Category: Disability equal rights

Posted on

Linda Steele: Challenging Law’s ‘Monopoly on Violence’

Challenging Law’s ‘Monopoly on Violence’: Human Rights and Disability-Specific Lawful Violence

Dr Linda Steele, Lecturer, School of Law University of Wollongong, Australia

29 March 2016

The Convention on the Rights of Persons with Disabilities[i] (‘the CRPD’) provides a human rights basis for seeing non-consensual medical treatment, detention and chemical and physical restraint as forms of discriminatory violence against people with disability. United Nations human rights bodies must be consistent and persistent in urging states parties to reform criminal and civil laws to explicitly prohibit these practices and provide legal avenues for redress. Until this occurs, these practices will continue to be lawful forms of violence which are condoned and, indeed, made possible by the state and by law.

In my blog post I will briefly discuss the concept of ‘lawful violence’ and why non-consensual medical treatment, detention and physical and chemical restraint constitute ‘disability-specific lawful violence’. I will then explain how the CRPD provides a human rights basis to contest the lawfulness of this violence, and what needs to be done to urge states parties to follow the CRPD and ultimately prohibit and remedy disability-specific lawful violence.

Questioning Violence’s Legal Status

People with disability experience disproportionately high rates of violence when compared to people without disability[ii] (even taking into account the issues with data collection which result in an under-quantification of the rates of violence against people with disability[iii]). There are numerous approaches to categorizing violence against people with disability for the purposes of analysis and devising recommendations for law reform directed to reducing its incidence and enhancing justice for survivors. One approach which I adopt in this blog post is to categories violence in terms of its legal status under domestic law: whether violence is prohibited and legally actionable, or instead permitted and condoned by law. This approach is particularly fruitful for appreciating the significance of the interface of the CRPD and domestic law to states parties addressing all forms of violence against people with disability.

  • Unlawful violence

Some unwanted contact, detention and restraint against people with disability constitutes ‘unlawful violence’ – violence that is prohibited by domestic criminal laws (e.g. offences of assault or sexual assault) and/or constitutes a tortious wrong pursuant to civil law (e.g. torts of battery or false imprisonment). While people with disability experiencing ‘unlawful violence’ technically have available to them criminal and civil legal protection and remedies, at an individual level there are considerable issues with enforcing these laws vis-à-vis survivors with disability. These issues are due to such factors as discriminatory views about disability (and the intersection of disability with gender, sexuality, race, criminality and age) held by police, prosecutors and judges, and because of discriminatory evidential and procedural laws.

Despite the significant issues with ‘unlawful violence’ vis-à-vis people with disability, there are some forms of unwanted contact, detention and restraint of people with disability which do not even fit within this category of ‘unlawful violence’ such that there is not even the possibility of punishment and remedy. For present purposes, non-consensual medical treatment, detention and restraint of people with disability do not fall within the category of ‘unlawful violence’, as I will now turn to explain.

  • Lawful violence

Some unwanted contact, detention and restraint of people with disability – notably non-consensual medical treatment, detention and physical and chemical restraint – is not prohibited or actionable under domestic law and instead is legally permissible. As such, these practices fall outside of the category of ‘unlawful violence’ and sit in a different category of ‘lawful violence’ or, as I term it by reason of the significance of ‘disability’ to its lawfulness, a category of ‘disability-specific lawful violence’.[iv]

Disability-Specific Lawful Violence

Drawing on the work of Robert Cover[v] on ‘legal violence’ (i.e. violence permitted by law), Austin Sarat and Thomas Kearns[vi] argue that law has a ‘monopoly’ on violence, because law determines what is possible to do to another’s body without any legal accountability. Domestic law, and particularly criminal law and tort law, has singular control over violence because regardless of individual experiences of or social values towards unwanted contact detention and restraint (or, indeed, even international human rights perspectives on unwanted contact, detention and restraint) it is the domestic legal system that determines what will be punished or remedied and conversely what will be permitted and go without any punishment of the perpetrator or remedy for the survivor. Unwanted contact, detention and restraint becomes violence that is ‘lawful’ where it is permitted by law. This is not to suggest that legal permissibility means that lawful violence is completely at large. Generally, lawful violence is deeply embedded in legislative and common law frameworks and in judicial and administrative procedures (many of which purportedly ‘protect’ those subjected to lawful violence through ‘procedural’ oversight). Therefore, the state and law are significantly complicit in the operation of and legitimation of unwanted contact, detention and restraint where this is permitted by law.

  • Lawfulness

Turning then to non-consensual medical treatment, detention and physical and chemical restraint of people with disability, these practices are lawful violence in the sense discussed above because they are not prohibited by or actionable under law. In very general terms, criminal law defines assault and civil law defines battery in terms of non-consensual interpersonal physical contact or the non-consensual threat of such contact. The tort of false imprisonment and related criminal offences consider detention and restraint unlawful where it is the non-consensual deprivation of liberty in a delimited space. In the face of the general criminal and tortious prohibition of these acts, the entry point for the legality of such acts vis-à-vis people with disability is the legal exceptions to unlawful violence created by certain defences to criminal responsibility and tortious liability: consent, necessity and lawful authority. These are discussed here in very general terms (noting there will be differences between jurisdictions):

  1. Consent: Interpersonal physical contact does not constitute assault if consented to by the individual. However, where the individual does not have capacity to consent, the law permits a third party to consent on that person’s behalf. In the context of medical treatment of people with disability (such as sterilization) there are established legal processes for recognizing third party consent, e.g., involving determining lack of legal capacity on the basis of mental incapacity and then determining whether the medical decision is in the individual’s ‘best interests’ or a ‘step of last resort’.[vii]
  2. Necessity: Non-consensual medical treatment, detention and physical and chemical restraint of people with disability might also be considered to fall in the defence of medical necessity if the procedure is considered ‘necessary’ in order to protect the individual’s life, health or wellbeing and the act is reasonable and proportionate to the ‘harm’ to be addressed (regardless of whether this harm is in the context of an immediate and short term emergency or an ongoing state of affairs).[viii]
  3. Lawful authority: Non-consensual medical treatment, detention and physical and chemical restraint of people with disability are lawful when done pursuant to statutory or judicial authority.[ix] Such authority includes civil and forensic mental health legislation authoring detention and treatment, as well as legislation authorizing chemical and physical restraint.

These defences carve out an exception to ‘unlawful violence’ for non-consensual medical treatment, detention and physical and chemical restraint of people with disability, such that they become forms of ‘lawful violence’ regulated by law. This procedural protection on an individual basis of when and how such interventions take place elides questioning at a systemic level why these unwanted practices should ever be permitted and in turn elides categorically naming these practices as violence.

Yet, the ‘regulation’ by law of these practices is typically framed as ‘protective’ because law’s involvement provides administrative and judicial procedural oversight to when and how these non-consensual interventions occur. In fact, the greater ‘procedural justice’ afforded to people with disability in the past couple of decades is frequently characterized as a marker of a more enlightened and progressive approach by law and society to people with disability insofar as it is juxtaposed to earlier purportedly extra-legal, arbitrary and repressive practices towards people with disability. However, far from showing law’s role in the ‘salvation’ or ‘empowerment’ of people with disability, the legal processes through which non-consensual medical treatment, detention and physical and chemical restraint of people with disability are permitted in fact signal law’s complicity in this violence: the state’s regulation of a legal economy of violence against people with disability. The state and law contributes to the production of broader social and ethical norms about what is permissible to be done to people with disability and ultimately lowers the value of the bodies and lives of people with disability.

The status of some violence against people with disability as lawful has implications for the punishment of perpetrators and remedies for survivors – in short, there are none. For example, if an individual is detained in a mental health facility and given treatment pursuant to a court order made under civil mental health legislation, that individual cannot report this to police and have the doctor charged with assault (although if the doctor acts outside of the specifics of the order, this would then be unlawful). Similarly, if a girl with intellectual disability is sterilized pursuant to her parent’s consent, she cannot claim civil damages for battery where the doctor acted pursuant to her parents’ decision which was authorized by the court as being in her best interests. A further example is the detention in forensic mental health system of a non-convicted individual on basis of unfitness: this is lawful if is unfitness determined pursuant to the legal process specified by forensic mental health legislation and an individual cannot claim damages for years of imprisonment.

  • Disability-specificity

Above I have explained how non-consensual medical treatment, detention and physical and chemical restraint of people with disability become ‘lawful violence’. I refer to this as ‘disability-specific’ lawful violence because disability is central to the lawfulness of this violence specifically to (and sometimes exclusively to) people with disability:

  1. This violence occurs in institutional circumstances specific to the marginalization, segregation and regulation of people with disability, e.g., mental health facilities, forensic mental health system, sterilization.
  2. Circulating across all of the defences discussed above and the associated legal frameworks of substituted decision-making (in the context of the defence of consent) and authorizing legislation (in the context of the defence of lawful authority), are stereotypes about disability as exemplified by judicial interpretation of such value-laden legal concepts as ‘harm’, ‘necessity’, ‘reasonable’, ‘best interests’ in relation to people with disability.[x]
  3. These defences and the associated legal frameworks of substituted decision-making and authorizing legislation appear as socially and ethically acceptable because of ideas associated with people with disability as needing (and benefiting from) medical treatment, detention and restraint. Significant here are discourses of disability linked to medicine and defect (rationales of therapy), helplessness (rationales of care and protection) and danger (rationales of risk management).
  4. Running across all of the defences and the associated legal frameworks of substituted decision-making and authorizing legislation is the significance of ‘mental incapacity’: either as the basis for the removal of legal capacity (e.g. in defences of consent and necessity) and/or as a basis for indicating lack of self-control, danger or vulnerability (e.g. in defences of necessity and lawful authority). ‘Mental incapacity’, while typically thought of as a scientifically objective characteristic of individuals, is a problematic concept embodying norms of rationality, self-sufficiency and bodily impermeability that are premised on an able subject.[xi]

Therefore, categorizing violence against people with disability in terms of its legal status illuminates how some violence against people with disability is legally permitted and state sanctioned. Where law has a monopoly over ‘violence’ against people with disability, it is arguable that turning to law to address individual instances of this violence is futile. A criminal or civil action can never be successful even with the best lawyers and judges: we cannot turn to domestic law for punishment or remedy (nor can we turn to the state to condone this violence) because law says they are not ‘violence’ in the legal sense and as such are not wrongs or harms and do not constitute injustices.

CRPD and Disability-Specific Lawful Violence

The CRPD provides the possibility of seeing non-consensual medical treatment, detention and physical and chemical restraint of people with disability as violence, and provides a human rights basis for states parties to prohibit these practices as unlawful violence. The CRPD explicitly imposes obligations on states parties to protect people with disability from violence, including by taking legal measures (presumably to prohibit violence and provide appropriate remedies). Article 16 of the CRPD states in part that: ‘States Parties shall take all appropriate legislative, administrative, social, educational and other measures to protect persons with disabilities, both within and outside the home, from all forms of exploitation, violence and abuse, including their gender-based aspects.’

Yet, the obligation in Article 16 is not merely to protect individuals from currently unlawful violence, e.g., enhancing enforcement in relation to individual cases. Rather, when Article 16 is read in conjunction with other Articles of the CRPD, it becomes apparent that states parties’ obligations under the CRPD in relation to violence include protecting people with disability from forms of violence which are presently lawful and hence from ‘disability-specific lawful violence’:

  1. The right to equality and non-discrimination in Article 5 and the right to personal integrity in Article 17 of the CRPD mean that individuals must have recognized their self-determination and ability to make their own decisions to consent to or withhold consent to interventions in their bodies and in their lives to the same degree as people without disability. People with disability cannot be subjected to non-consensual physical contact, detention or restraint on the basis of their disability.
  2. The right to equality and non-discrimination in Article 5 in conjunction with the right to legal capacity in Article 12 of the CRPD means that individuals should have their legal capacity to make decisions recognized to the same extent as individuals without disability and should not be denied legal capacity on the basis of ‘mental incapacity’. The right to exercise autonomy in consenting or withholding consent should be available to all regardless of perceived ‘mental incapacity’. In turn, non-consensual physical contact, detention or restraint on the basis of a denial of legal capacity is discriminatory because it applies only to individuals with a disability-linked ‘mental incapacity’ (itself a discriminatory concept, as mentioned above).[xii] On a similar basis, non-consensual detention on the basis of disability constitutes arbitrary detention pursuant to Article 14.[xiii]
  3. The right to freedom from torture in Article 15 means that the purportedly protective judicial and administrative procedural frameworks surrounding non-consensual contact, detention or restraint could, perversely, render these interventions not merely violence but state-sanctioned discriminatory violence and hence torture.[xiv]
  4. The shift evident in the preamble to the CRPD in the meaning of disability from a medical model to disability as ‘an evolving concept and that disability results from the interaction between persons with impairments and attitudinal and environmental barriers that hinders their full and effective participation in society on an equal basis with others’ illuminates the significance of the social and political contingency of the meaning of disability to the realization of the human rights of people with disability including through domestic legal frameworks. In turn, this shift suggests that stereotypes about disability might presently circulate in legal frameworks that render lawful non-consensual contact, detention or restraint of people with disability.

The CRPD is quite radical in the new approach to violence against people with disability that it provides. This is because this approach contests foundational concepts of consent, capacity, state/judicial authority which order domestic legal systems (and to a certain extent international human rights law). This approach also contests old (but ever growing) institutions, disciplines and industries of incarceration and therapy through which non-consensual physical contact, detention or restraint are administered.

What needs to be done?

Despite these rather revolutionary ideas about disability and violence provided by the CRPD, disability-specific lawful violence continues. While the CRPD has prompted some states parties to ‘review’ (though perhaps not necessarily ‘reform’) capacity laws and mental health laws, ten years on from the coming into force the CRPD has not witnessed the prohibition of non-consensual physical contact, detention or restraint of people with disability.

Here I conclude by making a number of suggestions related to the significance of the interface of CRPD and domestic law to the prohibition and remedying of (presently lawful) violence against people with disability.

United Nations human rights committees must be consistent and persistent in urging states parties to reform criminal and civil laws to explicitly prohibit non-consensual physical contact, detention or restraint of people with disability including prohibit forced medical treatment, detention and chemical and physical restraint. United Nations human rights bodies should continue to encourage states parties to remove or withdraw interpretive declarations which interpret human rights to enable non-consensual medical treatment, detention and restraint (even when only as a ‘last resort’ or when in ‘best interests’). Unfortunately, these strategies might be impeded by the discrepancies which exist between United Nations human rights bodies in relation to the approach to disability and violence, with some human rights bodies failing to acknowledge disability-specific lawful violence and focusing on the ‘procedural’ protection approach to (regulating) violence. The discrepancies between United Nations human rights bodies might enable states parties to pick and choose how to interpret their obligations related to violence in such a way that ultimately focuses on addressing currently ‘unlawful’ violence and ignoring eliminating disability-specific lawful violence. United Nations human rights bodies might need to turn to consider the ideas of disability underpinning their approaches to violence against people with disability, some of which might precede the CRPD and its shift from a medical approach to disability.

A number of additional strategies which states parties should pursue (and which United Nations human rights bodies should encourage states parties to pursue) include:

  1. States parties should not limit their ‘review’ and ‘reform’ efforts to attaining a best practice in judicial and administrative oversight of disability-specific lawful violence (i.e. through procedural safeguards) to questioning whether some practices should ever be state sanctioned on anyone (including people with disability) regardless of the legal procedure through which this sanctioning occurs. Central to this is making apparent and naming the ideas about disability inherent in the law itself, rather than only addressing stereotypes about law that circulate in the application or enforcement of law at an individual level. This involves denaturalizing centuries-old legal concepts, legal procedures and jurisdictions – some of which are foundational to legal authority generally.
  2. States parties should consider the intersection of ideas about disability with other dimensions of identity, particularly being mindful of the identities of the individuals to whom these practices disproportionately apply: e.g. gender and forced mental health treatment and detention of women, age and chemical and physical restraint of older people with dementia in aged care facilities, Indigeneity and over-representation of Indigenous Australians in forensic mental health detention, gender and sterilization, ideas about criminality re people in forensic mental health detention.
  3. States parties should revisit the ideas of bodies and space envisaged by domestic laws related to violence, notably in relation to false imprisonment. In domestic law, detention and restraint focuses on external factors which restrict the individual’s movement – yet much of the interventions in the disability-specific context work from within the body – to restrain and regulate from within (e.g. chemical restraint[xv]).
  4. States parties should develop a strategy for ‘transitional justice’[xvi] that addresses prohibiting and making legally actionable future instances of non-consensual medical treatment, detention and restraint as well as developing a system to recognize, remedy and remember past instances of these practices when they were still lawful.[xvii] This might involve thinking beyond disability to how law (both international and domestic legal frameworks) have dealt with mass atrocities, historical injustices and state-sanctioned violence in relation to other marginalized groups. This system must not only focus on the individuals and institutions administering these practices, but also address how to make the state and law account for their complicity.
  5. States parties should address the role of ‘para-legal’ regulatory frameworks such as bioethics (e.g. research, clinical, professional) in legitimizing the administration of disability-specific lawful violence.[xviii]
  6. States parties should work with health, medical and disability services to challenge institutional, disciplinary and (importantly in an increasingly privatized and corporatized context) economic imperatives[xix] for the continuation of the administration of disability-specific lawful violence.
  7. States parties should encourage reforms to tertiary legal education which take a critical approach to disability and to disability-specific lawful violence in courses such as criminal law and tort law. Typically, law text books cover the operation of defences in relation to people with disability in a self-evident and non-critical manner which then naturalizes the legal treatment of people with disability and negates their subjection to violence and the law and state’s complicity in this violence.

Ultimately, the lower legal threshold of violence in relation to people with disability reflects a devaluing of bodies and lives of individuals with disability – until this is addressed the human rights of people with disability promised by the CRPD will be profoundly and disappointingly incomplete.

 

[i] Convention on the Rights of Persons with Disabilities, opened for signature 13 December 2006, 2515 UNTS 3 (entered into force 3 May 2008).

[ii] See, e.g., Karen Hughes, Mark A Bellis, Lisa Jones, Sara Wood, Geoff Bates, Lindsay Eckley, Ellie McCoy, Christopher Mikton, Tom Shakespeare and Alana Officer, ‘Prevalence and Risk of Violence against Adults with Disabilities: A Systematic Review and Meta-Analysis of Observational Studies’ (2012) 379(9826) Lancet 1621.

[iii] See, e.g., Jess Cadwallader, Anne Kavanagh and Sally Robinson, ‘We Count What Matters, and Violence Against People with Disability Matters’, The Conversation, 27 November 2015, http://theconversation.com/we-count-what-matters-and-violence-against-people-with-disability-matters-51320, accessed 6 January 2016.

[iv] On ‘disability-specific lawful violence’ generally see, e.g., Linda Steele, ‘Disability, Abnormality and Criminal Law: Sterilisation as Lawful and Good Violence’ (2014) 23(3) Griffith Law Review 467; Submission to the Senate Community Affairs References Committee, Inquiry into violence, abuse and neglect against people with disability in institutional and residential settings, including the gender and age related dimensions, and the particular situation of Aboriginal and Torres Strait Islander people with disability, and culturally and linguistically diverse people with disability (2015).

[v] Robert Cover, ‘Violence and the Word’ (1986) 95 Yale Law Journal 1601.

[vi] Austin Sarat and Thomas R Kearns, ‘Introduction’ in Austin Sarat and Thomas R Kearns (eds), Law’s Violence (University of Michigan Press, 1992) 1, 4.

[vii] In the Australian context see, e.g., Secretary, Department of Health and Community Services v JWB (1992) 175 CLR 218.

[viii] In the UK and Australian context see, e.g., Re F (Mental Patient Sterilisation) [1990] 2 AC 1.

[ix] In the Australian context see, e.g., Coco v R (1994) 179 CLR 427.

[x] On best interests see, e.g., Linda Steele, ‘Making Sense of the Family Court’s Decisions on the Non-Therapeutic Sterilisation of Girls with Intellectual Disability’ (2008) 22(1) Australian Journal of Family Law 1.

[xi] See, e.g., Linda Steele, ‘Disability, Abnormality and Criminal Law: Sterilisation as Lawful and Good Violence’ (2014) 23(3) Griffith Law Review 467.

[xii] Committee on the Rights of Persons with Disabilities, General Comment No 1 (2014): Article 12: Equal recognition before the law, 11th sess, UN Doc CRPD/C/GC/1 (19 May 2014).

[xiii] Committee on the Rights of Persons with Disabilities, General Comment No 1 (2014): Article 12: Equal recognition before the law, 11th sess, UN Doc CRPD/C/GC/1 (19 May 2014); see also Report of the Working Group on Arbitrary Detention: United Nations Basic Principles and Guidelines on Remedies and Procedures on the Right of Anyone Deprived of Their Liberty to Bring Proceedings Before a Court, 30th sess, UN Doc A/HRC/30/37 (6 July 2015), notably Principle 20 and Guideline 20.

[xiv] Committee on the Rights of Persons with Disabilities, General Comment No 1 (2014): Article 12: Equal recognition before the law, 11th sess, UN Doc CRPD/C/GC/1 (19 May 2014) 11[42]. On non-consensual medical treatment, detention and restraint of people with disability as torture, see Dinesh Wadiwel, ‘Black Sites: Disability and Torture’, paper presented at Critical Social Futures: Querying Systems of Disability Support, Symposium of The Australia Sociological Association, 19 June 2015.

[xv] Erick Fabris, Tranquil Prisons: Chemical Incarceration under Community Treatment Orders (University of Toronto Press, 2011).

[xvi] See, e.g., Carolyn Frohmader and Therese Sands, Australian Cross Disability Alliance (ACDA) Submission to the Senate Community Affairs References Committee Inquiry into Violence, Abuse and Neglect Against People with Disability in Institutional and Residential Settings, August 2015.

[xvii] See, eg, Hege Orefellen, ‘Hege Orefellen on Reparations’, Campaign to Support CRPD Absolute Prohibition of Commitment and Forced Treatment, https://absoluteprohibition.wordpress.com/2016/02/06/hege-orefellen-on-reparations/, accessed 27 March 2016.

[xviii] The significance of bioethics is apparent from the controversy around Ashley X: see, e.g., Eva Feder Kittay, ‘Forever Small: The Strange Case of Ashley X’ (2011) 26(3) Hypatia 610.

[xix] On the ‘therapeutic industrial complex’ see, e.g., Michelle Chen, ‘How Prison Reform Could Turn the Prison-Industrial Complex Into the Treatment-Industrial Complex’, The Nation (20 November 2015) http://www.thenation.com/article/how-prison-reform-could-turn-the-prison-industrial-complex-into-the-treatment-industrial-complex/, accessed 29 March 2016.

Posted on

Documenta (México)

We at Documenta work to ensure the CRPD absolute prohibition of commitment and forced treatment for persons with psychosocial and intelectual disabilities in Mexico, particularly in connection with security measures.

The second video has English subtitles; others are in Spanish.  Please visit Documenta’s website http://www.documenta.org.mx and their YouTube channel https://www.youtube.com/channel/UC2mXb9uN_To_JrwND7HvGuw for more information.

[youtube https://www.youtube.com/watch?v=fPo2BfAVAFQ]

Published on Nov 10, 2015

Este año, Documenta presentó el caso de Arturo ante el Comité de la ONU sobre los Derechos de las Personas con Discapacidad. Su caso representa la terrible realidad de las personas con discapacidad cuando se enfrentan a un proceso penal en México.

[youtube https://www.youtube.com/watch?v=okUZBlI4s2w]

Published on Nov 27, 2015

Un corto documental sobre las dificultades de Víctor como persona con discapacidad psicosocial al enfrentarse al sistema de justicia penal de México. #CuestionemosLaInimputabilidad

[vimeo 136127114 w=500 h=281]

En la voz de… Eunice Leyva García 1 (Abogada del Área de Litigio Estratégico de Documenta A.C.), Primera intervención/Sobre Peritajes realizados.

Posted on

The contested freedom of the ‘scary’ – Karlijn Roex

The contested freedom of the ‘scary’: the use of coercion in psychiatry violates basic human rights

Detention, solitary confinement, forced drugging; throughout history, societies have had the tendency to aggressively constrain people with psycho-social disabilities and preferred an security-obsessed instrumentalism above universal human rights. But recently, the use of coercion in psychiatry is a highly debated practice in human rights circles; witness the latest report of Human Rights Watch[1] on shackling. This increased interest has gotten a great impulse by the recent release of the UN Convention on the Rights of Persons with Disabilities. Drawing upon scientific work, ‘user’ narratives and moral principles, I support the call made by the Committee on the Rights of Persons with Disabilities (CRPD) to abandon the use of coercion in psychiatry.

According to authoritative documents of the Convention[2], the use of coercion in psychiatry is a form of discrimination of people with psycho-social disabilities, and violates the right of these people to enjoy autonomy and personal integrity. These principles are to be respected, regardless of any instrumental benefits that may result from applying coercive psychiatric interventions. But the perceived instrumental benefits are exactly why the use of coercion in psychiatry has long gone uncontested. And these benefits have moral significance too. People have the right to be protected against themselves, or against dangerous fellow-humans. In fact, many proponents of coercion in psychiatry follow this ethical ‘lesser evil’ reasoning. According to them, it is allowed to introduce an evil when a greater evil is prevented by this. Thus, such a lesser evil argument justifies the abandonment of some key fundamental human rights. This is dangerous, because human rights are typically abandoned during the times in which they are most needed[3]. In fact, these human rights are meant to protect our scapegoated minorities from being oppressed during times of public fear. In times of public fear, some human rights become a privilege of the non-scary, or if one prefers, of the ‘respectable section of society’[4]. In the context here, the lucky ones are the people without psycho-social disabilities. The scary, by contrast, have to deal with a contested freedom.

Coercive psychiatric interventions are decisions or actions imposed on the individual, without his/ her informed consent, based on psycho-social disability. In this regard, the CRPD has also come out against the use of this danger standard, or any other criteria, as a way of legitimizing psychiatric detention[5]. To be clear, the coercive interventions that are discussed here are not taken because of a criminal suspicion or criminal conviction. Today, most countries allow coercive psychiatric interventions only when an individual is considered dangerous to him-/herself or to others. However, the initial assessment of dangerousness is taken by psychiatrists only. A court is not yet involved in this initial decision to psychiatrically detain an individual. This is highly problematic, because the psychiatric perspective and security-obsessed instrumentalism are clearly dominating the process of key decision making, at the cost of the human rights perspective. At the moment where the psychiatrists’ initial decision is critically reviewed, marks of shame have already been added to the affected individual. Not only has this mark of shame been added through the unfavourable initial psychiatric guess, which gains much epistemological authority in our societies, but also because of the very stigmatizing practice of the detention itself[6]. It is then much harder for the affected individual to win credibility.

We therefore see that the conditions for coercive psychiatric interventions have become stricter over time, but that they fail to seriously challenge the practice of arbitrary detention. This may explain why the ‘stricter’ danger standard has not led to a decrease in the number of psychiatric detentions[7]. Probably, the innovation has rather served to silence any critical voices from the human rights corner. This silencing has been achieved by incorporating insignificant parts of the critical demands into the existing policy, without meaningfully changing any inherently oppressive and discriminatory principles[8]. Apparently, there is a high demand in society to confine people with psycho-social disabilities, and one of the main drivers behind this demand is a perceived danger.

Protecting people against themselves: the right not to be a false positive[9]

But what is wrong with this dangerous-criterion? Is it, for instance, not our moral duty to protect people from themselves when needed? Obviously, it is! But we should become reflect one more moment about our ability to assess mental states: when is someone to be considered a danger to him-/ herself? Let me take suicide as an example. As a researcher in this topic, the literature clearly shows me that assessing the risk of suicide in individuals is a very difficult task. Most people that disclosure suicidal thoughts do not commit suicide, especially women[10]. Secondly, psychiatric risk assessments are proven to be really unreliable[11], leading to many ‘false positives’: people who are considered a danger while they are actually not. The statement whether someone is a danger, is in fact a hypothesis about mental states and future behaviours. These are unobservable things that are hard to measure. Even when an individual has committed self-harming acts in the past, this does not necessarily make him dangerous for the present, or the future. Test results are likely to be biased and steered by common prejudices about people with psycho-social disabilities[12], ethnic minorities, and the poor[13]. Worse, the dangerousness claim is strictly not falsifiable, at least at a short term: how can one prove today that one will not kill himself soon? As a consequence of this, many individuals are subjected to coercive interventions because they were wrongly labelled as ‘dangerous’ and cannot easily escape this label. Escaping the dangerousness-label is made even more difficult by general mistrusting attitudes of hospital staff towards mental patients[14], and the fact that people tend to start behaving conform the stigma over time, due to its adverse effects on them[15]. The accumulation of humiliating interactions, which would frustrate every normal person, can lead to responses that can be termed as ‘aggressive’. How would you respond if you learn that you were wrongly informed about your legal status[16] concerning something as important as your freedom?

These ‘false positives’ are vulnerable people, just like people who are a real danger to themselves. But is it actually a wise strategy to expose such people to some of the very traumatic coercive psychiatric interventions? There are numerous accounts of patients or ‘ex-users’ of psychiatry that indicate how stressful and traumatic these interventions were to them. Indeed, some human rights advocates define some of these interventions as torture. There are even indications that exposure to such interventions can lead to post-traumatic stress symptoms and suicide[17]. There are user narratives that indicate that individuals without any previous suicidal tendencies became suicidal after being exposed to coercive interventions, such as solitary confinement. User narratives indicate how humiliating these experiences can be, with people losing their personal integrity, humanity and dignity. Affected individuals often carry along these feelings until long after the incidents.

Protecting people against their dangerous fellow-citizens: contesting the freedom of the ‘Other’

But what if a person is not a danger to him-/ herself, but to others? When we want to be protected against our dangerous fellow-citizens, then what is morally wrong with that? Well, nothing, but of course we have to come with reasonable grounds and evidence of this supposed danger. The mere existence of a psycho-social disorder, cannot point towards a certain danger. When an individual tells me that he is going to harm me, he can be prosecuted for threats. Most countries have also criminalized several public order disturbances. We can already prosecute anybody who has visibly undertaken preparations for committing a criminal offense, or who has clearly tried to commit a certain crime. Therefore: we already have a great law that protects us against dangerous fellow-citizens: the Criminal Law! Even greater, this law protects the citizen against the state and an over-feared community. We cannot just convict an individual because of a mere suspicion; instead, conviction requires that we have some tangible evidence against this individual.

With this great law in mind, why would we create another law especially for people with psycho-social disabilities? Because we are afraid of people with psycho-social disabilities. A mere suspicion of dangerousness in a person with mental illness is already terrifying enough, isn’t it? Why then bother about visible evidence for a criminal conviction? Mental health laws are the dubious innovation of a frightened society. These laws enable communities to incarcerate individuals with psycho-social disabilities when we suspect that they are dangerous. This suspicion is backed with test results from, again, very unreliable and biased psychiatric risk-assessments. As a consequence, we have created two types of citizenship: the ‘normal’ citizens and the scary semi-citizens. The latter group has found his freedom contested: it can be denied at any time, as soon as a suspicion of dangerousness arises. Whereas the majority of us can feel safe and count on the basic human rights principles that respect our freedom and integrity, there is a group in our society whose members can simply be detained without the regular battery of legal requirements.

This is an inconvenient leak in our modern democracies, and should concern every citizen. No citizen can find himself guaranteed at the ‘right’ side of the divide, because the boundaries between mental illness and normality are time-dependent and not nature-given. In the past, we have seen the ‘psychiatrization’ of homosexuality, political dissent, and poverty. This teaches us that mental health laws are a convenient way to subtly discipline certain categories of people; much more smoothly and subtly than explicitly prosecuting these deviants through criminal courts[18]. And although our societies are now to be considered ‘free-minded’, or ‘post-modern’, we should always be aware of the disciplinary potential of mental health laws. This disciplinary potential can be toxic in combination with the timeless fact that we are never aware of the oppressive ideas of our own time.

In all, let’s give it a shot and abandon the use of coercion in psychiatry towards history. Fear makes that we immediately grab towards the so-called ‘last resort’ of a coercive intervention, whereas there are instances in which a simple conversation would already help. Such a conversation would also help us, learning about the specific and different logics behind madness, and therefore render it a little bit less unpredictable and scary.

Karlijn Roex is a PhD-candidate in Sociology and human rights activist. She lives in Germany.

[1] Human Rights Watch (2016, March 20). Indonesia: Treating Mental Health With Shackles. Human Rights Watch. Retrieved 21 March 2016, from: https://www.hrw.org/news/2016/03/20/indonesia-treating-mental-health-shackles

[2] See for instance: CRPD. (2015). Guidelines on Article 14 of the Convention on the Rights of Persons with Disabilities – The right to liberty and security of persons with disabilities. New York: United Nations; CRPD. (2014). General Comment No. 1 (2014). Article 12: Equal Recognition Before the Law. New York: United Nations; United Nations Human Rights Committee (2015, October 10). Dignity must prevail – An appeal to do away with non-consensual psychiatric treatment World Mental Health Day. United Nations. Retrieved 10 March 2016, from: http://www.ohchr.org/en/NewsEvents/Pages/DisplayNews.aspx?NewsID=16583&LangID=E

[3] Hudson, B. (2009). Justice in a Time of Terror. British journal of Criminology, Delinquency and Deviant Social Behaviour, 5(49), 702-717; Roex, K.L. A. & Riezen, Van. B. (2012). Counter-Terrorism in the Netherlands and the United Kingdom: A Comparative Literature Review Study. Social Cosmos, 3(1), 97-110.

[4] Berger, P.L. (1992). Sociology as a Form of Consciousness. In H. Robboy & C. Clark (edit.), Social Interaction. Readings in Sociology (pp. 6-22). Richmond: Worth Publishers.

[5] See for example CRPD. (2015). Guidelines on Article 14 of the Convention on the Rights of Persons with Disabilities – The right to liberty and security of persons with disabilities. New York: United Nations.

[6] Goffman, E. (1961). Asylums. Essays on the Social Situation of Mental Patients and Other Inmates. New York: Anchor Books; Becker, H. S. (1963). Outsiders. New York: The Free Press.

[7] At least in Europe. See: Salize, H. J., Dressing, H. & Peitz, M. (2002). Compulsory Admission and Involuntary Treatment of Mentally Ill Patients – Legislation and Practice in EU-Member States. Brussels: European Commission.

[8] This strategy to silence critics is widely analysed by the Foucaultian sociologist Mathiesen: Mathiesen, T. (2004). Silently Silenced. Essays on the Creation of Acquiescence in Modern Society. Winchester: Waterside Press. See also on this specific topic: Harding ,T.W. (2000): Human Rights Law in the Field of Mental Health: a Critical Review. Acta Psychiatrica Scandinavica, 101: 24-30

[9] Borrowed from Steadman, H. J. (1980). The Right Not to be A False Positive: Problems in the Application of the Dangerousness Standard. Psychiatric Quarterly, 2, 84-99.

[10] Cannetto, S. S. & Sakinosky, I. (1998). The Gender Paradox in Suicide. Suicide & Life Threatening Behavior, 28(1), 1-23 and Möller-Leimkühler, A. M. (2003). The Gender Gap in Suicide and Premature Death or: Why Are Men So Vulnerable? Eur Arch Psychiatry Clin Neurosc, 253: 1-8.

[11] Steadman, H. J. (1980). The Right Not to be A False Positive: Problems in the Application of the Dangerousness Standard. Psychiatric Quarterly, 2, 84-99; Madsen T, Agerbo E, Mortensen PB, Nordentoft M (2012) Predictors of psychiatric inpatient suicide: a national prospective register-based study. J Clin Psychiatry 73:144–151; Steeg S, Kapur N, Webb R, Applegate E, Stewart SL, Hawton K, Bergen H, Waters K, Cooper J (2012) The development of a population-level clinical screening tool for self-harm repetition and suicide: the ReACT self-harm rule. Psychol Med 42:2383–2394; Ryan C, Nielssen O, Paton M, Large M (2010) Clinical decisions in psychiatry should not be based on risk assessment. Australas Psychiatry 18:398–403.

[12] Link et al., (1999).Public Conceptions of Mental Illness: Labels, Causes, Dangerousness, and Social Distance. American Journal of Public Health, 89(9), 1328-1333; Perscosolido, et al. (2013). The ‘Backbone’ of Stigma: Identifying the Global Core of Public Prejudice Associated With Mental Illness. American Journal of Public Health, 103(5), 853-860.

[13] The population of involuntarily hospitalized psychiatric patients contains an overrepresentation of low-income indiivduals, black people, and people of an ethnic minority. See for example: Salize, H. J., Dressing, H. & Peitz, M. (2002). Compulsory Admission and Involuntary Treatment of Mentally Ill Patients – Legislation and Practice in EU-Member States. Brussels: European Commission.

[14] Goffman, E. (1961). Asylums. Essays on the Social Situation of Mental Patients and Other Inmates. New York: Anchor Books.

[15] Becker, H. S. (1963). Outsiders. New York: The Free Press.

[16] Something that appears to happen quite often in EU countries: see Salize et al. (2002)

[17] For instance: Large, M. M. & Ryan, C. (2014). Disturbing Findings about the Risk of Suicide and Psychiatric Hospitals. Soc Psychiatr Epidemiol, 49, 1353-1355.

[18] See also the different works of Michèl Foucault on this

Posted on

Aporte de Lucila López, Usuaria y sobreviviente de la psiquiatría en Argentina

CAMPAÑA DE APOYO A LA CDPD COMPROMISO CON LA PROHIBICIÓN ABSOLUTA DE LA PRIVACIÓN DE LA LIBERTAD Y EL TRATAMIENTO FORZADO DE LAS PERSONAS CON DISCAPACIDAD PSICOSOCIAL

 

Señores del Comité sobre los Derechos de las Personas con Discapacidad:

Solicito tengan a bien dar la merecida atención a todas las voces que elevamos los actores socio-políticos que pedimos la prohibición absoluta de la privación de la libertad por motivos de discapacidad psicosocial.

Lucila López

Usuaria y sobreviviente de la psiquiatría en Argentina.

(también se puede leer en https://sodisperu.org/2016/03/22/aporte-a-la-campana-prohibicionabsoluta-por-lucila-lopez-usuaria-y-sobreviviente-de-la-psiquiatria-en-argentina/)

CAMPAÑA DE APOYO A LA CDPD ART. 14 LL-MARZO14 2016 (doc)

Intentaré exponer los motivos sobre la importancia de obtener el apoyo necesario para que la Campaign to Support CRPD Absolute Prohibition of Commitment and Forced Treatment  – Campaña de apoyo CDPD COMPROMISO CON LA ABSOLUTA PROHIBICIÓN DE LA INTERNACIÓN Y EL TRATAMIENTO FORZADO iniciada por la Dra. Tina Mikowitz resulte como positivo fortalecimiento al momento de las Observaciones Generales a favor del irrestricto cumplimiento del artículo 14 inc. y todos los artículos vinculantes.

Artículo 14

Libertad y seguridad de la persona

  1. Los Estados Partes asegurarán que las personas con discapacidad, en igualdad de condiciones con las demás:

a) Disfruten del derecho a la libertad y seguridad de la persona;

b) No se vean privadas de su libertad ilegal o arbitrariamente y que cualquier privación de libertad sea de conformidad con la ley, y que la existencia de una discapacidad no justifique en ningún caso una privación de la libertad.

2. Los Estados Partes asegurarán que las personas con discapacidad que se vean privadas de su libertad en razón de un proceso tengan, en igualdad de condiciones con las demás, derecho a garantías de conformidad con el derecho internacional de los derechos humanos y a ser tratadas de conformidad con los objetivos y principios de la presente Convención, incluida la realización de ajustes razonables.

“El Comité sobre los Derechos de las Personas con Discapacidad reafirma que la libertad y la seguridad de la persona es uno de los derechos más preciosos a que tiene derecho. En particular, para las personas con discapacidad, y en especial las personas con discapacidad intelectual y discapacidad psicosocial tienen derecho a la libertad en conformidad con el artículo 14 de la Convención. En él se especifica el alcance del derecho a la libertad y a la seguridad de la persona en relación con las personas con discapacidad, prohíbe toda discriminación basada en la discapacidad. De este modo, el artículo 14 se relaciona directamente con el propósito de la Convención, que es garantizar el disfrute pleno e igual de todos los derechos humanos y las libertades fundamentales a todas las personas con discapacidad y promover el respeto de su dignidad inherente.”[i]

__________________

Nada se puede pensar por fuera de un contexto. El tema propuesto es un tema ineludible en términos de un pensamiento con eje en los Derechos Humanos.

Escribir en Argentina sobre la necesidad de garantizar la prohibición absoluta de privar de la libertad a las personas con discapacidad en nombre de tratamientos impuestos, forzados, en contra de la propia voluntad, es escribir en un contexto en el que el respeto a los DD.HH. es ostensiblemente violado provocando actualmente una seria preocupación para el CIDH, específicamente por una presa política. En relación al tema, es significativo que Estela de Carlotto[ii] haya preguntado -¿Cómo se puede decir que está muy bien una mujer presa? Y calificó esa afirmación de la más alta autoridad del país como “una barrabasada”. El texto completo es el siguiente:

“La barrabasada[iii]que dijeron es que la habían visitado en la cárcel y que estaba muy bien. Fue violento. ¿Cómo se puede decir que está muy bien una mujer presa?

Me permito hacer un parangón y preguntar:   ¿Cómo se puede decir que está bien una persona privada de la libertad (presa) por su discapacidad?

Estoy a favor de la prohibición absoluta de la privación de la libertad involuntaria y tratamientos forzados de las personas con discapacidad psicosocial y el compromiso para con todos comienza en el ejercicio para mi propia vida de ese derecho y el Art. 14 de la CDPD me autoriza a exigir el cumplimiento de la norma jurídica.

Mis argumentos son en nombre propio a partir de mis experiencias y la observación de la experiencia de otros, articulando mi condición de usuaria y sobreviviente de la psiquiatría, mi visión como profesional dedicada a la prevención en Salud Mental y Derechos Humanos y como familiar, en tanto soy madre de un hombre que siendo niño y hasta entrada su adultez, necesitó de la protección de sus derechos incluido el derecho a la salud y el derecho a la salud mental.

Estuve privada de la libertad y en contra de mi voluntad por última vez entre el 5 de julio de 2014 y el 12 de enero de 2015. La cuarta vez en mi vida y la más extensa en tiempo.

Esa misma barrabasada “que me encontraban muy bien” la escuché de familiares y amigo/as y me mantuve en un total mutismo.

Desde el año 2011, la crisis anterior con internación contraria a mi voluntad, comencé a guardar mutismo absoluto delante de los que apoyaron esa medida y están dispuestos a apoyarla de nuevo.

¿Por qué guardar mutismo?

Por lo intolerable que resulta la alianza entre los profesionales de la salud mental y familiares y/o amigos:

  • Ignoran la CDPD.
  • No tienen en cuenta el respeto a la persona como un igual.
  • Prevalezcan sobre mi cuerpo y sobre mi psiquismo[iv] decisiones ajenas violatorias de todos
  • Los siguientes derechos enumerados en la CDPD (Ley 26.378) que es parte del cuerpo jurídico de la Constitución Nacional de Argentina.

Artículo 5º

Igualdad y no discriminación

Artículo 12

Igual reconocimiento como persona ante la ley[v]       

Artículo 14

Libertad y seguridad de la persona

Artículo 15

Protección contra la tortura y otros tratos o penas crueles, inhumanos o degradantes

Artículo 17

Protección de la integridad personal

Artículo 18

Libertad de desplazamiento y nacionalidad

Artículo 19

Derecho a vivir de forma independiente y a ser incluido en la comunidad

Artículo 22

Respeto de la privacidad

Artículo 23

Respeto del hogar y de la familia

1.C) Las personas con discapacidad, incluidos los niños y las niñas, mantengan su fertilidad, en igualdad de condiciones con las demás.

Artículo 24

Educación

Artículo 25

Salud

Artículo 27

Trabajo y empleo

Artículo 28

Nivel de vida adecuado y protección social

Enumerados todos los derechos vinculantes que se violan a partir de la falta de respeto al art. 14, argumentaré los motivos por los que pido la PROHIBICIÓN ABSOLUTA DE LA PRIVACIÓN DE LA LIBERTAD INVOLUNTARIA.

En Argentina, exigir la prohibición absoluta de la libertad involuntaria por motivos de discapacidad psicosocial encuentra un horizonte de futuro posible con la prohibición establecida por la LNSM –Ley 26.657 – de la creación de nuevos manicomios públicos y privados en todo el territorio de la Nación y el cierre definitivo de todos para el año 2020.

La privación forzada de la libertad, -o internación involuntaria- o no por motivos de discapacidad psicosocial es claramente una acción discriminatoria, de acuerdo a la legislación argentina y el marco jurídico internacional:

“La discriminación es el acto de agrupar a los seres humanos según algún criterio que lleva a una forma de relacionarse socialmente. Concretamente, suele ser usado para hacer diferenciaciones que atentan contra la igualdad, ya que implica un posicionamiento jerarquizado entre grupos sociales 1, es decir, cuando se erige un grupo con más legitimidad o poder que el resto.

En el año 1988, se sancionó la Ley Nº 23.592 sobre Actos Discriminatorios que en su Artículo 1º reconoce como discriminación cualquier impedimento o restricción del pleno ejercicio “sobre bases igualitarias de los derechos y garantías fundamentales reconocidos en la Constitución Nacional […] por motivos tales como raza, religión, nacionalidad, ideología, opinión política o gremial, sexo, posición económica, condición social o caracteres físicos”. Asimismo, el documento titulado “Hacia un Plan Nacional contra la Discriminación”, aprobado por Decreto Nº 1086/2005.Instituto Nacional contra la Discriminación, la Xenofobia y el Racismo. (INADI ¿Qué es la discriminación?).-

 

La privación de la libertad involuntaria a partir de la  CDPD se constituye en un acto de violación de DD.HH.y el Estado se debe responsabilizar de ello[vi] pues  aún cuando en Argentina ha ratificado la CDPD y le ha dado status constitucional:

La Ley Nacional de Salud Mental Ley 26.657- que es considerada una Ley de Salud Mental modelo por todos los avances dirigidos hacia el nuevo paradigma social y del respeto de los DD.HH. de las personas con discapacidad, incurre en la violación del artículo 14 considerando que:

La LNSM En el Capítulo VII, Art. 20) contempla de la internación involuntaria: “Ley 26.657 ARTICULO 20. — La internación involuntaria de una persona debe concebirse como recurso terapéutico excepcional en caso de que no sean posibles los abordajes ambulatorios, y sólo podrá realizarse cuando a criterio del equipo de salud mediare situación de riesgo cierto e inminente para sí o para terceros. Para que proceda la internación involuntaria, además de los requisitos comunes a toda internación, debe hacerse constar… “

Acá encontramos un argumento a favor de la internación involuntaria contraria a la letra de la CDPD y su art. 14.-

La idea que prevalece en este artículo de la LNSM es la del paradigma del MMH., encuentra gran receptividad tanto en los profesionales de la salud como así también de familiares. Desde la implementación de la LNSM no se cumple con el art. 14 de la CDPD pero tampoco se cumple con lo que estipula la LNSM en el Art. 20, pues la concepción de recurso terapéutico excepcional se convierte en letra muerta de la ley y es una mera formulación administrativa o de buenas intenciones si se pueden llamar así a los argumentos esgrimidos para privar de la libertad en forma involuntaria.

Este acto discriminatorio y violatorio de DD.HH. goza de un consenso intelectual que supone el encierro de las PcD como “un corte, una instancia de reordenamiento subjetivo”.

El “corte subjetivo” se produce en la PcD en el momento que se denomina crisis y no necesita de ser privada de la libertad. Se puede “volver a la vida plena” en la vida plena de poder padecer un “corte” de “conexión con la realidad” si se brindan todos los apoyos y ajustes necesarios para tornar viable la vida en la comunidad.

No podemos ser discriminados por ser personas con discapacidad psicosocial y considerar terapéutico el encierro y el aislamiento que es una práctica iatrogénica al igual que la medicación forzada.

Vuelvo sobre la necesidad de contextuar el texto.

En Argentina hay una gran resistencia de parte de los profesionales de la salud mental a mencionar el tema discapacidad ligado al tema de las problemáticas de la salud mental.

En este presente inmediato, hablar de Derechos Humanos en Argentina articulados con la Salud Mental o con cualquier otro aspecto de la vida de las personas en general es un tema que pone en cierto peligro a quien se anima a denunciar.

Mi opinión al respecto después de muchos años de indagar el tema es que los profesionales de la salud mental junto a una gran parte de la población no aceptan que las PcD psicosocial somos personas con el reconocimiento de la dignidad y el valor inherentes y de los derechos iguales e inalienables de todos los miembros de la familia humana.

No aceptan la condición de sujeto de derecho en igualdad de condiciones que invoca la CDPD y esto es especialmente notorio al observar que en Argentina, la LNSM Nro. 26.657, es despreciada e incumplida por la corporación médico-psiquiátrica quienes consideran que debe ser derogada porque entre algunos de sus acertados artículos se promueve la interdisciplinariedad, el cierre de la totalidad de los manicomios públicos y privados en todo el territorio nacional y también promueve las internaciones en hospitales generales (considerando el respeto a quien desee ser internado de forma voluntaria).-

El primer obstáculo para hacer notar que el art. 20 de la LNSM 26.657 viola el Art. 14 de la CDPD es que los profesionales de la salud y de la salud mental, los trabajadores sociales y un amplio espectro de la justicia y una enorme masa de la población en general no están dispuestos a respetar los DD.HH. de las PcD psicosocial y que las lógicas manicomiales prevalecen en el imaginario social sobre los avances y cambios que en la materia se vienen discutiendo a nivel mundial.

La mayoría de las internaciones que se realizan son involuntarias y en general no se cumplen los pasos que la LNSM dispone para estos casos. Una ingeniería perversa de mecanismos burocráticos actúa evitando que la información llegue a la justicia en tiempo y forma, haciendo permanecer a una persona hasta por cuatro meses internada sin haber ejercido ni el consentimiento informando sobre el tratamiento que le administran arbitrariamente ni tuvo acceso a un abogado defensor como lo estipula la LNSM.

Es de mi particular interés las internaciones involuntarias de niños/as-adolescentes y jóvenes por motivos vinculados al consumo problemático de sustancias psicotrópicas en instituciones aberrantes con la anuencia de sus familias y también, en el otro extremo del arco, a las personas mayores y la naturalización de su institucionalización en lugares llamados geriátricos, residencias u hogares que también, con un proceder perverso, ocultan las problemáticas de discapacidad mental más propias de la ancianidad, del deterioro cognitivo que puede aparecer con el avance de la edad y otras formas de discapacidad mental que no son atendidas en su particular singularidad y sí son privadas de la libertad casi siempre sin su propio consentimiento.

Entonces sufren internaciones involuntarias y así se violan los DD.HH. de:

Niñas, niños, adolescentes mujeres y hombres, jóvenes, adulta/os y ancianas/os declarados o no personas con discapacidad mental por razones vinculadas a problemáticas de la salud mental.

En todos estos casos prevalece el concepto discriminatorio que no tenemos igual reconocimiento como persona ante la ley.

Partiendo de esta premisa comenzaré a exponer de qué manera la internación, la privación de la libertad involuntaria es una verdadera violación de DD.HH. que comete el Estado atropellando derechos y aumentando la discapacidad y propiciando el empobrecimiento de las personas afectadas en sus intereses económicos, sociales y culturales.

La internación involuntaria es iatrogénica:

  • en lugar de un resultado positivo para la salud, la privación de la libertad junto a tratamientos con drogas psiquiátricas forzados generan enfermedades, atenta contra la salud psíquica y física de la persona y la despoja del ejercicio de un sinfín de derechos aún cuando no se haya restringido su capacidad jurídica y esto también en internaciones –involuntarias o no- a corto plazo.

La realidad de una gran mayoría es que su capacidad jurídica está restringida.

En Argentina actualmente hay más de 20.000 personas privadas de la libertad en manicomios públicos y privados, según datos poco fidedignos, en su mayoría hombres entre 20 y 40 años que en su mayoría llevan un promedio de 15 a 20 años de privación de la libertad. De esa mayoría un número elevado entró en el circuito de las internaciones por consumo problemático de sustancias psicotrópicas siendo el alcohol la que encabeza el listado de ellas, que no es una droga ilegal.

Es muy llamativo que los datos oficiales oculten las cifras que puedan informar la cantidad de niñas y mujeres privadas de la libertad de manera involuntaria que hay en el país y me animo a decir que debe ser significativamente superior a la cantidad de hombres privados de la libertad.

En todos o en casi todos esos casos, ya sea en el ámbito público como en el privado la violación al art. 14 de la CDPD conlleva la violación de todos los otros artículos de la CDPD enumerados anteriormente.

La libertad y la seguridad de la persona son avasalladas y entonces su integridad en el más amplio concepto de la palabra también.

Hay una gran parte de la población privada de la libertad por motivos de discapacidad psicosocial que desconocen su verdadera identidad. Están desprovistas de documentos de identidad. No tienen contacto con familiares desde hace años y han sido separados de su comunidad.

Muchos, con estudios iniciados, han perdido el derecho a continuarlos, otros directamente no acceden porque comienzan el derrotero de las internaciones psiquiátricas durante la infancia. Conocí en el manicomio a un hombre mayor de cincuenta años que estaba internado desde los cinco años, desde su primera infancia… y allí murió.

Las instituciones psiquiátricas tienden a incurrir en una doble violación al Derecho a la Salud, en tanto:

  1. La privación de la libertad involuntaria o no, es iatrogénica.
  2. La PcD psicosocial internada en instituciones psiquiátricas suele carecer de verdadera atención médica en otros aspectos que su salud requiera: la aparición de síntomas de un quebrantamiento de la salud física suele ser ignorado, “interpretado” como síntoma o manipulación de la PcD desde el discurso médico-psiquiátrico y también, se le niega el acceso a profesionales de otras especialidades. Ejemplo: la asistencia de un otorrinolaringólogo… “porque es incómodo el traslado a un servicio especializado” y la persona debe aceptar y tolerar no ser atendida. Esta triste realidad trae aparejado resultados muy graves: muertes por enfermedades tratables tanto en la población femenina como en la masculina. También se les niega el acceso a los tratamientos indicados por médicos especialistas en el caso que tengan acceso a una consulta.

Todo esto está reñido con el principio básico del ser en igualdad de condiciones.

La vida privada de la libertad “no es vida”.

La privación de la libertad acompañada por el tratamiento forzada con drogas psiquiátricas provoca una especie de muerte psíquica.

Los acontecimientos de la vida cotidiana bajo los efectos de la medicación psiquiátrica –forzada o no, dentro y fuera de la internación- se perciben como si se mirara a través de un vidrio esmerilado, la voz de los otros llega a uno con un efecto retardado, y nuestros pensamientos también resultan lentos bajo los efectos de las drogas psiquiátricas. El contacto con el otro, con el afuera, está “mediado” por una cortina invisible que ralentiza los movimientos por el cuerpo rigidizado y los sentidos aletargados.

Así, el otro, cualquiera que sea, nos percibe “raros” “distintos” y los médicos aseveran que es el “devenir propio de la enfermedad diagnosticada” negando de cuajo que ese estado es el efecto de la privación de la libertad y del tratamiento químico forzado.

Con la privación de la libertad involuntaria, suele aparecer un estado de apatía profundo, un gran desinterés por todo… en mi experiencia esta apatía y el desinterés –incluso de hablar y permanecer en un mutismo absoluto- lo produce la imposibilidad de comprender que para el círculo de personas de mi afecto, esa situación fuera considerada buena, que dijeran que me “encontraban mejor”… si realmente esa es la mirada que tienen mis afectos cercanos, sean familiares o amigos, debo decir que no tienen registro alguno de las vivencias ciertas de humillación y maltrato que se viven en una internación.

Hay personas que estando internadas involuntariamente, hacen abandono de su aspecto físico y de su higiene. También eso es leído como un aspecto de “su enfermedad”… no se lee como un efecto iatrogénico de la privación de la libertad.

Los cambios a los que el cuerpo se ve sometido, desde el notorio aumento de peso con la pérdida de las formas propias del cuerpo y además, la falta de agilidad que provoca la medicación que rigidiza los músculos y el estado de “desconexión” que las mismas producen – y se aumenta notablemente con la privación de la libertad-, son otros aspectos que la persona padece, que pueden resultar motivo de vergüenza o mayor disminución de la estima.

La persona privada de la libertad, en un manicomio, tiene que poder evaluar estrategias de supervivencia y muchas veces, las elecciones son “el mal menor” y no lo que corresponde ni es justo ni a lo que se tiene derecho aún cuando se sea plenamente consciente de que se tiene derecho.

Cabe aclarar que una gran mayoría de la población internada desconoce todos sus derechos y además, cree que no los tiene. En las PcD psicosocial institucionalizadas durante muchos años en forma permanente o intermitente, se notan conductas propias de las personas sometidas a gran sometimiento y la faceta que muestran con claridad es la idea de “no tener derechos”

Así es muy poco probable que ellos luchen por una forma de vida independiente, el derecho a ser incluid en la comunidad en igualdad de condiciones porque se perciben así mismos como “personas enfermas”

Es común escuchar a adolescentes afectados a tratamientos -involuntarios o no- por consumo excesivo de drogas psicotrópicas, y en especial alcohol, decir “no tengo derecho a nada porque he consumido drogas” y ese discurso es avalado por los responsables de su rehabilitación y tratamiento y en cierta medida y en muchas oportunidades también ese concepto es sostenido por familiares, se suma a esto que los profesionales de la salud mental encuentran dificultades para aceptar que los problemas derivados del consumo excesivo de drogas legales o ilegales es un tema que debe ser abordado dentro del ámbito de la salud… y son enviados a lugares de encierro con un régimen propio y diría “sin ley” donde prevalece la ley del más fuerte que suele ser en general “un adicto recuperado” que impone tratos degradantes.

Así, son salvajemente humillados y denigrados, abusados sexualmente y de otras formas niñas/niños y adolescentes sometidos a trabajo solamente comparables a la tortura y la esclavitud en el marco de internaciones forzadas o no.

En relación a esta problemática de la salud mental el entramado es de una gran complejidad y la violación de DD.HH. es indescriptible.

Nadie que está privado de la libertad tiene la posibilidad de decidir un lugar de residencia por fuera del manicomio que le ha tocado en desgracia y en virtud de su status social o el de su familia…

La mayor cantidad de personas privadas de la libertad de modo involuntario lo son por problemas sociales y al mismo tiempo:

La mayor parte de las problemáticas llamadas “enfermedades mentales” provienen de problemas sociales no atendidos debidamente por el Estado y afectan de manera altamente significativa a la población de menos recursos.

Poblaciones importantes en las que, de generación en generación, han transcurrido sus vidas en situaciones de extrema pobreza sin conocimiento de los Derechos Humanos que los asisten si tienen la desgracia de “caer en el manicomio, no tienen salida”. Se patologiza la pobreza!!! Hay un perverso discurso que “dice que la persona no ha sido capaz de tener ingresos adecuados para su sustento y/o el de su familia y garantizar vivienda, educación y salud”.

Esa supuesta enfermedad de una persona: ¿cómo se llama cuándo el sistema de salud mental con la privación de la libertad –involuntaria o no- des-ancla a la persona de su vida, de sus bienes, de sus ingresos económicos, de su universidad o de su escuela de estudios primarios y así, la deja en un vacío de derechos y sobre eso la re-diagnostica?

No hay mayor factor discapacitante que la pobreza, el hambre, la falta de techo y de educación. Y eso puede ser un punto de partida o de llegada para una persona con discapacidad social.

También muchas personas que caen abruptamente en la pobreza como consecuencia de las crisis económicas que se conocen como “respuestas al humor de los mercados”, es decir: las crisis económicas resultado de propuestas políticas neoliberales y del salvaje capitalismo, arrojan a la “locura” y al intento de suicidio –cuando no a la muerte misma- a muchas personas que mantuvieron durante gran parte de su vida un status de vida acorde a los derechos propios de una persona trabajadora con derecho al trabajo, la salud y la vivienda como derechos básicos inalienables y esas personas, recalan en los manicomios con un diagnóstico de enfermos psiquiátricos pero en sus Historias Clínicas no constan las condiciones de existencia al momento de la internación ni sus antecedentes culturales, laborales, familiares y sociales, ni nada, absolutamente nada de su vida antes de haber sido calificado como enfermo/a psiquiátrico/a.

Con horror observo que la familia reproduce el sistema de pensamiento manicomial.

La misma familia termina violando el derecho al hogar y la familia.

Poco a poco se aleja hasta dejar en el abandono a la persona.

Se la priva de la familia, de los hijos y de los nietos.

La familia se aleja porque es estigmatizada y además no recibe psico-educación alguna para albergar al familiar que sufre y contribuir a su inserción en la comunidad. Todo lo contrario, siempre se acentúa el hecho que la persona está enferma, que su enfermedad es incurable y que con el tiempo estará cada vez peor.

Eso es verdad cuando a una persona la privan de la libertad, en forma involuntaria o no, porque todo lo que le va pasando no es consecuencia de su padecimiento espiritual, emocional o psíquico… es consecuencia del asilamiento tras los muros agudizado por la “droga- dependencia- inducida” y por la soledad impuesta, que llega a sus grados de tortura más elevado en las celdas de aislamiento o con la sujeción mecánica en los casos que la persona presente algún tipo de excitación motriz que bien pudo ser ocasionada por un ”medicamento” o por falta de una caricia… por un miedo extremo o por una profunda angustia que nadie parece dispuesto a aliviar con un acompañar en un cuerpo a cuerpo hasta que el terror disminuya.

¿Dónde están escritas las bases del encierro involuntario como forma de cura?

En la decisión de privar de la libertad a una persona con discapacidad psicosocial de manera forzada hay un pensamiento, hay una lógica “a priori” que dispone que esa persona “no tiene cura en su enfermedad” y es una persona gravosa para la comunidad a la que se atribuyen todo tipos de males para sí mismo y o para terceros y que merecen la condena del encierro. Esto subyace en el pensamiento de quienes ejercen autoridad sobre la PcD psicosocial y le restringen la vida y la sumen en una vida en su mínima expresión, carente de sueños y anhelos, de amor y de libertad.

En Argentina los manicomios en su mayoría cuentan con “dispositivos de inserción laboral” a los cuales las personas privadas de la libertad son “invitados” a participar. Esa invitación y la aceptación o no, lleva a aumentar la cantidad de etiquetas que una persona puede ir sumando en el encierro de acuerdo a lo que se llama la falta o no de “adherencia al tratamiento”. Si la persona acepta trabajar en un emprendimiento de inserción laboral intra-hospitalario, recibirá un peculio[vii]… una míseros centavos por su trabajo y si no acepta, se le calificará como a una persona “institucionalizada que no tiene voluntad ni interés en el trabajo” y con pocas posibilidades de su inserción en la comunidad.

Las personas que estando internadas nos preocupamos por nuestra situación laboral somos desmotivadas y se nos promueve un pensamiento basado en la imposibilidad de continuar con tareas “normales” y el “beneficio” de acceder a “pensiones por discapacidad”.

Sostener delante de un psiquiatra la firme decisión de continuar trabajando en el mercado de trabajo como un ciudadano más, es descalificado en sus palabras, se es tratado como una persona que niega su “incapacidad” y lo usual es que el médico psiquiatra desconozca absolutamente todo lo referido a esa persona: sus estudios, su historia laboral y su estándar de vida si se trata de un manicomio púbico y en uno privado, si la persona en situación de encierro tiene un estar en el mundo alivianado de preocupaciones económicas porque posee dinero suficiente… no es menos descalificado… solo que esa persona puede llegar a tener más posibilidades de una vida autónoma si es que los familiares no lo inhabilitan restringiendo su capacidad jurídica para hacer ellos, usufructo de los bienes económicos de la persona con discapacidad.

Ninguna persona que tenga como único sustento en Argentina una pensión por discapacidad puede acceder a una canasta básica de alimentos, ni a la vivienda ni a la salud, no puede tener una vida independiente y autónoma ni puede vivir con libertad en la comunidad porque sus ingresos económicos, que son considerados “un beneficio” social, no le permiten tener ninguna autonomía económica.

No existe un nivel de vida adecuado ni protección social verdadera.

Vuelvo sobre el rechazo en Argentina de parte de los profesionales de la salud por la noción de discapacidad de la “persona con padecimiento mental” en cualquiera de sus manifestaciones.

La discapacidad es una concepción que pone en cuestión a la tan preciada, tanto como despreciada “enfermedad mental” corriendo el eje de la enfermedad individual al eje de las barreras sociales que obstaculizan la libertad individual, lo que se da en llamar el cambio de paradigma.

Los aún hoy promotores de las lógicas manicomiales encuentran en la concepción de la discapacidad una herramienta que otorga derecho a quienes ellos le quieren negar -ya no los derechos- si no la vida misma condenándoles al encierro y al estado de ser muertos vivientes, verdaderos zombis que deambulan entre los muros sin más pregunta que si la inmunda comida llegó a la mesa o no… si alguien se acordó de su existencia y llegó de visita o no…

A las mujeres privadas de la libertad se les puede llegar a producir la esterilidad quirúrgica…de modo involuntario… como se las puede prostituir… o abusar sexualmente de ellas y provocarle embarazos no deseados y hasta obligarlas a abortos o someterlas al robo de sus hijos…

Ingresar al manicomio es ingresar a la mismísima anomia[viii]: no se tuvo vida, la vida comienza y termina en los muros del manicomio.

La falta de ley a la que la palabra anomia refiere es lo que hace del manicomio un territorio que es tierra de nadie… y feudo de unos cuántos a la vez… en ese feudo la crueldad es ejercida con menos sutileza a medida que el ejecutor se aleja de la jerarquía del psiquiatra… y llega al personal de limpieza…

La degradación del concepto de ser humano y ser humano en igualdad de condiciones se traduce en el concepto de enfermo mental que es legislado por una concepción que se rige por un supuesto científico que designa la normalidad de las personas…

¿Quién puede decir yo soy normal, usted es normal y usted no sin sonrojarse?

Solamente alguien enceguecido de soberbia, solamente un ser que tanto teme a la locura, es capaz de pensar que es posible encerrarla tras los muros sin cometer violación de DD.HH.

La anomia en este caso es el estado provocado por un conjunto de personas que han degradado del juramento hipocrático y de otras que ejercen la violación de Derechos Humanos.

Para los que imponen esa legislación –paradójicamente carente de ley- para los que degradan con sus conceptos la condición humana al extremo de la privación involuntaria de la libertad, de tratamientos forzados, de humillaciones, torturas y tratos degradantes… para ellos la concepción de la diversidad funcional no existe y sin embargo, los involucra en tanto seres humanos- lo peor que les puede pasar es probar su propia medicina.

Puedo escribir miles de palabras más para tratar de transmitir la tortura que significa ser privada de la libertad – forma involuntaria o no- y de las graves consecuencias en mi salud y la observada en la salud de otros, como yo, obligados a la ingesta de drogas psiquiátricas en contra de nuestra voluntad.

Sin embargo, los profesionales de la salud mental con compendios de siglas alfanuméricas que definen conductas como los son los DSM y el CIE viven tan pagados de sus saberes y tan pagados por la industria farmacéutica y por los circuitos económicos que se destinan al sistema de salud,

  • son incapaces de recapacitar sobre sus prácticas, sobre su negación del paradigma de la discapacidad y ni pensar que puedan asomar su inteligencia al mundo de la diversidad funcional,
  • ni pueden comprender un mundo en evolución a velocidades nunca vividas en direcciones impensables hace menos de un cuarto de siglo, que desborda de nuevas problemáticas sociales donde todo parece desquiciado[ix] y estallado -y no necesariamente enfermo- sino nuevo y desconocido.

Como nuevo y desconocido hasta hace poco en Argentina es que nosotros, las PcD psicosocial, tenemos derechos y somos sujetos de derechos, pedimos trato en pie de igualdad y nos negamos a la internación involuntaria y al tratamiento forzado.

Hay una palabra en psicología muy interesante: constructo.

No voy a definir con exactitud el término, voy a explicar que constructo viene a designar esos aspectos que se saben que existen pero son difíciles de probar, de definir o controvertidos al momento de querer hacerlos “objetivables”.

Son constructos la inteligencia, la personalidad y la creatividad.

Me pregunto en qué lugar del cerebro está el recuerdo del olor dulce de mi abuela paterna… y de la voz de mi madre… dónde se guardan las canciones de cuna con las que he mecido el sueño de mis niños… dónde en el cerebro está el registro del primer diente, de la primera risa, de la primera travesura de mis hijos…en qué célula está el clima que rodeaba la escena que recuerdo de mi padre lustrando mis zapatos para ir a la escuela… dónde viven en mí los cuentos de hadas y brujas, el encanto del otoño teñido con el recuerdo del primer beso… donde se localizan los recuerdos de los compañeros desaparecidos, cómo perduran sus voces a pesar de los años… dónde se almacena todo lo aprendido y dónde permanece lo desaprendido, donde se produce y se reproduce la capacidad de amar cuando se ha sido vejada… cómo y donde están objetivados en mi cerebro lo que me permite pensar en colores para pintar, danzar, reír y llorar… olvidar y recordar…

Me pregunto de qué otra manera se puede privar de la libertad en forma involuntaria si no es a la fuerza y si no es desconociendo los derechos que nos atañen.

Esa fuerza tan bien descrita por Antonin Artaud en su CARTA A LOS DIRECTORES DE LOS ASILOS DE LOS LOCOS. “……………………………………………………….No nos sorprende ver hasta qué punto ustedes están por debajo de una tarea para la que sólo hay muy pocos predestinados. Pero nos rebelamos contra el derecho concedido a ciertos hombres – incapacitados o no – de dar por terminadas sus investigaciones en el campo del espíritu con un veredicto de encarcelamiento perpetuo……………………………………………………………………………………………………………………………………………………………….. ¡Y qué encarcelamiento! Se sabe – nunca se sabrá lo suficiente – que los asilos, lejos de ser “asilos”, son cárceles horrendas donde los recluidos proveen mano de obra gratuita y cómoda, y donde la brutalidad es norma. Y ustedes toleran todo esto. El hospicio de alienados, bajo el amparo de la ciencia y de la justicia, es comparable a los cuarteles, a las cárceles, a los penales…………………………………………………………………………………………………………………………………………………………………………….Esperamos que mañana por la mañana, a la hora de la visita médica, recuerden esto, cuando traten de conversar sin léxico con esos hombres sobre los cuales – reconózcanlo – sólo tienen la superioridad que da la fuerza.[x]

Lucila López

Usuaria y Sobreviviente de la Psiquiatría                                                                                           Psicóloga Social                                                                                                                                                                                            Psicodramatista                                                                                                                                       Analista Institucional                                                                                                                             Agente Comunitaria en Prevención de adicciones.

Miembro de WNUSP

Miembro de INWWD 

 

C.A.B.A

ARGENTINA

______________________________________________

Escrito por Lucila López en apoyo a la CAMPAÑA POR LA PROHIBICIÓN ABSOLUTA DE LA PRIVACIÓN DE LA LIBERTAD Y EL TRATAMIENTO FORZADO DE LAS PERSONAS CON DISCAPACIDAD PSICOSOCIAL, POR EL CUMPLIMIENTO IRRESTRICTO DEL ART. 14.- Buenos Aires, Argentina, Marzo 14, 2016

logo_wnusp

 

[i] Committee on the Rights of Persons with Disabilities /Guidelines on article 14 of the Convention on the Rights of Persons with DisabilitiesThe right to liberty and security of persons with disabilities/

Adopted during the Committee’s 14th session, held in September 2015

[ii] Estela de Carlotto, Presidenta a Abuelas de Plaza de Mayo uno de los organismos más importantes de Derechos Humanos de la Argentina.

[iii] *) Barrabasada: 2. Hecho equivocado que origina un gran destrozo o perjuicio. (evil thing) RAE

[iv] Y la de todos los privados de la libertad por motivos de discapacidad psicosocial.

[v] Ley NSM viola el art. 12 al decir: “Se presume la capacidad jurídica”… En la CDPD el art. 12 especifica “igual reconocimiento ante la ley”…

 

[vi] Se hace indispensable el resarcimiento económico.

[vii] *) Para el libre ejercicio del artículo 19, el respeto absoluto del art. 27 – Trabajo y empleo es una condición inalienable y elemental.

Me voy a detener a explicar en el significado de peculio porque es gravísimo que haya muchas PcD psicosocial y con otras discapacidades también, que trabajen con carácter obligatorio y sean pagadas con un peculio porque eso es rayano a un sistema de esclavitud.  El Derecho al Trabajo y al Empleo se viola de manera flagrante y es una vergüenza.

Peculio.- Significado – etimología- definiciones. Del lat. peculium.

  1. m. Dinero y bienes propios de una persona.
  2. m. Hacienda o caudal que el padre o señor permitía al hijo o siervo para su uso y comercio.

La palabra peculio proviene en su etimología del latín “peculium” que a su vez deriva de “pecus” que significa ganado, ya que esa era la medida que se aplicaba para valorar los bienes, cuando no existía la moneda. Los peculios eran porciones pequeñas de bie

nes, que se separaban en el antiguo Derecho Romano, del patrimonio familiar, que pertenecía en su integridad y en propiedad al pater, jefe de la unidad político religiosa en qué consistía la familia, y varón de mayor edad dentro de ella. Destina una pequeña porción a hijo y esclavos. También relacionado con el ámbito carcelario.

Hasta hace pocos días el peculio era de $150.- mensuales, equivalentes a  u$s 0,34 diarios.

Actualmente el peculio es $300.- mensuales equivalente a u$s 20,34 = u$s 0,68 diarios.

Los talleres protegidos para personas con discapacidad están naturalizados y solamente en la Provincia de Buenos Aires, hay 4.500 personas con discapacidad que trabajan en más 173 talleres protegidos.  En la Ciudad Autónoma de Buenos Aires un importante taller protegido, las personas con discapacidad psicosocial  hacen  los muebles para la administración pública y hospitales de la ciudad.

El actual valor del peculio en la Provincia de Buenos Aires fue anunciado hace pocos días por el Ministro de Desarrollos Social quien dijo: “van a recibir 300 pesos por mes como parte del peculio, en lugar de los 150 que cobran actualmente, que van a servir no solo para ayudar a ellos sino también a sus familias”. Asimismo informó que los operarios recibirán una tarjeta para la compra de productos alimenticios por un monto de 100 pesos mensuales. (equivalente a u$s 0,21 diarios ¡para alimentos! ¿Y consideran que deben ayudar a la familia!

Al día 14 de enero de 2016 se les adeudaba el pago desde septiembre de 2015.

[viii] Anomia: del gr. ἀνομία anomía.1. f. Ausencia de ley. 2. f. Psicol. y Sociol. Conjunto de situaciones que derivan de la carencia de normas sociales o de su degradación RAE

[ix] Desquiciar

  1. tr. Desencajar o sacar de quicio algo. Desquiciar una puerta, una ventana.U. t. c. prnl. U. t. en sent. fig.
  2. tr. Descomponer algo quitándole la firmeza con que se mantenía. U. t. c. prnl.
  3. tr. Trastornar, descomponer o exasperar a alguien. U. t. c. prnl.
  4. tr. p. us. Hacer perder a alguien la privanza, o la amistad o valimiento con otrapersona. RAE

[x] http://lalibertaddeotrodecir.blogspot.com.ar/2016/03/carta-los-directores-de-los-asilos-de.html

 

 

 

 

 

Posted on

Aporte de Asociación Azul

http://www.asociacionazul.org.ar/novedad/campana-de-apoyo-a-la-prohibicion-absoluta-de-la-cdpd-de-los-tratamientos-forzosos-y-los-internamientos-involuntarios-9/

Campaña de Apoyo a la Prohibición Absoluta de la CDPD de los Tratamientos Forzosos y los Internamientos Involuntarios.
Por  Asociación Azul, por la vida independiente de las personas con discapacidad, Argentina
La comprensión completa y visceral de que todo aquello rotulado como “discapacidad” (o términos relacionados) es parte de las incontables diferencias entre los miembros de una población, que de ningún modo altera y menos pone en duda la pertenencia a la misma, solo será posible cuando el sistema de creencias y esquema de valores de la sociedad den una vuelta de campana sobre sí mismos.
Esa vuelta de campana es necesaria, y será revitalizadora. Contribuirá a mejorar la situación de muchísimas personas, no solo de las que tienen discapacidad, y de la sociedad en su conjunto. Contribuirá a mejorar el mundo, oikos, la casa del hombre.
Por ese cambio arrasador luchan hoy las personas con discapacidad en todo el mundo. En esta Campaña en particular, creo que se lucha por cambiar las percepciones del resto de una sociedad que, atrincherada detrás de la voz de “los que saben”,  condena a algunos de sus miembros a la tortura, el aislamiento, el terror, el sufrimiento, por “buenas razones”.
La Convención es como la rama de un árbol, fuerte y flexible, que nos permite rasgar las bases y telones de este sistema: hablan los protagonistas y dicen tortura, sufrimiento, encierro, dolor, muerte adelantada.
Es necesario asegurar que siga la lucha, apoyada por las señales de quienes deben resguardar la Convención, para que los Estados garanticen urgente y decisivamente un sistema respetuoso de la libertad de todas las personas con los apoyos para sostener esa libertad en sus comunidades. Las personas de las que trata esta Campaña son personas que quieren ser libres y disfrutar de los mismos derechos que los demás en su comunidad. Y la comunidad necesita dejar de tener miedo, para servir mejor a todos sus habitantes y disfrutar de las contribuciones de todas las personas.
Posted on

Workfare coercion in UK – Anne-Laure Donskoy

Workfare coercion in the UK: an assault on persons with disabilities and their human rights

Anne-Laure Donskoy_Survivor researcher, UK

12067142_10153490835343527_664282852_n

While there is a lot of focus on coercion organised and implemented in psychiatry, less attention is being paid to state engineered welfare measures based on libertarian paternalism1, which have coercive practices at their core. Among them are policies that strongly support behavioural change using positive psychology and cognitive behavioural therapy. Freidli and Stearn (2015)2 call this “psychocompulsion”. These policies and measures are increasingly used to ambush and coerce persons with disabilities and the long term sick into adopting new ways of being and living conditions under the constant threat of sanctions and which have driven many to attempt to their lives. This paper builds on the work of Friedli and Stearn3 as an attempt to highlight current coercive welfare policies, including forcing ‘therapy’ on individuals, as human rights violation of the CRPD.

 

Background: Psychocompulsion as state sponsored human rights violations

Psychocompulsion, the use of psychological strategies to “nudge” individuals to make “life changes” that fit a political ideology or programme, is not entirely new to the UK. Already in the 1970s, some long term job claimants would be sent for a medical examination, on the premise that if people were not physically ill then they should be able to find and take up work, any work. This had all the flavours of Victorian paternalism written all over it. The ‘mentally disordered’ and the ‘mentally handicapped’ experienced a particular brand of paternalism, hidden away from society and from consciousness in specialist homes and services, often suffering physical and mental abuse or used in rehabilitation work with little or no protection.

Today, psychocompulsion in the UK has been promoted by the Behavioural Insights Team (nicknamed the “Nudge Unit”), now in private hands as a social purpose company but still working closely with the Cabinet Office4, thereby guaranteeing prime influence on policy making. It is clear that psychocompulsion is being used to lock individuals, including the long term unemployed, the sick and persons with disabilities, into back-to-work schemes as a conditionality of welfare. In recent months and weeks, voices of dissent have arisen mostly from social movements, denouncing the use of coercion which put people’s lives at risk5.

As Friedli and Stearn’s paper show, this finger wagging attitude has taken on a far more sinister slant.

First, it turns on its head the idea that unemployment is the product of a failing economy by strongly suggesting that it is a state of mind, worse still a ‘mental illness’ that can be corrected by changing the psychology of claimants, thus placing the onus of responsibility for success, for betterment, for choice etc. on the individuals themselves. This totally ignores issues of social (in-)justice.

Second, it widens the scope by netting in the most vulnerable people in society, specifically the long term sick and those with disabilities, including psychosocial disabilities. This strategy narrowly avoids attracting full-on accusations of discrimination by putting these individuals on par with the long term unemployed and by stressing ad nauseam that the policy is about helping people which should be achieved through (any type of paid) employment. Paid employment becomes the embodiment and the “pinnacle of human experience”.6

Third, the underlying premise that ‘work is good for you’ ignores those dissenting voices which argue that without strong provisos (taking into account the complexity of individual circumstances, choice, timeliness, appropriateness as much as the quality of support and work on offer) the argument is both unhelpful and counterproductive7, and can have devastating consequences for those concerned.

Finally, the stance of the policy totally fits within the libertarian paternalism agenda which moves away from collective to total individual (libertarian) responsibility, slowly realising Ayn Rand’s vision for a permanently productive (and permanently disposable/replaceable) workforce serving an elite. In this scheme, all coercive strategies acquire a legitimacy that the psychiatric survivor movement rejects.

 

Being ill or disabled, and on welfare benefits: state coercion and the CRPD

The Welfare Reform Act 2012 introduced a wide range of reforms to the benefits and tax credits system. The stated aim was to reduce the financial burden of the cost of welfare. This is being achieved by introducing ever drastic and punitive policies under the guises of a responsibilisation agenda, underpinned with an intense authoritarian ideology not seen or experienced since Victorian times. The Tory manifesto of the 2015 general elections claimed it aimed to help people with mental health issues back in to work. The reality is very different and people with mental health issues clearly face discriminations which other groups do not.

 

Article 4: The rights and freedoms of persons with disabilities are violated under the social security scrutiny regime:

When people with mental health issues are on welfare benefits, they find themselves the object of intense, intrusive and inappropriate scrutiny by the system, notably through the Work Capability Assessment (WCA) which has consistently failed these claimants as it is totally unsuited to their singular predicaments and experiences. As a result, more and more people are placed on the Work Related Activity Group of the Employment and Support Allowance which comes with strict conditionalities. Also affected are those under the new Universal Credit (UC) system which is being rolled out for all benefits claimants which places yet another layer of scrutiny on individuals, possibly more so those in work.

 

Article 1-5: Discrimination

A judicial review in 2013 found that the WCA process actively discriminates against people with mental health issues. Since then very little has been done to change the process and the status quo remains.

The Centre for Welfare reform, in its recent report A Fair Society?, also shows that persons with disabilities are targeted the most despite the fact that they have the greatest and often most complex needs.

12674235_10153490835108527_56659396_n

 

Article 10: Right to life: “States Parties reaffirm that every human being has the inherent right to life and shall take all necessary measures to ensure its effective enjoyment by persons with disabilities on an equal basis with others”.

A poll of over 1,000 GPs commissioned by Rethink Mental Illness in 2015, found that over 20% have patients who have felt suicidal due to the WCA8.

In a report sent to the Department for Work and Pensions (DWP), the senior coroner for inner north London, Mary Hassell, said “the trigger” for the suicide was the man being found fit for work by the department”9.

[A Freedom of Information request has] revealed that the Department for Work and Pensions (DWP) has investigated decisions, via peer reviews, about the welfare payments of 60 claimants following their deaths. A peer review, according to the DWP guidance for employees, must be undertaken when suicide is associated with DWP activity to ensure that any DWP action or involvement with the person was appropriate and procedurally correct.10

 

Article 13: Access to justice: 13.1: “States Parties shall ensure effective access to justice for persons with disabilities on an equal basis with others, including through the provision of procedural and age-appropriate accommodations, in order to facilitate their effective role as direct and indirect participants, including as witnesses, in all legal proceedings, including at investigative and other preliminary stages.”

Benefit claimants who wish to appeal a decision need access to justice. This represents an expense they can ill afford (if at all) therefore need access to legal aid. However, the Ministry of Justice has removed welfare benefits matters from the scope of legal aid funding, thereby denying access to justice and discriminating against the most vulnerable and poorest, among whom people with mental health issues:

In order to challenge a decision of a First-tier Tribunal (FtT) the appellant needs to identify an error of law in the FtT’s decision and then request permission to appeal to the Upper Tribunal (UT). The process of appealing on a point of law to the UT has two stages, but, for the reasons set out below, the legal aid contract only covers the second stage … The absence of any legal aid at Stage One of an appeal to a UT on a point of law represents a major flaw in the current scheme as it is simply unrealistic to expect an appellant to draft an appeal on a point of law without any assistance.11

In the future, social security claimants who find themselves faced with an incorrect Upper Tribunal decision, or who win their case at the Upper Tribunal but find themselves on the receiving end of an appeal by the DWP12, HMRC13 or a local authority, could be facing the courts and the costs risks attached on their own or not at all.14

In practice, benefit claimants who wish to appeal decisions have to resort to charitable organisations to support them through the process. However these are seeing their funding cut, or they are not coping with increasing number of calls for help.15 There has also been some criticism from within the legal system with regard to persons with intellectual disabilities on matters of legal representation regarding privation of liberty; the same issues also apply to persons with psychosocial disabilities:

The Law Society, which represents solicitors throughout England and Wales, intervened [in a particular case]. Its president, Jonathan Smithers, said: “When a vulnerable person doesn’t have friends or family to represent them during a decision to restrict their liberty, it is vital that person is able to participate in the decision-making process . . . If this is not possible then they must have a legal representative to protect their rights as well as their health and general welfare. Those who are least able to defend themselves should not be sacrificed on the altar of austerity.” 16

 

Actively changing the narrative of workfare and welfare benefits

The narrative of welfare is changing drastically. As Friedi says, we are moving from a “what people have to do [to find work] to what they have to be [demonstrating the right attitude to be employable]17. This is exemplified through the new ‘Work and Health Programme’ planned to be rolled out in England and Wales.

This programme has many strands, including:

−   Embedding psychological services within Job Centres

−   Placing ‘job coaches’ within GP surgeries for people with certain conditions (specifically people with mental health issues): the ‘Working Better’ pilot scheme is funded by the Department for Work and Pensions and the coaches will be provided by welfare to work agency, Remploy (a welfare-to-work subsidiary of the Maximus).

12325145_10153490835113527_1349725544_n

 

This programme blurs the boundary between health and welfare, health and work domains, in a way that has not happened before. This is a coordinated move to effectively bring in the benefits system within NHS care: joblessness, being unemployed becomes an illness, specifically a mental illness which needs to and care be cured through psychological therapies.

It will not only extend benefit conditionality into the NHS but also compromise clinical independence and clinical ethics. In practice, people who display the wrong attitude to work, to work placements or who have been unemployed for a long time will be referred to psychologists and given forced Cognitive Behavioural Therapy, and be sent many motivational emails and text messages throughout the week; or they will be prescribed referrals to an in-house ‘job coach’. Failure to comply with these forced prescriptions will trigger an immediate sanction regime. This will inevitably threaten if not destroy that first quality that patients place in their doctor, trust. People may become reluctant to say anything whether it is about their situation or their health for fear of being forced into the schemes.

 

CRPD violations:

Articles 1-5: (equality, choice, autonomy, capacity)

Persons with disabilities are specifically targeted by the new measures

 

Article 25 (Right to health):

Currently both schemes are in the early stages of being rolled out (pilot stage) and the official line claims that they are voluntary. However, as the Tory manifesto stated “We will help you back into work if you have a long-term yet treatable condition”, this is set to become compulsory: “People who might benefit from treatment should get the medical help they need so they can return to work. If they refuse a recommended treatment, we will review whether their benefits should be reduced.”(p. 28). However, being forced to receive “therapy” for a “treatable condition” is not the same thing as being offered support, which would imply that the individual is free to choose to take it up or not. Most observers agree that what is currently taking place on a voluntary basis as part of the pilot projects will become compulsory, which would only follow the UK Government’s own stance of applying any means to get people “back to work”18.

This means that people with mental health problems will no longer be able to freely choose to consent, or withhold their consent, to ‘treatment’. There is also a high risk that people will feel intimidated into consenting to undergo these ‘therapies’. This is very similar to what happens in psychiatry whereby the right to health is invoked to forcibly treat people for their own good, “in their best interest” … but as their only option. To decline a recommended treatment or to fail to comply to the letter with the injunctions and expectations of the system will result in benefits sanctions.

Cognitive behavioural therapy (CBT), the approach chosen by the Government is highly controversial and does not suit everybody. Therefore a one-fits-all approach, whether it is applied forcibly or not, will be counterproductive as it may make some people feel worse (counter to their right to health) and shows the total lack of understanding of the often complex and singular situations of persons with disabilities.

 

Art 10: (Right to life)

Any Government that uses coercion and sanctions as a means to a political end must take full responsibility for the consequences of its actions. As with the Work Capability Assessment, people being coerced into receiving behavioural or any therapy they did not fully consent to, may experience adverse effects (making people even more unwell by making them even poorer and forcing them to live in a constant state of anxiety, making them suicidal).

It also denies the person as an autonomous individual able to make their own choices (Art 12, Equal recognition before the law; Art 16, Freedom from exploitation, violence and abuse and threatens their integrity (Art 17)).

It also contradicts the Government’s own claims that it is doing everything to make UK domestic law compliant with the CRPD:

The Convention is not legally binding in domestic law in the UK but is given effect through the comprehensive range of existing and developing legislation, policies and programmes that are collectively delivering the Government’s vision of equality.19

 

Article 17 (Protecting the integrity of the person): The issue of coercion goes beyond “designating work as a cure for unemployment and poverty”20 as Friedli puts it; this is also about changing people’s societal status and identity. In the new narrative, there are productive and unproductive individuals, therefore there is no such thing as a long-term sick or disabled person (all disabilities included). These notions pretty much disappear in the name of inclusiveness and fairness (in relation to so-called “hard working people”21 who are deserving of help and will do their utmost not to rely on the state for their individual needs).

Language is indeed important in this context, and language is shifting. As many have observed, ‘sick notes’ have become ‘fit notes’, the term ‘disability’ too is being erased as ‘Disability Living Allowance’ becomes ‘Personal Individual Payment’. This speaks to a simplistic but powerful narrative of ‘can-do-no-matter-what’ supported by having a compulsory ‘right attitude, which is where psychocompulsion comes in. Nudging then forcing people into having the ‘right attitude’.

 

Forcing people back to work by reducing their welfare benefits

Persons with disabilities are clearly targeted over and above other categories of individuals (Art 1-5 equality, discrimination, choice, autonomy). Indeed, another form of coercion has emerged through a recent drastic to the ESA in weekly support from £103 to £73, contained in the Welfare Reform and Work Bill. It will apply to new ESA claimants in the work-related activity group. This vote, pushed through Parliament on 7 March 201622, is meant to “incentivise disabled people to find work quicker”. This (purely ideological) decision will not only strip them of financial security but also reinforce the idea, by bringing the rate into line with Jobseeker’s Allowance, that disability no longer exists, that anyone can and should work, that there are only productive (deserving) and unproductive (undeserving) people.

 

An unethical social experiment

It has come to light that these new programmes are also the subject of ‘research’. The new Work and Health Programme is currently at a research and trialing stage23. As Kitty Jones writes,

Part of the experimental nudge element of this research entails enlisting GPs to “prescribe” job coaches, and to participate in constructing “a health and work passport to collate employment and health information.24

However, this ‘research’ (if one can call it so), has been heavily criticised because it is not sanctioned according to the usual robust ethical guidelines. Research that adheres to robust ethical guidelines would absolutely seek not to cause harm to its participants, and would seek their informed consent beforehand25. This is not the case here where claimants are the participants are the involuntary and ‘unconsented’ participants of an experiment they know nothing about.

There are a wide range of legal and Human Rights implications connected with experimentation and research trials conducted on social groups and human subjects.26

A spokesperson for Disabled People Against Cuts (DPAC), talked of the UN CRPD Committee’s visit to the UK and described the situation thus:

It means the UN will examine the vicious and punitive attacks on disabled people’s independent living as well as the cuts which have seen so many placed in inhuman circumstances and has led to unnecessary deaths.27

 

Articles 1-5: discrimination against persons with disabilities who are targeted through this programme.

Article 9: right to communication: The existence of this experiment and the format of its conduct has not been communicated with the claimants (the participants).

 

Article 10 (Right to Life): when coercion brings people to the brink of suicide or they succeed in killing themselves (one court case at least has pronounced on the clear link between benefits sanctions and reasons for suicide):

Research from the Black Triangle campaign group found more than 80 cases of suicide directly linked to billions of pounds in benefit cuts. John McArdle, co-founder of Black Triangle, said: “The Dept of Work and Pensions refuses to reveal the findings of their own peer reviews of suicides linked to the sanctions so we will never know the truth in those cases. . . He said the Work Capability Assessment regime applied to all sick and disabled people, without adequate risk assessment ‘built into the system’28

Mortality rates bring their own tales of woe:

[The government] published or, rather, was forced to after several Freedom of Information requests – that show more than 80 people a month are dying after being declared “fit for work”. These are complex figures but early analysis points to two notable facts. First that

2,380 people died between December 2011 and February 2014 shortly after being judged “fit for work” and rejected for the sickness and disability benefit, Employment and Support Allowance (ESA). We also now know that 7,200 claimants died after being awarded ESA and being placed in the work-related activity group – by definition, people whom the government had judged were able to “prepare” to get back to work.29

 

Articles 12, 17, 19: Coercive measures embedded in all aspects of the Work and Health Programme and its various tools and strategies run counter to the premise that the person is free and able to make choices for themselves, and considerably threatens their right to independent living when they are forced into poverty.

Nothing seems to shift the current UK Government’s assault on people with disabilities or long term sickness, and on their human rights. Not the many Freedom of Information requests which have revealed that the DWP did look into the death of 60 benefits claimants but sat on the findings; nor a Commons Select Committee inquiry into benefits sanctions in April 2015, nor the visit by the UN CRPD committee at the request of a disability group (DPAC) in the late autumn of 2015, nor a coroner’s report clearly linking a claimant’s suicide to the stress caused by the Work Capability Assessment. The UK is effectively engineering and encouraging coercive and punitive policies that specifically target people with disabilities and the long term sick, putting their lives and their future at high risk. Many have observed that ‘austerity’ was only ever an excuse to establish and implement ideological policies. This is not about saving money in hard times; this is about the willful annihilation of the disabled, either through language or deeds.

 

Anne-Laure Donskoy

March 2016

 

Notes:

1https://kittysjones.wordpress.com/2015/11/28/the-goverments-reductive-positivistic-approach-to-social-research- is-a-nudge-back-to-the-nineteenth-century/– The idea that it is both possible and legitimate for governments, public and private institutions to affect and change the behaviours of citizens whilst also [controversially] “respecting freedom of choice.”

2 Friedli L, et al. Med Humanit 2015;41:40–47. doi:10.1136/medhum-2014-010622

3 See also this short film: https://vimeo.com/157125824

4 http://www.behaviouralinsights.co.uk/

5 http://www.disabilitynewsservice.com/coroners-ground-breaking-verdict-suicide-was-triggered-by-fit-for-work-test/

6Cole M. Sociology contra government? The contest for the meaning of unemployment in UK policy debates. Work Employment Soc 2008;22(1):27–43.

7 Even the Department of Work and Pensions (DWP) who are driving these policies, acknowledged in a 2006 study have put forth provisos that “account must be taken of the nature and quality of work and its social context” and that, for sick and disabled people, “there is little direct reference or linkage to scientific evidence on the physical or mental health benefits of (early) (return to) work for sick or disabled people.” 8https://www.gov.uk/government/publications/is-work-good-for-your-health-and-well-being

https://www.rethink.org/media-centre/2012/09/new-gp-survey-shows-government-welfare-test-is-pushing- vulnerable-people-to-the-brink

9 See note 3

10 https://www.wsws.org/en/articles/2015/02/05/welf-f05.html

11 https://gclaw.wordpress.com/2014/05/30/what-legal-aid-is-still-available-for-work-undertaken-on-welfare-benefits-post-laspo/

12 Department of Works and Pensions

13 Her Majesty’s Revenue and Customs

14 http://www.cpag.org.uk/content/legal-aid-reform-or-termination

15 http://www.theguardian.com/society/2014/feb/25/benefit-cuts-welfare-linked-mental-health

16 http://www.theguardian.com/society/2016/mar/10/judge-challenges-government-over-legal-representation-for-

vulnerable-people?CMP=share_btn_tw

17 https://www.youtube.com/watch?v=Dt-V0e0-ipY

18 A side point has been made by Friedli and others about the questionable ethics of those clinical psychologists who accept to take part in such initiatives and about the rapid expansion of the back-to-work industry.

19 Office for Disability Issues, UK Initial Report On the UN Convention on the Rights of Persons with Disabilities, May 2011,

www.odi.gov.uk/un-report

20 https://www.youtube.com/watch?v=Dt-V0e0-ipY

21 An expression used as a constant leitmotiv by the UK government.

22 Ministers claimed “financial privilege” to assert the Commons’ right to have the final say on budgetary measures

23 http://php.york.ac.uk/inst/spru/research/summs/esa.php

24 https://kittysjones.wordpress.com/2015/12/14/the-department-for-work-and-pensions-dont-know-what-their-ethical-and- safeguarding-guidelines-are-but-still-claim-they-have-some/

25 https://en.wikipedia.org/wiki/Ethical_research_in_social_science

26 See note 15

27 http://www.disabilitynewsservice.com/confirmed-un-is-investigating-uks-grave-violations-of-disabled-peoples-rights/

28http://www.mirror.co.uk/news/uk-news/more-80-suicide-cases-directly-5634404

29 http://www.theguardian.com/commentisfree/2015/aug/27/death-britains-benefits-system-fit-for-work-safety-net

 

 

Posted on

Contribution to the Campaign to Support the CRPD Absolute Prohibition of Commitment and Forced Treatment: María Teresa Fernández Vázquez (Mexico)

an English summary of the Spanish original posted at https://absoluteprohibition.wordpress.com/2016/03/18/aporte-a-la-campana-por-la-prohibicion-absoluta-en-la-cdpd-de-los-tratamientos-forzosos-y-los-internamientos-involuntarios-maria-teresa-fernandez-mexico/ and at https://sodisperu.org/2016/03/14/aporte-a-la-campana-por-la-prohibicion-absoluta-en-la-cdpd-de-los-tratamientos-forzosos-y-los-internamientos-involuntarios/

In this text I try to argue my support for the Campaign from three different approaches. First, from a humanistic and social perspective that sees the human person as a unique and irreducible being, whose “inexhaustible potential of existence” [1] unfolds and may unfold in infinite ways and expressions, all of which are equally valuable and precious. For centuries, however, persons with disabilities in general, and persons with psychosocial disabilities in particular, have been put down and aside, and their expressions rarely acknowledged or approved by the vast majority. Either through ignorance, fear, negligence, lust for power and control, etc., both governments and societies have been ready to repress human conducts that do not fit the socially construed parameters already embedded in unquestioned norms, habits, symbols and cultural stereotypes. So that the status quo is maintained. We should consider any attempt at repression of human expression as a form of social and political oppression that should not be tolerated. Instead, societies should open themselves to human diversity, and build with all those who are different a permanent dialogue; create – hand in hand with them – new forms of social interaction and coexistence that enrich us all. To this I bet.

Secondly, I talk from my personal experience as the sister of a man who in his adolescence was diagnosed with epilepsy and later in his life became an alcoholic. My brother was confined to health centers, “farms” and psychiatric hospitals on the recommendation of his treating physicians. I can testify the increasing deterioration suffered by my brother after each placement, which culminated with his painful and early death. His commitments were absolutely intolerable and ominous: for him, for us as his family, and for us all. I deeply regret that we did not have access to the information, advice, proper support or the services that would have allowed my brother to live his life differently, according to his needs and potential; humanly, in short. The worst of it all is that today – forty years later – things have not changed much. There is still the same lack of such: information, advice, proper support and services. People with psychosocial disabilities keep on being ill-treated and committed, even against their will; even if there is proved evidence that such treatments do not work, but, on the contrary, they do profound and irreversible harm. Both: governments (through laws, policies and lack of political will), health professionals and society as a whole continue to condemn persons with psychosocial disabilities to oblivion and to death, and do it with absolute impunity. This too is unacceptable and has to be changed. The UN Convention on the rights of persons with disabilities tells us how.

The third perspective I support the Campaign from is that of the UN Convention on the Rights of Persons with Disabilities, being myself a person with a physical disability and thus actively involved in its process. Complying with the Convention means respecting the dignity and individual autonomy of all persons with disabilities, as well as respecting their right to equality and non discrimination, to personal liberty and security. As the CRPD Committee declares: “forced treatment by psychiatric and other health and medical professionals is a violation of the right to equal recognition before the law (art. 5) 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” (Par. 42).[2] The Committee also states that the segregation of persons with disabilities in institutions violates a number of the rights guaranteed under the Convention (Par. 46).

It is absolutely unacceptable, under the Convention, not to respect the dignity of persons with psychosocial disabilities, or to subject them to scrutiny and rude, authoritative assessments. Nor is admissible for anyone to attribute himself the faculty to decide in his opinion what best suits them, or to hold them in places where they loose everything: their autonomy, their freedom, and even their dignity. Places where they remain – subjected and powerless – under the absolute control of other persons’ will – never their own – and their integrity is lacerated. As the CRPD Committee clearly declares, such practices are in frank violation of the UN Convention on the rights of persons with disabilities and must be eradicated.

Instead, States Parties to the Convention – as well as the whole of societies – should fulfill their moral and legal obligation to eradicate all existing barriers and take all the necessary measures to guarantee that people with psychosocial disabilities enjoy each and every of their fundamental rights and are included as active and irreplaceable parts of society on an equal basis with others.

 

[1] Boff, Leonardo. Tiempo de la trascendencia, el ser humano como un proyecto infinito, Santander, Sal Terrae, Brasil, 2000.

[2] Committee on the Rights of Persons with Disabilities, General Comment No. 1 on Article 12 (2014).

Posted on

Aporte a la Campaña por la “Prohibición Absoluta en la CDPD de los Tratamientos Forzosos y los Internamientos Involuntarios”: María Teresa Fernández (México)

https://sodisperu.org/2016/03/14/aporte-a-la-campana-por-la-prohibicion-absoluta-en-la-cdpd-de-los-tratamientos-forzosos-y-los-internamientos-involuntarios/

Publicado el marzo 14, 2016 por Deja un comentario

La institucionalización de personas con discapacidad es una declaración de incompetencia de las autoridades gubernamentales y de las sociedades frente al fenómeno que representa la existencia humana. Una declaración de soberbia supina y de falta de voluntad; también, de indolencia, y también, de impunidad. Nos atribuimos la facultad de decidir si una a una de estas personas debe vivir, y cómo; o debe morir – y literalmente – encerrada entre muros estrechos e indiferentes, atada a una cama, un catre, un poste; sometida a un medicamento o a un cierto trato, el que nos venga a bien dispensarle; reducida y frustrada en sus posibilidades y sueños, sin más compañía que su propia intimidad diferente y asustada. Y nos creemos juiciosos, protectores, responsables – éticos. Nos decimos humanos y nos damos baños de pureza. Mejor sería hacerlo en el Ganges.

Mi hermano fue diagnosticado con epilepsia cuando entró en la adolescencia. Se hizo alcohólico después. Me llevaba 18 años. Fue internado varias veces en distintos centros, hospitales y “granjas”. Cada vez que salía – de más en más aminorado – había perdido algo nuevo: el brillo de sus ojos, su sonrisa franca y espontánea, alguna más de sus ganas de vivir.

Y sin embargo seguimos. Seguimos sin prestar atención a lo que filósofos, teólogos, humanistas, han venido repitiendo a lo largo de la historia: el ser humano – como sus expresiones y manifestaciones – es único e irreductible, como inagotable es su potencial de existencia. Nuestra pequeñez y cortedad de miras – aunadas a nuestras ansias de “normalidad”, de resultados y de eficacia; de absurdos absurdos, pues – no alcanza, siquiera, a preguntarse lo que esas cualidades de “único” y de “irreductible”, en relación con la persona humana, puedan significar.

Si no, ¿por qué, a pesar de los tantos “avances”:  científicos, tecnológicos, garantistas de derechos, seguimos sin ser capaces de aceptar que el ser humano tiene una existencia “condenada a abrir caminos siempre nuevos y siempre sorprendentes”[1]?, ¿por qué no nos permitimos el diálogo posible – y promisorio – con las diversas percepciones y expresiones humanas de la realidad?

Cuando un niño es inquieto, o “de más” ; o un adolescente, desinteresado, o su respuesta es glacial; cuando una mujer rompe en llanto, o monta en cólera, ante – decimos – “la menor provocación”, no tardamos en enjuiciar su conducta, y diagnosticarla, y patologizarla; no sólo su conducta, su ser por entero. Son pocos y cortos los pasos para transitar del juicio al diagnóstico y de ahí a la etiqueta – que lo será, ya para siempre, incuestionable e inamovible; y luego, a la medicalización, y al mismo tiempo, o poco después, al encierro. Y en este apresurado camino nos hemos olvidado:  de él, de ella, de la persona humana que ahí vivía.  Ya hemos llegado – y con plena conciencia – al umbral. Es la muerte. Una muerte que  – pareciera que confiamos – todo lo resolverá; o por lo menos, hemos logrado que así pensando y haciendo todo se resuelva, al menos, para nosotros. La impunidad.

Cada vez que mi hermano salía de uno de esos encierros nos decía que no quería más: que se lo llevaran, que lo encerraran, que lo amarraran, que lo durmieran, que le aplicaran electro shocks. Que lo mal trataran, que lo desnudaran, que lo despojaran, hasta de su dignidad. Era intolerable. Era ominoso. Yo era muy joven. Hoy tengo 64 años. Hace 40 que mi hermano murió en uno cualquiera de esos hospitales. Sigue vivo en mí.

Estos años me han servido para aprender que a quien le importa lo humano, se propone indagar lo que hay ahí adentro de ese otro, también humano. Descubrir su razón, su interés, su necesidad, su intención, su propuesta, su expresión – diferentes. Y vestir su piel. Y estar dispuesto a moverse y a tender puentes – y cruzar esos puentes.

Por eso me pareció extraordinario que el proceso de negociación de lo que llegaría a ser la Convención de Naciones Unidas sobre los derechos de las personas con discapacidad (CDPD, 2006),[2] hubiera asumido ese reto:  abrir sus puertas – y poner oídos atentos – a lo que las propias personas con discapacidad psicosocial tenían que decir sobre ellas mismas: que son seres humanos, iguales, íntegros e integrales, redondos; formados e  informados; presentes, pensantes, sintientes, activos y comprometidos; con las mismas necesidades y búsquedas de cualquier otro ser humano – y con los mismos derechos y obligaciones; y aún así, cada una y cada uno, con maneras y expresiones distintas, únicas, propias, privadas: las suyas. Como usted, apreciable lector; como yo también, y como todas y todos. Y tan así, que la intervención de estas personas con discapacidad en las negociaciones para la Convención conmocionó – impactó –, y fue capaz de crear posibilidades nunca antes vislumbradas, para ellas, para las y los demás: Un camino al diálogo real con la diversidad.  El inicio de un movimiento franco hacia la aprehensión – y la inclusión – de formas variadas de ser y estar en el mundo. Para desde ahí, aprender. Y desde ahí, convivir. Desde ahí, transformarse y transformar.

Hasta entonces, no había pasado todavía que alguien defendiera públicamente, y con tanta fuerza y claridad, que no es posible vivir ignorando o aniquilando a seres humanos, y por el simple hecho de no ser capaces – nosotros – de inteligir sus maneras; o porque molesta que griten fuerte y disonante cuando el mundo les duele; o porque amenazan los referentes de los útiles y cómodos statu quo.

Las personas con discapacidad psicosocial desmantelaron  – en y con la Convención – uno a uno de los mitos que nos hemos fabricado sobre ellas: su indefensión, su fragilidad, su “peligrosidad”; su incapacidad: de tomar decisiones, de asumir obligaciones y responsabilidades; de vivir en este mundo y atreverse a cuestionarlo; de aportar, de enriquecer-nos.  No es gratuito, entonces, que – en y desde la Convención –, no quepa más hacer distingos sobre ellas. O no, si para atentar en contra de su dignidad, o para propiciar que se vulneren sus derechos; tampoco para someterlas a escrutinios y valoraciones groseras, autoritarias y sin fundamento, o al menos, moral. O para que alguien pueda atribuirse la facultad de poder decidir a su juicio lo que mejor les conviene, o de recluirlas en instancias en las que todo lo pierdan, incluso su autonomía y su libertad; incluso su dignidad.  Lugares donde queden – sometidas e impotentes – bajo el control absoluto de otra u otras voluntades – nunca la suya – y se lacere su integridad. ¿Qué razón – y qué derecho – le asiste: al Estado, a los profesionales de la salud, a las familias, a la sociedad en general, para permitirse un acto semejante?, me pregunto y se lo pregunto, sí, a usted, apreciable lector o lectora.

Todas las personas con discapacidad han sido reconocidas por la Convención con la misma dignidad y derechos que el resto de las personas.  Derechos de las personas con discapacidad – “incluidas aquellas que necesitan un apoyo más intenso” (Preámbulo CDPD, inciso j)) – son que se respete su dignidad y su valor; que se respete y aprecie su diferencia, tanto como su autonomía, su independencia y su libertad para tomar sus propias decisiones  – incluso, cuando estas decisiones puedan no coincidir con las nuestras, o nuestras opiniones y creencias – o nuestra voluntad; o nuestros intereses. Es también un derecho de todas las personas con discapacidad –reconocido por la Convención– que se les proporcionen los apoyos que ellas estimen necesitar para tomar sus propias decisiones (Artículo 12.3 CDPD), incluida la de dónde y con quién vivir, y sin que se vean obligadas a vivir con arreglo a un sistema de vida específico (Artículo 19. a)CDPD). También es derecho de ellas disponer de los servicios de apoyo que faciliten su existencia y su inclusión en la comunidad y eviten que se les separe o aísle de ésta (artículo 19. b) CDPD).

El Comité de Naciones Unidas sobre los Derechos de las Personas con Discapacidad (CRPD), en su Observación General No.1,[3] ha abundado sobre el alcance del derecho de las personas con discapacidad a tomar sus propias decisiones y que éstas sean respetadas: “en todo momento, incluso en situaciones de crisis, deben respetarse la autonomía individual y la capacidad de las personas con discapacidad de adoptar decisiones,” (O.G.No.1 CRPD, Párr.18). También ha afirmado que entre estas decisiones se incluyen aquellas “decisiones fundamentales con respecto a su salud” (O.G.No.1 CRPD, Párr. 8); y más específicamente, el Comité ha reconocido el derecho de las personas con discapacidad a no ser internadas contra su voluntad en una institución de salud mental y a no ser obligadas a someterse a un tratamiento de salud mental (Artículo 14 CDPD) (O.G.No.1 CRPD, Párr. 31). También el Comité CRPD ha dejado en claro que todas las formas de apoyo en la toma de decisiones que las personas con discapacidad opten por recibir, “incluidas las formas más intensas, deben estar basadas en la voluntad y las preferencias de la persona, no en lo que se suponga que es su interés superior objetivo.” (O.G.No.1 CRPD, Párr. 29, Inciso b)).

Lamento profundamente que nada de esto fuera del dominio público cuando yo era niña. Cuando mi madre, al no disponer de los recursos necesarios: información, asesoramiento, apoyos y servicios – porque no existían, o eran inaccesibles – no encontró mejor opción para él, para ella y para mí, que poner a mi hermano a disposición de los médicos. Ella creyendo que sabían lo que era debido hacer; ellos alegando saberlo, a pesar de que un número incontable de historias – entre las que después se contaría también la de mi hermano – testimoniaban fehacientemente lo contrario.

Gracias a mi involucramiento con los procesos sobre la Convención de Naciones Unidas sobre los Derechos de las Personas con Discapacidad, he aprendido que es éticamente insostenible pretender – usted, yo, los gobiernos y las sociedades – seguir ignorando las incuestionables e infinitas realidades y posibilidades humanas. Que es inadmisible seguir apelando a maneras arcaicas y lugares comunes para enmascarar nuestra incapacidad de derribar barreras, estigmas y prejuicios, o nuestra falta – evidente – de voluntad. Como la que reconoce el valor de otras existencias y mantiene con ellas interacciones fecundas; la que incursiona en nuevas formas de acercamiento a las situaciones y de brindar atención y cuidados.

Hace 40 años no existían los servicios y los apoyos que habrían llevado la historia de mi hermano por otros caminos, hoy lo sabemos, menos crueles y fatales; que habrían permitido que él – con la debida asistencia – encontrara sus propias respuestas.  Al día de hoy, esos servicios y esos apoyos siguen sin estar disponibles, o aquí, en mi país. A saber a cuántas más vidas les han hecho falta también para crearse y recrearse a sí mismas; a cuántas personas más su inexistencia las sigue condenando al olvido – o a la muerte. De las grandes claves para el cambio, y algo tan sencillo y a la vez tan crucial para producirlo, hoy sigue sin ser habitado; sin siquiera ser explorado; o aquí, en mi país. Esto también es inaceptable.

Es por todo eso que yo me pronuncio – y decididamente – por la “Prohibición Absoluta en la CDPD de los Tratamientos Forzosos y los Internamientos Involuntarios”. 

Porque, en resumen, considero que estas prácticas:

  • Son reductivas de la persona humana y de la situación existencial que experimenta;
  • Van contra la dignidad, la autonomía y la libertad de las personas con discapacidad (Art. 3 CDPD);
  • “Medicalizan” problemas que son de índole social, en los que intervienen otros elementos contextuales: familiares, sociales, e incluso políticos, que entonces son ignorados, desatendidos y perpetuados; incluso, profundizados;
  • Son invasivas, autoritarias y jerárquicas, al aplicarse a las personas aún en contra de su voluntad;
  • Son cuestionables en sus fines, en sus efectos y consecuencias – muchas irreversibles y fatales –, y en su efectividad.
  • Refuerzan los estigmas y prejuicios sociales sobre las personas con discapacidad psicosocial, al utilizar categorías diagnósticas que – además de cuestionables – encasillan arbitraria y vitaliciamente a las personas, haciéndolas vulnerables a la exclusión, a la discriminación y a la muerte – la social, la biológica;
  • Son violatorias de derechos inalienables de las personas con discapacidad como, entre otros, el derecho a no ser privadas de su libertad por motivo de discapacidad (Art. 14 CDPD); el derecho a otorgar su consentimiento libre e informado sobre los tratamientos médicos que se le propongan (Art. 25. Inciso d)); el derecho a la integridad física y moral (Art. 16); el derecho a vivir de manera autónoma e independiente en la comunidad y a ser incluida como parte activa y necesaria de ella (Art.19 CDPD).

Con mi pronunciamiento en apoyo a la “Prohibición Absoluta” quiero honrar la memoria de mi hermano, sí; pero también porque yo misma soy persona con discapacidad, en mi caso motriz, y sé lo que es y significa ser discriminada y excluida por tener una discapacidad. Pero, además, porque si bien he logrado evitar ser diagnosticada o etiquetada como persona con discapacidad psicosocial, yo también encuentro muy difícil lidiar con los tantos absurdos de nuestro mundo, y acomodarme, y cada vez, en alguna de sus escasas y limitadas formas permitidas de ser y de estar en él.

Y porque sueño.  Sueño con una humanidad polifónica y multiforme; lo suficientemente abierta, crítica y dialogante para permitirse tender hacia la otredad, en lugar de ignorarla, repudiarla o temerle; una humanidad que sabe vivir junto al otro y crear –con él–  realidades e intercambios nuevos, permeables, interdependientes, nutricios. Sueño mujeres y hombres convencidos de que toda y cualquier expresión humana – por ajena o chocante que nos resulte o parezca – no puede, al final, sino complementarnos, fortalecernos, enriquecernos.

Y porque sé que tarde o temprano así se habrá demostrado.

[1] Boff, Leonardo. Tiempo de la trascendencia, el ser humano como un proyecto infinito, Santander, Sal Terrae, Brasil, 2000.
[2] ONU, Convención sobre los Derechos de las Personas con Discapacidad, Resolución A/RES/61/106, Sexagésimo primer período de sesiones, Asamblea General, Naciones Unidas, del 13 de diciembre de 2006. Entró en vigor el 3 de mayo de 2008. Disponible en: http://www.un.org/disabilities/documents/convention/convoptprot-s.pdf
[3] ONU, Observación General No.1 (2014) sobre el Artículo 12: Igual reconocimiento como persona ante la ley, Comité sobre los Derechos de las Personas con Discapacidad, 11º período de sesiones. ONU Doc. CRPD/C/GC/1, del 19 de mayo de 2014.

Pueden leer más de la Campaña #ProhibiciónAbsolutaen: https://absoluteprohibition.wordpress.com/ 

Posted on

CAPA video and petition to Canadian Govt

CAPA has joined the call to action urging the Canadian government to follow the guidelines of the UN Declaration for the Rights of Persons with Disabilities (CRPD). Although Canada signed this convention, they added a reservation which undermines one of the convention’s most important protections!

Allowing substitute decision making means that people with disabilities, including those in the psychiatric system, are often given “treatment” they do not want because somebody else decided it was best for them.

Check out our video below, sign the petition and go to chrusp.org for more information.
[youtube https://www.youtube.com/watch?v=zp2Y5YxwIdU]

Posted on

Una campaña en contra de los internamientos involuntarios y las intervenciones psiquiátricas forzadas, por Ana María Sánchez

http://congresovisible.org/agora/post/una-campana-en-contra-de-los-internamientos-involuntarios-y-las-intervenciones-psiquiatricas-forzadas-por-ana-maria-sanchez/8152/

Escribo en apoyo a la campaña contra la prohibición absoluta de los internamientos involuntarios y las intervenciones psiquiátricas forzadas. Me piden argumentar con base a la Convención de los Derechos de las personas con Discapacidad y lo haré, aunque el argumento que expongo es el de la salvaguarda de la dignidad de todas las personas con respeto absoluto a sus derechos.

Me motiva escribir esta invitación a sumarnos en la insistente y motivada convocatoria que hace CHRUSP, Center for the Human Rights of Users and Survivors of Psychiatry, pero también ante la posibilidad de generar los cambios profundos que den un vuelco a paradigmas que estigmatizan y discriminan. Me sumo contra los internamientos involuntarios y las intervenciones psiquiátricas forzadas porque:

1. Reducen a la persona a un objeto al quien se le busca controlar, aniquilan la voluntad y la creatividad, acabando con su libertad.

2. Atemorizan, estigmatizan y desinforman sobre la discapacidad psicosocial.

3. No resuelven la parte estructural de una sociedad que actúa desde el paradigma de la “normalidad” encerrando a todos los que no se adaptan a los convencionalismos sociales.

4. Es una respuesta política cómoda e insuficiente que no responde a las necesidades específicas de las personas con discapacidad psicosocial y de sus familias.

5. Descarta y abandona a las personas con discapacidad psicosocial, las confina a vivir en aislamiento, privadas de su libertad y sometidas a tratos crueles e inhumanos.

6. Promueve el olvido social y la negligencia política ante los abusos y violaciones de los derechos de las personas con discapacidad psicosocial.

 

Me sumo hoy a esta causa, convencida desde mi propia lucha a favor del reconocimiento de los derechos de las personas con discapacidad. Desde las experiencias de personas que se han visto coartadas y obligadas a vivir aletargadas, forzadas a un tratamiento y confinamiento, separadas de una sociedad que busca normalizar, homogeneizar y catalogar a quienes somos diferentes. A partir de los testimonios de personas con discapacidad psicosocial y sus familiares que sufren rechazo y discriminación, padecen la falta de servicios adecuados y el abandono en reclusión o en calle, entre otros. No nos olvidemos por ejemplo, de la violencia contra mujeres con discapacidad psicosocial, sus derechos son negados y olvidados y por lo general no se retoma la lucha desde los movimientos a favor de los derechos de las mujeres.

La Convención de los derechos de las personas con discapacidad y otros instrumentos internacionales nos hacen la invitación a pensar y actuar para que los derechos de todos y todas se promuevan y respeten. No es suficiente estar en contra de los internamientos y tratamientos forzados, se requiere pensar creativamente para hacer del modelo de derechos humanos una realidad y exigir al estado las políticas públicas que promuevan y garanticen la realización de los derechos de las personas con discapacidad psicosocial.

Para más información sobre esta campaña: https://absoluteprohibition.wordpress.com/page/2/

 

 

Posted on

Sarah Knutson: Rethinking Public Safety – The Case for 100% Voluntary

(originally appeared on Mad in America website)

(now available in Italian translation on il cappellaio matto website)

By 

Featured Blogs February 15, 2016

Not long after posting this Principle from the 10th Annual Conference on Human Rights and Psychiatric Oppression, the following comments appeared on my Facebook page:

“It would have to be replaced with something else, we need to have strong supports we need to take care of each other.”

“Hey you radicals mental illness is a physical illness that requires the attention of a specially trained medical doctor if don’t like the treatment leave for a dessert[sic] island where you can suffer without disturbing others”

CRPDThese are understandably difficult issues.  Historically, there has been a lot of difference of opinion and genuine debate. In 2006, the United Nations weighed in.  They approved the Convention on the Rights of Persons with Disabilities (CRPD).  The CRPD prohibits involuntary detention and forced interventions based on psychosocial disability.  These are considered acts of discrimination that violate the right to equal protection under the law.  Under the CRPD, people with psychosocial disabilities have the same rights to liberty, autonomy, dignity, informed consent, self-determination and security of the individual and property as everyone else.

Shortly thereafter, forced ‘treatment’ was also held to violate the Convention Against Torture:

States should impose an absolute ban on all forced and non-consensual medical interventions against persons with disabilities, including the non-consensual administration of psychosurgery, electroshock and mind-altering drugs, for both long- and short- term application. The obligation to end forced psychiatric interventions based on grounds of disability is of immediate application and scarce financial resources cannot justify postponement of its implementation.

Forced treatment and commitment should be replaced by services in the community that meet needs expressed by persons with disabilities and respect the autonomy, choices, dignity and privacy of the person concerned. States must revise the legal provisions that allow detention on mental health grounds or in mental health facilities and any coercive interventions or treatments in the mental health setting without the free and informed consent of the person concerned.

Many of us hoped that would be the end of it: No forced treatment, clear and simple.  Nevertheless, the debate goes on.  It seemingly has sped up – rather than let up – over the past several years.  Clearly, many of us are sincerely struggling with these issues.  There are people of conscience on all sides.

 

The Case for 100% Voluntary

For the past ten years, the international community has been progressively moving away from involuntary interventions. This essay is the first in a multi-part series.  It highlights important reasons why the rest of us should follow suit. They are as follows:

1.     These issues are universal, not medical

Life, by nature, is difficult and risky.  Our primary certainties are death, loss, and vulnerability. Pain, suffering, sickness and need are pretty much a given.

The idea is to minimize risk as much as possible, but still keep the essential spontaneity of feeling alive.  This a highly personal undertaking. One is never certain what this means for someone else.

That being said, communities can and should offer support to all who want it. At certain times, any of us might want help to balance: (1) factors that concern others, (2) feasible (medical, natural and community) alternatives; (3) risks and benefits; and (4) personal values and lifestyle considerations. The onus, however, is on would-be supporters to earn and maintain our trust. This is the approach adopted by the United Nations in the CRPD. (Art. 12).

2.     Clinicians are lousy predictors

It’s hard to know in advance who is a ‘danger.’  Clinicians are notoriously poor in predicting suicide or violence.  In individual cases, they barely do better than the toss of a coin.

Equally disturbing, the people they will lock up have not been accused of a crime, much less convicted.  Yet, on flimsy odds, innocent people lose jobs, businesses, careers, homes, custody of kids, and much more.

And that’s not the half of it.  Typically, to lose freedom in society, twelve jurors who have been carefully screened for bias must unanimously agree that someone is guilty beyond a reasonable doubt. In the mental health system, a single clinician with little to lose and a lot to gain makes the call.  By far the safest course is erring on the side of lock up. Guessing wrong means serious harm, distraught families, internal reviews, bad press, lawsuits, potential job or income loss.  Sleepless nights and calls at home should not be overlooked.

3.     Drugs, at best, are problematic

Contrary to popular belief, the choice to refuse drugs is rational.  Even if you meet diagnostic criteria, there are many good reasons to ‘just say no.’ This not just for individuals and families, but for insurers and governments as well.

During the past several decades of increasing drug use, disability rates have sky-rocketed.  Long-term outcomes and relapse rates have worsened overall. Particularly disturbing is the fact that third world countries (where people are too poor to afford the drugs) get dramatically better results.

Even as a first-line of defense in emergency settings, there are serious concerns.  In simple fact, drugs are not harm neutral.  Known effects include death, psychosis, rage, despair, agitation, shaking, vomiting, impulsivity, tics, uncontrollable movements, memory loss, skin crawling, insatiable hunger, rapid weight gain, dulled awareness, impotence, insomnia, hypersomnia, fatigue, mood swings, and the list goes on. Many of us have experienced the drugs creating urges to violence or suicide we never had before.  Some of us have acted this out.

The long-term considerations are equally alarming.  Susceptibility to relapse, loss of brain matter, obesity, diabetes, congestive heart failure, and permanent disability increase as a function of exposure.  Due at least in part to drug effects, the ‘mentally ill’ lose 15-25 years (on average!) of our natural lifespan.

For many people, the health risks of drugs aren’t even the half of it. A lot of what you like depends upon your values. Preferences and comfort differ for, e.g.: relying on drugs vs. learning self-mastery, following rules vs. asking questions, respect for experts vs. internal wisdom, managing feelings vs. experiencing feelings, medical vs. natural approaches, and seeing the source of healing as science vs. human or spiritual connection.

When it comes to drugs, one nutter’s meds are anutter’s poison.

4.     Promising alternatives are not being considered

Many do better with non-medical approaches (or might if these were offered).  Fortunately, the options are legion. (See end notes.) Unfortunately, the alternatives are not well-known by clinicians, politicians or the general public.  They therefore not widely offered or available, and are not considered to be worthy of clinical trials.

This is not ‘the other guy’s problem.’  Vast numbers of us are potentially affected.  One in four crosses paths with the mental health system. (3) One in three currently takes a psychoactive drug. (4) And that hardly scratches the tip of the iceberg of all who are struggling.

What separates ‘the worried well’ from the ‘social menace’?  I’d like to think it was more than my natural affinity for the only approach the doctor on call was taught to offer.

5.     Natural diversity is not a pathology

Human experience cuts deep and scatters wide.  Statistically speaking, there are many shared traits, values, and approaches to life. But outliers are a fact as well.

Our variability is to be expected.  Diversity, not conformity, is the real ‘normal.’ It contributes to the robustness, resourcefulness, and creativity of our species.  While it may not get you dates or jobs in a self-promoting, efficiency-driven, corporate-run economy, it is not a disorder.

To the contrary, it is far more like a subculture than an ‘illness.’ In actuality, scores of us value our internal experience, being true to ourselves and treating others generously.  If we speak truth to power and get fired, this is not just impulsivity, mania or disorder.  It’s having the courage of our convictions. We want a world that’s more than just self-promotion, might is right, and going along to get along.  It’s a beautiful vision.  Many of us are dying (including by suicide) for the want of it.  Far from being a social menace, in the 1960’s, Dr. King argued that such ‘creative maladjustment’ is essential in our quest for a socially just, equitable world.

6.     This is about trauma, not disordered brains

Trauma’ is pervasive and potentially causal. Ninety (90!) percent of the public mental health system are ‘trauma’ survivors.  In effect, vast numbers of vulnerable citizens are growing up without a way to meet fundamental human needs. Things like:

  • reliable access to food and habitable shelter
  • safety of person and property
  • dignity, respect and fair treatment
  • meaningful participation and voice
  • the means to make a living and obtain basic life necessities
  • relational, educational, vocational and cultural opportunities for development
  • support to share and make sense of experience in our way

If the aim is to create a safer world, trauma is a much more pressing problem to fix than ‘chemical imbalances’.  There are numerous reasons for this.  We have not even begun to scratch the surface of the implications of a truly trauma-informed system of care.  As the next essay in this series will address.

7.     Do the math – it adds up to ‘voluntary.’

The primary mechanisms for a safer world are already in place.  We already have a criminal justice system with the capacity for detention, probation, in-home monitoring, geographic restriction, behavioral health treatment, drug testing, ‘no contact’ orders, restorative justice, etc.  We already have civil restraining orders, lawsuits, and mediation.  The essential task is to update these protections – and make them meaningfully available – to address modern needs.

The money we save by making things voluntary (police, hospitals, courts, lawyers, lawsuits, staff/ patient injuries, security, insurance, staffing needs, drugs) will go a long way to making this possible.  We could fund numerous thoughtful, responsive, social justice informed alternatives.

We could invest in a truly trauma-informed criminal justice system, rather than dumping that burden on hospitals and their employees. The change in morale itself is worth the price of admission.  Imagine no locked doors and everyone wants to be there. Violence happens, you call the police. Just like everywhere else.

8.     The continued prejudice against people with psychosocial disabilities is not worthy of a free society.

There’s a saying in twelve-step rooms: Every time you point a finger, there’s three pointing back at you.  Suffice it to say, majority fears and prejudice must stop ruling the day. That is discrimination – and it begets discrimination.

In actuality, people from all walks of life have presented a grave risk of injury to self or others at one time or another in their lives: Wall Street brokers, weapons manufacturers, new parents, drinkers, children, teens, Frat houses, Nyquil users, pot smokers, crack addicts, bungee jumpers, martial artists, car racers, dirt bikers, inline skaters, snake handlers, fire builders, gymnasts, boxers, weight lifters, ragers, ex-cons, insomniacs, equestrians, skiers, diabetics who eat sugar, cardiac patients who drive…  There is no end to the list. Some people (trapeze artists, law enforcement, fire departments, magicians, military, security guards, skydivers, operators of heavy machinery) even make a living from this.

There is no principled way of distinguishing the predisposition to such risks from any other kind of psychosocial diversity.  If you needed any better proof of this, the diagnostic criteria for so-called ‘mental disorders’ are so useless that CMS threw them out in 2013 and told the APA to start over.

In any place but a psychiatric exam room, those seen as a cause for alarm would have the following rights: due process, equal protection, liberty, privacy, security of person and property, free speech, freedom of association, freedom to travel, right to contract, written charges, trial by jury, Miranda, and compensation for unjust takings.  You need these protections more, not less when you’ve committed no crime and are simply having the worst day of your life.

In a society worthy of calling itself ‘free,’ public safety would mean all of us. It would go without saying that service recipients are ‘the public’ just as much as anyone else. We would look at fear and prejudice as the real social menace.  People who use mental health services would not need protection from people like you. 

So please.  Stop locking us up ‘for our own good’ and calling it a favor.  This only distracts from the real question:  If the crisis services are so great, then why isn’t everyone using them? 

Here’s a litmus test. Think about your last life crisis. Did you use these services? Did they feel like a useful, viable option for you?

Before you say, “No but I’m not [crazy, poor, uninsured…],” stop yourself. Try this instead, “No, but I’m not human.”

It has a different ring to it, doesn’t it?

 

This blog is a contribution to the Campaign to Support the CRPD Absolute Prohibition of Commitment and Forced Treatment. To see all of the Mad in America blogs for this campaign click here.

*

Click here for supporting resources →

 

Sarah Knutson

 

Sarah Knutson is an ex-lawyer, ex-therapist, survivor-activist.  She is an organizer at the Wellness & Recovery Human Rights Campaign. You can reach her at the Virtual Drop-In Respite, an all-volunteer, peer-run online community that aspires to feel like human family and advance human rights.

MENU