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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.
I don’t think that we will necessarily ‘as a movement’ make decisions together, on this website or anywhere else. But who knows, maybe something will coalesce and we will only know when it happens. We have to be alert to what moves us, and what inspires us. Many good things are happening in other parts of the world, and MIA is still America-centric, for example.
I agree with you about groups that try to get taken out of the DSM sometimes doing that at the expense of everyone else. I am active in feminist and lesbian groups, where it is something I struggle with at times, to look at the ways that, for example, many lesbians are still being psychiatrized for their sexuality alone, or because someone suspects their sexuality. And at the same time not differentiate, not make that the sole issue facing lesbians who have been psychiatrized, because many of us are psychiatrized for other reasons, labeled in ways and circumstances that aren’t apparently related to being lesbian. That is how I approach it in this situation that I relate to personally, and I think it can be done in other intersectionalities also.
I know a couple of psych survivors who have gone to Standing Rock, and think it is a good energy to connect with, however we relate it to the psych survivor aspect of our lives and work.
I really do not mean to say that everyone needs to blast their experiences in the world. Part of the violation committed against us was putting all our private experiences on display, to be picked over by people who were hostile to us. Decisions about what to be public about are personal and situational, in my opinion.
It can serve the movement for people to come out publicly, but I think for too long we have acted as if telling our stories is the most important thing. Sometimes it can be better to, for instance, write a pseudonymous blog, or help others get out of psychiatry, or any number of things that can be done quietly.
Having said that, I do think that if one is getting active on these issues, speaking out, I do ask the person to come out as a survivor and not pretend they are just an ally.
Rachel, thanks for being here and doing what you are doing to save yourself.
I don’t think that disobedience means flinging yourself at everybody standing in your way, making a big show. It’s how we care for ourselves and decisions we make in every moment, what will serve and preserve the sacred in us, and in others and in the planet. Sometimes that is deception, and I have no problems with it as a means of preventing forced psychiatry.
Yes, speaking out is the first step. Those in a position to speak out without risking their own bodies and lives have an obligation to do so. At a minimum. And we have to hold people in the movement – by which I am including allies, not only survivors – accountable for how they act on their ethical positions, and for whether they take a position opposing all forced psychiatry to begin with. There is no middle ground on this, I am tired of coddling people and being expected to treat someone as my friend when they refuse to support my basic human right to not be subjected to torture and arbitrary detention. (Note that all discriminatory detention is considered arbitrary detention, so using this term doesn’t mean we’re just asking them to follow their own laws, all psych commitment is arbitrary detention under the CRPD standards.)
Regarding rights and duties, I will speak about international human rights law, a system that has developed over time with certain principles and aims to be above and beyond the laws created by states. It is above and beyond because it talks about duties that states have towards the people.
It is true that people also have duties to each other, and it is basically to treat one another as we want to be treated. So the Universal Declaration of Human Rights says we all have duties to each other, without which no one would enjoy their basic human rights. But people labeled by psychiatry have no more duties than anybody else is, and we sure don’t have a duty to accept subordination to psychiatry, we don’t have a duty to accept being locked up or forcibly treated. The duties that governments come up with, that might be what they post in psych wards, are how they want us to behave there. So I’d say take that with many grains of salt. They might have the power to enforce those ‘duties’ against you, the power to punish you if you don’t do what they say. And they may be supported in that by the country’s domestic law, but they may not be; what they claim to be your duties might be only the policy of a particular institution.
Now about rights. Also with rights, we have the same rights as anyone else. This is the single most basic premise underlying the Convention on the Rights of Persons with Disabilities. Governments that ratify the CRPD undertake an obligation to not discriminate against anyone based on disability. It is clear from the negotiation history and many of the CRPD’s provisions that it is intended to cover psychiatrically labeled people, and I don’t think there is serious disagreement on this any more. The CRPD says that everyone has legal capacity (right to make decisions) and the right to have others respect their will and preferences; that there can be no deprivation of liberty based on disability (psych commitment or similar regimes); that we have the right to free and informed consent in health care, and to not be tortured or otherwise ill-treated; and that we have a right to be provided with supports if we choose them, for living in the community and also for help with decision-making; these supports are not to be imposed against our will.
Many governments and academics try to find ways to make the CRPD fit with psych commitment and forced treatment, by ignoring some of what it says or not taking the totality of all provisions; these are often deliberate moves rather than misinterpretation, especially post-2015 since the Committee on the Rights of Persons with Disabilities issued substantive interpretive guidelines on Article 12 (legal capacity) and Article 14 (liberty and security of person). So we fight back.
You can contact me through this website by email, if you want to talk more about your country situation and prefer to do it more privately.
Regarding the rest, I don’t think I’m saying anything that has to be kept private for security reasons. Yes, if psychiatry is watching this blog, they may know that a level of resistance is being encouraged. But I believe it is a kind of resistance that builds our stamina and rises, it is not an aggression that they can respond to by making us feel bad or doubtful about ourselves, or provoke us into escalation that lets others paint us as bad and scary. If we are to be scary, it will be for our spiritual power. And like other non-violent movements before us, we rise because of our ethical commitments, because everything stems from that, and that is exactly where psychiatry is weak. They cannot win, because they are wrong.
I’m not naive, violence happens and will happen and you know, violence is already happening against us just as it was happening and continues to happen against Native Americans, just as it happened and continues to happen against African Americans before, during and after the civil rights movement. It’s about how we act, how we meet the systemic, endemic violence we are surrounded by and find ways to stay grounded in our own love and the power of the sacred, however we relate to that.
All the best,
i agree, good point.
The reason why strategically there is a move to label him psychiatrically – feelers being put out in mainstream media, politicians, in addition to garden variety folks and psych professionals who covet a role for themselves – is that it is one possible avenue to get him out of office. You mention this, but I think it is worth going into more detail about why psychiatric labels are connected to the idea of unfitness for office.
The constitutional provision at issue, the 25th Amendment, doesn’t specify what it takes to judge the president to be unfit, but the term ‘inability’ or ‘unable’ is also used. According to wikipedia’s version of the legislative history and motivation (I haven’t taken the time to research further), this is not about a judgment of the president’s competence in the sense of meeting job requirements, but rather competence in the sense that amounts to a physical or mental disability.
We shy away from making job requirements for the president (in the sense of qualities or competencies to do the work of being president), it’s political and there’s the idea that people have a right to choose whoever they want as a political leader. Yet, it would make a lot more sense if everything that we now lump into the idea of mental disability or mental incapacity would instead be referred to an examination of what we actually see as an impediment to a person carrying out the job. There is something to our sense of the current president’s unfitness for the office he has been elected to, in terms of his belligerent character as someone who deliberately taunts and targets large numbers of individuals and groups with his hostility, as someone who is ineffective at communicating about policy issues, as someone who is maintaining numerous situations in which he has a financial conflict of interest with his office, and more. And, maybe we want job descriptions, but if we don’t (and that would require a constitutional amendment) we are stuck with this president unless the congress goes through with impeachment, which requires more people to act.
Ultimately what’s going on exposes the bankruptcy of ‘mental capacity’ evaluations as a whole, and is a good example for all of us of how psychiatric diagnoses function to invalidate people, violating their rights to enjoy legal capacity that are guaranteed by the Convention on the Rights of Persons with Disabilities, Article 12. (Yes, I’ve linked this up with CRPD. If this interests you, google and read CRPD General Comment No. 1, especially paragraphs 13-15 that reject the invalidation of people’s decision-making by virtue of ‘mental incapacity’ or ‘unsound mind’ judgments. Read all of it, see also the section on support, and paragraph 42 which says plainly that forced treatment violates both legal capacity and the right to be free from torture and ill-treatment.)
I have one other point that goes to the overall context politically. There are (at least) two ways we can respond to the current situation, two ways we can understand the lessons to be drawn. One is to blame ourselves for not electing another candidate; another is to look at the flaws of the political, economic and social system that was problematic before this election and remains so albeit with much deeper problems and in deeper crisis than ever before. We are good in crises, we wake up and look at each other, draw together and take care of each other. There are lessons also from Standing Rock and what is ongoing there, and all the movements that pre-existed the current administration including ours, needing to reinvigorate ourselves and having some synergistic potential. I am not in any way saying ‘bad is good’ but there is a great deal in the balance and many ways we can respond to the bad, some of which may have the potential for deeper and lasting change than others.
It’s not clear what reform of mental health legislation you are supporting. Since you mention lack of capacity assessments, I guess that you support the kind of reform that is designed to subsume commitment and forced treatment in mental health under the framework of legal incapacity.
Are you aware that legal incapacity laws are also discriminatory? The Committee on the Rights of Persons with Disabilities, monitoring body of the Convention on the Rights of Persons with Disabilities to which UK is a party, has elaborated on this in a General Comment, http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRPD/C/GC/1&Lang=en.
Among their points:
13. Legal capacity and mental capacity are distinct concepts. Legal capacity is the ability to hold rights and duties (legal standing) and to exercise those rights and duties (legal agency). It is the key to accessing meaningful participation in society. Mental capacity refers to the decision-making skills of a person, which naturally vary from one person to another and may be different for a given person depending on many factors, including environmental and social factors. Legal instruments such as the Universal Declaration of Human Rights (art. 6), the International Covenant on Civil and Political Rights (art. 16) and the Convention on the Elimination of All Forms of Discrimination Against Women (art. 15) do not specify the distinction between mental and legal capacity. Article 12 of the Convention on the Rights of Persons with Disabilities, however, makes it clear that “unsoundedness of mind” and other discriminatory labels are not legitimate reasons for the denial of legal capacity (both legal standing and legal agency). Under article 12 of the Convention, perceived or actual deficits in mental capacity must not be used as justification for denying legal capacity.
14. Legal capacity is an inherent right accorded to all people, including persons with disabilities. As noted above, it consists of two strands. The first is legal standing to hold rights and to be recognized as a legal person before the law. This may include, for example, having a birth certificate, seeking medical assistance, registering to be on the electoral role or applying for a passport. The second is legal agency to act on those rights and to have those actions recognized by the law. It is this component that is frequently denied or diminished for persons with disabilities. For example, laws may allow persons with disabilities to own property, but may not always respect the actions taken by them in terms of buying and selling property. Legal capacity means that all people, including persons with disabilities, have legal standing and legal agency simply by virtue of being human. Therefore, both strands of legal capacity must be recognized for the right to legal capacity to be fulfilled; they cannot be separated. The concept of mental capacity is highly controversial in and of itself. Mental capacity is not, as is commonly presented, an objective, scientific and naturally occurring phenomenon. Mental capacity is contingent on social and political contexts, as are the disciplines, professions and practices which play a dominant role in assessing mental capacity.
15. In most of the State party reports that the Committee has examined so far, the concepts of mental and legal capacity have been conflated so that where a person is considered to have impaired decision-making skills, often because of a cognitive or psychosocial disability, his or her legal capacity to make a particular decision is consequently removed. This is decided simply on the basis of the diagnosis of an impairment (status approach), or where a person makes a decision that is considered to have negative consequences (outcome approach), or where a person’s decision-making skills are considered to be deficient (functional approach). The functional approach attempts to assess mental capacity and deny legal capacity accordingly. It is often based on whether a person can understand the nature and consequences of a decision and/or whether he or she can use or weigh the relevant information. This approach is flawed for two key reasons: (a) it is discriminatorily applied to people with disabilities; and (b) it presumes to be able to accurately assess the inner-workings of the human mind and, when the person does not pass the assessment, it then denies him or her a core human right — the right to equal recognition before the law. In all of those approaches, a person’s disability and/or decision- making skills are taken as legitimate grounds for denying his or her legal capacity and lowering his or her status as a person before the law. Article 12 does not permit such discriminatory denial of legal capacity, but, rather, requires that support be provided in the exercise of legal capacity.
I have copy/pasted this long quote rather than pulling out only one or two sentences so you can see the Committee’s reasoning in context. They also later in the document specify that “the provision of support to exercise legal capacity should not hinge on mental capacity assessments; new, non-discriminatory indicators of support needs are required in the provision of support to exercise legal capacity.” (para 29(i)).
A wide range of support is contemplated:
17. Support in the exercise of legal capacity must respect the rights, will and preferences of persons with disabilities and should never amount to substitute decision-making. Article 12, paragraph 3, does not specify what form the support should take. “Support” is a broad term that encompasses both informal and formal support arrangements, of varying types and intensity. For example, persons with disabilities may choose one or more trusted support persons to assist them in exercising their legal capacity for certain types of decisions, or may call on other forms of support, such as peer support, advocacy (including self-advocacy support), or assistance with communication. Support to persons with disabilities in the exercise of their legal capacity might include measures relating to universal design and accessibility — for example, requiring private and public actors, such as banks and financial institutions, to provide information in an understandable format or to provide professional sign language interpretation — in order to enable persons with disabilities to perform the legal acts required to open a bank account, conclude contracts or conduct other social transactions. Support can also constitute the development and recognition of diverse, non-conventional methods of communication, especially for those who use non-verbal forms of communication to express their will and preferences. For many persons with disabilities, the ability to plan in advance is an important form of support, whereby they can state their will and preferences which should be followed at a time when they may not be in a position to communicate their wishes to others. All persons with disabilities have the right to engage in advance planning and should be given the opportunity to do so on an equal basis with others. States parties can provide various forms of advance planning mechanisms to accommodate various preferences, but all the options should be non-discriminatory. Support should be provided to a person, where desired, to complete an advance planning process. The point at which an advance directive enters into force (and ceases to have effect) should be decided by the person and included in the text of the directive; it should not be based on an assessment that the person lacks mental capacity.
You will see that they include advance directives, but as some of us have pointed out, advance directives are problematic if they are meant to bind the person’s will at the time an event occurs; since the person retains legal capacity at all times, it’s not clear that having provided at an earlier time for something to be done towards them would legitimize for instance the use of force to accomplish it at a later time when they refuse the intervention.
These two paragraphs reinforce the right to legal capacity as persisting at all times and being unqualified; support is not a control mechanism but a means of exercising a will that the person has formed at some level; the person can always override a misinterpretation of his/her will by the supporter, and no person can be obligated to use support.
18. The type and intensity of support to be provided will vary significantly from one person to another owing to the diversity of persons with disabilities. This is in accordance with article 3 (d), which sets out “respect for difference and acceptance of persons with disabilities as part of human diversity and humanity” as a general principle of the Convention. At all times, including in crisis situations, the individual autonomy and capacity of persons with disabilities to make decisions must be respected.
19. Some persons with disabilities only seek recognition of their right to legal capacity on an equal basis with others, as provided for in article 12, paragraph 2, of the Convention, and may not wish to exercise their right to support, as provided for in article 12, paragraph 3.
Here is what the General Comment says specifically about abolishing forced psychiatric interventions and the need for independent support and non-medical alternatives in mental health context.
42. As has been stated by the Committee in several concluding observations, forced treatment by psychiatric and other health and medical professionals is a violation of the right to equal recognition before the law and an infringement of the rights to personal integrity (art. 17); freedom from torture (art. 15); and freedom from violence, exploitation and abuse (art. 16). This practice denies the legal capacity of a person to choose medical treatment and is therefore a violation of article 12 of the Convention. States parties must, instead, respect the legal capacity of persons with disabilities to make decisions at all times, including in crisis situations; must ensure that accurate and accessible information is provided about service options and that non-medical approaches are made available; and must provide access to independent support. States parties have an obligation to provide access to support for decisions regarding psychiatric and other medical treatment. Forced treatment is a particular problem for persons with psychosocial, intellectual and other cognitive disabilities. States parties must abolish policies and legislative provisions that allow or perpetrate forced treatment, as it is an ongoing violation found in mental health laws across the globe, despite empirical evidence indicating its lack of effectiveness and the views of people using mental health systems who have experienced deep pain and trauma as a result of forced treatment. The Committee recommends that States parties ensure that decisions relating to a person’s physical or mental integrity can only be taken with the free and informed consent of the person concerned.
There is more that is worthwhile to point out, but I will invite you to contact me through MIA if interested in exploring how this framework answers particular questions. I will also point you to a follow up document, the CRPD Committee’s Guidelines on Article 14 (liberty and security of the person) which links up the question of non-discrimination in relation to liberty and security (which you are addressing in this article re mental health legislation) and legal capacity: http://www.ohchr.org/Documents/HRBodies/CRPD/GC/GuidelinesArticle14.doc.
Hi Otto. Thanks for speaking out. We need every voice and comparatively few in our movement speak openly from the perspective of having been in forensic psychiatry.
You are in Canada, which has ratified the Convention on the Rights of Persons with Disabilities. It sounds like you may already be aware of international human rights, but I can put you in touch with survivors who are working on reporting about forced psychiatry of all kinds, as a human rights violation under this treaty. I will try to email you through this site.
The UN expert committee (Committee on the Rights of Persons with Disabilities) which monitors this treaty has said a number of times that forensic psychiatric commitment and forced treatment in the prison/jail setting is a violation of CRPD, the same as other psychiatric commitment and forced treatment. They have mentioned restorative justice, so long as it does not involve coerced mental health treatment as a supposed diversion, as an alternative to prison to be pursued.
The CHRUSP website has links to UN materials and some of my writings and those of others, if you are interested to look into the international human rights aspect further. http://www.chrusp.org/home/resources
Please see this very powerful group of presentations by Hege Orefellen (WNUSP), Liv Skree (WSO), Reshma Valliappan (WNUSP and The Red Door), Guri Gabrielsen (Head of Dept, Norwegian Equality and Non-Discrimination Ombud), and Mette Ellingsdalen (WSO). These are the presentations from a WNUSP side event on CRPD Article 6 – Violence Against Women and Girls with Disabilities: Intersectional and Double Violence in Medical and Institutional Settings, 19 August 2015.
thanks oldhead. if you like the CHRUSP page on facebook you will get information on anything i am doing as next steps.
happy to connect with you.
all the best,
Great article. Important for international work also, where the exact distinction between community mental health and real community is very much at issue in the application of Article 19 of the Convention on the Rights of Persons with Disabilities, on living independently & being included in the community. I address this in a submission to the CRPD Committee for their preparation of a General Comment on this provision. https://dk-media.s3.amazonaws.com/AA/AG/chrusp-biz/downloads/302948/CHRUSPArticle19.pdf.
I am going to share your article and also hope it can be translated as it is an issue everywhere.
You’re right; while I can’t control what anyone posts and I will do my best to give a meaningful response to anything that warrants one, I am not intending to debate the demands.
What you propose sounds like what law enforcement is mandated to do, and if that is the intent then I agree. Police are a horror in the US and almost everywhere, and we need social change on many more axes than just ending discrimination based on psychiatric labels or psychosocial disability/ unusual behavior or appearance/ choose your respectful wording. I believe that many of the survivor-developed alternatives in mental health, such as Intentional Peer Support, together with some of the work being done on Restorative Justice, along with comprehensive overhaul to stop the war mentality of police encountering people of color, holds hope for a better approach to situations where people are endangering others or have harmed others.
Sarah Knutson also has a post on MIA on this topic, giving an example much publicized in the press of an approach that worked: https://www.madinamerica.com/2013/10/tuff-love-necessary-public-safety-alternative/.
To clarify about the demands of the Campaign. The absolute prohibition of commitment and forced treatment is already established in international law under the Convention on the Rights of Persons with Disabilities. The Campaign is meant to demonstrate support for this standard and to share knowledge. It is in a sense a friendly campaign to strengthen the work of the Committee on the Rights of Persons with Disabilities, and also the Working Group on Arbitrary Detention which has adopted the CRPD standard.
If there are demands, they might be: for governments to enact laws and policies abolishing forced psychiatry, for judges to act in accordance with the absolute prohibition (as the WGAD and CRPD Committee called on them to do, see materials linked on Campaign website for more detail); for psychiatrists to accept the removal of their delegated state power and become merely treating professionals….
What you propose, if it is as I understand it, and isn’t intended to actually go after people who haven’t done harm but are just perceived as annoying or alarming by someone else, then it is a good point, and maybe you are going even farther than I thought at first and proposing abolition of prison as a punishment or accountability measure, which it would be very interesting to explore further.
Thank you! Look forward to it.
I invite you to think beyond the current circumstances you and your son face.
As food for thought here is the opinion of the Special Rapporteur on health and the Special Rapporteur on the Rights of Persons with Disabilities, the health rapporteur is a child psychiatrist in Lithuania.
The idea that only a spiritual take on the question will resolve it is a dismissive response to a fundamental question of social justice and comprehensive human rights. Positing a choice between prison and forced psychiatry is the liberal left non-answer to the human rights disaster that is forced psychiatry – a collusion between state power, financial power, and medical violence. Survivor knowledge together with allies have created something new in the CRPD – a right to support plus freedom. A right to reasonable accommodation plus equality and dignity in all aspects of life.
If you are interested in exploring the issue further please see my blogs on this website; I have discussed the question of criminal responsibility and many other issues.
I’d like to address a few things here. I started writing something that got deleted by mistake so please bear with me if anything seems disconnected.
First, your comment on your role as a parent and that your son will never be a survivor. When I say survivor, I do not mean “person who has ‘recovered’ from ‘mental illness.'” I mean a survivor of psychiatric oppression and abuse. Your son certainly is a survivor, and he has his own knowledge of what that means. Even if he is still being severely oppressed, and even if he is struggling to deal with his own disability or impairment and get the right kinds of support and accommodations to make a satisfying life for himself, he is still a survivor as I understand it. Many people in the survivor movement reject the notion that you have to somehow overcome disability in order to qualify in some way; and this is one of the things I believe that the disability rights framework contributes to our movement.
The specific abuse you mention, that your son was excluded from the services on the basis of your (and his?) choice not to use antipsychotics, is against the CRPD and I am glad to know that you won a decision from the Supreme Court in this regard. I would be interested to see the decision if you can provide a link (I can read the Spanish).
A few possibilities for you to look into:
Cindi Fisher does some great work connecting with parents in the US, she has some other demands on her time now but you may want to link up with her, as I think the challenges are not so different. This is her website: http://www.mentalhealthrightsyes.org.
You might want to connect with ENUSP – European Network of (ex-) Users and Survivors of Psychiatry to find out whether there are good organizations and resources at the European level dealing with autism. I know of organizations of autistic people in France and Germany, and also Autistic Minority International which is based in Switzerland and advocates at the UN. If you cannot find these with a google search send me an email through this website and I will try to connect you.
The CRPD Committee has been sensitized to the situation of autistic people, through the efforts of the organizations I’ve mentioned, and they are also sensitized to the issue of harm being done by psychiatric drugs.
If you and your son do not succeed in getting satisfaction from the courts, you have the option of making an individual complaint under the CRPD optional protocol, which Spain has also ratified. You could submit the complaint on behalf of your son but you would need to have his consent or document why his consent should not be required. Given the standard in General Comment No 1 I would expect that the Committee would not accept the severity of your son’s disability as a reason to not require his consent, so this is a further encouragement to pay attention to his will and preferences in this respect as well as in other areas of life.
One last possibility, is that I’m aware of a Hearing Voices group that put on the international Hearing Voices conference in Madrid this past year. Even if that is not an issue for your son, it could be a good group for you and your son to connect with as support for alternatives to the psychiatric medical model.
essentially yes, under the CRPD standard (yes, it is no longer a meaningful legal term). the challenge is to reform domestic law to make the new standard effective.
I agree! Anyone who has ways of getting it noticed, please share.
Yes I absolutely agree we should start discussing in a semi-organized way what kinds of legal research and training are needed. I am hoping to organize something with other survivor lawyers as a place from which some of that could begin, or a place where it could be centered. And this would need to be open to collaboration with non-lawyer survivors interested in thinking about it together. There may well end up being many forums, but this is something I am hoping to do.
I don’t understand your point. In fact, under constitutional law there is no distinction between the classifications of mental disability and physical disability. There is a high degree of discrimination against us, which is political and seeps into law but is not based on any rational legal distinction that can stand up to scrutiny. This seems to be the position you take also at the end of your comment, so we agree on that.
You are saying that you would prefer to talk about people labeled as mentally ill being a suspect class without bringing disability. If that works, I have no problem with it. But what we have seen in the past is that the classification of mental illness itself is problematic – it operates as a negation of the person and imposition of a narrative on their experiences that is delegitimizing. Those of us working on this in the international movement so far have all chosen to use the disability framework as being more flexible and friendly to our interpretations and less wedded to the medical model and prejudice. This was certainly the case in the UN. The “Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care” of 1991 is in the procedural safeguards paradigm; although it’s not characterized as a non-discrimination instrument per se it does include provisions on non-discrimination – and they are all non-discrimination within a discriminatory framework that has us as deserving inferior rights. It’s possible that post-CRPD one could create laws explicitly dealing with non-discrimination based on “mental illness” or an equivalent classification that would actually be human rights based and do away with forced psychiatry and substitute decision-making. See my post on what CRPD compliant mental health legislation would look like, as a related hypothesis. I wrote that in response to repeated questions asking me in essence to plug the loophole, to see if there was a possibility that the CRPD standard of absolute prohibition could be met within the context of a mental health law. But since I wrote it, everyone who has commented on the subject in our movement has said that they think it’s better to work for national legislation that is comprehensive disability rights legislation and includes people with psychosocial disabilities, legal capacity reform, and abolition of forced psychiatry. I think this is for two reasons, it creates a larger constituency that is harder to marginalize and it situates our rights more clearly as part of a theoretical framework (legal theory and doctrine, legal philosophy, politics of non-discrimination) that is somewhat accepted.
Reasonable accommodation, mainstreaming/ inclusion and participation, acceptance of diversity and not penalizing that diversity, autonomy meaning we get to have the final say while using as much support or as little support as we want, that is all hugely relevant to abolishing forced psychiatry and would be much harder outside the disability framework.
Thanks for your response, BPD Transformation. Stay tuned re law reform, it will be a huge project to challenge the destructive politics in our country but even there I am hopeful that our vision can be seen and heard as another part of the progressive vision many movements are building now, like BlackLivesMatter, Idle No More, feminism, anti-hate of all kinds (e.g. support for Syrian refugees, rejecting bigotry).
With regard to feminism it is something I am developing as an aspect and area of my work, and I won’t debate it for the same reasons I don’t debate the abolition of forced psychiatry. I don’t debate my human rights. I advocate and fight for and defend these rights. My intellectual stance, my theory and practice is just not about debate. People who find debate useful should go ahead and do it; I have learned from hearing people debate an issue respectfully but I also see how quickly debate turns disrespectful, and it becomes exhausting to engage with it. I trust that my work will be useful or not on its own terms.
I also want to clarify that I am not leaving work on the CRPD entirely, it’s a new phase for me but I am still involved at the international level in my personal capacity and through CHRUSP.
With regard to survivor knowledge, there too I feel my best contribution is to speak my truths and find ways to work that I find effective. I am open to projects that other survivors initiate, and believe there is room for us all, and room to criticize each other’s work and disagree also on a principled basis, and still to work together beyond disagreements in a kind of principled pragmatism when that also is mutually agreeable. So yes, I expect to keep commenting, here and elsewhere.
The way I reconcile these issues is with the concept of “perceived impairment/disability.” This is recognized in the US ADA, in the WHO ICF “International Classification of Functioning” (although the ICF is hugely problematic in other ways, highly medical model in the way it describes the problems people might face in the mental realm, following DSM/ICD diagnoses from what a colleague says whose opinions I trust), in the Inter-American Convention on Elimination of Discrimination against People with Disabilities, and last but not least in the jurisprudence of the CRPD Committee although it is not in the CRPD itself.
When I analyzed my own experience of forced psychiatry in the context of a law school human rights class (years ago before I worked on the CRPD), it seemed to me that there were three key components. One, analogous to rape, was forced drugging. I eventually formulated that as torture under human rights law, and I have been thinking recently about the close connections it has with actual rape in the sense of bodily autonomy and embodied personhood as I mention in my post, and will hope to address further in other papers. The s second component was something I conceptualized as poverty, it has to do with being treated as if you are worthless and do not merit getting your basic needs met in a dignified way. The emblematic experience was that they served us a mixture of coffee and tea that tasted vile, just because “some people like coffee and some people like tea.” We were not considered human enough to care about how our beverage tastes. The third component was the “on account of factor.” I had interned in the immigrant and refugee rights clinic and was thinking about the standard to find persecution for purposes of granting asylum, there had to be something about the person that they could not change or should not be forced to change, that somehow motivated the persecution. It seemed to me that in our case the “on account of factor” is disability. Somebody, multiple people, think that there is something wrong with us that warrants adverse treatment, and this something is not a group characteristic like race or sex but is supposed to be something that deviates from a supposed and desired norm at an individual level. With psychiatric labeling there is both a sense of fault and obliteration or obscuring of fault, because it is viewing the social and personal from a medicalized viewpoint. In any case, I think that disability is an accurate description or naming of both the reason for the persecution, and also the experiences that some of us have of not being able to fit in or to do all the things that we see others around us doing apparently with ease. So in that sense I think that the concept of disability should be able to reconcile those of us who just want to left alone, with those of us who want supports and accommodation of some kind. I don’t believe these experiences are contradictory or give rise to contradictory politics. In fact the CRPD Committee has adopted this approach of affirming both experiences in its General Comment No. 1 on Article 12 (legal capacity), saying that people have a right to support if they wish, but can also choose to claim only the right to have their legal capacity respected and refuse support. This of course is crucial for our movement.
I hope this clarifies for you my reasoning and the background and context of how the concept of disability is used in the CRPD with respect to survivor experiences.
I want to make a couple of comments. First, thank you for bringing this to MIA, or bringing out this dimension generally. I have lived a lot of the things you describe over a long period of time, and in ways that are integrated with my everyday life. For me, the situation of forced psychiatry itself was the final trigger to a death of self, but it took me decades of searching and healing to find meaning in and of the chaos. It is still happening but takes a different form. And the death was not completed then but also continued over time.
Second, there are aspects of spiritual experience that cannot be discussed outside a particular context, and the privacies and separations involved in this need to be both respected and honored in some way. I do not find any psychology particularly useful, and I identify most closely with feminist lesbian practice as a self-declared witch. There is a politics to this as well as a simple separation, and I want the reality of female autonomy and separate healing/knowledge spaces to be part of the vision of the survivor movement(s) including in terms of how we deal with, and understand, spiritual experiences.
I like your idea of a website “Psychics Against Psychiatry.” I knew that the haldol I was forced to take had left me with significant harm two decades later that remained unhealed. A healer trained in kinesiology doubted when I said this to him but agreed after he checked me energetically and treated me over several months in many ways that included nutritional advice that is still valid and useful for me today (another two decades later almost). I will post some about my own experiences in a reply to the main post.
What you describe is right on target, and I have written about some of the same things. Yet the solutions you promote are not dealing with misogyny per se but rather ethical behavior in general. I venture to say that while those are all good ideas, they are not going to address male privilege. In fact, it’s likely to be women who take in the message that they need to examine their own behavior – that is part of misogyny and female socialization, to be accustomed to thinking we are the problem, it’s ok for others to judge us and means we should change, but not ok for us to judge others – especially men – and insist that they need to change.
There are specifics to dealing with any kind of oppression, and women in particular need to claim for ourselves the right, ability, and power to name male oppression when we see it and not to back down in the face of criticism and judgment – you’re not nice, you’re drawing attention to yourself, you’re uncool, why are you focusing on only women, you’re a “TERF”, etc. Feminism is reviving its anger, and part of this is due to things happening around the Michigan Womyn’s Music Festival and the awareness of a need for female-only spaces and female autonomy to do whatever we damn please with it.
I am sure there will be negative comments to me, as female-only space is under attack from transgender activists, who also attack women’s freedom of speech when we dare to say that female reality can’t be trampled under males’ gender identities. That’s part of what it means to be a feminist nowadays and I won’t let it stop me from speaking. I hope that women wake up in our movement and everywhere and deal with all the misogyny by coming together, supporting each other, withdrawing our labor from men and organizations when we find ourselves being exploited, not being afraid to claim female-only space and create it as much as we wish.
Terry Lynch and all who are doing the tireless work of debunking psychiatry’s disinformation need to be honored, and called upon as resources for the dismantling of psychiatry as a control and abuse system (i.e. enforced by state power). I see a close relationship between the denial and aggressive promotion of disinformation that is part of the medical model, the pathologizing of human suffering as being something defective in the person, and the violence psychiatry uses to get its point across and make people into the zombies they would rather deal with.
Thanks Jim and Mary for your own tireless work in Ireland and internationally.
Yes, I think it is a disaster that the Rules segregate our people with unequal standards. It is an ongoing struggle and many people’s thinking is still changing now; the fact that they are not saying specifically that anything involuntary is ok, means that there is room to argue as I suggested, for a CRPD-consistent interpretation. It’s hard to pick all this apart and to maintain an ability to see it clearly while feeling both disappointed and also cautiously hopeful that if the word gets out about how to read these new Rules together with CRPD, we can get closer to what we want, at least a prohibition of involuntary treatment and transfers to mental health settings. I don’t think I mentioned, but has to be read in conjunction with CRPD Article 12 and General Comment No. 1 on the question of legal capacity, because they are likely to try and justify forced treatment on the basis of psychiatrists’ judgment that a person lacks decision-making capacity; CRPD says that is prohibited and everyone has the right to make their own decisions; support and any attempt to provide support has to respect the person’s will and preferences.
I agree about diagnosis. I think that there is a gender dimension in this as well; even for physical health problems it is common for doctors to ignore self-reported, self-described complaints of women and to channel everything we subjectively experience as a problem into a labeling that justifies them “fixing” us by changing us in some way. In other words they tell us we are the problem, and advertising and sexual harassment and invasions of privacy and put-downs of various kinds keep telling us there’s something wrong with us. Also the same things, plus direct gaslightling by abusers, tells us not to trust our own perceptions of danger and wrongness, and to appease everyone else rather than become aware of our own needs, our own power to meet our needs, and our own responsibilities from an internal rather than external standpoint.
Thanks again for sharing your reflections and experience.
Thank you Olga! It is a complex piece and I keep discovering more layers to it myself as I read the responses.
Yes, female as well as male therapists commit acts of abuse and violence. For women, being abused by another woman can feel even more intimate as a violation.
And an added point to what I said in response to Ben’s comment, talking about feminism as a source for my theory against psychiatric oppression does not mean that I have a reductionist view that psychiatric abuse is only done by men against women. Far from it.
There is a lot to respond to here.
1. Feminism addresses the systemic oppression by men of women. What I am calling lesbian-feminism is not the same as queer/feminist theory. It is theory and practice grounded in the lives of lesbians in particular. In my thought and experience, and the way I understand some of the writers that I am familiar with also, lesbian existence is relevant for feminism as a whole because it centers the notion of female autonomy. This is captured in the slogan “A woman like a man is like a fish without a bicycle.” Patriarchy pays attention to women only as they might be serving, not serving, inconvenient to, etc., men. Female autonomy is central to achieving liberation from oppression for all women, but lesbian existence is both an affirmation (and inspiration) that such autonomy is possible, and a life that gives us relevant experiences and perspectives to develop what it means to live a life that can be centered as female. Lesbian-feminists are feminist lesbians who are conscious of this relevance.
2. Judith Butler takes an individualistic view that treats gender as equally oppressive of males and of females, and I disagree with that position. I place myself generally with gender-critical feminism and radical feminism, which defines gender as a system of oppression by males of females, an imposed construct, rather than a performance based on individual identities. The sense in which I use “performative” is social and legal, similar to the way a contract is performative – if I say, I offer to fix your bicycle for $20 and you say “it’s a deal” you are not just describing something, you create a legal relationship with your words.
3. I think the question of individual females abusing individual males needs to be addressed as intersectional oppression, with analysis of both the gender dimension and sources of institutional power in which individual women may partake. A female psychiatrist, or psychiatric nurse or case manager, is wielding institutional power over both males and females, and this can complicate the experience of female as well as male survivors, because we all expect men rather than women to be in those roles of power and we want to believe that women will do things differently. But we have to take care not to make the outrage be, “how dare she as a woman do this to me?” She is not exercising institutionalized women’s power but rather wielding it in a system that was created predominantly by men in a context that has a lot to do with men’s systemic oppression of women.
White survivors may face similar experiences when people of color are in the roles of psychiatrist and other wielders of institutional power. We have to separate our own racism and sexism from our outrage at having been abused.
4. A little clarity about my work, which you have mentioned supportively. It is not only that I play a role in conveying and keeping track of what UN actors have said; I have been a key figure myself in the development of the UN norms and their ongoing interpretation. It is important to claim this in part because, as a female as well as a grass-roots lawyer and survivor of psychiatric abuse, my contributions of that nature sometimes go unacknowledged.
I resonate with the last thing you said about inconveniences vs the big problems in life. Keep trying, you will find the right audience for your work. Often that seems to be the key.
What a horrible thing to do to a girl, as well as just repressive of any child’s natural genius.
The incidents of abuse pile up and up, I suppose the useful thing to do would be to get serious about compiling them into a database and issuing periodic human rights reports. I hear some survivors may be doing this at local or national level in a few places, would love to see it happening in the US. (And for these initiatives to connect with each other, and to use the materials in UN reporting and related advocacy.)
That is really sad to hear about. When I was locked up I was frightened of being put in a state institution and never getting out. There are many survivors in our movement who have survived the state institutions, and the worst kinds of abuse in isolation rooms and restraints, and I have learned that we can’t lose hope for anybody.
Do you know about the Hearing Voices Network? Their work is phenomenal both to support voice hearers and to educate the public that you don’t need to be afraid of hearing voices, there are many ways to understand this phenomenon and to work with the voices.
I hope that the woman who is still institutionalized can learn about our movement and see if it is useful to her somehow.
I wish you success in your lawsuits, my legal work is only on international human rights.
Lawsuits are one way to seek reparations, and can also help to educate judges and the public about human rights and about legal theories based on non-discrimination and full equality. If you find any good lawyers, and if they are interested in bringing in human rights standards and/or legal theories, I would love to talk with them.
I think it may be relevant to look at the kinds of injuries I am describing, as well as the kind and severity of ongoing oppression, in relation to our inability to mobilize civil disobedience. Putting ourselves in a situation where we will be under the control of state authorities who might use their power to put us back in the same system of abuse and torture, is daunting. It can even be an act of self-affirmation to refuse to do that just to prove a point, to refuse to expose oneself to their violence.
Yet I think if a few people start it could be possible for more to join in, so long as there is a reason for the CD beyond the abstract idea of it. Aubrey Shomo’s acts of resistance are showing us that it’s possible to fight back using good strategy and to win. We can’t extrapolate exactly from anything to anything else, but that’s a start.
And I welcome your decision for anti-psychiatry and demand for full civil rights, government for and by the people and to see the “elites” brought to justice. We do have the power to speak out and to fight back, having a vision of what we want when we are doing that gives us a focus which is itself powerful.
Thanks for your comment Kim, glad to hear it resonated.
yes! that is what I have been most focused on also. as a survivor I feel that I have been bearing witness with that aim ever since it happened over thirty years ago.
Thanks for that, B. I admire those who resisted. When I was locked up, my inspiration was a woman there who kept her own clothes, very hippie-looking, rather than put on the degrading “hospital gowns” that opened either in the back or the front. And she refused to take drugs. She wrote poetry in a notebook she kept, she was from Israel and I remembered her talking to her little father in Yiddish. Eventually they put her in a straitjacket and injected her. I was transferred from that place soon after so I don’t know how anything turned out for her. But a very brief connection with this woman, whose name was Shoshanna, was one of the things that helped keep me going.
I hope that those who continue to expose psychiatry’s institutional corruption both internally and of our state institutions (I want to say democratic institutions, but democracy has been a facade for some time) will be successful in undermining it’s hold on the public imagination and public policy.
One thing I would add to your analysis, which is a little jarring to me from a human rights point of view. It’s not only that Murphy’s bill will introduce human rights violations – it’s that it will worsen existing human rights violations. Each and every instance of forced psychiatry that is going on under current laws is a human rights violation, and these laws have to be repealed or nullified, or simply discontinued in practice. We have to set the bar as high as we are fighting for – which is nothing less than the full abolition of all forced, coerced, deceptive and harmful psychiatry.
There are potential strategies that can be worked on even in the US. I hope to come back and pursue these when I’m done with my studies.
Dear Someone Else,
Thanks as always for commenting on my post.
I agree with you that there are not good prospects for reparations. Right now it appears that the only revolutions that are allowed to truly succeed are those that can be assimilated into global monopoly-capitalist patriarchy to make the populations more governable. It is a bleak assessment and a bleak reality. I sometimes view what I do as preparing the groundwork, along with so many others, for what can come after, at a time when human beings may be more ready for being, I want to say, fully human in the sense of being aware of responsibilities for self and to others in ways that can let us live in greater harmony.
It does seem to me that psychiatry as an industry of social control allied to the security state is strong, given the alliance of corporate rule to the security state in general, which is reducing the scope for citizenship and democracy (citizenship in the sense of responsiveness/taking responsibility for the well-being of the community, and democracy in the sense of collective decision-making; not citizenship in the nationalism sense or democracy in the ideological sense). It will be interesting to see where the critiques by Whitaker, Gøtsche and others will go, how far, and whether the CRPD requirements to abolish incapacity, commitment and forced interventions will be actually implemented anywhere. I have hopes still for what can happen in places where psychiatry does not have such a stranglehold as in the US, and in the US itself possibly hopes for changes at the local level based on strong community organizing and incorporating CRPD human rights concepts and principles.
As for gaslighting, I agree that this is a big part of what psychiatry does, and also a big part of the way that people purporting to be our allies in the human rights field at times claim to agree with us but actually in the fine print are still allowing for forced psychiatry to continue – not saying emphatically it has to stop now, and taking action to make that happen. Some of it is actual constraints but a great deal is accommodation to what people are being told is the right way to do things, to go slow, not antagonize too much, etc. And then they don’t want to outright disappoint us but they are not coming all the way.
What you say about corporate personhood, and the severing of the link between spirituality and law, is interesting. I have thought about the link between on the one hand granting personhood to fictional legal entities, and on the other denying it to human beings (legal incapacity, and forced treatment/commitment which is in part also a denial of legal capacity). It would be interesting to address this aspect of psychiatric abuse in some way, someone could do it graphically.
Thanks again for your comments, it helps to think together and maybe we will find better ways to fight back and win.
I started to reply to you but internet wasn’t working and reply got lost in the ether.
It looks like you are commenting on the article that I linked in my post, rather than on the content of my post itself.
For me, spirituality is not something that belongs to any religion, any philosophical perspective or any discipline or practice. It is as accessible to any of us, as the air we breathe. Feminism promoted this insight for example in Robin Morgan (I think) ‘s classic saying, any woman can be a witch. All she has to do is say, I am a witch, I am a witch, I am a witch. It has to do with an intentional openness and exploration, it is inside each of us.
Mindfulness, as you point out, does not necessarily imply spirituality, but it is one way of getting there.
And spirituality is not so far away from healing. For myself, I had a dual practice for a while, focusing on healing and also on exploring spirituality. After a certain point they merged. This is a similar theme I have found repeated in my life, that I start something new that is separate from other things I’m doing, and eventually I find that it has a point of convergence or merges into a larger pattern.
That is actually what I am finding now with the links between spiritual and legal responsibility. It is complex and not resolved, but certainly interesting to explore.
Replying to the reply of theinarticulatepoet below (because this website limits the threaded comment back and forth, apparently):
Your comments are a reminder of the two potential ways to define what a mental health law is, that I was alluding to but didn’t bring out clearly enough.
One is “Mental Health Acts” that authorize and regulate and provide for so-called procedural safeguards on commitment and forced treatment, and sometimes guardianship. This is clearly contrary to the CRPD and such legal provisions need to be repealed – not reformed.
The other is simply the concept of legislation in the field of mental health services. It is better I think to say legislation regarding the services, than legislation regarding “mental health” – nobody’s mental health (experienced or alleged) should be the basis of legislation; as is said about reproductive rights, “Keep your laws off my body.” In the sense of legislation with regard to mental health services, I think it’s possible to have a mental health legislation that prohibits rather than permits forced treatment and detention, and sets out new policies and guidelines following from this principle and from the shift away from medical model. The question would be, whether the very concept of a mental health legislation would evoke for too many people involved the old paradigm of coercion and control, and whether they would be able to separate this definition from the other one.
So with that in mind – if a mental health law could be devised that prohibits forced treatment and detention, etc., as I laid out in the original post – do you think it would be desirable? Or, do you think that it will just not be possible to make this distinction and people will misunderstand the intent and think we are about reforming rather than abolishing psychiatric commitment and forced treatment?
With respect to civil and criminal laws needing to be changed to deal with situations now addressed in mental health law – what do you mean? In my view (and as I understand the CRPD), situations of conflict and potential need for support involving people with (experienced or alleged) psychosocial disability need to be dealt with in non-discriminatory fashion, including respect for the person’s legal capacity to make decisions. Support has to be offered and provided in a way that respects the person’s autonomy and choices. What need do you see for particular changes in other areas of law?
I don’t suppose that this website will let you reply underneath me but maybe you can do as I did and reply above, if you want to continue discussion.
Thank you Olga for exposing the way that these psychologists talk about forced treatment and for your pledge to never diagnose anyone and never condone forced treatment. I wonder how many others would take that pledge? In psychiatry, psychology, social work, psychiatric nursing or any related profession?
That’s exactly my approach from the beginning, rules and laws are created by humans and can be changed by humans. I did have many moments of contemplating how big a change could be brought about by what we were creating in the CRPD and checking every angle to make sure I was satisfied no one was going to get hurt in the process, if it is done the way we envisioned. Thanks for your thoughts.
Yes, there is a need to change both law and practice. Use of restraints – chemical and physical – is something that can be prohibited by law also, if it was possible to get the political will to make that kind of change. I know the real problem is political will.
My aim in writing this post was 1) to say to those who think that there’s a need for some mental health legislation but may not understand completely what mental health legislation has been or what it might be, ok, if you want to legislate in the mental health field here’s something useful you can do. And 2) to say to those who want to use the concept of CRPD-compliant mental health legislation as window dressing for creating what is really CRPD-non-compliant legislation, no, if you are using this concept here are some parameters of what it has to mean. It won’t create political will if there is really none, but if there is a political will to do something and there is room for advocacy about what exactly will be done, that is the value of such a proposal.
The CRPD Concluding Observations on Denmark said that Denmark’s Psychiatric Act violated the right to liberty and security of the person, and that the government should take measures including revision of this Act to ensure that people with disabilities enjoy this right. So you have an opening to push as a first step for a process of review, that should prominently include the psychiatric survivor community.
I am aware of problems in Denmark that make this kind of advocacy difficult, and certainly in the US we are not there either. But I see it as a global struggle and am interested in any advance that could happen in a country where there is a review process going on and there is some potential for movement.
Why do you think 1) that it’s desirable to have no mental health laws at all and 2) that it may not be possible?
What does a “mental health law” mean to you? (Is it a law that regulates forced treatment and commitment, or something else?)
These are the kinds of questions I’ve been trying to explore.
And Murphy’s legislation is of course the conventional kind of mental health law that is a tool of oppression. Do you think that even talking about a CRPD-compliant mental health law opens the door to people thinking that we can compromise? Or do you think it would be at all interesting to say to those who think the mh system and its laws are broken and need to be fixed, not “here’s a compromise where we agree to give up some of our rights but not all” but instead “here’s our vision, it can be put in the form of a law also”.
Good luck uncovering the truth and seeking justice in whatever way you do. For some of us justice comes in vindication of our personal case, for others in joining the fight to stop the violations, or both. Speak out, yes.
yes it is. what do you make of it?
Nancy, thanks for commenting. Would you care to provide a link to your article? I would be interested and other readers of this post might be also.
I would love to have ways to get together and work on how we can implement restorative justice/rights of redress for survivors of psychiatric torture. It’s a movement whose time has come.
Yes. Our movement has been saying it’s torture since before the 10th International Conference Principles – and we’d know it’s torture even if there was no official recognition anywhere.
The Committee on the Rights of Persons with Disabilities is the most important official body that can start to act on these claims. While the US hasn’t ratified yet, 152 other countries have, and many have also ratified the Optional Protocol, which allows individuals to make complaints that the Committee adjudicates. They don’t have a marshall to enforce their decision but it can be a very significant step if they would direct that a country is obligated to make holistic reparations to people harmed by forced psychiatry.
MIA readers in countries outside the US should consult this table of ratifications – http://www.un.org/disabilities/countries.asp?id=166 – and check especially the last column which shows if a country has ratified the Optional Protocol. If it has, you could have a good strategy in getting people together to bring a complaint. Contact me through MIA website if you do anything like this so those of us active at international level can advise and support.
We are devastated in so many ways. Honoring ourselves for surviving, is also part of what I call self-reparations.
I’m trying to plan either a webinar, or series of webinars, and/or next blog post, that would help to carry the discussion forward to what we all might do, beyond what’s suggested briefly here.
I think it’s not only law but politics. Law is made by human beings; it works according to certain rules and principles, but it is malleable and provides for changes – e.g. not only by court cases in our system but also by legislation, and even constitutional amendment though we know how hard that is.
Last night on Lauren Tenney’s radio show, Sarah Knutson and I were having some of this discussion about what could be possible using our US legal system, and I have also talked about this in some of my presentations over the past year. Maybe it is time for a dedicated slot to look at all the ways we can use human rights law and mechanisms creatively given our legal system that doesn’t allow it much scope. I will think about doing that sometime soon.
That certainly qualifies as torture of a child, I wonder if you could get media attention or other advocacy to help where you are. If you want to email me through the MIA website I can see if I know anyone in your area – but you likely know the available resources better than I do.
Internationally you could make an urgent appeal to the Special Rapporteur on Health – http://www.ohchr.org/EN/Issues/Health/Pages/SRRightHealthIndex.aspx – or the Special Rapporteur on the Rights of Persons with Disabilities – http://www.ohchr.org/EN/Issues/Disability/SRDisabilities/Pages/SRDisabilitiesIndex.aspx. Despite the name, this doesn’t get truly immediate action, but if you are interested email me on that also and I can tell you more. I am suggesting these two particular Special Rapporteurs based on my knowledge of the individuals holding the mandates and their positions on the issues.
I agree with you about reparations. It can be key to looking at all the different ways harm is done to individuals who are forced, to all those of us who are labeled and “othered” by psychiatry, and to society as a whole. In the US we are far from getting anything of this into national or local policy or law, but anything can happen. One interesting possibility is working on local human rights ordinances that would include these issues ideally in a reparations framework, in a community where there is some awareness and solidarity.
Chiming in here to offer support to Sera and Western Mass RLC. There is a persistent strain within capitalism itself of people rejecting the ordinary ways to make money, but often as it seems to be in Alex’s narrative it becomes a personal bootstraps story, if I can do it so can you. This is a narrative entirely within the capitalist/individualist framework. However many times it gets tried, in however many places, these initiatives don’t abolish capitalism and don’t change the conditions for the majority of people who continue to be oppressed by it. I’m all for entrepreneurial solutions and for all the kinds of creative ways that people find to make a living and get their needs met in spite of the toxic economic system we live in. I’d say that virtually all of them require making some kind of compromise, having some area of life left that we don’t look at too closely because we are all tied up in it somehow. If you are depending on donations from others, they are getting their money from somewhere that you choose not to engage with. That doesn’t mean we can’t have ethics, we have to – especially around not allowing the state to pull our strings. But in terms of capitalism itself, it’s seriously unfair to expect peer supports and other radical movements to live on air. This has been a debate in the left as far as I can see so long as there has been a left. It won’t go away until capitalism does.
I do think that for our movement the debate sometimes also relates politically to the question of whether peer support should be a service or whether it should be something we do for each other simply as a way of creating community (e.g. the way churches, synagogues, temples or mosques can create community). And I would say that there is a need for both, because people who care enough to spend a lot of time and attention offering support, who love it and want to do a lot of it, should be recognized as doing work and supported financially for it.
I’m interested in the whole issue of what happens when people just use peer support places as day hospitals – and the phenomenon of day hospitals itself. I think actually that this too relates to capitalism, in the sense that in our society there is pressure to “do something” with your days and to define what you are doing and who you therefore are. So day hospitals & the mh system with a mental patient label creates some slack and it’s hard to get out of it. While as I’ve understood what I read about peer respites and peer support, there should be some way to create slack for us to take time and pay attention to ourselves without having to worry either about being identified as a social/economic loser-mental patient, or as mentally-ill/chemically-imbalanced. In any case thanks for the article and discussion, I’ve shared on Facebook to show my support and draw attention to the cause and hope the movement succeeds in getting you back your funding.
One thing I’d like to raise here that has occurred to me on many occasions. I think there is a gender divide in talking about madness or altered state experiences, that we need to explore. I can identify with part of Dan’s experiences and other men who have explored their altered states from the inside out. But there is something I can’t connect with, and I’m not sure what it is. I could speculate that it has something to do with gendered expectations of self and others and by others towards the self, related to connection and solitude among other things – which is not a simple “men are this” and “women are that” but how any individual experiences and assimilates and relates to those expectations. But it also has to do with permission to talk about spiritual crisis and spiritual awakening, and how patriarchal religions create a binary where women are material and men are spiritual, and after centuries of this, it is still more necessary for women to treat our stories as private in order to protect something essential. There are a lot of spiritual narratives out there by non-mad women (or at least not saying they are, or have been, mad) but what I’ve seen by women doesn’t fill to its full capacity in the sense of really owning and affirming the public space to love oneself. (well OK, that reminds me there is Ntozake Shange’s “for colored girls who have considered suicide (when the rainbow is enuf)”…. “I found god in myself/ and I loved her fiercely.”) Food for thought.
This is a concern of mine also, and I have heard it raised often, especially by women who experienced abuse and trauma in the family. One aspect to consider even if the person is being asked who should be present, is, what happens if there is really no one you can think of? Or if you are tempted to involve the family because you want their love, but you get more heartbroken? It’s a lot to ask of any process or group of people to create a space to heal all of that. Maybe the starting point needs to be, not an assumption that you need an open dialogue with a bunch of people in your life or whom you want in your life (which would put pressure on the person to channel their wishes for healing into that framework) but, what do you need? Do you need to heal? Do you need solitude supported materially and practically with kindness? It’s also “documented” and known to many of us from experience that solitude can be a healer. This could also relate to the question above from Mad Ann, who asks what about people who have been too traumatized to create the heart-to-heart connection? There are many paths, we need at minimum connection in the sense of kindness and perhaps respect, combined with a good-faith empathy…. but people need to proceed in their own way in figuring out the life mysteries including the mysteries about connection and solitude.
Dear Sera and all,
Thanks for this post. I hear you being deeply affected by Ferguson and also by ways in which our own movement, or some sectors of it, may resist becoming politicized or human rights-oriented.
I heartily agree that we are a human rights movement. But I don’t think that anyone can afford to just invoke the concept of human rights without defining particular content. Until we created the Convention on the Rights of Persons with Disabilities with standards that call for the abolition of the particular kinds of discrimination that have done the most to harm people who experience altered states or have been labeled psychiatry, human rights legal standards excluded us no matter how much we thought of ourselves as a human rights movement. (And we did, we had the “international conferences for human rights and against psychiatric oppression”.)
Using the CRPD does not mean that we are limiting ourselves to being a cross-disability movement or a peer movement – it means that we bring something to the human rights movement as a whole, that others without similar lived experience don’t bring. So, the demands from the Ferguson protesters while I agree with them don’t encompass all of what we need. In particular:
– Right to legal capacity: right to have our decisions accepted even if a doctor, lawyer or banker doesn’t think we are exercising good judgment. An end to the ability of psychiatry to force treatment or hospitalization on anyone because “they lack capacity” since there is no such thing under the CRPD. (See Committee on the Rights of Persons with Disabilities General Comment No. 1, an authoritative interpretation, if the text of the CRPD itself leaves room for doubt in anyone’s mind.)
– Right to not be locked up based on psychiatric profiling as being dangerous, or based on anyone’s belief that we need “treatment” or can’t take care of ourselves. There is never any valid reason to hospitalize someone in psychiatry against his/her will.
– Absolute ban on forced psychiatric “treatment”/interventions, or treatment without the free and informed consent of the person concerned.
These standards are expectedly under attack from global and US psychiatry, and there is controversy now in some of the other UN human rights treaty bodies that don’t want to accept the CRPD. Many of us think it is inevitable that they will accept the CRPD standards eventually but those standards need to be defended.
So while I agree entirely that what is going on in Ferguson and around the country with racist violence and the militarization of police is relevant to those of us who have been labeled by psychiatry – and actually my FB feed is full of people making these connections, including the way the police treat psych-labeled people of all races, the “demonization” etc., though as a white person I really can’t in any way know what it is like to be targeted everywhere no matter what my behavior simply because of skin color and ethnicity – I think that the only way to come together for human rights is to contribute our own experiences and perspectives so that they don’t get left out.
This is true of every group, class, sector of the population who is harmed by human rights violations. We have to not just add/aggregate, but create synergy among all of them and work for a common vision. I am so deeply moved and encouraged by what young Black people are doing in response to Ferguson and earlier in response to the killing of Trayvon Martin. Personally I am becoming very interested in working on restorative justice in a way that takes into account the perspective of people labeled/harmed by psychiatry, who (for example) may have extra barriers to being open and trusting anyone if this is put forward as expectation rather than choice, and who may completely reject the idea of having treatment professionals involved in a justice scenario. I think all of us are being challenged to make the connections in our own lives and create something new, in whatever ways we can.
So great to read this. In the World Network of Users and Survivors of Psychiatry (www.wnusp.net) we have members in the Global South who similarly identify psychiatry as a colonial imposition. In one of our submissions to the UN we talked about psychiatry as a harmful cultural practice originating in the west and being harmful to people everywhere. That didn’t get much traction at the time but we will keep mentioning it in addition to the other advocacy points.
It was great connecting with you at NARPA, and I’m posting this on Facebook to share with global friends who might want to connect with you as well.
I agree with you about the need for other kinds of solution. I don’t know what makes sense in a pluralistic state society. I read as much as I can about indigenous justice practices which are hands on and face to face. People have to take responsibility for their action in this regard (such as shunning someone who has committed great harm and won’t mend their ways) and in that sense have a much more direct relationship to whatever social control mechanisms exist because individual members of the community operate these social controls directly. In contrast, in American society we operate these mechanisms in an alienated way – judges and juries don’t have to carry out the sentence, prison staff aren’t responsible for having imposed it, the general public wants more sympathy for defendants or more jail time but doesn’t have to take responsibility for consequences of either decision.
I would like to investigate more about community courts that are being started, unfortunately the mental health courts are one way that this happens and it is an illegitimate version because it perpetuates forced drugging and medicalization of life issues. But there are other kinds of community courts and it might have insights that are directly applicable to prison abolition in non-indigenous settings.
I think there are two points, one as to whether there would have to be an explicit claim of disability in order to invoke a request for leniency based on extenuating circumstances and what the impact of this would be, and whether there should be a determination of “diminished capacity” as such. The latter I think is clearly wrong and violates the equal right to legal personhood and legal capacity. The CRPD Committee has not ruled on this yet but in my opinion it is clearly implied, as I have written in several places. The former I think is questionable, I leave that open as to whether it will always result in discrimination and not real leniency, or whether it is possible to raise awareness and frame legislation and judicial obligations in such a way that it is a positive thing, akin to reasonable accommodation, and would carry no negative legal or social consequences.
There isn’t such broad leeway in all criminal justice systems as I understand it. If there is, then there should be no problem, and the insanity defense can simply be abolished without anything more. But I suppose that would want to have some way to raise awareness or provide for consideration within the context of a trial of contextual issues where discrimination and marginalization of perspectives might be resulting in unfairness. For example, if it is just not well or easily understood that a person can bring up strong fears of abuse based on past experience and have it seen in a sympathetic light, so long as the person doesn’t claim a license to abuse others on this basis, I think we need some way to make sure it can be brought in or some large-scale training for the judiciary and/or legislation to make sure there is a mandate to consider such issues sympathetically. That is what I’d be concerned about.
While both are incarceral systems, the psychiatric system pretends that it is not designed as a “justice” system or as a form of punishment. It is clearly designed as a form of control (witness the “danger” criterion as well as the use of intervention that disable a person from spontaneous and self-authentic action) as well as a way to absorb people who are considered in need of care and burdensome to their families or society. In psychiatry the incarceration is veiled as medical, and is also mixed, for some people, with access to help and support and desired services, and this creates both intentional and unintentional confusion about the nature of psychiatric detention and perceived necessity of it.
It’s interesting that looking at the interrelationship between the prison system and psychiatry, including the insanity defense and forensic psychiatry, makes it clear that both are incarceral systems that have much the same purpose of control and absorption of parts of the population that society, or social authorities, consider to be unproductive and potentially disruptive. Working on the CERD report (which can be found on the CHRUSP website http://www.chrusp.org), and reading in full Michelle Alexander’s The New Jim Crow, has helped me to appreciate more the destructive nature of the criminal justice system. And having read Michel Foucault’s History of Madness made me more aware of the common roots of the prison system and psychiatric institutions.
So we probably are moving towards a stronger and more informed advocacy for prison abolition along with abolition of forced psychiatry. I want to link these but also not wait to abolish forced psychiatry until we have the complete solution to criminal justice alternatives, since there is a clear rationale based on disability non-discrimination to abolish forced psychiatry from a human rights point of view.
Bonnie, you are probably right. For me it has been helpful to think through some of the issues this way in order to specify some of the concepts and to suggest what would have to be done and why it is not enough. Otherwise it is too easy for people to reject the advocacy to do away with both systems as being pie in the sky.
Thanks for your questions. I would like to work out some way that we acknowledge the impact of altered realities and serious distress on people’s decision-making, as it applies to acts that constitute violations of the criminal law – while still treating the person as a moral agent who is to be held responsible for the choices made.
Remember also that even the existing insanity defense – at least in the U.S. – is supposed to be not about your state of mind at the trial, but at the time the offense was committed. So I would say that the defendant should be offered the opportunity to describe any extenuating circumstances including anything that impacted on their decision-making at the time – and that the defendant’s lawyer could put on information and evidence, it does not have to be the defendant testifying if they don’t want to.
The question of competence to stand trial, in my view, should be addressed in the framework of universal legal capacity with support, as the Committee on the Rights of Persons with Disabilities has indicated in its Concluding Observations on Article 13 access to justice – so that procedural accommodations should be made, and support provided if necessary, so that the person is able to participate in the proceedings.
I see that in your country the two issues are disposed of together, as I know is the case in Latin America also – and in Japan under a relatively recent preventive detention law that diverts people whom the judge considers to have a mental disorder, into forensic psychiatry. This approach when the person goes into forced psychiatry deprives the person of the right to a fair trial of guilt or innocence.
As to how it should work without specifying that the defendant has a disorder – it could be done by having degrees of the offense that could be reduced based on various kinds of extenuating circumstances, or in any other way that a procedure could be devised that is inclusive and not discriminatory.
I agree with you that as it works in practice, it is not a choice between insanity acquittal and other acquittal but between insanity acquittal and a conviction of guilt. But it can be analyzed from a legal point of view in that, if it is considered an acquittal, why is it an acquittal where the person still goes to a type of imprisonment? So that is the reasoning that led the two authors I mentioned to argue that treating insanity acquittals differently from other acquittals is a type of discrimination.
I also agree that forced psychiatry happens in prisons too, and so it is necessary to apply all the human rights requirements fully to prisons so that forced treatment is prohibited and abolished, and people are entitled to non-discrimination, reasonable accommodation and needed supports and services on the basis of their free and informed consent.
Regarding your question about why a defendant should get the benefits of an insanity defense – your first sentence there seems to be missing some words, so I’m not sure I understand. My reason for wanting to see a slightly different twist to Szasz’s point of view is that I think there is insufficient appreciation and consideration of how a person is impacted by distress and altered realities, when it comes to criminal justice issues. I don’t think that it automatically means acquittal or a free pass. Instead, I see it in terms of considering how the world looked to that person at the time they committed the offense, and whether that would justify their actions or whether they should be held responsible for the choice they made that constituted a criminal act. There are some defenses in criminal law that already make provision for such a situation, and people with disabilities should be given the full benefit of those defenses. (My colleague Sarah Knutson made this suggestion and went into more details, which I set out in the article that I submitted for publication.)
There are likely aspects of all this I haven’t worked out fully yet in concept, but I am hoping that it provides a starting point for some useful discussions.
I’d like to make a clarification that occurs to me from re-reading my post. It’s not only “all or nothing” insanity acquittals that I object to but also any acquittal that is based on a concept of diminished responsibility in a way that relies on a concept of mental capacity. I recall the first-person story of Tristano Ajmone, told in a compilation by WNUSP and Bapu Trust, that discusses his own horrendous experiences in forensic psychiatry after a verdict of partially diminished criminal responsibility.
The aim of the kind of leniency I describe, is to have an inquiry that is disability-neutral, so that it does not stigmatize people who benefit from it. A verdict of partial or diminished responsibility even if not accompanied by forensic psychiatry still carries an implication that the person’s ability to be treated as a moral agent is inferior to that of others. For this reason leniency should be incorporated into concepts that are applicable to everyone, such as reduction in the degree of the offense. In some countries there is a broader approach to diminished responsibility per se that includes foreigners to the country and indigenous people. In such cases, I think it would be necessary to articulate what are the underlying reasons for the leniency and mainstream the issues of disability such as altered reality and extreme distress, so that we are not left with some version of the insanity defense that is ultimately an equation of actual or perceived mental capacity with legal capacity.
Sharon (and all),
Thanks for bringing this issue out. It is time for the movement to fully support individuals who are labeled as NGRI, which has not always happened due to many of us having our own prejudices about people accused or convicted of crimes.
I agree that we have to abolish the insanity defense and forensic psychiatry. While those two are not the same – in theory it is possible to abolish forensic psychiatry but retain the insanity defense – I think there are good reasons to do away with both.
Forensic psychiatry is just another psychiatric commitment and forced treatment regime and so it is wrong and violates human rights for the same reasons as civil commitment. With respect to the insanity defense, I think that we have to separate the question of moral blame and punishment from disability. What does it mean for anyone to know right from wrong?
It comes down to questions of subjective perception and experience, what did the world look like to the person when she/he committed the offense and given that, would we still apply a judgement of moral and legal responsibility? I would support this kind of inquiry to be part of an adjudication of criminal responsibility, if we want to accommodate concerns about unfairness in the application of criminal law to people experiencing altered reality. In a paper that I have submitted for publication, I propose such an alternative as a disability-inclusive way of dealing with fairness concerns that may not be otherwise accommodated, while the insanity defense as we know it should be abolished.
But at the same time I would be concerned about an open-ended inquiry that could simply accommodate existing prejudices of all kinds – race and gender in particular (witness the application of the Stand Your Ground defense).
In any case, thank you for opening up needed discussion. I had not been aware that John Rohrer’s case involved NGRI, but I wrote an affidavit for his case on the international law supporting a prohibition of forced psychiatric interventions. That can be accessed on the CHRUSP website at https://dk-media.s3.amazonaws.com/AA/AG/chrusp-biz/downloads/289371/RohrerAffidavit.pdf or on PsychRights.
It’s ironic that Australia has made interpretive declarations on the CRPD saying that they don’t agree with abolishing substitute decision-making or abolishing forced psychiatric treatment – i.e. they don’t want even adults who are labeled with psychiatric diagnoses to have the right to make decisions for themselves or to refuse treatment.
I agree with your premise that this is about manipulation of children but let’s not forget that children are made powerless by not having the right to refuse when their parents put them into psychiatry – parents are manipulated too.
Children should certainly have the right to refuse on their own. I suggest that psychiatric treatments – including neurotransmitter drugs – should be seen as an intrusive treatment because of the effects on the mind and brain and personality as well as danger to overall health. I’d rather see no such treatments on children at all, and to ban them entirely below a certain age.
I am not sure what you mean about judging ourselves by invalid criteria. I am saying precisely that we need to create a cultural space for conversation about certain experiences, on our own terms – as people who have had those experiences. This brings it into the wider discourse and does not marginalize it. If the specificity is not described and delved into, it continues to be marginalized by denial and dismissal.
Thank you for this contribution. While I agree with you about the interconnections, I cannot see the kind of healing I am describing as being self-referential; as I said it is a healing that is nearly synonymous with justice, where healing and justice are two sides of the same state of harmony that is sought. I don’t see it as being individually achievable in an absolute or complete sense (or perhaps even in any true sense) without the transformation of society.
I don’t think that we can ignore the personal either. If we try to be there for others while we ourselves are empty, we will give our emptiness to others and suck them in in a negative way.
With respect to the question of whether we are a distinct group in society or are issues are separate from others. I think they are not separate so much as specific. Without naming and describing particular experiences, without insisting on opening the space and creating the language for them, those experiences are being silenced and those who have the experiences are marginalized. Conversations about poverty are another aspect that has to be brought to the foreground. That is not my lived reality now and I deliberately spoke from my own experience in this post, but I want the conversations to be about articulating all the aspects of our lives that we speak about to ourselves (I mean even in our own thoughts) but hide from others because we are judging ourselves by criteria that are not really valid once we are able to see it critically, with a lens of human rights or non-discrimination or whatever allows us to get that perspective.
Something is missing culturally – not psychologically in my mind – because we are lacking these conversations. Culture is something, like politics, that is itself contested but is not inherently a thing of privilege. All human societies create culture – meaning, beauty, values, knowledge, technology – and it is essential in my view to any movement for social justice. Culture requires specificity, description, creativity.
I want our movement to go beyond recovery narratives and bearing witness narratives. I see that as essential politically as well as personally.
I do not know if you and I will agree, but thank you for the discussion.
B, have you seen the CRPD Committee’s Concluding Observations on Austria? There should be ways to follow up with the government to publicize the Committee’s recommendations and urge them to follow through. They are very strong on abolition of psychiatric commitment. http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRPD%2fC%2fAUT%2fCO%2f1&Lang=en.
I also see that Austria has ratified the Optional Protocol, which means that if a person’s rights under the CRPD are being violated and they have exhausted domestic remedies – meaning that they have pursued without success all the legal avenues for relief available domestically – they can make a complaint to the CRPD Committee. The Committee is not a court but its views on individual communications should carry considerable weight. See the left hand menu under Complaints Procedure, http://www.ohchr.org/en/hrbodies/crpd/pages/crpdindex.aspx.
I did not find the author’s name anywhere in her letter. She is using a common tactic to divide us from one another in the movement against psychiatric oppression. I am one of a vast number of people with a variety of experiences long and short in the psychiatric system who consider it to be torture and arbitrary detention.
As far as what can be done for this family – the mother’s narrative is a good example of how the mental illness story takes over and allows people to justify acts of disrespect and violence that they ordinarily would avoid. I agree with B (below) who suggests that Open Dialogue could have been helpful. At this point I can only hope that all those involved find their way free from blame and create healing in their lives.
Thanks for the comments. I see that most of the comments are from the U.S. – and I’m aware that my posts may have contributed to some confusion about just what is the position of the U.N., and how it all relates to us.
My advocacy is for the worldwide movement; while of course I want it to have an impact in the U.S., I am well aware that the U.S. is not going to be on the front lines of change. That honor will go to countries in the Global South that have less psychiatry and in some cases do not have any specific legislation that authorizes involuntary commitment or compulsory mental health treatment. For example, my colleague in Peru, Alberto Vasquez, tells me that his country has no such mental health legislation and, while “emergency” treatment is permitted under a general health law, this is rarely used. Alberto and his colleagues are working to reform the Civil Code which deals with legal capacity, to come into compliance with CRPD Article 12, and as he said in our side event at the UN last Tuesday, he looks forward to using the General Comment to bring this change into being.
Of course, Peru has ratified the CRPD, without any reservations or declarations, as have a total of 144 countries (a few unfortunately with reservations and declarations). Only those countries that have ratified the CRPD are directly bound to its obligations, and it is those countries to which the Committee on the Rights of Persons with Disabilities has addressed its guidance in the General Comment on Article 12.
The United States has not ratified the CRPD though it has signed it. As a signatory, the U.S. is bound under international law not to undermine its provisions, and to abide by its principles. The U.S. flagrantly violates this obligation with the psychiatric profiling done by President Obama last year, stirring up bigotry by saying that people labeled with psychiatric disabilities should be targeted for special scrutiny in measures to prevent gun violence. And now if it passes the Murphy Bill, this will be another flagrant violation. There is one potential option we could have to call attention to this violation of obligations under international law, the process known as Universal Periodic Review in the Human Rights Council. But we cannot appeal to the Committee on the Rights of Persons with Disabilities, because that is only for people in countries that have ratified the CRPD.
You may have seen my other recent posts about the Concluding Observations of another treaty body, the Human Rights Committee, which were directed at the United States. The Human Rights Committee monitors the International Covenant on Civil and Political Rights. It is the oldest treaty monitoring committee and it took this generic name which is sometimes confusing. The United States ratified the ICCPR and so has to make periodic reports to the Human Rights Committee, after which the Committee makes Concluding Observations commenting on progress and recommending specific actions for change.
The Center for the Human Rights of Users and Survivors of Psychiatry, with several other endorsing organizations and individual volunteers, made our own report on the U.S. to the Human Rights Committee, arguing that forced psychiatric interventions violate the prohibition of torture and ill-treatment that is found in the ICCPR. We knew that the Human Rights Committee was less likely than the CRPD Committee to give us the Concluding Observations we wanted. But we were encouraged by the questions asked of the U.S., including the great questioning done by Ms Zonke Majodina, Human Rights Committee member from South Africa.
Unfortunately, the Human Rights Committee stayed with its standard that allows forced psychiatric interventions although they significantly narrowed the scope and acknowledged the possibility that it may not be permitted at all. This is progress but of dubious value. CHRUSP and our global allies will continue the advocacy for the Human Rights Committee to adopt the same standards as the Committee on the Rights of Persons with Disabilities.
From now on, I will try to identify the specific UN mechanism that is speaking and not use the shorthand of saying the “UN” pronounced on something. It’s going to be complicated to use any of these things in the U.S. but that doesn’t mean that the revolution being carried with and through the UN – through the Convention on the Rights of Persons with Disabilities, its monitoring committee (the Committee on the Rights of Persons with Disabilities) and any UN mechanisms that are influenced by it, in particular – has no value. It is a worldwide revolution and a worldwide movement, and it cannot help but affect the U.S. as well.
After I shared this post and the earlier one, https://www.madinamerica.com/2014/03/un-us-generally-prohibit-non-consensual-psychiatric-treatment/ on email lists, Lauro Purcil from the Philippines asked some questions that allowed me to clarify further. With his permission I am posting his questions here with my answer.
I would still need to read carefully several more times to absorb the views you expressed in this posting.
Some questions came to my mind:
1. Is it right to have the impression that due to the fact that there are certain psychiatric conditions that are not yet understood and fathomed, such as those who are termed “not even interested to bother and be asked for consent,” we may tolerate the acts of forced medication and non consensual detention?
2. The Human Rights Council’s recommendations may still be reviewed by the International Committee on the UNCRPD? We would need to be informed at this stage, what now has the International Committee reccomended if any on the issues tackled by the HRC?
Consider these questions from someone who has yet to understand some psychosocial conditions.
Thanks for the good questions.
1. No, it is not acceptable that there should be any person who should be deemed “not even interested to bother and ask for consent” so as to tolerate forced medication and nonconsensual detention.
And you are right to point out that this is a problem. Full legal capacity means that we have to ask about the person’s will and preferences and not treat them as if they are an object and anything can be done to them.
Often it is clear that a person doesn’t want it. But the context of power inequality and a narrowing of the person’s options leads to the situation where many people do not object, and go on to accept the medication or electroshock or even the detention or restraint, because they do not feel that they have any say, and they might not effectively have the power to say no. So we need to address all these situations and ensure that everything being done in mental health services is being done in accordance with the person’s own meaningful choice.
We often say that the crucial thing is whether something is going against the person’s will. But that doesn’t mean that if a person doesn’t actively resist, that anything can be done to them. In this way all issues related to legal capacity and consent are similar to the issue of consent in sexual relations. Under patriarchal laws a woman had to show that she actively resisted, in order for the act to be considered rape. But if you are met with a gun or knife, or overpowering physical strength or even the male power that has been directed against you in society since you were born, you might choose to submit to aggression rather than fight back. It does not mean that the act was consensual. Submitting to aggression is not the same as choosing something of your free and informed will. The same applies in the context of psychiatry and mental health services, and in relation to all acts related to legal capacity, especially where it concerns the integrity of the person but really in any aspect of life.
2. These are recommendations of the Human Rights Committee, not the Council. The Human Rights Committee monitors compliance with the ICCPR, just as the Committee on the Rights of Persons with Disabilities monitors compliance with the CRPD.
The U.S. has ratified the ICCPR, but has not ratified the CRPD. Therefore the CRPD Committee cannot make concluding observations on the U.S.
We are working to encourage the Human Rights Committee to harmonize its standards with those of the CRPD, and particularly with the interpretation of the CRPD by the CRPD Committee, which is the authoritative body within the UN to say what the CRPD means and how it applies. Members of the Human Rights Committee in the past expressed their own views about the meaning of CRPD Article 14 and did not see it similarly to the CRPD Committee. Now three things may help to change this situation.
First, the CRPD Committee last September came out with clear and unequivocal Concluding Observations that show Article 14 prohibits all involuntary commitment and detention in mental health facilities.
Second, WNUSP members have been actively working to bring information to the Human Rights Committee in country-specific situations and we believe that the Committee is becoming more open to understanding that forced psychiatry is like rape or other violence and is not in any way acceptable as treatment. Personal testimonies and related evidence of the harm and suffering inflicted are important to continuing this process of awareness-raising.
Third, the CRPD Committee has been doing its own outreach to the Human Rights Committee on the issue of psychiatric detention and nonconsensual interventions, which are prohibited under CRPD Article 14. We had the impression that this outreach was helping to create more of an opening for the HR Committee to hear us and consider changing their positions.
The Human Rights Committee is independent from the Committee on the Rights of Persons with Disabilities. It is not obligated to follow the same standards as the CRPD Committee, but given that the CRPD has a higher standard of human rights protection in this regard it is highly questionable for the HR Committee to continue to adhere to a lower standard. I think that eventually it would be seen to the detriment of the Human Rights Committee if they continue to maintain the inferior standard (allowing psychiatric detention and forced interventions as a “last resort” etc.).
3. To answer a question you did not ask: I think it is valuable to acknowledge progressive movement and struggling to understand and internalize what we are bringing to them, which is a change in how they have previously understood international law, even at the same time as we do not accept the standard the Human Rights Committee is using. We want them to continue moving, all the way to a standard that is the same as the one under the CRPD.
Also I think we have to figure out ways to use a recommendation that still endorses human rights violations, but that shows that the standard is in flux and is moving towards a complete prohibition, that acknowledges the harm being done, and that calls into question the central premises on which the existing mental health system is based – and to use the recommendation in a way that in no way endorses the human rights violations ourselves. Maybe it cannot be done. It is a challenge and we will have to see if it is possible.
The reason for wanting to try, is to activate the discussion in the U.S. that should have happened after the National Council on Disability recommended that federal policy move towards a totally voluntary mental health system, in January 2000, to create some space and get some movement happening in federal policy and state policy. There are supposed to be follow up mechanisms provided by the U.S. government and we can explore whether a meaningful conversation can be initiated about how we will abolish forced psychiatry, or whether it is not possible. And if it is not possible, we bring this back to the HRCmte and follow up with them; if it is possible, we can acknowledge any progress that is made and then ask the HRCmte next time to tell them how to move further.
It is complex advocacy because we are advocating for the treaty body to change its own standards at the same time that we are advocating for the changes in domestic law and policy.
4. To answer another question –
It may be an unfortunate choice of how to express myself, that I am referring to the “UN” generally in my blog titles; I have done that because many people reading the blogs are not aware of what the Human Rights Committee is, or the Committee on the Rights of Persons with Disabilities, and I wanted to be concise. But I see that it might create misunderstanding about what is the “UN” standard.
I would say that the CRPD Committee is overall a higher authority in the UN on the question of the rights of persons with disabilities, than is the Human Rights Committee. This is because they are dealing with the treaty specifically on these questions and they should be the people with the greatest thematic expertise on these issues. But also, in the UN system the highest standard of human rights protection should be the one applied.
The Human Rights Committee is still relevant especially to countries that haven’t ratified the CRPD, and because it is not desirable to have any treaty body apply inferior standards.
After I shared this post and the second one, https://www.madinamerica.com/2014/03/staying-new-paradigm-thoughts-human-rights-committee-recommendation/ on email lists, Lauro Purcil from the Philippines asked some questions that allowed me to clarify further. With his permission I am posting his questions here with my answer.
The work I do is intended to give us all better tools with which to actually eliminate human rights violations such as forced psychiatric drugging, in prisons as well as psychiatric institutions. Without false modesty, I can say that my work has already given us many such tools at the international level. Next week I head to a meeting at the UN in Vienna that is specifically to address revision of an outdated document on the rights of prisoners. I hope to succeed in eliminating parts of that document that endorse forced psychiatry in prison and to replace them with standards for equality and non-discrimination, and for support that respects the person’s autonomy and choices, in line with the Convention on the Rights of Persons with Disabilities.
I invite discussion with currently and formerly incarcerated people and with prison advocates; you can contact me through MIA or through the CHRUSP website.
I hear you Steve and respectfully I disagree. The protective detention is generally framed within a mental health context so that it is still both discriminatory and intrinsically related to forced treatment. I have seen in the context of court hearings and also in the experience of friends in the system, the power of detention is used to coerce people to waive their rights to refuse treatment, even when the system is recognizing such a right. I think we mentioned this too in our shadow report to the Human Rights Committee, as one form of nonconsensual drugging. You can read our report on the CHRUSP website linked on the home page, http://www.chrusp.org.
Many people do have questions about how to meaningfully support someone who is suicidal or self-harming, while respecting the person’s autonomy. Work is being done by activists who come from lived experience of these issues and also work on supporting others, who understand detention and other coercive measures such as restraint and solitary confinement – not only forced drugging/ECT – to be harmful as they cause terror and powerlessness, adding to an extreme state rather than helping the person to come through it. (I would say that this was certainly true in my own experience.)
Many of us have also thought a great deal about the norm of universal legal capacity as articulated in CRPD Article 12, and what it means to eliminate substituted decision-making and offer support that respects the person’s right to make decisions, even in crisis situations. (See the CRPD Committee’s draft General Comment on Article 12, the section on 12.3 dealing with access to support, which you can read at http://www.ohchr.org/EN/HRBodies/CRPD/Pages/DGCArticles12And9.aspx). I have written my own explorations of this question in a paper titled CRPD Article 12 and the Alternative to Functional Capacity, available on SSRN http://papers.ssrn.com/sol3/cf_dev/AbsByAuth.cfm?per_id=1348856.)
Our job is challenging because we are confronting a system with multiple complex violations. I think that our advocacy to the HR Committee showed that it makes sense to bring out the complexity. We focused on forced drugging in psychiatry because that is what had engaged the Committee’s interest, but brought out the context in which forced drugging takes place because in our experiences and in society it is interconnected.
Thanks again for your response and the discussion.
While I agree that detention that is based on dangerous behavior without any reference to a psychiatric diagnosis would not violate the CRPD, such detention, called “preventive detention” because it is imposed when no wrongful act has actually been done, in order to prevent one from occurring, is universally frowned on in the human rights world. It is notoriously difficult to predict future behavior and it is easy for such detention to become arbitrary if it does not start out that way.
I’m interested in what makes sense to stop acts of violence, and from what I see I tend to oppose any kind of preventive interventions done on individuals, rather I would focus on training first responders and security personnel as well as anyone who might have to play such a role on how to do the dangerous work of de-escalation and confronting someone intent on violence.
Thanks for your thoughts on this.
Don’t give up hope where you are. If your government has ratified any human rights treaty you can participate in a similar process to what we have done here. You can contact me and I’d be happy to advise at least on some of the basics of where to find information and what standards should be applied.
Thanks for these detailed comments. You raise a number of issues about the culture of compliance, the NIMH new approach and how it may affect routine mental health practices – I’d like to understand it better but it sounds like it amounts to mass nonconsensual experimentation – and mental health courts. Those are all important to bring to the table if and when we have opportunities for a meaningful dialogue with the federal and state governments, and also for the next shadow reports. (There are opportunities to report under the Convention against Torture and the Convention on the Elimination of Racial Discrimination later this year, and in the Universal Periodic Review process next year. I have not decided to what extent I can work on these, and would welcome others to join me. The next reporting opportunity under the International Covenant on Civil and Political Rights will be four or five years from now.)
And thanks for the information about PAIMI. It ends up being something of a non-issue but it’s good to know.
Thanks for this comment. In my experience of UN advocacy, it seems that it can contribute to opening up space for more people to see that forced drugging is wrong, that it amounts to torture when used against us just as when it is used against political prisoners (and some of us justifiably consider ourselves to be political prisoners also). Manfred Nowak when he was Special Rapporteur on Torture (in the report of 2008, UN Doc. A/63/175) addressed this directly (paragraph 62-63 of the report).
I think ultimately we are appealing to others who are not ourselves, who have not directly experienced psychiatric torture, to understand that we are human and have human rights. This is true whether we are appealing directly to the society around us, or to the UN. At the UN there is a stated commitment to principles of human rights including discrimination, and mechanisms of participation by civil society along with governments that can make for a more open process of seeking systemic justice, than we often find in the political process or in domestic courts. Sometimes there are such openings in domestic law and politics also, and we need to both create these and honor them when they occur.
I hope that the positions taken by UN bodies, as well as the forum the UN gives us to make personal testimonies and the ripple effects as other US non-governmental organizations hear us and express solidarity, will start to make the general public question their comfortable beliefs. And on that note I’d like to share Aubrey Shomo’s powerful testimony given to the Human Rights Committee just before they started the dialogue with the U.S. government on Thursday. http://youtu.be/biFui1PtUn8.
I agree with you. Next time it would be great to include this information. There is so much to address and we missed this one.
I do not know what Dr Jones referred to in her statement about federal law, as I am not aware of any such standard particularly with regard to a prohibition of nonconsensual psychiatric medication. Also, the constitutional standards and regulations to which she refers fall short of a prohibition, although Jim Gottstein has argued that if interpreted properly there would be no instances of forced drugging that could meet the constitutional standard.
I think Ms Majodina’s follow up comments suggest that she also did not take Dr Jones’ response at face value.
We await the Concluding Observations to see how to move forward from here.
I am not sure what Dr Jones was referring to when she made this comment. Federal law does not actually prohibit forced psychiatric interventions, to my knowledge.
The issue of life-saving interventions needs to be distinguished from forced psychiatry, which does not have a direct effect on the body’s capacity to sustain life. Rather psychiatric interventions affect consciousness and behavior. I write some about this in my response to the Special Rapporteur on Torture’s report on torture in healthcare settings, http://antitorture.org/wp-content/uploads/2014/03/PDF_Torture_in_Healthcare_Publication.pdf. Interested to know your thoughts on it, but I made an attempt there to distinguish, and maybe not as clear and what I wrote in this paragraph.
Thanks for your thoughtful comment about the obstacles to implementation. If we get good Concluding Observations, we will be advocating for a process with the federal government to follow up and discuss how they can be implemented. Let’s discuss more at that time.
It’s true that on the issue of detention the report was self-contradictory. But on the call for an absolute ban on forced drugging etc. it was unequivocal. Since that report and the statement, the Special Rapporteur has issued additional official reports and public commentary that contain further contradictions, but the report still exists as a UN document and should be upheld to the extent that it is favorable. The aspects of the report that are self-contradictory and not in line with the CRPD – such as the part of the paragraph you cited that opines that detention could be based on danger to self or others – should be disregarded as they do not reflect accurately the most authoritative international standards. The Committee on the Rights of Persons with Disabilities, which is the authoritative body that interprets the Convention of the same name, holds that danger to self or others standards cannot justify psychiatric detention and that no one should be detained in any kind of a mental health facility. (See my blog posts https://www.madinamerica.com/2013/10/un-leaves-no-doubt-end-mental-health-detention/ and https://www.madinamerica.com/2013/09/un-ensure-one-detained-kind-mental-health-facility/.)
In the Special Rapporteur’s statement last year to the Human Rights Council he did reverse himself, as we had requested. This year he seems to be moving back to the danger criterion, in his report on a visit to Ghana and on a case of forced psychiatry in the Netherlands. It is a flaw in the Special Rapporteur’s jurisprudence that we should be aware of in considering whether to submit cases to him.
The call for an absolute ban in last year’s report, in my opinion, continues to have validity irrespective of whether the mandate holder still agrees with that position. We do not know what made him change his views, but we do know that the World Psychiatric Association and American Psychiatric Association sent him a letter, which is included along with his response in a compilation that has just been published. I have an article too in that compilation, which you can read at http://antitorture.org/wp-content/uploads/2014/03/PDF_Torture_in_Healthcare_Publication.pdf. See also his Introduction to that compilation.
We hope that the Human Rights Committee will continue to move even closer to the standards of the CRPD Committee, and we are aware that the CRPD Committee has sent a letter about this to the Human Rights Committee, though the contents of the letter are not public.
And we are hoping that the Concluding Observations that are to be issued by the Human Rights Committee will be something we can work with to open up space for abolition of all involuntary commitment and forced interventions in the psychiatric system.
Thanks for that comment. I agree.
I think History of Madness is valuable despite its flaws, particularly for me in its dealing with madness as a social construct that is closely related to both legal incapacity and social denunciation – and even more, to a kind of moral shaming and segregation.
What I’ve been thinking in relation to the medical model – part of the reason it is so damaging is that it is not a healing model but rather a model of social denunciation and moral condemnation. The concept of “mental illness” is different from the belief in a mind-body continuum that is part of many systems of holistic medicine. The main reason for this in my opinion is the moral values that adhere to “mental illness” – so that it operates irrespective of whether a person suffers subjectively or not, objectifying the person. Some of the versions of what people consider “alternatives to the medical model” still retain a reference to mental health, and in that sense still seem to be partly situating themselves within a model of health and illness, or distress and well-being – whereas there may be many other ways to conceptualize what is going on: social conflict, spiritual crisis, good and evil, etc. I’d like for us to explore what “mental health” means and whether we still want to use that terminology and concept, even if we are coming at it from a perspective of empathy and respect for a person’s self-representation and self-knowledge.
What I’m aiming to do in some of my work now is to explore how the current forms of psychiatric oppression are connected to deeper structures precisely in order to work on ending those deeper structures or anticipating them at the same time to the extent possible.
In short, I agree. Thanks for commenting.