#2. Industry Has No Business Deciding Fundamental Rights

This is Day 2 of our 30-day blog (more info here) on the Declaration of Principles adopted by the 10th Annual Conference on Human Rights and Psychiatric Oppression (Toronto, May 14-18, 1982).  Today we are talking about Principle 2.

Principle 2 reads in full as follows:

We oppose involuntary psychiatric intervention because it is an unethical and unconstitutional denial of freedom, due process and the right to be let alone.

Basic Rationale

We could hardly design a less ethical, more self-serving, counter-productive system if we tried.  The person you go to for service not only bills you and makes their living from the services you use, they also determine:  

• How much of their service you need and for how long. 
• When and how you get a clean bill of health.
• How capable you are, how good your judgment is, and whether or not you can decide for yourself whether to stop using their services.

Based on their status as trained 'professionals', everyone who matters – your family, friends, employer, law enforcement, the courts - trusts them and not you.  If you reject their advice, you get labelled – officially permanently in your medical record – as a bad patient who lacks insight.  This is then used as evidence that you need more of their service. 

Adding insult to injury, current law has made them responsible for you. As a practical matter, this pits important interests of theirs directly against yours.  If you screw up, hurt yourself or another, they get sued, lose their license, their job, their career.   In other words, your civil rights to freedom, liberty, privacy and fair hearings are actually a problem for them from a liability and risk management point of view.  

In the final analysis, it boils down to this:  

The less freedom you have, the safer they are.  The more control they have, the less risk you present. The more you do what they say, the safer they feel.  The more doped up you are, the less they worry.   The fewer choices you have, the less they have to do, the easier their job is, the better bargain you are, the bigger bang you make with the insurance-paid buck.  

The conflict of interest is blatant, unavoidable and utterly at odds with professional obligation. It may be less obvious in voluntary, outpatient contexts, but on the locked wards it is the law of the land.  So long as our actions put providers at risk, any freedom or privacy we have will always be a problem their point of view.

How can we develop trust in this kind of relationship?   

How can providers support our personhood or capacity, when the law holds them responsible for choices we make?  

Notably, the legal profession expressly rejected this model of professional responsibility.  Lawyers are not required to report clients for contemplated crimes, no matter likely or heinous.  Nor are they held liable or responsible for any decisions their clients make, no matter how deadly, malicious, intentional or irrational.  The reason by given by lawyers and courts is the need to protect the sanctity of the attorney-client relationship. So the rationale goes, public policy is better served when people are able to get unbiased counsel.  If this is the law for potential crooks, then why not ordinary citizens who are having a hard time?  The bitter, insane irony is that,  if you can afford it, you are far safer going to a lawyer than a mental health professional with your deepest, darkest human concerns.

Someday, maybe the healthcare professions will get the same gumption as lawyers, and begin to stand up for the real best interests of people they serve.  In the meantime, all of these are incredibly good reasons why service providers – no matter how expert in their field -- should not be determining fundamental rights.

Questions for Reflection

We are building this Blog together.  Your lived experience is needed and valued.  It is essential to building our shared knowledge and expertise as a movement.  Please comment on any or all of these questions or in any way that speaks to you personally.

1. Has psychiatry, the industry, or a mental health provider ever messed with your freedom, due process or right to be let alone? 

2. What would you like others of conscience to know about your experience? 

3. What about this experience affected you the most?

4. How did that impact your relationship with the mental health industry or important others?  

5. When you picture yourself in the worst of it, how did you maintain your sense of personhood and what made that possible? 

6.  Can you recall a time when someone fully respected your personhood and autonomy as a human being? How was that different and why did it matter? 

7. Think ahead to the advice you would give to future generations.  What is the most important thing you would want them to know about the importance of respecting fundamental human rights like freedom, due process and the right to be let alone? 

8. Privileging some people to decide the rights of others is not private matter.  The power exists only because society, as a whole, has decided to look the other way.  If we were all willing to make a sincere effort to share power and responsibility for the health and wellbeing of the communities we live in, what new, creative, collaborative, constructive or growth-producing approaches would we be trying out?  

Conference on Principle 2: Postponed

More information here.