Monday, January 27, 2020

Comments by Tina Minkowitz, Esq.

Showing 206 of 206 comments.

  • ‘Rare and little known’? Horseshit. It’s the signature effect of neuroleptics (miscalled ‘antipsychotics’), and was part of the basis for neuroleptics being named among the forms of physical torture by the UN in 1986.

    UN Doc. E/CN.4/1986/15, para. 119 (page 29), includes:

    ‘Administration of drugs, in detention or psychiatric institutions
    ….
    neuroleptics, that cause trembling, shivering and contractions, but mainly make the subject apathetic and dull his [or her] intelligence’

    Breggin wrote tons about akathisia in his 1983 scientific book Psychiatric Drugs: Hazardous to the Brain. It was well known in the survivor community before that time. I was forcibly drugged in 1977 and it was known as a common effect then. So common that there were anti-cholinergic drugs they gave to counter that effect, including ‘cogentin’. Those drugs actually only masked the akathisia and eliminated some of the more obvious manifestations, didn’t relieve it.

  • Unfortunately I don’t know of anything happening in the US that is strategic litigation with the aim of abolishing all power to force someone into psychiatric facilities or so-called treatments. I am less familiar with what is going on in relation to autism.

    When you say ‘justice for the middle class family’ I’m not sure what you mean – people with lower incomes who may not be considered ‘middle class’ certainly need justice also, e.g. against social welfare agencies that look on them prejudicially based on class. Interested to know what you are concerned about here and how it relates to mental health system and autism industry.

  • PacificDawn, I appreciate your point of view but want to point out that doing it without any framework of non-discrimination didn’t get us anywhere all the time that was being tried, because discrimination existed. (e.g. there would always be a ‘medical exception’ for why administration of neuroleptic drugs, though torture against anyone else, was just fine and even good for you as a treatment if a psychiatrist said you were the kind of person that ‘needed it’.) So if disability non-discrimination is not the way to go, what else would be? Not intending to put you on the spot, it’s an open and genuine question, if you have any thoughts on that I’m interested. Any other way to address discrimination, or otherwise to get past that roadblock?

  • ADA includes those ‘regarded as’ having a disability or having a ‘history of disability’, as people with disabilities. That allows me to see myself there, as a survivor of psychiatry having a history of being regarded as disabled (psych diagnosis and accompanying discriminatory violence and detention).

    CRPD doesn’t include that language but treaty body has routinely included phrases like ‘actual or perceived impairment’ especially in addressing detention, i.e. ‘detention based on actual or perceived impairment’ is prohibited.

    I believe that we can promote the total de-medicalization of distress/disturbance/crisis and diversity – what you are calling ‘mental illness’ and autism/aspergers – as an adaptation of the social model of disability. These experiences/conditions/ways of being are not linked to physical pathology unlike everything that is considered a physical, sensory or intellectual impairment. This means it is justified to take a different approach to the social model of disability, than the standard one developed by people with physical impairments in the UK (where the ‘orthodox’ social model came from – impairment plus barriers, with impairment an essential part of the understanding).

    This is one way I think my conceptual framework is useful – by conceptualizing the needs in crisis situations in ways that totally bypass not only the false medical narrative of chemical imbalance but also the clinical narrative of mental illness that is equally artificial and socially constructed and that takes away authority from the person over her own life and meaning. I think it is possible to advance it as an interpretation/application of the CRPD because it makes sense and fits the logic of the CRPD paradigm shift on legal capacity and its approach to abolition of psychiatric detention and forced treatment, which are now well established.

  • Yes, for sure. It can be crazy-making to read US case law on forced psychiatry though, but maybe they can take international law or international human rights courses and then do an independent study on CRPD.

    There is something I should mention about law study that might be interesting to people – and I’ll make a caveat afterwards. There is a Center for Disability Law and Policy at NUI-Galway (in Ireland) that has a summer school and also a one-year master’s degree program, focusing on the CRPD. The summer school is open to non-lawyers and I believe that non-lawyers can also qualify for the master’s degree (but check their website). The caveat is that, while this is probably the best that exists, it’s not perfect in terms of upholding fully the right to legal capacity, and so you have to bring your critical thinking as I wrote in my comment to oldhead above. (I wrote about my disagreement with Eilionoir Flynn, who heads the program, and her co-authors of two relevant papers Anna Arstein-Kerslake and Piers Gooding, who received their PhDs there and work closely with Eilionoir, in this paper: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=293055). And still, some people I work closely with study there and have studied there and remain associated also, so am saying it is a mixed bag, and can be worthwhile – don’t know what scholarship they options they have though, so might be prohibitive.

  • Thanks for your comment. I think that we need to strategize on how to make those sweeping legal changes even in the US. People are working on this in other countries, and from what I know Peru is the closest to being able to reach total abolition in the non-criminal context (see my earlier blog post https://www.madinamerica.com/2018/10/peruvian-legal-capacity-reform-celebration-and-analysis/). Law is created by human beings, and it can be disentangled and re-made by human beings.

    And meanwhile I agree about getting creative to help currently detained people and to prevent others from getting entangled. My conceptual/policy framework might be useful in thinking about what needs to exist as an alternative response, that could help prevent people from being put into the system. Of course many people in the survivor community are already practicing ways of supporting people to stay out of the system – and I welcome debate and critique of my framework too.

    One possibility for helping currently detained people, especially if it relates to a long-standing situation, is to make a complaint to a UN Special Rapporteur or the Working Group on Arbitrary Detention. It can take a long time for the UN to act on such complaints (technically called communications), and their opinions are not binding, but sometimes bringing international attention to a case can help. (It is possible for the person to remain anonymous at the level of publicity but they need to make their identity known to the Special Rapporteur or Working Group in order for them to be able to investigate and communicate with the relevant public officials). People can make complaints on their own behalf, or you can also do it for another person with their consent. Here is a guide that I wrote up for people wanting to make individual complaints and/or other kinds of advocacy using UN human rights mechanisms: http://www.chrusp.org/file/339476/UsingHRMechanisms.docx.

  • Thanks OldHead. Oh, it’s complicated. What non-lawyers can do: be aware of the ways that lawyers and psychiatrists who want to subvert the CRPD are developing tricky language to do this. Listen carefully and critically to anything you hear said about the CPRD. If it doesn’t smell right, if it ends up leading to a statement that some coercion is ok, or that it’s a last resort, etc., question it.

    Read General Comment No. 1 and the Guidelines on Article 14, make study groups on this if you want, to understand what the standards are that the CPRD Committee has developed. When I have read the General Comment aloud, stopping to discuss it in pieces, in a mixed group of survivors and lawyers and dissident mental health folks, people could understand what the GC was saying.

    If that’s too daunting, then take it from me – and from the WPA’s Paul Appelbaum, who conceded this point! – that the CPRD contains an absolute prohibition of forced psychiatric interventions. (Appelbaum’s acknowledgement of the absolute prohibition came in an editorial urging states to ignore or amend the CRPD.) Fight for it! In the US, you can talk about the CRPD is an advancement of the same policy position stated by the NCD 19 years ago, in ‘From Privileges to Rights: People Labeled with Psychiatric Disabilities Speak for Themselves’. Ask the NCD to take up this issue again.

    If you want to get involved with international human rights mechanisms, here is a resource on what you can do: http://www.chrusp.org/file/339476/UsingHRMechanisms.docx. The Universal Periodic Review of the US in the Human Rights Council is coming up soon and the US Human Rights Network has started putting out information and training materials about it, check it out – https://www.upr2020.org. They will have information about the process, and you can check back with me about how to argue forced psychiatry as a human rights violation in that context if you want.

    One other thing – if people support the conceptual/policy framework I’m developing, I would ask you to refer to it in relevant advocacy, discuss it, debate it, adapt it (and credit me). I think this has potential to answer the questions about so-called hard cases that some of our opponents are saying the CPRD hasn’t addressed – it has (e.g. GC1 said in two places that decision-making has to be respected in crisis situations), but the positive elements haven’t fully been brought out before.

    Thank you for your comments and support.

  • Hi everyone, I’m able to log in now.

    I consider the CRPD essential to the abolition of the legal power of psychiatry to deprive people of their liberty (engage in arbitrary detention based on actual or perceived disability) and penetrate our bodies with their toxic drugs and shocks and surgeries against our will (engage in acts of torture). (Re torture, I think the clearest UN citation holding the administration of neuroleptic drugs to be torture is from Special Rapporteur on Torture P Kooijmans in 1986, E/CN.4/1986/15.)

    CRPD is not enough however, to push us over the hurdle of medical power joined to the power of state as a mechanism of repression. The elements are there, our adaptation of the social model of disability has the power to confront and split and dissolve this alliance and its power, but it has not been successfully pushed through to clear understanding in the UN mechanisms that support us. Maybe similar to the Deaf people’s struggle to see themselves as a cultural and linguistic group, our issue is both disability and not-disability. But Deaf people are not up against the same kind of economic and political interests – the interests of the state in maintaining a form of repression notwithstanding its illegitimacy. Our struggle has been to a degree coopted by UN mechanisms’ defining it as ‘human rights in mental health’ and as a need for non-coercive supports preliminary to abolition of torture and arbitrary detention. And this cooptation has been facilitated by the moves that changed the International Disability Alliance from a cooperative alliance of DPOs, in which each global DPO had a sovereign and non-delegable voice, to a technical bureaucratic secretariat that hoards information and power and opportunities and channels everything through itself. I have said both of things many times. I fought it to the extent I could while I was in positions within both IDA and WNUSP.

    Back to CRPD. We have a global movement, but here on this page it is mainly US and Canada. Though US has not ratified the CRPD, and if it does it will be with so many reservations, understandings and declarations it will be hard to see what remains, Canada has ratified CRPD and also recently its Optional Protocol. With the OP, Canadians can take complaints of individuals to the CRPD Committee and receive a decision on the violation of human rights in the CRPD. (You have to ‘exhaust domestic remedies’ for this procedure; also available in any country including the US are the Special Procedures of the Human Rights Council. See my guide to using UN human rights mechanisms, on the CHRUSP website – linked for now in a box on the home page.)

    I don’t know where progress will come from or how. Peru’s legal capacity reform was a huge step but not enough, as I wrote in my last blog post on this site. We need an abolitionist movement that targets psychiatry as a social institution of fake science and repression, in addition to the abolitionist movement that calls for repeal of the mental health laws along with other ‘substitute decision-making regimes’ (in the words of the CRPD Committee), and a movement that focuses on reparations as the way to conceptualize the totality of violations and remedies needed to abolish forced psychiatry and to provide redress to victims.

    BTW, I am *not* offering the CRPD course this year, but expect to do so again in 2020, and will be posting on social media closer to that time.

    I would like to suggest to Mad in America correspondents that they follow the CRPD Committee, Working Group on Arbitrary Detention, and Special Rapporteur on the Rights of Persons with Disabilities to be able to catch news of statements that are upholding the correct standard and that do not seek to push us under the ‘expertise’ of mental health professionals. Those bodies usually have not publicized their stance so much with press releases and campaigns; it is too bad that the most publicity has come from the health-related entities. But it is possible for anyone to read the documents that come out of the CRPD Committee – like their General Comment No. 5 on Article 19, living independently and being included in the community, which contained this paragraph:

    ‘It [the obligation to respect the right to live independently and be included in the community] also entails the obligation to release all individuals who are being confined against their will in mental health services or other disability-specific forms of deprivation of liberty. It further includes the prohibition of all forms of guardianship and the obligation to replace substituted decision-making regimes by supported decision-making alternatives.’

    All the best,

    Tina

  • It’s wrong to make generalizations. Some of us need solitude more than relationships. Or we need both and need to not have to imbibe the mental heath mantra that ‘we all need to reach out’.

    What I think is problematic about the kind of self-care that makes a show of itself, is that it’s defensive and it relies on a mental health prescription to do something that the person finds necessary. Also it can amount to a mental health labeling of the people you decide to avoid.

    How about if we all acknowledge a variety of human needs and predilections, and don’t make general prescriptions for anyone else’s well-being?

  • Your reply went to both places but it is easier to reply here. I stand by my comment, as the right to health understood without a duty to health amounts to a right to obtain good quality health care acceptable to the person, as well as to have the preconditions for health such as clean water and food. There is nothing wrong with economic and social rights per se; the right to housing does not mean that the government should forcibly house someone who wants to live outside.

  • i agree that one of the needed avenues for work is to continue to challenge the psychiatric belief system and its practices. That is part of the story, to remove the ‘bio’ entirely from the belief system – as a friend pointed out to me, the New York Times has recently published an article stating flatly that there is no such thing as chemical imbalance related to madness or psychiatric labels. This should be promoted widely.

    it is difficult to say ‘the UN’ has resolved an issue in a particular way when there are different bodies in the UN that continue to contradict each other. In ordinary discussions, we might say ‘the UN’ to refer to what any Special Rapporteur says, etc., but it becomes confusing when they disagree. it is probably best to talk about the specific body or mechanism or agency of the UN has done a particular thing, e.g. the UN Human Rights Council has said… or the UN Committee on the Rights of Persons with Disabilities has said…

    I would like to believe that the CRPD standards are gradually winning in the UN, but there are still some holdouts. One of the avenues I think is necessary is to remind them of where the CRPD came from, and take seriously the leadership of survivors as was done in the drafting process. We are not alone; we have allies in the UN and elsewhere and they are needed and make important contributions, but too often they have been listening to each other and ignoring those of us with the real expertise.

  • Thanks for finding the silver lining at least in the resolution; I read it a little differently than you do but agree that the ‘freedom in health’ as proclaimed in the resolution is something to hold the UN and governments accountable to.

    Freedom is freedom; health is health. Individuals have a right to get health care they need; in the US where people die in a system that can deny them easy treatment for lack of money, the right to health care is real, and it is absurd to talk about a right to illness. A right to illness could be invoked to deny desired treatment and allow the person to die, just as a right to health is invoked by some psychiatrists to justify forced interventions. A right to illness on the other hand can be invoked to support your freedom to refuse treatment irrespective of whether or not you are actually ill – it is a way to avoid the dispute about whether the illness is real, whether the doctor is right or wrong. And a right to health can be invoked to demand that societal resources be equitably distributed so no one has to do without health care.

    All human rights are rights held by the individual, and cannot be legitimately invoked to justify the deprivation of some other human right to the same individual. That is a managerial approach to human rights that subverts the true purpose. If freedom from forced interventions is part of the right to health, this is both a cobbling together of a right to integrity of the person with the right to health so that we acknowledge a right to integrity, to be free from unwanted intrusions, in the context of health care; and it is also possibly an argument that such freedom is also part of what the right to health itself means, that there can be no health without integrity and freedom from forced interventions. I do not think either of these is bad; but I do think that forced psychiatry has to be taken beyond and outside the context of health care because it is a regime that has nothing to do with health and instead is for social control – management of people who are viewed as unruly or disruptive for one reason or another, active or passive. For that reason I support, as WNUSP proposed in its statement in the meeting, a framework of reparations for forced psychiatry as a widespread and systematic human rights violation, as the way forward to have the conversation that all the survivors in the meeting wanted to have: implementation of our full human rights throughout society, and end to legalized discrimination/ subordination/ torture.

    Regarding WHO, this organization has called for the abolition of forced treatment and no longer recommends that countries adopt mental health legislation. This has been a huge shift for WHO. I cannot fully endorse their training materials but there are parts of those materials that clearly uphold the CRPD standard of no force/coercion. In fact, Michelle Funk from WHO is a better supporter of the CRPD and abolition of force at this point than Nils Melzer, for the reasons I described.

  • We need to help people get off drugs and help people stay away from psychiatry in our communities; I agree with you about neoliberalism but also agree with the commenters about forced psychiatry needing to be addressed as well as the business/ ‘pill mill’ aspect. We can also do a lot on community level to persuade people to not call the mental health system on each other as an enforcer, and not call police on each other unless there is a situation that truly calls for police involvement. To remind each other that calling 911 is calling in armed state power, and it’s not friendly or helpful; to help or support someone we have to let them be who they are and work with them not against them.

    This kind of community work can make a difference potentially to both building support to abolish the mental health laws and incapacity laws, and to letting them fall into disuse.

  • I am not sure it is a deference to corporate psychiatry, rather I’d say to institutional psychiatry. In the case of UN human rights mechanisms that monitor compliance with the prohibition of torture, they have been accustomed to working closely with psychiatrists. Psychiatrists and other doctors accompany them on visits to places of detention, usually prisons, to verify if a person has been tortured, and they act as witnesses to torture and support victims. This institutional collaboration makes it even more difficult for many human rights experts that deal with torture to open their minds to accept that psychiatry in its ordinary and routine work is simply torture. One thing that helps us make the argument however is the fact that human rights experts have long acknowledged that forced psychiatric drugging and psychiatric incarceration of people who are viewed by some psychiatrists as sane would quality as torture and other cruel, inhuman or degrading or degrading treatment. To say that the same abominable acts when done to someone psychiatrists have labeled as mad is actually beneficial to the person, manifests discrimination in treating people with psychosocial disabilities as subhuman. Special Rapporteur on Torture Manfred Nowak in 2008 managed to acknowledge this discrimination and other factors that justify addressing forced psychiatry in the framework of prohibition of torture, but the institutional bias still exists in these mechanisms generally.

    Also, though I sounded an alarm in this post, I don’t think we have failed; it is one side of the struggle that we have always to keep our eyes open to see the obstacles. So long as we are fighting, we become free in the struggle and keep creating more space and more allies.

    Regarding how UN decisions are made: it has been said that there many UNs, each part of the UN can operate independently. The Committee on the Rights of Persons with Disabilities still emphatically supports the abolition of forced psychiatry, and can be expected to do so into the future. The Office of the High Commissioner for Human Rights, which hosted this meeting, has a complicated role; it is the secretariat for the CRPD Committee and for other human rights treaty bodies, some of which continue to oppose the CRPD standard; it is also the secretariat for the Special Rapporteurs, and has its own staff who advise on particular topics, including a disability adviser and a health adviser. The OHCHR disability adviser is Facundo Chavez, who moderated the first panel in the continuation of Day 1; he knows his material and supports the CRPD standard, and the High Commissioner himself articulated the CRPD standard of abolition when he spoke in the opening panel.

    The different parts of the UN speak to each other and try to harmonize their standards. This meeting was also responding to a resolution of the Human Rights Council, which is a UN body made up of member states, i.e. governments. Brazil and Portugal have been sponsoring resolutions on human rights and mental health, and the last resolution called for OHCHR to arrange this consultation. To the extent that the UN member states retain a degree of power over the secretariat, including funding, they make their influence felt. It can be difficult for human rights experts whether in OHCHR or treaty bodies like the CRPD Committee to oppose states parties, but it is their role as independent experts to pronounce the standards they believe to be correct.

    Meanwhile none of these actors can ignore civil society, both those whose rights are at stake – in this case users and survivors of psychiatry – and those who have structural power and interests in either opposing or regulating the exercise of those rights. (I’m thinking of psychiatrists but also of lawyers and academics who may support state interests or view themselves as intermediaries between state and people who are seeking to change long-standing discrimination embedded in law.)

    International law itself is complicated, especially human rights law at the global level. We do not have a global court that can make binding rulings on human rights violations complaints by individuals. (Human rights courts do exist in some regions; at least one such regional court, the European Court of Human Rights, has refused to accept the full CRPD standard of abolition of forced psychiatry and substituted decision-making.) At the global level, human rights law depends for its impact on the willingness of states to adopt and/or enforce the standard in its domestic law.

    International law is a good area to see the dynamic between law and politics, they overlap and merge into each other in a different way than in domestic law. And ultimately it is a tool we use. Sometimes there are openings that allow international law itself to change; we had that in the CRPD and it continues to open doors.

  • I think it’s a great article that lays out a vision of abolition. It can’t do everything – can’t solve the problem of capitalism for instance. It sounds to me like Au Valencia is coming from a viewpoint that is libertarian as well as grounded in social solidarity. While the perspective and tone is confrontational, the substantive points made capture in clear and plain language the demands our radical movement has been making for a long time. I noticed that this article posted by official MIA account on facebook was getting over 100 shares to which I added my own. Au Valencia has done great work here that deserves our attention. How to take these steps, is all our responsibility. Personally I hope to see activists working for state-level legislative abolition of psychiatric force/coercion, lawyers working on strategic litigation theories and plans, and more. It is wonderful to see the clear thinking of more activists envisioning abolition.

  • Hi Judi –

    I replied to you at length elsewhere and won’t repeat it all here.

    But for MIA readers I will say that
    1) I agree that SSRIs are dangerous and the kinds of risks you mention here, especially early death, should be publicized.
    2) I focus on neuroleptics for a few reasons. Neuroleptics are used against people to control them, they are called a chemical straightjacket and chemical lobotomy for good reason. Neuroleptics cause both psychic apathy and intense physical/mental suffering (akathisia) at the same time. No one likes neuroleptics, some people tolerate a small dose to suppress voices or something else in their minds that is deeply troubling to them. But mostly people are dosed with neuroleptics against their will, whether by outright force or by intimidation or incentives/disincentives of some kind. For this reason people taking neuroleptics have usually been out of sight out of mind of society, news media, who think of us as the crazies locked up in institutions. They don’t market to us, they market to those who want to control us. That has changed somewhat now as neuroleptics are being given out like candy for all kinds of things, horrifying. But I still think it’s the dominant characteristic. While on the other hand antidepressants are marketed to people and some people like taking them, enjoy the effects and say it makes them feel very good. Debate about antidepressants is on the level of awareness-raising and letting people know about what the harms are that your doctor won’t tell you – less about countering the ideology of institutionalization. It sound like in your case you were forcibly drugged with an SSRI – so I suppose that there is a lot of crossover and it’s not all one or the other.

    My personal experience was being drugged with neuroleptics, so i come with a deep knowledge of that. I am open to including all the psychiatric drugs, which as you remind me, all cause some form of brain damage, in a call for abolition/replacement with nontoxic alternatives.

  • The terminology gets developed for particular purposes – for me ‘forced interventions’ was a way of talking about the whole group of them, drugging, shock, restraint and solitary confinement, and the lockup itself, without using the term ‘treatment’ which of course is a lie that is offensive to the reality. We can use the word torture, but it was necessary to make an argument about what it is that we mean when we say psychiatric torture. See Manfred Nowak’s report as Special Rapporteur on Torture from 2008 (can search for UN Doc # A/63/175), and my work on torture, which you can find on the CHRUSP website Resources page or on the CRPD Course website under Segment 2.

    On the terminology and concept of disability- I think that disability captures the element of discrimination, the ‘on account of factor’. Why are these forms of mistreatment targeted at certain people and not others? Psychiatric labeling ties into an ideology of fitness and unfitness, that treats any impairment or infirmity as meaning the person is an inferior human being whose rights do not have to be respected, who can be treated as expendable.

    For some of us, the subjective anguish we go through in our lives or divergent habits or beliefs really mean we are different in ways that society treats as an impairment even though we don’t necessarily experience it that way. (Some people who are born with physical characteristics different than the norm also do not see themselves as impaired.) For this reason, and also because many of us reject the concept outright but nevertheless were treated as inferior human beings based on psychiatric labeling, we use the terminology of ‘actual or perceived impairment/disability’.

    Also some of us are highly affected in terms of what we can do in our lives or how we live, because of the anguish or divergent habits or beliefs, and may need accommodation or supports from others. It does not have to be a shame or secret to have these needs. Ideally we would live in ways that it was naturally accepted people are all different and have whatever needs we have, but so long as we live in a society that has concepts of ‘normality’ and acceptability that some of us remain outside of, there’s a need to name that as discrimination to be remedied.

    Be that as it may, even if you still disagree with the term disability – if you can find other ways of framing legal theories to abolish forced psychiatry that will have any traction, that will gain adherence and understanding in the legal community, I’d certainly support that as complementary. In my experience in this movement, everything we tried earlier, simply talking about forced drugging as an abomination that should not be done to anyone, failed because society shrugged its collective shoulder and said, so what? Because it is done to ‘those people’ who are not seen as real people worthy of rights protection. Naming the discrimination knocks on the door more insistently, and I don’t know any other way to name it besides disability, which I think is accurate for the reasons stated.

  • Agree with the commenter above ‘a girl called colleen’. The conclusion ignores entirely one whole area of study and findings, the traumatic effect of coercion in the mh system per se. There is no way that better packaging can ever negate that and it is offensive to try, akin to the old misogynist advice to women, ‘if rape is inevitable relax and enjoy it.’

    I will point out two additional ways that the post here, or perhaps the study itself if the author is following the study’s self-characterization, is offensive to survivors of forced psychiatric interventions and promotes an incorrect standard of human rights.

    1) To refer to coercion of ‘service users’ is offensive and misleading, as it characterizes survivors of forced unwanted interventions as people who are ‘using services.’ If it’s unwanted I’m not using it, such language obscures agency and victimization.

    2) To say that ‘human rights violations … *may result from* involuntary hospitalization’ is to imply that involuntary hospitalization itself does not violate human rights. This is incorrect. Ireland is a state party to the Convention on the Rights of Persons with Disabilities, which is authoritatively interpreted to prohibit involuntary hospitalization/institutionalization based on actual or perceived psychosocial disability. Recently the CRPD treaty body said in a General Comment on Article 19, living independently and being included in the community (excerpts, with ** around the most pertinent sentences):

    27. Legal personality and legal agency are the basis of the realization of independent living within the community for persons with disabilities. Article 19 is, therefore, linked to the recognition and exercise of legal personality and legal capacity as enshrined in article 12 of the Convention, and further explained in the Committee’s general comment No. 1 (2014) on equal recognition before the law. *Further, it is linked to the absolute prohibition of detention on the basis of disability as enshrined in Article 14 and elaborated in the respective guidelines.*

    48. The obligation [to respect the right to live independently and be included in the community] also requires States parties to repeal and refrain from enacting laws, policies and structures that maintain and create barriers in access to support services as well as general facilities and services. *It also entails the obligation to release all individuals who are being confined against their will in mental health services or other disability-specific forms of deprivation of liberty.* It further includes the prohibition of all forms of guardianship and the obligation to replace substituted decision-making regimes by supported decision-making alternatives.

    83. Involuntary institutionalization on the basis of impairment or associated circumstances such as presumed “dangerousness” and other factors as elaborated in the Committee’s guidelines on article 14 is often caused or increased by a lack of disability specific support services. Implementing article 19 thus will ultimately prevent violation of article 14.

    Advocates in Ireland and everywhere need to know their human rights and defend the full meaning of the CRPD, and not be misled by the professions that are still invested in coercion.

    For those of us in countries that haven’t yet ratified the CRPD, take heart in knowing that other parts of the UN are gradually coming around to the same point of view, as the Working Group on Arbitrary Detention showed in their recent report on the US. I blogged about this and link to the WGAD report and recommendations, here: https://www.madinamerica.com/2017/10/un-to-usa-forced-treatment-prohibited/.

  • The Working Group on Arbitrary Detention can deal with detention based on discrimination of any kind. In the case of older people it is often a combination of age and actual or perceived disability but it can also be age alone. The WGAD has spoken out against forced treatment in the mental health context because of the linkage with arbitrary detention, which is their particular mandate. People in skilled nursing facilities might be in a situation of detention if they can’t leave; you would need to check and compare with how the WGAD defines detention, this might be a place to start: http://www.ohchr.org/EN/HRBodies/HRC/RegularSessions/Session30/Documents/A_HRC_30_37_ENG.docx

    But that is only one of a number of UN human rights mechanisms that we can address. Here is the web page for the UN Independent Expert on the enjoyment of all human rights by older persons: http://www.ohchr.org/EN/Issues/OlderPersons/IE/Pages/IEOlderPersons.aspx. You might want to write to her about the problem and give her information about how it is taking place, whether in the US or in any other countries you know of. There is also other work at the UN on the rights of older persons described here http://www.ohchr.org/EN/Issues/OlderPersons/Pages/OlderPersonsIndex.aspx including a process to create a new treaty, that is taking place in New York-based meetings roughly once a year, https://social.un.org/ageing-working-group/index.shtml. Get involved and bring this abuse to their attention; I am trying to stay involved but it’s difficult to relate to a second treaty process after the CRPD one. I can advise about human rights law and how to frame these issues to relate with the legal concepts and framework.

  • I started a long reply to you last night and then closed my browser by mistake and lost it all.

    Therapy or recovery is not a remedy for forced treatment, the remedy is abolition and a full and comprehensive effort to make reparations to victims/survivors. Governments may never make reparations as they should, which is not just individual compensation but a comprehensive approach to looking at the harm that has been done by human rights violations, to individuals and society as a whole, and working on whatever needs to be done to repair, at the economic, social, cultural, communal and individual levels. But we are working on that repair, through our human rights advocacy, I have come to understand this recently. The first step of reparations is to stop the violations and guarantee that they won’t continue, and in addition we need to allow all of us to come forward and say what we need once the harm has stopped and we are not threatened with it any more.

    Individual healing from the traumatic effects of psychiatric violence as well as the effects of psychiatric drugs and procedures is part of what some of us need, and for some people it may take the form of therapy. For others of us, it is inconceivable to go to the profession that harmed us to help with healing.

    In general, therapy is something that some people find useful as a space to explore what they need to do to change their lives and heal from trauma or destructive life patterns, others go to 12 step programs or peer support or use psychiatric drugs or have a spiritual practice or muddle through. No disrespect to any of these ways, they are all valid and also all can have their down sides and don’t work for everybody. Therapy in particular can be criticized as giving up power to another person, but that may be really the Freudian analysis paradigm, and a lot depends on the individual needs of a particular person, their situation, their personality, and the person they end up with as a therapist. For me therapy is not an option so my understanding of it is theoretical at this point.

    The recovery approach I have been looking into a little bit as it appears in the WHO training modules (http://www.who.int/mental_health/policy/quality_rights/guidance_training_tools/en/) and I think it has some value for transforming conventional mental health services; primarily in opening up the possibility that people can change their lives and that the focus can be on what the person wants to do and not on what someone can label as being ‘wrong’ with them. But it’s not for everyone, we can’t assume that recovery-based mental health services are the answer to what everybody needs in a time of distress or life problems or altered consciousness. So the challenge is to find ways to create proactively a framework for the kinds of services people want and need in various circumstances. I have been thinking about this in context of the work of the CRPD Committee that recently produced a General Comment on Article 19, living independently and being included in the community (http://www.ohchr.org/Documents/HRBodies/CRPD/GC/CRPD_C_18_R_1.docx), to which I made submissions initially and on the first draft of the GC. I am planning to write a blog post on this General Comment as it has helped to clarify some of my thinking about various elements both more mainstream and what I’ll call utopian, in the sense of thinking about ideal ways I’d want society and life to be organized rather than particular alternative practices.

    I’ll close here, re your comments about treatments being done on a minor, I agree with you that there should be some kind of oversight to ensure minors aren’t being given medical treatment with destructive effects. CRPD says that children have a right to have their views about any matter concerning themselves be given due weight in accordance with the child’s age and maturity, without any discrimination based on disability. Also the CRPD Committee has said in concluding observations that children should not be subjected to involuntary psychiatric treatments. It could make sense in addition to have safeguards to protect the minor’s ability to stand up for him/herself and ensure that explanations are given in a way that she/he can understand to express his/her will and preferences.

  • The USA is not monolithic, I’d say. Some state legislatures and municipal governments have enacted legislation to support human rights treaties and work to comply with them at that sub-federal level. Also right now the federal government is not in good shape, but I know that ADAPT and others promoting the Disability Integration Act have not given up. I haven’t been able to really keep up with the things going on in federal administration, so couldn’t say if within any relevant agencies there are people who are approachable.

    It’s also not only the Right, there has been even in Center politics an attitude towards human rights treaties that takes the US as an example for the world to follow rather than one participant among a vast number of others who are all subject to the same standards, and that fails as often as any other country does. There’s a very skewed attitude towards human rights here, especially noticeable when compared with other countries at a similar level of economic development.

    In any case, there are a growing number of organizations that are promoting human rights and using human rights mechanisms, and we have been part of that. US Human Rights Network both does its own advocacy and plays a coordination role in some of the UN processes, and folks from our movement who have participated in that have made some connections and helped to raise awareness with those other activists. So a lot of work, and worth to keep doing. Thanks for your question.

  • Not sure what you are saying in your first two paragraphs. Re the Southern California organization, it’s a great initiative and could be copied by people in any other states or cities. The early movement if you remember was organized small scale, with city-based organizations. We have national and international organizations and campaigns that are already on board, and that has helped people to connect more locally.

    And ‘angry mental patient’ – maybe you haven’t encountered that stereotype directed against you? I sure have, and it has been combined with gender stereotypes that women aren’t supposed to express anger, in my case. That stereotype is embodied in the ‘danger to self and/or others’ standard in commitment laws, which the UN has repeatedly condemned (because we have brought it to their attention). It is also embodied in the discriminatory and cynical gun-control laws that we have called psychiatric profiling, and in the readiness of police to shoot to kill people, mainly people of color, whom they consider to be ’emotionally disturbed’.

    Re suggestions of what to do, there is quite a lot going on internationally, some of my international work is done now through the Absolute Prohibition campaign, see http://absoluteprohibition.org which also has a Facebook page. Nationally there is a challenge for organizations and independent activists to work together, and I am hoping to connect with those who want to collectively figure this out. It’s not rocket science really, just setting a few things in motion and seeing where people are already starting to move in good ways.

  • It’s hard to get free when there are people who hang these labels on you and are still in your life.

    I think that together we are stronger. Some survivors are lawyers and we have lawyer allies as well; it can make a difference to have somebody willing to step in and go to bat for you when you are vulnerable, once in my experience just knowing that a friend of mine would be able to help in this way allowed me to calm myself and get out of a bad situation. In political organizing and activism, in civil disobedience we would be taking risks but a psychiatrizing response would likely backfire on the state because it would show the social control use of psychiatry for what it is.

    That’s one avenue, and there can be many others. We don’t have to take any action we don’t feel right about or prepared for, and even if we are hiding, there are ways to contribute e.g. to participate in a collective advocacy campaign by helping to write or come up with ideas.

  • Thanks for your comment.

    I believe that when we abolish forced treatment, and commitment, as a legal matter, when we make it illegal, it will be much harder to threaten anyone into complying with these tortures. This can come in any number of ways, legislative repeal/abolition, judicial decisions, and/or more policy-oriented administrative or programmatic approaches.

    It has been very effective so far to work with and through the UN. The negotiation of the Convention on the Rights of Persons with Disabilities provided a global forum and a fulcrum to gain leverage over the political/legal issues in all countries at the same time. The UN for better or worse, and whatever its flaws, is a place where at times governments come together with high aspirations and want to do the right thing. Even if they are still violating those standards at home, when they come together they learn from civil society (ordinary folks and advocates who come) and they get inspired. They send their human rights-oriented people to these meetings. So that was an amazing first step, and then the UN human rights system has a number of independent expert mechanisms that helps to hold the governments accountable for what they signed up to.

    It’s a long haul, but we have comrades in many countries working for the same things, and it is worth it.

  • I think that your post is a derail from my subject, and is not at all what I have in mind.

    I do not share your views on immigration, and if you reference the Nazis you should know that their targeting of Jews and others they considered non-Aryan was similar to the hostility against immigrants that is being fomented here and in Europe – by groups including prominently the neo-Nazis. So I consider your reference to that era dishonest. Yes, they targeted people labeled with psychiatric diagnoses and other people with disabilities who were institutionalized first, or rather got the idea for extermination camps from the deliberate killing of people with psych labels and other pwd by psychiatrists. But you are twisting it around to make it seem like we are endangered by other people who are actually victims and not at fault.

    Frankly I think the moderators should delete the comment as it is really inappropriate, but that is up to them.

  • old head,

    You say ‘alternative to starvation,’ yet tell that to the woman I know, a professional and human rights advocate, who cannot imagine her life without psychiatric drugs and doesn’t want to. She isn’t starving, by any stretch of the imagination. Nor are psych drugs all she does, she is aware of needing certain kinds of support in her daily life and she has someone to give it to her.

    On the other hand, I also know many people who are in an in-between place, who are looking for something, would welcome a drug if it actually got rid of the ways they feel terrible, hate the adverse effects, would welcome enthusiastically something better. Psychiatry hasn’t worked for them but nothing else has either, they are desperately unhappy and haven’t connected with anything that lets them live in peace.

    The way you describe psychiatry, I don’t think you are separating the coercive institutional and legal aspects from the paternalism (which can be equally present in therapy), and from any possible elements that give anybody something that they need.

    I entirely agree that abolition of psychiatry as a social control institution cannot be subject to development of alternatives. Abolition of legalized coercion is the first step, then there are other collateral ways that it operates as social control. That is what CRPD requires.

    And, in its current form psychiatry as a profession, as a social institution, cannot be separated from paternalism and legally-empowered coercion. Organized psychiatry does not want to liberate itself from its deified status and struggle as ordinary human beings, I suppose they aren’t sure they’d have anything to offer. This doesn’t seem to me any different the way it operates, than white supremacy and male supremacy; it takes a willingness to let go of hierarchy and not see it as part of one’s own identity, to find an identity that doesn’t depend on being above someone else. I think it can be done.

  • Hope this reply posts in the right place, replying to old head.

    In my view, Miranda requirements on involuntary commitments would just be another procedural reform that makes little difference in the end and reinforces the legal and social legitimacy of that abusive practice. Involuntary commitment is a creature of law and it can be destroyed by destroying the laws that allow it to happen. Few psychiatrists would be willing to risk arrest and lawsuits for false imprisonment, if the commitment laws did not give their acts the stamp of legality.

    Re delegitimization again, how would you accomplish that? Who, what institution(s) give psychiatry its current legitimacy as a medical profession, and could take it away?

  • Thanks for the follow-up information.

    It makes sense that the western middle class, who would be in charge of those kind of programs, would have little ability to understand the need for food as simple. Yet we don’t even have to go to an African country to see the impact of hunger on students; in the US this is the reason for the school lunch program, and periodically politicians have to be reminded of hunger as a reality.

  • Look forward to hearing more.

    Re-reading your comment I definitely agree with the point about expert witnesses and see that as overlapping between the CRPD requirement to eliminate legal capacity deprivations based on ‘mental capacity’ assessments, and the delegitimization of psychiatric diagnosis as any kind of science.

    I agree that psychiatric diagnoses are not science, not neutral or objective in any sense, and this is something that can be worked on.

    Re the question of neurotoxins as medication, I think you have to find a way to distinguish from chemotherapy for cancer or else to deal with both in the same way. And I would wonder about the possibility advanced by Joanna Moncrieff of prescribing based on drug effects and what the person wants rather than diagnosis. That would wreak havoc with insurance under current US system, don’t know how it would work in other countries, but would be closer to what I am advocating or groping towards, in terms of return to the ‘art’ and honest science of medicine.

  • Not sure what you mean – that after abolition of psychiatry the same drugs can be available to people? And abolition of psychiatry being its delegitimization as a profession? So the drugs would be… just an option for people to try and figure out for themselves?

    I still wonder about how the abolition would be accomplished and what would come in its place.

    I am mindful of Michelle Alexander’s warnings in The New Jim Crow or the cautionary message that is implied from that book, that a terrible institution might just take other forms if the basis isn’t rooted out.

    This could apply both to abolition of legalized forced paternalistic interventions such as psychiatry (what is required by CRPD) and to abolition of psychiatry (which wouldn’t necessarily eliminate forced paternalistic interventions).

    I suppose that abolition of psychiatry would be accomplished if there is a strong enough movement, but I also believe that if psychiatry’s legalized coercive power is taken away, the nature of the institution would have to change. Still hoping to understand how people envision the delegitimization.

  • I have a sense of frustration at this proposal, much as for me personally it would be fine if psychiatry lost its accreditation and the neurotoxins were banned. My frustration is in two parts:

    1. I don’t see much possibility of it happening. Despite all the scandals, institutionally I see psychiatry continuing to rehabilitate itself and sell itself both as happy pills, or last resort way out of terror, and social control. Also, the rest of medicine is becoming institutionally more like psychiatry and so will have less ability to criticize it.

    2. People want psychiatry, and its neurotoxins. And I can’t tell them that they’re just wrong. Our bodies are all so different from one another, what feels good, what tastes good to me is vastly different even from what works for my partner. If some people feel their spirituality is enhanced by SSRIs and others are dampened down by them, as a recent study found, what does that tell us? What is spirituality, is it the same thing or different for the two groups?

    I’m interested in what can be done, because ultimately I do think we need to have a real shift back to sustainable and holistic ways of doing everything. But, similar to how I feel about western medicine – re western medicine I have friends who survived cancer because of chemo or radiation, and who are kept alive in progressively disabling conditions because of medications and assistive devices, and I have friends who use psychiatric medications as their choice and cannot and do not want to stop. I don’t want to dictate to anybody what their health choices should be.

    Do you, or anyone in this conversation, have any thoughts on how to address this tension? In terms of what I addressed in this article, it has partly to do with the relationship between autonomy and quality.

  • I don’t think ‘we’ are to blame for what news media do any more than ‘we’ are to blame for what government does. That’s a navel-gazing trap that lets the actual perpetrators off the hook.

    If you mean that we need to seek out the best news outlets we can, and use critical thinking on all of them – including those that are promoting themselves as reliable and ‘non-fake’ – I entirely agree with you and have said as much myself in many places. Not sure how that relates to autonomy and quality in health care, are you making a connection?

  • I don’t know if you misunderstood me or if you simply disagree. As far as I can tell in the U.S., given our economic system, political system and other factors, single payer makes more sense here than a hybrid as in what ‘uprising’ in their comments here calls Obamneycare.

    Irrespective of where we go in creating a system that actually provides for universal health care – which the ACA does not, and for the record ACA remains a giveaway to insurance companies as well as doing a lot of good in getting people health care who wouldn’t have it otherwise- irrespective of how we get there, my point in this article is that universal access is not the sum total of health as a human right.

    I am not very interested in debating the economic justice aspects of this, particularly in this forum. I prefer to focus on the points made in the article about the need for a movement to reclaim autonomy and power with regard to our own health, and to promote quality from the perspective of those who are using health care – both of which necessitate a movement that is independent from health care providers, and that we do not have right now, or if we do it is not very visible or active outside the context of psychiatric survivors and related groups.

  • That says a lot about western donors’ priorities. I wonder about some of the details of where the interests and pressure are coming from, at what point it is direct complicity with an industry, versus assumptions and agendas that just are not responsive to what people are saying about themselves and their needs. Why do the donors have this agenda, in other words? That would be worthwhile to figure out.

  • 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.

  • Two comments:

    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.

  • Yes, agree.

    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.

  • kindredspirit,

    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.

    Take care,

    Tina

  • 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.)

  • Hi AntiP,

    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,

    Tina

  • 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.

  • Hi.

    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.

    All the best,

    Tina Minkowitz

  • 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

    All the best,

    Tina

  • 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.

    http://www.treatybodywebcast.org/crpd-14-public-side-event-on-violence-against-women-and-girls-with-disabilities-intersectional-and-double-violence-in-medical-and-institutional-settings-world-network-of-users-survivors/

  • 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.

  • 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.

  • Hi spinoff,

    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.

    All the best,

    Tina

  • 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.

    All the best,

    Tina

  • 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.

    All the best,

    Tina

  • 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).

    All the best,

    Tina

  • Hi Oldhead,

    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.

    All the best,

    Tina

  • Hi Steve,

    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.

    All the best,

    Tina

  • 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.

    All the best,

    Tina

  • 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.

    Tina

  • Hi Sera,

    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.

    All the best,

    Tina

  • 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.

    All the best,

    Tina

  • 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.

    Tina

  • Hi Julie,

    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.

    Tina

  • Hi Ben,

    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.

    All the best,

    Tina

  • 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.)

    Tina

  • 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.

    Tina

  • 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.

    Tina

  • 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.

    Tina

  • 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.

    Tina

  • 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.

    Tina

  • David,

    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.

    All the best,

    Tina

  • 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.

  • 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.

  • 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”.

  • 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.

    All the best,

    Tina

  • 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.

    Tina

  • 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.

  • Hi Francesca,

    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.

    All the best,

    Tina

  • 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.

    All the best,

    Tina

  • 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.

  • Dear Ute,

    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.

    Tina

  • 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.

  • Dear all,

    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.

    All the best,

    Tina

  • 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.

    Hi Tina,
    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.
    Lauro

    ***
    My response:

    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.

    Hi Tina,
    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.
    Lauro

    ***
    My response:

    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.

  • 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.

  • Amy,

    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.

    Tina

  • 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 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.

  • 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.

    All the best,

    Tina

  • I agree with you – it is interesting how psychiatry is obsessed with force medicating Jesus and those who have strong beliefs – I have witnessed it happening both to Christians and to Muslims, and to pagans and those who are just awakening to their own spiritual needs and listening to hear what wisdom might be there for them.

    There are some good arguments from a human rights perspective that tie in to the freedom of thought and the freedom of religion. In creating the Convention on the Rights of Persons with Disabilities I focused on the issues of forced psychiatry as torture, involuntary commitment as an arbitrary and discriminatory detention, and the right to legal capacity to make one’s own decisions, as the most strategic. Freedom of thought is absolute but freedom to express one’s religious beliefs can be limited, according to the standards of international law. I thought that freedom from torture, while it encompasses torture that is aimed at making a person give up certain beliefs or incapacitating the person from experiencing and adhering to their beliefs, is broader. I think this was the right judgment call at the time, but we should now go further and work on articulating the right to freedom of thought and freedom of religion more profoundly when it is being violating by forced psychiatry.

    And what you are raising from a cultural and spiritual perspective, yes it is certainly ironic that this country persecutes religious people in psychiatry while the first amendment is widely believed to be sacrosanct.

    Best wishes to you,

    Tina

  • Yes. I wonder if Foucault himself intended his work to be “purely” academic as a study of what is and has been, or if he wanted to open up possibilities for change by demonstrating how social discourse is humanly constructed. Certainly he has contributed to the opening up though in complex ways. I would be interested to look at his other books too – maybe another winter when I can get more deeply immersed, or sooner, who knows? Would be interested to hear what you discover or remember about this.

    Tina

  • Very beautiful, I cried.

    I hope that the winds of change are blowing as hard as you say. 2008 was just after the Convention on the Rights of Persons with Disabilities had come into force. It is still a hard road but we are making progress there too, with establishing that forced psychiatry is contrary to international law. The system of pharma’s abuse should also be considered contrary to international law, there is reckless disregard for human life.

  • I want to comment on my own post a bit, and might make some small edits. Just after I wrote this, I began reading some Marxist intellectual theory from the 1970s – related to theology as a matter of fact – which is helping me to clarify some things.

    When I say “legal capacity is not the be-all and end-all of existence” I do not mean in any way to diminish the devastating impact of legal capacity deprivations in a person’s life. As I experienced myself, being treated as someone who is a cipher in the eyes of the law is life-endangering and highly traumatizing. What I mean is more like, “legal capacity is not the sum total of a person’s agency in the world.” I am intending to say that there is agency under even the worst oppression, that, even when we are treated as legal ciphers, we are in fact “still there” – still experiencing, still taking it all in, still making choices however horrifying and however much we find the choices to be unbearable.

    I am also understanding even more clearly that legal capacity reform has to do with practice/praxis and can only develop so far on a purely theoretical level before we reach questions that have to remain unanswered for the time being. The theory has developed to the extent it has, both in my work and in that of others, because it is being put to the test of what we know from experience, looking at our own experiences from a disability standpoint as a basis for criticism of the existing system. The necessity for practice/praxis as an integral part of theory and in an ongoing relationship with it has been implicit all along in this work and it is exciting for me to understand that this is not a weakness or a frustration but instead a confirmation that the work is developing as needed.

    As a possible esoteric sidelight to all this, the unifying aspect to the insight is that we are looking at the level of social relations (or socioeconomic relations) and not so much at the personal, not at the individual in isolation. It’s interesting because of course it is the individual exercise of legal capacity as a socially-validated expression of autonomy that is at issue: we are precisely identifying the social relations around the construction of the individual in law, deconstructing how these relationships operate destructively to suppress some people’s autonomy, and proposing alternative social relations and legal validation.

    I hope that my mention of Marxism does not scare people off. In the United States especially there has been a fear of socialism and anything related to it, from the McCarthy-era persecutions to more recent intellectual/political culture where the left pretends to be mainstream and often deprives itself of a meaningful critical standpoint. In any case, here it is, I know people may have very disparate ideas of what Marxism is and means, and hope you will glean what I mean here rather than attributing to me any beliefs based on some version of Marxism that I do not espouse.

  • Thanks for your comment, Duane. I hope it is clear that I am including people who have experienced or been labeled with madness, mental health problems or trauma (to use a formulation that may capture both self-defined experience and pure labeling) as people with disabilities, along with other groups. Legal capacity affects a wide range of people with disabilities – older people labeled with dementia, people with intellectual/developmental disabilities, neurodiverse people, people with brain injury, etc. in addition to ourselves. Older people in general are especially likely to be deprived of legal capacity. And there is the question of children, who arguably also must come into the framework of universal legal capacity. (I discuss children in relation to legal capacity somewhat in a paper on SSRN, CRPD Article 12 and the Alternative to Functional Capacity, available at http://ssrn.com/abstract=2371939.

  • Ben,

    Thanks for these comments. I’m especially drawn to what you say about support having been a kind of Trojan horse luring people into schemes of psychiatric torture and other abuse. It seems to be a common response in the psychiatric survivor community to be suspicious of anything claiming to be “support” especially when it is attached to some legal issue. (In New York, outpatient commitment is called “assisted outpatient treatment” to give a classic example.)

    This response from our community is part of what has prompted me to delineate that the support model is only part of the story. The Committee on the Rights of Persons with Disabilities supports this view in its draft General Comment on Article 12, saying that a person may choose not to claim the right to support and instead only take advantage of the right to exercise legal capacity.

    Other survivors have strongly suggested that we need to look carefully at how to ensure that any support for the exercise of legal capacity is not misused. Even with good intentions, there is a lot of power that comes from being in a position to interpret something to another person, help the person in their decision-making process or help them express themselves to someone else. I address this a little bit in two papers I have posted on Social Science Research Network (SSRN) – CRPD Article 12 and the Alternative to Functional Capacity; and Legal Capacity from a Psychosocial Disability Perspective – which can be accessed through my author page on SSRN, http://ssrn.com/author=1348856.

    With respect to the United States, yes, until we ratify and implement without obstructive reservations, understandings and declarations, people in this country will not have sufficient tools available to do the advocacy that can result in the most meaningful response from the UN. The Committee on the Rights of Persons with Disabilities is the most advanced treaty body in its thinking on these issues, as should be expected because they are experts in this treaty itself. Committees monitoring treaties that the US has already ratified, such as the International Covenant on Civil and Political Rights, are not as advanced and we have a lesser possibility of obtaining good recommendations from them.

    Thanks again for writing.

    All the best,

    Tina

  • Sera,

    Thanks for posting this article and addressing the complexity of issues while holding a clear no-force position.

    It is gratifying to me as one of the originators of the human rights law prohibiting forced treatment, that these discussions are happening.

    A few comments.

    1) I think it’s important to both have the discussions in the mental health context (including alternative services and even peer support) and to take it out of that context entirely. The mental health system, including alternatives, has been the vehicle for social response to a wide variety of situations involving crisis and distress. That is a social policy choice more than it is a choice made by individuals, although individuals’ choices (as people experiencing distress, or as family or community members) contribute to the growing role of the mh system in this regard.

    I’d like to see more analysis from a disability non-discrimination point of view – both in terms of politics (mad/disability pride) and in terms of law. I don’t see much of this on Mad in America website but it is needed – here, in disability studies forums, and in legal communities. The disability non-discrimination analysis, in turn, needs to be informed by a survivor point of view, as we managed to reflect in the Disability Convention; there needs to be work done of this nature, especially by survivor lawyers, looking at the ADA and constitutional equal protection standards.

    2) I’d like to see discussion of the issue of legal capacity in particular. Incapacity is the last refuge of force. Recently in discussions where survivors of forced psychiatry have defended the practice, they have commented that they were incapable of consenting or refusing and therefore force was justified.

    The legal alternative to incapacity is called supported decision-making, and it is what we came up with in the Disability Convention (CRPD). The concept originated independently from users and survivors of psychiatry, and the intellectual/developmental disability community. No one wanted to accept that our legal capacity would be restricted in any situation but we felt there was a value to having support or assistance made available for anything related to the exercise of legal capacity – such as understanding information, coming to a decision, expressing your decision, etc.

    The tension between these two – respecting the person’s own choices while allowing for and even promoting a great deal of involvement by others in decision-making. Some people working on the issue are promoting a highly interventionist version of supported decision-making that allows some forced interventions. Others including myself take a strict view that the person’s decisions must be respected, and and the monitoring committee for the Disability Convention also is indicating that it will take a strict view.

    The tension does exist, and I don’t believe that it is prohibited to use one’s own judgment to question or express concern about what a person wants to do. It depends on what one’s role and relationship is to the person, and other contextual factors, and there has to be the willingness to back off when the person entirely rejects what you are offering. (E.g. in my case, I do not ever want to be harassed by mental health professionals offering their treatments.) I believe that the framework of Intentional Peer Support works as a guide to how to implement supported decision-making. (Chris Hansen has said that she became involved in IPS because it answered these questions that we were being faced with in discussions of the CRPD.)

    Again, thanks for pushing the discussion forward to get us closer to making no psychiatric force a reality.

    In solidarity,

    Tina

  • I’m glad Sera has deepened the discussion on how to get to no-force in practice and will be commenting on some aspects from my point of view as a human rights lawyer and activist.

    The human rights of Kendra Webdale are answered in the same way Sera answered the issue of assaults on health care workers.

    There are many people who commit murders – most of them have not been psychiatrically labeled. Why is society targeting only the small subset of those who have been labeled, or whom the media wants to label after the fact, for preventive detention? And why based on the disability (diagnosis/labeling as disability whether the person experiences subjective disability or not) rather than the question of violence alone?

    It is in my view nothing other than discrimination that can account for this.

    – Tina

  • To all who may have been interested in the topic of this blog post: the CRPD and the limitations being incorporated into its possible ratification by the US:

    I wish that I could have engaged with you in a conversation about this topic. Please feel free to contact me if you are interested in pursuing this – and also if you manage to get down this far in the comments, please feel free to discuss topic on which I posted.

  • I never asked Francesca what she proposed to do as an advocacy agenda. I am very clear that human rights and non-discrimination compels the abolition of forced psychiatry. Reaching out to discuss possible alternative responses to a particular crisis situation, and whether it makes sense to allow advance directives authorizing force, are as far as I will ever be willing to go to accommodate those who wish to deny my human rights and those of others so that they can maintain the status quo of psychiatric-state violence.

    It remains my opinion that it is wrong for Mad in America to allow the discussion to be hijacked by a commenter rather than focus on the topic under discussion. It was not a post about the general question of abolition of forced psychiatry; it was rather about the danger of CRPD ratification with limitations that impede its implementation in the US.

    Francesca might have engaged with the CRPD aspect and stated her own position on this, but instead she chose to do something else. People interested in the CRPD have refrained from commenting after seeing the direction the discussion has taken. I would ask the MIA editors to consider policy on this for the future.

  • This is the mission of the Campaign to Repeal Mental Health Laws, as posted on its website http://repealmentalhealthlaws.org.

    Our mission

    We are working for the repeal of mental health laws in the United States and Canada that allow people to be deprived of their liberty, drugged, restrained, electroshocked and otherwise treated against their will in the name of “psychiatric help.” The United Nations has called on countries to abolish such laws to comply with human rights obligations and has said that forced psychiatric treatment/interventions can amount to torture. The purpose of the campaign is to educate the public about all forms of forced psychiatric treatment/interventions and, most importantly, to take action to eradicate laws that allow these human rights violations to occur.

    Strategies to Achieve our Goals

    We are working to collect evidence of human rights violations by talking with people across the United States and Canada who have had direct experience with any form of forced psychiatric treatment/interventions and with people inside the mental health system who are sympathetic and would like to see changes made. We are working to make this evidence and these stories known to the public.

    We are working to show the public that these human rights violations can happen to anyone and that the range of people who have been affected includes soldiers, children, teachers, lawyers, journalists, doctors, service workers … in short, all of us. There is no “them.”

    We are exploring a number of ways to challenge mental health laws through legal action and to advocate legislative repeal.

    We are working to collect and share information on alternatives to psychiatric incarceration and all forms of forced psychiatric treatment/interventions. Abolishing these laws and practices in no way means denying the kinds of help needed to support and guide us through difficult times in our lives.

  • Francesca Allan is making inflammatory comments about the Repealing Mental Health Laws group and about me and unnamed others whom she considers to be “extremists”. However, her core question deserves to be discussed. She claims that because she cannot find an answer to the situation she experienced outside forced psychiatry, forced psychiatry must continue to be legally permitted.

    In fact, I did answer her question in another forum but she did not like my answer. Sorry for that. I am a human rights lawyer and would welcome for people who work on support practices to consider her situation and come up with ideas. I do find that thinking together has often helped in similar situations where a person needs an alternative to the existing system.

    It is hard to imagine in hindsight what could have been done differently. Forced drugging is irrevocable in the sense that once it is done, there is never a chance to go back and try something else. It is possible looking ahead, which is why we have crisis plans and advance directives.

    People have different kinds of tolerance for pain and suffering, different values about neuroleptics and other psychiatric drugs. Support for the exercise of legal capacity means that if a person is not conversing in the ordinary way, you engage with them in whatever way is possible, and certainly offer what you have that might relieve their subjective suffering. Maybe in this situation responding by putting out the fire – with blankets to smother it, ice packs or water to throw on it, whatever – might have helped. Or a sedative that is not a neuroleptic. Neuroleptics should be really the last, last, last resort that anyone should think of, unless a person has tried it and finds it useful. That is also part of support for the exercise of legal capacity.

    For information on alternative practices – beyond the resources on Mad in America itself – I suggest investigating Intentional Peer Support, Soteria, Open Dialogue, Family Group Conferencing/Eindhoven Project, Hearing Voices Network, Personal Ombudsman (PO) as a start. All of these practices supply principles for how to engage with people in altered states or serious distress. They are my own resources for thinking about what can be done differently.

    I would not be happy about advance directives for forced psychiatry, but if society can allow a man to agree for someone else to kill him and eat him (as has been done – I forget in which country) it should be acceptable to agree that someone will force a psychiatric drug on you even if at the time you are refusing. It is a serious decision; colleagues in the movement have suggested that everyone should be encouraged to make out advance directives even (or perhaps especially) if they have never experienced it before. (What “it” is – psychosis, madness, altered consciousness, being crazy, being forced into psychiatry.)

    Yet advance directives will never be enough, as there are always people who won’t have them, just as many people don’t make out a last will and testament. Furthermore, advance directives are based on an incapacity framework so that there is no reason for anyone to actually try to engage with the person creatively, it is reduced to a simple yes/no about drugs based on the preference you declared at the time you wrote it. Some ADs and crisis plans are much more detailed, and that is great, but we still need to engage with the person in real time and not pass over their present self while looking only at what they said at some time in the past. I think that is profoundly disrespectful and alienating.

    A last comment on the notion of what is realistic or not realistic. Numerous reforms have been tried throughout the years in mental health law. In 1986 the NY Court of Appeals issued a landmark decision in the case of Rivers v Katz, saying that even involuntary psychiatric inmates have the right to refuse treatment if they can make a decision about treatment. (In one part of the decision this was phrased as “a rational decision about treatment”.) Those of us in the movement then thought this was great, we had no idea that courts would almost always find that the person is incapable of making a decision. Courts fall back on their assumptions and act conservatively according to their view of the world; deferring to psychiatrists is less costly for them than taking the risk of enforcing a meaningful right to refuse. In part this is because it would require something more directive (like the court orders for school desegregation that fashioned remedies such as busing and continued court supervision), so that it doesn’t amount to leaving the person in a detention situation among people whom she has just won a court hearing against, with the likelihood of retaliation (including by retaining the person longer as a coercive measure or discharging them abruptly if they still need a place of respite). Also, while some people will just shake themselves off and go on, many people do need some active connection and support, which our psychiatric institutions simply don’t provide. Reforms within a system of abuse just create bureaucratic requirements and loopholes. That was the reason for creating the Campaign to Repeal Mental Health Laws, http://repealmentalhealthlaws.org. (BTW, the Facebook group Francesca mentions is an extension of this Campaign and is open to people who agree with the mission and the posting policy as spelled out on that page.)

    A ban on forced treatment, if it is legally made and enforced, will work because psychiatrists will face criminal prosecution and personal lawsuits if they persist. But it is clear that a complete overhaul of the mental health system is needed at the same time, so that people are not simply left to their own devices when that is not what they want or need.

    No one has all the answers to anything, but the issue of forced psychiatry – including psychiatric incarceration as well as forced drugging, forced ECT, restraint and solitary confinement – is something that has tended to polarize people. Doing nothing about the current situation is not benign, because people are suffering every day from forced drugging. I personally am connected with two people who are under outpatient commitment and have to take neuroleptics; one of them has tardive dyskinesia and they will not take her off the drugs (multiple ones). Having to witness this abuse and not be able to do anything about it is itself traumatizing. Of the people who signed the RMHL petition – over 760 – many have told the stories of psychiatric abuse of themselves or a family member. You can still sign the petition at http://www.change.org/petitions/us-senate-ratify-the-un-convention-on-the-rights-of-persons-with-disabilities-without-reservations-understandings-or-declarations-ruds if you haven’t done so already.

    The CRPD is opening up conversations like this one around the world, and I hope that it will continue as a fruitful exploration of possibilities for change. I think we all agree that the system we have now is not acceptable, and that it violates human rights.

  • Just a clarification – there are different bodies of the UN that don’t all act the same, although I myself sometimes oversimplify. The UN body that will review the US in March 2014 is the Human Rights Committee, a treaty body that monitors the International Covenant on Civil and Political Rights (ICCPR), which the US has ratified. CHRUSP and other organizations have submitted a report on forced and nonconsensual psychiatric drugging, and are asking the Human Rights Committee to find that this practice violates human rights (particularly the freedom from torture and ill-treatment) and that the US should put an end to it. (See http://www.chrusp.org/home/us_crpd – and scroll down to the second half of the page dealing with human rights reporting.)

    There is a close link between legal capacity and freedom from forced psychiatry, as was illustrated recently by a conversation in a Facebook group (which I won’t quote directly as participants are entitled to their privacy). If we don’t promote and explain the right to legal capacity and the difference between support in decision-making that respects the person’s autonomy will and preferences, and substitute decision-making, then people will continue to believe forced treatment is inevitable when a person is believed to lack the capacity to make a decision about treatment.

    Thanks Ben for bringing up Article 12 in this context.

    All the best,

    Tina

  • Diane,

    I was just reading that article in Foreign Affairs also before I wrote my post. The thing is, that argument for treaty ratification (American involvement) is the one that is being pushed by CRPD ratification-with-RUDs proponents. They want America to have a seat at the table, though they mistake the nature of the table. The Committee on the Rights of Persons with Disabilities isn’t an institution in which governments participate. The Conference of States Parties is, but so far has been very careful not to overstep and intrude on the proper domain of the Committee by issuing interpretive statements on the CRPD in any way. I didn’t mention this in the post, but it also gives one pause to think about the US trying to change this, and to use the COSP to limit interpretations of the treaty. It is true as one of the witnesses said, probably Meyer, that governments can give their views on General Comments made by a treaty body, just as NGOs can, and this is part of the legitimate participation of any state party. Again, however, a country that has ratified insincerely really should not be given much weight if it is going to try and water down the standards for everyone else, and I would hope the CRPD Committee would not allow this to happen.

    Both approaches in my view – the US rejection of multilateral treaties, and the negative role it plays at times when it participates – not always, e.g. on some issues like LGBT rights the US plays a constructive role – are imperialistic and anti-human rights.

    Take care,

    Tina

  • I don’t understand why the desire to have a name and a syndrome. It’s misleading I think to say that something is a symptom of such a syndrome, as if the named syndrome were a cause. In reality any of the psychiatric diagnoses amounts to giving a name to a (somewhat arbitrary) set of experiences that trouble a person or those around them.

    Regarding the “stigma” attached to a label: in my experience the problem was that the label was an excuse to disregard my own self-narrative and to designate psychiatric abuse as a beneficial therapy, thus again denying my self narrative. It is only to the extent I have accepted the abuse as somehow deserved, that I experienced “stigma.”

    Also, I am not sure where you get the information on Japan, but colleagues in the user/survivor movement in Japan still report that large numbers of people are incarcerated in psychiatric institutions. See http://www.jngmdp.org/e/.

    Thanks for writing here, and I don’t mean to discourage people from whatever they think will make things better. But as someone who was labeled with schizophrenia and wonders what it was really intended to say about me, I don’t agree with the view put forth here that a “psychosis susceptibility syndrome” makes any more sense.

  • p.s. I think the worst thing about it actually, is that it legitimizes police violence against anyone who isn’t self-identifying as mentally ill. it makes human contact and connection by the police a “special privilege” that is only granted at the expense of having to demonstrate that you already under the control of another system.

    It might be that having a card is easier for people than having to initiate a conversation about what you need if you are in a public space and experiencing crisis or distress, but it should not be framed in medical terms or give up power to police or to the mh system.

  • next step in the police state. of course it is voluntary, for now. people will be made to fear that if they don’t have such a card they will get shot. but if a cop is going to shoot you i doubt that he (she?) will ask you for your card first. it will surely end up as a database and will be an easy (for the cops & mh system) automatic ticket to commitment and forced drugging.

    thanks for informing us, michael.

  • I think “stigma” as a word or concept is not inherently objectionable. In a recent human rights report the concept of “stigmatized identities” was used in a respectful way to describe LGBT, disability and other identities that society treats with particular dislike. I think it is often useful to call attention to the dislike or hatred that is a part of discrimination.

    But the “anti-stigma” campaigns around “mental illness” are as you say geared to feeding people into the medical model and encouraging people to seek treatment within a medical framework. It is as if to say, “we will put our arms around your shoulder so long as you accept ‘your’ label and take ‘your’ drugs.” The anti-stigma campaigns developed from a particular context and mind-set and can never shake it.

    I also agree that philosophically a campaign against “stigma” is in effect stigmatizing. It says “this condition shouldn’t come with a lot of baggage” but draws your attention to the condition rather than the mind-set of those who are stigmatizing. That is why discrimination, prejudice, “ableism,” etc. make more sense to focus on. And of course there is the legal aspect. Anti-discrimination is a powerful concept in the world (and as some of you know I have devoted my work to using and applying anti-discrimination in international human rights law to end psychiatric oppression).

    I think there is a need in society to address personal prejudices (and “prejudice” has also been at times rejected as being a non-legal term) and social stereotypes, as well as the legalized discrimination. Something that stayed with me from the movie Lincoln, which I know had many flaws and didn’t address the role of African Americans in the struggle for 13th amendment, was the depiction of a choice between “racial equality” and “equality under the law.” The latter was considered more acceptable by white men who didn’t see African Americans as actually being their equals as human beings. It is of course how our 13th & 14th Amendments got written and how our anti-discrimination law works to this day. There is famously no way to legislate change in attitudes.

    Yet, there is a need to change attitudes as a way of supporting legal change to be lasting and deep – and the Convention on the Rights of Persons with Disabilities incorporates an obligation on governments to conduct awareness-raising activities to combat negative stereotypes etc. I think other human rights treaties may also address this dimension, not certain. To me it’s highly debatable whether people especially in this country would trust any government-led awareness-raising campaign, but maybe that is too cynical. (Like everything else in the CRPD that is supposed to be done in close consultation with disabled people’s organizations, offering some checks on the result, but still like anything else it can be gamed by a government that selects favored organizations, or creates a co-opted organization, etc. – as I daresay we all know.)

    In any case, Sera, thanks for bringing this out and contributing to our own awareness-raising work.

    Tina

  • Ted,

    You are aiming too low when you want to maintain the Donaldson standard. “Danger to self or others” is calumny and discrimination and has to be analyzed as an aspect of our oppression. It’s actually similar to the Plessy v Ferguson case and “separate but equal”. Separate is never equal.

    Donaldson, though it appeared to create a more progressive standard than the old “lock em up without any legal mumbo jumbo beyond the fact that they’re crazy,” helps the pro-force people in two ways. First, it doesn’t outlaw psychiatric force, and not only that it reinforces the legal justification for it. Secondly, because it makes it possible to lock someone for “dangerousness” if and only if the person is also labeled as mentally ill (then it opened the door for sex offenders, which is also dealt with as a mental disorder) it pushes psychiatrists, families and judges (and the media) in the direction of seeking to apply mental illness labels to people they deem dangerous, and seeking to apply a “dangerous” label to people they deem mentally ill and want to have locked up.

    In other words, the current spate of intense psychiatric profiling is fed by the Donaldson standard, it is its logical conclusion. The hate-speech campaigns to expand commitment laws amount in part to arguing that all mentally ill people are dangerous (“dangerousness” cannot be proven, it’s a defamation) so lock em all up to prevent any possibility of danger to your family, your child, etc. It has the same structure as lynching, or pogroms. You the presumptively good innocent people are in danger from these bogeymen. Let’s not look at the evil in the hearts and actions of those who are given a free pass as good and innocent. And let’s scrutinize those who are labeled as evil until we drive them to the point of reacting, which will create an excuse to get rid of them. If they don’t react we will label them as abnormal and get rid of them anyway. Same as witchburning also.

    Finally another good reason to aim higher than Donaldson, that everyone needs to know about. The Convention on the Rights of Persons with Disabilities has incorporated a standard that prohibits all psychiatric commitment. That this is the actual standard being applied under that treaty has now been proclaimed definitively by the Committee on the Rights of Persons with Disabilities, which has authority to interpret the treaty. Although it has not been ratified by the U.S. (and see our petition https://www.change.org/petitions/u-s-senate-ratify-the-un-convention-on-the-rights-of-persons-with-disabilities-without-reservations-understandings-or-declarations-ruds), the standard is influencing international human rights law in general, and will reach us eventually. I wrote about this in a blog post (https://www.madinamerica.com/2013/09/un-ensure-one-detained-kind-mental-health-facility/) and will try to write more.

    A second point worth making is that the Americans with Disabilities Act is supposed to protect us too, but court interpretations have been infected with the same defamation that we are dangerous. It is not always applied consistently and I’m no expert, but it is something I wish that more of us (survivor lawyers) would look into.

    Lastly, regarding organizing. I like the idea of a network but would also like to make something more like the old movement that was a network of groups as well as individuals. There are organizations – some grassroots and some in principle national or trans-national – that are working in the direction you describe but not everyone knows about each other’s work. I would like to mention the Campaign to Repeal Mental Health Laws (http://repealmentalhealthlaws.org) – we have a huge challenge due to the large nature of our ambition, but we have started to work in ways that can have an impact. I see the work of RMHL as being strategic in the sense that you have argued for.

    Strategic may at times be in the eye of the beholder, and there will always be disagreements. In the campaigns for marriage equality there has been fierce disagreement about strategy and tactics, and there have also been disagreements in the LGBT community about whether marriage is something to fight for. It’s worth keeping that in mind. I am interested in joining any effort that will move us towards achieving freedom, which for me is inextricably linked with repeal of all the laws that make us an inferior caste in society, especially the commitment laws.

    Take care,

    Tina

  • Dear Suskar,

    The assumptions we make and the way we tell a story narrow the kinds of responses we can make to it. When you use terms like “mania” and especially when you attribute causative power to a state so described, we immediately think about psychiatric or mental health solutions. Such words are used sometimes as a convenience or shorthand but they really don’t do justice to what people are experiencing. Chris Hansen has a segment in the Intentional Peer Support workshop where she asks people to tell their life story using psychiatric diagnoses and concepts, and then without them. The stories are incredibly different – and our responses to them are different.

    We don’t have the power to predict anyone’s future with anything near good accuracy – I won’t even suggest 100%. This is no more true about predicting what people will do who experience states that get named schizophrenia or mania, than it is about anyone else. We also don’t have the power to know for certain what will happen if we do X or fail to do Y. Hindsight can eat a person up, I know from personal experience.

    Regarding the kind of childhood you had – I can relate. My mother was very strange and while I will not label her, she took a variety of psychiatric drugs at different times throughout her life – neuroleptics, benzos and SSRIs – and she somehow managed to relate to each member of the family in a way that was differentially abusive. Like you, I experienced it as that was just the way things were. I would wish in that kind of situation, for families to be less isolated, but this is a cultural thing – in no way would I have wanted the mental health or child welfare systems to intervene in my family.

    Looking at the stories you tell, it’s clear there was a problem with violence. That’s separate from the mania. I can’t tell you how many people I know who experience mania and psychosis (their terminology or what they get labeled with) and who have never been violent and abhor violence. On the other hand, I also know several people who report that when taking SSRIs they felt impulses to suicide that they never experienced at any other time. It doesn’t sound like that was the case with your father or brother. I don’t know what to say, except that my heart goes out to you in dealing with these losses and the violence surrounding them.

    After the psychiatric profiling got going in earnest as official national discourse after the Newtown shootings last December, I started some discussions about what we could do in a positive way in these situations. (Before it became clear that we – survivors of psychiatry – were going to be silenced in every way possible.) One idea was to share stories and knowledge about how we deal with impulses to violence that we might have had, to learn from each other about what could be useful to stop it from happening. This would still be a good idea.

    I know that I was kind of awed by Antoinette Tuff, who convinced a man with a gun to put it down and let the police come, and not to shoot anyone. I want to learn from her example that it is possible and to imagine and cultivate in myself what it takes to act as she did. She took a risk, not flamboyantly as entrepreneurs often are proud of risk taking, but humbly because she did what had to be done.

    This is a necessarily incomplete response, I thank you for writing and hope that we can generate some discussion about how to react to situations of potential violence, and situations where something else is going on that causes disruption or disturbance in someone else’s life or in our communal life with another person.

    Best wishes,

    Tina

  • Yes. And that is something we are working on also through the CRPD and its interpretation. I have materials on the CHRUSP website on this and will be doing another submission to a relevant UN process this year as well. Look on http://www.chrusp.org/home/resources under Prison Reform/Abolition and CRPD. I will try to post here as well on the topic and will look forward to comments.

    See also the latest report of the Special Rapporteur on Torture, dealing with the rights of prisoners – it is related to the same process for which I will be submitting comments on behalf of WNUSP: the review of the Standard Minimum Rules on the Treatment of Prisoners. He takes up the key demands of WNUSP in this paper, and to read it is is necessary to understand that Rules 82 and 83 of the existing SMR are entitled “insane and mentally abnormal prisoners” and are all about transfer to forced psychiatry. See http://antitorture.org/sm/.

  • I feel humble and sorrowful reading the accounts of horrific abuse, from dragonfly and barringer above. Yes, I agree it is a burning of the witches also. And it is a return to slavery times, as I have heard African Americans say when being hauled off to be force drugged.

    And mjk, yes the message is coming from many places. The planet and global societies are in danger in so many ways and people have to, and are, rising up – but what will it take, when the machinery of death and destruction and the technology of control are so highly developed? It can be easy to despair if I look at the big picture, but I have been going one step at a time and what gives me hope is that there have been some abuses and oppressions that ended.

    Having read parts of Michelle Alexander’s “The New Jim Crow” I am mindful that oppression comes back in other forms (and as dragonfly points out also). Psychiatry creates a social caste based on its selections, and if psychiatry is gone there will be new ways developed to exclude people who are persecuted. Will there be any end resolution to have a world of justice and peace? I don’t know, but that is ultimately what I am working for and hoping for even if the hope seems incredibly optimistic. Hope is just that, it’s not expectation.

    Thanks to everyone who has commented on this post and to others who have helped to distribute it. I have been told that it will be translated into German and distributed there, which I consider a great honor especially because of the linkage I have made with persecution of Jews, and the Nazi murders – I alluded to but didn’t say directly in my post a fact that many of you know, which is that psychiatrists invented the gas chamber and used it first on psychiatric inmates and other people with disabilities.

    Ted, I have learned that the post disappeared from the front page because I edited it, it is being restored. I made an edit to acknowledge a point raised by a friend who commented on my statement that were “damn strong” to survive.

    It’s hard for me to keep looking at this, but I will end by saying that I want to nurture this anger, not always at high pitch but constantly there, to bring our changes into reality. I continue to be heartened by the work so many of us are doing. And I’d like to close by reminding people of both the CHRUSP website http://www.chrusp.org where you can find my writings and other resources, and the Campaign to Repeal Mental Health Laws (RMHL) – http://repealmentalhealthlaws.org which is open to new members who agree with the mission and want to take part.

    RMHL also has a petition that you may want to sign, calling on the U.S. Senate to ratify the Convention on the Rights of Persons with Disabilities without any reservations, understandings or declarations – https://www.change.org/petitions/u-s-senate-ratify-the-un-convention-on-the-rights-of-persons-with-disabilities-without-reservations-understandings-or-declarations-ruds.

  • Dear Stephen,

    I think that psychiatric “hospitals” and “wards” qualify as concentration camps. It is not applied to all of us, but part of the point I am making, and that was made by my friends in the conversations I describe, is that having it as a constant threat is used as a bullying and silencing tactic. The Nazis didn’t necessarily round up all the Jews to begin with either.

    But I agree with you that things are getting worse, and though I don’t want to imagine particular horrific scenarios, I agree that we need to save ourselves (and society).

    Tina

  • Like you Ted, I come from the “old movement” – you certainly even way before I got involved in 1978. We used “anti-psychiatry” in the way you do, which I always see as a short hand for anti-psychiatric oppression. The psychiatric profession has been in every country the strongest force behind the creation of mental health laws that allow incarceration and forced treatment. They were responsible for the final form of the UN’s “Principles on the Protection of Persons with Mental Illness” – a nonbinding 1991 declaration that approved of incarceration and forced treatment and has been superseded now by the Convention on the Rights of Persons with Disabilities. Psychiatry as a profession is not simply a discipline that someone can be trained in, it is organized and consistently acts against us politically and legally, as well as economically and by its systemic perpetuation of torture, negligence and other abuses.

  • Two comments. It used to be that people could get ordinary welfare without having to claim a disability, and this was enough to live on. But welfare payments did not go up with inflation, and they also made it harder to get. I don’t know what is actually possible now for welfare, but SSI has always been a little bit more.

    And, I’m wondering about the relation between the non-discrimination/social model of disability, and the disability benefits/pensions thing. I guess that there should be a unitary system to support people who can’t work for whatever reason or who need to take time off or can’t work in the usual systems or usual ways. Hard in a society that is suspicious of people when we aren’t fitting like cogs into the system. That is the real thing that has to be changed underneath it all.

    Thanks for a good thought-provoking article.

  • Peter,

    Thanks for this very good information. I have a question and a comment.

    The question: In your understanding, is the advance directive effective to stop any commitment or forced treatment in psychiatry including forensic and including as a chemical restraint in situations psychiatrists label as an emergency?

    The comment: Regarding the CRPD, the new laws most emphatically do not comply. They ignore the standard on legal capacity in particular, which does not allow for a person’s decision about medical treatment to be disrespected on the basis of lacking insight because of a disability. The Committee on the Rights of Persons with Disabilities has repeatedly expressed the view that all mental health services have to be based on the free and informed consent of the person concerned.

    We will see very soon if the Committee is strengthening its views against forced psychiatry, staying the same or going in a wrong direction, stay tuned and I will be posting on my own blog when the information from the recent session comes out.

    All the best,

    Tina

  • Bob (and also Matthew, as I’m amplifying on my above comment as well),

    I want to comment that I appreciate your speaking to NAMI and the opening up of dialogue. You reach people that I wouldn’t with a head-on torture argument, and that Breggin wouldn’t with his description of what the drugs do, period (e.g. his 1983 book), without any framework of looking at whether they make sense as a treatment.

    As a human rights lawyer and activist I’m interested in what will open up pathways for change and I agree that this is one of them.

    For me, the question of whether psychiatric treatment is good or bad has been a non-issue. The reality I lived was that it was torture (neuroleptic drugging in particular). I’m aware that other people experience it quite differently, so the way I make sense of this is to talk about requiring free and informed consent. I also see that this is not enough though. We need to challenge what is being offered to people who are in crisis and needing something. I’ve been educated a lot by many who take a much more unequivocal stand than I do about psychiatry as being a corrupt enterprise, all its treatments as worthless, etc. I hope that those voices will also keep continuing to be heard in the mix, and as I read your comments and Matthew’s, it is the intention that they will be.

    And I have seen the openings among people who identify with NAMI. In hearings earlier this year in Connecticut NAMI members testified against outpatient commitment and talked about the harm done to their sons and daughters by forced treatment. I trust that the site is going to invite people who want to dialogue, and not those who are coming to defend the policy positions of NAMI that have caused so much harm and that were pointed out by a commenter above.

    Best wishes,

    Tina

  • Dear Matthew,

    Thanks for the opening to point out upper class forms of aggression. Usually I have chosen to tune it out because it’s one too many front for me to fight on. But I hope that others might take up this invitation, and I will also keep it in mind.

    I would very much welcome for more people to engage with my posts to raise honest questions and concerns, and I have to say I don’t think I’ve experienced abuse here. It’s rather been that only survivors usually will comment at all.

    Best wishes,

    Tina

  • Matthew,

    I find the focus on survivors’ behavior in your post to be a replication of oppression. I wish you would have found a way to call for politeness more even-handedly. Perhaps I missed it, but I didn’t see any mention of the ways that non-survivors have behaved aggressively (including upper class forms of aggression), comparable to what you say about survivors:

    “We want to run a site that people are able to explore and participate in without fear of the fanatic jack-in-the-box, sitting on its springs, waiting to pop up and rip someone a new one the moment they offer a thought that doesn’t match the survivor-approved gold standard of word-choice and understanding.”

    Best wishes,

    Tina Minkowitz

  • Steve, thanks for sharing what you do as a peer worker.

    One comment on your last post, I wonder if residents/inmates intervene when it’s well-liked staff being attacked more than when it’s other inmates? Because it would be so much more a challenge of power.

    Cataract, I’m interested in exploring ways of dealing with the triggering aspects of talking about forced psychiatry as torture. I feel it’s necessary to open this up but I have difficulty with it myself and have to steel myself to read the material.

    Thanks for the comments,

    Tina

  • Nijinsky, I relate to what you are saying about a “schizophrenic” approaching this relationship with thought. I think it’s a good insight and maybe goes part of the way towards defining what is happening when we get labeled with that label… I have always thought of it as a garbage diagnosis but there are real experiences as well.

  • I join with some of the comments here, in particular I would like to hear from the author how she would respond on the question of NAMI’s public policy that is counter to our human rights and equality. And I also feel conflicted because I do think it’s good that Bob Whitaker spoke to them and is building bridges. I agree with the comment that hopes the author (and NAMI) will look into the work being done in Finland, and by Hearing Voices Network, etc., to come to some changes in their policy and advocacy as well as to find solutions in their personal lives.

    I’d like to invite the author to look at my blog on Mad in America and to address the issue of psychiatric torture as we are dealing with it from a human rights perspective. It is not pretty to hear that the United Nations Special Rapporteur on Torture has condemned the practice of nonconsensual medication, and that this practice meets the criteria for torture. It is not pretty, and I for one acknowledge that people opting for this abuse are acting in a context where they don’t understand either the seriousness of the harm they are inflicting or how to think differently so as to allow for a different way of responding. I have not yet had any psychiatrist come to me and say that he or she is grappling with the implications of practicing in a way that amounts to torture (or ill-treatment). I have received a lot of sulky, defensive responses that claim my definition of their acts as torture is abusive to psychiatrists. I’d like to invite and challenge NAMI to engage positively with me on the issue of addressing these harms within the human rights framework, including the obligation of governments to repeal all legal provisions that authorize psychiatric incarceration or treatment against the person’s will or without her/his free and informed consent.

    See https://www.madinamerica.com/2013/06/we-name-it-torture/ and my other blog posts, also http://www.chrusp.org.

    Best wishes,

    Tina Minkowitz

  • recovery1,

    I’d like to engage with your comments to address a few points that I don’t think are correct.

    First, there is nothing in my advocacy that in any way seeks to prevent people from having access to services in the mental health system that the person wants to use. The Human Rights Committee is asking specifically about nonconsensual medication.

    Secondly, there are other ways of understanding the relationship between mental health problems and crime, than to draw the conclusion that these problems represent “illnesses” that can be treated medically in a reliable way, and the further conclusion that such treatment would prevent the person from committing minor criminal offenses.

    Consider the following:

    1. Much of what is labeled as mental illness – of any kind, whether “personality disorder,” “psychosis,” “schizophrenia,” “bipolar,” “depression,” “anxiety disorder” etc. – is related to traumatic experiences in the past or present. It is no secret, and not even controversial, to say that people who come to the attention of the psychiatric system overwhelmingly tend to have a history of (usually multiple) traumatic experiences. So do those who go into the prison system.

    It makes more sense to me, and is more respectful of the individual as a human being who has agency, to talk about what the person is dealing with and how it is impacting on them, rather than to use medical model terminology that is objectifying and, as you see through the MIA website, that channels people into a system that often causes them a lot of harm.

    Actually that would apply to both psychiatric system and the prison system. They work hand-in-glove with each other. People commit crimes under the influence of psychiatric drugs and psychiatric drug withdrawal. Forced drugging happens quite a bit in the prison system as well as in psychiatry.

    I’d like to see people have better access to whatever helps them deal with their own life challenges and responsibilities to others. I’ve just read Laura Delano’s April blog on the MIA site that says folks are putting together a directory of such services. One aspect we need to pay attention to is access (and cultural competence) for people of color and other sectors that are too often left out of the good practices.

    2. We also know that racism, sexism, disablism and other kinds of discrimination affect who goes to prison and the factors that go into this: how crime is defined, who is arrested, who has the best lawyers, who is viewed as sympathetic by a judge and/or jury, etc. If there are a lot of arrests for minor crimes that affect young men of color who have psychiatric diagnoses or mental health problems, I would suggest that there may be a problem with how these crimes are defined or how the law is being applied.

    The disability rights framework can be very helpful in getting us away from medical-model thinking. The main premise (or insight) of the disability rights framework is that the difficulties inherent to mental health issues are only a small part of the problem; the rest is the response we are met with by society.

    A social-model analysis can sometimes help individuals, since they may have rights under the Americans with Disabilities Act that they are unaware of. It is also the basis for our human rights advocacy at the UN, which aims at overall changes in society.

    Thanks for your comment, and for bringing up the issue of people labeled with psychiatric disabilities in prison, especially those from communities of color.

    Best wishes,

    Tina

  • Olga, I see that the report has been translated into all UN official languages (French, Arabic, Spanish, Russian, Chinese, in addition to English), you can download here: http://www.ohchr.org/EN/Issues/Torture/SRTorture/Pages/SRTortureIndex.aspx

    The statement is available in Spanish as well as English, I have it linked on the CHRUSP resources page http://www.chrusp.org/home/resources

  • Thank you Laura. We are the evidence & we need to get this evidence into the media. Our voices are almost entirely absent. Why aren’t any of the mainstream media picking up on what is written here on the MIA blogs? I know you can’t answer that, only expressing my own anguish of the day.

    And while I’m here I’ll put in a plug for the Day of Action I’ve been organizing to Stop Psychiatric Profiling, people are invited to do an action big or small in their own communities to protest the Obama/Biden proposals and also in NYS to protest the “NY SAFE Act”. Please see https://www.facebook.com/events/413065465440858/

    *To protest the scapegoating of people labeled with mental illness by politicians, media, gun control advocates and the pro-gun lobby

    :In particular to protest the “NY SAFE Act” pushed through NY’s legislature and signed by Gov Cuomo, which expands state and federal criminal databases of people labeled as mentally ill, unconnected to any actual crime or act of violence, and expanded outpatient commitment (forced drugging in the community)
    :To protest any discriminatory proposals coming out of Vice President Biden’s Task Force

    *To invoke our connection to Martin Luther King Jr. and the values and traditions of nonviolence:

    :We are a nonviolent community
    :Many of us have been traumatized by violence and do all we can to stop it
    :We are being labeled and profiled wrongly as violent, because of the actions of a few individuals
    :Forced psychiatry is violent
    :The new laws being enacted – in NY and likely at the federal level and in other states – will further restrict our civil liberties and constitutional rights
    :We are protesting nonviolently for our civil and human rights

    *To affirm and celebrate our “creative maladjustment” to a society that pits neighbor against neighbor with a duty to report thoughtcrimes and eccentricities to the state

    (“Creative Maladjustment” comes from several of King’s speeches, including a 1967 speech of King to the American Psychological Association where he called for an International Association to Advance Creative Maladjustment, see http://www.psychologytoday.com/print/53556. David Oaks and MindFreedom International have taken up this call as part of the Mad Pride movement, http://www.mindfreedom.org/kb/mental-health-global/iaacm. We honor David and wish him well in his recovery from serious injuries and surgery.)

    ****

    On Martin Luther King Day, January 21, 2013, people everywhere are invited to hold demonstrations, vigils and any other nonviolent acts of expression and protest, to inform the public about our point of view and gather in solidarity.

    Please take photos and post them.

    You can use hashtags #OccupyPsychiatry #StopMHProfiling and #CreativeMaladjustment

  • This post is insightful and appreciated. I also agree with the comments by Marion Goldstein about violence causing violence, and about needing to face and understand evil acts.

    We need to look at all forms of violence including violence perpetrated by children on their parents, and also psychiatric commitment and everything that comes with it, including forced drugging, restraints and solitary confinement, as a form of violence (recognized by the UN as a torture and ill-treatment). Both these issues figured in the Lanza shooting.

    With regard to comments about what different medical models especially with regard to autism, I see the neurodiversity movement as entirely different than NAMI because it is adults speaking for themselves (“Nothing about us without us”). While I comment as an outsider to autism, the way I understand their claim of a biological basis is as a chosen way of looking at their diversity, similarly to how many LGBT people see their diversity as biological. I can accept this in an extended sense of biology as being the totality of what a human being experiences as innate.

    I am sorry to have to say that “crux” adopts a similar posture to NAMI in claiming that the parents of children with autism represent “autism” and that adults with autism do not. Not for nothing, is the motto of the disability movement “Nothing about us without us!”

    There are many things we may never know about everything that may produce disturbances in consciousness including environmental toxins, physical conditions, trauma and abuse, as well as spiritual crises and awakenings.

    The disability movements had to wrestle with issues of cause/prevention in the course of working on the Convention on the Rights of Persons with Disabilities (in which I played a key role as one of a large group of drafters). There is a tension between saying “I’m ok as I am, I have a right to be me, don’t assume it’s better to be you than to be me” and calling attention to harms that cause us to suffer in ways that then we are punished for even more by labels and discrimination. This is the social model of disability, it’s not either/or but both/and/or.

    It’s important not to lose sight of mad pride or other disability pride or to pit them against a recovery model or a trauma model or an understanding of environmental toxins including psych drugs. We need family perspectives and community perspectives; as more recent commenters are saying we need to confront the full horror of violence – and not jump into the arms of the first “knight in shining armor” that promises to slay the dragons. We need to look at domestic violence in all its faces, including psychiatric commitment and institutionalization by family members of those they feel responsible for but don’t know how to support or love well enough to avoid harming them.

    And yes, Nothing about us without us!

  • So glad to see you here David. And from the responses it is obvious how much the discussion is needed. It’s a starting point that goes beyond suicide itself, just as the work of the hearing voices network goes beyond hearing voices. I like very much what the comment just above mine here (by mjk) says about suicide being about something you can’t live with, or can’t live without, or both.

    Look forward to seeing how the conversation develops.

  • Jack,

    Thanks for your words of support. Actually the developments in Australia and Ireland fall far short of what is required, and from what I have seen amount to superficial changes. But significantly it has opened up the conversation about abolition of commitment and forced “treatment”.

    As for an assembly of interested parties, we do have a Campaign to Repeal Mental Health Laws that is a focal point of looking at these issues and how to make our goals a reality. Look for us on facebook https://www.facebook.com/groups/356040824414503/ and on the web http://repealmentalhealthlaws.org and contact us if you are interested in getting more involved.

    Best wishes,

    Tina

  • Emily,

    I stand by my language based on what I understand about the groups opposing the CRPD. If you are not a fundamentalist right-wing Christian and oppose the treaty I would say you are just ill-informed.

    What I wrote here about the CRPD prohibiting forced psychiatry is exactly true. That is why we need it ratified without any reservations, understandings or declarations.

    In fact, the U.S. is now taking our standard of psychiatry to the rest of the world. Ratifying the CRPD, particularly without the RUDs, will actually give those of us who oppose the globalization of psychiatry a platform and hook to oppose it.

    Tina

  • Duane,

    I wouldn’t foreclose any particular avenues of how to go about enacting into law a prohibition of forced psychiatry. It could be through an ADA amendment. I’m not really comfortable with “least restrictive” because that suggests that restrictive measures, which in psychiatry include actual coercion, are still permitted.

    acidpop5,

    I’m not clear on why you think the ADA is a problem for us. There are limitations in the ADA but the concept of non-discrimination is helpful and is basically the same as what you say about making us a suspect class.

    Best wishes,

    Tina

  • Belinda,

    I think your reply raises the issue of the need for awareness-raising in addition to changing laws. Changing laws in itself is only a partial solution, as we have seen repeatedly with any major change – there is a wonderful book by Michelle Alexander called “The New Jim Crow” in which she argues that the racism underlying slavery and Jim Crow laws is now being expressed in a racist system of mass incarceration in which African Americans are overwhelmingly affected. We have to change the ways that we relate to each other at every level, and to offer people information and tools to make the transition to a more equitable social reality.

    Best wishes,

    Tina

  • Alberto,

    Thanks for your thoughtful comment. In the context of the Committee’s recommendations to other countries, I think it is most likely that they were responding to advocacy by civil society in Argentina, which strongly supports the mental health law as a vehicle for changing from institutionalization to community-based services, despite the law’s acceptance of forced psychiatry. I really do not know if the Committee read the law or if its support for forced psychiatry was pointed out in any NGO submission, or if they asked questions about this in the dialogue with Argentina. I was highly disappointed that NGOs from Argentina as well as the Committee refused to uphold the CRPD standards fully in this particular case. One powerful NGO (not user/survivor-run) put forward the view that silence on any deficiencies of the law would mean that even its good provisions wouldn’t be implemented. While I am not on the ground in Argentina, I think that this was an unacceptable sacrifice and likely is giving too much power to fear in any case.

    But, while I am disappointed in the Committee in this particular case (and also in their comments regarding penal law, in Argentina) I think the overall tenor of their jurisprudence is clear about abolition of forced psychiatry. And even regarding Argentina’s mental health bill, I don’t think they endorsed the involuntary measures, so there is room for future advocacy to bring out what the Committee and NGOs ignored this time.

    Best wishes,

    Tina

  • Emily,

    Thanks for your thoughts but I disagree that no forced treatment or substituted decision-making happens systematically today in the mental health system. Discussions in workshops at Alternatives showed how people’s rights and dignity and bodies are still being violated in this way.

    I would also suggest that all of the abuses work together. People know that if they do not comply with treatment they can be subjected to involuntary measures. This is so pervasive that it may not even have to be made explicit.

    And if you look at both the recommendations on legal capacity, and the recommendations on abolishing forced treatment and changing mental health policy and practices, you will see there is a holistic approach. The Committee is talking about free and informed consent, and about ensuring access to peer support and alternatives to the medical model.

    The power given to psychiatry to pathologize, label and drug people is not only social and economic, it is also reinforced by the state power given to them to have people locked up, forcibly drugged and shocked, restrained and put in solitary confinement.

    There is also an issue raised in your reply, about what disability is. “Disability” does not mean there is something wrong with a person, it means that society has labeled and discriminated against the person. This is part of the social model of disability, and it is in the Americans with Disabilities Act as well as the CRPD. The ADA includes protection against discrimination for people who are “regarded as” having a disability and not only for those who experience or identify themselves as having a disability. In the UK, social model advocates use the term “disabled people” rather than “people with disabilities” to emphasize that we are disabled by society. And yes, when somebody is labeled, drugged and has their body and rights violated in other ways by psychiatry, the person might experience disability even if they hadn’t before.

    We have to both get rid of the power of psychiatry to label people and also fight their social and economic power in other ways, like the initiative to hold hearings on the DSM. All of this is synergistic and there are different areas of work that speak to one person’s experience or another’s. I hope that we can share support and solidarity for all the avenues of work.

    Best wishes,

    Tina

  • Steve,

    I agree with you also about honest reporting of alternatives, and about making alternatives available “through realistic funding mechanisms”. If there is only medication and “case management” (and electroshock… and psychosurgery… and the new technologies for delivery of medication to those who have a hard time remembering to take it…) then on the systemic level there is no true free and informed consent. Making alternatives widely available and affordable is an essential part of what needs to be done.

    Tina

  • Thanks everyone for your comments. I’m not sure what kind of a schedule I will keep for the blog, but anticipate at least once a month. I’m glad to be here on MIA. For those following the posts, please see my reply to Anonime that addresses some questions others may have as well.

  • To reply to this and your other post – I will get into these questions in more detail in future blogs, because it deserves a full explanation.

    Basically the argument is along three prongs.

    1 – Forced psychiatry, that is anything done without the person’s own free and informed consent, is an act of violence and not a legitimate medical treatment. There are reasons why forced psychiatry should be put under even greater scrutiny than ordinary medical treatment: it interferes with freedom of thought, consciousness, personality, conscience. It is highly controversial both in the medical paradigm itself and in terms of the well documented harms it causes and the dubious benefits. In this type of situation, if there is any question about the person’s consent it should not be done.

    (And I agree with you that we need to pay attention to the quality of information provided, as well as to the circumstances under which consent is given, if there is intimidation its not free.)

    2 – Locking up a person for any period of time on the basis that the person may be dangerous to themselves or to others, is not allowed in the U.S. and most other countries unless the person is given a psychiatric diagnosis. This is discrimination.

    Theoretically it would be possible for a country to enact laws like this that would operate without any psychiatric diagnosis & be applicable to everyone. But as a colleague in Ireland found recently, when a group of people starts talking about having a general “danger law” applicable to the whole population and not just the mad community, they see how huge a violation of civil liberties it is and would not want to do it. (I do think it’s a real danger though, for countries having a strong right wing movement.)

    And there are alternatives that we can explore. For me, giving psychiatry the power to legally imprison anyone, or giving anyone this power “in the person’s best interest” is just not acceptable and never will be.

    3 – Depriving anyone of the right to make decisions for themselves, by saying they lack the capacity to give consent, is another form of discrimination based on disability. Instead of treating the person as if she is not really there and having someone else make the decision (whether a court, a doctor or a surrogate decision-maker), we have to use supportive ways to explore with the person what he or she actually wants. This is related to principles of accessibility and reasonable accommodation, and in the c/s/x movement the practice of Intentional Peer Support (created by Shery Mead) fits well with this human rights framework.

    I see I’ve written at length and hope this begins to answer some important questions.