Category: Involuntary commitment

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Jolijn Santegoeds – Why forced psychiatric treatment must be prohibited

Why forced psychiatric treatment must be prohibited

Translation of Dutch article “Waarom gedwongen GGZ behandeling verboden moet worden”

Why forced psychiatric treatment must be prohibited
29 March 2016, by Jolijn Santegoeds, founder of Stichting Mind Rights[1], Co-chair of World Network of Users and Survivors of Psychiatry (WNUSP)[2], board member of European Network of (Ex-) Users and Survivors of Psychiatry (ENUSP)[3]

Click here to download the article:
Why forced psychiatric treatment must be prohibited_29 March 2016

 

For centuries there has been resistance against forced admission in institutions, confinement in isolation cells, tying persons up with fixation-straps, the forced administration of medication, forced electroshocks, and other forced psychiatric treatments.

Coercion is not care
Coercion is one of the most horrific things that people can do to each other, while good care is actually one of the best things that people can offer to each other. There is a fundamental difference between coercion and care.

Coercion works countereffective to wellbeing, and leads amongst others to despair, fear, anger and grief for the person concerned. During coercion the voice of the person is ignored, and their boundaries are not respected. Coercion does not lead to more safety, or recovery of mental health. On the contrary: By suffering, powerlessness, and a lack of support, the risks for increasing psychosocial problems and escalation increase. Coercion is the opposite of care.

Coercion means a lack of care
Forced psychiatric interventions are not a solution, but are a problem for mental health care. For a long time, the existence of forced treatments, which enables caregivers to turn their back to the crisissituation and leave the person behind without actual support, is undermining the real development of good care practices.

Good care is possible
Good care can prevent coercion. By a respectful attitude and good support, problems and escalation can be prevented successfully, which makes coercion obsolete[4]. Real care is possible.

Efforts are needed
Despite the fact that all stakeholders in Dutch mental health care want to ban coercion[5], the total number of the use of coercion (the number of  legal measures RM and IBS) is rising annually. There are however specific initiatives to reduce coercion at various locations, such as the development of HIC (High/Intensive Care psychiatry)[6], where they aim to prevent solitary confinement by enabling intensive support. On the other hand there is an enormous rise in outpatient coercion (conditional measures), as well as in incidents with “confused people”. It has been concluded a number of times, that the practices are “persistent”, and that the culture is “hard to change”.

Learning from history
Europe has a long history of xenophobia against persons with psychosocial problems. Ever since the 15th century there have been special prison-like “madhouses”, where persons were chained and locked up like beasts, and exorcisms were common. After the discoveries of Charles Darwin and the Renaissance (17th and 18th century), the medical sector started to arise, followed by the arrival of the first Dutch Lunacy-law in the 19thcentury, which arranged “admission and nursing of lunatics in mental hospitals”, with the goal to provide “more humane” care as compared to the madhouses. The young medical science comprised a diversity of perceptions, and in the 20th century a lot of experiments followed, such as hot and cold baths, lobotomy, electroshock and so on. The “special anthropology”[7] or racial-science and eugenics, focussed on the search for the perfect human being, and “racial hygiene” to “avoid deterioration of the race”, openly doubting the capacities of certain populations, which resulted in genocide which didn’t spare psychiatric patients (WOII).

After these dark pages in history, universal declarations of human rights were established, emphasizing the value of each human being, and gradually the community became more tolerant. However, psychiatry hardly changed and held on to the questionable and experimental foundation, with confinement, regulation regimes, and experimental treatment methods as the unchanged core of the treatment range. Currently, efforts are still made to force persons into behavioural changes with the argument that they are “incapable of will” themselves, and not able to express preferences. This is absolutely incorrect: Every person sends signals. The challenge is to deal with that in a good way. Real care notices the person behind the behaviour. Professional care is something totally different than primitive repression of symptoms.

It is time to draw a line. It is urgently needed to recognize that mental health care got on a wrong track by history. Harsh ‘correction’ of persons until they are found ‘good enough’ is not a righteous goal of mental health care. It should be about wellbeing. Coercion is a revealed mistake of mental health care. Innovation is needed.

Worldwide need for coercion-free care
All over the world forced treatment exists. Extremely atrocious images are known from poorer parts of the world, with chained people for example in Asia[8] and Africa[9], but also in our own country with Brandon[10] and Alex[11]. As long as the western world keeps claiming that coercion is the same as good care, these scenes will be harder to ban, especially since several countries have high expectation of the western approach. It is important to come up with good solutions in the world wide search for coercion-free care.

Call by the United Nations
Since 2006, the UN Convention on the Rights of Persons with Disabilities (CRPD)[12]exists, which illustrates that a worldwide change is needed towards persons with disabilities. Several UN mechanisms clarify that coercion in care is a violation of human rights[13], [14], [15], [16], also when it comes to the Netherlands[17], [18]. A change is needed.

What’s next?
This is an important question.
What do we want now? Are we finally going to make it really right?
Are we going to show ourselves from our best sides?

A real change of culture is needed. Mental health care needs to reinvent itself, and put an end to the confinement and the use of coercion. Good care is possible.

“Yes but it is not possible…”
Commonly heard reactions are “These are good ideals, but not realistic” or “There is no other way, because the system isn’t supportive” or “The community is totally not ready for this”. The implicit assumption that a culture change would be ”unrealistic”, indicates limited perspective, hope and ambition. The system is in our hands. We are the current generation. Change is possible. The world is changing constantly. Also mental health care can change[19], [20], as can the public opinion. We are not powerless or insensitive. Efforts are needed to make the world better and nicer together. We can do that.

Change can feel scary. Without positive history or good practices elsewhere it may be a bit harder to imagine that everything can be different, but this cannot be a reason to just give up immediately. We do not question ourselves whether stopping all hunger in the world is realistic before we start with that. Every person counts. Real care is possible and needs to be realized, also in acute and complex crisis situations. Practices of abuse need to stop instantly. This is the task that has been given to our generation. It is worth to unite all our efforts to make the historical shift from exclusion to inclusion.

Also the remark “Yes but coercion is needed, as long as there are no alternatives”  needs to be refuted here. Coercion is not care, but it is abuse, and there is no valid excuse for abuse. Coercion is never needed. Good care is needed.

Making human rights a reality
The UN Convention on the Rights of Persons with Disabilities (CRPD) gives a momentum for change. If everyone cooperates now, throughout all layers of the system, then the intended change gets an unprecedented impulse. The articles of the UN-Convention offer a guidance, which enables worldwide coherent action. The UN Convention offers vast opportunities to change the world.

Together we can ban forced psychiatric treatments. When there’s will, there’s a way. In history, confinement was put central, and by now we know better. So we have to do better too. A largely unexplored world is ahead of us.

Key points
It is not easy to change the mental health care system, and the confidence in mental health care doesn’t restore without efforts. Several things are necessary to change the situation sustainably:

-Realise good care
The old fashioned psychiatry is not founded on human rights, diversity and inclusion, but on xenophobia and exclusion. Science has focussed so far on homogenising the community, and attempts to change the people (a bodice and check box mentality). Modern mental health care should focus on enabling a heterogeneous and  diverse community, by creating the right conditions in the community and to enable self-determination, liberty and inclusion, so that everyone can be happy and live a fulfilling life in our community. A fundamental reform is needed in mental health care.

Wellbeing – or mental health – is a very personal intrinsic value, which cannot be produced by coercion. Recovery from psychosocial problems is not an isolated process of the person concerned, but is closely intertwined with the social context of the person, such as chances in life, social acceptance and inclusion. The range of care needs to be reviewed fully, and adapted to the requirements of today.

Deprivation of liberty needs to be stopped immediately. The organization of care of good quality is necessary and urgent, and cannot be postponed any longer. The previous guidelines under the law BOPZ of 1994 to use coercion “as little as possible” and “as short as possible” have failed obviously, and the numbers on the use of coercion (legal measures RM and IBS) continuously keep on rising annually, and have more than doubled in the past 10 years. This trend is unacceptable, and therefore something really needs to change now. A need for support cannot be a reason for deprivation of liberty. Good care is possible.

Without good care, the mess will only transfer. It is absolutely necessary to make all possible efforts right now to provide care of good quality, including good care in crisis situations.

– Legislation: prohibit coercion, arrange care
The legislation on forced psychiatric treatments needs to be changed. The goal of mental health care is not: Treating vulnerable persons in a rough way, but the goal is to provide good care, also in crisis situations. A transition is needed.

The lunacy law dates from 1841, from a time when the medical profession was absolutely in it’s infancy. The law BOPZ of 1994, and also the law proposal on Mandatory Mental Health Care (recent) have a similar structure of legal measures RM and IBS, and resp. confinement and forced treatment form the core. This system is not founded upon awareness of human rights, and it is not about care of good quality, and it has to change.

Forced treatment is abuse. Legislation needs to protect all citizens from abuse. When the government participates in the abuse against certain groups, this is torture[21], [22], which is absolutely prohibited. The laws on coercion, such as BOPZ and the law proposal on Mandatory Mental Health Care are therefore unacceptable.

Legislation is meant to offer a fair framework for the community. A prohibition of forced treatments is necessary because of human rights[23]. Additionally, certain legislation can speed up the provision of good care and organize innovation[24]. It is possible to create laws that are really useful to the community. Wouldn’t that be great?

– Compensation: Recognize the seriousness
For years and years, the government and countless caregivers have taken over the lives of psychiatric patients, and forcefully subjected them to “care”, such as horrible forced treatment, isolation cells, forced medication, restraint-belts, electroshocks, all motivated by so-called “good intentions”. The sincerity of those responsible can now prove itself by genuine recognition of the suffering that many had to endure. A compensation would be appropriate: When you break something you have to pay for it. We consider that very normal.

* Apologies are needed to recover the relation between (ex-) users and caregivers.
* Recognition of the trauma’s by coercion, and support in overcoming these if desired.
* Compensation to show that the change of attitude is genuine.

Now it’s time to show that the Netherlands is indeed a civilized country.

Take action
I would like to call on everyone to contribute to the change in culture. Let’s ensure together that human rights will be realized for every human being, and that old-fashioned psychiatry disappears, and that mental health care only comprises good care.

Please spread this message to raise awareness.

 

**

To reinforce the above plea, I have attached a description of my personal experiences with forced psychiatry, which can be found via this link:

“16 years old, depressed and tortured in psychiatry – A testimony on forced psychiatric interventions constituting torture and ill-treatment”

 

**

This publication is part of the ‘Absolute Prohibition Campaign’, see https://absoluteprohibition.wordpress.com

 

[1] Actiegroep Tekeer tegen de isoleer! / Stichting Mind Rights www.mindrights.nl

[2] WNUSP: World Network of Users and Survivors of Psychiatry www.wnusp.net

[3] ENUSP: European Network of (Ex-) Users and Survivors of Psychiatry www.enusp.org

[4] Report: Best practices rondom dwangreductie in de GGZ 2011

[5] Declaration on reduction of coercion:  Intentieverklaring GGZ: preventie van dwang in de GGZ 2011

[6] High Intensive Care HIC (HIC)

[7] Description of Racial-science e.a.: Winkler Prins Algemeene Encyclopaedie, vijfde druk, Elsevier, 1936

[8] Human Rights Watch “Living in hell – abuses against people with psychosocial disabilities in Indonesia”, 2016

[9] Robin Hammond, fotoserie “Condemned – Mental health in African countries in crisis”

[10] Brandon van Ingen, Jongen al 3 jaar vastgebonden in een zorginstelling

[11] Alex Oudman, Schokkende beelden uit isoleercel – Toen en nu

[12] UN Convention on the Rights of Persons with Disabilities (CRPD)

[13] CRPD General Comment no. 1 on CRPD article 12 Equal Recognition before the law

[14] CRPD Guidelines on CRPD article 14 Liberty and Security of Person

[15] Statement of 2 UN Special Rapporteurs “Dignity must prevail – an appeal to do away with non-consensual psychiatric treatments” World Mental Health Day, 10 October 2015

[16] A/HRC/22/53 Special Rapporteur on Torture, Juan E Mendez, Torture in health care settings (2013)

[17] Communication sent to the Kingdom of the Netherlands by the UN Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment and the UN Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health. AL Health (2002-7) G/SO 214 (53-24) NLD 2/2013, October 2013, https://spdb.ohchr.org/hrdb/24th/public_-_AL_Netherlands_08.10.13_(2.2013).pdf

[18] CAT/C/NLD/CO/5-6, CAT Concluding Observations on the Netherlands

[19] High Intensive Care HIC (HIC)

[20] Intensive Home Treatment (IHT)

[21] Torture, for full definitiion see article 1 CAT, Convention Against Torture.

[22] A/HRC/22/53 Special Rapporteur on Torture, Juan E Mendez, Torture in health care settings (2013)

[23] amongst others the right to liberty, freedom from torture / Civil and political rights and CRPD

[24] amongst others the right to health care and adequate standard of living / Social, economic and cultural rights and CRPD

 

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ENUSP -Forced psychiatric interventions constitute a violation of rights and disable care

Human rights context

Since 2006, the United Nations Convention on the Rights of Persons with Disabilities (UN CRPD) calls for a paradigm shift to break away from paternalistic laws and paternalistic attitudes towards persons with disabilities, and shift to respectful support of decision-making based on the person’s own will and preferences. The implicit call of the UN CRPD to put an end to forced psychiatric treatments has been made explicit by several publications of the CRPD Committee, and especially by the Guidelines to Article 14. The Guidelines make clear that the detention of persons with psychosocial disabilities under domestic legislation on the grounds of their actual or perceived impairment and supposed dangerousness to themselves and/or to others “is discriminatory in nature and amounts to arbitrary deprivation of liberty.”[1]

 

Nevertheless, two UN treaty bodies currently are in conflict with the standards set by the UN CRPD: the Human Rights Committee[2] and the Subcommittee on Prevention of Torture (SPT) in their document “Rights of persons institutionalized and medically treated without informed consent”. Yet the Human Rights Committee admits that forced measures are harmful: “The Committee emphasizes the harm inherent in any deprivation of liberty and also the particular harms that may result in situations of involuntary hospitalization.” [3] The Human Rights Committee even recommends States parties “to revise outdated laws and practices” and says that “States parties should make available adequate community-based or alternative social-care services for persons with psychosocial disabilities, in order to provide less restrictive alternatives to confinement.” However, despite this, the Human Rights Committee acknowledges the possibility of forced measures, provided they are applied “as a measure of last resort and for the shortest appropriate period of time, and must be accompanied by adequate procedural and substantive safeguards established by law.”[4]

Also the SPT allows forced commitment and forced treatment, but they go even further by saying that abolition would violate the “right to health” and the “right to be free from torture and other ill-treatment”. For instance, the SPT states “…placement in a psychiatric facility may be necessary to protect the detainee from discrimination, abuse and health risks stemming from illness”[5], “The measure [treatment without consent] must be a last resort to avoid irreparable damage to the life, integrity or health of the person concerned…”[6]. In addition, the SPT acknowledges restraints as a legitimate measure: “Restraints, physical or pharmacological … should be considered only as measures of last resort for safety reasons”[7], and further allows for “medical isolation”[8].

It is interesting to note that before the publication of these two documents mentioned above, the thematic report “Torture in Health Care Settings” by the UN Special Rapporteur on Torture and other cruel, inhuman or degrading treatment or punishment (A/HRC/22/53), urged an absolute ban on forced psychiatric interventions, in order to ensure that persons with psychosocial, intellectual and other disabilities be free from torture and ill-treatment. However his voice apparently was not heard, as well as other voices documenting numerous violations of human rights in psychiatric institutions. One of them is the report of FRA issued in 2012, which reveals the trauma and fear that people experience, and states that “the extremely substandard conditions, absence of health care and persistent abuse have resulted in deaths of residents in institutional care.”[9]

 

Therefore, it can be seen that the arguments in favour of the administration of forced measures are based on false grounds, because as has been proven by numerous sources, including CPT reports and the sources mentioned above, psychiatric institutions in no case can be considered a safe haven from discrimination, abuse, torture and ill treatment. With regard to medical considerations and care we put forward the following:

 

Forced psychiatric interventions are not care.

Care is supposed to result in improved well-being and recovery. Well-being – or mental health – is a very personal, intrinsic value, which cannot be produced by force. Caring for one another is one of the best things that people can offer to each other. On the contrary, forced psychiatric interventions are very traumatizing, and result in suffering and more psychosocial problems. It makes the situation worse, and is amongst the worst things that people can do to each other. There is a huge difference between forced interventions and care. They are the total opposite of each other.

 

Forced psychiatric interventions disable care.

Forced psychiatric interventions are counter-productive to mental health and care, and represent a “breach of contact”. This can be seen on the one hand, for example, with nurses who stop trying to communicate or provide support, and resort to forced interventions. It can also be seen on the other hand, in the feelings of misunderstanding and trauma of the person subjected to forced interventions, which disable meaningful contact. It is obvious that good contact and communication are necessary for good mental health care. The end of communication, as is induced by forced psychiatric interventions, is a very harmful practice, which makes meaningful contact, and therefore mental health care in itself, impossible.

 

Forced psychiatric interventions do not result in safety.

Due to suffering, increased psychosocial problems, and a lack of any support for recovery caused by forced psychiatric interventions, the risks of escalation increase, and can even result in an endless circle of struggle and escalation, as our experiences show. The common argument given “to protect from harm or injury to self or others”, is not based on factual evidence supporting this statement. Forced psychiatric interventions do not result in more safety, but lead to more crises, and subsequently to greater risk of escalation.

 

Forced psychiatric interventions indicate a deficiency in mental health care.

Forced psychiatric interventions are more of a mechanism for (attempted) social control embedded within an underdeveloped and structurally neglected (and politically abused) system of mental health care that is built on the horrible remnants of the past, rather than on skills to support mental health and well-being. Underdevelopment and insufficient funding of the mental health care system is in place because of the extremely low political priority given to mental health care, consequently explaining the extremely low level of funding. It is impossible to deliver quality care without proper funding and attention to quality standards. However, due to historical stigma, mental health care remains unpopular with society, i.e. voters, and therefore politicians. In case of dire shortage of funding, the best possible solution for the system is to keep things calm, by delivering lots of harmful and in many cases unwanted medication to isolated people and calling it medical care. However, real mental health care is possible when efforts are made and sufficient funding is provided.

 

A world of options between “last resort” and “no care”

Many persons, including many States, cannot see beyond a very narrow “black and white” approach regarding psychosocial crisis situations, with only two options: either forced treatments (torture), or doing nothing (neglect). This simply isn’t the full picture. Between these two extremities, there is a largely undiscovered world of options for real support and real mental health care in psychosocial crisis-situations, with aspects such as: non-violent de-escalation, prevention of crisis in the earliest stage possible, focussing on contact and openness instead of repression, building trust and providing real support in acute crisis-situations. (Ex-) users and survivors who have experienced this are the best positioned to be involved in this shift of paradigm.

 

Real development of mental health care is urgently needed.

Unfortunately for decades, the real development of good care practices has been undermined by the existence of forced treatments, which has enabled caregivers to turn their back to the crisis situation, and leave the person behind without actual care, repressed and stripped of their dignity. This should stop. Forced psychiatric interventions constitute a very serious human rights violation. They can never be called care and cannot be considered a safety and anti-discrimination measure, because they lead to exactly the opposite.

 

We believe in the creative potential of humanity and the possibility to solve complicated problems when appropriate efforts are made. But in order to allocate the appropriate resources and generate enough creative efforts, appropriate motivation is needed. The UN CRPD standards give us and should give policymakers such motivation to realize and state publicly that the status quo in psychiatry is totally unacceptable and must be changed to a humane system of real care.

 

The discrepancies in the recommendations referred to above, even among different entities of the same organization (United Nations) must be eliminated and the provisions of the CRPD must prevail.

 

This is a challenge, but by thinking and acting together, it is possible to make this a reality.

 

We must keep in mind just one thing as a basis for this objective:

 

 

Forced psychiatric interventions constitute torture and ill-treatment and

must be banned!

 

 

 

 

 

 

 

[1] CRPD Committee’s Guidelines on article 14 Liberty and security of person, III, para.6 (September 2015)

[2] General Comment No.35, para.19 (30 October 2014)

[3] Ibid.

[4] Ibid.

[5] SPT, Rights of persons institutionalized and medically treated without informed consent, para.8

[6] Id. para.15

[7] Id. para. 9

[8] Id. para.10

[9] European Fundamental Rights Agency: Involuntary placement and involuntary treatment of persons with mental health problems, 2012. Available at: http://fra.europa.eu/sites/default/files/involuntary-placement-and-involuntary-treatment-of-persons-with-mental-health-problems_en.pdf

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Robert Whitaker: Medical Science Argues Against Forced Treatment Too

The argument that is usually made against involuntary commitment and forced treatment is that these actions, under the authority of a state, violate a person’s basic civil rights. They deprive a person of liberty and personal autonomy, and do so in the absence of a criminal charge. The United Nations Convention on the Rights of Persons With Disabilities upholds that position by prohibiting discrimination in relation to these rights. That is a morally powerful argument, and it should stand at the center of any protest against forced treatment.

However, there is another argument, one of adjunctive value, that can be made against involuntary commitment and forced treatment. Medical science argues against forced treatment too.

The “state,” in order to justify involuntary commitment and forced treatment, will argue that such coercion is necessary to provide “medical treatment” to individuals who, because of their impaired state of mind, won’t give their consent to such treatment. The implication is that if the “psychotic” individual were of sound mind, he or she would want this treatment, and thus the state is serving as a helpful guardian. But this “medical” argument falls apart upon close examination.

First, there is evidence that psychiatric hospitalization itself—whether voluntary or involuntary– leads to an increased risk of suicide. In a 2014 study, researchers at the University of Copenhagen looked at the psychiatric care received by 2,429 individuals in the year before they committed suicide, and after matching this group of completed suicides to a control group of 50,323 people in the general population, and after making adjustments for risk factors, they concluded that the risk of dying from suicide rose as people received increasing levels of psychiatric care. Taking psychiatric medications was associated with a six-fold increased likelihood that people would kill themselves; contact with a psychiatric outpatient clinic with an eight-fold increase; visiting a psychiatric emergency room with a 28-fold increase; and admission to a psychiatric hospital a 44-fold increase.[1]

In an editorial that accompanied the article, which was published in the Journal of Social Psychiatry and Psychiatric Epidemiology, the writers—all experts in suicide research—observed that these were robust findings. The Danish study, they wrote, “demonstrated a statistically strong and dose-dependent relationship between the extent of psychiatric treatment and the probability of suicide. This relationship is stepwise, with significant increases in suicide risk occurring with increasing levels of psychiatric treatment.” This link was so strong, they concluded, that “it would seem sensible, for example, all things being equal, to regard a non-depressed person undergoing psychiatric review in the emergency department as at far greater risk [of suicide] than a person with depression, who has only ever been treated in the community.”

These researchers concluded that it is “entirely plausible that the stigma and trauma inherent in (particularly involuntary) psychiatric treatment might, in already vulnerable individuals, contribute to some suicides. We believe that it is likely that a proportion of people who suicide during or after an admission to hospital do so because of factors inherent in that hospitalization.”[2]

Second, from a medical point of view, the “therapeutic relationship” between “patient” and “doctor” is understood to be an important factor to a “good outcome,” and forced treatment regularly leads to a breakdown in that relationship. The personal accounts of people who have been forcibly treated regularly compare it to torture, rape, and so forth. Moreover, these accounts cannot be dismissed as the writings of people who are “impaired” in their thinking, either at the time or later; such personal accounts often reveal an extraordinary level of detail and clarity.

Third, forced treatment regularly involves injections of an antipsychotic, and such initial treatment is regularly a precursor to long-term treatment with such drugs (and often in a coercive manner). However, there is now substantial evidence that such drug treatment over the long term does harm. For instance:

  • There is evidence that the drugs shrink brain volumes, with this shrinkage associated with an increase in negative symptoms, functional impairment, and cognitive decline.[3]
  • The drugs induce tardive dyskinesia in a significant percentage of patients, which reflects permanent damage having been done to the basal ganglia.
  • Martin Harrow, in his longitudinal study of psychotic patients, found that medicated patients fared worse over the long-term on every domain of functioning. The medicated patients were eight times less likely to be in recovery at the end of 15 years than those off the medication.[4]

This is simply a quick review of the medical case that can be made against forced treatment. But even this cursory review tells of treatment that increases the risk of suicide, can prove devastating to the “therapeutic relationship,” and may set a person onto a long-term course of medication use that has been found to be associated with a variety of harms and poor outcomes. As such, the argument that involuntary commitment and forced treatment are in the best “medical” interest of the “impaired” person falls apart when viewed through this scientific lens, and once it does, involuntary commitment and forced treatment can be clearly seen for what they are.

They are not a means for providing necessary “medical help” to an individual. They are an assertion of state authority and power over an individual, and that assertion of authority violates the person’s fundamental civil rights. Any societal discussion of involuntary commitment and forced treatment needs to focus on that issue, and not be distracted by the “medically helpful” claim.

 

[1] C. Hjorthøj, Risk of suicide according to level of psychiatric treatment—a nationwide nested case control study. Soc Psychiatry Psychiatr Epidemiol (2014) 49: 1357-65.

[2] M. Large. Disturbing findings about the risk of suicide and psychiatric hospitals. Soc Psychiatry Psychiatry Epidemiol (2014) 49:1353-55.

[3] J. Radua, “Multimodal meta-analysis of structural and functional changes in first 
episode psychosis and the effects of antipsychotic medications,” Neuroscience and 
Biobehavioral Review 36 (2012): 2325–33.

[4] M. Harrow. “Factors involved in outcome and recovery in schizophrenia patients not on antipsychotics medications.” J Nerv Ment Dis (2007) 195: 407-414.

 

 

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Documenta (México)

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

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

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

Published on Nov 10, 2015

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

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

Published on Nov 27, 2015

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

[vimeo 136127114 w=500 h=281]

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

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In Italy, we don’t have a law against torture, by Erveda Sansi

 

contro psicofarmaci_col_rid

Drawing by Vincenzo Iannuzzi

 In Italy, the situation in the psychiatric field, with almost no exception, has worsened from the period of questioning psychiatric institution, in the beginning of the sixties. Then, Italy has been at the forefront of the closure of mental hospitals. Not only Giorgio Antonucci, Franco Basaglia and many professionals, but also a good part of the common people, realized that psychiatric hospitals were not places of care. Civil society, then, was sensitive to the issue of smash-down asylum culture. Publications appeared, there was an open debate, workers and students organized themselves and entered in asylums to see the conditions in which their fellow citizens were locked up. They protested and denounced the deplorable conditions the internees were forced to live in.

However, since several years, we observe a re-institutionalisation process and, at the same time, in some Italian hospital’s psychiatric wards happened many deplorable facts, due to forced treatment, institutionalization and forced restraint. Some of these facts have become infamous after that committees and relatives have asked for justice, as in the case of the well liked teacher Francesco Mastrogiovanni, 58 years old, that was debated also on national television channels. Franco Mastrogiovanni, after a forced psychiatric treatment the 4th August 2009, (because of a road traffic offense: circulation, at night, on a street closed to traffic), has been heavily sedated, tied to the bed of Vallo della Lucania’s hospital psychiatric ward, and left to die after four days of abandonment. During the 80 hours hospitalization he was nourished only with saline solutions; he was tied hands and feet to the bed, in such a position that his respiratory functions where compromised, and he was sedated with high doses of psychiatric drugs, without supervision from the staff. At wrists and ankles there are 4 cm wide grazes. A hidden camera recorded everything; the video is of public domain. At the trial the responsible physicians were found guilty and sentenced to 3 and 4 years detention, that, with the mitigating clauses, they won’t have to serve. The 12 nurses were acquitted because “they obeyed an order”. The Committee truth and justice for Francesco Mastrogiovanni, asks for truth and justice. Watch also the film 87 ore (87 hours), gli ultimi giorni di Francesco Mastrogiovanni (Francesco Mastrogiovanni’s the last days) by Costanza Quadriglio.

 

In Italy some deaths due to forced hospitalization and/or prolonged or short-time use of mechanical and chemical restraint have been reported by the press, television and network (this mean that there are a lot of other such “incidents”, we don’t know):

27 October 2005: Riccardo Rasman dies during a coercive treatment by the policemen, for a hospitalization against his will, in a psychiatric ward in Trieste.

21 June 2006: Giseppe Casu, guilty of having wanted to pursue his peddler job in the village square, dies in a psychiatric ward in the hospital “Santissima Trinità” of Cagliari, as a consequence of a thromboembolism, after a forced hospitalization and having been heavily sedated. He was tied hands and feet to the bed, for 7 days and was sedated with high doses of psychiatric drugs against his will.

28 August 2006: A.S., the 17th of August 2006 is admitted to the psychiatric ward in Palermo, for medical investigations. A.S. died after 2 days coma, the 28th of August, probably for excessive doses of psychiatric drugs.

26 May 2007: Edmond Idehen a 38 years old Nigerian man, went voluntarily into the psychiatric ward of Bologna’s hospital “Istituto Psichiatrico Ottonello – Ospedale Maggiore Bologna”. As he tried to leave the hospital, because he did not feel cared, the doctors forced him to stay, with the help of policemen. Edmond Idehen died as a consequence of a hearth attack while nurses and policemen held him down. He was also strongly sedated with psychiatric drugs.

12 June 2006: Roberto Melino, 24 years old, dies for a hearth attack; he entered voluntarily the psychiatric ward of Empoli’s “San Giuseppe” hospital. As he tried to leave the hospital, he was forced to stay by the doctors, and obliged to take high doses of psychiatric drugs, in spite of his evident and serious breath difficulties.

15 June 2008: Giuseppe Uva, 43 years old, was brought inside a police station, because he was driving in state of high alcoholic level. There he was subjected to ill-treatments. After 3 hours he was forced to an obligatory hospitalization in the Varese’s “Circolo” hospital and was forced to take psychiatric drugs. He died because of the stress provoked by the mix of alcohol and psychiatric drugs.

30 August 2010: Lauretana La Coca, 32 years old, entered voluntarily in Termini Imerese’s “Salvatore Cimino” hospital. After 10 days of hospitalization her condition got worse, till she got into a comatose state and died.

Giuseppe D.: A man, more than 70 years old, was interned in Reggio Emilia’s psychiatric prison. His problem was that the neighbour’s daughter is a psychiatrist. His lawyer took a legal action to the European Court of human Rights, but until now there has been no answer, so the Pisa’s student group “Collettivo Antipsichiatrico Artaud”, together with “Telefono viola” from Milan, decided to release the documentation relating to this case in Internet, according with Giuseppe D.’s will, his lawyer, and his relatives.

2 April 2010: Eric Beamont, 37 years old, the 2 April 2010 was hospitalized in Lamezia. After 2 days he entered coma, so the doctors transferred him to the Catanzaro’s “Pugliese – Ciaccio” hospital, where he died. There is the suspect that the death of Eric was caused from a high dose of benzodiazepine. Diagnosis was: subarachnoid hemorrhage[1]

28 May 2015 Massimiliano Malzone died during a forced treatment.

11 July 2015 Amedeo Testarmata died during a forced treatment.

29 July 2015 Mauro Guerra died during a forced treatment.

5 August 2015 Andrea Soldi died during a forced treatment…

Unfortunately in this article we have not described isolated occurrences, but an emblematic situation of violation of human rights in the Italian psychiatric institutions.

These are just some of the “incidents” that came to the limelight, but many more of them are not known when they happen, because, for example, people who live in loneliness are involved, or people whose relatives have given their consent, or simply when people want to get rid of a person perceived as annoying. We The Mad Hatter Association, constantly of forced psychiatric treatments, during which treated people suffer heavy damages. Forced treatments are often made on request of relatives, when patients refuse to take any longer the psychiatric drugs, or when their behaviour is perceived as disturbing. A friend of us (I.M.) tried to escape, but he was chased and filled with drugs; shortly after he was found dead at the bottom of a ravine. He was 40 years old. Another friend (A.S.) was walking on a path between fields and was stopped by police, because he was known as a “mentally ill” person. Then they called the psychiatrist on duty and told him: “He was walking near the railway and could possibly have in mind to commit suicide”; so they locked him up. I know this person, who often walks in the fields, where, however, it’s easy to be located near the railway, because of the constitution of the territory. He had never the intention of committing suicide. Another acquaintance of us died, throwing himself under a train, terrified by the fact that his mother, according to the psychiatrist, would refer to forced psychiatric treatment for him. Another one (U.S.) has suffered of heavy harassment, after having reported his superior’s embezzlement, noticed during his duties as a municipal technician. He was subjected to forced psychiatric treatment, kidnapped by police in riot gear. While he was sleeping, his door was smashed down, and he was thrown on the ground face down and handcuffed. He says that at least they could have tried to open the door, which was not locked. Now he is terrified and he even fears the dark; he is forced to take psychiatric drugs.

We can not think of de-institutionalization before we have dismissed the rules that allow forced psychiatric treatment, that allow to hold a person against his will, without having committed any crime, without the right to an equitable process, based on the alleged dangerousness and only because this person was diagnosed with a mental illness.

The so called “Basaglia law” the law nr. 180 from 13.5.1978, then joined and actually regulated by Law 833/1978 articles 33, 34, 35, 64, establishes the “Accertamenti e Trattamenti sanitari volontari e obbligatori” (“Forced health verifications and treatments”). In 1978 the law nr. 180 imposed the asylums’ closure, and the elimination of dangerousness or/and public scandal as criterion for forced treatment. But in the most Italian province, asylums didn’t close. So it was necessary to make another law, (because these asylums were too expensive), the law n. 724 from 23.12.1994, art. 3 paragraph 5, which dispose that these asylums had to be closed within the 31.12.1996; again disregarded, differed until the end of 1999. In 1996 the asylum inmates in Italy were 11.516 in 62 public asylums and 4.752 in private asylums.

According to this art. 180 law, forced treatment and included forced hospitalization, are possible if there are the following conditions: 1) a person “suffering mental illness” requires urgent medical treatment; 2) refuse the treatment; 3) it’s not possible to take adequate measures outside the hospitals. Forced treatments has a maximum duration of seven days, but can be renewed if necessary and then extended if it persists for a reasoned clinical need (it’s not an exception that the duration is extended for months and years). For forced treatments and the consequently limitation of personal freedom, there must be a request signed by two physicians, an administrative validation from the Mayor is required, followed by the validation of a judicial review by the Tutelary Judge.

Legislation of forced psychiatric treatment provides ample scope for arbitrariness and it is in strong contrast to the human rights regulations, that aim at preserving even people with disabilities from inhuman and degrading treatments. For those who commit a crime, it is expected that the judicial authority, within certain specific procedural rules, sanctions or imposes restrictive measures. We constantly deal with innocent people in forced psychiatric treatment, who can no longer find a way out of the psychiatric institution.

“I have to confess”, said a psychiatrist, “to have a person completely in my power, made me feel a kind of sadistic shiver”.

In Italy the CRPD was ratified in 2009, but just at now we have not a law against torture, torture is not a crime, torture is not forbidden in Italy. So, those who torture does not violate the law. In the meantime a lot of intermediate psychiatric institutions (also called little asylums) were built. They are public or private and reimbursed from the State. A very great business is behind. Some other examples: Lazio Region President Polverini’s decree on Lazio hospital system: the number of beds in Psychiatric Institutions raise from 369 up to 629; more 70%. 50 beds for the public structure and 210 for the private structure trigger the chronicization circuit.

260 beds = 90.000 life days subtracted to the people at the cost of 10.000.000 €.

Didn’t the Basaglia Law foresee the closing up of madhouses?

  • Professor Antonucci, what is, to date, the status of implementation of the law 180?

– Apart from some single exceptional case, what proposed Franco Basaglia is not realized, but it continues a job that Basaglia obviously would not approve: authoritarian interventions, taking people by force and bring it in psychiatric clinics, which are the continuation of the asylum. The asylum was established by the authoritarian intervention: I take a person against his will, then I submit her to a series of forced interventions, which are the essence of the mental hospital”. (http://www.psicoterapia.it)

The deplorable situation of the six Forensic Psychiatric Hospitals recently became more visible, after surprise-inspections of a parliamentary committee. The videos of the visits, showed by the national television, and the press releases can be found on the web. A parliamentary report had already been made in June 2010, but the photographs show a situation that until now has not yet changed. People held for decades for minor offenses, whose penalty would have expired long time since, if not repeatedly and automatically renewed.

Here below we report some data extracted from the text of the parliamentary relation on the June 2010 inspection of the 6 Italian psychiatric prisons (forensic institutions) still active (Senator Ignazio Marino, physician ,was Chair of the Investigative Committee on the National Health Care System). After the 1978 “Basaglia law”, madhouses had to be closed, but the 6 psychiatric prisons mentioned above keep doing the same job. Senator Marino was also concerned about the increasing of electroshock (from 9 institutions allowed to give electroshock before 2008, now we have more than 90 psychiatric institutions who dispense ECT).

The regulations and logics that manage these psychiatric prisons (forensic institutions) (in Italian OPG-Ospedale Psichiatrico Giudiziario), are the same inherited by the fascist Rocco Code (1934). 40 % of the 1500 actual convicted should already have been released, for detention terms expired, but they see their penalty end terms deferred in order of their supposed social dangerousness.

Nine people each cell, dirty bathrooms and bed sheets; dirty nurses’ gowns as well. In Barcellona Pozzo di Gotto (Messina), 329 convicted are overcrowded in cells built in 1914. Dirt everywhere. One patient was found naked, tied up to his bed, with a haematoma on his head. Aversa, built in 1898. 320 people locked up six by cell, in inhuman conditions.

NAS (Antisofistication and health nucleus of Carabinieri (Police)) reported and denounced all this to the Public Prosecutor’s Office, but this office is often made by the same persons that sentence patients to life.

In the Secondigliano OPG, the psychiatric prison is interior to the jail. Here stays since 25 years a patient who was sentenced two years. Burns and black eyes are not reported on the clinical diary. Feet and hands go gangrenous.

In Montelupo Fiorentino OPG they are 170 in a very scruffy building. In Reggio Emilia OPG they are 274 where they should be 132. 3 showers serve 158 patients. One is tied up to his bed since 5 days for disciplinary reasons. 3 in 9 meters square. “The OPG (psychiatric prison) are one of the “silence zones”, explains Alberto, of the Pisa Antipsychiatric Collective dedicated to Antonin Artaud, “and they show the political use of psychiatry. The consume of psychiatric drugs is more and more pushed, the electroshock comes back “in fashion”, perhaps to “heal post partum depression”. And a law lies in ambush in order to bring the forced hospitalization terms from 7 to 30 days”. After the scandal came to light, on 17 January 2012 the Senate Judiciary Committee unanimously approved the definitive closure of the OPG by 31 March 2013. The closure was extended until March 31, 2015. After the closure of the facilities in 2015, according to Law Decree n. 211/2011, converted into Law no. 9/2012, have been replaced by residences for Execution of Security Measures (R.E.M.S.). We have to closedown the Forensic Psychiatric Hospitals, instead of changing the name of them. If we don’t shut dawn these places once and for all, we cannot talk about de-institutionalization. Close them not in order to transfer their users to other psychiatric institutions, but to give these people a life dignity.

A research (source: British Medical Journal) conducted in 6 European countries (Italy, Spain, England, Netherlands, Sweden, Germany), that have closed asylums in the 70s, saw that between 1990 and 2003 an increase in the number of beds in forensic psychiatric hospitals, in psychiatric wards, in so-called safe houses. Supported housing is seen as an alternatives to asylums, as a sign of de-institutionalization, but they are rather a form of institutionalization. Also forced treatments are increasing. It is not clear the reason why the number of beds in Forensic Psychiatric Hospital increased, since there is no correlation between crimes like homicides and de-institutionalized persons.

It would be important to spread the awareness that forced treatments, like the restraint is an anti-therapeutic act, that makes cures more difficult, rather than to facilitate them. Physical restraint is not exercised only in the field of psychiatry. The areas of operation where should be discussed the problem of legitimacy, usefulness and appropriateness of physical restraint, do not consist only in hospitals, but also in nursing homes for the elderly, therapeutic communities for drug addicts and nursing homes for people with disabilities related to congenital or early acquired disabilities. An improvement in psychiatric nursing practice, characterized by the renunciation of physical restraint, would be a strong signal in order to spot out the problem also in other operating environments, urging those who work in this field to act with similar treatment practices, rather than restrictive ones.

Referring to the psychiatric drugs there are rules of the Convention on Human Rights, which require user’s fully informed consent, before administering, even if he’s disabled. Most psychiatric drugs are prescribed for a long time, sometimes for life, without informing the user on their effects, and without any help in the resolution of his real and existential problems. Psychiatric drugs can cause neurological diseases, that sometimes become irreversible. Akathisia, dyskinesia, are very unpleasant effects and can throw a person in despair. Often the user is encouraged to continue taking the drugs even when he asks to withdraw them, and it is almost impossible to find professionals who help and give directions for withdrawal. Peter Breggin, a psychiatrist, working with institutions as WHO (World Health Organisation) and FDA (Food and Drug Administration), wrote hundreds of pages on the harmful effects of psychiatric drugs. Peter Lehmann, who tested the effects of drugs on himself during his hospitalization in a psychiatric clinic, has published and continues to publish the results of his research for which he uses pharmaceutical and medical literature. The effect of psychiatric drugs is known, but the billion-dollar business behind it is too big to lose it. Peter Lehmann is the first survivor of psychiatry to be awarded with the honorary degree, conferred him by the clinical psychology faculty of the Aristotele’s University of Thessaloniki, for his work as researcher and activist in the field of mental health.

A person who starts to take drugs, in most cases will be induced to take them for life, because they create addiction problems. The psychiatric user develops a very strong dependence toward the psychiatric service too. For the psychiatrists, lack of compliance is in fact intended in it self an aggravation of the disease. Then the conditioning that takes place, goes in the direction of dependence from psychiatric services, of becoming “childish” and “chronic patient”.

Although in almost all European countries asylums and psychiatric hospitals have been eliminated or substantially reduced, this does not mean that in the new post-asylum structures, asylum-dispositifs have been eliminated. People are, with few exceptions, completely sedated by psychiatric drugs, even though apparently there are implemented programs such as art therapy. The intake of psychiatric drugs is induced also in order to make the user unconscious.

Erwin Redig, a German psychiatric survivor, says: “There are people putting us under pressure to force us to take them (psychiatric drugs). If we do not take them, our changes embarrass them. If this is our case, we must make clear to ourselves that we are swallowing drugs for other people’s welfare, because they find us unpleasant if we do not”.

“The dispositif of discomfort-complex, that operates in a small residence, acts more broadly in the society”. Neuroleptic drugs affect thinking, block the flow of thoughts, and make people flatten. I relate the words of a healthcare professional: “As soon as psychiatric drugs are given to people, they literally get extinguished. To what extend is it fair to cancel the person?” Although in the European countries, the asylum psychiatry and the psychiatric hospitalization of users have given way to communities, the psychiatric institution culture has not changed. The patterns of asylum residentiality are still active. But most of all it is still alive an asylum mentality, therefore it is important for everyone to be aware how much everybody’s mentality is crucial in creating or not creating devices that belong to psychiatric institutions; operating devices that constitute a widespread operating module. “Residential Intermediate Structures”, foreseen in Italy by the 1983 law, should have had the provisional nature as their specificity; therefore they should not constitute either a definite admission or a final place for forced hospitalization; they should have been  transitional housing, that could break prejudice and exclusion logics. In March 1999, by a special decree, to the Italian Regions was imposed the definitive closure of the asylums, under threat of strong economic sanctions, because despite the birth, on paper, of the new “local services”, mental hospitals were still crowded with patients.

Named by the derogatory title of “asylum residuals”, for these people that nobody wanted, residential structures accounted for an illusion of freedom; they founded themselves to be again in a mental institution. “Many patients”, writes one of them in an autobiography, “have never been so well in terms of comfort, but nevertheless they are in a state of fearful desolation”.

An induced need of security, the defence from a potentially dangerous mind sick person that at any time, during an outbreak, could commit heinous actions against others or against himself; shortly, on the basis of this need and of this false scientific fundamentals, we build the myth of the need of post-asylums psychiatric institutions. If we don’t get reed of the psychiatric prejudice, the “mental health” institution remains. There are many alternatives pursued by individuals, associations or institutions, but they are deliberately ignored. The responsibility for solving the problems of institutionalization, is not up only to psychiatrists or to mental health professionals, but to the whole civil society. Everybody contributes to the asylum mentality. Users as well, who have internalized the psychiatric diagnosis and can no longer live without it.

Mary Nettle, chairman of Enusp until 2010, expects an increasing involvement of users and survivors of psychiatry in researches about psychiatry; while they often are excluded or not paid on the pretext that they are not professionals.

Although many examples exist that  prove that you can accompany a person in troubles out of his problems, through dialogue and support in the resolution of the objective and material difficulties, and helping him to get awareness of his own rights, these experiments and their positive results continue to be deliberately ignored.

 

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La Prohibición Absoluta a los Internamientos Involuntarios y Tratamientos Forzados en Psiquiatría: Tensiones con los mecanismos de privación de libertad por motivos de salud mental en Chile – Francisca Figueroa

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http://www.saludmentalycomunidad.cl/la-prohibicion-absoluta-a-los-internamientos-involuntarios-y-tratamientos-forzados-en-psiquiatria-tensiones-con-los-mecanismos-de-privacion-de-libertad-por-motivos-de-salud-mental-en-chile/

A continuación, presentamos el texto de la abogada chilena Francisca Figueroa que se suma a la campaña en Apoyo a la Prohibición Absoluta de la CDPD de los Tratamientos Forzosos y los Internamientos Involuntarios

Tensiones con los mecanismos de privación de libertad por motivos de salud mental en Chile

La campaña por la Prohibición Absoluta de los internamientos involuntarios y tratamientos psiquiátricos forzados se enmarca dentro del contexto de los art. 12, 14 y 15 de la Convención sobre los Derechos de las Personas con Discapacidad (en adelante, CDPD), adoptada por la Asamblea General de la Organización de las Naciones Unidas con fecha 13 de diciembre de 2006 en la ciudad de Nueva York; la cual fue ratificada y promulgada por Chile, entrando en vigencia en nuestro país el año 2008.

El contenido específico de las disposiciones que tal instrumento de derechos humanos refiere –el cual extiende su alcance a las personas en situación de discapacidad mental o psicosocial, e intelectual (Fernández, 2010: 10)-, se encuentra aún en proceso de delimitación por parte del Comité sobre los Derechos de las Personas con Discapacidad, el que recientemente se pronunció respecto al alcance del derecho contenido en el art. 14 de la CDPD, éste es, el derecho a la Libertad y Seguridad de la Persona.

Tal pronunciamiento impone un cambio de paradigma al prohibir de forma categórica y absoluta la privación de libertad de la persona por motivos de discapacidad –sea ésta,  real o aparente-, aun al considerarse que la persona se encuentra en situación de crisis o que puede constituir un peligro para sí mismo u otros (pr. 13, 14 y 15). En tal aspecto radica, el carácter absoluto de la prohibición.

Los fundamentos jurídicos de este posicionamiento radical por la no discriminación, dicen relación con el alcance del art. 12 de la CDPD, el cual impone a los Estados Partes el deber de reconocer la capacidad jurídica de las personas en situación de discapacidad en igualdad de condiciones y en todos los aspectos de su vida. Así, si bien el art. 14 impone como limitación al derecho a la libertad de la persona que ésta se ajuste a la legalidad, no es menos cierto que existen en el ordenamiento jurídico chileno, leyes que sistemáticamente niegan la capacidad jurídica de la persona en diversos ámbitos de desarrollo de su vida, lo cual se encuentra en evidente contradicción con la CDPD (Observatorio de Derechos Humanos de las Personas con Discapacidad mental, 2014), conforme se ha pronunciado el Comité sobre los Derechos de las Personas con Discapacidad y el Relator Especial sobre la Tortura y otros Tratos o Penas Crueles, Inhumanos o Degradantes.

Ejemplo de esto son los regímenes de interdicción, las declaraciones de inimputabilidad penal, las normas que regulan los internamientos involuntarios y los tratamientos invasivos e irreversibles -como son, las psicocirugías, las terapias de electroshock y esterilizaciones, entre otros- en los que operan mecanismos de sustitución de la voluntad de persona (Instituto Nacional de Derechos Humanos [INDH], 2014), vulnerando el Principio de Autonomía contenido en el art. 3 letra a) de la CDPD que contempla “El respeto de la dignidad inherente, la autonomía individual, incluida la libertad de tomar las propias decisiones, y la independencia de las personas” y el art. 12; sometiendo a la persona a un estatus de minoridad social propio de los paternalistas sistemas de tutela decimonónicos (Castel, 2009).

Para dar cuenta de este desolador panorama, pese a la entrada en vigencia de la CDPD en Chile el año 2008, es posible constatar la siguiente situación conforme datos oficiales del Ministerio de Salud (2014):

…las medidas forzadas en relación con la hospitalización han aumentado entre los años 2004 y 2012. La proporción de ingresos de urgencia se han triplicado, llegando a 30,8% del total de ingresos. Los ingresos administrativos (hospitalizaciones involuntarias autorizadas por las SEREMI de Salud) se han cuadriplicado y durante el año 2012 representaron el 6,6% de los ingresos, mientras que los ingresos por orden judicial se duplicaron, con un 5,4% para el 2012. Además, también hubo un incremento en el uso de la contención y/o aislamiento, desde 17,8% del total personas hospitalizadas en el 2004 a 26,1% en el 2012 (ídem: 53).

Así, atendido al panorama anteriormente descrito y los actuales estándares de derechos humanos a los que se ha comprometido a dar cumplimiento el Estado de Chile, deben progresivamente abolirse los regímenes administrativos de internamientos involuntarios que no hacen sino reproducir el estigma que asocia “enfermedad mental” y peligrosidad, cuestión que se advierte claramente en las disposiciones del D.S. Nº 570 del Ministerio de Salud, que permite privar de libertad a una persona “aparentemente afectada por un trastorno mental” e internarle en un establecimiento psiquiátrico por cuanto su conducta “pone en riesgo su integridad y la de los demás, o bien, altera el orden o la tranquilidad en lugares de uso o acceso público”, operando los encierros psiquiátricos a modo de auténticas medidas de seguridad predelictuales (Dufraix, 2013: 272-274; Horwitz y López, 2004: 565) y por lo demás, sin cumplir con garantías mínimas de resguardo a los derechos humanos, al carecer de control judicial, de órgano autónomo de revisión y de un procedimiento de apelación contra la resolución administrativa-sanitaria que priva de libertad a la persona contra su voluntad (INDH, 2014: 120; Ministerio de Salud, 2014: 37).

Si bien se ha planteado como un avance en la materia la creación de la Comisión Nacional de Protección de las Personas afectadas por Enfermedad Mental y las Comisiones Regionales establecidas en virtud de la Ley 20.584, se hace indispensable advertir que éstas dependen tanto en su constitución como en su funcionamiento de la autoridad administrativa a quien debe controlar y observar, careciendo de facultades resolutivas vinculantes y por tanto, no siendo apta para garantizar un resguardo imparcial de los derechos humanos conforme el compromiso adoptado por Chile al ratificar la CDPD. Sobre este punto, el Comité sobre los Derechos de las Personas con Discapacidad ha sido explícito al referir que los Estados Partes deben establecer mecanismos independientes de vigilancia y garantizar la participación de la sociedad civil en las labores monitoreo (pr. 19).

Por otra parte, los alcances de la Prohibición Absoluta invitan a re-pensar a la luz de la CDPD, el régimen de inimputabilidad penal y la utilización de los internamientos psiquiátricos involuntarios y tratamientos forzados en instituciones de salud mental a modo de medidas de seguridad, conforme se contempla en el art. 457 del Código Procesal Penal. Éstas, fundadas en la declaración de peligrosidad de la persona en ausencia de culpabilidad, no sólo privan del ejercicio de derechos fundamentales careciendo de regulación constitucional (Falcone, 2007: 248), sino también, vulneran los actuales estándares de derechos humanos que comprometen a los Estados Partes a reconocer la capacidad jurídica de las personas en situación de discapacidad en todos los ámbitos de la vida. Al respecto, el Comité ha recomendado la eliminación de las medidas de seguridad, incluyendo las de tratamiento médico obligatorio en instituciones psiquiátricas (pr. 16, 20).

La objeción a este posicionamiento es evidente. ¿Qué sucede si la persona se encuentra “descompensada” y creemos que puede llevar a cabo comportamientos que afecten los derechos de los otros?. Es en ese punto donde el Comité ancla su posicionamiento en la no discriminación, al recordarnos que tanto las personas en situación de discapacidad como las que no, tenemos el deber de no causar daños a los demás (pr. 14), así como contamos con la libertad para disponer de nuestra integridad e incluso nuestra vida, cuestión que hace que las autolesiones y la tentativa de suicidio no sean punibles en el Código Penal. Por tanto, ¿Qué justifica el privar de libertad a una persona en situación de discapacidad en base a un pronóstico de peligrosidad –y en el caso de los internamientos administrativos, no habiendo cometido la persona hecho constitutivo de delito alguno-, siendo que todas las personas contamos con el mismo deber respecto a los derechos de demás e idéntica libertad de disposición respecto a los derechos propios?. La respuesta es que tal privación de libertad no se ancla sino en una evidente manifestación de discriminación por motivos de discapacidad, prohibida explícitamente por el art. 14 de la CDPD.

La campaña por la Prohibición Absoluta es en una invitación a enterarnos de los nuevos estándares de derechos humanos que rigen en materia de privación de libertad y tratamientos forzados por motivos de salud mental, los que han hecho propias las voces de críticos y sobrevivientes de la psiquiatría que han padecido la violencia del modelo psiquiátrico, justificado por la ideología terapéutica que específicamente se analiza por el Relator Especial sobre la Tortura y otros Tratos o Penas Crueles, Inhumanos o Degradantes en sus Informes A/63/175 y A/HRC/22/53, extendiendo a estas prácticas no consentidas las categorías de tortura y malos tratos, dando aplicación al art. 15 de la CDPD que contempla tal prohibición.

De esta manera, hacemos una invitación a cuestionar las racionalidades que justifican la vigencia de un estatuto legal paralelo respecto a las personas etiquetadas con diagnósticos psiquiátricos, el cual permite privarlas de libertad en base a criterios que se imponen a modo de pensamiento único a través de la hegemonía del modelo médico-psiquiátrico en salud mental, negando la autonomía de la persona y controlando sus diferencias en el plano psíquico a través del uso de la violencia.

Francisca Figueroa San Martín, Abogada. 

Bibliografía

Castel, R. (2009). El orden psiquiátrico. Edad de oro del alienismo. Buenos Aires: Nueva Visión.

Committee on the Rights of Persons with Disabilities (2015). Guidelines on article 14 of 

the Convention on the Rights of Persons with Disabilities. The right lo liberty and security of persons with disabilities. [en línea] Ginebra, Suiza. Disponible en: http://www.ohchr.org/EN/HRBodies/CRPD/Pages/CRPDIndex.aspx

Dufraix, R. (2013). Las medidas de seguridad aplicables al inimputable por condición mental en el Derecho Penal Chileno. Tesis Doctoral. Universidad del País Vasco.

Falcone, D. (2004). Una mirada crítica a la regulación de las medidas de seguridad en Chile. Revista de Derecho de la Pontificia Universidad Católica de Valparaíso. XXIX, pp. 235-256.

Fernández, M. (2010). La discapacidad mental o psicosocial y la convención sobre los Derechos      de las Personas con Discapacidad. Revista de derechos humanos – dfensor. (11), pp. 10-17

Horwitz, M. y López, J. (2004). Derecho procesal penal chileno, Tomo II. Santiago: Editorial Jurídica de Chile.

Instituto Nacional de Derechos Humanos [INDH], (2014). Situación de los Derechos Humanos en Chile. Informe Anual 2014. [en línea] Santiago. Disponible en: http://www.indh.cl/informe-anual-situacion-de-los-derechos-humanos-en-chile-2014 [Último acceso 15 Marzo 2016].

Ministerio de Salud, (2014). “Evaluación Sistemas de Salud Mental de Chile”. Segundo Informe, 2014. Informe sobre la base del Instrumento de evaluación del sistema de salud mental de OMS (OMS IESM/ WHO AIMS). [en línea] Santiago de Chile. Disponible en: http://www.who.int/mental_health/who_aims_country_reports/who_aims_report_chile.pdf [Último acceso 12 Febrero 2016].

Observatorio de Derechos Humanos de las personas con Discapacidad mental (2014). Derechos humanos de las personas con Discapacidad mental: Diagnóstico de la situación en Chile.  [en línea] Santiago de Chile.  Disponible en: http://www.observatoriodiscapacidadmental.cl/wp-content/uploads/2014/05/informe-ODDHHPDM-final.pdf[Último acceso 13  Marzo 2016].

Organización de Naciones Unidas [ONU], (2006). Convención sobre los Derechos de las Personas con Discapacidad y Protocolo Facultativo. [en línea] Nueva York. Disponible en: http://www.un.org/disabilities/documents/convention/convoptprot-s.pdf [Último acceso 15  Marzo 2016].

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Pink Belette: La psiquiatrie en France/ Psychiatry in France

La psychiatrie en France, zone de non-droit (par Pink Belette)

Une patiente française sous contrainte fait son « audit » dans le cadre de la campagne pour soutenir l’Abolition totale des soins et de l’hospitalisation sans consentement en application de la CDPH de l’ONU

http://depsychiatriser.blogspot.no/2016/03/la-psychiatrie-en-france-zone-de-non.html

 

Pourquoi je suis contre les « soins sous contrainte » :

On pourrait croire que, au pays de la liberté, on a encore droit à son intégrité morale et physique.

Rien n’est plus faux. Par experience, impossible pour quiconque d’échapper à un soin sous contrainte (SPDT, « soin à la demande d’un tiers » ou « péril imminent »).

Il suffit que : une personne la demande (que ce soit la famille, un voisin…), qu’on soit « pas bien », déstabilisé, agité, « instable », en colère, dépressif, sur la défensive, « en opposition », « délirant », amaigri, boulimique, fumeur de shit, drogué…

Il suffit aussi qu’on refuse l’hospitalisation ou un traitement pour que les médecins se relaient pour demander un soin sous contrainte. Une fois hospitalisé, « on » vous fait comprendre que vous perdez vos droits à la personne, l’argument étant : « maintenant on est responsable de vous pour TOUT »… Par contre, vis-à-vis de vous, « on » n’est responsable de rien…

 

Depuis la loi Bachelot du 5 Juillet 2011, en particulier si on a le malheur de contester le diagnostic ou le traitement, c’est alors après la sortie d’hospitalisation qu’on ne peut plus se débarrasser de la contrainte, et c’est là que c’est le plus pervers : injections forcées, consultations obligatoires avec un praticien hospitalier non choisi (à la rigueur, on a le choix entre deux médecins).

Le pire : si on refuse de se rendre au centre médico-psychologique du secteur assigné, la police vient gentiment vous cueillir chez vous pour vous hospitaliser en soins obligatoires à un degré encore plus coercitif (SPDRE, « sur la demande de l’Etat ») et sur un temps plus long et sans contact autorisé avec l’extérieur (!) jusqu’à ce qu’il aient réussi à réduire votre volonté à néant. Ainsi, il arrive que les personnes concernées doivent abandonner leur logement pour « vivre » en psychiatrie (parfois pendant des dizaines d’années, voir le cas de Dimitri Fargette)…

 

Je suis témoin : en France, il y a réellement du souci à se faire…

  1. Il n’y a aucune alternative à la psychiatrie institutionnelle (lobbying des psychiatres ET de l’industrie pharmaceutique contre d’autres formes de thérapies) ;
  2. Aucune littérature ou culture antipsychiatrique (des « survivants », il n’y en a pas…)
  3. L’Ordre des Medecins Psychiatres qui suspend : tout psychiatre « en décalage » avec le système consensuel (d’après le Dr. O.G, psychiatre libéral et ex-chef de clinique) ;
  4. L’Ordre des Medecins Psychiatres qui suspend : un psychiatre responsable de la mort d’une patiente… seulement pour 2 semaines (voir l’affaire Florence Edaine)
  5. La « Mafia des tutelles » : tout patient faisant des séjours répétés est automatiquement placé sous curatelle ou tutelle (sans consentement, c’est renforcé)…
  6. Des mères se voient enlever leurs enfants immédiatement après la pose d’un diagnostic de maladie mentale ; jamais de scandale médiatique…
  7. On fait comprendre aux femmes en âge de procréer qu’il faut surtout adopter la contraception, en sous-entendant qu’on leur enlèverait leur enfant de toute façon. Ce qu’on ne leur dit pas, c’est que tous les neuroleptiques passent la barrière placentaire, c’est pourquoi j’ai entendu parler d’autant de cas d’avortements spontanés chez les femmes sous traitement. Dixit une infirmière, on donne de l’Haldol aux femmes enceintes, ce qui « prouverait » soi-disant « le peu de nocivité de l’Haldol » (!). Jamais d’étude là-dessus ni de scandale médiatique…
  8. Des services fermés qui regorgent de dépressifs qui ne sont pas en « péril imminent » et qui se sentent surtout mal de recevoir par exemple 4(!) antidépresseurs à la fois…
  9. Une cellule d’isolement toujours occupée (appelée « chambre de soins intensifs »!), ce qui participe du « folklore »…
  10. « Abonné une fois, abonné toujours » : les traitements qu’on ne peut plus JAMAIS arrêter ;
  11. Aucune étude à long-terme sur les effets des psychotropes…
  12. Aucun recours en cas d’abus psychiatriques (système interne de « médiation » caduc : mal vous en prend d’écrire une lettre au directeur de l’établissement…)

 

Pourquoi je suis contre ce nouveau système de « Juge des Libertés et Détentions » (relatif à la loi du 27 septembre 2013) :

On vous fait croire que c’est une voie de recours. Rien n’est plus faux, à part en cas de vice de forme (ce qui n’arrive quasiment jamais, puisque les psychiatres ont intérêt à ce que la procédure se passe en bonne et dûe forme). Au contraire, c’est un enfermement de plus…

  1. Le juge n’est pas psychiatre, il se garderait bien de remettre en question le jugement des médecins sur le fond. Par contre, on lui a expliqué que tout patient qui conteste le traitement est en « opposition », ce qui constitue déjà une preuve de « déni de maladie ».
  2. Les médecins y trouvent donc une voie bien pratique pour se décharger de leurs responsabilités, puisque « c’est le juge qui décide ». Et alors on voit défiler les patients dans le bureau du juge, accompagnés d’un soignant : « on vous amène Mme X »…
  3. On vous octroie un avocat commis d’office une semaine avant, mais qu’on ne peut pas contacter avant. Le jour de l’audience, c’est 15 minutes pour faire connaissance et se préparer, et ceci « dans les cases »…
  4. Ce qui est très alarmant, c’est qu’on ne trouve pas d’avocat en libéral, à part peut-être à Paris, et seulement pour un recours aux assises.
  5. Le juge prétexte qu’il ne peut lever le soin sous contrainte si c’est à la demande du directeur de l’établissement. Or, toutes les demandes de mise en soins sous contrainte passent par l’approbation du directeur. Tout le monde se donne bonne conscience, donc ;
  6. Une fois l’audience terminée (10 minutes), où l’on se voit déstabilisé, accusé et mis en doute, le juge « ordonne » le maintien en hospitalisation complète et de la mesure de contrainte, ce qui confère force de loi aux médecins (et donc une impunité totale) et SURTOUT donne encore plus de poids à la mesure.
  7. Inutile de préciser que si on était encore crédible avant, on ne l’est plus du tout et c’est définitif. Si on refuse de signer la feuille ou de comparaître, c’est pire, et on s’attire les foudres des médecins et du personnel soignant, qui vous mettent la pression, vous humilient et vous maltraitent. On ne peut pas non plus refuser que l’audience ait lieu.
  8. Le juge sait pertinemment qu’il s’agit d’une volonté potitique de faire taire les « récalcitrants » par voie chimique et coercitive. Il y adhère donc pleinement.

 

Pourquoi je suis contre les traitements forcés :

J’insiste sur le fait que les psychiatres hospitaliers ont les pleins pouvoirs sur le choix et le dosage des traitements, il ne s’agit JAMAIS d’un consentement éclairé. La « balance bénéfice-risque » est toujours de leur côté, même en cas de surdosage, même si la personne prend déjà 17 médicaments et pèse 200kg (ce qui est le cas d’une amie à qui on a donné Zyprexa ET Xeroquel suite à quoi elle a fait un accident vasculaire cérébral). Ils ne sont jamais responsables des effets secondaires non plus et vous orientent « gentiment » vers votre généraliste…

De plus, c’est toujours les médecins qui « décident » à votre place si vous allez bien ou non, et ce, même s’ils ne vous connaissent pas ou vous on vu seulement 5 minutes…

L’effet pervers de la chose, c’est que c’est tellement insupportable d’être enfermé et camisolé chimiquement qu’au bout d’un mois, on fait semblant d’aller mieux, on renie ses opinions et on arrête de se plaindre des effets secondaires pour pouvoir sortir, sous peine de se voir diagnostiquer en plus des « troubles du comportement » et un « déni de la maladie»…

 

J’AI ETE TORTUREE : au Zyprexa (surdosage), au Solian, au Tercian, au Risperdal (8 mg pour un poids de 50 kg), à l’Haldol (90 gouttes par jour) et « shootée » au Valium (40mg!)…

Le médecin et le personnel infirmier refusaient de prendre en compte : les troubles de l’élocution, tremblements, convulsions, dyskinésies, impatiences insupportables, angoisses mortelles, envie de mourir et tortures psychiques (« enfer » mental) qui ont apparu immédiatement et ont même empiré avec le temps. Je me suis battue en vain en plaidant que les neuroleptiques anesthésient la conscience, font perdre la mémoire, rendent docile et influençable, rendent dépressif et encore plus anxieux, affectent les capacités intellectuelles et détruisent l’âme.

J’ai également été mise plusieurs fois en isolement avec violences de la part du personnel ET des employés de la sécurité, alors que je n’ai JAMAIS été agressive. J’ai été mise sous contention, j’ai été déshabillée de force, j’ai été déshydratée, humiliée, bafouée, maltraitée…

Aujourd’hui, même si j’ai droit à un traitement moins inhumain, l’Abilify en injectable (après une 4ème tentative de suicide), je reste « accro » au Valium, traumatisée et toujours en alerte, dans l’angoisse de manquer à mes « obligations » ou de faire mauvaise impression, sans parler de l’absence totale de perspectives, de motivation et de joie dans ma vie, sans parler de ma vie affective qui est une misère (mort spirituelle, isolation, dépression, anxiété…).

Ma carrière artistique, qui avait débuté avec succès, a été définitivement brisée pendant mes meilleures années (la trentaine) et je suis aujourd’hui dans l’incapacité de créer alors qu’avant je foisonnais d’idées et me donnais les moyens pour les mettre en œuvre. Il est également trop tard et trop compliqué pour moi maintenant pour devenir mère.

Je vis dans la précarité à la charge de l’Etat.

 

Pourquoi j’ai toujours été opposée à leurs « diagnostics » pathologisants :

Je suis une personne ayant vécu les pires traumatismes dans la petite enfance (viols et abus, harcèlement), dont la plupart des souvenirs sont remontés plus de trente ans après, ce qui a grandement affecté mon équilibre psychique. J’ai malheureusement dû constater que, d’après les psychiatres (pour autant qu’ils m’aient crue…), il n’y aurait aucune relation de cause à effet entre ce que j’ai subi et mes troubles (!), ce qui est tellement énorme et risible qu’on aurait plutôt envie d’en pleurer…

J’ai pu constater, à l’instar de la Dre Muriel Salmona, seule psychiatre en France à ma connaissance qui aborde la souffrance psychique sous l’angle du trauma, qu’en France, aucune prise en charge spécifique n’est prévue ou proposée, et après 8 ans de psychiatrie, aucun médecin à ce jour ne m’a diagnostiqué un syndrôme de stress post-traumatique avec dissociation, ce qui pourtant devrait être le cas après des viols dans la grande majorité des cas selon la Dre muriel Salmona ( Association Mémoire Traumatique et Victimologie ). Je n’ai quasiment jamais pu faire de travail thérapeutique avec un psychiatre.

Quant à leur diagnostic de schizophrénie, il n’a jamais été étayé, expliqué ou argumenté, et mon dossier a été établi sur des « observations » des médecins et de simples « impressions » du personnel soignant… J’ai constaté également que parler de spiritualité conduisait immanquablement à un diagnostic de « délire mystique », donc, selon eux, de schizophrénie.

J’en conclus que l’enfermement et leurs mauvais soins n’ont fait qu’en rajouter à mes traumatismes, je ne crois pas un seul instant que leurs maladies imaginaires résultent d’un déséquilibre chimique dans mon cerveau ou d’une quelconque « maladie » biologique, je sais que les effets des neuroleptiques sont catastrophiques à long-terme et je suis totalement en accord avec de nombreux anti-psychiatres à l’international, dont le Dr. Peter Breggin, Joanna Moncrieff, David Healy, Robert Whitaker, Thomas Szazs, Peter Goetzsche et autres… (cf. le site madinamerica.com).

 

CONFORMEMENT À LA CONVENTION DES NATIONS UNIES SUR LES DROITS DES PERSONNES HANDICAPÉES, ARTICLES 12, 14 ET 15, TEL QU’INTERPRÉTÉ DANS L’OBSERVATION GÉNÉRALE NO. 1 ET LES LIGNES DIRECTRICES SUR L’ARTICLE 14, ET AUX PRINCIPES DE BASE ET LIGNES DIRECTRICES PUBLIEES PAR LE GROUPE DE TRAVAIL SUR LA DETENTION ARBITRAIRE DE L’ONU, PRINCIPE 20 ET LIGNE DIRECTRICE 20, JE PLAIDE POUR L’ABOLITION TOTALE DE LA PSYCHIATRIE COERCITIVE ET DES TRAITEMENTS FORCES.

JE REVENDIQUE TOUS MES DROITS A LA PERSONNE EN TANT QUE FEMME MAJEURE PROTEGEE, PERSONNE HANDICAPEE, EN PARTICULIER LE DROIT INALIENABLE DE DISPOSER PLEINEMENT DE MON CORPS ET DE MON ESPRIT SANS CHIMIE IATROGENE, DE MA LIBERTE INCONDITIONNELLE.

JE CONSIDERE LA PSYCHIATRIE INSTITUTIONNELLE ET SES PRATIQUES COERCITIVES COMME UN CRIME CONTRE L’HUMANITE, UNE ATTEINTE A LA DIGNITE ET A LA LIBERTE DE PENSEE 

Pink Belette, Mars 2016

 

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Psychiatry in France, NO-RIGHTS-ZONE (By Pink Belette)

A french patient under forced commitment makes her « audit assignment » as part of the campaign to support CRPD absolute prohibition of commitment and forced treatment

 

Why I am against commitment and forced treatment :

One could believe that, in the land of liberty, one is still entitled to his or her physical and moral integrity.

Experience proves it wrong. It is impossible for anyone to escape forced commitment (so-called « care on demand of a third party » or « imminent danger »).

It’s already a done deal if : one person asks for it (family, neighbour…), one is « not well », unsettled, agitated, « not stable », gets angry, is depressed, on the defensive, « in opposition », exuberant, emaciated, bulimic, shit smoker, drugged…

It is sufficient if one refuses hospitalization or a treatment for the doctors to relieve each other in order to enforce commitment. Once hospitalized, it is been made perfectly clear that one looses his or her personal rights, only argument is : « now we are responsible of you for EVERYTHING »… Thus, towards the « patient », nobody is responsible of anything…

 

Since the « Bachelot law » of July 5th 2011, particularly if one has something to object, be it diagnose or treatment, it is then after being out of hospital that one cannot get rid of commitment, which is most perverse : forced injections, mandatory appointments with an non-chosen clinical psychiatrist (or, best case, with a choice between two doctors).

And, worst of all : if one refuses to go to the assigned medical center of one’s district, the police comes to pick one up at home and rehospitalization is mandatory with an increased commitment that is even more coercive (« on demand of the State »), on a longer lapse of time and with no authorization to communicate with the outside (!) until they succeed to break one’s will and reduce one to nothingness… It so happens that people loose their home and « live » in psychiatry (sometimes for decades, see Dimitri Fargette’s case)…

 

I witness : in France, there is really matter to worry about… 

  1. There is no alternative to institutional psychiatry (lobbying of psychiatrists AND pharmaceutical industry against other forms of therapies) ;
  2. No antipsychiatric litterature nor culture (no « survivors »…)
  3. The « College of Psychiatrists » who suspends : every psychiatrist « not aligned » with this consensual system (according to Dr. O.G, liberal psychiatrist and former head of clinic);
  4. The « College of psychiatrists » suspending : a psychiatrist responsible for the death of a patient… only for two weeks (see the case of young patient Florence Edaine)
  5. The « Guardianship mafia » : every patient who is repeatedly hospitalized is automatically placed under guardianship under a certain degree (without consent, it is being reinforced…)
  6. Single mothers get their children robbed and placed immediately after a diagnosis of mental illness is established, never one scandal about this…
  7. Women in age to bear a child are being strongly recommended a contraception, with a wink that their child would be taken away from them anyway. What they are not being told is that all neuroleptics pass the placenta barrier, that’s why i have heard of so many miscarriages from women under treatment. A quote from a nurse : « pregnant women are given Haldol, which proves it’s little nocivity » (!). Never one study about that nor mediatic scandal.
  8. Closed wards full of depressive people who are not in « immediate danger » and are feeling bad mainly because they are being given for example 4 (!) antidepressants at a time…
  9. An always occupied isolation chamber (so-called « intensive care chamber »!), which participates to the « folklore »…
  10. « Once subscriber, always subscriber » : treatments one can NEVER withdraw from ;
  11. No long-term study on psychotropic medication… (All so-called studies are biased)
  12. No recourse in case of even flagrant psychiatric abuse (internal system of « mediation » obsolete : it’s a very bad idea to write a letter to the director of the institution…)

 

Why I am against this new system of « Judge of Liberties and Detentions » (related to the law of september 27th 2013) :

They are making believe it is a recourse. I was proved wrong, except for instance on a technicality (which almost never happens, because it’s in the psychiatrists’ interest that the procedure goes well and in due form). On the contrary, it’s in the sense of more legal coercion…

  1. The judge is no psychiatrist, he would never ever put into question the judgment of the physicians concerning the core. Thus, he has been briefed about the « fact » that any patient who opposes treatment is « in opposition », which establishes already a proof of « illness denial » (and as a proof of illness itself).
  2. Therein it has been found a very practical way for doctors to be discharged of their responsibilities, as « it’s the judge who decides ». And now, bunches of patients are being spotted filing up before the judges’ office, escorted by a nurse : « we bring you Ms. X »…
  3. Patients get a mandated advocate one week before the audience, but who cannot be contacted in advance. At audience day, it’s 15 minutes to meet and prepare, and, of course, in a « formated » way.
  4. Very alarming is the fact that no liberal advocate is to be found for psychiatric abuse pleas, except maybe in Paris, and mostly for a recourse before the Court of Assize.
  5. The judge pretends he cannot lift the forced commitment because it’s asked for by the hospital director. Yet, all demands for forced commitment have to be validated by the director. Hence everyone gives him- or herself a good conscience there ;
  6. Once the audience done (10 minutes), where one gets destabilized, accused and doubted of, the judge « orders » the maintaining of the person in complete hospitalization and of the measure, which confers force of law on the doctors (hence, total impunity).
  7. Not to mention the fact that if one still had credibility before, it’s no longer the case and irreversible. If one refuses to sign the convocation or to attend the audience, it’s worse, and one is being bullied by staff members and doctors alike, who put one under pressure, humiliates one… One also cannot refuse the audience being held despite of one’s absence.
  8. The judge knows pretty well that it’s a political will to make silent the « opponents » of the system, chemically and coercively. He therefore fully concurs with it.

 

Why I am against forced treatment :

I insist on the fact that hospital psychiatrists are almighty regarding the choice and dosage of treatments, it’s never about an « informed consent ». The « benefit- risk balance » is always on their side, even in case of overdosage, even if the person already takes 17 meds and weighs 400 pounds (which is the case of a friend to whom was administered Zyprexa AND Seroquel after which she had a cerebral attack with impairment). They are also never responsible for side effects and, in case of complaint, derefer to one’s generalist physician…

Thus, it is always them who « decide » on one’s behalf if one is well or not and this, even if they don’t know the person or have seen him or her only five minutes…

Perverse effect of the thing : it’s so unbearable being locked up and silenced chemically, that, after a month, one pretends to feel better, disavow his or her opinions and stops complaining about side effects in order to get out, knowing that otherwise one will be diagnosed behavioural troubles and « illness deny »…

 

I WAS TORTURED : with Zyprexa (overdosis), Amisulpride, Cyamemazine, Risperdal (8 mg for a weight of 100 pounds), Haldol (90 drops a day) and « shooted » with Valium (40mg!)…

The doctors and staff refused to take into account : speaking troubles, heavy trembling, convulsions, dyskinesia, unbearable akathisia, heavy existential fear, wish to be dead and psychical tortures (mental « hell ») which appeared immediately and even worsened as time went by. I fought in vain, pleading that neuroleptics anesthetize consciousness, occasion memory loss, make one docile and influentiable, make depressive and even more anxious, impair one cognitively and destroy the soul.

I was also put into solitary confinement several times with violences from the staff AND security agents, despite the fact I have NEVER been even agressive. I was put under contention, was violently undressed, dehydrated, humiliated, spoliated, mistreated…

Today, even if I get a « less inhumane » treatment – Abilify retard injection – (after a 4th suicide attempt), I remain addicted to Valium, traumatized and always on alert, fearing to miss my « obligations » or to make bad impression, without mentioning total absence of perspectives, motivation or joy in life, without mentioning my affective life that is a misery (spiritual death, isolation, depression, anxiety…).

My artistic career, which finally started with success has been definitively broken during my best years (in my 30′) and today I am totally unable to create despite the fact that before, I had thousands of ideas and was giving a great deal to put them into meaningful use. It is also too late and too complicated for me now to become a mother.

I live in precarity at the charge of the State.

 

Why I was always opposed to their pathologizing « diagnoses » :

I’m a person who endured the worst traumas in early childhood (rape and abuse, mobbing…), while most memories came up again more than 30 years afterwards, which greatly affected my emotional balance. I had unfortunately to experience that, according to psychiatrists (if they even believed me), there would be no cause-to-effect relationship between what I had to bear and my troubles (!), which I find so enormous and stupid that one would rather cry…

I had to notice, alike Dr. Muriel Salmona – only psychiatrist in France knowingly approaching psychical suffering under the perspective of trauma – that in France, no specific caretaking is being proposed nor planned, and after 8 years of psychiatry, not one physician has diagnosed me a post-traumatic stress disorder with dissociation which, according to Dr. Muriel Salmona (« Association Mémoire Traumatique et Victimologie ») is the case after rape and abuse.

I could almost never do a therapeutic work with a psychiatrist.

Regarding their diagnosis of schizophrenia, it has never been illustrated, explained or argumented, and my medical records have been established on mere « observations » from the doctors and sheer « impressions » from the staff…

I also came to the conclusion that to actually speak about spirituality would eventually always end in them diagnosing a « mystical delirium » and, as such, schizophrenia.

My conclusion is that their imprisoning and bad treatments have done none but to aggravate my traumas and personal issues, I don’t believe a second that their imaginary « diseases » result in a chemical imbalance in my brain or an unknown « biological » illness, I know that neuroleptics and affiliated meds are catastrophic in the long-term (causing brain damage) and I totally agree with numerous anti-psychiatrists internationally, such as the Drs. Peter Breggin, Joanna Moncrieff, David Healy, Robert Whitaker, Thomas Szazs, Peter Goetzsche and others… (see on madinamerica.com).

 

IN ACCORDANCE WITH THE UNITED NATIONS CONVENTION ON THE RIGHTS OF PERSONS WITH DISABILITIES, ARTICLES 12, 14 AND 15, AS INTERPRETED IN GENERAL COMMENT NO. 1 AND THE GUIDELINES ON ARTICLE 14, AND WITH THE BASIC PRINCIPLES AND GUIDELINES OF THE UN WORKING GROUP ON ARBITRARY DETENTION PUBLISHED IN 2015, PRINCIPLE 20 AND GUIDELINE 20, I SPEAK IN FAVOUR OF ABSOLUTE PROHIBITION OF COERCIVE PSYCHIATRY AND FORCED TREATMENT.

I RECLAIM ALL MY RIGHTS TO PERSONHOOD AS A DISABLED ADULT WOMAN UNDER PROTECTION, IN PARTICULAR THE INALIENABLE RIGHT TO DISPOSE ENTIRELY OF MY BODY, MIND AND SOUL WITHOUT IATROGENIC CHEMICALS AND MY UNCONDITIONAL LIBERTY.

I CONSIDER INSTITUTIONAL PSYCHIATRY AND ITS COERCIVE PRACTICES A CRIME AGAINST HUMANITY, A SEVERE HARM TO DIGNITY AND TO FREEDOM OF THINKING.

 

Pink Belette, March 2016

 

 

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Christian Discher – The forgotten and the “Hell in Ueckermünde”

The forgotten and the “Hell in Ueckermünde” [Die Hölle von Ueckermünde] Has anything changed in German Psychiatry’s since the wall came down?

http://inklusionspolitik.de/en/the-forgotten-and-the-hell-in-ueckermunde-die-holle-von-ueckermunde-has-anything-changed-in-german-psychiatrys-since-the-wall-came-down/

by Christian Discher

In Germany, politicians and social research institutes campaign under the claim that we live in a society, in which all people are to be included: older people and people in need of care; disabled people; women; homo- and transsexual people, as well as transgender people; children; the sick; men; and immigrants. Universities receive millions of euros in funding, so that they can begin and maintain research projects focused issues facing “inclusion“. However, due to the mighty cleave between theory and reality, results in research rarely become established practical behaviors or values. Still, a closer look at the concept of inclusion makes it clear: Germany has a long way to go before it can be considered an inclusive society. In the debate over discrimination and exclusion (Inklusion/Exklusion: Stichweh 1997), the public receives hardly any information about the fate of those who, due to a particular psychological disturbance, are forced to live in psychiatric wards. Mainstream media does occasionally report on particular offences, when an acutely ill person is institutionalized. Nonetheless, the difference between mentally ill criminals and mentally ill people is not highlighted. (legal foundation) Meanwhile, depression and eating disorders are widely recognized. Such is as well the case with schizophrenia only with the difference, that the schizophrenic, after being released from treatment, is rarely able to find a place in our society. The latter are those who make us anxious on the subway with their loud announcements the stalking methods of secret government services or CSI. Others beg and attempt to convert their audience. An honest question: who, when confronted with such people in the bus or on the street, doesn’t feel anxious?(Discher: 2015) That the diagnosis of schizophrenia or psychosis – now known to be rooted in a diseased metabolic system – leads to paranoid thoughts and socially inacceptable behaviors, […] Clarification is not provided by mainstream media. Yet, in the case of many diagnosed schizophrenics, this diagnosis is ungrounded. As C. was seventeen years old, he was treated in the intensive care unit at the psychiatric and psychotherapeutic clinic in Ueckermünde. Stettiner Haff (August 2014) Bild 1 In 1993, when the ARD compromisingly distributed the report, Die Hölle von Ueckermünde Hell in Ueckermünde [by Ernst Klee]  the media reacted aggressively. (Moussavian) The inhumane involuntary commitment in the psychiatric wards that took place in this period of the GDR called for worldwide shock and chagrin. What was more horrifying? The argumentation of interviewed personnel or the forcible commitment of human beings? Or was it the terrified men, who had not seen light for years and were showcased to the public without prior consent? Investigative journalism at whose cost? In 2014, on the 25th anniversary of the fall of the Berlin wall, people celebrated their newly won freedom. But what had become of those, who experienced Ueckermünde, and how is it with those, who are being treated their today? Ueckermünde, a small city at Stettiner Haff touts its “inclusivity” projects. On the website of a regional politician (Dahlemann: 2013), to following goal is heralded: “The beginning of an inclusive region [at the Stettiner Haff” “Many were already there in Bürgersaal. Whether Kulturspeicher or Kleeblattchule Anklam, politicians like Patrik Dahlemann, or regular people – they were all there in order to drive the project forward. Hopefully, it will then become concrete, so that many ideas like that of market for leisure activities, carpooling center, consulting center, among others, will be able to be better implemented and ‘inclusion on the backwater‘ will be brought to life.” The mission is expressed honestly, in words that include everyone. Nevertheless, the number people who retire early in Germany on account of psychological illness is increasing dramatically. In opposition to other German states, the number of mental illnesses in Mecklenburg-Vorpommern increased 102% between 1997 and 2011. The number of in-patients being treated grows at a steady rate. In plans for the further development of an integrative aid services for psychologically ill persons in Mecklenburg-Vorpommern, attempts are made to react to structural problems. There are even discussions about interdisciplinary collaborations. During this negative development, the role and responsibilities of those who are active in systematic psychiatric clinics is not questioned. But how do those people fare, who are placed in House 12, a clinic on the edge of Ueckermünde? On a sign at the Ravenstein St. exit, the way to the center for forensic psychiatry as well as to Kita Morgenstern is described.

Wegweiser zur Klinik für Forensische Psychiatrie und Psychotherapie

Further information leads the visitor to the AMEOS hospital complex. The clinic for psychiatry, psychotherapy, and psychosomatic treatment, which is located at 23 Ravensteinstraße, is not mentioned. Before the interested person can find a proper description of the way to the clinic, he or she must first conduct fairly extensive internet research. On its modern web page, the hospital appeals to its 130 year old tradition and gives a detailed presentation of its guiding principles. With 87 in-patient beds, 6 wards, an ambulance, as well as five different treatment options in the day-clinic, the hospital offers enough space for a large number of patients. Modern methods of diagnosis and responsible doctors rounds out the presentation. Since the end of the Second World War, the institution had been reformed. (Cf. Seiffert: 2010).

“Normal psychologically ill” patients as well as the mentally retarded were brought into either red brick buildings or an old socialist construction. Signs that are for orientation say “open and closed integration“ guide you to the buildings. What do the terms integration and inclusion have in common? Across from House 40 is a landing. It is a concrete construction from the socialist era –desperately in need of cleaning – that, in 1997 and for some years thereafter, was still being used in 1997 as an open ward. Today, it is used as dormitory space for disabled people; children play soccer, unconcerned and joyful. The kindergarten Morgenstern is walled in, surrounded by dilapidated shanties that are used as storage spaces. Barbed wire walls tower behind the kindergarten. A sports field, monitored by countless video cameras. Not too far away, at 15 Ravensteinstraße, is the hospital for forensic psychiatry and psychotherapy. With its impressive architecture and reedy ponds, it could easily be mistaken for a vacation spot, if one overlooks the security cameras. Is the latter really a proper place for the rest and recovery of children, patients, and disabled persons, a proper place for the new form of “inclusion” in Ueckermünde? Are the patients and residents given a modern place for sports activities? No. In 1997, at the age of 17 years, C. was checked into House 12, the ward for acute psychiatric illnesses in Ueckermünde. He was just about to complete his Abitur , a high-school examination in Germany, as he suddenly faced a personal identity crisis. Homosexuality, a young love affair, and exclusion in his social environment; problems with his parents. Inner changes and experiences, common among adolescents. In order to help himself come through these developments, he turned to god, began to pray regularly and trust his inner voice. Through conversations with helpful friends, C. searched for a way out of this life-crisis. It was to no avail. His way was impeded by too many of the difficulties and realities of growing-up. He then sought support from a female pastor. He sat across from her, crying, and listened to the advice he would eventually follow: he should check himself into the clinic in his home city. That time, he wasn’t offered alternatives. That he had lost a massive amount of weight in the weeks before he checked in to the clinic played no part in any of the conversations. As he came to the hospital, C. had no idea that he was in the psychiatry ward. It was a bad time. He wanted to display himself honestly, to stand by his homosexuality. He undressed and waited in the corridor of the ward. He realized quickly, however, that this was no way to solve his problem. He calmed himself down but still could not understand that the doors of the ward were locked. He was not used to being shut in, and he felt completely closed in. No one questioned him about his problems; no one noticed the life crisis. At the entrance to the lavatory, he suffered a hemorrhage, that would eventually lead to his downfall. The cleaning of the lavatory and his body cost time. As he made his way back to his room, nurses and doctors were waiting in the corridor. Insecure in front of the crowd, he pushed one to the side, excusing himself with the words, “You made me anxious.” No one knew about his problems and painful stomach illness. His behavior led to his institutionalization at the acute psychiatric ward in Ueckermünde. Discher (2015).

Extract of an Interview with C. “As soon as I got there, someone gave me medication, and I was fixed in 24 hours. The assistant to the doctor assured me, “Don´t worry, you won´t remember the time here”. “I wasn’t addressed to as “Mr.”, but as “Ms.” … After my first day in the acute ward I couldn’t speak anymore. Walking and moving around were as good as impossible. I would need two years until I could say a normal sentence again, and I would need more than five before I could return to my life. But that had nothing to do with the diagnosis I received: I had to recover from the treatment itself. I don’t think I need to tell you that this didn’t get any better after my release from Ueckermünde. I got to know a bunch of people. Many of them are dead; they killed themselves. I wanted to do it, too, yet somehow I knew, that I would make it. “Today I’m married. Despite all of the written attestations of my “below average intelligence”, “boundless hubris – particularly concerning life plans”, and my “immaturity and naïveté”, I  passed my Abitur and later I finished my studies at university. Now I have a job with responsibility and I have both feed on the ground. Out of all of my relations, only my closest friends know about my experience at Ueckermünde … and how I can’t help but remember my stay, every day, every word of it. Everything.” “I have yet to meet someone, who, after their stay in House 12, managed to get their life back together. Either they’ve got a pension, or they aren’t around anymore.”

How should the “normal person” understand the abnormal if no clear distinction is made between forensic psychiatry and the common clinic for psychiatry, psychotherapy, and psychosomatic? Who would have believed C. after his stay in House 12? Who would have even checked if the measures, which stripped him of his freedom, were justified?Judges aren’t doctors. When making decisions, they rely on the testament of medical experts. What goes on behind closed doors is typically controlled by the state and not subject to criticism. General standards make sure that there is consistency and verifiability. Tied up, untied, time to get up.

The lost identities and life goals are lost to the place, that was meant to heal them. I have spoken with countless individuals. Only after long and detailed searches in the internet can one become acquainted with the terrifying life histories which are inseparable from modern forms of psychiatric treatment. Bernd Seiffert from NRW. Thomas Juritz, Olaf L., Mario Hagemeister from Rostock. They are no longer among us. Ueckermünde and the fates of people with psychiatric illnesses are harldy mentioned in publically broadcast legal. After the therapeutically accompanying in Ueckermünde, one is thrown back into life, into the self-help and support groups, into assistant living, or—under the cloak of “inclusion”—into a sheltered workshop? Although people hear about the events in these hospitals, they never really learn about them. Only when they are affected can they afford a look into the inside workings of the red brick buildings. There is no way back. They have been permanently away from life.

These types of clinics create illnesses, psychosis, a metabolic illness of the brain, is not single-handedly responsible for the inability of patients to reenter their lives. If family members with psychosis feel themselves overwhelmed and rely on the advice of professionals, the story of C. will become commonplace. Today, everyone feels a personal connection to talk about depression. Depression has arrived in our society. Do people outside really know what it means to be taken over by deep sadness, avolition, or an urge to suicide? Or is “depressive” merely used as a popular word, because our society is too unreflective?  In this context, clinics are not discussed as much. Nowadays, who would be excited to go to a psychiatrist and get a prescription? These types of forcibly commitment and methods of treatment for younger and older people in Ueckermünde relegate the psychiatry’s to the shadows, that pay effort for a reorientation in medical and health care. Professions with leap of faith: the entire staff, composed of doctors, psychologists, social workers and consultants, that is, those whose level of trustworthiness is much greater than that of the psychologically ill. There is no chance of a collapse. Not only is that red brick building part of the complete system of our society, but the people that work there and go about their business as servants of the everyday, keep it alive. Outer facades and inner building structures are easily renovated. People and their way of thinking are not. Perhaps it is time for the 130 year old tradition of the psychological clinic to reveal its inner workings to the eye of the public.

We are searching for the way toward “inclusion”, that is, toward a society that is open and inclusive for everyone. Meanwhile, this word— “inclusion”—is a lovingly used in-word that sparks the interest of the public and propels politicians in their campaigns, but ultimately forgets the people who are left because no one is lobbying for them. “Inclusion” is a perfectly valid term in scholarship. It is wonderfully suited for raising millions of euros for research projects, the results of which are often not applicable in practice. Those who teach the concept of “inclusion” rarely think it out to its end or represent it practically. Those who actually campaign for “inclusion”, as they happily fulfill their contracts and are kept satisfied by their acting and remain in silence. (Discher 2015)

Bibliography

Thanks B. for your  support.

Adresse Kita Morgenstern: Christophorus Tagesstätte Kita Morgenstern, in: http://www.kita-portal mv.de/de/tageseinrichtungen/kitas_in_m_v/kitas_in_m_v_kita_profil&kitaid=66 (27.01.15).

AMEOS Klinikum: Klinik für Psychiatrie und Psychotherapie Ueckermünde: Ravensteinstraße 23, in: http://www.ameos.eu/1638.html (27.01.2015).

AMEOS Klinikum für Forensische Psychiatrie und Psychotherapie Ueckermünde. Ravensteinstraße 15a. Ueckermünde 17373. Deutschland. in: http://www.ameos.eu/forensik-uede.html(27.01.2015). Auszug aus dem Bericht Sicherheit und Gesundheit. Schwerpunkt psychische Erkrankungen, in: http://www.baua.de/de/Informationen-fuer-die-Praxis/Statistiken/Schwerpunkt/Psyche.html (10.01.2015)

Antwort der Bundesregierung auf die Kleine Anfrage der Abgeordneten Dr. Martina Bunge, Dr. Ilja Seifert, Diana Golze, weiterer Abgeordneter und der Fraktion DIE LINKE. – Drucksache 17/10576 – Zwangsbehandlungen in Deutschland, in: http://dipbt.bundestag.de/dip21/btd/17/107/1710712.pdf

Autor unbekannt: Tod in Rostock, in: http://www.todinrostock.de.(27.01.15).

Bundesanstalt für Arbeitsschutz und Arbeitsmedizin: Auszug aus dem Bericht Sicherheit und Gesundheit. Schwerpunkt psychische Erkrankungen, in: http://www.baua.de/de/Informationen-fuer-die-Praxis/Statistiken/Schwerpunkt/Psyche.html (10.01.2015)

Dahlemann, Patrick. 2013: Startschuss für eine inklusive Region am Haff: http://patrick-dahlemann.de/nk-startschuss-fur-eine-inklusive-region-am-haff/(10.01.2015). Die Hölle von Ueckermünde, in: https://www.youtube.com/watch?v=odtM4k9H4k4&spfreload=10.

Discher, Christian. 2015: Die Übriggebliebenen (in Vorbereitung).

Klee, Ernst, in: http://www.fischerverlage.de/autor/Ernst_Klee/2830 (27.01.15).

Mecklenburg Vorpommern. Ministerium für Arbeit, Gleichstellung und Soziales Plan zur Weiterentwicklung eines integrativen Hilfesystems für psychisch Kranke Menschen in Mecklenburg-Vorpommern, in , http://www.regierung-mv.de/cms2/Regierungsportal_prod/Regierungsportal/de/sm/_Service/Publikationen/index.jsp?publikid=4665

Moussavian, Sima: Die Hölle von Ueckermünde- Inhalt.in: http://www.helpster.de/die-hoelle-von-ueckermuende-inhalt_207544 (27.01.2015).

Netzwerk für Inklusion am Stettiner Haff, in: http://www.inkaha.de/index.php/component/content/category/33-website(10.01.2015).

Neurologen und Psychiater im Netz: Psychosen. Krankheitsbild. Herausgegeben von Berufsverbänden und Fachgesellschaften für Psychiatrie, Kinder- und Jugendpsychiatrie, Psychotherapie, Psychosomatik, Nervenheilkunde und Neurologie aus Deutschland, Österreich und der Schweiz, in: http://www.neurologen-und-psychiater-im-netz.org/psychiatrie-psychosomatik-psychotherapie/stoerungen-erkrankungen/psychosen/krankheitsbild/(27.01.15).

Seiffert, Bernd. Sein Trauerblog, in: http://psychiatriekritikerberndseiffert.blogspot.de. (27.01.15).

Seiffert, Bernd.2010: Das Verbrechen der Psychiatrie. Eine Zusammenfassung von Bernd Seiffert, in: http://www.meinungsverbrechen.de/wp-content/uploads/2011/03/Die-Verbrechen-der-Psychiatrie_02_2010.pdf (27.01.15).

Stichweh, Rudolf.1995). Inklusion/Exklusion, Differenzierung und Weltgesellschaft. Anmerkung des Autors: „Erweiterte Fassung eines Aufsatzes, der zunächst in Soziale Systeme 3, 1997, 123-136, erschienen ist. Der Abschnitt V ist neu hinzugefügt“, in: http://www.fiw.unibonn.de/demokratieforschung/personen/stichweh/pdfs/17_36stichweh_6.pdf (27.01.2015).

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The contested freedom of the ‘scary’ – Karlijn Roex

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

Lucila López

Usuaria y sobreviviente de la psiquiatría en Argentina.

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

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

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

Artículo 14

Libertad y seguridad de la persona

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

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

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

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

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

__________________

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

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

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

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

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

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

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

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

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

¿Por qué guardar mutismo?

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

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

Artículo 5º

Igualdad y no discriminación

Artículo 12

Igual reconocimiento como persona ante la ley[v]       

Artículo 14

Libertad y seguridad de la persona

Artículo 15

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

Artículo 17

Protección de la integridad personal

Artículo 18

Libertad de desplazamiento y nacionalidad

Artículo 19

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

Artículo 22

Respeto de la privacidad

Artículo 23

Respeto del hogar y de la familia

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

Artículo 24

Educación

Artículo 25

Salud

Artículo 27

Trabajo y empleo

Artículo 28

Nivel de vida adecuado y protección social

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

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

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

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

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

 

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

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

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

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

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

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

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

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

Vuelvo sobre la necesidad de contextuar el texto.

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

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

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

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

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

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

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

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

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

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

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

La internación involuntaria es iatrogénica:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Hay una palabra en psicología muy interesante: constructo.

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

Son constructos la inteligencia, la personalidad y la creatividad.

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

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

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

Lucila López

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

Miembro de WNUSP

Miembro de INWWD 

 

C.A.B.A

ARGENTINA

______________________________________________

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

logo_wnusp

 

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

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

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

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

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

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

 

[vi] Se hace indispensable el resarcimiento económico.

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

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

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

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

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

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

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

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

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

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

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

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

[ix] Desquiciar

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

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

 

 

 

 

 

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Le témoignage d’Agnès: traitements dégradants, traitements forcés en France.

http://depsychiatriser.blogspot.no/2016/03/le-temoignage-dagnes-traitements.html

En violation de l’article 16 de l’ONU, les personnes présentant un handicap psychiques subissent des traitement dégradants qui bafouent  toute dignité humaine.

Voici mon témoignage :

J’ai été hospitalisée 2 fois dernièrement à l’hôpital psychiatrique relevant de mon département
En juin, il m’ont placée dans une chambre d’isolation et m’ont attachée pendant 2 jours. J’étais allée aux toilettes le dimanche à midi et j’ai été hospitalisée vers 17heures. Le lendemain toujours attachée, j’ai crié que j’avais envie de faire pipi. Ne voyant personne venir, j’ai fini à bout par uriner dans mon lit. Des infirmiers sont venus. Ils m’ont déshabillée de force et m’ont écarté les jambes pour me placer une couche pour incontinents. Ils m’ont arraché la veste de pyjama et essayé d’ôter mon soutien-gorge, le tout avec une violence inouïe.Aujourd’hui encore j’ai un profond sentiment de honte tant je  ressens cet acte comme un viol de mon intimité. En y pensant ma gorge se noue et mon estomac se serre.

La 2éme fois en septembre cette fois, j’ai été placée en chambre d’isolement. Elle était pourvue de toilettes verrouillées de l’extérieur ce qui vous contraint à aller uriner dans un seau hygiénique sous “l’œil bienveillant” d’une caméra de vidéo-surveillance. Enfermée ainsi pendant 3 jours et 4 nuits, vous perdez la notion jour et nuit. Quand, vous sortez enfin, vous voilà docile comme un mouton prêt à quémander ou presque les médicaments que ‘l’on vous a prescrits et que l’on vous donne à heure fixe 3 fois par jour.

Tels sont les méthodes chocs employées par l’hôpital psychiatrique de mon département pour mâter les plus récalcitrants… Comment conserver l’estime de soi et se réintégrer socialement quand on a subi de tels traitements et qu’on ne peut communiquer sur ce qu’on a vécu ?

Je vis dans le sud de la France, pays des droits de l’Homme qui a pour devise “Liberté, Égalité, Fraternité”. J’ai une reconnaissance de handicap à 80%.

Je veux que vous apportiez mon témoignage pour que cessent ces méthodes indignes pour l’être humain et indignes du XXIe siècle.

Je voudrais dire aussi que lorsque j’ai été attachée, ils ont serré si fort les liens de contention que j’étais dans l’incapacité de bouger et que même sans bouger, ma cheville a été entaillée.

J’ajouterai que dans ce même hôpital, on utilise des mesures vexatoires à l’encontre des patients; on leur ôte toute dignité en les contraignant à rester en pyjama devant les autres patients pendant au moins 5 jours, le plus souvent une semaine, voire plus. C’est le médecin qui décide de la levée de la contrainte.

Enfin, il faut savoir que dans notre pays, les malades psychiatriques internés relèvent du “juge des liberté et de la détention” qui est aussi le juge des prisonniers de droit commun, alors que la plupart d’entre nous, n’avons commis aucun délit. Au bout de 10 jours environ, vous êtes admis à comparaître devant lui. Comment se défendre quand assommée de médicaments, on a peine à avoir les idées claires, à aligner ces phrases à trouver ses mots ? En fait le but de cette audience est avant tout de démontrer que vous n’êtes pas coopérant avec les soins ce qui justifie la poursuite de votre internement dans l’établissement.

Je pourrais aussi parler des effets qu’ont eu sur moi les neuroleptiques. Lorsqu’on me les a administrés pour la première fois, j’étais revenue à la réalité après 3 jours de bouffée délirante aiguë. Depuis chaque fois que je les arrête ou qu’on les baisse trop brusquement  ou qu’on me prescrit un traitement inadapté, je rechute.

On me disait brillante et aujourd’hui, je ne suis plus que l’ombre de moi-même: j’ai perdu mon affect, tout sens critique toute capacité d’analyser, toute intelligence émotionnelle et mes facultés cognitives. Comme ce sont les émotions qui fixent la mémoire, je suis vide de souvenirs depuis 17 ans. J’ai de grands trous noirs concernant des événements que j’ai vécus ce qui est terriblement angoissant. J’ai perdu toute curiosité intellectuelle, tout intérêt pour les choses y compris pour le domaine pour lequel j’ai effectué des études universitaires. Je subis la vie sans la vivre vraiment. Je suis une morte-vivante. A certains moments j’ai même été zombifiée. C’est ainsi qu’on m’a imposée une contrainte de soins après ma sortie de l’hôpital (loi qui a été généralisée en France par Nicolas Sarkozy en  2011) : tous les 14 jours, on m’administrait une piqûre de 50 mg de risperdal constat et les infirmiers passaient tous les soirs à mon domicile pour me contraindre à prendre un comprimé de 4 mg de risperdal (rispéridone). Incapable de me concentrer et souffrant de terribles anxiétés, j’ai été contrainte de prendre un travail à mi-temps.

Vous pouvez publier mon témoignage. J’ose espérer qu’il va servir à mettre fin à certaines méthodes utilisée par la psychiatrie moderne. Je sais qu’un jour, des gens s’étonneront de l’emploi de méthodes si barbares et  que peut-être dans un proche avenir des individus, avec l’avancée des connaissances, traîneront en justice les médecins et les industries pharmaceutiques, responsables de leur état.

C’est paradoxal. Les “psychiatres” comme leur nom l’indique devraient soigner la psychée (l’âme). Or justement en tant qu’handicapés psychiques, nous ne sommes pas traités comme des êtres humains par certains personnels soignants et cela dans l’indifférence presque totale de la société qui cautionne de tels traitements dégradants qui vont pourtant à l’encontre de la Convention de l’ONU contre la torture et les traitements dégradants. : il y a les végétaux, les animaux, les malades mentaux et l’espèce humaine. Que s’imaginent-ils? Que parce que nous perdons la raison, nous perdons notre conscience, que nous n’avons pas d’âme et que notre ressenti est celui d’un animal ? En fait je pense qu’ils ne font pas ça non parce que nous constituons un danger pour eux et pour les patients mais parce qu’ils croient qu’en nous traitant comme ça, cela nous dissuadera d’arrêter les médicament. Qu’ils se détrompent! Nous les arrêterons encore et encore pour leur prouver le contraire et nous prouver aussi à nous-même que nous sommes des êtres humains.

J’en ai moi-même fait l’expérience : en 2013, j’ai été hospitalisée une nouvelle fois à l’hôpital psychiatrique, après avoir arrêté mes médicaments,. Je n’y ai pas subi de sévices et cette fois là, et je suis tombée sur une psychiatre humaine qui m’a bien expliqué qu’il fallait que je sois stabilisée pendant 4 ans avant de pouvoir essayer (avec l’aide d’un médecin) d’arrêter les neuroleptiques. Je n’ai  plus jamais arrêté mes médicaments. J’ai rechuté en 2015 (j’avais des comprimés à cette époque que je prenais toute seule) peut-être parce que mes doses étaient trop basses. A l’hôpital sous la pression de ma famille, le psychiatre a instauré une injection retard d’abilify et comme ce traitement est destiné aux personnes atteintes de schizophrénie, j’ai rechuté une 2e fois, un mois après.

Aujourd’hui, j’aimerais bien revenir aux comprimés et être considéré comme un être humain responsable. Les injections retard sont dégradantes..Elles ne permettent pas de nuancer et d’ajuster au plus près les médicaments. Sans compter que leurs effets à long terme ne sont pas connus. Que se passerait-il en cas de syndrome malin des neuroleptiques ? C’est une question que je me pose. Malheureusement les psychiatres abusent de ces injections les généralisent et les banalisent sans mesurer les effets qu’elles engendrent. Quant à moi, je n’ arrêterai plus mon traitement car avec ce que j’ai lu là-dessus, j’ai bien compris que les neuroleptiques ou antipsychotiques sont comme une drogue et doivent être arrêtés très progressivement pendant une longue période avec des paliers de stabilisation. Les arrêter brutalement c’est le meilleur moyen de basculer dans la folie. Il m’aura fallu 17 ans pour que je comprenne tout ça, alors que si on m’avait expliqué cela dès le début(ou presque) en me considérant comme un adulte à part entière, un malade comme les autres, doué de conscience et de raison,  je n’en serais sûrement pas à ma 10ème ou 11éme hospitalisation.

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Don Weitz: Fight to be Free

Fight To Be Free: Abolish Involuntary Commitment and Forced Psychiatric Treatment – A Submission to Committee on Rights for Persons with Disabilities/CRPD 

by Don Weitz

Over 60 years ago, I was labeled “schizophrenic”, locked up and forcibly drugged 110 times with subcoma insulin shock in Mclean Hospital, a psychoprison (psychiatric hospital) near Boston, affiliated with Harvard Medical School and Massachusetts General Hospital. Because I was going through an existential identity crisis – psuychiatrized as “mental illness” & “schizophrenia” – struggling to find out what I wanted to do or be with my life in college, my family colluded with the psychiatrists to “treat” and involuntarily committed me, locked me up without my consent. For 15 months, I lived on an all-male ward with 15- 20 other patients, some brain-damaged by electroshock and lobotomy, others intimidated and traumatized by “safe and effective” psychiatric drugs, all of us suffered the degradation and humiliation of being incarcerated, having our daily institutional lives totally controlled by shrinks. After I was “discharged” in 1953, I suffered frequent anxiety or panic attacks for the next few years while studying psychology in university and seeing other psychiatrists. At that time, patients had no legal or civil rights, including no right to appeal involuntary committal, I had no right to appeal or refuse insulin shock or any unwanted psychiatric treatment. I know something about what it feels like to be treated like a prisoner, what it’s like to lose your freedom without a hearing or trial – preventive detention which is what involuntary committal really is. I know what it’s like to be tortured in the coercive and inhumane psychiatric system where human rights are sanitized as ”privileges”. Violations of our human rights in the 1950s are still violated today. Human rights in psychiatry are a sham. (1).

Involuntary Committal

Involuntary committal is a legal atrocity that must be abolished. It’s a very common and widespread legal psychiatric procedure enforced by psychiatrists, judges and police in virtually every country where psychiatry is legitimized by oppressive mental health laws and promoted by psychiatrically-biased government officials and the corporate media – the psychiatric police state. Involuntary committal laws authorize the incarceration or imprisonment of people in all psychiatric facilities and mental health centres, not just for days but also for weeks, months or years – particularly under the Ontario government’s “certificates of renewal.” (2,3) To be clear, involuntary committal is loss of freedom without a public hearing or trial and without charge of any civil or criminal offence. Although legal and enforced by many states and provinces, involuntary committal is actually preventive detention which is strictly prohibited under international human rights law; virtually all provincial and state mental health laws violate our human rights and international law, yet there’s little or no awareness, discussion and resistance re this grim fact.

In Ontario, the criteria for depriving a citizen of freedom are so ill-defined, vague and broad they can apply to virtually any person. Involuntary committal qualifies as a blatant violation of human rights or “patients’ rights” which are never mentioned in mental health legislation. Consider this wording of “involuntary admission” and initial 72-hour psychiatric assessment in Ontario’s Mental Health Act:

“Conditions for involuntary admission –

(a) that the patient is suffering from a mental disorder of a nature or quality that likely will result in,

(i) serious bodily harm to the patient,

(ii) serious bodily harm to another person, or

(iii) serious physical impairment of the patient,

or [will result] in substantial mental or physical deterioration

unless the patient remains in the custody of  a psychiatric facility;…” (4)

Under the Act’s definitions, “mental disorder means any disease or disability of the mind.” This definition is a legal fiction, it’s nonsensical, illogical and unscientific; as an abstraction or theoretical construct the mind, as Szasz has pointed out, can not be diseased or disabled, only the body can be diseased. Further, this key definition obviously supports psychiatry’s unscientific and discredited biomedical medical of “mental illness” which is entrenched in all editions of the equally discredited Diagnostic and Statistical Manual of Mental Disorders (DSM), psychiatry’s bible of bogus and stigmatizing diagnostic labels. Further, the phrase “substantial mental or physical or deterioration” is dangerously imprecise and subjective, it allows any physician to lock up and label innocent citizens simply by signing certificates such as “Form 1” which authorizes an initial 72 hour period of observation and assessment”, frequently followed by “Form 2” which authorizes 2 weeks of  involuntary commitment followed by “Form 3 which authorizes an additional 30 days and longer periods under a “certificate of renewal.” Also, the key term “ likely will result” is extremely misleading and problematic since it is common knowledge that psychiatrists can not validly and reliably predict harm, dangerousness or violence.

Forced Treatment

It’s bad enough that psychiatrists have so much power and that so many are incompetent while depriving thousands, if not millions of innocent people of freedom every day; however, they also have the power to forcibly treat or assault us – in the name of “mental health” of course. Although “informed consent” is a key medical-ethical concept and principle in medicine and has been since the historic Nuremberg Code of 1947, it’s frequently violated in psychiatry and the mental health system, another sham. Why7 Because psychiatrists and other physicians routinely ignore or violate its basic criteria. Consider these fundamental requirements of consent and informed consent   to treatmeent clearly and concisely spelled out in Ontario’s Health Care Consent Act:

Elements of Consent

The following are the elements required for consent to treatment:

1.The consent must relate to treatment.

2.The consent must be informed.

3.The consent must be given voluntarily.

  1. The consent must not be given through misrepresentation or fraud.

Informed consent…

1.The nature of the treatment.

2.The expected benefits of the treatment.

3.The material risks of the treatment.

4.The material side effects of the treatment.

5.Alternative courses of action.

6.The likely consequences of not having the treatment. (5)

Although some psychiatric survivors may have consented to psychiatric drugs (“medication”) and/or electroshock (“ECT”), virtually none has been fully informed of their major risks and alternatives. For many, such consent has been given involuntarily-by threat, staff pressure, intimidation, physical restraint or force. During the public hearings on electroshock in Toronto in April 2005, not one survivor recalled being informed about the major effects of  “ECT” such as permanent memory loss, brain damage, and trauma; non-medical or community alternatives were never mentioned. Similar consent violations were recalled during survivor testimony on psychiatric drugs (”medication”). In other words, informed consent to psychiatric treatment is a myth, virtually nonexistent, particularly in psychiatric facilities. (6)  Given many studies, common knowledge and personal testimony of violations of informed consent to treatment, we are talking about forced treatment, psychiatric assault. Psychiatrists and other doctors who fail to fully inform patients about any prescribed treatments and risks should be criminally charged with medical negligence and assault. At the same time, all psychiatric patients should be given basic and accurate information, written or in alternate formats they can easily access and understand, on informed consent; they should also be given opportunities to discuss any questions about informed consent, including the right to refuse any treatment, with a patient advocate or lawyer, and translator if requested.

Its time to start criminalizing and launching class-action lawsuits against forced psychiatric treatments and involuntary committal; it’s time to stop sanitizing these serious human rights violations and psychiatric crimes as “treatments.”

Enough talk. How about some real action for a change? It’s our freedom and lives that are at stake!

 

Notes

  1. D. Weitz. “Struggling Against Psychiatry’s Human Rights Violations: An Antipsychiatry Perspective”. Radical Psychology [online] vol.7, 2008, http://www.radicalpsychology.org/vol7-1/weitz2008.html.

For other major critiques of psychiatry, also see, T. Szasz. Psychiatry: The Science of Lies. Syracuse University Press, 2008; P. Breggin, Brain-Disabling Treatments in Psychiatry, NY:Springer Publishing Company, 2008; B. Burstow, Psychiatry and the Business of Madness: An Ethical and Epistemological Accounting, Palgrave Macmillan, 2015.

  1. D.Hiltz and A. Szigeti. A Guide to Consent & Capacity Law in Ontario. LexisNexis Canada Inc., 2006/2007.
  1. H. Savage and C. McKague. Mental Health Law in Canada. Toronto: Butterworths, 1988.
  1. Mental Health Act. R.S.O. 1990 S.20 (5).  In Hiltz & Szigeti, p.295.
  1. Hiltz & Szigeti, p, 182.
  1. Coalition Against Psychiatric Assault. Inquiry Into Psychiatry, 2005. https://coalitionagainstpsychiatricassault.wordpress.com/events/past-events/inquiry-into-psychiatry-2005/

***

Don Weitz is a psychiatric survivor, antipsychiatry and social justice activist.

In the early 1950s, he was forcibly administered 110 insulin shocks while involuntarily committed and incarcerated for 15 months in Mclean Hospital. For over 30 years, he has been active in the antipsychiatry liberation movement. In 1977, he co-founded with Harvey “Alf” Jackson and Bob Carson the Ontario Mental Patients Association that soon changed its name to On Our Own. In 1980 with shock survivor and lawyer Carla McKague, he co-founded Phoenix Rising, the first survivor-controlled antipsychiatry magazine in Canada. A few years later in 1983, he was one of the founding members of the Ontario Committee to Stop Electroshock which was the first organization to organize public hearings on electroshock and lobbied the Toronto Board of Health and Ontario government to abolish “ECT” and has participated in nonviolent civil disobedience in Canada and the United States. In 2003 with Dr. Bonnie Burstow, Don co-founded the Coalition Against Psychiatric Assault (CAPA) which organized public hearings on psychiatric drugs and electroshock in 2005; CAPA has also organized several public rallies and demonstrations against shock including a Toronto protest as part of the International Day of Protest Against Electroshock on May 16, 2015. Since the late 1990s, Don has also been an outspoken critic of homelessness and advocate for affordable housing as a member of the Ontario Coalition Against Poverty. He lives in Toronto.

 

 

 

 

 

 

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

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

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

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

The third perspective I support the Campaign from is that of the UN Convention on the Rights of Persons with Disabilities, being myself a person with a physical disability and thus actively involved in its process. Complying with the Convention means respecting the dignity and individual autonomy of all persons with disabilities, as well as respecting their right to equality and non discrimination, to personal liberty and security. As the CRPD Committee declares: “forced treatment by psychiatric and other health and medical professionals is a violation of the right to equal recognition before the law (art. 5) and an infringement of the rights to personal integrity (art. 17); freedom from torture (art. 15); and freedom from violence, exploitation and abuse (art. 16). This practice denies the legal capacity of a person to choose medical treatment and is therefore a violation of article 12 of the Convention” (Par. 42).[2] The Committee also states that the segregation of persons with disabilities in institutions violates a number of the rights guaranteed under the Convention (Par. 46).

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

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

 

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

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

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

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

Publicado el marzo 14, 2016 por Deja un comentario

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Porque, en resumen, considero que estas prácticas:

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

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

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

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

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

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

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

http://depsychiatriser.blogspot.no/2016/03/contribution-jules-malleus-la-campagne.html

Merci au Comité de la Convention Droits des Personnes Handicapées.
Merci aux Usagers et Survivants de la Psychiatrie.
Vous avez su vous exprimer, vous avez su les écouter.
Grâce à vous, les bases sont en place pour faire respecter les droits de l’homme là où ils sont bafoués.
Merci du fond du cœur à chacun d’entre vous.
Je m’appelle Jules Malleus.

Sous ce nom, j’écris des articles et des contes qui sont souvent en rapport avec la psychiatrie.

Je ne prétends pas être un expert en quoi que ce soit, mais je voudrais vous expliquer ici pourquoi je participe à la Campagne pour soutenir l’Abolition totale des soins et de l’hospitalisation sans consentement en application de la CDPH de l’ONU.

https://absoluteprohibition.org
www.absoluteprohibition.org

Je souhaiterais vous parler d’une machine.
Une machine avec des engrenages et avec des pistons.
Une machine inventée par les hommes.
Cette machine, je lui en veux. Je peux même dire que je la hais.
J’accuse cette machine d’avoir détruit peu à peu ma mère, mon père, et certains de mes amis.
C’est la machine des traitements psychopharmacologiques imposés aux personnes.

Vous connaissez cette machine: C’est la machine du film Metropolis de Fritz Lang, sorti en 1927. Le héros du film recule frappé d’effroi, car il a compris que la machine est un Moloch, c’est à dire une sorte de culte maléfique auquel on sacrifie les êtres humains.En haut de l’escalier de la machine, il y a des êtres humains. Les mains liées dans le dos. Maltraités par les gardes, qui sont aux ordres des deux personnages porteurs d’une haute coiffe. Analogiquement, ce sont les patients psychiatriques traités sans leur consentement.

Ils sont poussés dans l’antre de la machine. En tous points, ils ressemblent à des esclaves. Ils ont perdus tous leurs droits  : leur corps et leur psychisme sont à la merci de la machine.

Les deux personnages à l’entrée du four portent un masque d’impassibilité  : ils ne manifestent pas d’émotion. Leur coiffe est une mitre de prétention à une connaissance supérieure  : dans l’analogie, ce sont les médecins qui désignent les prisonniers et décident de leur sort.

Quand je pense aux traitements forcés, et bien je pense à ceci  :

 
«  Toute résistance est inutile. Vous allez être assimilée.  »

La capitaine Janeway subit un traitement forcé dans l’épisode 146 de la série Star Trek Voyager. Le traitement servira à assimiler la victime dans le collectif auquel appartient le vilain monsieur.

J’ai placé cette photo parce que l’objectif d’un traitement psychiatrique est de rendre la personne moins «  anormale  », c’est à dire de la normaliser en quelque sorte. L’injection prive la victime de sa volonté  : celle-ci devient esclave du collectif.

C’est à dire que la différence, la diversité, vouloir être «  hors norme  », par exemple, est considéré comme une maladie, qu’on se propose d’éliminer, par la force.

Le traitement forcé n’est que le début  :

Dans le film «  Le Seigneur des Anneaux III  », de Peter Jackson, 2003, le héros Frodo reçoit une injection forcée de l’araignée géante Shelob, ce qui a pour effet de le faire baver et de lui faire perdre ses moyens. L’araignée entortille alors sa victime de sécrétions gluantes afin de laisser sa viande faisander quelque temps dans sa caverne.

C’est à dire que le venin sert à paralyser la victime. Les traitements dits anti-psychotiques font de même et diminuent les capacités de défense du patient. Il devient alors plus facile de briser la personnalité afin de faire consentir à ce que l’on veut.

J’ai appris la programmation informatique, afin d’essayer de gagner ma vie. Et ce que je vous propose c’est un algorithme. L’algorithme qui suit n’existe pas dans les textes, il n’est pas enseigné non plus.
Il représente davantage une sorte de boutade destinée à faire comprendre l’absurdité d’un système.

C’est mon analyse de ce qui se passe quand une institution et ses rouages se mettent à tourner sans rien prouver de concret. Le mot-clé est non-compliance. Non-compliance au traitement signifie que vous êtes aussi dans le déni du trouble, donc on vous classe dans la case psychotique.

J’ai montré cet algorithme à des survivants: certains m’ont confirmé ceci. Ils m’ont expliqué qu’ils étaient obligés de jouer la comédie du malade et de la guérison pour parvenir à sortir de l’enfer des droguages abrutissants qui leur étaient imposés.

Quand une indication n’est pas étayée par des preuves biologiques, quand la maladie supposée n’a pas été caractérisée par des pathologistes, alors il me semble légitime de qualifier le traitement d’expérimental.

J’estime aussi que la mécanique d’augmentation des doses que j’ai décrite dans cet algorithme n’est pas autre chose qu’une machine de torture.

Les victimes du traitement forcé ont été diffamées. On n’a plus confiance en elles. Elles font peur. Les personnes n’ont plus confiance en elles-mêmes. Certaines présentent des maladies iatrogènes. Beaucoup sont traumatisées par l’expérience. Elles vivent dans la peur d’un nouveau traitement forcé, elles sont menacées de «  rechuter  ». Beaucoup restent engluées dans des addictions psychopharmacologiques auto-destructrices. Il en résulte la perte de son potentiel, l’empêchement de se réaliser, l’échec, le désespoir, la culpabilité, le chômage, la précarité, et cela conduit souvent à la fuite dans l’addiction, et au suicide.

Témoignage d’Agnès:

“Ayant été hospitalisée à 10 reprises, j’ai subi des traitements
dégradants, des humiliations. Nous sommes traités là-bas comme des animaux. On nous attache, on nous met à l’isolation etc…
Ce n’est pas parce que nous sommes en crise et donc soit-disant dangereux que l’on nous traite ainsi. Non, le but est de nous casser pour nous faire avaler des médicaments et nous donner une leçon pour que nous n’arrêtions plus de les prendre. Et toute la société accepte cela comme une chose normale.”

Et voilà …

Moloch est repus. Moloch vous remercie.

Et cela va continuer à moins que …

Ensemble exigeons que les lois de santé mentale de notre pays ne permettent plus, mais au contraire abolissent, le traitement forcé.

Références:

La convention ONU relative aux droits des personnes handicapées (CDPH)
http://www.un.org/french/disabilities/default.asp?id=1413

L’Observation générale n° 1 sur l’article 12
http://www.ohchr.org/EN/HRBodies/CRPD/Pages/GC.aspx

Statistiques 2014 Psychiatrie France
http://www.atih.sante.fr/sites/default/files/public/content/2790/rapport_2014_psychiatrie.xlsx

Statistiques judiciaires sur les hospitalisations psychiatriques sans consentement en 2014 en France
http://psychiatrie.crpa.asso.fr/2015-07-28-cm-Statistiques-judiciaires-sur-les-hospitalisations-psychiatriques-sans-consentement-en-2014?lang=fr

Le dossier de presse et les photos du rapport 2015 de la Contrôleure générale des lieux de privation de liberté en France
http://www.cglpl.fr/2016/publication-du-rapport-dactivite-2015/

Les UMD, “Unités pour Malades Difficiles”, un témoignage.
http://psychiatrie.crpa.asso.fr/IMG/pdf/2016-02-16-temoignage-sdre-epsm-rhone-alpes_2.pdf

Dimitri, 19 ans de maltraitance d’une personne adulte handicapée en institution: attaché, drogué, envoyé en UMD.
https://www.facebook.com/Soutien-%C3%A0-Dimitri-Fargette-1665872200308023/

Thomas Szasz, 1997: “Insanity: the idea and its consequences.”

Posted on

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

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

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

Posted on

-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 3rd 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. 

  1. 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.
  1. 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. 
  1. 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

2)

Tor Levin Hofgaard:  Bryter vi menneskerettighetene?

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

3)

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

4)

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

5)

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

6)

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

7)

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

8)

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

9)

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/

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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.

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¿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/

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“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.

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