German translations

German survivors and allies, please join the Campaign!

Deutsch Kollegen, treten Sie bitte der Kampagne.

Aufruf zur Aktion (doc)

Methodology Deutsch(German) (doc)

The website “il cappellaio matto” will also take submissions in German.  See Collaborating Websites.

Die Website “il Cappellaio Matto” werden die Einreichungen in deutscher Sprache statt.  Siehe Collaborating Websites.

Bienvenue site français!

New collaborating website Dé-psychiatriser, contact person Jules Malleus jj.malleus@gmail.com.

http://depsychiatriser.blogspot.fr/

The personal blog of an abolitionist of psychiatry. Original articles and drawings in french.

(Ce blog représente l’opinion personnelle d’un citoyen français abolitioniste de la psychiatrie. Articles et dessins originaux. Pétition.)

 

Australian survivor/consumer/service user/mad/neuro-diverse person?

For Australian survivors, consumers, service users, mad or neuro-diverse people interested in participating in the Campaign:

(from Facebook post)

Want to have YOUR say to the United Nations about your experience of forced treatment? Start writing (or painting, or drawing…)…

On 29 March blog sites around the world will go live with personal stories of the impacts of forced psychiatric treatment. The campaign aims to bring these human rights issues to the attention of the United Nations. Read more about the campaign below.

If you’re in Australia and have a story to share, www.ConsumersAustralia.org is happy to put it on their website. There will be a new page dedicated to this campaign. So start writing, or get creative and send artwork or music if you prefer. 

Submissions needed by 14 March if possible. Email submissions to madmin@consumersaustralia.org

Calling Norwegian, Swedish and Danish participants!

We have collaborating sites now that will accept writing and artwork for the Campaign in Norwegian, Swedish and Danish languages.

Contact person for these three websites is Sigrun Tømeras, who can be reached through this webform: http://contact-sigrun.blogspot.no
My personal blog: http://stomm-blog.blogspot.no

Mental health collection blog: http://psykisk-blogger.blogspot.com

Blog of the Norwegian Association for Mental Health: http://nfph.no

Sarah Knutson: Einstein, Social Justice and the New Relativity

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

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

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

Three ways of seeing experience

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

1. The DSM Model of ‘mental disorders’

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

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

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

2. The Medical Model of ‘mental illness’

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

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

3. The Social Justice Model of fundamental human needs

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

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

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

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

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

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

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

Before you immediately brush this off, consider the following:

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

Support for the Social Justice Model

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

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

Now consider this:

1. Research on public and behavioral health impacts

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

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

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

Don’t believe it?  Check out the following:

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

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

The results speak for themselves.

2. Tremendous explanatory power

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

The basic paradigm is this:

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

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

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

For our purposes, there are two basic nervous systems:

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

and

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

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

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

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

4. Explaining intense or extreme responses

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

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

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

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

 


Dimensions of Fight-Flight-Freeze

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

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


 

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

 


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

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


 

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

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

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

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

References:

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

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

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

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

(originally appeared on Mad in America website)

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

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

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

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

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

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

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

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

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

 

The Case for 100% Voluntary

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

1.     These issues are universal, not medical

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

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

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

2.     Clinicians are lousy predictors

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

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

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

3.     Drugs, at best, are problematic

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

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

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

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

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

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

4.     Promising alternatives are not being considered

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

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

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

5.     Natural diversity is not a pathology

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

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

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

6.     This is about trauma, not disordered brains

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

*

Click here for supporting resources →

 

 

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

Italian translation and website

ERVEDA-NOTSO

Italian translation of the Call to Action now available, also please see the website “il cappellaio matto” (the mad hatter) http://www.ilcappellaiomatto.org

Il cappellaio matto is also a collaborating site that will accept contributions in German, Italian, French, English, Spanish and Arabic, and potentially others!   Contact  erveda.sansi@gmail.com.

Introduzione della campagna  (doc)

Metodologia (doc)

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

Action : Lancer des messages coordonnés sur des blogs partenaires le 29 mars 2016 – jour de l’ouverture de la 15ème session du Comité des Droits des personnes handicapées de l’ONU

Participants : Survivants, (ex)usagers des services de psychiatrie, sympathisants, chercheurs, avocats, universitaires, gestionnaires, professionnels de santé et des services, journalistes, citoyens concernés du monde …

Langues utilisées : Même si la majorité des participants s’expriment en anglais, des sites web en espagnol,  en norvégien, et en allemand collaborent déjà à cette campagne. Tout site web ou bloggeur francophone est le bienvenu pour nous rejoindre avec des contributions en français ou en toute autre langue.

Contenu : Partager avec votre cœur et votre esprit tout aspect relatif à l’abolition totale et pourquoi elle est nécessaire : les dégâts causés par les traitements chimiques sans consentement ; la solidarité et la construction d’une société inclusive où tous sont égaux ; les implications juridiques de la CDPH au niveau du droit international et national ; l’accueil de la CDPH par d’autres mécanismes relatifs aux droits de l’homme ; le potentiel provoqué par cette abolition de transformer les services et les formes de soutien pour les personnes en situation de handicap psychosocial tels que nous les souhaitons ; la relation entre les diagnostics pathologisants conduisant au traitement forcé et à la contrainte, etc. Ne vous limitez pas à ces exemples. Ce qui compte est d’avoir un maximum de voix d’un maximum de perspectives exprimant la valeur et la nécessité absolue de cette abolition.

Références : Relier vos arguments ou vos déclarations à la CDPH (notamment ses articles 12, 14, 15, 17, 19, 25(d), 28), et à l’Observation générale n° 1 sur l’article 12, et /ou les Directives pour l’article 14 (Guidelines on Article 14), et exprimer votre soutien de l’approche du Comité de la CDPH. Cette approche constitue un changement de paradigme allant d’un système sécuritaire procédural (paradigme obsolète des lois sur la santé mentale) à un système d’abolition totale (nouveau paradigme de la CDPH).

***Il serait également utile de faire référence aux Principes de base et lignes directrices publiés par le Groupe de travail sur la détention arbitraire de l’ONU, Principe 20 et Lignes directrice 20, qui construisent un pont entre l’ancien et le nouveau paradigme en chargeant les juges d’appliquer cette abolition totale.

Contexte : La CDPH représente un défi sérieux au statu quo de la loi et au pouvoir de la psychiatrie organisée. Deux Organes de Traités des Nations Unies sont en conflit ouvert avec le texte et l’interprétation faisant autorité de la CDPH : le Comité des droits de l’homme (qui surveille la mise en application du Pacte international relatif aux droits civils et politiques) dans son Observation générale no 35 (par. 19) ; et le Sous-comité pour la prévention de la torture (qui effectue des visites des lieux de détention et contrôle les mécanismes nationaux de prévention qui font de même) dans son document “Rights [sic] of persons institutionalized and medically treated without informed consent(Droits (sic) des personnes placées en institution et soumises aux traitements sans consentement éclairé). La position du Sous-comité pour la prévention de la torture est la plus sévère, permettant non seulement le placement et le traitement sans consentement mais expliquant aussi que son abolition serait en violation du droit à la santé et au droit ne pas être soumis à la torture ou aux mauvais traitements. Autrement dit, le Comité soutient l’argument du « droit au traitement » avancé par la psychiatrie conventionnelle. Comme nous le savons, cet argument est basé sur la négation de la capacité et du droit des personnes en situation de handicap psychosocial de prendre leurs propres décisions et de défendre leur autonomie corporelle tels que garantis par l’article 12 du CDPH. L’autonomie corporelle est un droit fondamental rattaché à la personnalité de chacun et indispensable à notre sécurité ; deux aspects des droits de l’homme nécessaires à notre bien-être.

Références :

http://www.madinamerica.com/2015/12/human-rights-updates/ https://www.youtube.com/results?search_query=tina+minkowitz+crpd

Contact : Tina Minkowitz tminkowitz@earthlink.net

https://absoluteprohibition.wordpress.com

 

 

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

Si vous disposez d’un blog personnel que vous souhaitez utiliser pour communiquer dans le cadre de cette campagne, merci de nous fournir son nom, son adresse (url) et un résumé de son contenu avant le 14 mars prochain.

Si vous ne disposez pas de blog personnel, mais souhaitez participer, merci de me contacter afin que je puisse faire tous mes efforts pour vous mettre en lien avec un ou plusieurs blogs collectifs participants.

Si vous disposez d’un blog collectif que ce soit un blog d’association, de terrain, universitaire, journalistique ou autre collectif et vous souhaiterez l’ouvrir à des invités dans le cadre de cette campagne, je vous remercie de me contacter le plus rapidement possible.

Vous êtes également invités à partager l’Appel à l’Action et cette note sur la Méthodologie sur votre blog ou votre site web ou encore dans vos réseaux sociaux. Merci de bien vouloir donner mes coordonnées ci-dessous avec toute communication.

 

Contact : Tina Minkowitz, tminkowitz@earthlink.net

Center for the Human Rights of Users and Survivors of Psychiatry, www.chrusp.org

https://absoluteprohibition.wordpress.com

 

Hege Orefellen on Reparations

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

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

****

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

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

****

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Thank you.

 

****

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Gracias.

 

 

Bonnie Burstow on Call to Action

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

The CHRUSP Call to Action and Its Significance

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Summarizing Remarks, Invitations, Suggestions, and Warnings

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

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

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

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

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

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

References

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

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

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