Olga Runciman – ‘A true story filled with lies’

I wrote this piece from a place of anger and outrage and it was never intended for anyone’s eyes or ears and is therefore completely raw.

A series of circumstances resulted in Michael Rassum reading it and he said I can put music to this. The result is our spoken word ‘A true Story Filled with Lies’

Why did I write it? Because this person whom I call Peter (not her real name) died of her psychiatric drugs and despite it being a clear cut case her family and I watched how psychiatry closed around itself, protecting itself and they got away with it. For years her family have sought justice just like so many others. They never got it.

Her death was the reason that we were a group who joined together and created the organization ‘Death in Psychiatry’ an organization for those who have lost a loved one to psychiatry and to stop others suffering the same fate. Dorrit Cato Christensen who has also contributed to this campaign lost her daughter and she is also one of the founding members of the organization and is today the chair.

Psychiatry has been unable to prove that it is dealing with a biogenetic illness and, likewise, its drug treatments fall dismally short of what is considered good evidence based medicine. On the contrary the evidence especially long term, point at an increased risk of chronicity, brain damage, early death – up to 25 years shorter and, as in ‘Peter’s’ case, sudden death due to drug induced arrhythmia of the heart.

To force treat people with drugs that carry with it a risk of brain damage, death and little evidence of any long, term benefits what so ever, is an unspeakable act of institutional violence.

This piece is a true story the only thing that is changed is the name and gender. It is in three sections. “Death”, “Big Pharma, the Unholy Alliance” and finally the funeral called the “Winds of Change”.

I am today a psychiatric survivor, but this could have been me.
Or you or one of your loved ones…

Please support CRPD Absolute Prohibition of Commitment and Forced Treatment.

 

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.

 

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).

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.

 

 

 

 

 

 

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).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

* * * * *

Originally posted on paulajcaplan.net

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

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

 

 

¿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/

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.

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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.