Saturday, July 9, 2016

Iatrogenic Advocates: Modern Guardians of "The Mentally Ill"

At all levels of society, including business, academics, organizations and families, those in positions of relative social power seem to believe they have the right to speak on behalf of those who have less of it. Everywhere we look, those at the top of conventional power hierarchies are freely appropriating the voices of those lower on the totem pole. They are speaking to and for our needs. They are deciding what is good for us and our families. They are deciding what policies and positions are necessary, good and right for all sorts of us without ever having to be troubled to talk people of our sort. They are deciding, literally, the directions and fate of organizations in which hundreds, thousands, even millions of us have invested our efforts, trust or lives without one wit of socially enforceable obligation to even give a rip. 

It's no different in the mental health arena.  A few short days ago, the House of Representatives voted to create Two Americas - one for the diagnosed and one for the presumably 'normal.'  They did so with the almost unequivocal blessing of the mental health organizations who are supposed to protect the rights and interests those of us who have been psychiatrically labelled.

Yep, our closest allies and biggest benefactors freely traded away our humanity in return for trinket programs and/ or a pass on being slated for organizational extinction by vindictive political interests. In the final analysis, they were ok with the fact that the people they represent - and say they serve - will now be targeted and singled out for heightened screening, supervision, oversight and control compared to other Americans.  In fact, for the most part, they are now going around waiving flags of success and bragging about the great deals they negotiated on our behalf.  

In some ways, none of this is all that new.  From the beginning of our nation, there have been two sets of laws, two sets of rights for American citizens, depending on which category you fall into. The moment you get a diagnosis, you fall into the latter category.  You can be stripped of rights to liberty, person and property without the normal due process protections afforded every other American citizen.  Equally egregious, the only basis for this is that some mental health professional, somewhere, has at some time in your life given you a mental health label.  Instant second class citizenship.  Instant life sentence to a lesser personhood.  

Post-diagnosis, somebody who thinks you're not behaving only has to know of the label and invoke it.  From that moment on, for all practical purposes, you are are assumed crazy until proven sane.  The onus falls on you.  Only those Americans who manage to stay diagnosis-free get to retain their full legal status to full protection under the law.

The injustice of this is obvious to all who care to look.  Many are rightly shaking their heads, wondering how we got to this place - how all of this happened and why, in modern times, does it keep getting even worse?  

Part of the problem lies in the structure of so-called charitable or public interest organizations and their relationship to causes they purport to represent.  In this regard, the world of mental health is no different than others.  Nonprofits spring up all the time for all sorts of causes.  The variety that purport to speak for 'The Mentally Ill' are a dime a dozen.  We are a lucrative cause, and a ready-made source of healthcare and philanthropic funding.  Numerous so-called advocacy and public interest organizations make a living from our issues. They say they are working for us - that they represent us and our best interests.

On the whole, however, these organizations are self-serving and out of touch.  While some may be well-intentioned, in practice, they are a recipe for de facto fraud and self-dealing.  They are not run by or for those of us they claim to serve.  They are not accountable to us, to our values, our vision or to the outcomes we want to achieve.  They make little, if any, meaningful effort to reach out to us, engage us, ask what we want or what would make our lives better.  To the contrary, their agenda is determined by founders, board members, funders, liability concerns, lawyers and insurance companies, government regulations - everybody but us.  If fact, they consider it our responsibility to seek them out if we want to have a voice with them on our own issues.  

In a word, they are using us. They are appropriating our pain, our victimization, the fact of our second class citizen status.  And then, with a subtle slip of the hand they are converting our issues -and all the resources and goodwill that go with them - to advance their own priorities and agendas. They are making decisions about us, without us - often without ever having met us - and calling it for our benefit.  They are shamelessly, unabashedly bragging about how much good they have done for us - and how grateful we and everyone else should be for what they do - even while stepping in front of us on the podium and substituting their own voices for ours.  Even while stealing the very seats at the table that should be rightly ours and then afterwards sweeping the floor of crumbs that we would happily make a meal of. 

What morally legitimate paradigm would operate this way?  It’s like:  You hear a rumor that Joe Peer needs help. So you write up a grant, get Uncle Sam to fund it, do what you feel like doing, collect a paycheck every week and then tell everybody what a sad case Joe Peer is and how much he loves what you are doing for him.  Uncle Sam keeps the paychecks coming.  No one knows you’ve never even met Joe Peer. 

This is self-promotion, self-dealing, a blatant breach of trust.  It has nothing to do with advocacy or the public good.  It has everything to do with the vulnerability - the powerlessness and the susceptibility to being taking advantage of - of the populations these organizations claim to be protecting.

Guardianship by any other name...

These are the new mental health guardians.  Make no mistake about it:  If you have a diagnosis, you have a guardian.  In fact, you have many of them.  They are appointed, not on an personal private level, but for our people as a whole.

It's not that we appoint them or that some court or elected official does.  Nope, they actually appoint themselves.  They pull together enough money, resources and legal know how.  Then they create a mission statement, vision, and by-laws.  They submit papers to the IRS and, presto!, done deal.  Now, there is another nonprofit that gets to speak for us, claim seats at the table on our behalf, and solicit funds and public goodwill intended for our benefit.

This is how you get to be a designated guardian of other people's causes - and other people's futures - in the United States of America today.  It is hard to conceive of any way of doing business that would do less in the way of supporting a people's legitimate quest for self-determination.

Indeed, the vast majority of these organizations - and those who direct and run them - are not members of the actual groups they claim to represent.  They may be close to us.  They may be educated or have a lot of book learning.  They may have good hearts and good will.  But they have not walked in our shoes or seen life from our eyes. And, because of that, few and far between are those who really understand.  

Iatrogenic leadership...

But lack of understanding is the least of our concerns.  The impact of these organizations is far from neutral - it is often downright damaging.  By and large, they replicate, rather than challenge, the status quo, along with the harmful dominant culture assumptions that maintain it.  They impoverish our people and our cause by draining away resources that rightly should belong to us.  They give the illusion that our voices are present and that our interests have been represented.  In a word, they are causing, intensifying, perpetuating the same disenfranchisement, disconnection, discrimination and marginalization they are funded to repair.

Ironically, insidiously, this re-enacts the essential trauma and oppression that our people have experienced at the hands of psychiatry since its inception. The essential dynamic is one wherein a few designated 'experts' who 'know' are allowed to substitute their judgment for what is in our 'best interests.'  As with psychiatry, such attitudes thrive in a climate of discrimination.

We live in a dominant culture that takes it for granted that those in some roles (guardians, experts, managers) ‘know’ better than others (diagnosed, unschooled, employees) what is ‘good’ for them. This conventional practice of classifying people into hierarchical categories of social worth is a huge part of the problem.  It reifies the construct of social unworthiness, and validates the relative social privilege of the so-called worthy.   The effect is to amplify the voice, legitimacy and power that privileged roles already have, while effecting political and social death for the sorry-lotted rest of us. This perpetuates - rather than alleviates- the oppression of those who are so ‘labeled’.

Indeed, the very social characteristics that qualify some people as ‘the ones who know best’ --things like family standing, position in society, employment roles and academic credentials -- are the very factors that get used and abused by those with more social standing to devoice and disempower those of us with less of it.  Such distinctions arguably are what created the social structures that oppress so many of us in the first place.

Not surprisingly then, these structures historically have been part of the problem, not the solution for our people.  While the people, positions and organizations that make them up may vary over time, in essential form, they preceded our oppression and were embedded in the existing social fabric that allowed it to materialize.  They may have even motivated, engineered or actively supported the institutional expediencies that stripped us of our rights. At the very least, they perpetuate our continued vulnerability to labeling and marginalization across demographics.

Do You Have Authority to Exercise Authority? 

The Universal Declaration of Human Rights makes clear that authority for governance derives from the governed. (Art. 21.3) Similarly, the Convention on the Rights of Persons With Disabilities expressly rejects a ‘guardianship’ approach to governance. (Art. 12).  Thus, would-be leaders may not simply substitute their judgment for that of the constituency they claim to serve.  Rather, they may only represent individuals who have requested their assistance.  Moreover, the scope of their authority is to ascertain and support the 'rights, will and preferences' (Art. 12) of those they endeavor to assist.

By all appearances, the organizational guardians of mental health fail dismally with regard to these standards (as does our government).  So let’s be clear here.  From the point of view of the world community, the decisions being made on behalf of 'The Mentally Ill' in America are morally null and void.  In a nutshell:

We didn’t ask you. You don’t know us.  You make your living catering to a system that oppresses us. You are abusing your power and calling it ‘help’. If don’t see how that’s happening or your part in it, you’ve just proven the point. 


  1. I couldn't have said it better.Spot on.Only addition would be is to include the court system's irresponsibility of prescribing "treatment" at the barrel of a gun and from 50,000 ft. for "addiction recovery!"

  2. Absolutely excellent and extremely insightful.

  3. Wow. Incredibly well written and powerfully accurate. Thank you.

  4. The career "consumers" or "peers" never spoke on my behalf or for the other tens of thousands of victims of psychiatry who didn't come from middle class families or lives of privilege and opportunity.

    1. No, Rodney, they wouldn't. That is not how they are indoctrinated.


Please share your thoughts: