M’hamed El Yagoubi, Campagne pour soutenir l’Abolition totale des soins et de l’hospitalisation sans consentement en application de la CDPH de l’ONU

http://cvjn.over-blog.com/2016/03/campagne-pour-soutenir-l-abolition-totale-des-soins-et-de-l-hospitalisation-sans-consentement-en-application-de-la-cdph-de-l-onu.htm

http://depsychiatriser.blogspot.no/2016/03/contribution-de-mhamed-el-yagoubi-la.html

aussi en traduction italien, http://www.ilcappellaiomatto.org/2016/03/campagne-pour-soutenir-labolition.html

13 Mars 2016

Photo de Nathalie prise le mois d’août 2012 Pont de l’Arc, Aix-en-Provence

7ae59-noforcedtreatment

Documents en français

Call To Action (French) – Appel à l’Action Methodologie (French) Campagne pour soutenir l’Abolition totale des soins et de l’hospitalisation sans consentement en application de la CDPH de l’ONU …

https://absoluteprohibition.wordpress.com/2016/02/10/documents-en-francais/

http://depsychiatriser.blogspot.fr/2016/03/contribution-de-mhamed-el-yagoubi-la.html

Campagne pour soutenir l’Abolition totale des soins et de l’hospitalisation sans consentement en application de la CDPH de l’ONU

Nathalie Dale. Née le 21 mai 1970 à Cagnes-sur-Mer. France.

Morte le 31 janvier 2014 à Aix-en-Provence. France.

Cause : Défaillance respiratoire au surcharge médicamenteux selon le certificat établi par le service de médecine légale le 03/02/2014.

1 – Détruite par un traitement psychiatrique non seulement inefficace mais dangereux et mortel dans son dosage à longue durée.

2– Traumatisée par l’enlèvement brutal de son enfant par le juge avec la complicité de la psychiatre de l’hôpital de Montperrin (Aix-en-Provence) et ses collaborateurs juste après l’accouchement le 30 mars 2010 à 10h00. Elle ne l’a jamais vu. Elle l’a reconnu dans sa déclaration administrative et lui a donné un nom.

3 – Dépossédée de ses allocations par les mandataires déléguées du « service juridique de la protection des majeurs».

4 – Hospitalisation sous contrainte à l’aide d’un arrêté préfectoral du 19 octobre 2010, non basé sur une enquête préalable mais sur une pétition d’une partie du voisinage aux comportements malveillants abusant de sa vulnérabilité. Elle aurait été sauvée si les services concernés avaient été animés d’un peu d’humanité et avaient pris en compte les nombreux rapports d’alerte que je leur avais adressés en tant qu’ex-mari et compagnon. Peut-être eux-mêmes sont-ils victimes d’un système incontrôlable et monstrueux. Un rapport écrit a été communiqué à la préfecture (Agence régionale de Santé) le 14 mars 2011 sur cet arrêté abusif violant totalement ses droits et sa dignité.

Le cas de Nathalie pointe les aspects les plus obscurs dans le non-respect des droits de l’homme et du patient en situation de handicap psychique : La maltraitance psychiatrique et l’abus tutélaire et curatelle.

Nathalie fut mise sous curatelle renforcée le 08 avril 2010 alors qu’elle était hospitalisée à l’hôpital de Montperrin. Elle n’avait pas été consultée pour avoir son avis. Un abus de sa faiblesse et les effets de sa grossesse ont été sans aucun doute une atteinte plausible à ses droits.

Elle fut éjectée de l’hôpital psychiatrique de Montperrin le 26 avril 2010 sans aucun centime, sans accompagnement social et sans suivi médical pendant de longs mois. Elle faillit mourir d’inanition dans un pays d’abondance, alors que l’hôpital et d’autres services prélevaient directement ses maigres allocations (AAH). Grâce à ma vigilance et mon soutien matériel et moral, elle a échappé à une catastrophe, mais pas pour longtemps.

Nathalie subit un internement psychiatrique du 19 octobre 2010 au 19 janvier 2011 suite à un arrêté préfectoral. Nathalie fut mise sous contrainte des « soins » obligatoires sous le contrôle de la même psychiatre au CMP (Centre médico-psychologique). Aucune écoute dans la dignité et le respect de ses droits mais des séances « expédiées » avec des menaces de retournement à l’hôpital psychiatrique et la prescription de « médicaments » aux effets dévastateurs et mortels : Lexomil, Imovane, Lepticur, Sulfarlem, Clopixol, etc. Elle passait les trois quarts de la journée dans son lit. Immobilisée, l’incapacité de se lever ou de faire quelques pas. Les traitements prescrits pendant les RDV qui ne duraient que quelques minutes n’ont pas été modifiés. Je dis quelques minutes parce que je l’ai accompagné plusieurs fois à ce centre (CMP) obsolète. Lexomil, Imovane, injection (coplixol), lepticur, sulfarlem, etc. Aucune visite chez elle ni par les infirmières ni par cette la psychiatre. Tous les RDV se faisaient le matin à 09h00 dans ce centre. Nathalie ne manifestait aucun trouble et aucune inquiétude au début de la journée. Elle est matinale. Son fonctionnement global est normal. A partir de midi, les effets dévastateurs des traitements imposés commençaient à être visibles. Ils provoquaient un ralentissement de ses perceptions et de ses réactions. Sa langue se diluait, ses yeux se fixaient en haut, confusion et perte dans l’espace et le temps, la bouche ouverte avec sa langue qui descendait, toujours sèche, difficulté d’avaler, des mouvements et des réflexes de ses deux épaules perceptibles, tête baissée sur la table quand elle est sur son canapé, un ralentissement du fonctionnement de son corps, perte de sensations et de perception . Quand elle marche et quand elle parle, aucune coordination, elle tombait, elle éprouvait des difficultés cinétiques pour aller aux toilettes faire pipi. Parfois, elle le faisait dans son lit non par imprudence mais par l’incapacité de se mouvoir. Elle ne sentait plus ses jambes. Quand elle faisait un effort pour quitter son lit, elle tombait par terre sans pouvoir avoir la capacité de se redresser. Elle restait allongée avec sa langue qui sortait. Quand elle prenait son bain, ce qu’elle aimait faire tous les jours chez elle, elle aimait rester au contact de l’eau fraîche, pas trop, elle restait longtemps endormie. Elle ne prenait pas son traitement au-delà de ce qui est prescrit.

L’intervention des services de la préfecture en collaboration du personnel de la psychiatrie le 19 octobre 2010 entre 20h et 00h ont laissé des traces profondes dans le reste de sa vie. Terrorisée et mise dans un état psychologique dégradé de façon irréversible, alors que ces services savaient très bien qu’elle était fragile, dépossédée par leur pouvoir inhumain, poussée par leurs mécanismes destructeurs à l’irréparable et à l’impensable juste pour satisfaire une pétition d’un groupe de voisins violents et animés par un esprit communautariste défaillant.Elle ne pouvait pas sortir, quand ils étaient devant l’immeuble où elle habitait par peur. Quand je l’accompagnais tous les jours, dès qu’elle voyait un véhicule des services de la police ou de la gendarmerie, elle paniquait parce qu’elle a intériorisé le contenu de cet arrêté préfectoral qui fait froid dans le dos. Les pires dictatures n’auraient pas pu le faire. Et pourtant, cette décision mortifère est prise par la préfecture des Bouches-du-Rhône, haute représentation de l’ Etat de «droit». La France.

Ces éléments de connaissance sur les effets dévastateurs des traitements qu’elle prenaient ont été codifiés et mis en manuscrit pendant un longue période surtout depuis juin 2011 jusqu’à la fin de vie 31 janvier 2014. Il aurait été plus parlant si la victime était là pour témoigner. J’ai pris le risque de mettre en ligne ces quelques éléments dans une méthodologie crue pour ne pas trahir son vécu infernal que j’ai bien assumé son partage.

Ces pratiques « médico-psychiatriques », aggravées par l’enlèvement de son enfant et l’internement abusif et la privation de ses allocations par le service de curatelle ont été administrées jusqu’à l’étouffement fatal le 31 janvier 2014. Et pourtant, le dernier rapport communiqué aux services concernés sur la gravité de son état de santé et d’atteinte à ses droits a été fait le 07 octobre 2013. Un autre rapport a été communiqué le 28 décembre 2013 au Député chargé de la mission d’information parlementaire sur les dérives de la psychiatrie en France, M. Denys Robilard. Malheureusement, aucune suite.

Nathalie est victime des traitements « médicamenteux psychiatriques » abusifs suite à un internement illégitime et aggravé et une mise sous curatelle défectueuse et prédatrice.

Pour une provocation de plus, des acteurs institutionnels de la psychiatrie organisent à Marseille, Aix-en-Provence et Salon du 14 au 27 mars 2016, ce qu’ils appellent «Semaines sur la santé mentale». Il est plutôt réel de dire «Semaines sur l’institutionnalisation de la maltraitance psychiatrique mortifère».

Collectif Vérité et Justice pour Nathalie

www.cvjn.over-blog.com

M’hamed EL Yagoubi

compagnon de Nathalie

Fait à Marseille, le 13 mars 2016

March 18, 2016March 1, 2020

Paula Caplan – Myths are Used to Justify Depriving People Diagnosed as Mentally Ill of Their Human Rights

http://www.madinamerica.com/2016/03/myths-are-used-to-justify-depriving-people-diagnosed-as-mentally-ill-of-their-human-rights/

By PAULA J. CAPLAN, PHD

Featured Blogs March 14, 2016

Who in this world ought to have the right to make decisions about their lives, and who is required to lose that right and have the medical community and the courts take over?

Despite the fact that no one in history, not even the omnipotent American Psychiatric Association — which produces and profits mightily from the “Bible” of mental disorders — has come up with a halfway good definition of “mental illness,” and despite the fact that the process of creating and applying the labels of mental illness is unscientific, any of those labels can be used to deprive the person so labeled of their human rights. This is terrifying. It ought to terrify those who are so labeled and those who are not, because deprivation of human rights on totally arbitrary grounds is inhumane and immoral.

The combination of the specter of terrorism and highly publicized incidents of gun violence have led rapidly to politicians, therapists, and the general public blaming “the mentally ill” for these dangers, and that is used to justify depriving not just terrorists and other killers but anyone with a label of mental disorder of their rights. They can be locked up against their will, they can be ordered to comply with just about anything that a professional calls “treatment of the mentally ill,” no matter how these actions can harm the person and in the absence of scientific evidence that the “treatments” of people who have been psychiatrically labeled will prevent violence. In other words, the huge leap is often made from “This person has a psychiatric label” to “This person is therefore dangerous to themselves and others,” even in the absence of any history or current indication of such dangerousness, and that leap is then used to lock people up and/or otherwise “treat” them against their will.

Now the United Nations human rights treaty called the Convention on the Rights of Persons with Disabilities includes the absolute prohibition of forced commitment and forced treatment, and the brilliant and tireless advocate Tina Minkowitz is leading a campaign to show that there is a wide base of support for these prohibitions. This is especially important in the United States, because 162 nations have ratified the CRPD, but the U.S. has not.

Minkowitz worked on drafting and negotiations for the treaty from 2002-2006 and helped ensure the incorporation in the CRPD of Article 12, which says that “states,” countries and national governments bound by international law recognize that people with disabilities have the right to make their own decisions in all aspects of life and to do so free from coercion. Note that “people with disabilities” applies to anyone who has received a diagnosis of any mental disorder (in addition to other disabilities). It is important to note the CRPD’s Article14, which specifies according to the text and the authoritative interpretation by the Committee on the Rights of Persons with Disabilities that the existence of disability or perceived disability cannot be used to justify deprivation of liberty, and Article 25 requires that healthcare be provided on the basis of free and informed consent. The word “perceived” is crucial, in light of the fact that the ballooning numbers of categories listed as mental disorders in the two primary handbooks used to classify people as mentally ill have made it possible, even likely, that anyone entering a therapist’s or other professional’s office in other than a calm and happy state will be diagnosed as psychiatrically disordered, moving just about anyone into the “perceived as disabled” category. So one crucial myth that is relevant to the CRPD is that psychiatric diagnoses are scientific and usually appropriately applied.

If no harm came from being classified as mentally ill, there would be less cause for alarm. But it is easy, even likely, for laypeople, therapists and other healthcare professionals, and judges to assume wrongly that having a disability (even a perceived disability) means that one’s judgment is impaired and that one should not be allowed to make choices about their lives, their bodies, and the treatments to which they will be subjected. Frequently, the criterion of “dangerous to oneself and/or others” is used to justify forced commitment or forced treatment, and this is done despite the proven fact that people diagnosed as mentally ill are actually less likely than others to commit acts of violence and more likely to be victims of violence. The evidence for this pattern is all the more remarkable, given that for a number of reasons (e.g., defense attorneys trying to get psychiatric labels for their clients in order to obtain reduced sentences or diversion from prison to the mental health system; the skyhigh frequency of prisoners being diagnosed as mentally ill so that they can be heavily medicated and thus reduce the need for prison staff), statistics in the near future are likely to show an increasingly high correlation between psychiatric labels and violence. Thus, two other crucial myths that are relevant to the CRPD are that people who have received psychiatric labels are likely to be incompetent to make choices about their lives and that they are more likely than other people to be violent.

A fourth crucial myth is that forced commitment and forced treatment are beneficial (and, by implication, not harmful). That this is a myth is reflected in the high rates of suicide that follow inpatient treatment and the increased rates of suicide caused by many psychiatric drugs, as well as the plummeting rates of recovery and increased rates of longterm disability that have followed the introduction of various psychiatric drugs into the market and the use of electroshock.

Another myth is this: The important word “orthogonal” applies to the question of whether people diagnosed as mentally ill are able to make their own choices and whether they have good judgment. We all know people who have no psychiatric labels but who make terrible choices and poor judgment, yet those limitations are not used to deprive the of their human rights. These capacities are orthogonal to whether or not one has been diagnosed as mentally ill, meaning that knowing whether or not a person has a diagnosis is simply not a predictor of their judgment and ability to make good choices for themselves. A related myth is that if someone is diagnosed as mentally ill, all of their decision making power must be wrenched away from them, when — as with many people who are not so diagnosed — sometimes what the person needs is a little support of various kinds, including assistance with filling out forms or practical help with cooking or shopping or getting a service animal during times when they are struggling.

The CRPD standard is for people who have or are perceived to have disabilities must be provided the opportunity to give free and informed consent. That is very far from what happens with the vast majority of people treated by psychotherapists, not to mention those who are deprived of their human rights. Consider this: Psychiatric diagnosis is the bedrock, the first cause of everything bad that happens to people in and through the mental health system. If they do not diagnose you, they cannot treat (or “treat”) you, whether or not the treatments are helpful to you. But almost no one who enters a therapist’s office is ever fully informed and thus almost no one is put in a position where they even might give informed consent. Why? There are three reasons:

They are almost never told, “In order for your insurance to pay my bills, I will have to give you a psychiatric diagnosis, but you have the right to know that psychiatric diagnoses are unscientific, that getting one does not help alleviate suffering, and that getting one carries a wide array of risks of harm, from plummeting self-confidence to loss of employment and of child custody and of security clearance…even to death from treatments that are justified on the basis of your label.”
They are almost never told, “I am recommending Treatment X, but I am going to tell you everything about the potential benefits and potential kinds of harm that can result.” The reason they are almost never told this is that these days, the vast majority of treatments are with psychiatric drugs, and lawsuits have repeatedly revealed that the drug companies purposefully conceal much of the harm, so there is no way for conscientious therapists to get that information and thus no way for them to convey it to their patients. Something similar happens with electroshock and with expensive but intensively marketed programs called things like “neurobiofeedback” that have not been shown to be helpful but that are often very costly.
They are almost never told, “I am recommending Treatment X, but I am also going to describe for you the huge array of approaches that have been helpful to people who are going through what you are going through … and that often carry little or no risks of harm.”

Alarmed about the lack of disclosure, which puts suffering people who seek help in the mental health system at huge risk of harm with no way even to know what questions to ask and what recommendations to challenge, I organized the filing of nine complaints to the Ethics Department of the American Psychiatric Association, because that APA publishes and hugely profits from the Diagnostic and Statistical Manual of Mental Disorders (DSM), whose categories had been used against the complaints with tragic effects. We said that if the APA had honestly disclosed the unscientific nature of its categories and the risks of harm, as well as that getting a label would be helpful largely or only in order to get insurance coverage for treatment, the complainants would not have blindly accepted their labels and the treatments that were justified to them on the basis of the labels (“You have Disorder Y, so you should accept Treatment Z, because that is what is used for people with Y”). The APA dismissed the complaints on spurious grounds and with not one iota of attention to their merits.

Five of those complainants then filed complaints with the U.S. Department of Health and Human Services’s Office of Civil Rights (OCR). The complaints were filed pursuant to the Americans with Disabilities Act, according to which people can be discriminated against by being treated as though they are disabled (mentally ill in these cases) when in fact they are not. All of the complainants had been experiencing upsetting life situations but should by no means have been diagnosed as mentally ill. Yet according to the (falsely-marketed as scientific) DSM, they were mentally ill, and the treatments that were justified on the basis of their labels had had devastating consequences for them. The OCR dismissed the complaints on spurious grounds and with no attention to their merits.

The outcomes of these complaints provide a solid paper trail revealing that in the United States, the enterprise of psychiatric diagnosis is entirely unregulated. This makes it even less regulated than the major financial institutions whose unregulated actions seriously damaged the economy. The paper trail shows that both the lobby group called the APA, which earned more than $100 million from the last edition of the DSM and spent not one cent to reveal the truth about its manual or to warn of the harms they knew about, and the government entity (OCR of HHS) that by all rights ought to provide oversight and regulation, have chosen to do nothing. This makes it all the more compelling for all of us to press for the United States government to ratify the CRPD. The loss of human rights of just one of us through fraudulent advertising, cover-ups, and perpetuation of dangerous myths is the loss of human rights of us all.

As a U.S. citizen, I am embarrassed and appalled that as this country discusses whether or not to ratify the CRPD, it wants to add what are called “RUDs,” reservations, understandings, and declarations created by the current federal administration and the Senate Foreign Relations Committee. According to Minkowitz, these include the claim that U.S law already fulfills or exceeds the obligations our country would have under the CRPD treaty. The above described complaints that we filed — and the rejection of those complaints by the U.S. Department of Health and Human Services’s Office of Civil Rights gives the lie to that claim, since there is simply no governmental regulation of psychiatric diagnosis, and diagnosis is the sine qua non of forced commitment and forced treatment.

* * * * *

Originally posted on paulajcaplan.net

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.

Paula J. Caplan, PhDPaula J. Caplan, PhD, is a clinical and research psychologist, activist, Associate at the DuBois Institute, Harvard University, and the author of 11 books, including one that won three national awards for nonfiction and two about psychiatric diagnosis. Her books include They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal and the edited Bias in Psychiatric Diagnosis.

March 15, 2016March 1, 2020

-We are not violating the human rights. -Yes, you are! by Anne Grethe Teien

http://agteien.blogspot.no/2016/03/we-are-not-violating-human-rights-yes_74.html

Introduction

Psychiatric human rights violations are often denied and trivialized, even distortedly re-defined as “human rights” and “right to necessary health help”. The UN convention for the rights of persons with disabilities, CRPD, is changing that. CRPD demands an absolute prohibition of forced psychiatric treatment and involuntary commitment. These are important requirements in giving people with psychosocial disabilities equal human rights. In this text, I will look at different aspects of the CRPD related to that demand. I will illustrate with some references to Norway, the country where I live, showing ways in which the Norwegian Mental Health Act does not comply with the convention. I will also share some further reflections. Towards the end I have written a short version of my own experiences from forced psychiatry. Mental health laws may vary between countries, but some elements are prevalent: the laws are typically directed specifically towards people with psychosocial disabilities and involve forced treatment and involuntary commitment . This text is written for the Campaign to Support CRPD Absolute Prohibition of Forced Treatment and Involuntary Commitment (17). Procrastinations must stop – CRPD-based law reforms must begin!

Norway and the CRPD

Norway ratified the CRPD June 3^rd 2013, but came up with some interpretative declarations of article 12, 14 and 25 that undermine central parts of the convention (1). Norway uses these declarations to try to defend the Mental Health Act and forced psychiatric treatment. In February 2015, the president of the Norwegian Psychological Association, Tor Levin Hofgaard, wrote an article asking for a clarification from the government whether health personnel violate the human rights when they follow the coercion regulations in the Mental Health Act (2). He referred to a report sent to the authorities in December 2013 by the then Equality and Anti-Discrimination Ombud – LDO, Sunniva Ørstavik (3). The report said that the Mental Health Act is discriminatory and does not comply with the CRPD. LDO also urged Norway to quickly withdraw its interpretative declarations. In public, the LDO report was met with a noisy silence by the authorities. So, as time had went on, Hofgaard asked for the mentioned clarification. Anne Grethe Erlandsen, State Secretary in the Ministry of Health and Care Services, answered on behalf of the Norwegian authorities: “Vi bryter ikke menneskerettighetene” / – We are not violating the human rights (4). That answer is absolutely not right.

Norway uses much coercion in psychiatry. In spite of reduction strategies, the use of coercion stays at stably high levels (3: p.6-8; 5: p.20-23). Also, reduction strategies instead of CRPD-based abolishment strategies do not go to the core of the issue. Norway is used to see itself as a human rights protective nation and often does not hesitate to criticize other countries for their human rights violations. So it is maybe hard for the authorities to take in that the state of Norway is actually accepting torture and other severe human rights abuses in its own mental health system, via the Mental Health Act. Point 42 of the CRPD General Comments No 1 says as follows:

“As has been stated by the Committee in several concluding observations, forced treatment by psychiatric and other health and medical professionals is a violation of the right to equal recognition before the law and an infringement of the rights to personal integrity (art. 17); freedom from torture (art. 15); and freedom from violence, exploitation and abuse (art. 16). This practice denies the legal capacity of a person to choose medical treatment and is therefore a violation of article 12 of the Convention. States parties must, instead, respect the legal capacity of persons with disabilities to make decisions at all times, including in crisis situations; must ensure that accurate and accessible information is provided about service options and that non-medical approaches are made available; and must provide access to independent support. States parties have an obligation to provide access to support for decisions regarding psychiatric and other medical treatment. Forced treatment is a particular problem for persons with psychosocial, intellectual and other cognitive disabilities. States parties must abolish policies and legislative provisions that allow or perpetrate forced treatment, as it is an ongoing violation found in mental health laws across the globe, despite empirical evidence indicating its lack of effectiveness and the views of people using mental health systems who have experienced deep pain and trauma as a result of forced treatment. The Committee recommends that States parties ensure that decisions relating to a person’s physical or mental integrity can only be taken with the free and informed consent of the person concerned.“ (6: #42)

Neglected harms and traumas – and the need for reparations

Long-term studies have shown higher recovery rates for people who were not on neuroleptics and on very low doses (14, 15). The list of potential harmful effects from neuroleptic drugs is long, including tardive dyskinesia, brain damage, cognitive decline, neuroleptic-induced supersensitivity psychosis, Parkinsonism, sexual dysfunction, weight gain, diabetes, demotivation, anxiety, aggression, suicide, akathisia [ an extreme form of restlessness which in itself can lead to suicide], neuroleptic malignant syndrome — a potentially lethal complication of treatment etc (14, 18). In a research summary on possible harms from forced psychiatry done by nurse and researcher Reidun Norvoll, she listed the following main categories: 1) violation of autonomy and of psychological and physical integrity. Deprivation of freedom of movement (deprivation of freedom). 2) Physical harm and death. 3) Violence and abuse. 4) Trauma, retraumatisation and posttraumatic stress syndrome. 5) Offences/violations, loss of dignity and experiences of punishment. 6) Psychological agony in the forms of shame, anxiety, feeling unsafe, anger, powerlessness, depression and loss of self esteem. 7) Social problems and loss of social identity. 8) Loss of access to own coping skills and of possibilities to self development. 9) Loss of access to voluntary treatment. 10) Harmed therapeutic relationships, resentment against- and distrust in mental health services. (7: p. 16; 8: #5.3).

It can be hard to process traumas that are not acknowledged and understood as such by society in general. When mental health services represents the abuser and as it is officially seen as the mental health helper, one can be left in a very lonely situation trying to handle psychiatry-induced traumas. I think, as part of the implementation of CRPD, there should be provided access to help and support to those who struggle with traumas and other harms from forced psychiatry. I imagine a reality where it is possible for everyone to ask for help when they feel they need it, knowing that they have the CRPD on their side; that the state can not expose them to torture and other terrible human rights violations for being in mental pain (!).

When the necessary abolishment of discriminatory mental health laws and the prohibition of forced psychiatric treatment and commitment has become reality, I think that representatives from politics and psychiatry should publicly perform statements about- and apologies for -the severe human rights abuses that have been going on for so long towards people with psychosocial disabilities. After all the societal acceptance, silence and denial of these kinds of abuses, I think such an acknowledgement and apology is of significant importance for starting reparation work. Compensations is also a relevant part of this. At the same time, there should be no pressure towards victims of forced psychiatry to forgive and get over. I strongly recommend survivor and lawyer Hege Orefellen’s appeal on the urgent need for effective remedies, redress and guarantees of non-repetition regarding torture and other ill-treatment in psychiatry (9). Her appeal was held during a CRPD side-event about article 15 and its potential to end impunity for torture in psychiatry (10). Also, in Guidelines on article 14 of the CRPD, point 24 (a-f) one can read about “access to justice, reparation and redress to persons with disabilities deprived of their liberty in infringement of article 14 taken alone, and taken in conjunction with article 12 and/or article 15 of the Convention” (11).

Danger- and treatment criteria

The Norwegian Mental Health Act has, in addition to its danger criteria, a criterion called the treatment criterion, which does not require danger to oneself or others. The treatment criterion allows for psychiatric coercion if the person is claimed to have a severe mental disorder, and application of forced psychiatry is seen as necessary to prevent the person from having his/her prospects for recovery or significant improvement seriously reduced; alternatively that it’s seen as very possible that the person’s condition in the very near future will significantly deteriorate without coercion (12: Section 3 – 3. 3 a). A very wishy-washy criterion indeed, which is much in use. In 2014 the treatment criterion alone was used in 72% of the cases among people commited (16: p.37).

Both the treatment criterion and the criteria regarding danger to oneself or others discriminate against people with psychosocial disabilities in that disability, or ‘serious mental disorder’, is a premise for psychiatric coercion to apply. In other words, this discrimination is a violation of CRPD article 14 which says that the existence of a disability shall in no case justify a deprivation of liberty (13). Secondly, as the Mental Health Act allows for forced psychiatric treatment, it violates the right to personal integrity (art. 17); freedom from torture (art. 15); and freedom from violence, exploitation and abuse (art. 16). (6:#42).

Points 13-15 in the Guidelines on article 14 are also relevant in this context:

“VII. Deprivation of liberty on the basis of perceived dangerousness of persons with disabilities, alleged need for care or treatment, or any other reasons.

Throughout all the reviews of State party reports, the Committee has established that it is contrary to article 14 to allow for the detention of persons with disabilities based on the perceived danger of persons to themselves or to others. The involuntary detention of persons with disabilities based on risk or dangerousness, alleged need of care or treatment or other reasons tied to impairment or health diagnosis is contrary to the right to liberty, and amounts to arbitrary deprivation of liberty.

Persons with intellectual or psychosocial impairments are frequently considered dangerous to themselves and others when they do not consent to and/or resist medical or therapeutic treatment. All persons, including those with disabilities, have a duty to do no harm. Legal systems based on the rule of law have criminal and other laws in place to deal with the breach of this obligation. Persons with disabilities are frequently denied equal protection under these laws by being diverted to a separate track of law, including through mental health laws. These laws and procedures commonly have a lower standard when it comes to human rights protection, particularly the right to due process and fair trial, and are incompatible with article 13 in conjunction with article 14 of the Convention.

The freedom to make one’s own choices established as a principle in article 3(a) of the Convention includes the freedom to take risks and make mistakes on an equal basis with others. In its General Comment No. 1, the Committee stated that decisions about medical and psychiatric treatment must be based on the free and informed consent of the person concerned and respect the person’s autonomy, will and preferences. Deprivation of liberty on the basis of actual or perceived impairment or health conditions in mental health institutions which deprives persons with disabilities of their legal capacity also amounts to a violation of article 12 of the Convention.” (11: #13-15)

The laws that apply to people in the rest of society regarding acute situations and in the criminal justice system, must apply to people with disabilities too in non-discriminatory ways. The CRPD’s demand for absolute prohibition of forced treatment and involuntary commitment means that it applies both in criminal justice- and civil contexts. (11: #14, 16, 20-21, also 10-12). For people with psychosocial disabilities who come in contact with the criminal justice system, necessary support must be provided to ensure the right to legal capacity, equal recognition before the law and a fair trial. Forced psychiatric treatment and involuntary commitment can not be applied as sanctions for criminal acts and/or for the prevention of such.

Replacing substituted decision-making with supported decision-making

Substituted decision making must be replaced by supported decision making systems. Giving access to supported decision-making for some but still maintaining substitute decision-making regimes, is not sufficient to comply with article 12 of the CRPD (6: #28). From General Comment No 1:

“A supported decision-making regime comprises various support options which give primacy to a person’s will and preferences and respect human rights norms. It should provide protection for all rights, including those related to autonomy (right to legal capacity, right to equal recognition before the law, right to choose where to live, etc.) and rights related to freedom from abuse and ill-treatment (…).” (6: #29)

Some who agree with the CRPD in that diagnostic criteria for coercion should be abolished, still seem fine with the idea that ‘mental incapacity’ can be used as criteria for psychiatric coercion. This is not in line with the CRPD, which neither accepts disability criteria for the deprivation of freedom nor psychiatric coercion. Here is a relevant point to note, from General Comments No1: “The provision of support to exercise legal capacity should not hinge on mental capacity assessments; new, non-discriminatory indicators of support needs are required in the provision of support to exercise legal capacity.” (6:#29 i)

A summary of my own experiences from forced psychiatry

I was not suicidal when psychiatry put me under the Mental Health Act and decided I should get forced neuroleptic “treatment”. I had never been suicidal. The former mentioned treatment criterion is the criterion that was used on me. Forced psychiatry, with its locking me up, restraining me, drugging me, and keeping me on CTO when discharged from hospital, certainly did not make my life better in any way– everything became indescribably much worse. I experienced forced psychiatry as one long punishment for having mental problems. After having been on neuroleptics for a while, my cognition, my intellectual abilities, were severely affected and reduced – and so was my language: from usually having a rich vocabulary I could just utter short, simple sentences. My body became rigid and lost its fine motor skills so I couldn’t dance anymore. A period I also had akathisia, a terrible restlessness which made me walk endlessly back and forth, back and forth. I’m trained a professional dancer and having my dance abilities medicated away was a big loss in itself. The medication took away my vitality, my sensitivity. My emotions were numbed. My personality faded away. Then a severe depression set in – just a complete state of hopelessness – and for the first time in my life I became suicidal. Again and again I said to the staff, psychologists, doctors: – I can not be on meds. I tried to have them understand that the neuroleptics were destroying me and my life. They communicated to me that they thought I was being fussy. They were a big wall that just would not listen to me. Respectlessly enough, some even told me –yes, told me -that I was doing better. The doctors said I would need to be on meds for the rest of my life. That was a message which just manifested the complete hopeless situation. From entering psychiatry, indeed having mental problems, but being a vital, thoughtful, and expressive person who was dancing several times a week, psychiatry had coercively medicated me away from myself and iatrogenically made me severely depressed and suicidal . In effect a slow form of forced euthanasia . One day, while on CTO, shortly after a new forced injection in the buttocks with those horrible meds, I did a dramatic suicide attempt. I was put back into the hospital. I am very glad that I survived. Because unbelievably, a couple of months later, I was told that someone had made a bureaucratic mistake: the coercion documents had not been renewed in time, so there was nothing they could do to hold me back. Of course they would recommend me to stick to the treatment (Ha!) and not leave the hospital too fast (Ha!). I left the hospital the same day. It took me about half a year to become myself again, to be able to think and speak freely, to get my sensitivity, my emotions back, to dance, to feel human again, to feel life. I have never been in a mental hospital since then. I have never had another dose of neuroleptics. And I have never been suicidal again. More than a decade later, I am still traumatized by my experiences from forced psychiatry.

Conclusion

I am very thankful to the CRPD committee for their important work. The CRPD represents a paradigm shift, and there is clearly a resistance out there to accept the full width and depth of the convention. That human rights and non-discrimination applies equally to people with disabilities should not be seen as a radical message in 2016, but sadly, it still is. Societies with their leaders need to realize that systematic, legalized discrimination and abuse of people with disabilities is based on tradition and habitual ways of thinking –not on human rights. That something has been brutally wrong for a long time does not make it more right. Forced psychiatric treatment and involuntary commitment need to be absolutely prohibited.

Thank you for your attention.

References:

1) MDAC: Legal Opinion on Norway’s Declaration/Reservation to the UN Convention on the Rights of Persons with Disabilities http://mdac.org/sites/mdac.org/files/norway_declaration_-_legal_opinion.pdf

Tor Levin Hofgaard: Bryter vi menneskerettighetene?

http://www.dagensmedisin.no/blogger/tor-levin-hofgaard/2015/02/19/avklaring-etterlyses-bryter-vi-menneskerettighetene/

In Norwegian: Equality and anti-discrimination ombud (LDO): CRPD report to Norwegian authorities 2013 – summary http://www.ldo.no/globalassets/brosjyrer-handboker-rapporter/rapporter_analyser/crpd–2013/crpd_report_sammendrag_pdf_ok.pdf

Anne Grethe Erlandsen: Vi bryter ikke menneskerettighetene http://www.dagensmedisin.no/artikler/2015/02/27/vi-bryter-ikke-menneskerettighetene/

In Norwegian: LDO’s report to the CRPD committee 2015 – a supplement to Norway’s 1st periodic report http://www.ldo.no/globalassets/03_nyheter-og-fag/publikasjoner/crpd2015rapport.pdf

Link to download of CRPD General Comment No 1: http://www.ohchr.org/EN/HRBodies/CRPD/Pages/GC.aspx

In Norwegian: Equality and anti-discrimination ombud (LDO): CRPD report to Norwegian authorities 2013- full version http://www.ldo.no/globalassets/brosjyrer-handboker-rapporter/rapporter_analyser/crpd–2013/rapportcrpd_psykiskhelsevern_pdf.pdf

NOU 2011: 9. Økt selvbestemmelse og rettssikkerhet — Balansegangen mellom selvbestemmelsesrett og omsorgsansvar i psykisk helsevern. 5. Kunnskapsstatus med hensyn til skadevirkninger av tvang i det psykiske helsevernet. Utredning for Paulsrud-utvalget https://www.regjeringen.no/no/dokumenter/nou-2011-9/id647625/?q=&ch=12

Hege Orefellen: Torture and other ill-treatment in psychiatry – urgent need for effective remedies, redress and guarantees of non-repetition https://absoluteprohibition.wordpress.com/2016/02/06/hege-orefellen-on-reparations/

10)

CRPD 13: WNUSP side event on Article 15: Its Potential to End Impunity for Torture in Psychiatry http://www.treatybodywebcast.org/crpd-13-wnusp-side-event-on-article-15-english-audio/

11)

Link to guidelines on article 14 of the CRPD under “Recent Events and Developments” http://www.ohchr.org/EN/HRBodies/CRPD/Pages/CRPDIndex.aspx

12)

Norwegian Mental Health Act translated to English http://app.uio.no/ub/ujur/oversatte-lover/data/lov-19990702-062-eng.pdf

13)

CRPD Convention http://www.ohchr.org/EN/HRBodies/CRPD/Pages/ConventionRightsPersonsWithDisabilities.aspx#14

14)

Via Mad in America / ‘Anatomy of an Epidemic’ (Robert Whitaker): List of long-term outcomes literature for antipsychotics http://www.madinamerica.com/mia-manual/antipsychoticsschizophrenia/

15)

Lex Wunderink et al: Recovery in Remitted First-Episode Psychosis at 7 Years of Follow-up of an Early Dose Reduction/Discontinuation or Maintenance Treatment Strategy. Long-term Follow-up of a 2-Year Randomized Clinical Trial http://archpsyc.jamanetwork.com/article.aspx?articleid=1707650

16)

Bruk av tvang i psykisk helsevern for voksne i 2014 (report on the use of coercion in psychiatry in Norway 2014) https://helsedirektoratet.no/Lists/Publikasjoner/Attachments/1161/Rapport%20om%20tvang%20IS-2452.pdf

17)

Campaign to Support CRPD Absolute Prohibition of Forced Treatment and Involuntary Commitment https://absoluteprohibition.wordpress.com/

18)

RxISK Guide: Antipsychotics for Prescribers: What are the risks? http://rxisk.org/antipsychotics-for-prescribers/#How_likely_are_the_listed_side_effects_of_antipsychotics_to_happen

Other:

Status of Ratification Interactive Dashboard – Convention on the Rights of Persons with Disabilities http://indicators.ohchr.org/

March 15, 2016March 1, 2020

Peter Gøtzsche – FORCED ADMISSION AND FORCED TREATMENT IN PSYCHIATRY CAUSES MORE HARM THAN GOOD

http://www.deadlymedicines.dk/forced-admission-and-forced-treatment-in-psychiatry-causes-more-harm-than-good/

By Peter C. Gøtzsche, Professor, MD, DrMedSci, MSc

8 March 2016

Forced treatment in psychiatry as we currently know it cannot be defended, neither on ethical, legal or scientific grounds. Ethically, the patients’ values and preferences are not being respected, although the fundamental human right to equal recognition before the law applies to everyone, also to people with mental disorders.1,2 This is clear from the United Nations Convention on the Rights of Persons with Disabilities,2 which virtually all countries have ratified. However, we ignore the convention and continue to discriminate against people with mental problems.

Please consider this. Doctors cannot give patients insulin without their permission, not even if the lack of insulin might kill them, and they cannot give adult Jehova’s witnesses blood transfusions without their permission, even if the lack of blood might kill them. The only drugs that can be given without permission are also some of the most dangerous ones. Psychiatric drugs are the third major killer after heart disease and cancer, with an estimated 539,000 deaths in the United States and European Union combined.1,3 Only soldiers at war and psychiatric patients are forced to run risks against their will that might kill or cripple them. But there is an important, ethically relevant difference: soldiers have chosen to become soldiers; psychiatric patients have not chosen to become psychiatric patients.

In many countries, a person considered insane, or in a similar condition, can be admitted to a psychiatric ward on an involuntary basis if the prospect of cure or substantial and significant improvement of the condition would otherwise be significantly impaired. After having studied the science carefully over many years, I have come to doubt that this is ever the case.1

Forced treatment most commonly involves the use of antipsychotics, but they are very poor drugs. The placebo controlled trials are seriously flawed because they have not been adequately blinded.1 Antipsychotics have many and conspicuous side effects, so most doctors and patients can guess whether an active drug or a placebo is given, which exaggerates the measured effect markedly.1 Furthermore, almost all patients in these trials were already in treatment with an antipsychotic drug before they were randomised after a short wash-out period. This cold turkey design means that abstinence symptoms – which may include psychosis – are being inflicted on patients who get placebo. Even helped by these formidable biases in the trials, the outcome is poor. The minimal improvement on the Clinical Global Impressions Ratings corresponds to about 15 points on the Positive and Negative Syndrome Scale,4 but what was obtained in recent placebo controlled trials in submissions to the FDA for newer antipsychotics was only 6 points,5 although it is easy for scores to improve quite a bit if people are knocked down by a tranquilliser and express their abnormal ideas less frequently. Thus, the FDA has approved newer antipsychotic drugs whose effect is far below what is clinically relevant. Old drugs are similarly ineffective.1

Whereas the benefits of antipsychotics are doubtful, the harms are certain, and the cold turkey design is lethal. One in every 145 patients who entered the trials for risperidone, olanzapine, quetiapine and sertindole died, but none of these deaths were mentioned in the scientific literature.6 Therefore, if we want to find out how lethal these drugs are, we should look at trials in dementia, as such patients are not so likely to have received antipsychotics before randomisation. Randomised trials in dementia shows that for every 100 patients treated for a few weeks, one is killed by an antipsychotic, compared to those treated with placebo.7 It could even be worse than this because deaths are seriously underreported in published trials. For example, a review found that only 19 of 50 deaths and 1 of 9 suicides on olanzapine described in trial summaries on websites also appeared in journal articles.8

There is no evidence that mechanical restraint in belts or seclusion has any benefits, but these treatments can also be lethal. Violence breeds violence and when psychotic patients become violent, it is very often because of the inhumane treatment they receive. It may also be because they get abstinence symptoms when they drop a few doses of an antipsychotic because they are very unpleasant to take, which can include akathisia – an extreme form of restlessness that predisposes to both suicide and homicide.1

Electroshock is also forced on people although it doesn’t seem to work for schizophrenia and although the effect on depression is temporary, which often results in a series of shocks.1 About half of the patients get memory loss1 and the more treatments they get, the more severe is the memory loss.9 Some psychiatrists claim that electroshock can be lifesaving but this has never been documented whereas we know that electroshock may kill people: about 1 in 1000 patients die.10

Another reason for using force is if patients present an obvious and substantial danger to themselves or others, in which case they can be involuntarily admitted. However, this is not necessary. The National Italian Mental Health Law specifies that a reason for involuntary treatment cannot be that the patient is dangerous. This is a matter for the police, as it also is in Iceland, and patients in Italy can decide that they want treatment elsewhere.1

Forced treatment does more harm than good and it kills many people, not only because of the direct harms of the drugs but also because of suicide. A register study of 2,429 suicides showed that the closer the contact with psychiatric staff – which often involves forced treatment – the worse the outcome.11 Compared to people who had not received any psychiatric treatment in the preceding year, the adjusted rate ratio for suicide was 44 (95% confidence interval 36 to 54) for people who had been admitted to a psychiatric hospital. These patients would be expected to be at greater risk of suicide than other patients (confounding by indication), but most of the potential biases in the study favoured the null hypothesis of there being no relationship. An accompanying editorial noted that some of the people who commit suicide during or after an admission to hospital do so because of conditions inherent in that hospitalisation.12

I fully admit that some patients are very difficult to treat optimally without using force. But it seems that, with adequate leadership and training of staff in de-escalation techniques, it is possible to practice psychiatry without using force.1,13,14 In Iceland, belts have not been used since 1932, and there are psychiatrists all over the world who have dealt with deeply disturbed patients for their entire career without ever having used antipsychotics, ECT or force.1

I believe we have to abolish laws of forced admission and treatment, in accordance with the United Nations Convention on the Rights of Persons with Disabilities.2 Abandoning using force will be harmful to some patients but it will benefit vastly many more. We will need to work out how we may best deal with those patients who would have benefited from forced treatment in a future where force is no longer allowed.

Peter C Gøtzsche graduated as a Master of Science in biology and chemistry in 1974 and as a physician 1984. He is a specialist in internal medicine. Co-founded the Cochrane Collaboration in 1993 and established The Nordic Cochrane Centre the same year. He became professor of Clinical Research Design and Analysis in 2010 at the University of Copenhagen.

References

1 Gøtzsche PC. Deadly psychiatry and organised denial. Copenhagen: People’s Press; 2015.

2 United Nations Convention on the Rights of Persons with Disabilities. General comment No. 1 2014 May 19. http://daccess-dds-ny.un.org/doc/UNDOC/GEN/G14/031/20/PDF/G1403120.pdf?OpenElement (accessed 1 April 2015).

3 Gøtzsche PC. Does long term use of psychiatric drugs cause more harm than good? BMJ 2015;350:h2435.

4 Leucht S, Kane JM, Etschel E, et al. Linking the PANSS, BPRS, and CGI: clinical implications. Neuropsychopharmacology 2006;31:2318-25.

5 Khin NA, Chen YF, Yang Y, et al. Exploratory analyses of efficacy data from schizophrenia trials in support of new drug applications submitted to the US Food and Drug Administration. J Clin Psychiatry 2012;73:856–64.

6 Whitaker R. Mad in America. Cambridge: Perseus Books Group; 2002.
7 Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-

analysis of randomized placebo-controlled trials. JAMA 2005;294:1934–43.

8 Hughes S, Cohen D, Jaggi R. Differences in reporting serious adverse events in industry sponsored clinical trial registries and journal articles on antidepressant and antipsychotic drugs: a cross-sectional study. BMJ Open 2014;4:e005535.

9 Sackeim HA, Prudic J, Fuller R, et al. The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology 2007;32:244-54.

10 Read J, Bentall R. The effectiveness of electroconvulsive therapy: a literature review. Epidemiol Psichiatr Soc 2010 Oct-Dec;19:333-47.

11 Hjorthøj CR, Madsen T, Agerbo E, et al. Risk of suicide according to level of psychiatric treatment: a nationwide nested case-control study. Soc Psychiatry Psychiatr Epidemiol 2014;49:1357–65.

12 Large MM, Ryan CJ. Disturbing findings about the risk of suicide and psychiatric hospitals. Soc Psychiatry Psychiatr Epidemiol 2014;49:1353–5.

13 Fiorillo A, De Rosa C, Del Vecchio V, et al. How to improve clinical practice on involuntary hospital admissions of psychiatric patients: Suggestions from the EUNOMIA study. Eur Psychiat 2011;26:201-7.

14 Scanlan JN. Interventions to reduce the use of seclusion and restraint in inpatient psychiatric settings: what we know so far, a review of the literature. Int J Soc Psychiat 2010;56:412–23.

March 15, 2016March 1, 2020

AFTERSHOCK, by Connie Neil

An offering in support of the CRPD campaign, an excerpt of my (as yet) unpublished non-fiction book about my ECT and forced drug experience and my work to recover a mental balance.

Connie Neil

Shock survivor and anti-psychiatry activist

AFTERSHOCK

They wheel me into the white, tiled room and shunt me onto a table. “Oops-a-daisy. Slide over now, there’s a good girl.” Globs of cool slime smudge onto my temples, my chest, and the electrodes are lodged in those spots. The needle pierces my vein and fuzz creeps into my mind.

‘Wait! I can’t breathe.’ I can’t move or speak. My lungs are paralyzed. I try to tell them, try to scream for help, but a mask with a hose attached blocks my mouth and nose, and I know no more. Except I feel that I am dying.

How long after? Hours? Days? I have no idea how I got here. “Hush now, Connie, don’t make a fuss.” Am I making a fuss?

Perhaps my name brings me back to this world. I know nothing else. They show me how to hold a spoon and eat. That man – Bob — keeps fidgeting around saying, “Hush,” and that he is my husband. That shrieking noise is my baby, they say, held up to me by a leering old woman. I know nothing; care less.

Something bad has happened. I no longer exist. A shell is left in my place.

* * *

That was my first shock treatment and it was in a general hospital with anaesthetic and so-called relaxing drugs, a kind of chemical curare that stops all automatic movement –like breathing, like heartbeats. This method today is called the improved gentle ECT form by Max Fink, teacher of ECT. (Fink, 1999)

Like any sane person, given the disastrous reaction, I refused the next session. True to protocol, that is the signal I am clearly insane and cannot be trusted on the streets of Hamilton. I am institutionalized “on the mountain”, the crazy house the Ontario government runs with our tax dollars, for 20 more ordered against my will and without anaesthetic, so I can feel the full horror of destroying my mind.

If they knew the truth, I reasoned, of the permanent brain damage that was done by this seemingly barbaric operation, it would be outlawed, banned. There must be some major accident, something broken in the machine, which caused this horrendous aftershock for me.

But no: they already knew. This burning my brain away, this slump in my ability to learn was exactly what was planned. No, mine was a typical case handled in the socially accepted manner. Troublesome, opinionated, loudmouth rule-breaking new mother must be brought into line, or buried where nobody can hear her complaint. Shock will fix her.

And what did they wipe out? My acting/writing career, musical training, 8 to 15 years of memory, any trace of self-confidence, my IQ, EQ, every Q. All depleted or burned away with every session.

Where can I go to learn to be whole? Shrinks? Hell, no. To whom can I appeal when my every comment is deemed crazy? Neat trick, these bio-psychiatrists and their ilk concocted. This treatise is not about me: I am fine, perfectly fine, just fine, really fine; fine with my alternatives to achieve adequate balance but nowhere near what I was put into this lifetime to achieve. Yes, I am fine, but what of the millions over the past (2016 – 1939 which equals) 77 years who succumbed to this torture? Shock is ordered by an elitist group of mostly men upon women who make up two-thirds of the targeted victims fed electroshock purported to be a cure for depression, for sadness, for frustration, for reaction to reality that is unfair (Burstow, 2014, pg 195).

And what behaviour did I exhibit that was “a danger to myself and/or others”, the criteria for locking away recalcitrant members of society exhibiting egregious harm? I had a baby, got flu, and failed to wrest control of my baby’s care from my obsessed mother-in-law where I was parked while hubby wrote his final exams in another city. Shock was what I deserved, they judged. My adult history showed no crazy markers to convince authorities I was in need of their ‘help’. Before their infringement I had many successes.

What I Lost to Electroshock

We set out in two cars towing a trailer of our dismantled farm porch theatre set on a crisp winter day to drive 150 miles past Montreal to Lennoxville where Bishop University hosted the Inter Varsity Drama League Festival. Long trip. It was Ryerson’s first entry in five years. Fellow actor Robin Brewer and I sampled the whiskey bottle to keep warm until Donald Sutherland, our English teacher and chaperone, poured the remainder out onto the snow at our second stop. No more booze.

For our technical rehearsal, we re-constructed the set, designed and built by Bill Underwood, the only one not studying Radio and Television Arts. He later made his theatrical career at Stratford. The set was praised for simplicity and atmosphere by our adjudicator, Montreal producer Rupert Caplan. In the brief time allotted, we ran lights and cue-to-cue lines while director Ken MacKay roamed the gods checking that our projection was clear.

It would be surprising if we did not do well as Ryerson attracted talented young people. And we cleaned up with Tennessee Williams’ 27 Wagons Full of Cotton, his one-acter that the controversial Hollywood movie Baby Doll was based on. We took Best Production, Best Director, Best Actress and Honourable Mention for the lead actor.

At the awards dinner, when Rupert Caplan announced, “The winner is Connie Neil” he looked at me in surprise, did not recognize me off-stage, the mark of a talent for disguise. As I rose and walked forward, he added, “and accepting for Connie Neil is . . .” I had to tell him, “Connie Neil”. He fumbled, “Is it you?” I nodded. For the part of simple-minded Baby Doll I was padded to a plump roundness so that my ripped costume after the rape only revealed blood and bruises, and not my usual sleek shape. He said, “Although this is not a great play, it is an example of how a good performance can make a play great because the audience believes in it. Connie achieved a great degree of believability. She is a promising young actress.” Two universities choose that play; only ours won awards.

At the Banff School of Fine Arts that summer I took both acting and playwriting to help decide where I best fit. At the auditions for their mountain dialect play, they moved me up to advanced acting, the Shakespearian studies, and gave me the lead of Barbara Allen in the 3-act play Dark of the Moon. In this challenging role I was wooed by a witch-boy, raped in church, gave birth on-stage, mob-killed and left dead and sprawled on a rock for the witch-boy to play with. Brought the house down. People hung around backstage to weep and tell me how strongly I affected them with my performance.

I also got high marks in playwriting.

For my final Ryerson year I took the lesbian role in Jean-Paul Sartre’s “No Exit”, the play of three disreputable characters in a waiting room for the afterlife that for them is hell. I received Honourable Mention for acting: No mean feat in competition with eleven universities.

Aside from these honours I performed in musical and comic revues, dance shows, piano recitals, singing, radio and TV acting and wrote a number of plays.

All this stopped with electroshock. In reviewing old papers I came upon letters of congratulations; there had been national newspaper coverage. One was signed “Sharon”, and from the content we had been close. She named people I recognized, but she is lost in the area of my brain burnt out by thoughtless shock docs. What does it matter to them that a few lists or personnel are missing? It matters not at all.

Oh sure, my interests were still present, but all I was capable of was chorus work, minimally. Once I was helping choreograph Toronto City Hall Revue dance numbers. In the grand finale the lead dancer was to lift me, spin around and roll me out for the big finish. Because I had demonstrated both male and female roles, in performance I lifted him, spun him around and rolled him out for the final TA-DA. Did not even realize I had done it until we were in the wings and he asked, “What was that all about?” All I could do was laugh, and never tempt that brain shock mistake again on stage. Performing, even as an amateur, was over. That little brain glitch meant I was unreliable on-stage.

One reason I did well performing was my prodigious memory: All the script changes were imprinted on my mind. If an actor was in the wrong place or gave the wrong line, I could cover because I remembered every nuance of the rehearsal period. All gone now. No more connections. And what enrages me today is that psychiatry knew this destruction is the result of ECT, always the result, and in their arrogance, their greed, their lusting for the easy way around difficult personalities, they hide the truth they know; brain damage is always the result.

What Little They Disclose

Today there are legislated informed consent discussions as in the 2002 Andy Behrman memoir Electroboy. I notice the bio-psychiatrist and not the shock doc gives the information to him and his parents, outlining the different methods and expected results. It is now admitted the chief problem is memory loss, a condition even my nice psychiatrist suggested was brought on in me by my “mental illness”. They like to blame the victim: it is how they are trained. The classifications are: 1) neurotransmitter theory shows ECT is like antidepressant drugs and affects serotonin, dopamine and norepinephrine; 2) anticonvulsant theory claims ECT seizures condition the brain to become seizure-resistant; 3) neuroendocrine theory says these convulsions cause the hypothalamus to release mood stabilizers; and 4) brain damage theory admits that the damage created gives the illusion of mental stability.

Note that these are theories, not proven scientific facts that explain how ECT treats depression or mania. The fact that ECT results are unproven does not stop psychiatrists from charging ahead, delivering their shocks and, when they fail to ‘work’, adding more series of shocks until you no longer complain. You learn what torture comes from objecting.

THREE DECADES LATER

Close to the end of this retreat with meditation teacher Cecilie Kwiat at the Dharma Centre of Canada I was able to report that I could see what was hidden behind that all-encompassing blob of anger that dogged my steps for the past five years. Every word of those complaining 560 pages in my crumpled discarded memoir was filtered through the veil of my unrelieved anger; and I thought all along that anger, rage, fury was all that there was.

Since I had loosened up throughout this year, attending four retreats and finishing the story of what ECT had done to my very long life, I volunteered as copywriter to publicize teachers. Research for this chore interested me in attending Body, Speech & Mind with Albertan Cecilie Kwiat. She was a close student of Venerable Namgyal Rinpoche and had produced that text book from her (and other’s) notes of his teachings on a sea journey to Peru. And I had studied that text with both Buddhist nun Karma Chime Wongmo and the Rinpoche. I thought I knew the subject. I thought it would be easy.

But just as Cecilie taught, every moment brings a brand new “I” with a possible fresh outlook and opportunity for insight.

She arrived in time for the Namgyal Memorial weekend, a gathering that brought many old students to the centre to pay tribute to our lama who passed to the higher realms ten years past.

When I turned in my seat during the temple rituals I caught her brilliant smile, her hearty laugh, and I realized I had met her once before during a longer retreat that she attended with a few of her students. Seated side-by-side in the Tea House I had heard her answer a student’s questions with such clarity that I had to comment, “That was perfect,” and she smiled, “Thank you.”

This could be a stellar retreat. The morning after her first day of teaching as I lay between dreamland and waking I saw my brain, full of holes, covered in scabrous dead areas. This, I heard, was my leaky boat that would not carry me far on this river journey to enlightenment. Then, with tears wetting my face I heard my dead guru say, “You need mentoring!” Not even sure what that meant, I approached Cecilie after class and reported that little scene, expecting perhaps a name and phone number on a slip of paper. Instead, she made me cry. I tried to make my plea clear to her with dry eyes, but she poked me in the back, saying, “You’re frozen. Cry!”

She reached and captured my wrist and pulled me to her, seating me in her lap. Oh no! I must not sit in teacher’s lap! I would break her. Then what would the class do for a teacher? In my research I learned she had been run over by a gravel truck – twice – in a motorcycle accident in her youth, and was told she would never walk, never have a baby. But she fooled the doctors, and did both.

I was very awkward on her lap, trying to hold my weight off her while she questioned me about my history that I blubbered out to her, and she told me about her difficult childhood being called a Nazi because of her father. I blurted out, “Was he?” But that was not the point she was making. Some students were still in the temple. What a show we were putting on! They drifted away. Still on her lap like a toddler, she had me write in my notebook: “Here I am right now. As I am, may I be well and happy. May I be free from enmity.” It is the translation of White Tara’s mantra, my yidam, my guardian, and I had forgotten her Loving Kindness practice. That forgetting of crucial information was what was still, fifty years after shock, the plague accompanying ECT that thwarted my need for spiritual wholeness. I am ever unsure of what I know, what is missing.

I carried on with classes and exercises, but it took days to settle this stormy episode. I passed her a note for a private talk on vanishing emotions, a failing of mine because ECT was ordered for people who cause trouble, disturb others, have uncontrolled emotions; and so was my great fear. I over-react and, not only bury my emotions, I forget I have done so.

I explained to Cecilie that an unfeeling state makes everyday life easy, tempting, that nothing bothers me in that state, but because I do not notice the trigger, I cannot climb out. I am worried that outlawing my anger will kill all the emotions.

She talks about my heart, but I know my heart is closed. She tells me that is not true, that she does not work with people who have no heart: She can see my heart. Again she makes me write; “I aspire to be free from anger. I will un-armour my heart (and may armour it up again).

Her next class is on awareness of feelings and I take in what I can. There are fifty (some say 52) skulls worn by the deity as a necklace. These transformed mind states are now seen to be his adornment, his conquered wisdom. We must describe these mind states in our own language. We are often mistaken in what is our mind state, a result of conditioning. Change is all that is constant.

This has been a very cold and rainy retreat. The storm blew out our power for a day. Snow and mud makes walking a study in problem-solving – from one dry-ish clump leap to somewhere safe. We are to move from one form of meditation to another – sit, do body scans, review, walk slowly with one foot on solid ground, one foot over the abyss. Sheer boredom of looking at 25 of the negative, dismal mind states pushes me with my umbrella out of the temple to walk the centre, to sit under the shelter with the huge peace Buddha statue the Sayadaw, Rinpoche’s teacher, built here and all across the world. And here I caught a glimmering of another mind state.

I often wondered what I did in a past life to be born into this family. Cecilie phrased it differently: Whoever made me may have put me in this family, through attraction, to learn an important lesson. Could the lesson be Loving Kindness? To armour and de-armour my heart? Forgiveness? I already know anger.

I report that anger hides a great wall of refused and unresolved forgiveness. I see the wall, name it unforgiving, examine it and its many instances in my life. I even refused under hypnosis – not just once – to forgive especially my father. No. I won’t. Even I know these denials expand to big trouble in river city. With that early decision, unforgiving moves to other beings until it is global: I am intransigent. I judge. But now I think about who needs forgiveness (me, duh) and what qualities he (Dad) had and who this reminds me of (guess).

When Cecilie declares Congratulations! I stipulate I have not forgiven, only seen the awful wall of it. She repeats congratulations, that having seen it, the wall will dissolve bit-by-bit, one-by-one. She can see I can be kind and I agree I can be kind. I am kind. I wonder what is behind that dissolving wall.

To close the retreat we celebrate Cecilie’s 74^th birthday on November 1^st with two great cakes, balloons, gifts, and a healthy meal.

She took a compartment for her train trip back to Alberta, got in her car at the station drove off and hit black ice, a major accident. Many surgeries, many crises later, by Christmas, she was working her way into wheelchair rides and therapy to help her briefly stand. When my heart clutched at the photos in casts, amid hospital paraphernalia, what I take heart in is her still-brilliant smile.

If she can do that, so can I. Nothing can break Cecilie Kwiat. But just in case, I send her Loving Kindness.

In a noisy hostel in St Maarten, I cannot sleep for the rowdy drunken crowd outside my dark window, so I practice Metta. They leave and later I see in my dorm a white-robed figure approach my lower bunk. She offers something in her right hand. Is it a blessing? I see a square of light before my open eyes. On it I see a quick sequence of hieroglyphics. There’s a dark horse’s head, but other images change so quickly I can hardly register them. Then it is over and I ponder these screened messages.

On February 15, Cecilie Kwiat passed on into communion with the enlightened who have no need of their corporeal body. I miss her. And thank her for that parting visit.

An Understanding Forgiveness

Our school reunion lunch was set for the hottest July day, so I left my car in Oshawa and sailed into Toronto on the commuter GO train – early.

Walking up from Union Station I was so early that I found the one shaded park bench on King Street and parked myself at the end where a man of a certain age invited I might sit and join him. He wore tan slacks and a woven beige golf shirt with new trainers on his feet and a neat pewter-coloured close-clipped hairstyle. His teeth were perfect.

“Can you tell me where the . . . uh . . . the . . .” He scowled and concentrated on the elusive words, then triumphant, “the Eaton Centre is?”

I could and did. It was within walking distance, but he stayed seated. That was not what he wanted. We spent an hour piecing together what he needed to say.

He tried again, this time searching for the French word for psychiatrist. “I was . . . sis . . . sis”

And I supplied, “Psychiatrist?”

“Yes, but . . . neuro . . . sus . . . sus . . “

“Neuro-surgeon?”

“No, neuro . . . neuro sus . . .”

“Neuro-scientist?”

“Yes!”

Lordy, I was sharing a bench with the enemy. In my mind, this was the guy who made the pills, who screwed up my brain, who pushed me to ‘gentle’ shock treatment. Does the neuroscience model of brain-based consciousness really hold up? Here was the scientist behind psychiatry. And just look at what he had become: a wreck, my victim.

We painstakingly translated his story. Six years previous he had a stroke, could not speak. But his wife helped him and they were just fine together. Every time his wife came up in what I loosely describe as conversation, he cried. I understood the stroke had taken away his emotional controls. Here waited the enemy, at my mercy.

He also could not recall the word for “tomorrow”, not surprising as he was captured in the ever-constant now. What he needed to tell me was that his wife had died two years back, was buried in Barrie, where he was headed, just resting and walking in between trains. He had come from Belleville and, just like me, had walked up from Union Station to this shaded bench.

He stopped trying to control his tears and the quavering in his voice: He must tell me his tale. The tears were just scrubbed away by his hand. It was difficult to piece together what disturbed him.

Neither he nor his wife realized that her stomach pains were serious: He particularly grieved that he did not understand in time. When finally she was settled into hospital, the medical staff and his wife dismissed him, saying to come back “Tomorrow”. But when tomorrow came, she was gone. And he was alone. “Alone,” he cried, “alone.”

Two years were not enough time for him to accept her death and his damaged condition. So, what to do with the rest of his life? How to go forward?

Because he emigrated from France, I asked if his words were easier available in French. But no, it made no difference. Did he have friends, support, family there? But no, and he loved Canada and his life here – before his calamities.

I spoke as a Buddhist of the essence of a person going on eternally. And this sparked an interest and further distress. She spoke in his head as she was dying and declared there was no more suffering, that she was happy now, that she was fine. And then he went to the hospital, pleased with her stated recovery, and found her dead. What he cannot set aside is that she died alone, and now he was alone, struck asunder. The only comment that brought him some lightening of mood was when I observed that, “with your close connection, you will see her again. She will wait for you. You will be together, not alone.”

“Yes. I know it.”

And with that, he stood, offered his hand to shake, to stroll back the way he had come. Done. I joined my fellows at our reunion lunch. Good lunch; but a better chance meeting that corrected my biased view of all psycho-workers.

No matter what we achieve in this life through education, fame, important works, in the end we carry the exact same personal conditions that are the core of our life. Previously I could not see the purpose of this exalted class of doctors that had threatened my safety, harrowed my career, and damaged my brain. But this archetype of soul examiner invited me onto his bench to reveal his crying heart. Such hurt revealed; I could not do other than extend my hand and grasp his.

I see with softer eyes.

References:

Behrman, Andy (2002). Electroboy; A Memoir of Mania.

New York: Random House, Inc.

Burstow, B. & LeFrancois, B.A. & Diamond, S. (Eds.) (2014) Psychiatry Disrupted: Theorizing Resistance and Crafting the (R) Evolution

Montreal: McGill-Queen’s University Press

Fink, M. (1999). Electroshock: Restoring the Mind.

New York: Oxford University Press

March 15, 2016March 1, 2020

¿Qué ganamos con abolir la psiquiatría forzosa? -Andrea Cortés

http://congresovisible.org/agora/post/que-ganamos-con-abolir-la-psiquiatria-forzosa/8154/

Estamos impulsando cambios muy importantes que se sitúan al margen del conjunto de reivindicaciones sociales que son respaldadas por las mayorías. Me refiero al reconocimiento de los derechos de las personas con discapacidad psicosocial o discapacidad cognitiva.

Se cree erróneamente que la atención que recibimos constituye asunto resuelto y por consiguiente, la gente confía en las bondades de la psiquiatría, la farmacología, las terapias de cualquier índole y sobre todo, de la posibilidad de aislar y mantener en esa situación a quienes no se acoplan a lo comúnmente aceptado. La sociedad crea los problemas, luego los oculta y finge no tener nada que ver en esto, de esta forma los hospitales psiquiátricos son reductos en los que se encierra a seres “molestos” y/o etiquetados como “violentos y peligrosos”, bajo la dudosa promesa de un restablecimiento de sus facultades, o de una rehabilitación. La psiquiatría biologista ha contribuído a justificar estas acciones al atribuir como causas inequívocas de los trastornos mentales a daños cerebrales, descartando de plano toda la vida y el contexto familiar y social de las persona afectadas.

En realidad, el deshacerse de las personas con discapacidad psicosocial o cognitiva mediante el encierro, ya sea temporal o permanente en una institución psiquiátrica, es una práctica común y de buen recibo entre la población colombiana. Aprovechando en algunos casos la existencia de una interdicción para disponer de la vida de alguien, sin necesidad de matarla en forma física, pero sí, matándola en vida a fin de acceder a beneficios económicos. También existen abundantes casos en los que la libertad se suprime como castigo por tener una característica personal como orientación sexual o de género diversa, o también como única respuesta ante la carencia absoluta de estrategias de apoyo desde la familia y la comunidad para manejar los ‘trastornos mentales’ y procurar un nivel de vida apropiado a quienes viven con ellos.

La aceptación social de la institucionalización forzada hacia personas con discapacidad psicosocial o cognitiva, real o percibida, demuestra la ignorancia y el desinterés de la población por entender la naturaleza de los trastornos mentales debido al miedo y a los tabúes que alientan la estigmatización. En lugar de informarse y capacitarse para convivir, no solamente cuidar, a las personas con discapacidad psicosocial, éstas y las personas del entorno prefieren asumir que los “expertos” en el tema ya tienen todas las respuestas y que las soluciones sólo provienen de ellos, de la psiquiatría organizada. Muy pocos se atreven a dudar y los que los hacen jamás son escuchados. Como resultado las personas con discapacidad quedamos expuestas a ser maltratadas dentro de las instituciones con métodos denominados como terapéuticos pero que en realidad son tortura, puesto que no curan ni ayudan a mejorar la condición mental, claramente se trata de castigos para aplacar a los anormales e inadaptados. La indiferencia de la sociedad ante estos hechos los hace parecer legítimos.

Las personas con discapacidad en Colombia no conocemos cuáles son las posibilidades de impugnar o demandar una hospitalización forzada, desconocemos cómo reclamar una reparación por haber recibido torturas y tratamientos contra la propia voluntad, no contamos con la más mínima posibilidad de rechazar un tratamiento y acogernos a otro, así como tampoco de abandonar una institución voluntariamente.

Los psiquiatras y su personal de apoyo dentro de las clínicas cuentan con todas las ventajas, empezando por la credibilidad de las agobiadas familias. Controlan la información que les brindan sobre las enfermedades, los tratamientos y justifican todas sus acciones hacia los internos. Desatienden la obligación de ofrecernos a cuidadores y personas con discapacidad toda la información necesaria para que exista un verdadero consentimiento informado, contando con la opinión de quienes vamos a recibir los tratamientos. Las clínicas psiquiátricas son cárceles.

La abolición de la institucionalización forzada implicaría impulsar todos los cambios necesarios para brindar una atención eficaz y respetuosa hacia las personas con discapacidad psicosocial y cognitiva y le haría un aporte inmenso a la sociedad en términos de aprendizaje sobre respeto, inclusión y convivencia. También es evidente que puede contrariar a quienes vean amenazados sus intereses y privilegios. Pero somos más los afectados por el abuso de poder de los psiquiatras, de los laboratorios farmacológicos y de las instituciones que obtienen dinero a partir de nuestros padecimientos contribuyendo a empeorarlos. Nuestro bienestar físico y mental debe prevalecer ante los intereses institucionales, industriales y de personas particulares.

Andrea Cortés

Persona con discapacidad psicosocial

Activista independiente

Este texto fue escrito en el marco de la Campaña de Apoyo a la Prohibición Absoluta de la CDPD de los Tratamientos Forzosos y los Internamientos Involuntarios. Para obtener más información consulte el siguiente link: https://absoluteprohibition.wordpress.com/page/2/

March 6, 2016March 1, 2020

“I Must Have Died and Gone to Hell” Katherine Tapley-Milton

KT-ForcedDrugging(1) (docx) KT-ForcedDrugging(1) (pdf)

I MUST HAVE DIED AND GONE TO HELL

by Katherine Tapley-Milton[1]

My psychiatrist at Centracare[2] was foreign and had an accent that was hard to understand. He always treated me like I was a bad child. When he was going away for a couple of days he overdosed me with 30 mgs of Haldol. He said that it was “to keep me out of trouble”. You had to stand in line for your pills and I had no option but to take the medication or else the staff would have gotten nasty and forced me to take it.

You didn’t want to buck the hospital staff or you would end up being pinned down with a needle in your butt. I heard that political prisoners from Russia complained to the Western media that they were tortured with a horrible drug. That drug was called Haldol. Psychiatrists here affectionately call it Vitamin “H”. The overdose of Haldol put me into an “oculorgyric crisis”, which is what happens when your eye balls roll back in your head and stick there.

Wikipedia comments: “Oculogyric crisis (OGC) is the name of a dystonic reaction to certain drugs or medical conditions characterized by a prolonged involuntary upward deviation of the eyes. The term “oculogyric” refers to the bilateral elevation of the visual gaze.”

It is excruciatingly uncomfortable and terrifying. When this reaction started to happen to me I went to the nurse’s station and begged for the side effect pill called Cogentin. She rudely informed me “You’ll have to get a lot worse before we’ll do anything about it.” I went into a small room and my neck arched back and my eyeballs were stuck staring up at a light bulb. I was in physical and mental agony and could not believe the cruelty of someone who would just leave me like that. The side effects of the medication went on for days and days. It seemed like an eternity.

The pay phone was my only contact with the outside world, but the competition for its use was fierce among the patients. Also, it was difficult to hear over the din of the ward. There was moaning, crying, and screaming. I remember calling my parents long distance and begging them to get me out of Centracare. However, I was certified which meant that legally I couldn’t leave. Sobbing into the phone I told my father, “I must have died and gone to hell.”

[1] The author is from Sackville, Canada

[2] Centracare was Canada’s oldest psychiatric institution. It has since been demolish.

March 6, 2016March 1, 2020

Post on psychiatric torture by Initially NO

Initially NO has brought together art, graphics, narrative, essay, and articles of the CRPD containing rights that were denied to her, in a beautiful and moving composition asserting a claim for justice. Since the art and graphics are integral to her work and I cannot reproduce the layout here, I am sharing her introduction and a few samples of the art work and urge you to visit the original for the full effect.

of our human rights

Rights denied me, again and again over a 14 year period (1998-2012) brings back such feelings that make me not wish to attempt to talk about this again. It hurts so much, it was so painful, it upsets me to remember, but it upsets me even more knowing that over 5700 people are subjected to such horror, every year in the state of Victoria, Australia, people who actively say no I don’t want this, very clearly and are then put on Community Treatment Orders, and tortured with forced injections, electricity, and verbally abusive appointments, that must be met, or they’ll be put into arbitrary detention again. It hurts me that the people who say no they do not wish to take psychiatric prescriptions are then subjected to the system longer.

When you refuse to be injected they do this. One ambulance man said to me he was just a small cog in a big wheel. That’s the symbolism here and the bombs in the body profiteering, Otherwise, that many hands on a small young lady, as I was, as strip her and stick her.

This is what happens when you’re given threats of worse treatments such as electro-shock and detention if you do not turn up to a fornightly ‘depo’ injection. I had to pretend to be happy with this senario to a point. (I’ve cut out the true-feeling related swear words here to fit with #UN CRPD Absolute prohibition.)

Article 15 – Freedom from torture or cruel, inhuman or degrading treatment or punishment

1. No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment. In particular, no one shall be subjected without his or her free consent to medical or scientific experimentation.

March 3, 2016March 1, 2020

Poetry and Art by Jhilmil Breckenridge

Jhilmil IMG_0503 — Solitude, by Jhilmil Breckenridge

Staring by Jhilmil Breckenridge

February 28, 2016March 1, 2020

Sarah Knutson: Einstein, Social Justice and the New Relativity

Sarah Knutson’s second post for the Campaign. Original is on Mad in America.

By SARAH KNUTSON

Featured Blogs February 23, 2016

To create his theory of relativity, Einstein had to see things differently. He had to view the universe not as an object of mammalian proportions, but from the perspective of a subatomic particle. Essentially, he used imagination and empathy to come to know a new ‘reality’ of existence.

This essay is the second in a series. We previously outlined a rationale for a 100% voluntary mental health system (read about it here). Now, we take a deeper look at the nature of human experiences that lead to public concern. We delve deeply into the perspective of that experience and discover ourselves in a whole new realm.

Three ways of seeing experience

To understand where we are going, let’s first take a look at where we’ve been. Here are some competing models for approaching socially troubling human experiences.

1. The DSM Model of ‘mental disorders’

The DSM Model is based on the Diagnostic and Statistical Manual of Mental Disorders published by American Psychiatric Association. In no small part, the DSM has been the product of insider turf wars, political compromise, industry needs and billing concerns.(1) It is said to be atheoretical, but unquestionably the DSM views certain aspects of human experience as abnormal/ disorders. Possibly, this is just a nod to the practicalities of healthcare reimbursement. However, the process of distinguishing the truly abnormal (insurance pays) from the common effects of a stressful life (you pay) has left something to be desired.

Rote symptom checklists determine whether your anxiety, mood, grief, trauma, substance use, sexuality is ‘normal’ or ‘disordered.’ At a minimum, this is a lousy way to get to know another human being on the worst day of their life. Painful experiences, like getting fired, ending up homeless or being raped in shelter housing are routinely ignored or overlooked. It’s like the teacher pronouncing you ‘learning disordered’ without asking if you studied.

Reliability and validity have proved problematic as well. Individual diagnoses tend to vary, as do predictions of violence and suicide. Given that single bad call can change the course of a lifetime, concerns like these led whistleblower Paula Caplan, Ph.D., to report to the Washington Post in 2012: “Psychiatry’s bible, the DSM, is doing more harm than good.” A year later, the National Institute of Mental Health (think science, research, evidence-based) went on record as looking for a more valid approach (full statement here).

2. The Medical Model of ‘mental illness’

In contrast to the DSM, the Medical Model has a crystal clear vision. ‘Mental illness’ is a real disease. It is caused by pre-existing genetic, biochemical or physiologic abnormalities. Those affected are susceptible to disregarding personal welfare or that of others. Aggressive treatment (drugs, CBT) is required to correct or mitigate deficiencies.

For all its theoretical congruence, the medical model hasn’t fared much better than the DSM. Treating ‘mental illness’ takes a whopping 15-25 years (on average!) off of the average life span. The promised ‘chemical imbalances’ and bio-markers still haven’t materialized in the research. Disability rates have sky-rocketed. Long-term outcomes and relapse rates have worsened overall. (2) Many suspect that prescribed drugs increase violence and suicide.

3. The Social Justice Model of fundamental human needs

This model comes in no small part from the learnings of World War II, the Holocaust, Hiroshima, and Nagasaki. In the aftermath of atrocities, the nations of the world were interested in figuring a few things out. They needed a way for those on all sides to move forward. They wanted to set the stage for ‘never again.’ Their solution was the Universal Declaration of Human Rights of 1948 (UDHR).

The UDHR is premised on a simple idea. For all our differences, human beings have much in common. We all need certain things to live and be well:

nutritious food, habitable shelter
safety of person and property
dignity, respect and fair treatment
meaningful participation and voice
support for families to stay together and make a living
opportunities to develop ourselves across major life domains
freedom to make sense of experience in our way

Under the UDHR, advancing human rights is a universal, non-delegable obligation. Everyone everywhere is responsible for doing their part. The peoples of the world understood that the basic requirements for human dignity must be accessible to all. Without such access, neither individuals nor the human family as a whole will be well.

The theory of human conflict follows from this. Under the UDHR, conflict arises when human needs are in competition. It intensifies with time if only some of us have access to what all of us need.

Preventively locking someone up or drugging them against their will is a considerable human conflict. To meaningfully address such issues, the Social Justice Model counsels us to take a step back. Those we are fearing (sick, disordered, untrustworthy) may be messengers, not madness. Instead of privileging our perspective, what if we try to see the world through the other’s eyes:

Is it possible their experience might not be as senseless it seems?
Is it possible they may be expressing a history of social harms, rather than arbitrarily bent on inflicting new ones?

Before you immediately brush this off, consider the following:

If the nations of the world could adopt these attitudes in the aftermath of Hilter, concentration camps, kamikaze pilots and detonated atom bombs, then why not for modern public safety concerns?

Support for the Social Justice Model

Nearly 70 years ago, the United Nations predicted the following (UDHR Preamble):

‘[R]ecognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world.’
People everywhere long for a world in which ‘freedom of speech and belief and freedom from fear and want’ are the order of the day.
‘t is essential, if man is not to be compelled to have recourse, as a last resort, to rebellion against tyranny and oppression, that human rights should be protected by the rule of law.’
‘[D]isregard and contempt for human rights’ leads to ‘barbarous acts’ that ‘outrage[] the conscience of mankind.’

Now consider this:

1. Research on public and behavioral health impacts

An estimated ninety (90!) percent of those in the public mental health system are ‘trauma survivors.’ We have grown up without reliable access to same basic needs that the United Nations recognized as essential over six decades ago.

The same applies to the other so-called ‘problem’ groups in our society. Yep, ninety (90!) percent or more of us in substance use, criminal justice, and homeless settings are ‘trauma survivors’ as well.

This is not just about individual needs, but also family needs and the needs of entire communities. These issues affect all of us across demographics.

Don’t believe it? Check out the following:

National Association of State Mental Health Program Directors (NASMHPD), The Damaging Consequences of Violence and Trauma: Facts, Discussion Points, and Recommendations for the Behavioral Health System (2004). Full report here.
National Council for Behavioral Health (Breaking the Silence: Trauma-informed Behavioral Healthcare (2011). Full publication here.
Nadine Harris, MD, How Childhood Trauma Affects Health Across a Lifetime (TED Talk here.)
Substance Abuse and Mental Health Administration, SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach SAMHSA (2014). Full proposal here.
The School of Life, Sanity of Madness (1/18/2016). Full video here.

Yet, for all the fanfare about the need for more ‘trauma-informed care’, there has been little systemic response directed toward basic human needs. Equally disturbing, behavioral health system involvement has become an independent, exacerbating source of harm for many.

The results speak for themselves.

2. Tremendous explanatory power

In addition to the public health data, the Social Justice Model has tremendous explanatory power. It offers a straightforward way to make sense of experience (this essay), as well as principled ways to respond (future essay) that could easily be confirmed – or refuted – by research (future essay).

The basic paradigm is this:

Resources are seemingly scarce
People have basic needs
They see a threat or opportunity
This sets off a ‘high-stakes’ (aka ‘survival’) response
Predictable physical, mental and social effects occur.

The above theory draws on work that has already been done. In the trauma field, the human survival response (fight, flight, freeze) and its effects are widely known. See, e.g., ‘The Body Keeps Score‘ by Bessel van der Kolk. As it turns out, you can tweak the same theory to make sense of a broad variety of human experiences that lead to public concern.

3. The ‘normal’ response when the stakes are high

For our purposes, there are two basic nervous systems:

(1) ‘All-is-well’ (parasympathetic) for everyday routines. This covers stuff like eating, sleeping, relaxing, hanging out, having sex, small talk, hobbies, tinkering around…

and

(2) ‘High-stakes’ (sympathetic/ ‘survival response’/ fight-flight-freeze) for responding when the stakes are high. This is the ‘get your butt in gear’ reaction that takes over when something feels like a big deal.

High-stakes can get involved in all kinds of stuff. This includes both threats and opportunities. The critical factor is that (from the person’s point of view) the stakes are high. For example, here are some things that can set off the high-stakes response for me:

Discovering new possibilities, new gossip, twenty dollars or my cat in the road
Taking tests, exams, the best donut or advantage of someone else
Scoring a point, contract, bargain, victory or high
Getting paid, laid, yelled at, ripped off, excluded, assaulted or stopped by police
Going on first dates, adventures, job interviews or a personal rampage
Performing on the job, in sports, in college, during public hearings or psychiatric exams
Resisting temptation, peer pressure, arrest, detention or a doctor’s opinion

Suffice it to say, the definition of ‘high stakes’ is a personal matter. It depends on what you have lived or come to know. Thus, one person’s ‘high stakes’ might not even register on another’s radar.

4. Explaining intense or extreme responses

To discover relativity, Einstein had to take the perspective of atoms. To see the value of high-stakes responses, we have to experience what is happening from the high-stakes viewpoint.

When the stakes seem high, human beings are wired to respond in one of three ways: fight, flight or freeze.

‘Fight’ goes after threats and opportunities. It takes them on or brings them down.
‘Flight’ avoids threats and opportunities. It gets away (runs, hides) as fast as possible.
‘Freeze’ hides in plain sight. It shows no apparent reaction (de facto disappears), giving others nothing to notice or chase.

Despite their clear-sounding names, fight, flight and freeze are not fixed forms of expression. They are directional tendencies that can occur across many life dimensions. This allows personal strengths, past experiences and familiar (‘tried and true’) behaviors to be optimized for survival value. Here are some ways that I have expressed fight-flight-freeze when the stakes felt high to me:

Dimensions of Fight-Flight-Freeze

Physical
- fight: striking out, yelling, swearing, telling someone to ‘get out! breaking stuff
- flight: leaving the room, not showing up, running away, cutting, trying to kill myself
- freeze: doing nothing, hiding in bed
Emotional
- fight: raging, hating, envying, craving
- flight: avoiding, cowering, dreading, numbing with food, drugs, sex, spending, computer, games
- freeze: poker face, going numb
Social
- fight: verbally attacking, ridiculing, blaming others, complaining, rescuing
- flight: obeying, begging, flattering, apologizing, backtracking, blaming self, compensatory romantic interest
- freeze: saying nothing, playing along, going with the flow, withdrawing
Intellectual
- fight: arguing, planning, plotting, obsessing, out-smarting
- flight: distracting, fantasy
- freeze: forgetting, going blank
Spiritual/ existential
- mostly fight: praying, seeking visions, looking for signs, exploring energy, becoming a deity
- mostly flight: bargaining with God, trying to be a good person, wishing I were dead
- freeze: losing time/ awareness/ consciousness

(Please note: Depending on context and underlying intent, the same response may fit in multiple categories.)

The wide variability of high stakes responses is a tremendous asset to our species. It ensures that people will respond in numerous rich and creative ways. When an entire community is facing a threat, this promotes resilience and survival overall. If we all responded the same way to danger or opportunity, a single threat (predator, disease, disaster) could wipe us out. We need the extremes that people tend to under stress to safeguard group survival.

On the other hand, when the stakes are seemingly individual, the virtue of diversity can get obscured. Since only one person is reacting, this can look rather odd to everyone else. Imagine Beatlemania, but only you can see the Beatles. Visuals here if you need them (with a little help from my friend, JH).

It’s also worth noting that there is a dose-response effect. In other words, the higher the stakes and the longer I’ve been in that frame of mind, the more intense or extreme my responses tend to get. Over time, this has become a good way for me or others to gauge how important the needs involved are to me. For example, if things seem relatively manageable, then my responses tend to be manageable – both by me and others. On the other hand, if I can’t imagine living or being happy if the needs aren’t met, my responses tend to flair accordingly.

6. ‘Sarah, are you calling inappropriate the new normal?’

If you are nodding along with me at this point, thank you for getting it! On the other hand, if you are feeling confused or disgusted, you are not alone. Clearly, my experiences violate conventional norms. They routinely get seen as unacceptable, disordered or ill.

On the other hand, like the vast majority of the world, you may be seeing my life from an ‘all-is-well’ perspective. And, for ‘all-is-well’ living, my responses sure aren’t the norm.

But that is precisely the point I am trying to make. In behavioral health populations, all-is-well is not the norm. The norm in behavioral health populations is violence, deprivation, poverty, injustice, and marginalization. In other words, the stakes are high all the time. Problems build on each other, then compound exponentially. We rarely, if ever, get a break. We feel like we constantly have to defend our right to be. In dose-response terms, the dose is enormous. So, predict a pretty big response.

From my experience, despite a lifetime of trying to learn how to do it differently, that is what keeps happening. But don’t just take my word for it. Here is 18-year-old Sabrina Benaim“Explaining My Depression to My Mother.”

And before you say, stop making excuses for yourself and take a little responsibility, consider the following (apart from the 20 years of therapy, thousands of dollars out of pocket, 20+ drugs tried, studying this stuff at the doctoral level, devoting my life to trying to understand it):

There is a really good reason that high-stakes responses are hard to turn off: Any conscious, reality-based human being should be bothered by high-stakes conditions. As a practical matter, the high-stakes response is a message. It is like your hand burning on a hot stove. The intense feeling (pain) tells you to move your hand. This prevents further damage. If you just rationalize or drug that sensation away, there is no telling how bad you’ll end up. (We have the scars to prove it.)

Equally important, it is not an accident that high-stakes responses come across as ‘inappropriate’ and alarming. This is by nature’s design, and it serves a dual purpose:

Predators/ competitors are unable to anticipate or plan for what we’ll do.
Well-intended others will know that something is wrong.

Hence, while high-stakes responses no doubt alarm and baffle others, that is why it has actual survival value.

This highlights the futility of trying to classify so-called ‘mental disorders’ in a high-stakes population. The very purpose of our responses is to defy explanation. Outsiders are not supposed to know what is going on. It’s a plus, not a minus when potential predators can’t agree.

The same survival function also explains why observers find these responses so distressing. High-stakes responses are supposed to cause alarm. This scares outsiders off and alerts those close to us that all is not okay. If society worked the way nature intended, the outcome would be great. Opportunists are deterred. Allies rush to your aid. Real friends stick around and try to find a way to help.

That’s also a message for would-be helpers. The assessment tool is built right into the high-stakes system. The rules are fairly clear if you know what to look for:

High Stakes Rule #1: When something makes it worse, the stakes go up, and responses get increasingly extreme.

High Stakes Rule #2: When something makes it better, the stakes go down and all-is-well eases in over time.

In other words, the so-called ‘ravings of lunatics’ are actually ‘rational’ from a high-stakes perspective. They scare off opportunists, attract available allies and weed out would-be helpers who don’t help. If no help is found, they keep us alive and free to keep looking.

From this vantage point, perhaps now you can appreciate the violence – the actual soul torture – of forcing survivors to present as if ‘all-is-well.’ Not only does that obliterate what we have experienced, it takes away what is often the only means we have to communicate our pain to the culture at large.

Suffice it to say, given the state of the world today, you should find us painful to be around. You should find it difficult if asked to bear witness. That is what puts your hand on the stove burning with ours. That is what motivates you – everyone – to look for the source of the burning. That is what makes it possible for human beings, in the spirit of Einstein — to get curious about the little guy, wonder what it is like to feel that small and discover a whole new reality outside of ordinary vision.

With the benefit of hindsight, what do you say we also look for a better energy source to power human relationships? Instead of splitting dissenters off or leveling resistance, how about this time we stick with imagination and empathy and learn to create a workable, honest fusion?

References:

(1) Caplan, PJ (1995) They Say You’re Crazy: How The World’s Most Powerful Psychiatrists Decide Who’s Normal (Perseus Books: www.aw.com/gb).

(2) Whitaker, RH (2010). Anatomy of an Epidemic. New York: Random House.

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.

February 19, 2016March 1, 2020

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 SARAH KNUTSON

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”

CRPD These 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.

February 6, 2016March 1, 2020

Hege Orefellen on Reparations

This is a presentation given by Hege Orefellen, survivor and lawyer, at a side event to the CRPD Committee on Article 15 (freedom from torture and ill-treatment) last year. I am sharing it in the context of this Campaign, because thinking about reparations can help us to envision how to get from where we are now, with so much damage done and continuing under the regime of forced psychiatry, to a world where it is eradicated and people and society come together to heal and make lasting changes in how we treat each other.

Hege’s and other presentations and archived video from the side event are linked on the CHRUSP website Resources page and for the time being also on its sidebar.

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Aquí está una presentación realizada por Hege Orefellen, quien es sobreviviente y abogada, en un evento paralelo ante el Comité CDPD sobre el artículo 15 (prohibición de la tortura y los malos tratos) el año pasado. La estoy compartiendo en el contexto de esta Campaña, porque pensar en reparaciones puede ayudarnos a imaginar cómo llegar desde donde estamos ahora, con tanto daño hecho y continuando bajo el régimen de la psiquiatría forzada, a un mundo en el que se erradique este régimen, y la gente y la sociedad se unen para sanarnos y hacer cambios duraderos en la forma en que tratamos a los demás.

Las presentaciones de Hege y otras personas desde el evento paralelo, y el vídeo archivado, están vinculados en el sitio de CHRUSP, la página de Recursos y, por el momento también por su barra lateral.

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Torture and other ill-treatment in psychiatry – urgent need for effective remedies, redress and guarantees of non-repetition

Side-event to the CRPD Committee, 30 March 2015, PW, conference room

Hege Orefellen – World Network of Users and Survivors of Psychiatry and We Shall Overcome, Norway

As we have already heard from the strong testimonies here today, grave violations happen in the mental health setting. Deprivation of liberty can in itself be harmful. Indefinite detention is especially harsh, and commonly practiced against persons with psychosocial or other disabilities. Violent medical practises like forced electroshock, forced drugging, restraint and solitary confinement do not constitute help or care, nor does it have any legitimate purpose. It constitutes discriminatory and harmful practises that can cause severe pain and suffering, as well as deep fear and trauma, in its victims. Tina will talk about how these forced psychiatric interventions meet international definition of torture standards. I want to underscore the need for recognizing the severity of the harm done and the suffering inflicted on the victims. As a human rights lawyer, and as a survivor of forced psychiatry, I cannot say it strongly enough that these forced interventions, which always carry a factor of disability- based discrimination, needs to be categorized as torture and other ill-treatment, and be abolished. There is an urgent need for providing the victims with effective remedies and reparations. But there are obstacles;

We know the human rights framework regarding torture and other ill-treatment; the absolute prohibition, the states obligation to protect against it, the obligation to investigate allegations, and to give redress to victims. But when ill-treatment is carried out in the name of medical treatment, authorised by domestic legislation and enforced by national law, then there are no real protection or access to justice. There is no redress for victims, no accountability for perpetrators. The ill-treatment goes with impunity.

As Finn and Jolijn’s cases illustrate, there are a lack of effective remedies. We are rendered powerless in the hands of medical professionals who have been given the authority to define us out of our fundamental human rights. That is the situation that we, the survivors of forced psychiatry, are facing around the world today.

Recognizing forced psychiatric interventions as ill-treatment is a first crucial step that needs to be taken by the State parties. We welcome the increasing awareness among UN monitoring mechanisms, which is important to ensure justice and accountability on all levels. Especially we welcome the CRPD Committees General Comment No. 1 stating that forced treatment by psychiatric and other medical professionals is an infringement of CRPD Art 15. The Committee has spoken clearly both in the General Comment and in its Concluding Observations; there can be no legitimate detention in any kind of mental health facility, forced psychiatric interventions violate the prohibition on torture and ill- treatment as well as other provisions of the CRPD and must be abolished. We look forward to the Committees further development of jurisprudence under CRPD Art. 15, and encourage the Committee to take the urgent need for effective remedies, redress and guarantees of non-repetition into account.

The Committee Against Torture emphasizes, in its General Comment No. 3 (2012) on State parties obligation to ensure redress to torture victims, that the restoration of the dignity of the victim is the ultimate objective in the provision of redress.

According to the Basic Principles and Guidelines on the Right to a Remedy and Reparation for Victims of Gross Violation of International Human Rights Law adopted by the General Assembly in resolution 60/147 (2005) redress includes five forms of reparation; restitution, compensation, rehabilitation, satisfaction and guarantees of non-repetition. All of which are of great importance for victims of ill- treatment in the mental health system.

Restitution, a form of redress designed to re-establish the victim’s situation before the violation was committed, should include restoration of liberty, freedom from forced treatment, enjoyment of family life and citizenship, return to one’s place of residence, and restoration of employment.

Compensation should be provided for any economically assessable damage, such as physical or mental harm; lost opportunities, including employment and education; material damages and loss of earnings; moral damage; and costs required for legal assistance, medical and social services.

Rehabilitation for victims of forced psychiatry should aim to restore, as far as possible, their independence, physical, mental, social and vocational ability; and their full inclusion and participation in society. Victims of forced psychiatry may be at risk of re-traumatization and have a valid fear of acts which remind them of the ill-treatment they have endured. Consequently, a high priority should be placed on the need to create a context of confidence and trust in which assistance can be provided. Needless to say, when the ill-treatment has been carried out by medical professionals, within the public health system, it will be difficult, if not impossible, for the same system to regain that trust from its victims.

Satisfaction should include effective measures aimed at the cessation of continuing violations; verification of the facts and public disclosure of the truth; an official declaration or judicial decision restoring the rights of the victim; sanctions against persons liable for the violations; investigation and criminal prosecution, public apologies, including acknowledgement of the facts and acceptance of responsibility.

The right to truth is especially important for victims of forced psychiatry, were ill-treatment for so long, and on such a large scale, has been carried out under the guise of medical treatment. We need truth about what happened to us, truth about the consequences, public recognition and apologies, as a first step in a process of social reintegration, justice and healing. Since coercive mental health practices represent patterns of violence against persons with psychosocial and other disabilities, we need reparation on a collective, as well as an individual level, and we hope the CRPD Committee will take this into account in its future work and recommendations. State parties should develop procedures for redress covering all victims of forced psychiatric interventions.

Guarantees of non-repetition should include taking measures to combat impunity, prevent future acts, as well as reviewing and reforming laws contributing to or allowing these violations.

State parties should now recognize the immediate obligation to stop ill-treatment from being carried out through forced psychiatric interventions, undertake necessary action to repeal legislation that authorizes forced psychiatric treatment and detention, and develop laws and policies that replaces coercive regimes with services that fully respect the autonomy, will and equal rights of persons with disabilities.

Thank you.

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Tortura y otros malos tratos en psiquiatría – necesidad urgente de compensación, reparación y garantías de no repetición.

Evento paralelo a la sesión del Comité CDPD, marzo 30 de 2015, PW, Salón de Conferencias.

Hege Orefellen – Red Mundial de Usuarios/as y Sobrevivientes de la Psiquiatría y la organización We Shall Overcome, Noruega.

Como hemos escuchado en los poderosos testimonios de hoy aquí, ocurren graves violaciones en el sistema de salud mental. La privación de la libertad en sí misma puede ser muy perjudicial. La detención indefinida es particularmente severa y comúnmente practicada contra las personas con discapacidad psicosocial y con otras discapacidades. Las prácticas médicas violentas como los electrochoques, la medicación forzada, la restricción física y el confinamiento en solitario no constituyen formas de ayuda o cuidado y no cumplen ningún propósito legítimo. Se trata de prácticas discriminatorias y perjudiciales que pueden ocasionar fuerte dolor y sufrimiento así como profundo miedo y trauma en sus víctimas. Tina hablará de cómo estas intervenciones psiquiátricas forzosas constituyen tortura a la luz de los estándares internacionales. Deseo subrayar la necesidad de reconocer la severidad del daño y sufrimiento infligido a las víctimas. Como abogada de derechos humanos y sobreviviente de psiquiatría forzada, no puedo enfatizar lo suficiente el hecho de que estas intervenciones forzadas, que siempre conllevan un factor de discriminación por motivos de discapacidad, deben ser categorizadas como tortura y malos tratos y deben ser abolidas. Existe una urgente necesidad de proveer a las víctimas recursos y reparaciones efectivos. Sin embargo, hay obstáculos.

Conocemos el marco de derechos humanos sobre tortura y malos tratos, la prohibición absoluta, la obligación de los Estados de proteger a las personas contra ella, la obligación de investigar las denuncias y de otorgar reparación a las víctimas. Sin embargo, cuando los malos tratos se realizan en nombre de un tratamiento médico, autorizado por la legislación nacional y son ejecutados por el derecho interno, no podemos hablar de protección real ni de acceso a la justicia. No hay reparación para las víctimas ni justiciabilidad para los responsables. Los malos tratos quedan impunes.

Como ilustran los casos de Finn y Jolijn, las medidas de reparación efectiva son inexistentes. Quedamos impotentes en las manos de profesionales de la medicina a quienes se les ha otorgado la autoridad de definirnos por fuera de nuestros derechos humanos fundamentales. Esta es la situación que quienes somos sobrevivientes de la psiquiatría forzada enfrentamos hoy en todo el mundo.

Reconocer las intervenciones psiquiátricas forzosas como constitutivas de malos tratos, es un primer paso fundamental que debe ser dado por los Estados Parte. Felicitamos la mayor conciencia que existe en los órganos de monitoreo de la ONU, pues es muy importante para asegurar la justicia y justiciabilidad a todos los niveles. En particular, felicitamos la Observación General No. 1 del Comité CDPD, que afirma que el tratamiento forzado por parte de profesionales de la psiquiatría y la medicina constituye una violación al artículo 15 de la Convención. El Comité ha sido claro, tanto en sus Observaciones Generales como en sus recomendaciones a los Estados, que no puede haber una detención legítima en ningún tipo de institución de salud mental; las intervenciones psiquiátricas forzadas violan la prohibición contra la tortura y malos tratos así como otras disposiciones de la CDPD y por tanto deben abolirse. Esperamos con atención el desarrollo de la jurisprudencia del Comité bajo el artículo 15 de la CDPD y solicitamos que tome en cuenta la necesidad urgente de medidas efectivas de reparación, compensación y no repetición.

El comité contra la tortura enfatiza en su Observación General No. 3 (2012) la obligación de los Estados Parte de garantizar la reparación a las víctimas de tortura y afirma que la restauración de su dignidad es el objeto último de las disposiciones sobre reparaciones. Según los Principios y directrices básicos sobre el derecho de las víctimas de violaciones manifiestas de las normas internacionales de derechos humanos y de violaciones graves del derecho internacional humanitario a interponer recursos y obtener reparaciones, adoptados por la Asamblea General en su Resolución 60/147 (2005), la reparación plena y efectiva incluye restitución, indemnización, rehabilitación, satisfacción y garantías de no repetición. Todas ellas de gran importancia para las víctimas de malos tratos en el sistema de salud mental.

La restitución, una forma de reparación diseñada para devolver a la víctima a la situación anterior a la violación manifiesta, debe incluir el restablecimiento de la libertad, el derecho a estar libre de tratamiento forzado, el disfrute de la vida familiar y la ciudadanía, el retorno al lugar de residencia y el restablecimiento del empleo.

La indemnización debe otorgarse por cualquier daño que pueda tasarse económicamente, tal como daño físico o mental, pérdida de oportunidades incluyendo empleo y educación, perjuicios materiales y lucro cesante, daño moral y los costos incurridos por concepto de asistencia legal, médica y social.

La rehabilitación para las víctimas de psiquiatría forzada debe dirigirse a restablecer, tanto como sea posible, su independencia, sus habilidades físicas, mentales, sociales y vocacionales, así como su plena inclusión y participación en la sociedad. Las víctimas de psiquiatría forzada pueden estar en riesgo de revictimización y sentir temor fundado de actos que les recuerden los malos tratos vividos. En consecuencia, debe darse una alta prioridad a la necesidad de crear un contexto de seguridad y confianza en el que pueda prestarse asistencia. Sobra decir que cuando los malos tratos son realizados por parte de profesionales de la medicina en el marco del sistema público de salud, será muy difícil, si no imposible, que el mismo sistema genere confianza para sus víctimas.

Las medidas de satisfacción deben incluir mecanismos dirigidos a la cesación de las violaciones continuadas, la verificación de los hechos y la difusión pública de la verdad; un pronunciamiento oficial o judicial restableciendo los derechos de la víctima, sanciones contra las personas responsables de las violaciones de derechos, investigación y procesamiento penales, disculpas públicas, incluyendo el reconocimiento de los hechos ocurridos y la aceptación de responsabilidad por los mismos.

El derecho a la verdad es particularmente importante para las víctimas de psiquiatría forzada, que han vivido maltratos por un largo tiempo y de manera generalizada bajo el pretexto de recibir tratamiento médico. Necesitamos que se conozca la verdad sobre lo que nos pasó, la verdad sobre las consecuencias, que haya reconocimiento y disculpas públicas, como primer paso en el proceso de reincorporación social, justicia y sanación. En tanto las prácticas coercitivas en salud mental representan patrones de violencia contra las personas con discapacidad psicosocial y de otro tipo, necesitamos reparaciones tanto a nivel colectivo como individual y esperamos que el Comité CDPD tome esto en cuenta en su trabajo y recomendaciones futuras. Los Estados Parte deben desarrollar procedimientos para reparar a todas las víctimas de intervenciones psiquiátricas forzadas.

Las garantías de no repetición deben incluir medidas contra la impunidad, para la prevención de actos violatorios en el futuro, así como la revisión y reforma de las leyes que contribuyen o permiten las violaciones de derechos.

Los Estados Parte deben reconocer la obligación inmediata de impedir que haya malos tratos a través de las intervenciones psiquiátricas forzadas, adoptar las acciones necesarias para abolir leyes que autoricen el tratamiento psiquiátrico y la detención psiquiátrica forzados y desarrollar leyes y políticas que sustituyan regímenes coercitivos con servicios que respeten plenamente la autonomía, voluntad y la igualdad de derechos de las personas con discapacidad.

Gracias.

February 5, 2016March 1, 2020

Bonnie Burstow on Call to Action

reposted from BizOMadness blog, written by scholar and activist Dr. Bonnie Burstow

The CHRUSP Call to Action and Its Significance

Various instruments of the United Nations have commented on forced treatment, or involuntary confinement, or both (for details, see Burstow, 2015a), and a number of truly critical additions to international law have materialized. Arguably, the most significant of these is the Convention on the Rights of Persons with Disabilities (see http://www.ohchr.org/EN/HRBodies/CRPD/Pages/ConventionRightsPersonsWithDisabilities.aspx). What makes it so significant? For one thing, because this landmark convention puts forward nothing less than a total ban on both involuntary treatment and the involuntary confinement of people who have broken no laws.

To highlight a couple of relevant passages, article 12 of the CRPD states, “State parties shall recognize that persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life.” Correspondingly, article 14 states:

State parties shall ensure that people with disabilities, on an equal basis with others:

Enjoy the right to liberty and security of the person
Are not deprived of their liberty unlawfully or arbitrarily … and that the existence of a disability shall in no way justify a deprivation of liberty.

What is likewise significant, the guidance provided clarifies that the ban on forced treatment and on voluntary committal is to be seen as absolute (see http://www.ohchr.org/Documents/HRBodies/CRPD/14thsession/GuidelinesOnArticle14.doc).

What we have here in other words is nothing less than a colossal breakthrough.

In line with the CRPD breakthrough, CHRUSP (Center for the Human Rights of Users and Survivors of Psychiatry) has issued a call to action in support of the prohibition (see https://absoluteprohibition.wordpress.com/). I strongly support this campaign both as a human being generally and as a psychiatry abolitionist—hence this article.

First let me say that whether or not one is a psychiatry abolitionist, or to put this another way, whether one sees some value in psychiatry’s tenets and approaches or whether one regards them as both totally foundationless and inherently damaging, there is an onus upon us simply as human beings to find a way to support campaigns of this ilk. When basic rights such as the right to decide what does or does not enter one’s own body and the right not to be confined to a locked ward are at issue, we all of us have a moral obligation to do something to set the situation right. How can it be acceptable to override people’s right to make decisions for themselves? To stop people from walking about freely—especially when they have broken no law? Nor can the deprivation of such rights be warranted by claims (what follows are several of the standard ones) such as the person lacks the capacity to make decisions for themselves or they are of danger to self or others. As noted in Burstow (2015b), while for sure people may need assistance in making decisions, incapacity per se is a circular institutional construct; and besides that it is indefensible to deprive people of freedom on the basis of prediction, the elites involved in such decisions (read: psychiatric professionals) have virtually no ability to predict dangerousness. Nor for that matter do others.

The long and the short is that the cause is just, liberation from oppression is at issue, and irrespective of any differences in our respective understandings of psychiatry, there is ample reason for us all to place a priority on the current campaign. I am accordingly enthusiastically joining with leaders like Tina Minkowitz (see http://www.madinamerica.com/2016/01/campaign-to-support-crpd-absolute-prohibition/) in urging people to get involved.

That noted, while the campaign in question places a very special onus on all of us, and my major purpose in this article is to support that, I did additionally want to do what no other writer to date has done—to tease out the special meaning that the CRPD and such campaigns uniquely hold for those of us who are abolitionists, whether inadvertently or otherwise. What is especially apropos here is the attrition model of psychiatry abolition. So what is the attrition model of psychiatry abolition? And as an attrition model abolitionist, how do I understand the current campaign?

Predicated on the understanding that psychiatry abolition is a process and a direction as opposed to a goal which can be quickly attained, the attrition model of psychiatry abolition, as articulated in Burstow (2014) and adopted by Coalition Against Psychiatric Assault (see https://coalitionagainstpsychiatricassault.wordpress.com/attrition-model/)

is a model for determining what actions and campaigns to support and what to prioritize. An operant principle is that active support be predicated on the capacity or tendency of the action or campaign to move society in the direction of abolition. Pivotal to the model are the following defining questions:

1) If successful, will the action or campaigns that we are contemplating move us closer to the long range goal of psychiatry abolition?

2) Are they likely to avoid improving or adding legitimacy to the current system?

3) Do they avoid widening psychiatry’s net? (Burstow, 2014, p. 39).

Now again, while supporting the CHRUSP call to Action is urgent and necessary for the reasons already indicated, the degree of prioritization for an attrition model abolitionist would depend on the answers to such questions. So are there “yes answers” to the questions above? Let me suggest that albeit to varying degrees, in all three cases, yes.

To tackle this one by one, beginning with the first question, any measure which abolishes any integral aspect of psychiatry without question moves society demonstrably in the direction of abolition. Hence the prioritization by Coalition Against Psychiatric Assault, for example, of the abolition of certain “treatments” (e.g., ECT). And does this campaign target the abolition of anything integral to psychiatry? Obviously yes—all use of force and coercion. As such, the first criterion is satisfied.

Which brings us to Question Two: Is the campaign likely to avoid improving or adding legitimacy to the current system? This is the most ticklish of the questions, for a case could be made that the psychiatric system would be improved by becoming less coercive. This notwithstanding, my sense is that eliminating the coerciveness in no way constitutes an endorsement of psychiatry and could in fact function in the exact opposite way—that is, it could lead people to ask themselves: What else should go? It could even in the fullness of time, culminate in a more wholesale questioning of psychiatry—especially once it is seen that eliminating coercion can be accomplished without a plethora of horrid consequences following.

Finally, Question Three: Does the campaign in question avoid widening psychiatry’s net (translation: Would the campaign, if successful, avoid enabling psychiatry to scoop up ever more people?)? Here the answer is a resounding yes. The point is that were this campaign successful, not only would it not widen psychiatry’s net, it would demonstrably narrow it, allowing all those who say “no” to escape psychiatry altogether.

What follows from this analysis, this campaign is in line with abolitionist principles. And as such, prioritizing this campaign is a natural move for abolitionist groups to consider.

Summarizing Remarks, Invitations, Suggestions, and Warnings

A very important move has been taken by the United Nations in the passing of the CRPD. For the first time in history, there is an international legal clarification that psychiatric survivors must enjoy the same rights as everyone else—that is, force is absolutely prohibited. This is not just “any” organization taking this position, additionally—this is a mammoth mainstream organization which wields both moral and legal clout. Correspondingly, an important campaign is now under way to support the absolute prohibition that is part and parcel of the CRPD. What has been shown in this article is that the prioritization of this campaign makes sense both on a fundamental human rights level and additionally, on a psychiatry abolition level. Given the prestige of the United Nations and given that many countries have already signed and even ratified the Convention, moreover, explicitly wedding this campaign to the Convention itself is itself pragmatic.

My hope is, correspondingly, that many embrace this campaign and join us in actively promoting it. Please consider contributing articles and pictures to the CHRUSP website. Please talk to others. Perhaps create educational events. If your country has not signed the Convention, not ratified the Convention, has added a restriction, or is simply in non-compliance, you or your group might want to take the lead in making the problem known. We have a moment for change here—and my hope is that enough people will face whatever fears stop them and reach out and grab it. Not that winning this fight will be easy, for countries have a habit of ignoring/evading international law, including contractual obligations which pertain by virtue of being signatories to a convention. All the more reason to double and triple our efforts.

The biggest obstacle that we are likely to encounter is people’s fear of dangerousness. Be prepared to address it. Arguably, the second biggest is people’s sense that vulnerable folk are going to be deserted. A point to be made when talking to others is that the CRPD is clear that supports must be offered. And indeed, if we go about this correctly, the era of the CRPD could well become the era when an unprecedented number of new and exciting support options materialized for people—and, of course, voluntary ones. In this regard, contrary to the common and I would suggest duplicitous equation of psychiatry and services, and besides that “service” and “coercion” are more or less mutually exclusive categories, is not the stranglehold exercised by psychiatry itself one of the principal factors responsible for the paucity of services?

In ending, to comment briefly on a snag. Were this campaign successful—and yes, it is for sure an uphill battle—psychiatry’s likely response will be to step up its misrepresentation of its “treatments.” The point here is that the future of psychiatry would then be more dependent on personal buy-in; and as we know, institutional psychiatry, alas, has virtually no qualms about misrepresentation.

Now some may feel that this last point is a “red herring” or minimally a minor issue since the CRPD explicitly specifies that “informed” consent is necessary. To be clear, indeed it does, but so does almost every piece of “mental health” legislation in the world and that has had no impact whatever on the ongoing and ever expanding production and dissemination of psychiatric misinformation. Ironic though this may seem, the upshot is that in the event of success, stronger monitoring of and stronger reins on psychiatry would be absolutely necessary.

A conundrum to be sure, but hardly one that we have not encountered before.

References

Burstow, B. (2014). The withering of psychiatry: An attrition model for antipsychiatry. In B. Burstow, B. LeFrançois, & S. Diamond (Eds.), Psychiatry disrupted (pp. 34-51). Montreal: McGill-Queen’s University Press.

Burstow, B. (2015a). Canada—A Human Rights Violator (see http://bizomadness.blogspot.ca/2015/09/canada-human-rights-violator.html)

Burstow, B. (2015b). Psychiatry and the business of madness: An ethical and epistemological accounting. New York: Palgrave.