ratified the CRPD, also ratified the Optional Protocol.
The OP allows you to make a complaint to the CRPD Committee, and the Committee will judge whether your country has violated your rights under the CRPD. The catch is that you have to have exhausted domestic remedies, or have a valid reason why you couldn’t. This can get very technical so it’s good to ask a lawyer’s advice who knows or can find out about these standards.
It’s not enforceable and isn’t considered legally binding, but in some countries these decisions are taken very seriously and everywhere it at least puts a black mark against the country as a human rights violator.
If it’s not the UK, and for others reading this, you can check here to see if your country ratified. https://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IV-15-a&chapter=4&clang=_en What matters is the right-hand column, doesn’t matter which designation if there’s a date there, it means your country is party to the OP and you can use it.
I know, often when you need justice you need a particular result and there might be other avenues that get it quicker or more reliably. But this is available, if you can and want to navigate your way through the technicalities. (Most often exhaustion of remedies means pursuing a court case. If that isn’t relevant, and you got nowhere in the procedures your country offers, and your CRPD rights were violated, think about bringing it the case – if I’m guessing correctly and your country has ratified the OP.)
Thank you. This is the kind of feedback that strengthens me when I am having a hard time.
When I came into the movement in 1978, soon afterwards I am pretty sure I remember a piece of writing in Madness Network News that talked about forced psychiatry as state repression. That was what ‘clicked’ for me.
We all keep passing it on.
You say ‘Even legitimate complaints to our Minister are responded with by suggesting the complainant seek help from mental health services. Dog whistle slander (and a veiled threat) I consider this to be, i’m sure he sees it as care and concern.’
I agree with you. It denies the victim a legitimate response to their complaint, and the seeming medicalization even of the person’s complaining about abuse would also fit into the concept of ‘institutional arbitrariness’ that normalizes torture.
Thank you. I agree that it being normalized is part of the torture; I’d venture to say that normalization of torture also is a method of psychological torture that would fit among those mentioned by the Rapporteur.
Regarding akathisia – I agree. In fact an earlier Special Rapporteur on Torture, in 1986, listed among the forms of physical torture, ‘the administration of drugs, in detention or psychiatric institutions [names a couple of others] …. neuroleptics, that cause trembling, shivering and contractions, but mainly make the subject apathetic and dull his intelligence’ (UN Doc. No. E/CN.4/1986/15 – you can bring up the document by typing this number into a search engine). I’d say that’s a reference to akathisia and psychic apathy as well as cognitive impairment (blunting of both cognitive and emotional functions), which are the two signature features of neuroleptic drugs, so that earlier Rapporteur also got it right.
Sometimes we have to put different UN documents together, so long as they are consistent or we can make an argument as to why one should be preferred over another, in order to make the advocacy complete.
I appreciate your commenting about your experience and also that sometimes it’s necessary to stop. Thank you.
Yes, I agree with you.
That is also in accordance with the principle of the right to live independently in the community and receive support in the community. It’s a right guaranteed in Article 19 of the Convention on the Rights of Persons with Disabilities. It should apply at all times to situations of temporary need for support as well as more long-term needs.
In the US the Disability Integration Act has some provisions that would help us move in this direction, if interested you can read the text at https://www.congress.gov/bill/116th-congress/senate-bill/117 – I’d rather not go into detail about it here but you can contact me if interested in this in particular.
I think we have had to learn time and time again we are our own most important champions. No one is going to save us from the outside.
Sometimes, as happened with this report, an intelligent person within the UN, or academia, or a government body, puts the logic together and acknowledges the blatant truth of psychiatric violence. But we created the logic, the ‘path of logic’ (yes there’s a pun in there) as my wife likes to say.
Slowly, we are turning the wheel of history. Changes in the law are happening faster in the Global South where there is more openness to human rights norms of the UN, more humility in the face of human rights criticism. I don’t know how to move advocacy-wise in the US, but think that the stand taken by Bernie Sanders to oppose any increase in involuntary commitment is at least a start, in the political discourse and even better if he manages to become president. But it’s slow and agonizing.
We all have to be in this for the long haul, and work in whatever way we personally can – getting one more person out of psychiatry’s clutches, talking sense to politicians who will listen. For people who are active in state-government advocacy, think about upping the ante the next time they want to increase involuntary commitment (whether inpatient or outpatient) and bring in the UN standards including this recent report on torture.
You can call on me to advise any such initiative, and also to advise lawyers and advocates who want to use UN materials and mechanisms in individual cases. (I can’t take individual cases myself, and may not respond to those requests.)
It is very affirming to survivors. Much of the report, the bulk of it, is not dealing specifically with our situation, but for me it is the possibility to talk about ‘torturous environments’ as well as the recognition that particularly in relation to forced psychiatric interventions, the suffering and discrimination are such that they ‘may well’ amount to torture, even when it’s said to be in the person’s ‘best interests’/’medical necessity’, that is a great step forward.
Thanks for your comment.
All the points raised in this thread are good ones (taking the joke into account).
The question is what do we do with the massive evidence of harm that we have. How can we use it effectively in advocacy?
I don’t have answers to that – it depends a lot on country context, what is possible.
What do any of you think? (I know some like Initia are already working with the UN standards and calling psychiatry torture in your advocacy.)
Yes. That is all concrete physical harm that causes both physical and psychic pain and suffering. Thank you for that detailed list.
I agree with you that it is all torture unless it is done with the person’s truly free, and truly informed, consent.
The standard under the CRPD, which a number of other UN mechanisms have adopted, is that no psychiatric interventions can be done without the free and informed consent of the person concerned. This means that substitute consent by a third party like a guardian is not acceptable. It also means that coercing someone to say they consent, or giving misleading information that leads to an uninformed consent, is also not acceptable.
My views on informed consent as a human rights of the individual (instead of a means by which medical practitioners can escape liability) are presented here in this program – https://ercvoices.com/events/consent-to-treatment-workshop/; click on the links for slides and videos, and select those that are relevant (morning program, in the videos).
With regard to children, yes, they are being forced. The CRPD Committee on at least one occasion has called on a country to end forced psychiatric interventions done to children. I would have to look back through my materials to find the details but you can email me through this site if you wish and I’ll try.
The CRPD standard on children’s right to decide anything for themselves, is that they have ‘evolving capacities,’ and that children with disabilities have a right, on an equal basis as other children, to give their opinion about matters concerning themselves and for their opinion to be given due weight in accordance with the child’s age and maturity. The requirement that it has to be on an equal basis with other children means that they can’t say a child’s opinion is less worthy of respect because they have been given a psychiatric diagnosis of any kind (or any other kind of disability label).
This means that, in general, children have a right to be heard, but not an absolute right to make the decision themselves. My view is that, since forced psychiatric interventions are acknowledged to affect the physical and mental integrity of a person and amount to at least ill-treatment under the CRPD (General Comment 1 paragraph 42, Guidelines on Article 14 paragraph 12), it can never be done to anyone without that person’s explicit, free, and informed consent. So if the child is not in a position to give such consent, it must not be done to them at all. (The same for people who are in a coma or otherwise not in a position to communicate their will directly.)
This might be too much information or more technical than you are interested in, but I hope that it can be useful if you use this report or the CRPD in your advocacy.
CRPD is not magic. It depends on how countries put it into practice.
Colombia and Peru have enacted serious reforms of legal capacity that abolish guardianship and substitute decision-making. Arguably in both those countries now the remaining laws that allow forced psychiatry are incompatible with that legislation and should be overturned. In Peru, much of the mental health legislation on forced treatment had been eliminated already and what remains is ’emergency’ forced treatment for 12 hours. In Colombia the reform included repeal of forced treatment provisions in one particular law but there may be others that remain; there is also a residual clause repealing any legislation that is contrary to the reform law and I have discussed with colleagues there how to make this argument using the CRPD. (Right now in Colombia they are fighting off constitutional challenges to the reform law that are brought by proponents of guardianship and substituted decision-making; this is all part of how it goes, revolution isn’t easy or fast and we have to change minds at every step along the way.)
In US law, one of the most promising initiatives is the Disability Integration Act, which Bernie Sanders also supports (many of the others do too, it’s become pretty standard). I’ll leave that for another time, maybe will blog about it if I haven’t done so already.
BTW, CRPD wasn’t written by academics. I was one of the people who had a hand in writing it, I was a recent law school graduate (though older than that would suggest) and a grass roots activist in the survivor movement. It is a good story to tell, and many people have suggested I write the narrative account of it as I often tell it in person. Here is one account that was written for a book but I withdrew it due to attempted censorship that went to the heart of my advocacy. https://www.ssrn.com/abstract=2326668
Agree with that.
But even that is only a good faith downpayment on what needs to happen: total abolition of the regime of forced treatment and hospitalization that amounts to both arbitrary detention and substitute decision-making (equivalent to guardianship) under the CRPD. This as you know but others might not, is not only my interpretation but the official interpretation of the treaty by its international monitoring committee.
The fact that this part of CRPD was left off the table shows a narrowing of permissible discourse that our own movement leaders who participate in that table have colluded in.
Sanders’ policy may well be better than the others on this. Saying no *more* increases to involuntary commitment is a step, when others are calling for those increases. It separates him from Trump and the Jaffe crowd. But it still leaves us behind compared with the other disability groups. Our core issues are dealt with only by saying, well we won’t let them harm you any more than they’re already doing. Thanks a heap.
As I say it’s a step that he even listened to those who are willing to color inside those lines. But we – *WE* – have to be ready and willing to take it further. What are we afraid of? We have the arguments.
‘Rare and little known’? Horseshit. It’s the signature effect of neuroleptics (miscalled ‘antipsychotics’), and was part of the basis for neuroleptics being named among the forms of physical torture by the UN in 1986.
UN Doc. E/CN.4/1986/15, para. 119 (page 29), includes:
‘Administration of drugs, in detention or psychiatric institutions
neuroleptics, that cause trembling, shivering and contractions, but mainly make the subject apathetic and dull his [or her] intelligence’
Breggin wrote tons about akathisia in his 1983 scientific book Psychiatric Drugs: Hazardous to the Brain. It was well known in the survivor community before that time. I was forcibly drugged in 1977 and it was known as a common effect then. So common that there were anti-cholinergic drugs they gave to counter that effect, including ‘cogentin’. Those drugs actually only masked the akathisia and eliminated some of the more obvious manifestations, didn’t relieve it.
PacificDawn, I hear you about families being direct enforcers and violators of rights; I see that as part of the system of patriarchy in which men appropriate and control women’s sexual and reproductive powers and related labor. I think this is all getting far afield from the original post though, so I’d rather end the discussion here. Thank you for your comments.
Unfortunately I don’t know of anything happening in the US that is strategic litigation with the aim of abolishing all power to force someone into psychiatric facilities or so-called treatments. I am less familiar with what is going on in relation to autism.
When you say ‘justice for the middle class family’ I’m not sure what you mean – people with lower incomes who may not be considered ‘middle class’ certainly need justice also, e.g. against social welfare agencies that look on them prejudicially based on class. Interested to know what you are concerned about here and how it relates to mental health system and autism industry.
Until the laws get changed to prohibit these practices, getting lawyers’ help won’t do much good. Unless it is a program of strategic litigation to change the law for everyone.
PacificDawn, I appreciate your point of view but want to point out that doing it without any framework of non-discrimination didn’t get us anywhere all the time that was being tried, because discrimination existed. (e.g. there would always be a ‘medical exception’ for why administration of neuroleptic drugs, though torture against anyone else, was just fine and even good for you as a treatment if a psychiatrist said you were the kind of person that ‘needed it’.) So if disability non-discrimination is not the way to go, what else would be? Not intending to put you on the spot, it’s an open and genuine question, if you have any thoughts on that I’m interested. Any other way to address discrimination, or otherwise to get past that roadblock?
ADA includes those ‘regarded as’ having a disability or having a ‘history of disability’, as people with disabilities. That allows me to see myself there, as a survivor of psychiatry having a history of being regarded as disabled (psych diagnosis and accompanying discriminatory violence and detention).
CRPD doesn’t include that language but treaty body has routinely included phrases like ‘actual or perceived impairment’ especially in addressing detention, i.e. ‘detention based on actual or perceived impairment’ is prohibited.
I believe that we can promote the total de-medicalization of distress/disturbance/crisis and diversity – what you are calling ‘mental illness’ and autism/aspergers – as an adaptation of the social model of disability. These experiences/conditions/ways of being are not linked to physical pathology unlike everything that is considered a physical, sensory or intellectual impairment. This means it is justified to take a different approach to the social model of disability, than the standard one developed by people with physical impairments in the UK (where the ‘orthodox’ social model came from – impairment plus barriers, with impairment an essential part of the understanding).
This is one way I think my conceptual framework is useful – by conceptualizing the needs in crisis situations in ways that totally bypass not only the false medical narrative of chemical imbalance but also the clinical narrative of mental illness that is equally artificial and socially constructed and that takes away authority from the person over her own life and meaning. I think it is possible to advance it as an interpretation/application of the CRPD because it makes sense and fits the logic of the CRPD paradigm shift on legal capacity and its approach to abolition of psychiatric detention and forced treatment, which are now well established.
Yes, for sure. It can be crazy-making to read US case law on forced psychiatry though, but maybe they can take international law or international human rights courses and then do an independent study on CRPD.
There is something I should mention about law study that might be interesting to people – and I’ll make a caveat afterwards. There is a Center for Disability Law and Policy at NUI-Galway (in Ireland) that has a summer school and also a one-year master’s degree program, focusing on the CRPD. The summer school is open to non-lawyers and I believe that non-lawyers can also qualify for the master’s degree (but check their website). The caveat is that, while this is probably the best that exists, it’s not perfect in terms of upholding fully the right to legal capacity, and so you have to bring your critical thinking as I wrote in my comment to oldhead above. (I wrote about my disagreement with Eilionoir Flynn, who heads the program, and her co-authors of two relevant papers Anna Arstein-Kerslake and Piers Gooding, who received their PhDs there and work closely with Eilionoir, in this paper: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=293055). And still, some people I work closely with study there and have studied there and remain associated also, so am saying it is a mixed bag, and can be worthwhile – don’t know what scholarship they options they have though, so might be prohibitive.
Thanks for your comment. I think that we need to strategize on how to make those sweeping legal changes even in the US. People are working on this in other countries, and from what I know Peru is the closest to being able to reach total abolition in the non-criminal context (see my earlier blog post https://www.madinamerica.com/2018/10/peruvian-legal-capacity-reform-celebration-and-analysis/). Law is created by human beings, and it can be disentangled and re-made by human beings.
And meanwhile I agree about getting creative to help currently detained people and to prevent others from getting entangled. My conceptual/policy framework might be useful in thinking about what needs to exist as an alternative response, that could help prevent people from being put into the system. Of course many people in the survivor community are already practicing ways of supporting people to stay out of the system – and I welcome debate and critique of my framework too.
One possibility for helping currently detained people, especially if it relates to a long-standing situation, is to make a complaint to a UN Special Rapporteur or the Working Group on Arbitrary Detention. It can take a long time for the UN to act on such complaints (technically called communications), and their opinions are not binding, but sometimes bringing international attention to a case can help. (It is possible for the person to remain anonymous at the level of publicity but they need to make their identity known to the Special Rapporteur or Working Group in order for them to be able to investigate and communicate with the relevant public officials). People can make complaints on their own behalf, or you can also do it for another person with their consent. Here is a guide that I wrote up for people wanting to make individual complaints and/or other kinds of advocacy using UN human rights mechanisms: http://www.chrusp.org/file/339476/UsingHRMechanisms.docx.
Thanks OldHead. Oh, it’s complicated. What non-lawyers can do: be aware of the ways that lawyers and psychiatrists who want to subvert the CRPD are developing tricky language to do this. Listen carefully and critically to anything you hear said about the CPRD. If it doesn’t smell right, if it ends up leading to a statement that some coercion is ok, or that it’s a last resort, etc., question it.
Read General Comment No. 1 and the Guidelines on Article 14, make study groups on this if you want, to understand what the standards are that the CPRD Committee has developed. When I have read the General Comment aloud, stopping to discuss it in pieces, in a mixed group of survivors and lawyers and dissident mental health folks, people could understand what the GC was saying.
If that’s too daunting, then take it from me – and from the WPA’s Paul Appelbaum, who conceded this point! – that the CPRD contains an absolute prohibition of forced psychiatric interventions. (Appelbaum’s acknowledgement of the absolute prohibition came in an editorial urging states to ignore or amend the CRPD.) Fight for it! In the US, you can talk about the CRPD is an advancement of the same policy position stated by the NCD 19 years ago, in ‘From Privileges to Rights: People Labeled with Psychiatric Disabilities Speak for Themselves’. Ask the NCD to take up this issue again.
If you want to get involved with international human rights mechanisms, here is a resource on what you can do: http://www.chrusp.org/file/339476/UsingHRMechanisms.docx. The Universal Periodic Review of the US in the Human Rights Council is coming up soon and the US Human Rights Network has started putting out information and training materials about it, check it out – https://www.upr2020.org. They will have information about the process, and you can check back with me about how to argue forced psychiatry as a human rights violation in that context if you want.
One other thing – if people support the conceptual/policy framework I’m developing, I would ask you to refer to it in relevant advocacy, discuss it, debate it, adapt it (and credit me). I think this has potential to answer the questions about so-called hard cases that some of our opponents are saying the CPRD hasn’t addressed – it has (e.g. GC1 said in two places that decision-making has to be respected in crisis situations), but the positive elements haven’t fully been brought out before.
Thank you for your comments and support.
Hi everyone, I’m able to log in now.
I consider the CRPD essential to the abolition of the legal power of psychiatry to deprive people of their liberty (engage in arbitrary detention based on actual or perceived disability) and penetrate our bodies with their toxic drugs and shocks and surgeries against our will (engage in acts of torture). (Re torture, I think the clearest UN citation holding the administration of neuroleptic drugs to be torture is from Special Rapporteur on Torture P Kooijmans in 1986, E/CN.4/1986/15.)
CRPD is not enough however, to push us over the hurdle of medical power joined to the power of state as a mechanism of repression. The elements are there, our adaptation of the social model of disability has the power to confront and split and dissolve this alliance and its power, but it has not been successfully pushed through to clear understanding in the UN mechanisms that support us. Maybe similar to the Deaf people’s struggle to see themselves as a cultural and linguistic group, our issue is both disability and not-disability. But Deaf people are not up against the same kind of economic and political interests – the interests of the state in maintaining a form of repression notwithstanding its illegitimacy. Our struggle has been to a degree coopted by UN mechanisms’ defining it as ‘human rights in mental health’ and as a need for non-coercive supports preliminary to abolition of torture and arbitrary detention. And this cooptation has been facilitated by the moves that changed the International Disability Alliance from a cooperative alliance of DPOs, in which each global DPO had a sovereign and non-delegable voice, to a technical bureaucratic secretariat that hoards information and power and opportunities and channels everything through itself. I have said both of things many times. I fought it to the extent I could while I was in positions within both IDA and WNUSP.
Back to CRPD. We have a global movement, but here on this page it is mainly US and Canada. Though US has not ratified the CRPD, and if it does it will be with so many reservations, understandings and declarations it will be hard to see what remains, Canada has ratified CRPD and also recently its Optional Protocol. With the OP, Canadians can take complaints of individuals to the CRPD Committee and receive a decision on the violation of human rights in the CRPD. (You have to ‘exhaust domestic remedies’ for this procedure; also available in any country including the US are the Special Procedures of the Human Rights Council. See my guide to using UN human rights mechanisms, on the CHRUSP website – linked for now in a box on the home page.)
I don’t know where progress will come from or how. Peru’s legal capacity reform was a huge step but not enough, as I wrote in my last blog post on this site. We need an abolitionist movement that targets psychiatry as a social institution of fake science and repression, in addition to the abolitionist movement that calls for repeal of the mental health laws along with other ‘substitute decision-making regimes’ (in the words of the CRPD Committee), and a movement that focuses on reparations as the way to conceptualize the totality of violations and remedies needed to abolish forced psychiatry and to provide redress to victims.
BTW, I am *not* offering the CRPD course this year, but expect to do so again in 2020, and will be posting on social media closer to that time.
I would like to suggest to Mad in America correspondents that they follow the CRPD Committee, Working Group on Arbitrary Detention, and Special Rapporteur on the Rights of Persons with Disabilities to be able to catch news of statements that are upholding the correct standard and that do not seek to push us under the ‘expertise’ of mental health professionals. Those bodies usually have not publicized their stance so much with press releases and campaigns; it is too bad that the most publicity has come from the health-related entities. But it is possible for anyone to read the documents that come out of the CRPD Committee – like their General Comment No. 5 on Article 19, living independently and being included in the community, which contained this paragraph:
‘It [the obligation to respect the right to live independently and be included in the community] also entails the obligation to release all individuals who are being confined against their will in mental health services or other disability-specific forms of deprivation of liberty. It further includes the prohibition of all forms of guardianship and the obligation to replace substituted decision-making regimes by supported decision-making alternatives.’
All the best,
It’s wrong to make generalizations. Some of us need solitude more than relationships. Or we need both and need to not have to imbibe the mental heath mantra that ‘we all need to reach out’.
What I think is problematic about the kind of self-care that makes a show of itself, is that it’s defensive and it relies on a mental health prescription to do something that the person finds necessary. Also it can amount to a mental health labeling of the people you decide to avoid.
How about if we all acknowledge a variety of human needs and predilections, and don’t make general prescriptions for anyone else’s well-being?
Your reply went to both places but it is easier to reply here. I stand by my comment, as the right to health understood without a duty to health amounts to a right to obtain good quality health care acceptable to the person, as well as to have the preconditions for health such as clean water and food. There is nothing wrong with economic and social rights per se; the right to housing does not mean that the government should forcibly house someone who wants to live outside.
i agree that one of the needed avenues for work is to continue to challenge the psychiatric belief system and its practices. That is part of the story, to remove the ‘bio’ entirely from the belief system – as a friend pointed out to me, the New York Times has recently published an article stating flatly that there is no such thing as chemical imbalance related to madness or psychiatric labels. This should be promoted widely.
it is difficult to say ‘the UN’ has resolved an issue in a particular way when there are different bodies in the UN that continue to contradict each other. In ordinary discussions, we might say ‘the UN’ to refer to what any Special Rapporteur says, etc., but it becomes confusing when they disagree. it is probably best to talk about the specific body or mechanism or agency of the UN has done a particular thing, e.g. the UN Human Rights Council has said… or the UN Committee on the Rights of Persons with Disabilities has said…
I would like to believe that the CRPD standards are gradually winning in the UN, but there are still some holdouts. One of the avenues I think is necessary is to remind them of where the CRPD came from, and take seriously the leadership of survivors as was done in the drafting process. We are not alone; we have allies in the UN and elsewhere and they are needed and make important contributions, but too often they have been listening to each other and ignoring those of us with the real expertise.
In exactly the same way, the right to health is not a duty to health.
Thanks for finding the silver lining at least in the resolution; I read it a little differently than you do but agree that the ‘freedom in health’ as proclaimed in the resolution is something to hold the UN and governments accountable to.
Freedom is freedom; health is health. Individuals have a right to get health care they need; in the US where people die in a system that can deny them easy treatment for lack of money, the right to health care is real, and it is absurd to talk about a right to illness. A right to illness could be invoked to deny desired treatment and allow the person to die, just as a right to health is invoked by some psychiatrists to justify forced interventions. A right to illness on the other hand can be invoked to support your freedom to refuse treatment irrespective of whether or not you are actually ill – it is a way to avoid the dispute about whether the illness is real, whether the doctor is right or wrong. And a right to health can be invoked to demand that societal resources be equitably distributed so no one has to do without health care.
All human rights are rights held by the individual, and cannot be legitimately invoked to justify the deprivation of some other human right to the same individual. That is a managerial approach to human rights that subverts the true purpose. If freedom from forced interventions is part of the right to health, this is both a cobbling together of a right to integrity of the person with the right to health so that we acknowledge a right to integrity, to be free from unwanted intrusions, in the context of health care; and it is also possibly an argument that such freedom is also part of what the right to health itself means, that there can be no health without integrity and freedom from forced interventions. I do not think either of these is bad; but I do think that forced psychiatry has to be taken beyond and outside the context of health care because it is a regime that has nothing to do with health and instead is for social control – management of people who are viewed as unruly or disruptive for one reason or another, active or passive. For that reason I support, as WNUSP proposed in its statement in the meeting, a framework of reparations for forced psychiatry as a widespread and systematic human rights violation, as the way forward to have the conversation that all the survivors in the meeting wanted to have: implementation of our full human rights throughout society, and end to legalized discrimination/ subordination/ torture.
Regarding WHO, this organization has called for the abolition of forced treatment and no longer recommends that countries adopt mental health legislation. This has been a huge shift for WHO. I cannot fully endorse their training materials but there are parts of those materials that clearly uphold the CRPD standard of no force/coercion. In fact, Michelle Funk from WHO is a better supporter of the CRPD and abolition of force at this point than Nils Melzer, for the reasons I described.
We need to help people get off drugs and help people stay away from psychiatry in our communities; I agree with you about neoliberalism but also agree with the commenters about forced psychiatry needing to be addressed as well as the business/ ‘pill mill’ aspect. We can also do a lot on community level to persuade people to not call the mental health system on each other as an enforcer, and not call police on each other unless there is a situation that truly calls for police involvement. To remind each other that calling 911 is calling in armed state power, and it’s not friendly or helpful; to help or support someone we have to let them be who they are and work with them not against them.
This kind of community work can make a difference potentially to both building support to abolish the mental health laws and incapacity laws, and to letting them fall into disuse.
Julie, I’d rather not discuss recommendation for you in your individual case in this forum on Mad in America. Please send me an email about this.
I am not sure it is a deference to corporate psychiatry, rather I’d say to institutional psychiatry. In the case of UN human rights mechanisms that monitor compliance with the prohibition of torture, they have been accustomed to working closely with psychiatrists. Psychiatrists and other doctors accompany them on visits to places of detention, usually prisons, to verify if a person has been tortured, and they act as witnesses to torture and support victims. This institutional collaboration makes it even more difficult for many human rights experts that deal with torture to open their minds to accept that psychiatry in its ordinary and routine work is simply torture. One thing that helps us make the argument however is the fact that human rights experts have long acknowledged that forced psychiatric drugging and psychiatric incarceration of people who are viewed by some psychiatrists as sane would quality as torture and other cruel, inhuman or degrading or degrading treatment. To say that the same abominable acts when done to someone psychiatrists have labeled as mad is actually beneficial to the person, manifests discrimination in treating people with psychosocial disabilities as subhuman. Special Rapporteur on Torture Manfred Nowak in 2008 managed to acknowledge this discrimination and other factors that justify addressing forced psychiatry in the framework of prohibition of torture, but the institutional bias still exists in these mechanisms generally.
Also, though I sounded an alarm in this post, I don’t think we have failed; it is one side of the struggle that we have always to keep our eyes open to see the obstacles. So long as we are fighting, we become free in the struggle and keep creating more space and more allies.
Regarding how UN decisions are made: it has been said that there many UNs, each part of the UN can operate independently. The Committee on the Rights of Persons with Disabilities still emphatically supports the abolition of forced psychiatry, and can be expected to do so into the future. The Office of the High Commissioner for Human Rights, which hosted this meeting, has a complicated role; it is the secretariat for the CRPD Committee and for other human rights treaty bodies, some of which continue to oppose the CRPD standard; it is also the secretariat for the Special Rapporteurs, and has its own staff who advise on particular topics, including a disability adviser and a health adviser. The OHCHR disability adviser is Facundo Chavez, who moderated the first panel in the continuation of Day 1; he knows his material and supports the CRPD standard, and the High Commissioner himself articulated the CRPD standard of abolition when he spoke in the opening panel.
The different parts of the UN speak to each other and try to harmonize their standards. This meeting was also responding to a resolution of the Human Rights Council, which is a UN body made up of member states, i.e. governments. Brazil and Portugal have been sponsoring resolutions on human rights and mental health, and the last resolution called for OHCHR to arrange this consultation. To the extent that the UN member states retain a degree of power over the secretariat, including funding, they make their influence felt. It can be difficult for human rights experts whether in OHCHR or treaty bodies like the CRPD Committee to oppose states parties, but it is their role as independent experts to pronounce the standards they believe to be correct.
Meanwhile none of these actors can ignore civil society, both those whose rights are at stake – in this case users and survivors of psychiatry – and those who have structural power and interests in either opposing or regulating the exercise of those rights. (I’m thinking of psychiatrists but also of lawyers and academics who may support state interests or view themselves as intermediaries between state and people who are seeking to change long-standing discrimination embedded in law.)
International law itself is complicated, especially human rights law at the global level. We do not have a global court that can make binding rulings on human rights violations complaints by individuals. (Human rights courts do exist in some regions; at least one such regional court, the European Court of Human Rights, has refused to accept the full CRPD standard of abolition of forced psychiatry and substituted decision-making.) At the global level, human rights law depends for its impact on the willingness of states to adopt and/or enforce the standard in its domestic law.
International law is a good area to see the dynamic between law and politics, they overlap and merge into each other in a different way than in domestic law. And ultimately it is a tool we use. Sometimes there are openings that allow international law itself to change; we had that in the CRPD and it continues to open doors.
Yes, it did have that effect, as if he had wandered into the wrong meeting. He seemed to be trying to challenge the professor from Scotland who was critical, but that individual pushed back with further criticism.
I think it’s a great article that lays out a vision of abolition. It can’t do everything – can’t solve the problem of capitalism for instance. It sounds to me like Au Valencia is coming from a viewpoint that is libertarian as well as grounded in social solidarity. While the perspective and tone is confrontational, the substantive points made capture in clear and plain language the demands our radical movement has been making for a long time. I noticed that this article posted by official MIA account on facebook was getting over 100 shares to which I added my own. Au Valencia has done great work here that deserves our attention. How to take these steps, is all our responsibility. Personally I hope to see activists working for state-level legislative abolition of psychiatric force/coercion, lawyers working on strategic litigation theories and plans, and more. It is wonderful to see the clear thinking of more activists envisioning abolition.
Hi Judi –
I replied to you at length elsewhere and won’t repeat it all here.
But for MIA readers I will say that
1) I agree that SSRIs are dangerous and the kinds of risks you mention here, especially early death, should be publicized.
2) I focus on neuroleptics for a few reasons. Neuroleptics are used against people to control them, they are called a chemical straightjacket and chemical lobotomy for good reason. Neuroleptics cause both psychic apathy and intense physical/mental suffering (akathisia) at the same time. No one likes neuroleptics, some people tolerate a small dose to suppress voices or something else in their minds that is deeply troubling to them. But mostly people are dosed with neuroleptics against their will, whether by outright force or by intimidation or incentives/disincentives of some kind. For this reason people taking neuroleptics have usually been out of sight out of mind of society, news media, who think of us as the crazies locked up in institutions. They don’t market to us, they market to those who want to control us. That has changed somewhat now as neuroleptics are being given out like candy for all kinds of things, horrifying. But I still think it’s the dominant characteristic. While on the other hand antidepressants are marketed to people and some people like taking them, enjoy the effects and say it makes them feel very good. Debate about antidepressants is on the level of awareness-raising and letting people know about what the harms are that your doctor won’t tell you – less about countering the ideology of institutionalization. It sound like in your case you were forcibly drugged with an SSRI – so I suppose that there is a lot of crossover and it’s not all one or the other.
My personal experience was being drugged with neuroleptics, so i come with a deep knowledge of that. I am open to including all the psychiatric drugs, which as you remind me, all cause some form of brain damage, in a call for abolition/replacement with nontoxic alternatives.
The terminology gets developed for particular purposes – for me ‘forced interventions’ was a way of talking about the whole group of them, drugging, shock, restraint and solitary confinement, and the lockup itself, without using the term ‘treatment’ which of course is a lie that is offensive to the reality. We can use the word torture, but it was necessary to make an argument about what it is that we mean when we say psychiatric torture. See Manfred Nowak’s report as Special Rapporteur on Torture from 2008 (can search for UN Doc # A/63/175), and my work on torture, which you can find on the CHRUSP website Resources page or on the CRPD Course website under Segment 2.
On the terminology and concept of disability- I think that disability captures the element of discrimination, the ‘on account of factor’. Why are these forms of mistreatment targeted at certain people and not others? Psychiatric labeling ties into an ideology of fitness and unfitness, that treats any impairment or infirmity as meaning the person is an inferior human being whose rights do not have to be respected, who can be treated as expendable.
For some of us, the subjective anguish we go through in our lives or divergent habits or beliefs really mean we are different in ways that society treats as an impairment even though we don’t necessarily experience it that way. (Some people who are born with physical characteristics different than the norm also do not see themselves as impaired.) For this reason, and also because many of us reject the concept outright but nevertheless were treated as inferior human beings based on psychiatric labeling, we use the terminology of ‘actual or perceived impairment/disability’.
Also some of us are highly affected in terms of what we can do in our lives or how we live, because of the anguish or divergent habits or beliefs, and may need accommodation or supports from others. It does not have to be a shame or secret to have these needs. Ideally we would live in ways that it was naturally accepted people are all different and have whatever needs we have, but so long as we live in a society that has concepts of ‘normality’ and acceptability that some of us remain outside of, there’s a need to name that as discrimination to be remedied.
Be that as it may, even if you still disagree with the term disability – if you can find other ways of framing legal theories to abolish forced psychiatry that will have any traction, that will gain adherence and understanding in the legal community, I’d certainly support that as complementary. In my experience in this movement, everything we tried earlier, simply talking about forced drugging as an abomination that should not be done to anyone, failed because society shrugged its collective shoulder and said, so what? Because it is done to ‘those people’ who are not seen as real people worthy of rights protection. Naming the discrimination knocks on the door more insistently, and I don’t know any other way to name it besides disability, which I think is accurate for the reasons stated.
Agree with the commenter above ‘a girl called colleen’. The conclusion ignores entirely one whole area of study and findings, the traumatic effect of coercion in the mh system per se. There is no way that better packaging can ever negate that and it is offensive to try, akin to the old misogynist advice to women, ‘if rape is inevitable relax and enjoy it.’
I will point out two additional ways that the post here, or perhaps the study itself if the author is following the study’s self-characterization, is offensive to survivors of forced psychiatric interventions and promotes an incorrect standard of human rights.
1) To refer to coercion of ‘service users’ is offensive and misleading, as it characterizes survivors of forced unwanted interventions as people who are ‘using services.’ If it’s unwanted I’m not using it, such language obscures agency and victimization.
2) To say that ‘human rights violations … *may result from* involuntary hospitalization’ is to imply that involuntary hospitalization itself does not violate human rights. This is incorrect. Ireland is a state party to the Convention on the Rights of Persons with Disabilities, which is authoritatively interpreted to prohibit involuntary hospitalization/institutionalization based on actual or perceived psychosocial disability. Recently the CRPD treaty body said in a General Comment on Article 19, living independently and being included in the community (excerpts, with ** around the most pertinent sentences):
27. Legal personality and legal agency are the basis of the realization of independent living within the community for persons with disabilities. Article 19 is, therefore, linked to the recognition and exercise of legal personality and legal capacity as enshrined in article 12 of the Convention, and further explained in the Committee’s general comment No. 1 (2014) on equal recognition before the law. *Further, it is linked to the absolute prohibition of detention on the basis of disability as enshrined in Article 14 and elaborated in the respective guidelines.*
48. The obligation [to respect the right to live independently and be included in the community] also requires States parties to repeal and refrain from enacting laws, policies and structures that maintain and create barriers in access to support services as well as general facilities and services. *It also entails the obligation to release all individuals who are being confined against their will in mental health services or other disability-specific forms of deprivation of liberty.* It further includes the prohibition of all forms of guardianship and the obligation to replace substituted decision-making regimes by supported decision-making alternatives.
83. Involuntary institutionalization on the basis of impairment or associated circumstances such as presumed “dangerousness” and other factors as elaborated in the Committee’s guidelines on article 14 is often caused or increased by a lack of disability specific support services. Implementing article 19 thus will ultimately prevent violation of article 14.
Advocates in Ireland and everywhere need to know their human rights and defend the full meaning of the CRPD, and not be misled by the professions that are still invested in coercion.
For those of us in countries that haven’t yet ratified the CRPD, take heart in knowing that other parts of the UN are gradually coming around to the same point of view, as the Working Group on Arbitrary Detention showed in their recent report on the US. I blogged about this and link to the WGAD report and recommendations, here: https://www.madinamerica.com/2017/10/un-to-usa-forced-treatment-prohibited/.
The Working Group on Arbitrary Detention can deal with detention based on discrimination of any kind. In the case of older people it is often a combination of age and actual or perceived disability but it can also be age alone. The WGAD has spoken out against forced treatment in the mental health context because of the linkage with arbitrary detention, which is their particular mandate. People in skilled nursing facilities might be in a situation of detention if they can’t leave; you would need to check and compare with how the WGAD defines detention, this might be a place to start: http://www.ohchr.org/EN/HRBodies/HRC/RegularSessions/Session30/Documents/A_HRC_30_37_ENG.docx
But that is only one of a number of UN human rights mechanisms that we can address. Here is the web page for the UN Independent Expert on the enjoyment of all human rights by older persons: http://www.ohchr.org/EN/Issues/OlderPersons/IE/Pages/IEOlderPersons.aspx. You might want to write to her about the problem and give her information about how it is taking place, whether in the US or in any other countries you know of. There is also other work at the UN on the rights of older persons described here http://www.ohchr.org/EN/Issues/OlderPersons/Pages/OlderPersonsIndex.aspx including a process to create a new treaty, that is taking place in New York-based meetings roughly once a year, https://social.un.org/ageing-working-group/index.shtml. Get involved and bring this abuse to their attention; I am trying to stay involved but it’s difficult to relate to a second treaty process after the CRPD one. I can advise about human rights law and how to frame these issues to relate with the legal concepts and framework.
I started a long reply to you last night and then closed my browser by mistake and lost it all.
Therapy or recovery is not a remedy for forced treatment, the remedy is abolition and a full and comprehensive effort to make reparations to victims/survivors. Governments may never make reparations as they should, which is not just individual compensation but a comprehensive approach to looking at the harm that has been done by human rights violations, to individuals and society as a whole, and working on whatever needs to be done to repair, at the economic, social, cultural, communal and individual levels. But we are working on that repair, through our human rights advocacy, I have come to understand this recently. The first step of reparations is to stop the violations and guarantee that they won’t continue, and in addition we need to allow all of us to come forward and say what we need once the harm has stopped and we are not threatened with it any more.
Individual healing from the traumatic effects of psychiatric violence as well as the effects of psychiatric drugs and procedures is part of what some of us need, and for some people it may take the form of therapy. For others of us, it is inconceivable to go to the profession that harmed us to help with healing.
In general, therapy is something that some people find useful as a space to explore what they need to do to change their lives and heal from trauma or destructive life patterns, others go to 12 step programs or peer support or use psychiatric drugs or have a spiritual practice or muddle through. No disrespect to any of these ways, they are all valid and also all can have their down sides and don’t work for everybody. Therapy in particular can be criticized as giving up power to another person, but that may be really the Freudian analysis paradigm, and a lot depends on the individual needs of a particular person, their situation, their personality, and the person they end up with as a therapist. For me therapy is not an option so my understanding of it is theoretical at this point.
The recovery approach I have been looking into a little bit as it appears in the WHO training modules (http://www.who.int/mental_health/policy/quality_rights/guidance_training_tools/en/) and I think it has some value for transforming conventional mental health services; primarily in opening up the possibility that people can change their lives and that the focus can be on what the person wants to do and not on what someone can label as being ‘wrong’ with them. But it’s not for everyone, we can’t assume that recovery-based mental health services are the answer to what everybody needs in a time of distress or life problems or altered consciousness. So the challenge is to find ways to create proactively a framework for the kinds of services people want and need in various circumstances. I have been thinking about this in context of the work of the CRPD Committee that recently produced a General Comment on Article 19, living independently and being included in the community (http://www.ohchr.org/Documents/HRBodies/CRPD/GC/CRPD_C_18_R_1.docx), to which I made submissions initially and on the first draft of the GC. I am planning to write a blog post on this General Comment as it has helped to clarify some of my thinking about various elements both more mainstream and what I’ll call utopian, in the sense of thinking about ideal ways I’d want society and life to be organized rather than particular alternative practices.
I’ll close here, re your comments about treatments being done on a minor, I agree with you that there should be some kind of oversight to ensure minors aren’t being given medical treatment with destructive effects. CRPD says that children have a right to have their views about any matter concerning themselves be given due weight in accordance with the child’s age and maturity, without any discrimination based on disability. Also the CRPD Committee has said in concluding observations that children should not be subjected to involuntary psychiatric treatments. It could make sense in addition to have safeguards to protect the minor’s ability to stand up for him/herself and ensure that explanations are given in a way that she/he can understand to express his/her will and preferences.
The USA is not monolithic, I’d say. Some state legislatures and municipal governments have enacted legislation to support human rights treaties and work to comply with them at that sub-federal level. Also right now the federal government is not in good shape, but I know that ADAPT and others promoting the Disability Integration Act have not given up. I haven’t been able to really keep up with the things going on in federal administration, so couldn’t say if within any relevant agencies there are people who are approachable.
It’s also not only the Right, there has been even in Center politics an attitude towards human rights treaties that takes the US as an example for the world to follow rather than one participant among a vast number of others who are all subject to the same standards, and that fails as often as any other country does. There’s a very skewed attitude towards human rights here, especially noticeable when compared with other countries at a similar level of economic development.
In any case, there are a growing number of organizations that are promoting human rights and using human rights mechanisms, and we have been part of that. US Human Rights Network both does its own advocacy and plays a coordination role in some of the UN processes, and folks from our movement who have participated in that have made some connections and helped to raise awareness with those other activists. So a lot of work, and worth to keep doing. Thanks for your question.
Yes, of course that would be great. It’s good to know about your work. I might be visiting Spain next year, and it would be good to meet then.
Thanks very much Luis. I am in touch with a few others in Spain and would love to talk with you and know what you are involved with, and if you see possibilities for change in the laws and practices there.
Not sure what you are saying in your first two paragraphs. Re the Southern California organization, it’s a great initiative and could be copied by people in any other states or cities. The early movement if you remember was organized small scale, with city-based organizations. We have national and international organizations and campaigns that are already on board, and that has helped people to connect more locally.
And ‘angry mental patient’ – maybe you haven’t encountered that stereotype directed against you? I sure have, and it has been combined with gender stereotypes that women aren’t supposed to express anger, in my case. That stereotype is embodied in the ‘danger to self and/or others’ standard in commitment laws, which the UN has repeatedly condemned (because we have brought it to their attention). It is also embodied in the discriminatory and cynical gun-control laws that we have called psychiatric profiling, and in the readiness of police to shoot to kill people, mainly people of color, whom they consider to be ’emotionally disturbed’.
Re suggestions of what to do, there is quite a lot going on internationally, some of my international work is done now through the Absolute Prohibition campaign, see http://absoluteprohibition.org which also has a Facebook page. Nationally there is a challenge for organizations and independent activists to work together, and I am hoping to connect with those who want to collectively figure this out. It’s not rocket science really, just setting a few things in motion and seeing where people are already starting to move in good ways.
It’s hard to get free when there are people who hang these labels on you and are still in your life.
I think that together we are stronger. Some survivors are lawyers and we have lawyer allies as well; it can make a difference to have somebody willing to step in and go to bat for you when you are vulnerable, once in my experience just knowing that a friend of mine would be able to help in this way allowed me to calm myself and get out of a bad situation. In political organizing and activism, in civil disobedience we would be taking risks but a psychiatrizing response would likely backfire on the state because it would show the social control use of psychiatry for what it is.
That’s one avenue, and there can be many others. We don’t have to take any action we don’t feel right about or prepared for, and even if we are hiding, there are ways to contribute e.g. to participate in a collective advocacy campaign by helping to write or come up with ideas.
Thanks for your comment.
I believe that when we abolish forced treatment, and commitment, as a legal matter, when we make it illegal, it will be much harder to threaten anyone into complying with these tortures. This can come in any number of ways, legislative repeal/abolition, judicial decisions, and/or more policy-oriented administrative or programmatic approaches.
It has been very effective so far to work with and through the UN. The negotiation of the Convention on the Rights of Persons with Disabilities provided a global forum and a fulcrum to gain leverage over the political/legal issues in all countries at the same time. The UN for better or worse, and whatever its flaws, is a place where at times governments come together with high aspirations and want to do the right thing. Even if they are still violating those standards at home, when they come together they learn from civil society (ordinary folks and advocates who come) and they get inspired. They send their human rights-oriented people to these meetings. So that was an amazing first step, and then the UN human rights system has a number of independent expert mechanisms that helps to hold the governments accountable for what they signed up to.
It’s a long haul, but we have comrades in many countries working for the same things, and it is worth it.
I think that your post is a derail from my subject, and is not at all what I have in mind.
I do not share your views on immigration, and if you reference the Nazis you should know that their targeting of Jews and others they considered non-Aryan was similar to the hostility against immigrants that is being fomented here and in Europe – by groups including prominently the neo-Nazis. So I consider your reference to that era dishonest. Yes, they targeted people labeled with psychiatric diagnoses and other people with disabilities who were institutionalized first, or rather got the idea for extermination camps from the deliberate killing of people with psych labels and other pwd by psychiatrists. But you are twisting it around to make it seem like we are endangered by other people who are actually victims and not at fault.
Frankly I think the moderators should delete the comment as it is really inappropriate, but that is up to them.
You say ‘alternative to starvation,’ yet tell that to the woman I know, a professional and human rights advocate, who cannot imagine her life without psychiatric drugs and doesn’t want to. She isn’t starving, by any stretch of the imagination. Nor are psych drugs all she does, she is aware of needing certain kinds of support in her daily life and she has someone to give it to her.
On the other hand, I also know many people who are in an in-between place, who are looking for something, would welcome a drug if it actually got rid of the ways they feel terrible, hate the adverse effects, would welcome enthusiastically something better. Psychiatry hasn’t worked for them but nothing else has either, they are desperately unhappy and haven’t connected with anything that lets them live in peace.
The way you describe psychiatry, I don’t think you are separating the coercive institutional and legal aspects from the paternalism (which can be equally present in therapy), and from any possible elements that give anybody something that they need.
I entirely agree that abolition of psychiatry as a social control institution cannot be subject to development of alternatives. Abolition of legalized coercion is the first step, then there are other collateral ways that it operates as social control. That is what CRPD requires.
And, in its current form psychiatry as a profession, as a social institution, cannot be separated from paternalism and legally-empowered coercion. Organized psychiatry does not want to liberate itself from its deified status and struggle as ordinary human beings, I suppose they aren’t sure they’d have anything to offer. This doesn’t seem to me any different the way it operates, than white supremacy and male supremacy; it takes a willingness to let go of hierarchy and not see it as part of one’s own identity, to find an identity that doesn’t depend on being above someone else. I think it can be done.
That’s an interesting approach that is reasonable, as a way to envision what it would look like, thanks.
Hope this reply posts in the right place, replying to old head.
In my view, Miranda requirements on involuntary commitments would just be another procedural reform that makes little difference in the end and reinforces the legal and social legitimacy of that abusive practice. Involuntary commitment is a creature of law and it can be destroyed by destroying the laws that allow it to happen. Few psychiatrists would be willing to risk arrest and lawsuits for false imprisonment, if the commitment laws did not give their acts the stamp of legality.
Re delegitimization again, how would you accomplish that? Who, what institution(s) give psychiatry its current legitimacy as a medical profession, and could take it away?
Thanks for the information, I will follow up. Would welcome specific links or names of organizations, re Health Freedom movement.
Thanks for the follow-up information.
It makes sense that the western middle class, who would be in charge of those kind of programs, would have little ability to understand the need for food as simple. Yet we don’t even have to go to an African country to see the impact of hunger on students; in the US this is the reason for the school lunch program, and periodically politicians have to be reminded of hunger as a reality.
Do you understand the meaning of the sentence, ‘And really it seems to be happening a lot more to women than to men.’?
You will not stop me from speaking about the disparity. If you have something to say relevant to the OP, you should post an independent comment rather than piggyback on Julie’s to mansplain.
Look forward to hearing more.
Re-reading your comment I definitely agree with the point about expert witnesses and see that as overlapping between the CRPD requirement to eliminate legal capacity deprivations based on ‘mental capacity’ assessments, and the delegitimization of psychiatric diagnosis as any kind of science.
I agree that psychiatric diagnoses are not science, not neutral or objective in any sense, and this is something that can be worked on.
Re the question of neurotoxins as medication, I think you have to find a way to distinguish from chemotherapy for cancer or else to deal with both in the same way. And I would wonder about the possibility advanced by Joanna Moncrieff of prescribing based on drug effects and what the person wants rather than diagnosis. That would wreak havoc with insurance under current US system, don’t know how it would work in other countries, but would be closer to what I am advocating or groping towards, in terms of return to the ‘art’ and honest science of medicine.
Not sure what you mean – that after abolition of psychiatry the same drugs can be available to people? And abolition of psychiatry being its delegitimization as a profession? So the drugs would be… just an option for people to try and figure out for themselves?
I still wonder about how the abolition would be accomplished and what would come in its place.
I am mindful of Michelle Alexander’s warnings in The New Jim Crow or the cautionary message that is implied from that book, that a terrible institution might just take other forms if the basis isn’t rooted out.
This could apply both to abolition of legalized forced paternalistic interventions such as psychiatry (what is required by CRPD) and to abolition of psychiatry (which wouldn’t necessarily eliminate forced paternalistic interventions).
I suppose that abolition of psychiatry would be accomplished if there is a strong enough movement, but I also believe that if psychiatry’s legalized coercive power is taken away, the nature of the institution would have to change. Still hoping to understand how people envision the delegitimization.
Interested to hear more if you want to share.
I have a sense of frustration at this proposal, much as for me personally it would be fine if psychiatry lost its accreditation and the neurotoxins were banned. My frustration is in two parts:
1. I don’t see much possibility of it happening. Despite all the scandals, institutionally I see psychiatry continuing to rehabilitate itself and sell itself both as happy pills, or last resort way out of terror, and social control. Also, the rest of medicine is becoming institutionally more like psychiatry and so will have less ability to criticize it.
2. People want psychiatry, and its neurotoxins. And I can’t tell them that they’re just wrong. Our bodies are all so different from one another, what feels good, what tastes good to me is vastly different even from what works for my partner. If some people feel their spirituality is enhanced by SSRIs and others are dampened down by them, as a recent study found, what does that tell us? What is spirituality, is it the same thing or different for the two groups?
I’m interested in what can be done, because ultimately I do think we need to have a real shift back to sustainable and holistic ways of doing everything. But, similar to how I feel about western medicine – re western medicine I have friends who survived cancer because of chemo or radiation, and who are kept alive in progressively disabling conditions because of medications and assistive devices, and I have friends who use psychiatric medications as their choice and cannot and do not want to stop. I don’t want to dictate to anybody what their health choices should be.
Do you, or anyone in this conversation, have any thoughts on how to address this tension? In terms of what I addressed in this article, it has partly to do with the relationship between autonomy and quality.
I don’t think ‘we’ are to blame for what news media do any more than ‘we’ are to blame for what government does. That’s a navel-gazing trap that lets the actual perpetrators off the hook.
If you mean that we need to seek out the best news outlets we can, and use critical thinking on all of them – including those that are promoting themselves as reliable and ‘non-fake’ – I entirely agree with you and have said as much myself in many places. Not sure how that relates to autonomy and quality in health care, are you making a connection?
Thanks for your comments Julie – and congratulations on your own article on Medium that I saw today.
It makes me angry and disgusted to hear all these instances. And really it seems to be happening a lot more to women than to men. Maybe I will succeed in putting together some kind of small group to see what we can do, will surely count you in.
All the best,
I don’t know if you misunderstood me or if you simply disagree. As far as I can tell in the U.S., given our economic system, political system and other factors, single payer makes more sense here than a hybrid as in what ‘uprising’ in their comments here calls Obamneycare.
Irrespective of where we go in creating a system that actually provides for universal health care – which the ACA does not, and for the record ACA remains a giveaway to insurance companies as well as doing a lot of good in getting people health care who wouldn’t have it otherwise- irrespective of how we get there, my point in this article is that universal access is not the sum total of health as a human right.
I am not very interested in debating the economic justice aspects of this, particularly in this forum. I prefer to focus on the points made in the article about the need for a movement to reclaim autonomy and power with regard to our own health, and to promote quality from the perspective of those who are using health care – both of which necessitate a movement that is independent from health care providers, and that we do not have right now, or if we do it is not very visible or active outside the context of psychiatric survivors and related groups.
That says a lot about western donors’ priorities. I wonder about some of the details of where the interests and pressure are coming from, at what point it is direct complicity with an industry, versus assumptions and agendas that just are not responsive to what people are saying about themselves and their needs. Why do the donors have this agenda, in other words? That would be worthwhile to figure out.
Thanks Walter. I will see if we can substitute a permanent link in the post.
I think that is part of how the control is rationalized, and also how control can be accomplished without specifically coercive laws. That is a danger of a possible second-stage coercion even if mental health commitment laws are absent or not applicable. I think probably you are right that in addition to being a rationalization it is a mindset that ignores the way that capitalism and economic inequality socially and politically constructed and legally enforced, so that poverty and the ‘need’ for food stamps appears natural and thus responding to it is optional in any sense.
The US has never accepted the concept of economic, social and cultural rights, unlike most other countries in the world including European liberal democracies. This has to do with the history of international human rights and the Cold War, but remains a persistent part of our political culture. Economic justice rears its head periodically as a legitimate human rights demand, currently we are seeing this with the support for single payer health care, but legally and politically these rights are still largely treated as charity here.
It has been revolutionary for many people in the US to learn that housing, health care, adequate standard of living, are human rights and not just grants that can be conditioned on some kind of good behavior in the eyes of social authorities. This helps us to see these needs as dignified, as entitlements not in a cramped sense of ‘undeserving’ as the term sounds in the US but opposite, as something we have a right to just by being born. The same as we have a right just by being born, to not be abused by anyone whether a public official or not.
In my view, economic/social/cultural rights as human rights, and the concept of indivisibility of all human rights (a principle established in the 1993 Vienna Declaration of Human Rights and frequently invoked in international human rights work), strengthens both freedoms and entitlements, and should stand in opposition to the misuse of entitlements to coerce compliance. But the power and temptation is always going to be there, so it requires political consciousness and activism to keep opposing. It is a real, material power even though it is socially constructed and kept in place by law and custom.
Hope that is useful as a response, appreciate both your comment LavenderSage and also Julie’s reply.
I think a lot about the lessons from history about the racial caste system in the US, that Michelle Alexander drew out in The New Jim Crow, and others are also exploring in various media. Eradicating the relations of exploitation and oppression, the political hierarchies and their economic and social roots and manifestations, takes more than just abolishing one highly destructive institution. That is true with regard to racial justice, it’s true for the abolition of patriarchy, and it’s true for the abolition of forced psychiatry.
See my reply to Julie above also, it is not the end and I do not intend for this to be a doomsday last stand, just a warning. There is a lot of work to do, and people should read the report in full and see what they think, more to explore beyond what I’ve said. Also interesting initiatives that can move us in the right direction, in the US I have been supporting the Disability Integration Act (www.disabilityintegrationact.org) and may blog about that sometime.
Good question, and maybe my post could be misleading in one respect. While this is the latest development, and it is significant for good reasons – his critique of biopsychiatry is far-reaching and more detailed than anything that has ever before come out of the UN – it is not the last word from the UN, and the Special Rapporteur on Health is not the UN mechanism that has final authority over the subject matter.
The Committee on the Rights of Persons with Disabilities will continue to their work and presumably will continue to condemn all acts of forced psychiatry. This Committee currently has pending two individual cases that deal with forced psychiatry, and they have a chance to say what is required for justice at the individual level. (I submitted an amicus brief in one case, that can be found here: https://dk-media.s3.amazonaws.com/AA/AG/chrusp-biz/downloads/313551/CHRUSPthirdpartyDaniels.pdf.)
Also the Office of the High Commissioner for Human Rights, the Special Rapporteur on the Rights of Persons with Disabilities, and at this point the World Health Organization, are upholding the absolute prohibition of psychiatric commitment and forced treatment in their work. Recently WHO sent a letter to the government on Korea, opposing their proposed new mental health act because it maintains provisions that allow commitment and forced treatment, contrary to the CRPD.
In my post, I thought it was necessary to address the dangers of a gradualist approach that Dainius Pūras has adopted, precisely because the report also has value for its critique of biopsychiatry. Ideally there could be spaces for discussion among all concerned, and this will be difficult to do given the state of the survivor/user movement internationally at the present time, so we will see.
Great article. I would like to point out however, that there is certainly a connection with the dedicated advocacy being carried out by my friend and colleague Hege Orefellen, lawyer and survivor, and others including Mette Elingsdalen and Liv Skree, who have been using the international human rights framework since 2006 or so to bring pressure on the government to abolish forced interventions. They have worked through WSO and independently, and Hege now is running a pro bono law project through the International Commission of Jurists Norway branch, supported by retired Supreme Court justice Ketil Lund. By consistent human rights reporting in all the UN mechanisms available to them, as well as participating in law committees and consultations of the government, individual and systemic advocacy, and publicity in the media, this has certainly contributed significantly to the willingness of the Health Ministry to consider drug-free alternatives in psychiatry. As Bonnie and Oldhead say, it is a reform and does not fundamentally change the system; psychiatrists are still at the pinnacle of power. But I think it can be significant, in demonstrating that not only drug-free alternatives but also respecting freedom of choice and the right to refuse unwanted treatment is ethical, responsible, and not the bogeyman that mainstream psychiatry wants to paint it as. There is a synergy as Jim Gottstein illustrated in his three-part approach to change, between law reform, alternatives, and public awareness-raising.
I also cannot refrain from pointing out a gender dimension in this article and the situation described. All the psychiatrists mentioned are male, two psychiatric nurses are female, and all the patients interviewed are female. The patients’ stories show quite a bit of gender oppression in how they got there, and the placement of men in positions of power similarly belies Norway’s stated commitment to gender equality. Dismantling the authority of psychiatry, in my view links up with dismantling patriarchy and other hierarchical systems of social organization; these dismantling are synergistic too and it is useful to recognize where the systems connect.
1. You ask, ‘Who will remove psychiatry’s compulsory powers?’ In fact, this is easily done from a technical standpoint by repealing legal provisions that authorize those powers.
Law like psychiatry is a creation of human beings, psychiatry does not have any inherent powers to violently act on anyone’s bodies. It is given those powers by law, and law in turn must be accountable to both political processes and to fundamental principles of human rights set out in constitutions and in international human rights law to the extent that any country’s political and legal system provides for this.
In 2006, the Convention on the Rights of Persons with Disabilities (CRPD) set out a number of rights and principles that require the abolition of psychiatric commitment, forced treatment and substitute decision-making. I was actively involved in that process and represented the World Network of Users and Survivors of Psychiatry in proposing and explaining these provisions that were successfully enacted into the treaty. At last count, 172 countries are states parties to the CRPD, and it is legally binding on them as a matter of international law. (Many of them do not treat it as binding in their domestic courts, but some do; some even consider such human rights treaties to govern on a par with their domestic constitutions.)
The committee of independent experts that is elected to monitor compliance with the CRPD, the Committee on the Rights of Persons with Disabilities, has interpreted and applied its provisions to require an end to substitute decision-making and the absolute prohibition of forced treatment and of deprivation of liberty based on actual or perceived disability. They have said that states must repeal legal provisions such as those in mental health laws allowing deprivation of liberty based on factors such as danger to self or others, or need for care or treatment. For more information and resources, you can start at http://www.chrusp.org, an organizational website of the Center for the Human Rights of Users and Survivors of Psychiatry.
2. (This comment is both to the author of this blog and to the book she is writing about.)
If we look only at psychiatry as a modern phenomenon, we lose the history of how societies have dealt with what they perceive as madness, and how modern day societies that do not have a large psychiatric or mental health professional presence deal with madness. There is some good and some bad; in some societies people may be tied or chained to trees or locked in sheds because the mother of the household needs to go about her duties and can’t care for them. This is seen as the woman’s duty and the family or community participate in this dehumanization as, in in some other countries families and communities participate in the dehumanization of people through psychiatry. They do not see alternatives, and participating in dehumanization perpetuates their perceptions of the person as warranting such treatment, and affects the person in many possible ways, but all of which do not allow them to break out of how they are seen by others. (Again, this is true in both psychiatric and non-psychiatric settings.)
In some societies there are traditions of madness being seen as shamanic initiation or leading to shamanic initiation. This is fine, such practices should be supported and have also inspired many in other cultures to have a different view of the spiritual crisis and/or emergence that madness can be.
That leads me to two points about what is missing from a Marxist analysis as described here. First, patriarchy as a system of oppression prior to, intersecting with, absorbed into, parallel to, and/or competing with capitalism appears to be overlooked. Feminist Marxists have called attention to this blind spot in mainstream (male-dominated) Marxism for at least decades. I find the book ‘The Sexual Contract’ by Carole Pateman to be useful in understanding how patriarchy was transformed by capitalism. Patriarchy also is implicated in psychiatry and it is not enough to acknowledge that psychiatry reinforces women’s oppression. Patriarchy has been analyzed as a system, similar to capitalism, that in some part can account for psychiatry (e.g. in Mary Daly’s Gyn/Ecology). I do not think that either system fully accounts for psychiatry, but certainly we need to look at all of them. (In addition, institutionalized racism, or what I have heard described as racism as a practice, similarly can provide a partial account of the development and existence of psychiatry as a system of social control.)
Second, there is something that I think is separate from any other framework of system of oppression, that leads human beings to treat some members of a society as too different to be accepted in the community. It is a widespread phenomenon that I think is accurately described as disability-based discrimination, or simply exclusion of members of the community (also including older people) that appear to be weaker or who are made weaker by others’ reactions to them. We can talk about specifically how capitalism treats disabled people as ‘useless eaters’ and patriarchy puts disabled people under the control of male heads of the family or their surrogates, while making women responsible for either care or abuse/neglect, and for carrying out both the abuse/neglect and as directed by the patriarchs and other the measures they dictate for management and control. It would be interesting to look more deeply at Feminist-Marxist analysis of how women, and other subordinates like non-psychiatric mental health professionals, are roped in and have an intermediary role in the oppressive system. And, to look at how psychiatry came to serve patriarchy in an era of capitalism, by transferring social control and the abusive/neglectful care involved, at least in part from women in the family to a monetized system and its employees. And yet, without an ‘intersectional’ attention to disability-based oppression/disablement in particular, I cannot expect that either feminism or marxism will pay attention, and so I wonder what the material basis is of disability-based oppression as such, and what more we need to address in theory and practice, beyond simply rising up for liberation.
So to conclude (linking up with my #1 above), there’s a linkage with law and custom both in state and non-state societies, in thinking about how societies respond to distress and difference. Law both reflects and replicates a social and economic and political order (and a sexual order, and perhaps an ability order of some kind). I think that law is an important site for change while at the same time recognizing and being vigilant about the underlying systems that will act to recreate themselves if we do not make deeper change (Michelle Alexander has made this point more emphatically and concretely than any other writer I’m aware of, in The New Jim Crow). Thanks for this blog and for the discussion.